Interventional radiology (Higashimatsuyama-shi (Japan)最新文献

Kimura's disease is a lymphoproliferative disorder characterized by eosinophilic infiltration. Although it rarely causes peripheral arterial occlusive disease, its mechanism remains unclear. A 43-year-old man with a seven-year history of Kimura's disease, initially presenting with a cervical mass and treated with prednisolone, developed an ulcerative lesion from the right thumb to the middle finger. Ultrasonography revealed bilateral radial artery dilation and thrombosis. After he was diagnosed with Kimura's disease-associated vasculitis, he was treated with prostaglandin E1, warfarin, and cilostazol. Because of persistent symptoms, angioplasty was performed on the occluded radial artery. The patient's symptoms improved on the first postoperative day, with no re-occlusion observed after 2 years. Percutaneous transluminal angioplasty has been demonstrated as effective for early symptomatic relief in Kimura's disease.

Intranodal lymphangiography has replaced conventional pedal lymphangiography and has advanced lymphatic intervention. In this method, a lymph node is punctured and Lipiodol is injected to visualize the subsequent lymphatic vessels. This has facilitated the widespread adoption of lymphatic interventional radiology due to the simplicity of the technique and the shortened examination time of the procedure, which allows easy mapping of lymphatic vessels and lymphatic fluid dynamics. With this technique, lymphatic embolization was achieved by injecting an embolic substance into the lymph nodes upstream of the lymphatic leak. Although complications associated with lymphangiography are rare, caution should be exercised due to potential complications associated with the use of Lipiodol. This study summarizes intranodal lymphangiography techniques, complications, and lymphatic embolization.

Purpose: Transarterial embolization of the internal iliac artery-associated type II endoleaks necessitates adequate support to approach the abdominal aortic aneurysm sac. Herein, we report initial experience with transarterial embolization of the internal iliac artery-associated type II endoleaks using the quintet-coaxial catheter system. Techniques: The quintet-coaxial catheter system consisted of the following five coaxial devices: a 5-F thin-walled flexible guiding sheath, a 5-F guiding catheter, a 3.4-F large-bore distal access catheter, a 2.7-F high-flow microcatheter, and a 1.9-F microcatheter. From the ipsilateral femoral artery, the system was advanced into the abdominal aortic aneurysm sac via a long, thin, and tortuous access route arising from the lumbar and iliolumbar arteries. Embolization using a 20% mixture of n-butyl 2-cyanoacrylate with iodized oil was successfully performed in three cases with sac expansion caused by a persistent internal iliac artery-associated type II endoleaks. The inflow artery was embolized using metallic coils through the 2.7-F microcatheter. The 3.4-F large-bore distal access catheter improved the stability of the double coaxial microcatheter system and facilitated the access of the 1.9-F microcatheter to the abdominal aortic aneurysm sac. Conclusions: The quintet-coaxial catheter system enables the embolization of type II endoleaks through long, thin, and tortuous access routes.

Acute mesenteric arterial occlusion, resulting from impaired blood flow in the superior mesenteric artery, is classified into embolism and thrombosis; both conditions lead to rapid intestinal ischemia, with a high mortality rate of >30% within 30 days. A multidisciplinary treatment approach, including prompt revascularization, necrotic intestinal tract resection, intensive postoperative care, and recurrence prevention, is crucial for managing acute mesenteric arterial occlusion. Recent meta-analyses have indicated that endovascular treatments result in lower bowel resection and mortality rates than open revascularization. As a minimally invasive treatment option, endovascular therapy can become prevalent in the aging population. Interventional radiologists who provide diagnostic imaging and endovascular procedures must understand the disease and play a central role in the treatment team.

We performed transportal coil-assisted balloon-occluded retrograde transvenous obliteration II, a modification of balloon-occluded retrograde transvenous obliteration, for gastric varices due to left-sided portal hypertension. Significant scale-down of varices was confirmed on upper gastrointestinal endoscopy and contrast-enhanced computed tomography at 6 months after intervention. In the meantime, there were no complications related to treatment. We present transportal coil-assisted balloon-occluded retrograde transvenous obliteration II as a new alternative in addition to splenectomy and partial splenic embolization for gastric varices induced by left-sided portal hypertension.

