Purpose: To determine the optimal virtual-target definition for detecting renal cell carcinoma feeders using transarterial computed tomography angiography with automated feeder-detection software.

Material and Methods: This retrospective study included 17 patients with 17 renal cell carcinomas who underwent transarterial ethiodized-oil marking before cryoablation. Tumor feeders were automatically detected on transarterial renal computed tomography angiography images using the automated feeder-detection software with three virtual-target definitions: small (ellipsoidal area maximized within the tumor contour), medium (ellipsoidal area covering the entire tumor with a minimal peripheral margin), and large (ellipsoidal area including the tumor and a 5-mm peripheral margin). The detected feeders were classified as true or false positives according to the findings of selective renal arteriography, by consensus of two interventional radiologists. Feeder-detection sensitivity and the mean number of false-positive feeders per tumor were calculated for each virtual-target definition.

Results: For 17 tumors, 25 feeding arteries were identified on the arteriography. The feeder-detection sensitivity of the software was 80.0% (20/25), 88.0% (22/25), and 48.0% (12/25) for small, medium, and large virtual targets, respectively. The mean ± standard deviation number of false-positive feeders per tumor was 0.82 ± 1.3, 1.41 ± 1.1, and 2.82 ± 1.6 when using small, medium, and large virtual-target definitions, respectively.

Conclusions: The detection rate of renal cell carcinoma feeders with the automated feeder-detection software varies according to the virtual-target definition. Using a medium virtual target, covering the entire tumor with a minimal peripheral margin, may provide the highest sensitivity and an acceptable number of false-positive feeders.

We report a case of a large pheochromocytoma in a middle-aged woman with a good past health record. She presented with pheochromocytoma crisis, complaining of acute shortness of breath, and quickly deteriorated into refractory cardiogenic shock with multiorgan failure. Multi-axial CT showed a large mass in the left suprarenal region. Elevated serum catecholamines confirmed the diagnosis of pheochromocytoma. Left distal transradial adrenal artery embolization under local anesthesia was performed because of limited femoral access and very high perioperative risk. The aim was to devascularize the tumor and reduce catecholamine secretion. Her labile blood pressure improved after embolization. She gradually recovered and underwent adrenalectomy three weeks later.

Purpose: To investigate the optimal order of mixing N-butyl-2-cyanoacrylate-Lipiodol-iodine contrast materials (N-butyl cyanoacrylate-Lipiodol-iodinated contrast material).

Materials and Methods: Lipiodol was used as an oil-based contrast material. Three types of water-soluble iodinated contrast materials were used: iopamidol, iohexol, and iomeprol. The materials were mixed in three different orders: N-butyl cyanoacrylate-Lipiodol-iodinated contrast material, in which N-butyl-2-cyanoacrylate was first mixed with Lipiodol and then with iodinated contrast materials; N-butyl cyanoacrylate mixed first with an iodinated contrast material and then with Lipiodol, in which N-butyl-2-cyanoacrylate was first mixed with iodinated contrast material and then with Lipiodol; and Lipiodol mixed first with an iodinated contrast material and then with N-butyl cyanoacrylate, in which Lipiodol was first mixed with iodinated contrast materials and then with N-butyl-2-cyanoacrylate. N-butyl cyanoacrylate-Lipiodol-iodinated contrast material was prepared at two ratios: 2:3:1 (N-butyl cyanoacrylate-Lipiodol-iodinated contrast material 231) and 1:4:1 (N-butyl cyanoacrylate-Lipiodol-iodinated contrast material 141). The particle sizes and injection pressures of the mixtures were measured, and their adhesiveness was evaluated.

