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BACKGROUND: A congenital intrahepatic portosystemic shunt (IPSVS) is a rare vascular abnormality that is characterized by an anomalous intrahepatic venous tract that connects the intrahepatic portal vein with the hepatic venous system. Hepatic encephalopathy is an indication for IPSVS embolization, which is technically challenging because rapid blood flow through shunts can induce the migration of embolization material to systemic veins. This case report discusses the efficacy of percutaneous balloon-occluded retrograde transvenous obliteration for treating patients with IPSVSs. CASE SUMMARY: A 75-year-old woman presented with a six-month history of repeated hepatic encephalopathy due to an IPSVS without liver cirrhosis. We successfully embolized the IPSVS using percutaneous balloon-occluded retrograde transvenous obliteration with interlocking detachable coils. After the procedure, the patient exhibited no symptoms of hepatic encephalopathy for 14 mo. CONCLUSION: Balloon-occluded retrograde transvenous obliteration with detachable coils can be effective for the endovascular treatment of an IPSVS.

DOI： 10.12998/wjcc.v10.i6.2023

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PURPOSE: The purpose of the study is to evaluate the initial and midterm efficacy and safety of endovascular treatment (EVT) using Viabahn stent-graft (SG) for arterial injury and bleeding (AIB) at the visceral arteries. MATERIALS AND METHODS: Consecutive patients with visceral AIB who underwent EVT using Viabahn between January 2017 and February 2021 were retrospectively reviewed. Technical success, clinical success, peripheral organ ischemia, peri-procedural complications, bleeding-related mortality, 30-day mortality, neck length, re-bleeding, endoleaks, and patency of the SGs at 1, 3, 6, and 12 months were evaluated. RESULTS: EVT using Viabahn was performed in 14 patients (mean age: 68.6 years; 12 males) and 15 arteries. The technical and clinical success rates were 100%. The rates of peripheral organ ischemia, peri-procedural complications, bleeding-related mortality, and 30-day mortality were all 0%. The mean neck length was 9.9 mm. No endoleaks or re-bleeding occurred during the follow-up (mean: 732 days). The SG patency was confirmed after 1, 3, 6, and 12 months in 78.6%, 78.6%, 78.6%, and 56.1% of the patients, respectively. CONCLUSION: EVT using Viabahn for AIB at the visceral arteries was safe and effective. SG occlusions without ischemia often occurred after 12 months.

DOI： 10.1007/s11604-021-01192-8

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BACKGROUND: Operative mortality after endovascular aneurysm repair (EVAR) has been reported as lower than open surgical repair (OSR) for abdominal aortic aneurysm (AAA) in randomized controlled trials. However, many cohort studies have demonstrated similar mortality rates for both procedures. We compared operative mortality between EVAR and OSR, at our institution. METHODS: All AAA operations from 2012 to 2017 were reviewed, and baseline characteristics were collected. Outcomes included 30-day mortality, operative data, complications, length of hospital stay (LOS), costs, re-intervention, and survival rates were compared. A multivariable analysis with unbalanced characteristics was performed. RESULTS: We had a total of 162 patients, 100 having OSR and 62 for EVAR. The EVAR group was older, with higher ASA classification. Thirty-day mortality rate did not significantly differ (0/100 for OSR and 2/62 (3%) for EVAR; p = 0.145), while the EVAR group had less blood loss, shorter operative times, and LOS, but higher re-intervention rates (adjusted hazard ratio 6.4 (95%CI: 1.4, 26.8)). Survival rates did not significantly differ between the groups. EVAR cost approximately 1-million yen more. CONCLUSIONS: OSR had low 30-day mortality rate in selected low-risk patients whereas EVAR had less blood loss, shorter operative times, LOS and could be done in high-risk patients with low 30-day mortality but with higher re-intervention rate.

DOI： 10.1016/j.asjsur.2021.06.015

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Chronic mesenteric ischemia (CMI) involving occlusion and/or stenosis of multiple mesenteric arteries is rare. We report our experience with a 66-year-old man who presented with a more than 3 months history of abdominal pain and vomiting/diarrhea. A diagnosis of CMI due to occlusion of the superior mesenteric artery (SMA) and severe stenosis of the celiac artery by median arcuate ligament syndrome was made. Complete revascularization through iliac artery-SMA bypass grafting and arcuate ligament dissection assisted with staged-catheter intervention successfully alleviated the patient's symptoms. The patient has maintained a normal daily diet for 6 months postoperatively.

DOI： 10.3400/avd.cr.21-00109

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BACKGROUND: A Viabahn stent graft (SG) is a heparin-coated self-expandable SG for lower extremity arterial disease that exhibits high flexibility and accuracy in the delivery system. This study aimed to evaluate the short-term efficacy and safety of emergency endovascular treatment (EVT) using a Viabahn SG for upper and lower extremity arterial bleeding (ULEAB). METHODS: Consecutive patients with ULEAB who underwent emergency EVT using the Viabahn SG between January 2017 and August 2021 were retrospectively reviewed. The indications for EVT, location of artery, technical success, clinical success, limb ischemia, periprocedural complications, bleeding-related mortality, 30-day mortality, diameter of the target artery, diameter of the SG, neck length, rebleeding, endoleaks, and patency of the SGs at 1, 3, 6, and 12 months were evaluated. RESULTS: EVT using the Viabahn SG was performed in 22 patients (mean age, 72.0 ± 13.0 years; 11 men) and 23 arteries (upper, 6; lower, 17). The indications for EVT were pseudoaneurysm (n = 13, 59.1%), extravasation (n = 9, 39.1%), and inadvertent arterial cannulation (n = 1, 4.3%). The anatomical locations of the 23 ULEAB injuries were the brachiocephalic (1 [4.3%]), subclavian (3 [13.0%]), axillary (1 [4.3%]), brachial (1 [4.3%]), common iliac (4 [17.4%]), external iliac (8 [34.8%]), common femoral (2 [8.7%]), superficial femoral (2 [8.7%]), and popliteal (1 [4.3%]) arteries. The technical and clinical success rates were 100%. The rates of limb ischemia, periprocedural complications, and bleeding-related mortality were 0%, whereas the 30-day mortality rate was 22.7%. The mean diameters of the arteries and SGs were 7.7 ± 2.2 and 8.9 ± 2.3 mm, respectively. The mean neck length was 20.4 ± 11.3 mm. No endoleaks or rebleeding occurred during the follow-up period (mean, 169 ± 177 days). Two SG occlusions without limb ischemia occurred in the external iliac and brachial arteries after 1 and 4 months, respectively. Subsequently, cumulative SG patency was confirmed after 1, 3, 6, and 12 months in 91.7%, 91.7%, 81.5%, and 81.5% of patients, respectively. CONCLUSIONS: Emergency EVT using the Viabahn SG for ULEAB was effective and safe according to short-term outcomes. Appropriate size selection and neck length are important for successful treatment. SG patency was good after 1, 3, 6, and 12 months.

