PURPOSE: To evaluate the usefulness and safety of the "dual-needle pumping technique" for central venous access port (CV port) obstruction due to thrombus or fibrin sheath formation.
PATIENTS AND METHODS: For 25 patients who had a CV port obstruction due to thrombus or fibrin sheath formation between 2001 and 2016, we performed the "dual-needle pumping technique." The operator inserted two coreless needles in the port and alternately pumped the plungers of two syringes filled with distilled water or urokinase (UK) solution.
RESULTS: Overall, we achieved recanalization in 22 patients (88%). In 6 patients, success in recanalization was achieved by using distilled water only, while in 2 patients, failure occurred by using distilled water only before changing to the UK solution to achieve recanalization. Success in recanalization was attained in 14 patients by using the UK solution from the beginning. In 3 patients, the CV port system was withdrawn because the obstruction could not be removed. No complications occurred in relation to this procedure.
CONCLUSION: For removing an obstruction in the CV port system, the "dual-needle pumping technique" is a reasonable option to avoid system replacement. Thus, this procedure is considered useful and safe.
Purpose: This study aimed to retrospectively compare the local control and safety of microballoon-occluded transarterial chemoembolization (B-TACE) using miriplatin (MPT) and of conventional TACE (C-TACE) using epirubicin (EPIR) for hepatocellular carcinoma (HCC).
Materials and Methods: Thirty-nine patients (24 men, 15 women; mean age, 73.4 years) were treated using B-TACE with MPT (MPT-B-TACE group). As a historical comparison, 23 patients (13 men, 10 women; mean age, 72.2 years) who were treated using C-TACE with EPIR (EPIR-C-TACE group) were investigated. The therapeutic effect within 2 weeks after treatment was compared between the groups based on the Response Evaluation Criteria in Cancer of the Liver (RECICL), and time to local recurrence was compared based on the Kaplan-Meier method and log-rank tests. The side effects were compared based on the Common Terminology Criteria for Adverse Events (ver. 4.0).
Results: No significant differences were noted in patients' characteristics between the groups. The overall incidence of postembolization syndrome was significantly lower in the MPT-B-TACE group than in the EPIR-C-TACE group (p<0.05), but two cases in the MPT-B-TACE group developed grade 2 cholecystitis. Based on the RECICL, the objective response rate, including TE4 and TE3, within 2 weeks after treatment was significantly higher in the MPT-B-TACE group (89.7%) than in the EPIR-C-TACE group (78.3%). Overall, local recurrence was significantly less frequent in the MPT-B-TACE group than in the EPIR-C-TACE group (p=0.02).
Conclusion: MPT-B-TACE was associated with a higher objective response rate and lower local recurrence rate than EPIR-C-TACE without a significant increase in adverse effects.
Purpose: To retrospectively determine the effectiveness of percutaneous vertebroplasty (PVP) for patients with ambulation difficulties due to acute osteoporotic vertebral fractures.
Materials and Methods: We enrolled 62 patients who met the following criteria: almost normal ambulation before osteoporotic vertebral fracture, ambulation difficulties after onset, and a first-time PVP performed within 4 weeks. The patients were divided into Earlier (n = 46) or Later groups (n = 16) in which patients underwent PVP within 2 weeks or later, respectively. Mobility scores 7 days post-PVP in the Earlier group were compared with those 1 day before PVP in the Later group, that is, the conservatively waiting state. Earlier group values were also compared with those at 7 days post-PVP in the Later group to estimate the effectiveness of later PVP.
Results: Mobility scores at 7 days post-PVP in Earlier group were significantly better than those 1 day before PVP in the Later group, suggesting that PVP provided mobility improvements sooner than the conservatively waiting state. Meanwhile, the lack of a difference in mobility scores at 7 days post-PVP between the Earlier and Later groups indicated that later PVP provided improvement comparable to earlier PVP.
Conclusion: Earlier PVP contributes to earlier recovery from ambulation difficulties due to acute osteoporotic vertebral fractures than later PVP, while earlier and later PVP show equivalent efficacy in restoration of ambulation.
Purpose: To evaluate the feasibility of drug-eluting bead (DEB)-transarterial chemoembolization (TACE) with 75 mg epirubicin for hepatocellular carcinoma (HCC) in Japanese patients with unresectable HCC prior to conducting a planned randomized controlled trial.
Materials and Methods: This study was conducted as a prospective multi-center feasibility study. Eligible patients had unresectable Barcelona Clinic Liver Cancer stage A or B HCC that was unsuitable for curative treatments, and all patients received TACE with 75 mg epirubicin-loaded DEB. Tumor response, as the primary endpoint, was assessed after 4 weeks by computed tomography or magnetic resonance imaging, based on the modified Response Evaluation Criteria in Solid Tumors. Adverse events after treatment were evaluated as the secondary endpoint, based on the Common Terminology Criteria for Adverse Events version 4.0.