Results:N-butyl cyanoacrylate mixed first with Lipiodol and then with an iodinated contrast material and Lipiodol mixed first with an iodinated contrast material and then with NBCA could be prepared, but N-butyl cyanoacrylate mixed first with Lipiodol and then with an iodinated contrast material could not because of immediate polymerization between N-butyl-2-cyanoacrylate and iodinated contrast material. N-butyl cyanoacrylate mixed first with Lipiodol and then with an iodinated contrast material mixtures had large, irregular particles (33.1-126.5 μm) with non-uniform distribution. Lipiodol mixed first with an iodinated contrast material and then with N-butyl cyanoacrylate mixtures yielded significantly smaller, uniformly distributed particles (1.6-3.3 μm) irrespective of contrast material type. Both Lipiodol mixed first with an iodinated contrast material and then with NBCA and NBCA mixed first with Lipiodol and then with an iodinated contrast material mixtures showed no catheter adhesiveness.

Conclusions: Lipiodol mixed first with an iodinated contrast material and then with NBCA is an appropriate mixing order because of its uniform particle sizes irrespective of contrast materials, and low adhesiveness compared with other mixtures.

Purpose: This retrospective study investigated the factors influencing the difficulty and complications of peripherally inserted central catheter insertion.

Material and Methods: The study evaluated 189 cases of peripherally inserted central catheter insertion (139 patients) performed in our angiography unit from October 2023 to March 2024. Each vein was punctured under ultrasound guidance, and a guidewire and catheter were advanced under fluoroscopic guidance. The patients were classified into two groups based on the procedural time (≤10 minutes [short group] and >10 minutes [long group]), number of punctures, occurrence of procedure-related complications, and performance of venography, and patient characteristics and procedural details were compared in these groups.

Results: The long group featured a significantly higher proportion of female patients, deeper vessel depth, smaller vessel diameter, and higher proportion of junior residents among the operators than in the short group. The multiple-puncture group had a significantly younger age, higher proportion of female patients, and deeper vessel depth than the single-puncture group. The complication group had a younger age, lower platelet count, and deeper vessels than the non-complication group. The venography group exhibited a significantly smaller vessel diameter than the non-venography group.

Conclusions: For peripherally inserted central catheter insertion, younger age, female sex, deeper and smaller vessels, and less operator experience were associated with procedural difficulty. Younger age, low platelet counts, and deeper vessels were associated with procedural complications. A smaller vessel diameter was associated with the need for venography. These factors should be considered when selecting the operator, insertion site, method, and operation site to ensure a reliable procedure.

Purpose: To evaluate the feasibility of aorto-uni-iliac endovascular aortic repair using the Gore Excluder in selected patients.

Material and Methods: This retrospective study reviewed five cases of aorto-uni-iliac endovascular aortic repair for abdominal aortic aneurysm using the Gore Excluder between January 2014 and January 2024. Patient demographics, procedural details, and postoperative outcomes were evaluated. Study endpoints included technical success, overall survival, aneurysm sac changes, endoleak occurrence, secondary interventions, and aneurysm-related death to evaluate feasibility and mid-term durability. Technical success was defined as successful stent graft deployment without conversion to open repair.

Results: The cohort included one elective case in which a dedicated aorto-uni-iliac device was deemed unsuitable, three cases converted intraoperatively from bifurcated to aorto-uni-iliac configuration, and one case in which the dedicated device was unavailable. The aorto-uni-iliac configuration was achieved through off-label use of aortic extenders or an upside-down contralateral leg. All cases were technically successful. Three cases were emergency procedures. All cases required femoro-femoral crossover bypass. Slight type III endoleaks were detected in two cases on completion aortography but had resolved on postoperative computed tomography on days 11 and 16, respectively. No type III endoleaks were observed in any case during follow-up. No aneurysm-related deaths occurred. Over a median follow-up of 35 months (range: 1-62; excluding one same-day death), no sac enlargement was observed, suggesting acceptable durability. Median overall survival was 1,100 days (range: 0-1,966).

Conclusions: Aorto-uni-iliac endovascular aortic repair using the Gore Excluder for abdominal aortic aneurysm is feasible when dedicated aorto-uni-iliac devices are unavailable or unsuitable, particularly in emergencies.