DOI： 10.1186/s42155-021-00273-z

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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

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BACKGROUND: To evaluate outcomes of endovascular treatment (EVT) using a combination of multiple endovascular techniques for acute lower limb ischemia (ALLI) and to compare outcomes based on vessel type and artery location. METHODS: A total of 95 consecutive patients with ALLI (mean age, 72.0 years; 65 males; 104 lower limbs) who received emergency EVT using a combination of multiple endovascular techniques including thrombolysis, aspiration thrombectomy, stenting, and balloon angioplasty with or without surgical thromboembolectomy, between January 2005 and December 2017 were included. Vessel type was classified into native artery occlusion (native occlusion) and bypass graft occlusion (graft occlusion), including prosthetic and vein graft. Additionally, native arteries were categorized into below-knee occlusion and non-below-knee occlusion. Technical success, perioperative death (POD), ALLI-related death, amputation, amputation-free survival (AFS), and complications were compared according to vessel type (native occlusion vs. graft occlusion) and artery location (below-knee occlusion vs. non-below-knee occlusion). RESULTS: Of all patients with ALLI, 16.8% underwent a single endovascular technique, whereas 83.2% underwent a combination of multiple endovascular techniques. The technicalsuccess, POD, and ALLI-related death rates in the total number of patients were 94.7%, 11.6%, and 4.2%, respectively. A total of 67 patients (75 limbs) and 28 patients (29 limbs) were classified as having native occlusion and graft occlusion (prosthetic, 24 limbs; vein, 5 limbs), respectively. No significant differences in technical success (native occlusion: 92.5% vs. graft occlusion: 100%), POD (14.9% vs. 3.6%), and ALLI-related death (6.0% vs. 0%) were noted between native occlusion and graft occlusion. However, the 30-day AFS rate of native occlusion was significantly lower than that of graft occlusion (75.2% vs. 96.3%, P=0.01). The amputation rate (P=0.03) and AFS rate (P=0.03) of below-knee occlusion were significantly worse for below-knee occlusion patients than for non-below-knee occlusion patients. CONCLUSIONS: EVT using multiple endovascular techniques for ALLI is effective and safe. A combination of multiple endovascular techniques is crucial for successful treatment. However, native occlusion may have a lower AFS rate than graft occlusion, and below-knee occlusion may have a higher risk of amputation than non-below-knee occlusion.

DOI： 10.1016/j.avsg.2021.02.023

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Vascular Ehlers-Danlos syndrome (vEDS) causes fatal vascular complications due to vascular fragility. However, invasive therapeutic procedures are generally avoided except in emergencies. We report a case of vEDS presenting with rapid expansion of a hepatic arterial aneurysm successfully treated using prophylactic endovascular therapy. A 43-year-old woman with vEDS confirmed by genetic testing was hospitalized for a symptomatic hepatic arterial aneurysm that expanded rapidly within a week. Prophylactic coil embolization was then successfully performed. Although the general applicability of this approach cannot be determined, prophylactic endovascular therapy can clearly be an option for arterial aneurysms at high risk of rupture.

DOI： 10.3400/avd.cr.20-00144

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A 2-year-old boy with a rapidly growing sternal mass was referred to our hospital. Computed tomography revealed a dumbbell-shaped mass with widening of the synchondrosis between the third and fourth elements of the sternal body. The mass significantly shrunk 3 days later, and completely disappeared 2 weeks later, as confirmed by palpation. A diagnosis of self-limiting sternal tumor of childhood was made based on characteristic imaging findings.

DOI： 10.1016/j.radcr.2020.12.052

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Delayed vascular injury (DVI) with a hemodialysis catheter is a rare but potentially life-threatening complication. However, the appropriate treatment for DVI has not yet been established. A 44-year-old man underwent placement of a hemodialysis catheter via the left internal jugular vein, and the first leukapheresis procedure was performed without complications. However, 3 days after the insertion of the hemodialysis catheter, the patient developed sudden dyspnea. Chest radiographs and contrast-enhanced computed tomography revealed that the catheter tip had migrated and was located outside the left brachiocephalic vein. DVI with catheter migration was diagnosed. To perform safe and reliable hemostasis, we successfully performed transvenous balloon-assisted tract embolization with n-butyl cyanoacrylate and the catheter was removed. To our knowledge, there has been no previous report of the treatment of balloon-assisted tract embolization with n-butyl cyanoacrylate for DVI caused by a hemodialysis catheter. Our treatment approach may be safe and effective for DVI.

DOI： 10.1016/j.radcr.2020.05.077

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BACKGROUND: Balloon-assisted transcatheter arterial embolization (TAE) using n-butyl cyanoacrylate (NBCA) and lipiodol (Lp) mixture is a new endovascular treatment technique for iatrogenic arterial bleeding by groin puncture. It is less invasive compared to surgical repair, and NBCA migration into the circulation can be prevented by temporary balloon occlusion of the parent artery without ultrasound-guidance. This study aimed to report on the technical aspects and evaluate the efficacy and safety of fluoroscopically guided balloon-assisted transcatheter arterial embolization using NBCA for iatrogenic arterial bleeding by groin puncture. MATERIALS AND METHODS: The study included five patients (mean age 54.6 years; 3 male and 2 female) with iatrogenic arterial bleeding by groin puncture. We performed transcatheter arterial embolization using NBCA while occluding the responsible artery with a balloon catheter during the embolization to prevent NBCA migration. Two sheaths were inserted into the common femoral artery. A microcatheter was advanced into the pseudoaneurysm or extravasation via the contralateral sheath. A balloon catheter was advanced into the responsible artery until the balloon portion covered the leakage site via another sheath. After balloon inflation, the NBCA and Lip mixture was slowly injected until the pseudoaneurysm, or the extravasation was filled without touching the balloon. The microcatheter was removed immediately after the filling. We assessed technical success, overall success, and complications. RESULTS: The injured arteries were the external iliac artery (n = 1), the common femoral artery (n = 2), and the proximal portion of the superficial femoral artery (n = 2). NBCA was injected once in four cases and twice in one case where complete hemostasis could not be achieved with one injection. The technical and overall success rate was 100% with no complications, including distal embolization of NBCA. CONCLUSIONS: Balloon-assisted TAE using NBCA is a feasible, effective, and safe treatment for iatrogenic arterial bleeding by groin puncture. It may also be applicable in other arterial bleeding situations where the potential risk of distal embolization can be decreased by applying the balloon-assisted technique.

