Purpose: Large-bore chest tube insertion is commonly performed using the trocar technique and blunt dissection; however, large-bore chest tube can cause severe visceral injury due to penetration, which is a life-threatening complication. Conversely, small-bore chest tubes can be safely inserted using the Seldinger technique; however, small-bore chest tubes are prone to blockage, especially in empyema cases. Therefore, this study aimed to demonstrate large-bore chest tube insertion using the Seldinger technique over two guidewires following image-guided puncture.

Material and Methods: We started performing large-bore chest tube insertion using the Seldinger technique over two guidewires following image-guided puncture in February 2022. Demographic data and procedural details, such as chest tube size, dilator size, procedure time, and type of image-guided puncture, of patients who underwent this procedure between February 2022 and March 2023 were retrospectively reviewed. Technical success was defined as the successful drainage of the pleural cavity.

Results: This method was used for performing ten procedures in nine patients who presented with empyema, pneumothorax, and pulmonary fistula. The insertion of a large-bore chest tube with a size ranging from 18- to 24-French was successfully performed in all cases without any complications. The median procedure time was 17.5 (first quartile-third quartile, 13.5-28.0) min.

Conclusions: Large-bore chest tube insertion using the Seldinger technique over two guidewires may be used as an alternative to conventional methods.

An 87-year-old woman was hospitalized for liver abscesses and cholangitis due to common bile duct stones. She developed worsening anemia and abdominal pain. Contrast-enhanced computed tomography revealed an intrahepatic pseudoaneurysm and an arteriovenous fistula between the hepatic arteries and inferior vena cava. The initial endovascular treatment was transarterial embolization. The pseudoaneurysm was embolized with an N-butyl-2-cyanoacrylate mixture, and the inflow arteries of the arteriovenous fistula were embolized with microcoils. However, the residual perfusion of the arteriovenous fistula remained. A second endovascular treatment was performed using the transarterial and transvenous approaches. The inflow arteries were embolized using microcoils and gelatin sponges and the dominant outflow vein was embolized using microcoils, resulting in the disappearance of the perfusion in the arteriovenous fistula.

Nonocclusive mesenteric ischemia (NOMI) is a condition characterized by segmental or discontinuous mesenteric ischemia and intestinal necrosis without an organic obstruction in the mesenteric vessels. Diagnosis is challenging, and early intervention is crucial for improving patient outcomes. Various factors such as background factors, symptoms, biomarkers, and imaging techniques contribute to the diagnosis. Ensuring an early diagnosis and prompt treatment is of paramount importance. Although studies reported on the effectiveness of intra-arterial vasodilator infusion therapy as an endovascular treatment, its future role remains uncertain. Therefore, this review primarily aimed to provide a comprehensive summary of the advancements in the current state of NOMI management, with a specific emphasis on the implementation of endovascular therapy.

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.

Pelvic fractures are severe trauma that can cause hemorrhagic shock. The mortality rate is high when patients fall into shock. Therefore, prompt diagnosis and treatment are necessary. Hemostasis for hemorrhage associated with pelvic fractures is achieved through the mechanical stabilization of the fracture site, preperitoneal pelvic packing, and transcatheter arterial embolization. These techniques are frequently employed in hemodynamically unstable patients presenting with pelvic fractures. Among them, transcatheter arterial embolization is often considered the first-line choice: it is a particularly effective hemostatic method for arterial hemorrhage caused by pelvic fracture. An embolization technique and embolic agents should be considered comprehensively while considering the patient's hemodynamics, angiographic findings, and the urgency of the situation. This article describes the indications, techniques, results, and complications of transcatheter arterial embolization for pelvic fractures.

Transarterial chemoembolization is still an effective treatment option for hepatocellular carcinoma worldwide and is categorized into conventional transarterial chemoembolization with ethiodized oil transarterial chemoembolization and transarterial chemoembolization with drug-eluting spherical material transarterial chemoembolization. Several randomized controlled trials conducted in Europe have shown the equivalent efficacy of ethiodized oil transarterial chemoembolization and drug-eluting spherical material transarterial chemoembolization. However, a recent randomized controlled trials in Japan established the superiority of ethiodized oil transarterial chemoembolization in terms of complete response rates although higher liver toxicity for ethiodized oil transarterial chemoembolization. Nevertheless, the survival advantage of ethiodized oil transarterial chemoembolization is yet to be substantiated. The adverse effects of drug-eluting spherical material transarterial chemoembolization are milder than those of ethiodized oil transarterial chemoembolization, rendering drug-eluting spherical material transarterial chemoembolization an advantageous option for patients with bilobar tumors and impaired liver function/performance status. This article aims to provide an overview of these embolization techniques and a review of recent literature.