Purpose: Transarterial chemoembolization for hepatocellular carcinoma can be combined with radiofrequency ablation to improve local control. Radiofrequency ablation is usually performed under ultrasound guidance. Computed tomography can detect lesions in the whole liver, but when performing liver puncture under conventional computed tomography guidance, peripheral intrahepatic vessels cannot be visualized, risking vascular injury. The efficacy and safety of radiofrequency ablation under computed tomography guidance combined with transarterial chemoembolization were evaluated.

Material and Methods: A total of 186 procedures performed in 142 patients with hepatocellular carcinoma between September 2016 and December 2021, in which radiofrequency ablation was performed under computed tomography guidance combined with transarterial chemoembolization were evaluated. Patient background, survival, local recurrence, adverse events, and post-procedural bleeding were evaluated.

Results: Overall, 28 women and 114 men (median age, 74 years; age range, 49-90 years) were evaluated. The etiology of hepatocellular carcinoma was hepatitis B, hepatitis C, hepatitis B+C, and hepatitis non-B non-C in 49, 27, 28, and 38 patients, respectively. The Child-Pugh score was 5/6/≥7 in 137/41/8, and modified albumin-bilirubin was 1/2a/2b/3 in 97/45/42/2, respectively. The 1-, 2-, and 3-year overall survival rates were 96.1%, 87.4%, and 74.0%, respectively. Local recurrence developed after 33/186 procedures, and the 1-, 2-, and 3-year local recurrence-free survival rates (per procedure) were 86.4%, 76.6%, and 57.5%, respectively. Post-procedural bleeding occurred in 17/186 procedures; 13 required embolization, and 4 stopped bleeding spontaneously.

Conclusions: Computed tomography-guided radiofrequency ablation with simultaneous transarterial chemoembolization is a useful treatment for early-stage hepatocellular carcinomas that cannot be detected on ultrasound.

Lymphatic ascites developed in a woman in her fifties after she underwent total hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection for endometrial carcinoma. Approximately 500-1,000 mL of opalescent fluid was drained daily. Initially, dietary fat restrictions failed to reduce ascites. Two lipiodol lymphangiographies identified leaks from the iliac lymphatic vessels but were only partially successful at occluding these leaks. Octreotide injection and clamping of the drainage tube were attempted without success. On postoperative day 68, a mixture of lipiodol and n-butyl-2-cyanoacrylate was injected to embolize the leakage point, significantly reducing symptoms. The patient was discharged on day 76, and follow-up computed tomography two months later showed complete resolution of ascites. One year after surgery, the patient remained symptom-free.

Purpose: To review the utility of a spring-loaded blunt-tip co-axial needle in improving procedural outcomes when accessing "difficult-to-reach" targets during percutaneous image-guided procedures.

Material and Methods: In this single-center retrospective study, consecutive adult patients who underwent percutaneous image-guided procedures using a spring-loaded blunt-tip co-axial needle for "difficult-to-reach" targets from January 2021 to December 2024 were reviewed. Clinical information, including demographics and medical history, was recorded. Pre- and post-procedural radiological findings were assessed. Procedural details, modality of image guidance, technical success, and complications were analyzed. Post-procedural follow-up was reviewed.

Results: A total of 21 patients (median age: 68.0 years, range 33.0-88.0 years; 15 [71.4%] male) were included. Nearly half (n = 10, 47.6%) of the procedures were percutaneous image-guided drainage. One-third (n = 7, 33.3%) were hydrodissection performed for radiofrequency or microwave ablation of tumors. Three (14.3%) were image-guided biopsies. In one patient (4.8%), the needle was used for percutaneous embolization of a type II endoleak after endovascular repair of an enlarging internal iliac artery aneurysm. No procedure-related complication was encountered. In all 21 cases, adjacent organs were avoided, resulting in retained drainage, achieved tumor control with ablation, achieved tissue diagnosis with biopsy, and eliminated endoleak (100% technical success).

