搜索结果：Interventional radiology (Higashimatsuyama-shi (Japan)

The need for interventional radiology in hemostatic strategies for postpartum hemorrhage has been growing as a reliable and hopeful treatment method because of its non-invasive characteristics, high success rate of hemostatic outcomes, and potential to preserve fertility. Moreover, with the global trend of increasing postpartum hemorrhage, interventional radiology is expected to play an important role. An accurate pre-procedural diagnosis of the underlying cause of bleeding, including tone, trauma, tissue, or thrombin, utilizing contrast-enhanced computed tomography and clinical information, is essential for planning the appropriate technical approach to interventional radiology. This study outlines the fundamental aspects of primary postpartum hemorrhage, compares the computed tomography imaging characteristics associated with various causes, and discusses the appropriate procedural choices of interventional radiology based on the identified etiology.

This review highlights the role of interventional radiology in the management of renal trauma, emphasizing its contributions to imaging-based diagnosis, injury classification, and treatment. It discusses the indications for and clinical outcomes of transcatheter arterial embolization, as well as the management of renal artery dissection and urinary extravasation. Transcatheter arterial embolization has demonstrated favorable outcomes, even in high-grade injuries, and repeat procedures have proven effective for managing rebleeding. Renal artery dissection may be treated with stent placement to preserve renal function. Although urinary extravasation often resolves spontaneously, persistent cases may require ureteral stenting or percutaneous drainage. Additional interventional radiology-based interventions, including embolization and cryoablation, have also been reported. As a minimally invasive, organ-preserving treatment modality, interventional radiology plays a vital role in supporting non-operative management strategies for renal trauma.

Uterine artery embolization is a treatment option for symptomatic uterine myomas. The Japanese Society of Interventional Radiology Guideline Committee developed guidelines for uterine artery embolization procedures for symptomatic uterine myomas using an evidence-based methodology. This report describes the rationale for developing these guidelines and provides answers to clinical questions concerning uterine artery embolization procedures based on existing evidence and expert consensus.

Lower extremity artery disease affects more than 230 million people worldwide, leading to significant cardiovascular and limb-related complications. Recent advancements in endovascular treatment, driven by technological innovations and increasing patient prevalence due to aging populations and lifestyle diseases, has contributed to a growing demand for endovascular treatment. In Japan, the number of endovascular treatment procedures has increased specifically among cardiologists, whereas the involvement of interventional radiology physicians remains limited. This review explores the latest trends and clinical outcomes of endovascular treatment, and the importance of multidisciplinary collaboration, including the role of interventional radiology physicians. The findings encourage greater involvement of interventional radiology physicians in endovascular treatment.

Percutaneous interventions are widely performed for bile duct injuries due to surgery, trauma, and local ablation or transarterial chemoembolization for hepatocellular carcinoma. Most bilomas can be treated with percutaneous drainage alone, but additional biliary drainage or plastic stenting in the common bile duct, dilation of the coexisting biliary stricture, or embosclerosis is also required for refractory bilomas. For bile duct occlusions or disruptions, percutaneous transhepatic biliary drainage and long-term catheter placement across the affected segment are recommended. In addition, intrahepatic biliary ablation and/or percutaneous transhepatic portal vein embolization is effective for refractory bile leaks. Percutaneous drainage is required for infected necrotized hepatocellular carcinoma due to ascending cholangitis after transarterial chemoembolization. Plastic stent placement is also recommended for main bile duct strictures caused by transarterial chemoembolization.

This study aimed to evaluate the effect of the scan field of view on operator radiation exposure during computed tomography fluoroscopy in computed tomography-guided interventional radiology procedures. Two cylindrical phantoms (diameters: 220 mm and 330 mm) were scanned, and the tube currents were adjusted to achieve equivalent standard deviation values for scan field of view M (320 mm) and scan field of view L (500 mm), where standard deviation refers to the standard deviation of computed tomography attenuation values measured within a centrally placed square region of interest in the phantom image (expressed in Hounsfield units). Equivalent doses at the operator's position were measured under these standard deviation-equivalent conditions. The results showed that the equivalent doses at the operator's position were significantly lower when using scan field of view M. The difference in radiation exposure was more pronounced with the larger phantom and increased by up to 15% when using the larger scan field of view (L), with scan field of view M as the reference. These findings suggest that using a smaller scan field of view can effectively reduce radiation exposure to the operator when a wide field of view is unnecessary for computed tomography fluoroscopy.