DOI： 10.1186/s42155-020-00132-3

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PURPOSE: We aimed to illustrate the benefits of using warmed glue for viscosity reduction via the triaxial microballoon system for the treatment of various vascular disorders. METHODS: Seven patients who underwent 10 treatment sessions for hemoptysis, type II endoleak, post-pancreatic surgical bleeding, spontaneous retroperitoneal bleeding, or ovarian tumor bleeding were evaluated based on technical and clinical outcomes. In the procedure, the triaxial system, consisting of a 4.5-Fr guiding catheter, a 2.8-Fr microballoon catheter, and a 1.9-Fr no-taper microcatheter, was advanced into the target lesion. Glue (33% n-butyl cyanoacrylate mixed with Lipiodol) warmed to 40°C was injected under balloon occlusion. RESULTS: The common hepatic, right bronchial, intercostals, internal mammary, costocervical, lateral thoracic, superior thoracic, thoracoacromial, inferior thyroid, iliolumbar, lumbar, internal pudendal arteries, and branch of the inferior mesenteric artery were successfully embolized; 100% technical success and 100% clinical success were obtained after each session. CONCLUSION: Our modified balloon-occluded glue embolization may lead to better handling with more distal glue penetration capability.

DOI： 10.5152/dir.2019.19285

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PURPOSE: To present long-term results obtained with endovascular abdominal aortic aneurysm (AAA) repair (EVAR) using the Zenith AAA endovascular graft from a single institution. MATERIALS AND METHODS: Between 2007 and 2013, 95 consecutive patients (median age 77 years) underwent EVAR using Zenith. Data were prospectively collected and retrospectively analyzed until 2019. Primary outcomes were overall survival, freedom from AAA rupture, and freedom from AAA-related death. Secondary outcomes were freedom from late (> 30 days) re-intervention and surgical conversion, and freedom from aneurysm sac growth (> 5 mm). RESULTS: The initial technical success rate was 96.8%. There were no deaths or intraoperative conversions. Overall survival at 1, 3, 5, and 10 years was 90.8%, 81.7%. 74.3%, and 57.2%, respectively. AAA rupture occurred in one patient (1.1%). Freedom from AAA-related death was 100% during the follow-up period. Freedom from aneurysm sac growth at 1, 3, 5, and 10 years was 98.8%, 86.4%, 76.9%, 53.0%, respectively. Freedom from late re-intervention and open surgical conversion at 1, 3, 5, and 10 years was 98.9%, 88.9%, 86.7, and 57.9%, respectively. CONCLUSION: EVAR with Zenith endografts represents a safe and durable means of AAA repair, and risk of rupture and aneurysm-related death are low.

DOI： 10.1007/s11604-019-00892-6

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Transcatheter arterial chemoembolization (TACE) is a standard treatment for unresectable hepatocellular carcinoma; however, it does not always result in tumor control. Nevertheless, treatment outcome can be improved with monodisperse emulsions of anticancer agents. In this study, the distribution of a monodisperse miriplatin-Lipiodol emulsion in the tumor and its safety were evaluated in ten Japanese white rabbits. VX2 tumor was implanted into the left liver lobe. The animals were divided into control and experimental groups (of five animals each) and respectively administered a conventional miriplatin suspension or the emulsion via the left hepatic artery. Computed tomography (CT) was performed before, immediately after, and two days following TACE. All rabbits were sacrificed two days after the procedure. Each tumor was removed and cut in half for assessment of iodine concentration in one half by mass spectroscopy and evaluation of Lipiodol accumulation and adverse events in the other half. Mean Hounsfield unit (HU) values were measured using plain CT images taken before and after TACE. Iodine concentration was higher in the experimental group [1100 (750-1500) ppm, median (range)] than in the control group [840 (660-1800) ppm], although statistically not significant. Additionally, the HU value for the experimental group was higher than that for the control group immediately after [199.6 (134.0-301.7) vs. 165.3 (131.4-280.5)] and two days after [114.2 (56.1-229.8) vs. 58.3 (42.9-132.5)] TACE, although statistically not significant. Cholecystitis was observed in one rabbit in the control group. Ischemic bile duct injury was not observed in any group. The results show that Lipiodol accumulation and retention in VX2 tumor can possibly be improved with a monodisperse emulsion; however, it should be verified with a larger study. Moreover, no significant adverse events are associated with the use of the emulsion.

DOI： 10.1371/journal.pone.0222553

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PURPOSE: To report an unusual case of an abdominal aortic aneurysm (AAA) rupture caused by migration of a Zenith stent-graft main body years after its separation from the suprarenal stent. CASE REPORT: A 72-year-old man underwent endovascular aneurysm repair with a Zenith stent-graft for an infrarenal AAA in year 2000. At that time, a femorofemoral bypass was performed because the left external iliac and common femoral arteries were dissected during treatment. In 2013, follow-up computed tomography (CT) showed disconnection of the uncovered proximal stent, which led to a type Ia endoleak. An additional Zenith main body and Large Palmaz XL balloon-expandable stent were deployed; the endoleak disappeared. In 2016, the patient had abdominal pain, and emergency CT showed AAA rupture caused by migration of the first main body deployed in 2000 under the distal edge of the contralateral (left) leg of the additional main body from 2013, which led to a type IIIa endoleak between the 2 main bodies. A converter and iliac legs were deployed to successfully seal the type IIIa endoleak. The patient remains well 18 months after the second repair; CT scans document stable stent-grafts and no endoleak. CONCLUSION: Physicians should be aware of the potential risk for AAA rupture caused by late main body migration after treatment for suprarenal stent separation from a Zenith stent-graft.