Conclusions: The spring-loaded blunt-tip co-axial needle appeared to be useful in accessing "difficult-to-reach" targets in a variety of percutaneous image-guided procedures, including drainage, hydrodissection, biopsy, and percutaneous embolization of endoleak.

This report details a rare case of intraperitoneal bleeding from a failed puncture site during percutaneous trans-splenic portal vein access. A man in his 60s, who had undergone surgery for gallbladder cancer, presented with recurrent melena. Sclerotherapy for hepatopetal ectopic varices in the elevated jejunum loop was attempted using a percutaneous trans-splenic approach due to extrahepatic portal vein obstruction, which led to intraperitoneal bleeding. Despite initial splenic artery embolization, persistent bleeding required embolization of an intra-splenic vein branch. Although percutaneous trans-splenic portal vein access is generally safe, complications such as intraperitoneal bleeding can occur. Previous studies have highlighted the need for splenic artery embolization. However, this case emphasizes the importance of recognizing splenic venous bleeding as a potential complication and underscores the need for comprehensive management strategies.

Purpose: This study aimed to show balloon dilation of the puncture site as a technique to facilitate insertion of a large-bore sheath in patients undergoing percutaneous endovascular aneurysm repair who have previously undergone femoral cutdowns.

Materials and Methods: Three patients with prior femoral cutdowns who required percutaneous insertion of a large-bore sheath were included. After ultrasound-guided puncture of the femoral artery and preparation with a Perclose ProGlide suture, attempts to insert a 12F sheath using a dilator were unsuccessful. Consequently, a 5-mm-diameter balloon catheter was used to dilate the puncture site.

Results: In two patients, the balloon dilation allowed smooth sheath insertion without bleeding complications. Adequate hemostasis was achieved post-procedure. However, in the third patient, despite high-pressure balloon dilation, residual stenosis prevented sheath insertion. The stenosis was attributed to the puncture path crossing vascular sutures from the previous cutdown, leading to a decision to relocate the puncture site, which then allowed successful sheath insertion.

Conclusion: Balloon dilation at the puncture site is a viable technique for overcoming challenges in sheath insertion during percutaneous endovascular aneurysm repair in patients with previous femoral cutdowns. In cases in which the puncture site cannot be dilated with the use of a balloon, alternative strategies, such as changing the puncture site, are necessary.

The need for interventional radiology in hemostatic strategies for postpartum hemorrhage has been growing as a reliable and hopeful treatment method because of its non-invasive characteristics, high success rate of hemostatic outcomes, and potential to preserve fertility. Moreover, with the global trend of increasing postpartum hemorrhage, interventional radiology is expected to play an important role. An accurate pre-procedural diagnosis of the underlying cause of bleeding, including tone, trauma, tissue, or thrombin, utilizing contrast-enhanced computed tomography and clinical information, is essential for planning the appropriate technical approach to interventional radiology. This study outlines the fundamental aspects of primary postpartum hemorrhage, compares the computed tomography imaging characteristics associated with various causes, and discusses the appropriate procedural choices of interventional radiology based on the identified etiology.

This review highlights the role of interventional radiology in the management of renal trauma, emphasizing its contributions to imaging-based diagnosis, injury classification, and treatment. It discusses the indications for and clinical outcomes of transcatheter arterial embolization, as well as the management of renal artery dissection and urinary extravasation. Transcatheter arterial embolization has demonstrated favorable outcomes, even in high-grade injuries, and repeat procedures have proven effective for managing rebleeding. Renal artery dissection may be treated with stent placement to preserve renal function. Although urinary extravasation often resolves spontaneously, persistent cases may require ureteral stenting or percutaneous drainage. Additional interventional radiology-based interventions, including embolization and cryoablation, have also been reported. As a minimally invasive, organ-preserving treatment modality, interventional radiology plays a vital role in supporting non-operative management strategies for renal trauma.

