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 ImpactSystem-F has potential to change the strategies of pre-EVAR embolization.

DOI： 10.1177/15266028231179422

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

Acute portal vein thrombosis is characterized by nonspecific abdominal pain, causing severe morbidity and mortality. Prompt diagnosis is crucial to avoid short-term complications such as intestinal infarction, sepsis, and death. The therapeutic goal is to prevent thrombus extension into the mesenteric veins and intestinal ischemia complications. Systemic anticoagulation is the standard treatment. However, endovascular treatments such as thrombolysis, thrombectomy, balloon angioplasty, stent placement, and transjugular intrahepatic portosystemic shunt placement have been performed in patients who are refractory to anticoagulation therapy or at a high risk of intestinal ischemia. This review discusses the clinical and diagnostic considerations in acute portal vein thrombosis, focusing on current endovascular treatments that are effective and safe. However, prospective data are required to compare endovascular treatment techniques and assess their outcomes.

DOI： 10.22575/interventionalradiology.2023-0027

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Language：Japanese   Publisher：The Japanese Society of Interventional Radiology  

DOI： 10.11407/ivr.40.39

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

BACKGROUND: The association between the occlusion rate of the side branch arteries branching from the abdominal aortic aneurysm sac and aneurysm sac shrinkage is unclear. We aimed to evaluate the efficacy of preemptive embolization of multiple side branch arteries branching from the abdominal aortic aneurysm sac in early aneurysm sac shrinkage after endovascular aneurysm repair. METHODS: Patients undergoing endovascular aneurysm repair of abdominal aortic aneurysms, with or without preemptive embolization of multiple side branch arteries, including the inferior mesenteric artery and lumbar arteries, between January 2016 and August 2021, were retrospectively evaluated. Preemptive embolization was introduced at our institution in January 2018 and has been performed in all patients who undergo endovascular aneurysm repair since then. We compared occlusion rates of the side branch arteries, frequency of type 2 endoleaks, changes in aneurysm sac size, percentage of aneurysm sac size decrease, and frequency of reduction in the aneurysm sac diameter by > 5 mm. RESULTS: The study included 43 patients in the embolization group and 20 in the nonembolization group. Preemptive embolization was successfully performed without any ischemic complications. The total occlusion rate of side branch arteries was significantly higher in the embolization group than in the nonembolization group (70.2% vs. 29.3%, P < 0.05). At 24 months of follow-up, the type 2 endoleak frequency was significantly lower in the embolization group than in the nonembolization group (6.9% vs. 31.6%, P < 0.05). The frequency of reduction in the aneurysm sac diameter by > 5 mm was significantly higher in the embolization group than in the nonembolization group at 24 months (62.1% vs. 31.6% P < 0.05). The optimal cutoff value for the total occlusion rate of the side branch arteries to achieve reduction in the aneurysm sac diameter by > 5 mm at 24 months, after endovascular aneurysm repair, was 66.7% in all patients (area under the curve = 0.634; sensitivity = 62.5%; specificity = 70.8%). These findings suggest that occluding 66.7% or more of the side branch arteries may result in early aneurysmal shrinkage. CONCLUSIONS: Preemptive embolization of multiple side branch arteries, branching from the abdominal aortic aneurysm sac, may contribute to early aneurysm sac shrinkage; this may serve as a marker for fewer late complications after endovascular aneurysm repair.

DOI： 10.1016/j.avsg.2024.06.024

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PURPOSE: To compare the safety and effectiveness of n-butyl cyanoacrylate (nBCA)-ethiodized oil (NE) mixture and nBCA-ethiodized oil-ethanol (NEE) mixture embolization for Type II endoleak (T2EL) after endovascular aortic repair. MATERIALS AND METHODS: This study included 32 patients with 49 procedures who underwent T2EL embolization between January 2008 and June 2022. Cases with no follow-up after embolization, technical failure, treatment with coil only, Type I endoleak at the embolization, and re-embolization were excluded. The resultant final cohort included 24 patients (14 men and 10 women; mean age, 83.3 years [interquartile range, 77-89 years]) who underwent initial T2EL embolization, with 15 patients in the NE group and 9 patients in the NEE group. The 2 groups were compared in terms of adverse events (AEs), freedom from sac enlargement, and freedom from reintervention. RESULTS: The follow-up period after embolization for T2EL was 960 days (SD ± 1,007) in the NE group and 484 days (SD ± 192) in the NEE group, without significant differences. No AEs above moderate were observed in either group. The rate of freedom from sac enlargement at 1 year was 65.0% in the NE group and 87.5% in the NEE group (P = .03). The rate of freedom from reintervention at 1 year was 69.2% in the NE group and 100.0% in the NEE group (P = .02). CONCLUSIONS: The NEE group had significantly higher rates of freedom from sac enlargement and reintervention at 1 year compared with the NE group. These results suggest that T2EL embolization with NEE may be more effective than that with NE.