DOI： 10.1177/1526602819830979

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PURPOSE: Percutaneous isolated pancreatic perfusion (PIPP) is performed along with interventional radiology techniques to obtain high drug concentration by occluding the arterial inlet and venous outlet of the pancreas. The experimental study aimed to evaluate the contrast distribution in PIPP under different flow rates with or without anterior mesenteric artery (AMA) occlusion. MATERIALS AND METHODS: This study was approved by a local animal experiment ethics committee. Nine pigs were divided into Groups 1, 2, and 3, by infusion rates of 12, 24, and 36 mL/min. Groups 4 and 5 (3 pigs each) and Group 6 (2 pigs) underwent PIPP at the same respective infusion rates with and without AMA occlusion. Computed tomography (CT) arteriography was performed during PIPP with nonionic contrast media. The enhanced volume was calculated by adding the enhanced area in each slice using 1.25-mm axial images. The percent enhanced volume to the whole pancreas (%eV) was used to simulate drug distribution; the result was compared among groups. RESULTS: Without AMA occlusion, a larger %eV was obtained with high infusion rates (P = 0.039). The median %eV in Groups 1, 2, and 3 were 57.7, 74.2, and 90.5%, respectively. With AMA occlusion, CT demonstrated duodenal enhancement at an infusion rate of 36 mL/min, and the median %eV in Groups 4, 5, and 6 were 92.8, 95.4, and 98.5%, respectively. A significantly larger %eV was obtained after AMA occlusion (P = 0.031). CONCLUSION: A higher infusion rate or AMA occlusion increases the enhanced volume in PIPP in pig models. LEVEL OF EVIDENCE: No level of evidence.

DOI： 10.1007/s00270-018-1943-y

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Background A novel strategy to combine conventional transcatheter arterial chemoembolization (TACE) and TACE during portal vein occlusion (TACE-PVO) in the presence of high-flow arterioportal shunt (APS) has been developed to treat hepatocellular carcinoma (HCC) with portal invasion. Purpose To evaluate the efficacy of this strategy. Material and Methods Twenty-five cases of HCC with portal invasion, treated between April 2006 and December 2015, were evaluated. Balloon occlusion of the portal venous outlet was performed in eight cases of high-flow APS when performing TACE. Conventional TACE was performed in the other 17 cases. The primary endpoint was overall survival. Adverse events and deterioration of liver function were also evaluated. Results The median survival time (MST) was 12 months. One-, two-, and three-year survival rates were 48.0%, 39.3%, and 26.2%, respectively. Subgroup analysis and multivariate analysis revealed the CLIP score as prognostic factor. MST was 2.5 months in the subgroup with CLIP score ≥4 and 26.0 months in the subgroup with CLIP score ≤3 (hazard ratio = 7.7, 95% confidence interval = 2.3-25.8). Transient elevations of the levels of transaminase and bilirubin were observed; however, deterioration of liver function was infrequent; upgrading of Child-Pugh class in 9.1% of cases. Conclusion A novel strategy, combining conventional TACE and TACE-PVO, is effective for HCC with portal invasion. The CLIP score may be useful for considering treatment indication.

DOI： 10.1177/0284185117717762

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AIM: To evaluate the relationship between the location of hepatocellular carcinoma (HCC) and the efficacy of transarterial chemoembolization (TACE). METHODS: We evaluated 115 patients (127 nodules), excluding recurrent nodules, treated with TACE between January 2011 and June 2014. TACE efficacy was evaluated according to mRECIST. The HCC location coefficient was calculated as the distance from the central portal portion to the HCC center (mm)/liver diameter (mm) on multiplanar reconstruction images rendered (MPR) to visualize bifurcation of the right and left branches of the portal vein and HCC center. The HCC location coefficient was compared between complete response (CR) and non-CR groups in Child-Pugh grade A and B patients. RESULTS: The median location coefficient of HCC among all nodules, the right lobe, and the medial segment was significantly higher in the CR group than in the non-CR group in the Child-Pugh grade A patients (0.82 vs 0.62, P < 0.001; 0.71 vs 0.59, P < 0.01; 0.81 vs 0.49, P < 0.05, respectively). However, there was no significant difference in the median location coefficient of the HCC in the lateral segment between in the CR and in the non-CR groups (0.67 vs 0.65, P > 0.05). On the other hand, in the Child-Pugh grade B patients, the HCC median location coefficient in each lobe and segment was not significantly different between in the CR and in the non-CR groups. CONCLUSION: Improved TACE efficacy may be obtained for HCC in the peripheral zone of the right lobe and the medial segment in Child-Pugh grade A patients.

DOI： 10.3748/wjg.v23.i35.6437

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PURPOSE: To evaluate the usefulness and safety of endovascular treatments for acute upper limb ischemia (AULI) by using multiple techniques, and to compare catheter-directed thrombolysis (CDT) and percutaneous aspiration thromboembolectomy (PAT) as initial procedures. MATERIALS AND METHODS: The study included 18 patients (4 men and 14 women) with AULI, who underwent a total of 20 sessions of endovascular treatment using various endovascular techniques between January 2005 and April 2016. The patients were initially treated with CDT [n = 9, CDT-based group (C-G)], PAT [n = 6, PAT-based group (P-G)], or angioplasty (n = 3). In case of residual emboli, we performed additional endovascular techniques. We assessed technical success, clinical success, and complications. Additionally, we compared the urokinase dosage between the groups. RESULTS: The mean patient age was 74.4 years. Technical and clinical success was obtained in all patients. Among the 18 patients, 1 underwent CDT only, 2 underwent PAT only, 1 underwent angioplasty only, and 14 underwent multiple techniques. Two patients from the C-G experienced major complications (cerebellar hemorrhage 1; pseudo-aneurysm in a branch of the ulnar artery 1). The mean urokinase dosage was lower in the P-G than in the C-G (40,000 vs. 246,667 IU; Mann-Whitney U test, P = 0.004). CONCLUSION: Endovascular treatment is effective and safe for AULI. A combination of multiple endovascular techniques is important for successful treatment. PAT is suggested as an initial procedure among endovascular techniques, in terms of a lower dosage of urokinase and a lower complication rate. LEVEL OF EVIDENCE: IV, Case-control studies.