Results: Between May and August 2014, 8 patients from two institutions were enrolled in this clinical study. There were no instances of complete response observed, partial response was obtained in 4 patients, and the overall response rate was 50%. No patients experienced grade 4 or higher adverse events. Grade 3 thrombocytopenia occurred in 1 patient. One patient experienced a grade 3 increase in aspartate aminotransferase, alanine aminotransferase, and bilirubin levels. All adverse events were well managed with conservative medical care. There were no procedure-related deaths.
Conclusions: DEB-TACE with 75 mg epirubicin was found to be feasible in Japanese patients, and it was deemed appropriate to proceed to a randomized controlled trial comparing DEB-TACE and conventional TACE.
In this case of a Japanese woman with Budd-Chiari syndrome, percutaneous venoplasty of a single narrow accessory hepatic vein successfully restored normal hepatic circulation. The three major hepatic veins were occluded, whereas the inferior vena cava was patent. In this setting, percutaneous venoplasty of the single remaining hepatic vena caval branch was considered clinically effective.
A 46-year-old woman underwent emergent endovascular aneurysm repair for impending rupture of an abdominal aortic aneurysm. Contrast enhanced computed tomography (CT) 10 months after the procedure revealed a type 2 endoleak and enlargement of the aneurysm. Since the transarterial approach to the sac was technically difficult, direct translumbar embolization was performed. An elaster needle was inserted directly into the sac via a translumbar approach. Angiography revealed five arteries communicating with the endoleak sac. The inferior mesenteric artery and bilateral third lumbar arteries were selectively catheterized and embolized with coils. The sac and fourth lumbar arteries were embolized using an n-butyl-2-cyanoacrylate-lipiodol mixture. All of the communicating arteries and the sac were successfully embolized without severe complications. Follow-up CT images showed a reduction in the size of the aneurysm.
An incidental vascular abnormality was identified in a female patient in her 70s with a history of malignant lymphoma. Contrast-enhanced computed tomography (CT) scans revealed a pulmonary artery aneurysm (PAA) originating at the A10 branch of the right pulmonary artery (10 × 9 × 9 mm in size), which involved three distal branches at the aneurysmal sac. Retrospectively, this PAA was identified on CT images two years prior, and has been growing since. Endovascular embolization was performed with microcoils that were placed in the aneurysmal sac and the distal and proximal sites of the parent artery, achieving complete resolution of the PAA without complications. Coil embolization can be one of the treatment options in management of the unruptured PAA, although further investigations are necessary.
We report two patients with colon cancer suffering from stomal variceal bleeding who were treated by two different interventional approaches. In case 1, a retrograde approach was applied to perform sclerotherapy of stomal varices, due to liver metastases. After access to the superficial epigastric vein as one of the efferent veins by the percutaneous approach, stomal varices were embolized using a sclerosant under compression of the efferent veins by hand, rolled gauze packs, and balloon occlusion. In case 2, two vascular plugs were placed in the two afferent veins by the antegrade transhepatic approach. Case 1 suffered from massive ascites after the procedure. No recurrent stomal variceal bleeding occurred until the patients' death in both cases. Blood flow reduction to the stoma may be sufficient for patients with a short prognosis.
A 61-year-old woman with renal cancer underwent percutaneous cryoablation (PCA) for a metastatic hepatic tumor. Because the tumor was subcapsular and 3.6 cm in diameter, we performed transcatheter arterial embolization before PCA. Three cryoprobes were placed in triangular configuration; one inserted with an interposition of the normal hepatic parenchyma at a short distance. Computed tomography (CT) 2 days after PCA showed no contrast enhancement in the ablation zone with adequate ablation margins. CT after 2 months showed small enhancing foci on the hepatic surface. Tumors were located along previously inserted needle track, confirming diagnosis of needle tract seeding. A laparoscopically extirpated specimen revealed clear cell carcinoma, comparable to metastasis from renal cancer. CT after 6 months found additional seeding tumors, and systemic therapy was administered.
A 60-year-old woman underwent radiofrequency (RF) ablation to relieve uncontrollable pain from a recurrent sacrococcygeal chordoma, which had been treated 6 years prior using proton therapy. Although the pain had disappeared completely after the first RF ablation, it recurred 4 months after ablation. Moreover, a residual tumor was observed. A second RF ablation was performed 9 months after the first RF ablation for the residual tumor, again alleviating all pain. Patient symptoms were well controlled 7 months after the second RF ablation.
Delayed rupture after endovascular aortic aneurysm repair (EVAR) secondary to an isolated type II endoleak is rare. A woman in her 90s developed an abdominal aortic aneurysm rupture 20 months following EVAR. A type II endoleak was revealed via digital subtraction angiography. The trans-stent graft approach using a Brockenbrough needle was immediately performed, and the endoleak cavity was occluded with n-butyl-2-cyanoacrylate. Trans-stent graft embolization can be adopted promptly following angiography without changing the body position or access site, even in cases of delayed rupture due to isolated type II endoleak.
Pulmonary arteriovenous malformations (PAVMs) cause significant clinical complications, such as transient ischemic attack, stroke, and brain abscess. Nowadays, transcatheter embolization plays an important role in the treatment of PAVM. However, persistence can occur after transcatheter embolization for PAVM. Here, we review the current embolization technique, embolic material, and subsequent management.