A 50-year-old woman presented with recurrent urethral bleeding. Initial dynamic computed tomography scans revealed abnormal enhancement in the corpus cavernosum of the clitoris, supplied by the right obturator artery. Subsequent magnetic resonance imaging indicated slight swelling of the corpus cavernosum without intricate vascular tangles suggestive of a nidus. A diagnosis of a clitoral arterial-cavernous shunt was suspected. Treatment involved successful transarterial embolization. Although clitoral arterial-cavernous shunts are uncommon, they can be effectively treated with targeted interventional approaches guided by accurate diagnostic imaging.

Purpose: Portal vein thrombosis (PVT), is seen in about 25% of patients with cirrhosis. Chronic portal vein thrombosis can significantly alter anatomy, often leading to the diversion of splanchnic blood into expansive and compliant vascular channels. This process generates extensive collateral networks and large varices that function as portosystemic shunts. Portal cavernous transformation represents a critical vascular condition marked by the formation of a network of collateral veins that develops to bypass an obstructed portal vein [PV]. Given these physiological changes, performing liver transplantation is associated with higher morbidity and mortality rates. We present an early, single-center experience for portal vein reconstruction (PVR) and the creation of a transjugular intrahepatic portosystemic shunt (TIPS) to increase transplant candidacy in such patients. Material and Methods: Retrospectively, data was obtained from the Picture Archiving and Communication System (PACS) and Hospital Information System (HIS) from a single center between January 2016 to January 2024. In total, 15 patients with obliterative main portal vein thrombosis were selected. These patients underwent Percutaneous transhepatic portal vein recanalization with transjugular intrahepatic portosystemic shunt to increase their transplant eligibility after a collaborative imaging examination by transplant surgery and interventional radiology team. Up until liver transplant LT, patients were monitored in the hepatology/transplant clinic, and thereafter in the posttransplant clinic. To confirm portal vein PV patency, serial ultrasound/Dynamic computed tomography/magnetic resonance imaging was done. Results: Portal vein recanalization with transjugular intrahepatic portosystemic shunt was performed in 15 patients. Technical success, defined as the maintenance of patency in both the portal vein and the transjugular intrahepatic portosystemic shunt at the conclusion of the procedure, was achieved in all 15 cases (100%). Conclusions: Patients with portal vein thrombosis may significantly benefit from portal vein recanalization with transjugular intrahepatic portosystemic shunt, enhancing transplantation candidacy and facilitating physiologic end-to-end anastomoses.

This study aimed to evaluate the feasibility of the Repeatable Microcatheter-accessible Port (ReMAP™) system in initial clinical experiences. Eighteen patients with advanced hepatocellular carcinoma underwent ReMAP™ implantation. The 3.3-Fr catheter tip was positioned in the hepatic, gastroduodenal, or splenic artery, with the side hole located in the common or proper hepatic artery. The 6-Fr proximal end of the catheter was connected to the ReMAP™ device, implanted subcutaneously in the front thigh. A specialized 17-G cannulated needle was used to puncture the ReMAP™ system, allowing insertion of a microcatheter and guidewire, which exited via the side hole and were advanced into the targeted hepatic branches. ReMAP™ implantation was successful in all cases. A total of 85 treatment sessions using microcatheters inserted via the ReMAP™ system were performed. All sessions successfully facilitated selective arterial infusion chemotherapy (75 sessions) and selective transarterial chemoembolization (10 sessions). During the treatment period (mean duration: 4.6 months), complications occurred in three cases (18%), including hepatic arterial occlusion, dislocation of the indwelling catheter, and biloma. Locoregional treatments using the ReMAP™ system are feasible for patients with advanced hepatocellular carcinoma.