DOI： 10.1007/s00270-017-1599-z

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OBJECTIVES: To investigate haemodynamic changes in hepatocellular carcinoma (HCC) and liver under hepatic artery occlusion. METHODS: Thirty-eight HCC nodules in 25 patients were included. Computed tomography (CT) during hepatic arteriography (CTHA) with and without balloon occlusion of the hepatic artery was performed. CT attenuation and enhancement volume of HCC and liver with and without balloon occlusion were measured on CTHA. Influence of balloon position (segmental or subsegmental branch) was evaluated based on differences in HCC-to-liver attenuation ratio (H/L ratio) and enhancement volume of HCC and liver. RESULTS: In the segmental group (n = 20), H/L ratio and enhancement volume of HCC and liver were significantly lower with balloon occlusion than without balloon occlusion. However, in the subsegmental group (n = 18), H/L ratio was significantly higher and liver enhancement volume was significantly lower with balloon occlusion; HCC enhancement volume was similar with and without balloon occlusion. Rate of change in H/L ratio and enhancement volume of HCC and liver were lower in the segmental group than in the subsegmental group. There were significantly more perfusion defects in HCC in the segmental group. CONCLUSIONS: Hepatic artery occlusion causes haemodynamic changes in HCC and liver, especially with segmental occlusion. KEY POINTS: • Hepatic artery occlusion causes haemodynamic changes in hepatocellular carcinoma and liver. • Segmental occlusion decreased rate of change in hepatocellular carcinoma-to-liver attenuation ratio. • Subsegmental occlusion increased rate of change in hepatocellular carcinoma-to-liver attenuation ratio. • Hepatic artery occlusion decreased enhancement volume of hepatocellular carcinoma and liver. • Hepatic artery occlusion causes perfusion defects in hepatocellular carcinoma.

DOI： 10.1007/s00330-016-4573-2

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PURPOSE: To investigate how elevation of the arms affects diaphragm height. MATERIALS AND METHODS: We retrospectively reviewed angiography and computed tomography (CT) portography data from 44 patients who were treated for hepatocellular carcinoma at our institution from July 2013 to May 2014. Diaphragm height was determined independently by two radiologists as the distance from the upper edge of the first lumbar vertebra to the highest point of the right diaphragm. The differences in height between angiography and CT images were compared using a paired t-test. We also evaluated the influence of table height and distance between X-ray tube and flat panel detector [source-image distance (SID)] on a phantom model. RESULTS: Diaphragm height was higher on CT images [mean ± standard deviation (SD), 113.2 ± 27.2 mm] than on angiography images (105.5 ± 27.8 mm; P < 0.001). Inter-rater correlation was excellent both in angiography (R = 0.920; P < 0.001) and CT (R = 0.950; P < 0.001) measurements. Table height and SID had no influence on diaphragm height measurements (P = 0.33). CONCLUSION: The diaphragm elevation was observed on CT with arm elevation compared with angiography without arm elevation.

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We report the case of a man in his 70s who suffered from intestinal infarction caused by acute portal vein and mesenteric vein thrombosis (PVMVT). Combination therapy with percutaneous transcatheter thrombectomy and surgical bowel resection was successfully performed, and a satisfactory outcome was achieved. Intestinal infarction caused by PVMVT can be fatal and has a high mortality rate even if surgical resection is performed. The combination therapy of interventional radiology and surgery might be a safe and effective method for patients with this life-threatening condition.

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PURPOSE: To evaluate the usefulness of enhanced thin-slice computed tomography (TSCT) for delineating the right adrenal vein (RAV) anatomy before adrenal vein sampling (AVS). MATERIALS AND METHODS: A total of 151 consecutive AVSs with CT during angiography (interventional CT) were included. Of them, TSCT was performed before AVS for 72 patients. Successful RAV cannulation was confirmed using cortisol measurement. The RAV on TSCT was classified as certain, probable, or unidentified, and cases with certain or probable RAV identification were classified as useful. In the cases where AVS was successful, the anatomical features of the presumed RAV from the useful TSCT, including the position along the inferior vena cava, vertebral level, and distance from the upper pole of the right kidney, were compared with the RAV features identified on interventional CT. Estimated successful cannulation rates before interventional CT were compared between patients with and without useful TSCT. RESULTS: In total, 66 TSCTs were classified as useful. The anatomical features identified on TSCT were significantly correlated with those on interventional CT. The estimated successful cannulation rates for cases with and without useful TSCT were 92.4 and 82.4 %, respectively. CONCLUSIONS: TSCT clearly shows the anatomical features of the RAV, facilitating accurate sampling and increasing the success rate.

DOI： 10.1007/s11604-016-0564-0

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

PURPOSE: To evaluate the feasibility of a novel embolization technique, the Amplatzer vascular plug (AVP) anchoring technique, to stabilize the delivery system for microcoil embolization. MATERIALS AND METHODS: Three patients were enrolled in this study, including two cases of internal iliac artery aneurysms and one case of internal iliac arterial occlusion prior to endovascular aortic repair. An AVP was used in each case for embolization of one target artery, and the AVP was left in place. The AVP detachment wire was then used as an anchor to stabilize the delivery system for microcoil embolization to embolize the second target artery adjacent to the first target artery. The microcatheter for the microcoils was inserted parallel to the AVP detachment wire in the guiding sheath or catheter used for the AVP. RESULTS: The AVP anchoring technique was achieved and the microcatheter was easily advanced to the second target artery in all three cases. CONCLUSION: The AVP anchoring technique was found to be feasible to advance the microcatheter into the neighboring artery of an AVP-embolized artery.

DOI： 10.1007/s00270-015-1248-3

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

We report on a rare case of blunt traumatic hepatic arteriovenous fistula arising from a pseudoaneurysm in a 35-year-old woman. Transarterial embolization was performed with n-butyl-2-cyanoacrylate, under inflow control with loose coil packing within the pseudoaneurysm and outflow control by balloon occlusion of the hepatic vein. A promising therapeutic outcome was achieved without any serious adverse events. Thus, the combination of these techniques to control inflow and outflow was successfully used to treat this rare hepatic vascular injury.

DOI： 10.1272/jnms.83.27

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

BACKGROUND: Second-line therapy has limited activity in patients with recurrent or persistent uterine cervical cancer that has progressed after chemoradiation and palliative chemotherapy. The purpose of this study was to evaluate the efficacy of negative-balance isolated pelvic perfusion (NIPP) in patients with pretreated recurrent/persistent uterine cervical cancer. METHODS: Between April 2004 and May 2013, a total of 26 patients with recurrent or persistent uterine cervical cancer previously treated with platinum-based systemic chemotherapy and/or chemoradiotherapy received NIPP therapy at our institution, consisting of a 30-min isolated pelvic perfusion with cisplatin and fluorouracil, followed by isolated pelvic dialysis. Primary endpoints were response rate (RR) and progression-free survival (PFS), while secondary endpoints were overall survival (OS) and safety. Platinum pharmacokinetics were also evaluated. RESULTS: The RR was 57.7 % (complete response, five patients; partial response, ten patients). The median PFS and OS after NIPP therapy were 11.0 (95 % confidence interval [CI] 6.6-15.4) and 25.1 (95 % CI 17.1-33.1) months, respectively. PFS was significantly better in patients without intestinal involvement (p = 0.016) or dissemination (p < 0.001). Survival rates at 1, 2, and 3 years after initial NIPP therapy were 65.2, 50.4, and 13.4 %, respectively. The plasma pelvic-to-systemic exposure ratios were 15.4 and 15.8, based on the maximum concentration and the concentration-time curve, respectively. Most adverse events were mild (grade 1-2) (Common Terminology Criteria for Adverse Events, version 3.0). Severe neutropenia (grade 3 or higher) occurred in only 7.7 % of patients. CONCLUSIONS: NIPP appears to be an effective and feasible method for patients with pretreated recurrent or persistent cervical cancer.