Magnetic resonance imaging (MRI) is one of the guiding modalities used for percutaneous needle insertion during interventional procedures. MRI guidance has several advantages, including multiplanar imaging capability, superior soft tissue contrast resolution, and the absence of ionizing radiation. When performing MRI-guided procedures, it is important to understand the suitable MRI systems, instruments, and imaging sequences for intervention. Furthermore, needle artifact characteristics must be fully understood to ensure safe and accurate needle insertion. In this article, we present the fundamental knowledge as regards the use of MRI guidance for percutaneous needle insertion and review its usefulness in representative interventional procedures, such as biopsy and tumor ablation.

Splenic injury is one of the most common abdominal parenchymal organ injuries.

Since the spleen is a parenchymal organ with abundant blood flow, its injury can easily result in hemorrhagic shock. Therefore, prompt and appropriate management for hemostasis is critical. Management of splenic injury is determined by the hemodynamic status and the grade of injury. Splenectomy is the primary choice in cases with unstable hemodynamics, but splenic repair or non-operative management, including conservative treatment or transcatheter arterial embolization (TAE), may be chosen to preserve the spleen if time permits. Non-operative management has advantages over operative management in terms of complications and medical economics. TAE also plays a significant role in non-operative management by contributing to the improvement of patient outcomes.

Barcelona Clinic Liver Cancer staging system, which has been identified as the most commonly used staging system in patients with hepatocellular carcinoma, was initially published in 1999, and it was updated in 2022. This new Barcelona Clinic Liver Cancer staging shows more flexible strategies for the treatment of hepatocellular carcinoma based on each stage. Although the roles of trans-arterial chemoembolization were limited in intermediate stage (Barcelona Clinic Liver Cancer-B) patients in the previous version, its roles have been expanded in the new version of Barcelona Clinic Liver Cancer staging system. In this manuscript, we introduce how trans-arterial chemoembolization is incorporated in a new Barcelona Clinic Liver Cancer staging system and explore the new role of trans-arterial chemoembolization and what interventional radiologists seek for in a near future.

One of the major reasons for unresectability of the liver is that the remnant liver volume is insufficient to support postoperative liver function. Post-hepatectomy liver insufficiency is one of the most serious complications in patients undergoing major hepatic resection. Preoperative portal vein embolization is performed with the aim of inducing hypertrophy of the future liver remnant and is thought to reduce the risk of liver insufficiency after hepatectomy. We, interventional radiologists, are required to safely complete the procedure to promote future liver remnant hypertrophy as possible and understand portal vein anatomy variations and hemodynamics, embolization techniques, and how to deal with possible complications. The basic information interventional radiologists need to know about preoperative portal vein embolization is discussed in this review.

Superselective intra-arterial chemoradiotherapy for head and neck cancer is a combination of intensive local delivery of anticancer drugs using microcatheters and external beam radiation. Unlike conventional chemoradiotherapy, it is highly effective in treating the primary tumor, but it cannot treat distant metastases. In the field of head and neck cancer, where quality of life is significantly impaired by curative surgery from a functional and cosmetic point of view, it is a useful treatment not only for unresectable cases but also for resectable advanced cancers, with the maxillary sinus being a particularly good indication. This treatment is expected to outperform conventional systemic chemotherapy and even comes close to the outcomes of radical surgery if the patient is carefully selected and the appropriate technique is used. Currently, a multicenter phase III clinical trial to evaluate the efficacy of this treatment for maxillary sinus cancer has been completed, and the results are being analyzed.

It is more than 50 years since the concept of transjugular intrahepatic portosystemic shunt (TIPS) was first introduced as a percutaneous procedure for patients with refractory variceal bleeding and ascites. TIPS has become widely accepted in the management of complications of portal hypertension because it is less invasive than surgery. In the early days of TIPS, complications included the poor long-term patency of the stent and a high incidence of hepatic encephalopathy. In addition, an excessive shunt diameter after TIPS often resulted in severe hepatic encephalopathy. Although recent covered stents have significantly reduced shunt dysfunction, the development of hepatic encephalopathy and early liver failure remain to be crucial post-TIPS complications. This study reviews the current literature on the status of TIPS in the treatment of cirrhosis.

In 2008, carotid artery stenting was formally approved in Japan. Since then, more than fourteen years have already passed. Much evidence concerning carotid artery stenting has already been published, and several new devices are available. Thus, indications and procedures for carotid artery stenting have changed. In this review, I describe the current status of carotid artery stenting by literature review with particular focus on the evidence regarding its effectiveness and safety, history with the transition of devices in Japan, and complications related to carotid artery stenting procedures. A recent topic (a new category of subtype of carotid stenosis) is also mentioned briefly.