Hepatic artery embolization is a locoregional treatment for hepatocellular carcinoma that may modulate the tumor immune microenvironment. However, its effects on tumor-infiltrating cluster of differentiation 8-positive lymphocytes remain unclear. This study evaluates changes in tumor-infiltrating cluster of differentiation 8-positive lymphocytes following hepatic artery embolization in an orthotopic rat hepatocellular carcinoma model using flow cytometry and immunohistochemistry. Orthotopic hepatocellular carcinoma was established in rats using N1S1 cells. Animals were divided into an hepatic artery embolization group (n = 11) and a control group (n = 11). One week after the procedures, liver tumor tissues were harvested, and flow cytometry and immunohistochemistry were performed to quantify total and exhausted cluster of differentiation 8-positive lymphocytes. Tumor-infiltrating cluster of differentiation 8-positive lymphocytes significantly decreased in the hepatic artery embolization group compared to controls by both flow cytometry (0.13 &#xb1; 0.09 vs. 0.46 &#xb1; 0.27 &#xd7; 106/g, p < 0.01) and immunohistochemistry (14.67 &#xb1; 15.17 vs. 31.56 &#xb1; 20.98 cells/field of view, p < 0.05). However, the proportion of exhausted cluster of differentiation 8-positive lymphocytes by flow cytometry remained unchanged (8.24 &#xb1; 3.66% vs. 8.88 &#xb1; 2.60%, p = 0.72). Hepatic artery embolization reduces the number of tumor-infiltrating cluster of differentiation 8-positive lymphocytes without altering the proportion of exhausted T cells. These findings suggest that, to increase hepatic artery embolization efficacy in combination with immunotherapy, a strategy of recruiting more cluster of differentiation 8-positive lymphocytes into the tumor tissue may be necessary.

Tract hemorrhage following tunneled central venous catheter placement can be a challenging issue for some patients. We report our experience with the injection of a hemostatic agent into the central venous catheter tract for treatment of tract bleeding. The patient's central venous catheter exit site and surrounding area were cleaned with surgical preparation liquid and draped using an aseptic technique. The tract was infiltrated with 1% lignocaine. A hemostatic agent was injected along the tract alongside the central venous catheter using an 18G x1.5" blunt needle (Agani, Terumo, Japan) to fill the potential space around the catheter. The site was then re-dressed in a sterile manner, and an antimicrobial dressing was placed around the catheter exit site. A total of 21 patients were treated. The technical success rate was 100%. The clinical success rate following the initial procedure was 66.6%, improving to 95% and 100% after one and two re-interventions respectively. This described technique of central venous catheter tract injection with hemostatic material assists in achieving tract hemostasis.

To retrospectively evaluate local tumor control and imaging findings after seven-day administration of lenvatinib followed by conventional transarterial chemoembolization in patients with unresectable hepatocellular carcinoma. In this retrospective observational study, patients received lenvatinib for seven days, followed by a two-day withdrawal period, before undergoing conventional transarterial chemoembolization in routine clinical practice. The treatment efficacy of lenvatinib administration and the combination therapy was evaluated by computed tomography during hepatic arteriography and by ethiodized oil deposition on non-contrast-enhanced computed tomography after transarterial chemoembolization, respectively. Local recurrence-free survival and progression-free survival were evaluated using the Kaplan-Meier method and the modified Response Evaluation Criteria in Solid Tumors. Prognostic factors and adverse events were assessed. Thirty-two patients initiated scheduled lenvatinib-transarterial chemoembolization; 25 patients with 73 nodules completed the protocol and were analyzed. Of these nodules, 56 (76.7%) showed hyperenhancement, and 17 (23.3%) showed hypoenhancement on computed tomography during hepatic arteriography. Ethiodized oil deposition with a safety margin of &#x2265;1 mm was achieved in 60 nodules (82.2%). Local recurrence-free survival rates were 100% at three months, 91.7% at six months, and 75.9% at 12 months. Median progression-free survival was 8.0 months. Grade 3 adverse events occurred in 3 of 32 patients. Scheduled lenvatinib-transarterial chemoembolization demonstrated favorable local tumor control and acceptable safety in patients with unresectable hepatocellular carcinoma; however, these exploratory findings should be interpreted with caution given the single-arm retrospective design.