DOI： 10.1245/s10434-015-4494-3

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PURPOSE: To evaluate the feasibility of percutaneous isolated pancreas perfusion (PIPP) by using a pig model. MATERIALS AND METHODS: All experiments were approved by the institutional Animal Experiment Ethics Committee. Fifteen pigs were assigned to five groups, and PIPP was performed. Angiographic and dye injection studies were performed to confirm the patency of the PIPP system (group 1). Blood that contained cisplatin (1.5 mg per kilogram of body weight) in an extracorporeal circuit was circulated through the pancreas at three infusion rates (40, 60, and 80 mL/min) to determine the optimal infusion rate in terms of safety and pharmacologic effectiveness (groups 2, 3, and 4, respectively). Chronological laboratory data and histologic findings were assessed in group 5, which received the optimal infusion rate. Maximum platinum concentration (Cmax) and area under the platinum concentration-time curve were compared by using the Kruskal-Wallis and Mann-Whitney U tests. RESULTS: Angiography and dye injection confirmed the patency of the PIPP system. Histopathologic examinations showed no abnormalities in the pancreas or other organs at a 40 mL/min infusion rate of cisplatin. However, edematous changes in the pancreas were observed at higher infusion rates. The pharmacologic effectiveness did not differ significantly among groups; therefore, the optimal infusion rate of 40 mL/min was selected. The median pancreatic-to-systemic exposure ratios were 71.8 for Cmax and 54.8 for the area under the curve. All laboratory data remained normal or returned to pretreatment levels within 1 week. CONCLUSION: PIPP at a 40 mL/min infusion rate appears to be safe and feasible for perfusion of the pancreas.

DOI： 10.1148/radiol.15141596

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

OBJECTIVES: This study aimed to evaluate the feasibility and underlying pharmacokinetics of the retrograde-outflow technique for percutaneous isolated hepatic perfusion (PIHP). METHODS: Retrograde-outflow PIHP was performed in 12 male pigs (weight, 37-44 kg) by redirecting hepatic outflow through the portal vein. Blood with cisplatin (2.5 mg/kg) in an extracorporeal circuit was circulated through the liver under isolation using rotary pumps with balloon catheters. Hepatic angiographic examinations were conducted during perfusion, and histopathological examinations of the organs were conducted after perfusion. The maximum platinum concentration (C max), area under the concentration-time curve (AUC), and chronologic laboratory data were measured. RESULTS: Retrograde-outflow isolated hepatic angiography confirmed that contrast media flowed into the portal veins in all 12 pigs. The hepatic veins and inferior vena cava were not opacified. Hepatic C max (86.3 mg/l) was 39-fold greater than systemic C max (2.2 mg/l), and hepatic AUC (1330.8 min · mg/l) was 30-fold greater than systemic AUC (44.6 min · mg/l). Histopathological examinations revealed no ischaemic changes or other abnormalities in the liver, duodenum, small intestine, or colon. Within 1 week of the procedure, chronologic laboratory data (n = 3) normalized or returned to pre-therapy levels. CONCLUSIONS: The retrograde-outflow technique appears to enable safe and feasible PIHP therapy. KEY POINTS: • The portal vein acted as an outflow tract under retrograde-outflow PIHP. • Plasma hepatic-to-systemic exposure ratio was 39.2 for the maximum platinum concentration. • Plasma hepatic-to-systemic exposure ratio was 29.8 for the AUC. • The retrograde-outflow technique appears to enable safe and feasible PIHP.

DOI： 10.1007/s00330-014-3558-2

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

Hepatocellular carcinoma (HCC) is the sixth most common cancer and third leading cause of cancer-related death in the world. The Barcelona clinic liver cancer classification is the current standard classification system for the clinical management of patients with HCC and suggests that patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization (TACE). Interventional treatments such as TACE, balloon-occluded TACE, drug-eluting bead embolization, radioembolization, and combined therapies including TACE and radiofrequency ablation, continue to evolve, resulting in improved patient prognosis. However, patients with advanced-stage HCC typically receive only chemotherapy with sorafenib, a multi-kinase inhibitor, or palliative and conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidates for systemic therapy. However, these patients require therapy that is more effective than sorafenib or conservative treatment. Several researchers try to perform more effective therapies, such as combined therapies (TACE with radiotherapy and sorafenib with TACE), modified TACE for HCC with arterioportal or arteriohepatic vein shunts, TACE based on hepatic hemodynamics, and isolated hepatic perfusion. This review summarizes the published data and data on important ongoing studies concerning interventional treatments for unresectable HCC and discusses the technical improvements in these interventions, particularly for advanced-stage HCC.

DOI： 10.3748/wjg.v20.i37.13453

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This study investigated the anatomical relationship between the common carotid artery and internal jugular vein during head rotation for the effective performance of percutaneous transjugular procedures. The subjects included 30 volunteers who had never undergone internal jugular vein cannulation. In the supine position, two-dimensional ultrasonographic images of the right internal jugular vein and common carotid artery were obtained, 2 and 4 cm above the clavicle, along the lateral border of the sternal head of the sternocleidomastoid muscle. Ultrasonographic images were examined for head rotation at 0°, 15°, 30°, 45°, 60°, and 75° from the midline to the left. The percentage of overlap of the common carotid artery by the internal jugular vein and the flattening of the internal jugular vein at each head rotation position were measured and evaluated. The overlap of the common carotid artery by the internal jugular vein significantly increased at ≥45° of head rotation 2 cm above the clavicle (P < 0.01) and at ≥30° of head rotation 4 cm above the clavicle (P < 0.01), compared with that observed in the neutral position. The flattening of the internal jugular vein significantly decreased at ≥45° of head rotation 2 cm above the clavicle (P < 0.01) and at ≥30° of head rotation 4 cm above the clavicle (P < 0.01). Head rotation should be kept to <45° at 2 cm above the clavicle and <30° at 4 cm above the clavicle to decrease the risk of accidental puncture of the common carotid artery during internal jugular vein puncture. Moreover, flattening of the internal jugular vein gradually decreases during head rotation to the side.