We report a case of Budd-Chiari syndrome successfully treated with endovascular recanalization of an inferior vena cava occlusion using a modified sharp recanalization technique. A 45-year-old man presented with hepatic dysfunction, and contrast-enhanced computed tomography revealed a 1.5 cm chronic inferior vena cava occlusion. Standard sharp recanalization using the conventional end of a guidewire failed to cross the lesion. Therefore, we reshaped the end of a 0.035-inch guidewire into a sharper form, enabling successful penetration without the use of specialized devices. This modified technique, adapted from peripheral artery interventions, may offer a safer and more cost-effective option for treating fibrotic venous occlusions. Stepwise balloon dilation was subsequently performed to minimize complications. This report highlights the potential utility of a reshaped guidewire end as a practical alternative when the conventional technique fails.

Intravascular large B-cell lymphoma is a rare, aggressive lymphoma characterized by intravascular growth. The liver is a common site of involvement. Although liver biopsy provides sufficient tissue for diagnosis and treatment planning, it carries a risk of severe hemorrhage. This report describes the case of a woman in her 50s with intravascular large B-cell lymphoma who developed liver hemorrhage that was uncontrollable by transarterial embolization after undergoing ultrasound-guided percutaneous liver biopsy, necessitating laparoscopic hemostasis. Pathological findings revealed markedly dilated liver sinusoids filled with tumor cells, suggesting direct hemorrhage from these vessels. This case highlights the potential for increased hemorrhage risk in intravascular large B-cell lymphoma and underscores the necessity for careful consideration of alternative biopsy techniques, such as the transjugular approach or percutaneous biopsy with tract embolization.

Uterine artery embolization is a treatment option for symptomatic uterine myomas. The Japanese Society of Interventional Radiology Guideline Committee developed guidelines for uterine artery embolization procedures for symptomatic uterine myomas using an evidence-based methodology. This report describes the rationale for developing these guidelines and provides answers to clinical questions concerning uterine artery embolization procedures based on existing evidence and expert consensus.

Purpose: To evaluate the performance of automated tumor-feeder detection software in transarterial chemoembolization for hepatocellular carcinoma using angio-computed tomography.

Material and Methods: This was a retrospective study of 107 hepatocellular carcinomas in 74 patients who underwent selective transarterial chemoembolization between June 2021 and December 2022. Identification of tumor-feeding arteries on computed tomography during hepatic angiography images acquired prior to chemoembolization with angio-computed tomography was evaluated in two independent methods: analysis by automated tumor-feeder detection software and interpretation by radiologists. The sensitivity and positive predictive value of both were calculated, and the sensitivity was compared with the McNemar test. Differences with p <0.05 were considered statistically significant.

Results: Transarterial chemoembolization was applied to 107 hepatocellular carcinoma tumors fed by 114 arteries. No significant difference was observed in sensitivity between the software and the interpretation of radiologists (90.4% vs. 95.6%, p = 0.15). The positive predictive value for the software was 90.4%; that for the interpretation of radiologists was 86.8%.

Conclusions: The accuracy of automated tumor-feeder detection software applied to angio-computed tomography was comparable to that of radiologists.

Purpose: To evaluate the efficacy and safety of the GORE^® VIABAHN^® Endoprosthesis (stent graft) for traumatic or iatrogenic vessel injury.

Material and Methods: This prospective, multicenter, cohort study for post-marketing clinical surveillance was conducted in Japan. Efficacy and safety endpoints included successful device implantation, primary and secondary hemostasis of injury, 1-month and 1-year survival rate, and at 1-, 6-, 12-months post-procedure, primary and secondary patency rates, antiplatelet drug administration, and serious adverse events.

