Purpose: To evaluate the safety and midterm results of radiofrequency (RF) ablation for the treatment of renal cell carcinoma (RCC) in patients with von Hippel-Lindau (VHL) disease. Materials and methods: This study included 13 patients with VHL (8 women and 5 men; mean age: 35.5 years) and RCC. Each patient presented with 1-6 RCCs (mean: 2.4 ± 1.7) without extrarenal metastasis. The mean tumor diameter was 18.0 ± 5.0 mm. Transcatheter arterial embolization was performed for 5 (16.7%) of 31 tumors. All RF ablation procedures involved the percutaneous use of internally cooled RF electrodes under computed tomography fluoroscopic guidance. Adverse events were evaluated using the Common Terminology Criteria for Adverse Events, version 4.0, and pre- and post-treatment estimated glomerular filtration rates (eGFRs) were compared using paired t-tests. Local tumor progression, distant metastasis, and survival were also evaluated. Results: Twenty-three RF ablation sessions were technically successful. A grade 3 adverse event (hydronephrosis due to blood clotting, thus requiring ureteral stent placement) occurred in 1 (4%) of 23 sessions. The mean eGFR measured at ≥ 1 month after ablation was significantly lower than the mean eGFR before ablation (70.2 ± 21.9 versus 78.8 ± 23.0, p < 0.001). Local tumor progression was seen in 1 (3%) of 31 tumors. No patients died, required dialysis, or developed extra-renal metastases during a median 40-month follow-up. Conclusions: RF ablation for RCC is a safe, highly effective, and promising treatment option for patients with VHL disease.

Purpose

Transcatheter angiography is the gold standard for evaluating the condition and anatomy of the dural sinuses in patients with arteriovenous fistulas (AVFs); however, the patency and intraluminal condition of the dural sinuses can also be evaluated on magnetic resonance imaging (MRI). The purpose of this study was to evaluate the usefulness of MRI for the diagnosis of sinus occlusion.

Materials and Methods

Thirty-one patients (19 males, 12 females; age range, 52-81 years) were diagnosed with dural arteriovenous fistulas (DAVFs) and surrounding dural sinus occlusion on transcatheter angiography. Twenty-three patients with transverse-sigmoid DAVFs showed ipsilateral transverse and/or sigmoid sinus occlusion, and eight patients with cavernous sinus DAVFs showed ipsilateral inferior petrosal sinus occlusion. The MR images were retrospectively evaluated, focusing on the signal intensity and contrast enhancement of the occluded sinuses. The accessibility of transvenous embolization through the occluded sinuses was also assessed.

Results

The occluded sinuses showed isointensity in 24 patients and hypointensity in six on T1-weighted imaging (T1WI); furthermore, they showed isointensity in seven patients, hyperintensity in 17, and heterogeneous hypo- and hyperintensity in seven on T2-weighted imaging (T2WI). All occluded sinuses showed marked enhancement in the 14 patients in whom contrast-enhanced three-dimensional (3D) -T1WI was performed. Transvenous embolization was performed in 27 patients. An approach through the occluded sinuses was successful in 18 of these 20 patients.

Conclusion

The occluded sinuses showed various signal intensities on T1WI and T2WI, while all of the occluded sinuses showed homogeneous enhancement on contrast-enhanced T1WI.

A patient who had previously undergone endovascular abdominal aortic repair (EVAR) of an abdominal aortic aneurysm was found to have aneurysmal growth 5 years after the initial EVAR and endovascular reintervention was considered. However, the patient was deemed unsuitable for an ordinary bifurcated stent graft. Re-EVAR was successfully conducted with a back table modification of the Endurant bifurcated stent graft to an aorto-uni-iliac (AUI) stent graft in a setting where a manufactured AUI stent graft was not available; this procedure was followed by a crossover femoro-femoral bypass. The patient's one-year follow-up exam revealed a marked regression of the aneurysm without any related complications. This modified technique may extend the limits of abdominal endovascular treatment for patients who are not suitable for a bifurcated stent graft and may be applicable in situations where adequate AUI devices are not available.

Rectal varices most commonly develop in patients with portal hypertension due to liver cirrhosis. Although rectal varices rarely cause bleeding, their rupture can lead to life-threatening massive hemorrhages. Balloon-occluded retrograde obliteration (BRTO) is feasible in cases of varices involving a single or a few drainage vessels. Although rectal varices usually have numerous drainage vessels, the present case involved a single drainage vessel. The unusual presentation of the current case was considered to have been caused by a previous surgery for sigmoid colon carcinoma. BRTO was successfully performed through the left internal iliac vein, achieving complete hemostasis of the rectal varices.

This is a report on the case of a rare complication of an iliac occlusion that occurred after endovascular aortic aneurysm repair (EVAR) with a Zenith inverted limb. This case involved the treatment of a common iliac artery aneurysm. Owing to the short distance from the patient' s lowest renal artery to the aortic bifurcation, we planned the EVAR using a Zenith Inverted limb, which has a contralateral limb inverted into the main body. The EVAR was successfully performed. However, an occlusion occurred in the ipsilateral leg because of the fully opened contralateral leg that hampered the blood flow into the ipsilateral side. Therefore, we extended the ipsilateral leg proximally to the same level as the contralateral leg. To the best of our knowledge, no other cases involving occlusion of the Zenith inverted limb have been reported. Based on our experience, we recommend that attention should be focused on the position of the ipsilateral leg to prevent limb occlusion when deploying a Zenith inverted limb.

Automated tumor-feeder detection (AFD) software using cone-beam computed tomography technology is a new tool for three-dimensional vessel tracking. This software is now being used in transarterial targeted therapies, mainly in transarterial chemoembolization for hepatocellular carcinoma, as well as in transarterial embolization and superselective infusion chemotherapy. The detectability rate of the tumor feeder or access route to the target lesions with the AFD software are high in both intrahepatic and extrahepatic lesions. Therefore, the AFD software can reduce the procedural time and radiation exposure, as well as the workload during transarterial targeted therapies.