DOI： 10.1177/1742271X14524571

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

BACKGROUND: Renal arteriovenous malformations (AVMs) are rare vascular malformations that cause hematuria. Treatment for renal AVMs has evolved from open nephrectomy to transcatheter arterial embolization (TAE). PURPOSE: To retrospectively evaluate efficacy and adverse events of TAE for renal AVMs. MATERIAL AND METHODS: We examined 12 patients (three men, nine women; mean age, 56 years) with renal AVM with gross hematuria, who underwent 14 sessions of treatment, using various embolization materials (liquid embolization agents, gelatin sponge, and coils). Among the 12 patients, 10 had cirsoid AVMs, eight of which were high-flow lesions. The remaining two patients had aneurismal AVMs. We assessed technical and clinical success, and also complications. All patients were followed for 7-92 months (mean, 48 months). RESULTS: Technical success was obtained in all patients. Primary clinical success was obtained in all patients; however, recurrence was observed in two patients who were treated with coils alone. A second session of TAE led to the sustained relief of symptoms. Clinical success rate was significant better (P = 0.045) when coils combined with other agents or liquid agents were used, than when only coils were used. No major complications occurred in any of patients; post-embolization syndrome and deterioration of renal function were not observed. CONCLUSION: TAE treatment was safe, effective, and provided a good outcome, except when only coils were used as the embolization agent.

DOI： 10.1177/0284185113493085

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To date, no ideal endovascular strategy has been established for traumatic arterial occlusion. Here, we report the outcomes of a combination of endovascular recanalization techniques applied in two patients with high risk of leg amputation. A 33-year-old man with popliteal artery occlusion due to blunt trauma was treated by balloon angioplasty with long inflation time and aspiration thrombectomy. A 74-year-old woman with popliteal artery occlusion after total knee replacement was treated by aspiration thrombectomy and stent placement. In both cases, we achieved satisfactory recanalization, and peripheral ischemia was absent even 1 year later.

DOI： 10.1177/2047981613518772

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

The aim of this study was to evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) using warmed and nonwarmed miriplatin for hepatocellular carcinoma. Eighty patients (117 nodules), treated between January 2010 and June 2013, were evaluated. Thirty-two and 85 nodules were treated with nonwarmed and warmed miriplatin, respectively. The efficacy of TACE was evaluated on a per nodule basis according to treatment effect (TE). Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. TE grades were significantly improved in the warmed group compared to the nonwarmed group (nonwarmed: TE 4, 12.5%; TE 3, 0%; TE 2, 15.6%; TE 1, 71.9%; warmed: TE 4, 34.1%; TE 3, 5.9%; TE 2, 9.4%; TE 1, 50.6%; P = 0.017) . Multivariate analysis revealed significant impact of warming miriplatin on objective response rate (odds ratio, 12.35; 95% confidence interval, 2.90-90.0; P = 0.0028). CTCAE grades of elevated aspartate and alanine transaminase after TACE were significantly higher in the warmed group (P = 0.0083 and 0.0068, resp.); however, all adverse events were only transient. The use of warmed miriplatin in TACE significantly improved TE without causing serious complications.

DOI： 10.1155/2014/359296

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AIM: To retrospectively compare the short-term antitumor efficacy and safety of transcatheter arterial chemoembolization (TACE) with a cisplatin-iodized oil suspension (C-IS) and a miriplatin-iodized oil suspension (M-IS) for hepatocellular carcinoma (HCC). METHODS: Of patients who underwent TACE for unresectable HCC between January 2010 and August 2011, 25 and 21 patients received C-IS and M-IS, respectively. The short-term therapeutic efficacy of both groups was evaluated by the treatment effect seen on dynamic enhanced computed tomography or magnetic resonance imaging of tumor nodules 3 months after treatment. Adverse events were evaluated to compare C-IS and M-IS. RESULTS: After TACE using C-IS and M-IS, 100% necrosis or tumor size reduction was achieved in 30 and 18 tumor nodules, respectively (81% vs 53%; P = 0.006). Objective responses were achieved in 30 nodules exposed to TACE using C-IS and 17 exposed to TACE using M-IS (81% vs 50%; P = 0.011). Disease control was achieved in 36 nodules exposed to C-IS and 27 exposed to M-IS (97% vs 79%; P = 0.017). The percentage of patients attaining a complete response, an objective response and disease control was significantly greater in the C-IS group than in the M-IS group. No significant differences were found in the aspartate aminotransferase, alanine aminotransferase, total bilirubin and creatinine levels between the two groups either before treatment or 1 month after treatment. CONCLUSION: The short-term antitumor effects of TACE with C-IS may be superior to those with M-IS in terms of the complete response, objective response and disease control rates.

DOI： 10.1111/hepr.12212

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Our aim was to evaluate the long-term efficacy and safety of percutaneous transhepatic obliteration (PTO) alone and combined with balloon-occluded retrograde transvenous obliteration (BRTO) for gastroesophageal varices refractory to BRTO alone. Between July 1999 and December 2010, 13 patients with gastroesophageal varices refractory to BRTO were treated with PTO (n = 6) or a combination of PTO and BRTO (n = 7). We retrospectively investigated the rates of survival, recurrence, or worsening of the varices; hepatic function before and after the procedure; and complications. The procedure achieved complete obliteration or significant reduction of the varices in all 13 patients without major complications. During follow-up, the varices had recurred in 2 patients, of which one had hepatocellular carcinoma, and the other died suddenly from variceal rebleeding 7 years after PTO. The remaining 11 patients did not experience worsening of the varices and showed significant improvements in the serum ammonia levels and prothrombin time. The mean follow-up period was 90 months, and the cumulative survival rate at 1, 3, and 5 years was 92.9%, 85.7%, and 85.7%, respectively. Both PTO and combined PTO and BRTO seem as safe and effective procedures for the treatment of gastroesophageal varices refractory to BRTO alone.

