Language：Japanese   Publisher：(一社)日本インターベンショナルラジオロジー学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Radiographic detection of the Adamkiewicz artery (AKA) before aortic surgery helps to avoid spinal cord ischemia (SCI). We applied magnetic resonance angiography (MRA) using gadolinium enhancement (Gd-MRA) by means of the slow-infusion method with sequential k-space filling and compared AKA detectability with that of computed tomography angiography (CTA). METHODS: A total of 63 patients with thoracic or thoracoabdominal aortic disease (30 with aortic dissection [AD] and 33 with aortic aneurysm) who underwent both CTA and Gd-MRA to detect AKA were evaluated. The detectability of the AKA using Gd-MRA and CTA were compared among all patients and subgroups based on anatomical features. RESULTS: The detection rates of the AKAs using Gd-MRA and CTA were higher in all 63 patients (92.1% vs. 71.4%, P = 0.003). In AD cases, the detection rates using Gd-MRA and CTA were higher in all 30 patients (93.3% vs. 66.7%, P = 0.01) as well as in 7 patients whose AKA originated from false lumens (100% vs. 0%). In aneurysm cases, the detection rates using Gd-MRA and CTA were higher in 22 patients whose AKA originated from the nonaneurysmal parts (100% vs. 81.8%, P = 0.03). In clinical, SCI was observed in 1.8% of cases after open or endovascular repair. CONCLUSIONS: Despite the longer examination time and more complicated imaging techniques compared to those of CTA, the high spatial resolution of slow-infusion MRA may be preferable for detecting AKA before performing various thoracic and thoracoabdominal aortic surgeries.

DOI： 10.1016/j.avsg.2023.02.027

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: This study aimed to illustrate the utility of our original system to deliver vascular plugs into aortic side branches during endovascular aneurysm repair (EVAR). TECHNIQUE: Our device, which we named "System-F," consists of a 14 Fr sheath, a 12 Fr long sheath with a side hole, a stiff guidewire as a shaft, and a parallelly-inserted delivery catheter navigated through the side hole into the aneurysm sac. Vertical motion and horizontal rotation of the side hole allow multidimensional movement of the delivery catheter within the aneurysm. This system was applied in 7 cases undergoing EVAR; 4 inferior mesenteric arteries and 14 lumbar arteries were embolized using vascular plugs. Type II endoleak (T2EL) was not observed in the follow-up survey of any case. Conclusion: The applicability of System-F for vascular plug placement in the side branches of abdominal aortic aneurysms has the potential to achieve high delivery capability and be widely applied for the prevention of T2EL. CLINICAL IMPACT: System-F has potential to change the strategies of pre-EVAR embolization.

DOI： 10.1177/15266028231179422

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Many invasive procedures performed in the emergency room (ER) have potential risks and complications. Because of their limitations, in particular size, portable X-ray devices are generally not used during such procedures. However, miniaturized units enable physicians to obtain X-ray images without assistance. METHODS: We developed a safe, compact, and lightweight X-ray unit that was used during five invasive procedures in the ER. In all procedures, a chest X-ray image was obtained, to confirm the utility of the unit. RESULTS: Case 1 (central venous catheter placement): After needle and guidewire insertion and catheter placement, the location of the catheter could be confirmed. Case 2 (chest tube insertion): During insertion of a chest tube into the pleural space, the tip of the thoracic tube was confirmed to be at the correct location. Case 3 (percutaneous tracheostomy or cricothyroidotomy): After needle and guidewire insertion, the guidewire was visualized in the right main bronchus and was inserted into the trachea. Case 4 (resuscitative endovascular aortic balloon of the aorta): The captured image revealed that the catheter was located in zone I before balloon inflation. Case 5 (Sengstaken-Blakemore tube): The image revealed that the balloon was located in the stomach. CONCLUSIONS: The portable X-ray unit improved medical safety during invasive procedures frequently performed in the ER.

DOI： 10.1272/jnms.JNMS.2022_89-504

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Temperature alteration can modify the polymerization of n-butyl cyanoacrylate (NBCA)-iodized oil mixtures during vascular embolization; its effects on viscosity, polymerization time, and intra-arterial distribution of the NBCA-iodized oil mixture were investigated. MATERIALS AND METHODS: In vitro, the viscosities of NBCA, iodized oil, and NBCA-iodized oil mixtures (ratio, 1:1-8) were measured at 4-60 ºC using a rotational rheometer. The polymerization times (from contact with blood plasma to stasis) were recorded at 0-60 ºC using a high-speed video camera. In vivo, the 1:2 mixture was injected into rabbit renal arteries at 0, 20, and 60 ºC; intra-arterial distribution of the mixture was pathologically evaluated. RESULTS: The mixtures' viscosities decreased as temperature increased; those at 60 ºC were almost four to five times lower than those at 4 ºC. The polymerization time of NBCA and the 1:1-4 mixtures increased as temperature decreased in the 0-30 ºC range; the degree of time prolongation increased as the percentage of iodized oil decreased. The 0 ºC group demonstrated distributions of the mixture within more peripheral arterial branches than the 20 and 60 ºC groups. CONCLUSION: Warming reduces the mixture's viscosity; cooling prolongs polymerization. Both can be potential factors to improve the handling of NBCA-iodized oil mixtures for lesions requiring peripheral delivery. Temperature alteration influences the polymerization time, viscosity, and intra-arterial distribution of NBCA-iodized oil mixtures. Warming reduces the viscosity of the mixture, while cooling prolongs polymerization.

DOI： 10.1007/s11604-021-01143-3

PubMed

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Language：Japanese   Publisher：(株)Gakken  

＜文献概要＞Key Point ●外傷性出血は常に悲劇的なアクシデントであり,損傷形態に合わせたベストの診療プランをフレキシブルに設定して,迅速に完遂する必要がある.●外傷IVRは今日の外傷診療システムには欠かせない主翼のひとつであるが,具体的な手技の標準化には至っていない.●症例ごとの条件を的確に理解・整理しながら,急性期の生命維持と臓器機能温存を両立するバランスの良いIVRが求められている.

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

下部消化管出血に対する経皮的動脈塞栓術(transcatheter arterial embolization:TAE)が選択される機会は増えており,その有用性はすでに示されているが,消化管虚血などの合併症が問題となるため,塞栓範囲の設定や塞栓物質の選択を適切に行うことが重要である。下部消化管出血においては,直細動脈(vasa recta)が出血源であることが多く,出血点が明らかであれば金属コイルやn-butyl-2-cyanoacrylate(NBCA)を用いたvasa rectaの選択的塞栓が第一選択である。出血点が明らかでない場合の代替手段として,イミペネム・シラスタチン(IPM/CS)の使用がここ数年で報告されるようになった。(著者抄録)

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