Recent advances in systemic therapy for hepatocellular carcinoma are remarkable. The treatment goal for advanced hepatocellular carcinoma is to prolong survival, while for intermediate-stage hepatocellular carcinoma, it is to achieve a cancer-free and drug-free status. Patients unsuitable for transarterial chemoembolization may benefit from prior systemic therapy with lenvatinib or atezolizumab plus bevacizumab. The TACTICS-L trial, a prospective phase II trial, demonstrated favorable progression-free and overall survival by lenvatinib-transarterial chemoembolization sequential therapy. The REPLACEMENT trial, a multicenter, prospective, single-arm phase II trial, confirmed combination immunotherapy efficacy with atezolizumab plus bevacizumabin a population exceeding up-to-seven criteria. In a proof-of-concept study, atezolizumab plus bevacizumab plus curative therapy showed a 35% complete response rate and 23% drug-free status in intermediate-stage hepatocellular carcinoma patients with a tumor burden exceeding up-to-seven criteria.

Isolated persistent left superior vena cava is a rare congenital venous anomaly. It imposes technical challenges and increased risks in patients requiring a transjugular intrahepatic portosystemic shunt. The patient was a 67-year-old man with cirrhosis, recurrent large-volume ascites, hepatic hydrothorax, and portal vein thrombosis. The patient had a history of failed transjugular intrahepatic portosystemic shunt creation using a conventional CO₂ portal venography technique via a left jugular vein access. The patient underwent successful transjugular intrahepatic portosystemic shunt creation under fluoroscopy and intravascular ultrasound guidance. The patient required transjugular intrahepatic portosystemic shunt revision with mechanical thrombectomy in 2 months. Intravascular ultrasound can provide additional live information to assist transjugular intrahepatic portosystemic shunt creation in patients with complex congenital venous anatomy, including those with isolated persistent left superior vena cava.

Purpose: To evaluate the feasibility and preliminary evidence of the efficacy of combined cutting balloon and drug-coated balloon angioplasty for the treatment of arteriovenous fistula stenoses resistant to conventional balloon angioplasty. Material and Methods: From August 2018 to January 2019, 19 patients (mean age = 64.9 ± 8.6 years; males = 63%) with resistant arteriovenous fistula stenosis, defined as >30% residual stenosis after conventional balloon angioplasty, were enrolled into this single-center prospective pilot study. The resistant arteriovenous fistula stenoses were treated with a cutting balloon followed by a drug-coated balloon. The primary outcome measure was 6-month target lesion patency. Results: The degree of residual stenosis after conventional balloon angioplasty was 48.8 ± 11.3%, decreasing to 18.7 ± 10.4% after combined cutting and drug-coated balloon angioplasty. Technical success, defined as < 30% residual stenosis, was achieved in 94.7% (18 of 19 stenoses). The 6-month target lesion patency was 100%, while the 6-month access circuit primary patency was 94.7% (n = 18/19) due to recurrent non-target lesion stenosis. No venous rupture or major complication was encountered. Conclusions: This pilot study provides evidence to support the conduct of a phase 3 randomized clinical trial to prove the superiority of a cutting balloon and drug-coated balloon combination for resistant arteriovenous fistula stenoses.

Acute mesenteric ischemia is a life-threatening condition. A comprehensive approach involving a multidisciplinary team to review patient background, clinical history, physical examination, laboratory data, and imaging examination for respective diagnosis of superior mesenteric arterial occlusion, nonocclusive mesenteric ischemia, and superior mesenteric venous occlusion is essential. The most important imaging modality is computed tomography, which is used for diagnosis and for directing therapeutic strategy (e.g., endovascular revascularization, surgical bowel resection, or conservative management). Computed tomography image findings can support triaging of irreversible transmural bowel necrosis compared with reversible ischemic change with reperfusion. In this review article, the computed tomography imaging findings specifically associated with the pathophysiology of superior mesenteric arterial occlusion, nonocclusive mesenteric ischemia, and superior mesenteric venous occlusion are reviewed.

Endovascular treatment, such as catheter-directed thrombolysis, thrombectomy, balloon angioplasty, and metallic stent placement, is performed for symptomatic upper body central venous obstruction caused by both malignant and benign etiologies. In particular, metallic stent placement should be performed in emergent situations for malignant superior vena cava syndrome presenting with cerebral or laryngeal edema. In malignant cases, the obstruction is usually traversed via the femoral vein. When it fails, an additional trial via the brachial or internal jugular vein is performed, and if necessary, through-and-through access is established. In benign chronic obstructions that cannot be crossed by conventional techniques, sharp recanalization techniques are salvage options. The procedures are relatively safe; however, major complications such as acute pulmonary edema, cardiac tamponade, pulmonary embolism, and stent migration should be warned.