DOI： 10.1155/2013/498535

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

Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer-related deaths in the world. The Barcelona Clinic Liver Cancer (BCLC) classification has recently emerged as the standard classification system for clinical management of patients with HCC. According to the BCLC staging system, curative therapies (resection, transplantation, and percutaneous ablation) can improve survival in HCC patients diagnosed at an early stage and offer potential long-term curative effects. Patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization (TACE), and those diagnosed at an advanced stage receive sorafenib, a multikinase inhibitor, or conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidates for systemic therapy. TACE is often recommended for advanced-stage HCC patients all over the world because these patients desire therapy that is more effective than systemic chemotherapy or conservative treatment. This paper aims to summarize both the published data and important ongoing studies for TACE and to discuss technical improvements in TACE for advanced-stage HCC.

DOI： 10.1155/2013/479805

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：Japanese   Publisher：(株)アクセス・ケイ  

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Language：Japanese   Publisher：(一社)関東連合産科婦人科学会  

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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：Japanese   Publisher：(公社)川崎市医師会  

60歳代男性。上腹部痛、吐血・血便を主訴に救急搬送となった。血液検査では貧血や腎機能の低下がみられ、また造影CT検査では複数の血管にString of beans appearanceが認められ、分節性動脈中膜融解と診断された。治療は内視鏡による機械的刺激で出血の増悪をきたす可能性を考慮し、保存的加療の方針とし、集中治療室にて血圧管理を行った。その結果、循環動態は安定し、貧血の進行もみられず、入院10日後の血管造影検査ではString of beans appearanceの軽快を認めたため、13日目に退院となった。

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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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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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J07252&link_issn=&doc_id=20210701190004&doc_link_id=10.11407%2Fivr.35.335&url=https%3A%2F%2Fdoi.org%2F10.11407%2Fivr.35.335&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

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：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：Japanese   Publisher：日本医科大学医学会  

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

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Language：Japanese   Publisher：(株)メディカルアイ  

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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：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：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：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：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：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：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：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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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：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：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：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：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：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   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：Japanese   Publisher：(株)メディカルアイ  

動脈損傷に対するゴアバイアバーンステントグラフトを用いた血管内治療は末梢臓器血流を維持したまま止血を行うことが可能な理想的な治療法である。2016年12月に血管損傷に対する適応が保険認可されて以来、急速に普及してきている。本稿では、本デバイスの特徴・適応などの基本事項および実際に使用する上での注意点や問題点について解説する。(著者抄録)

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

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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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  

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

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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：(株)メディカルアイ  

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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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：Japanese   Publisher：(株)メディカルアイ  

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

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

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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：大道学館出版部  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J01556&link_issn=&doc_id=20160706450012&doc_link_id=%2Fam3daidc%2F2016%2F009306%2F012%2F0831-0837%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fam3daidc%2F2016%2F009306%2F012%2F0831-0837%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：(一社)日本静脈学会  

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Language：Japanese   Publisher：(一社)日本静脈学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：(株)メジカルビュー社  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：金原出版(株)  

経カテーテル的動脈塞栓術(TAE)を行った62例(男性46例、女性16例、平均64.9歳)を対象に、術前造影CTが消化管出血に対する影響について検討した。TAEは上部消化管出血に48回、下部消化管出血に21回の計69回行い、全例で技術的成功が得られた。TAEでの止血は56例(臨床的成功率90.3%)で得られ、残る6例に追加TAEを行い、うち5例で止血が得られ、1例は止血困難で死亡した。院内死亡は10例(16.1%、出血死1、原病死5、敗血症・多臓器不全死3、コレステリン塞栓1)であった。術前造影CTを行った29例中20例(69.0%、上部消化管60.0%、下部消化管88.9%)で活動性出血を認め、残る5例では血管造影でも活動性出血は認めず、選択的造影で血管外漏出を認めた。血管造影での出血検出率は45例(65.2%)であった。塞栓までの平均時間は上部消化管33.1分、下部消化管45.2分であった。術前CTの有無は、活動性出血検出率および塞栓までの時間に有意な影響を与えなかった。

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Language：Japanese   Publisher：(有)科学評論社  

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Language：Japanese   Publisher：金原出版(株)  

当院で副腎静脈サンプリングを施行した145例を対象に、血管造影画像に基づく副腎静脈の吻合様式について検討した。その結果、副腎静脈において吻合血管が描出されたのは右側で128例(88.3%)、左側で136例(93.8%)であった。右副腎静脈との吻合血管の種類と頻度は、それぞれ腎被膜静脈80.7%、後腹膜静脈33.1%、下横隔静脈11.0%、肝静脈5.5%、門脈5.5%、腎盂尿管静脈1.4%であった。右下肝静脈と右副腎静脈の共通幹形成は4.1%で認められた。左副腎静脈との吻合血管は、腎被膜静脈56.6%、後胃静脈9.7%、後腹膜静脈7.6%、腎盂尿管静脈1.4%、腰静脈0.7%であった。左下横隔静脈との共通幹形成は89.7%と高頻度にみられた。

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

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Language：Japanese   Publisher：血管外科症例検討会  

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

内視鏡的止血困難例26例を対象に,出血性上部消化管潰瘍に対するN-butyl-2-cyanoacrylate(NBCA)を用いた動脈塞栓術後の循環動態変化と粘膜治癒過程に関する評価・検討を行った。塞栓術により全例で即時的な止血と有意な循環動態の改善が確認された。塞栓術前の潰瘍病変は全例Forrest I(Ia 20,Ib 6)であり,塞栓術後には明らかな虚血性粘膜障害は認められず,11±7.9日でForrest IIIまでの改善が確認された。NBCAは適正な使用下では潰瘍治癒過程において大きな妨げにはならないものと考えられ,安全かつ有用性の高い塞栓物質であると考えられた。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J02824&link_issn=&doc_id=20141219440008&doc_link_id=10.11231%2Fjaem.34.1289&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.34.1289&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Language：English   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：(一社)日本Acute Care Surgery学会  

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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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Other Link： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J02793&link_issn=&doc_id=20140916480001&doc_link_id=10.11407%2Fivr.29.243&url=https%3A%2F%2Fdoi.org%2F10.11407%2Fivr.29.243&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

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：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：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：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：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：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：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：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：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：Japanese   Publisher：(一社)日本肝臓学会  

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Language：Japanese   Publisher：(一社)日本静脈学会  

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Language：Japanese   Publisher：(一社)日本静脈学会  

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

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Language：Japanese   Publisher：(一社)日本静脈学会  

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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：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：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：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：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：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：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：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   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：(株)メジカルビュー社  

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

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：血管外科症例検討会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本静脈学会  

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：金原出版(株)  

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：(株)メジカルビュー社  

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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)日本脈管学会  

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