A liver abscess developed in the left subphrenic space in a 42-year-old man with liver metastases from gastric cancer. Because ultrasound did not detect the abscess, percutaneous drainage was planned with real-time fluoroscopic fusion imaging guidance using angio-computed tomography. A computed tomography scan was obtained, and the abscess cavity was manually delineated using dedicated software. On the basis of pre- and intra-procedural computed tomography images, the transhepatic epigastric approach was selected. The delineated area was overlaid onto fluoroscopy, and a needle was advanced toward the overlaid target. A drainage catheter was inserted using the Seldinger technique. No adverse events occurred, and the inflammatory markers improved after drainage. This case reveals the potential utility of real-time fluoroscopic fusion imaging guidance using angio-computed tomography for abscess drainage in anatomically challenging locations.

Balloon-occluded retrograde transvenous obliteration (BRTO) has been developed in Japan as a treatment for gastric varices (GV). The technique has spread mainly around Asia, but is now gaining wider recognition in the United States and Europe. BRTO is characterized by high therapeutic efficacy against GV, and a recent study demonstrated that BRTO resulted in improved liver function after the procedure. In addition, BRTO is becoming an effective treatment for the recently proposed concept of "portosystemic shunt syndrome". In this review, we describe the indications, methods, and modifications of BRTO, and also discuss the indications and current status of BRTO for portosystemic shunt syndrome.

Inferior epigastric artery injury during femoral vein puncture is rare but typically occurs near its origin, requiring a careful and technically demanding approach. We report two cases of proximal right inferior epigastric artery injury following femoral vein puncture during catheter ablation. To minimize further damage, a steerable microcatheter was used to approach the distal inferior epigastric artery by adjusting its tip direction, and coil embolization was initiated distally. For proximal embolization, a balloon catheter was placed in the right external iliac artery for balloon-assisted, controlled coil packing at the origin. Complete hemostasis was achieved in both cases without complications. Balloon-assisted coil embolization using a steerable microcatheter appears to be an effective technique for managing proximal inferior epigastric artery injuries associated with femoral vein puncture.

Conventional balloon-occluded retrograde transvenous obliteration often fails to achieve complete occlusion in cases with complex collateral drainage, leading to variable outcomes. The cooperative anti-reflux and double interruption system, a coaxial dual-balloon device, was developed to achieve more stable venous occlusion. This study aimed to evaluate the clinical and hepatic functional benefits of double-balloon balloon-occluded retrograde transvenous obliteration compared with the conventional single-balloon method for gastric varices. This single-center retrospective study included 48 patients with gastric varices who underwent balloon-occluded retrograde transvenous obliteration between February 2008 and March 2020. Eighteen patients received the single-balloon method, and 30 underwent the double-balloon procedure. Clinical and technical success rates, complications, and hepatic function parameters (Child-Pugh and albumin-bilirubin scores) were compared up to 12 months after balloon-occluded retrograde transvenous obliteration. The clinical success rate was significantly higher with cooperative anti-reflux and double interruption system than with the single-balloon method (90.0% vs. 50.0%, p = 0.004), whereas technical success rates were high in both groups (100% vs. 88.9%). In the cooperative anti-reflux and double interruption system group, hepatic functional reserve improved markedly, with significant decreases in albumin-bilirubin (&#x394;albumin-bilirubin: -0.283 vs. +0.001, p < 0.05) and Child-Pugh scores (&#x394;Child-Pugh: -0.19 vs. +1.09, p < 0.05) during 5-12 months of follow-up. Complication rates were comparable between groups. Double-balloon balloon-occluded retrograde transvenous obliteration using the cooperative anti-reflux and double interruption system significantly improves clinical success and long-term hepatic function compared with the conventional method, providing a safe and effective treatment for gastric varices. This dual-balloon approach ensures stable occlusion and uniform sclerosant distribution even in cases with complex collateral drainage, leading to more reliable treatment outcomes and enhanced hepatic functional recovery.

