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

A 78-year-old man who had been treated for perihilar cholangiocarcinoma presented with hematemesis 1.5 years later. Computed tomography revealed a pseudoaneurysm of the proper hepatic artery protruding into the lumen of the duodenum. Esophagogastroduodenoscopy revealed a duodenal ulcer with massive hemorrhage at the duodenal bulb. Endoscopic hemostasis therapy was not possible due to the exposure of the proper hepatic artery pseudoaneurysm to the duodenal lumen. Endovascular stent-graft placement was chosen; the proper hepatic artery pseudoaneurysm disappeared and hematemesis was no longer observed. However, 2.5 years later, he presented with hematemesis, and esophagogastroduodenoscopy showed migration of the stent-graft into the duodenum due to duodenal ulcer recurrence.

A 54-year-old man presented with epigastric pain and underwent contrast-enhanced computed tomography. A ruptured anterior superior pancreaticoduodenal artery aneurysm was diagnosed. Transcatheter arterial embolization was successfully accomplished using coils; however, the patient started vomiting 18 days later. Contrast-enhanced computed tomography showed hepatic portal venous gas with gastric emphysema and duodenal stenosis. The patient was conservatively treated after being diagnosed with duodenal stenosis caused by hematoma, causing hepatic portal venous gas with gastric emphysema because of increased gastric pressure during vomiting. Consequently, the patient was doing well and was discharged.

Purpose: This study aimed to examine the effectiveness of preoperative image guided botulinum toxin A injection in achieving fascial closure and reducing recurrence rates after repair of complex incisional abdominal wall hernias. Material and Methods: A total of 32 patients, consisting of 14 males and 18 females, with complex incisional hernias who underwent image guided botulinum toxin A injection at a median 33 [28-38.3] days before surgery were included in this retrospective study. Their mean age was 59.4 ± 11.2 years. Abdominal computed tomography imaging was obtained prior to botulinum toxin A administration to characterize the hernia defects of 26 patients (81.3%, 26/32). The transverse and vertical abdominal wall defects were measured and recorded. Three-dimensional objects of the hernia sac and peritoneal cavity were created based on the delineated borders, and volumes were calculated. The loss of domain was determined using the following formula: where x represents the hernia sac volume and y represents the peritoneal volume. Under ultrasound guidance, the abdominal wall musculature was injected with 300 units of botulinum toxin A across six sites. The fascial closure rate and rate of hernia recurrence were the principal outcomes investigated. Results: Fascial closure was achieved in 29 patients (90.6%, 29/32). Recurrence was observed in two patients (6.3%, 2/32) over an average followup of 2.5 ± 1.5 years (maximum 6.5). Fascial closure was obtained in 12 out of 14 patients with previous hernia repairs (85.7%, 12/14). One botulinum toxin A related complication was observed-a weakened cough that resolved without further treatment. Conclusions: Botulinum toxin A is safe and effective in improving rates of fascial closure and reducing instances of reoccurrence in patients with complex incisional hernias.

Ultrasound-guided needle puncture is essential for both vascular and nonvascular interventions. Ultrasound is widely available in various clinical settings, requires no ionizing radiation, offers color Doppler imaging, and enables real-time visualization of the needle position during puncture. However, ultrasound imaging has some limitations, such as signal attenuation in deeper tissues and the inability to penetrate bone or air, and it is a heavily operator-dependent modality. Here, we outline the basic techniques and technical tips for ultrasound-guided needle puncture.

This article emphasizes image-guided puncture, a common technique used by interventional radiologists. It focuses on ultrasound, fluoroscopy, computed tomography, and computed tomography fluoroscopy-guided procedures. While techniques vary, successful outcomes without complications still heavily rely on operators' skill and judgment. Operators need knowledge of needle characteristics and expert needle manipulation. Continual skill refinement through daily practice is essential, aiming maximum results with minimal invasiveness. This article examines challenging cases of percutaneous needle biopsy, biliary intervention, radiofrequency ablation, and percutaneous abscess drainage while referencing previous review articles and discusses how to succeed in these cases by employing various techniques and approaches in various image-guided procedures. This article aimed to provide interventional radiologists with a comprehensive and practical guide for enhancing their image-guided puncture techniques, ultimately leading to successful outcomes.

Postoperative hepatic lymphorrhea is a rare complication that can lead to refractory ascites. During surgery with lymph node dissection of the hepatoduodenal ligament, leakage of liver lymph into the abdominal cavity can occur. Due to the development of interventional radiology for various lymphatic leaks in recent years, the pathogenesis of hepatic lymphatic leakage has become more evident. Percutaneous transhepatic lymphangiography is important for the diagnosis of hepatic lymphorrhea. Although there have been case reports of percutaneous embolization and sclerotherapy treatments for hepatic lymphorrhea in recent years, there have been no case studies. However, the standard treatment for this condition remains unknown. This study discusses the anatomy of hepatic lymphatics and the pathogenesis, diagnosis, and treatment of hepatic lymphorrhea, including the latest literature on interventional radiology.

In the current systemic therapy era, such as immunotherapy and molecular targeted therapy, treatment strategy of hepatocellular carcinoma is changing. Transarterial chemoembolization is more expected as a curative treatment option than before. Therefore, it is important to learn key techniques of transarterial chemoembolization procedures to achieve complete response. This article delineates the current indications for transarterial chemoembolization and several techniques used for its implementation.

Many pathological conditions involve the head and neck organs, which have complicated anatomy and functions. Recent advances in endovascular treatment have enabled clinicians to use it for treating various lesions, including hemorrhagic conditions, hypervascular tumors, and vascular malformations. Head and neck lesions may present with region-specific clinical manifestations, angioarchitecture, and complications, particularly regarding cosmetic, ingestion, respiratory, and neuronal functions. Therefore, the treatment strategy should consider cosmetic concerns and the preservation of critical functions. A detailed understanding of functional vascular anatomy and treatment techniques can help achieve successful management of head and neck lesions. This review summarizes the clinical manifestations of head and neck lesions, treatment strategies, and complications.

Purpose: This study aimed to evaluate the clinical outcomes of placing Viabahn stent grafts in visceral arterial injuries and identify the risk factors associated with stent graft occlusion.

Material and method: This multicenter, retrospective study included 29 procedures performed on 26 patients who underwent Viabahn stent graft placement between December 2017 and November 2022. We evaluated technical and clinical success rates, periprocedural complications, and stent graft patency using contrast-enhanced computed tomography. We conducted univariate analysis to examine the risk factors associated with Viabahn stent graft occlusion.

Result: The technical success rate was 96.6% (28 of 29), and the clinical success rate was 86.2% (25 of 29). The periprocedural complication rate was 17.2% (5 of 29), consisting of 4 mild adverse events and 1 patient death. The stent graft patency rates at 1, 3, 6, 12, and 24 months were 85%, 84.2%, 77.8%, 66.7%, and 50%, respectively. Univariate analysis indicated significant correlations between the lack of antiplatelet medication (P = .00074) and SG oversize ≥ 20% (P = .047).

Conclusions: This trial demonstrated the safety and effectiveness of Viabahn stent graft placement for visceral arterial injuries with high patency rates. Additionally, this study identified the lack of antiplatelet treatment and Viabahn oversize ≥ 20% as significant risk factors for Viabahn stent graft blockage in visceral arterial injuries.