DOI： 10.1016/j.jvir.2024.07.023

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

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DOI： 10.1016/j.jvir.2024.03.031

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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   Publishing type：Research paper (scientific journal)  

PURPOSE: Completely occlusive acute-subacute portal and mesenteric vein thrombosis (PVMVT) with severe complications is fatal. Endovascular treatments (EVTs) of acute-subacute PVMVT are not standardized. Thrombectomy combined with continuous catheter-directed thrombolysis is considered an effective treatment. Here, we aimed to evaluate the outcome of EVTs of completely occlusive acute-subacute PVMVT with severe complications in patients without cirrhosis. MATERIALS AND METHODS: Nineteen patients (nine men and 10 women; age, 60.1 ± 16.8 years) with completely occlusive acute-subacute PVMVT were retrospectively assessed. Acute-subacute PVMVT was defined as symptom onset within 40 days, with no cavernous transformation observed on contrast-enhanced computed tomography. The patients were treated with EVTs, a combination of thrombectomy (including aspiration thrombectomy, plain old balloon angioplasty, single injection of thrombolytic agents, and stent placement) and continuous catheter-directed thrombolysis. Kaplan-Meier analyses were performed to assess all-cause mortality, acute-subacute PVMVT-related mortality, and portal vein (PV) patency. The degree of recanalization and patency of PV, complications, factors related to acute-subacute PVMVT-related mortality, and factors related to patency of PV were also evaluated. RESULTS: The all-cause and acute-subacute PVMVT-related mortality rates were 36.8% (7/19) and 31.6% (6/19), respectively. Seven (36.8%) and 11 (57.9%) patients achieved complete and partial recanalization, respectively. Among the 18 patients who achieved recanalization, follow-up images after 608.7 ± 889.5 days confirmed recanalization in 83.3% (15/18) patients, and 53.3% (8/15) of these patients achieved patency of PV. Seven patients (36.8%) developed complications, and two (10.5%) required interventional treatment for complications. Deterioration of liver function significantly worsened the prognosis (P = 0.046), while anticoagulation therapy significantly maintained portal patency (P = 0.03). CONCLUSION: This endovascular method for acute-subacute PVMVT, which combines thrombectomy and continuous catheter-directed thrombolysis EVT approach was effective for thrombus resolution. However, further studies must define conditions that improve patient prognosis.

DOI： 10.1007/s11604-022-01377-9

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Interventional Radiology  

DOI： 10.11407/ivr.38.137

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Other Link： https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-23K07073/

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Interventional Radiology  

NBCA (n-butyl-2-cyanoacrylate) is a cyanoacrylate-based liquid adhesive used for endovascular interventions and has a major role in managing vascular abnormalities, bleeding, and many vascular diseases. NBCA reacts with ionic solutions such as blood or normal saline, and starts polymerization immediately causing vascular embolization. NBCA is typically used in combination with lipiodol for intravascular embolization to provide radiopacity and achieve an appropriate polymerization time. The embolic effect is permanent and has a strong embolic effect that does not depend on coagulation parameters, but it requires proficiency in handling due to the risk of serious ischemic complications and adherence to the catheter if not used properly. This article introduces the basics of NBCA such as its characteristics, precautions / preparations for use, mixing ratio, tips for injection, indications, contraindications, and possible complications, for safe use of NBCA.

DOI： 10.11407/ivr.38.2

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Other Link： https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-23K07073/

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

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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：The Japanese Society of Interventional Radiology  

Stent grafts including Viabahn and VBX are available for lower limb arteries. Viabahn is a self-expandable stent graft that is applicable for superficial femoral artery occlusive disease, injured artery, and hemodialysis fistulas. Viabahn has a high flexibility and is suitable for even tortuous vessels. On the other hand, VBX is a balloon-expandable stent graft and used for aorto-iliac occlusive disease. VBX has stronger radial force and enables more accurate place-ment compared to Viabahn. Additionally, VBX can expand the stent beyond its nominal de-ployed diameter using a larger balloon. This article introduces Viabahn and VBX for lower limb arteries, and focuses on characteristics of the devices, basic procedures, technical tips, com-plications, and literature review.

DOI： 10.11407/ivr.35.335

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

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

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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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：Japanese Association for Acute Medicine of Kanto  

Nutmeg is used for the spice of the food in the world. However it has an aspect of the substance causing food intoxication especially in Europe and the United States. Whereas it is not well known as that in Japan where we can find out a few case report only. Therefore, we report the food intoxication patient who take a large amount of nutmeg. In this case, patient feel anxiety and thirsty as a symptom firstly. After that patient is to be agitate state. Thus, nutmeg intoxication is the cause of the acute psychomotor behavioral abnormalities.

DOI： 10.24697/jaamkanto.39.2_285

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Publisher：メジカルビュー社  

DOI： 10.18885/ci.0000000405

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