It is common to see renewed arterial flow minutes after achieving a conventional endpoint during embolization procedures due to particle redistribution. This technique describes a method of leaving a catheter in place so that a repeat angiogram can be performed later during the procedure to assess the arterial flow and to allow for delayed endpoint assessment and top-up embolization in the setting of uterine and prostatic artery embolization. Between 2014 and 2024, 140 uterine artery embolizations and 50 prostatic artery embolizations were performed using bilateral common femoral artery access under ultrasound guidance. Simultaneous catheterization enabled alternating embolization and passive redistribution of embolic material, with the ability to deliver additional embolic load following delayed reassessment, including waits for hypogastric nerve block or gel foam preparation. This "swapping sides" strategy allowed flow reassessment and top-up before completion. Delayed angiographic reassessment demonstrated renewed perfusion in vascular territories that had previously met conventional endpoints, facilitating additional flow-directed embolization in all cases without prolonging procedure time or increasing contrast volume. In the uterine artery embolization cohort, the mean fibroid infarction rate was 97%, with 96% of patients reporting symptomatic improvement; long-term hysterectomy was required in 7.1%. In the prostatic artery embolization cohort, the mean reduction in International Prostate Symptom Score was 11 points, with a quality-of-life improvement of two points. No major access-site complications were observed. Bilateral femoral access facilitates a novel embolization workflow, "embolize-wait-reassess-top-up", without significant access-related penalty. These findings warrant reconsideration of dual femoral access in pelvic embolization.

A 73-year-old man underwent radical surgery for hilar cholangiocarcinoma. Complications included portal vein thrombosis on postoperative day 7 and anastomotic bile leakage. On postoperative day 33, massive bloody output (900 mL/day) occurred from a surgical drain. Contrast injection through a replaced drainage catheter revealed a main portal vein perforation at the site of the drain contact via the drain tract. Following conservative management by catheter clamping, computed tomography showed an abscess spilling into the portal vein through the perforation. Percutaneous transhepatic biliary drainage was performed for external drainage to prevent further influx. The patient recovered and was discharged on postoperative day 58. Portal vein bleeding should be recognized as a source of postoperative hemorrhage following pancreatobiliary surgery. Conservative management targeting spontaneous tract thrombosis may be a viable treatment option.

To investigate changes in respiratory function after radiofrequency ablation for lung tumors. Data from 21 patients who underwent respiratory function tests before radiofrequency ablation, during the early period (20-57 days; median, 34 days), and during the late period (104-692 days; median, 264 days) after lung radiofrequency ablation were retrospectively assessed. The index tumors included 10 primary lung cancers and 11 metastatic lung tumors, with a median tumor size of 12 mm (range, 4-21). Seventeen patients had a history of smoking, and the median Brinkman Index was 500 (range, 0-1,200). Percentage changes in vital capacity and forced expiratory volume in 1 s relative to baseline values were calculated and compared using the Wilcoxon signed-rank test. Risk factors for decreased vital capacity and forced expiratory volume in 1 s were examined by univariate analysis using the Mann-Whitney U test. All radiofrequency ablation procedures were completed as planned. Vital capacity and forced expiratory volume in 1 s showed significant decreases to 98.0% (p = 0.048) and 96.8% (p = 0.048), respectively, in the early period, but recovered to 100.2% (p = 0.89) and 98.1% (p = 0.28), respectively, in the late period. Forced expiratory volume in 1 s decreased significantly in the early period among patients with a Brinkman Index >500 (98.9% for Brinkman Index &#x2264;500 and 91.2% for Brinkman Index >500, p = 0.002). Respiratory function decreased temporarily within 2 months after lung radiofrequency ablation but recovered several months thereafter. Caution is needed because forced expiratory volume in 1 s tends to decrease in the early period after radiofrequency ablation in patients with a smoking history and a Brinkman Index >500.