Results: In 37 patients (mean age 73.3±12.5 years; 22 males; 59.5%), 38 vessel injuries were evaluated. Primary treated arteries were visceral, subclavian, and iliac arteries; 86.8% (33/38) were iatrogenic, and 13.2% (5/38) were traumatic vessel injury. Iatrogenic injury included pseudoaneurysm (63.6%), perforation (24.4%), rupture (15.2%), dissection (12.1%), or fistula (3.0%). Technical success in 36 patients (36/37; 97.3%) with 37 vessels (37/38; 97.4%), and primary and secondary hemostasis in all patients were achieved. Primary patency at 1-, 6-, and 12-months was 89.1%, 84.8%, and 80.6%, and secondary patency was 91.5%, 87.3%, and 82.4%, respectively. The Kaplan-Meier survival estimate was 94.4% through 1 month and 75.9% through 1 year. No device-related deaths occurred. Through 12 months, of the 19 serious adverse events (13 patients), three serious adverse events were judged by the investigator to be device-related (vascular stent graft stenosis) or procedure-related (device occlusion and cerebellar infarction).

Conclusions: The use of the VIABAHN stent graft for vessel injury was safe and effective in this study. Successful hemostasis was achieved through 1 month. Through 1 year, no device-related deaths were reported.

Purpose: To evaluate the sample weights obtained using a new semi-automatic biopsy needle and a new full-core biopsy needle, and to compare them with those obtained using a conventional semi-automatic needle under identical ex vivo conditions.

Material and Methods: A total of three biopsy needles were compared: the semi-automatic biopsy needles TEMNO Elite™ (Merit Medical Systems, South Jordan, UT, USA) and STARCUT^® (TSK Laboratory, Tochigi, Japan) and the full-core automatic biopsy needle CorVocet™ (Merit Medical Systems), with throw lengths of 15 mm, 20 mm, and 25 mm. Two materials were used for sampling: kamaboko (a type of Japanese fish cake) and chicken breast muscle. For each material, 20 specimens were collected using each needle type, resulting in 100 samples per material. All procedures were conducted under identical conditions.

Results: The TEMNO Elite™ needle yielded the heaviest samples among all tested needles in both kamaboko (9.21 ± 0.95 mg) and chicken breast (5.92 ± 0.51 mg), significantly surpassing all others (p < 0.05). STARCUT^® collected significantly more tissue than CorVocet™ (15 mm) in both materials (p < 0.05), while CorVocet™ (25 mm) collected more than STARCUT^® in chicken breast (p < 0.05). No significant difference was observed between STARCUT^® and CorVocet™ (20 mm) in both materials. For CorVocet™, sample weight increased with throw length in both materials.

Conclusions: The TEMNO Elite™ needle collected the heaviest biopsy specimens among all tested needles in both model materials.

This case report presents a unique endovascular technique using an electrically detachable coil as a temporary anchor for the treatment of a saccular celiac artery aneurysm. A man in his 60s with a 28-mm saccular aneurysm in the main trunk of the celiac artery underwent coil embolization. The short distance between the aneurysm and the bifurcation of the common hepatic and splenic arteries posed a significant challenge in preserving the bifurcation. By employing a detachable coil as a temporary anchor, the procedure enabled precise coil placement and eliminated the need for stents or balloons. Five-year outpatient follow-up imaging confirmed bifurcation patency and no aneurysm recurrence. This temporary anchoring technique can provide a practical alternative for embolization without the need for additional stents or balloons.

Purpose: Portal vein thrombosis (PVT), is seen in about 25% of patients with cirrhosis. Chronic portal vein thrombosis can significantly alter anatomy, often leading to the diversion of splanchnic blood into expansive and compliant vascular channels. This process generates extensive collateral networks and large varices that function as portosystemic shunts. Portal cavernous transformation represents a critical vascular condition marked by the formation of a network of collateral veins that develops to bypass an obstructed portal vein [PV]. Given these physiological changes, performing liver transplantation is associated with higher morbidity and mortality rates. We present an early, single-center experience for portal vein reconstruction (PVR) and the creation of a transjugular intrahepatic portosystemic shunt (TIPS) to increase transplant candidacy in such patients.

Material and Methods: Retrospectively, data was obtained from the Picture Archiving and Communication System (PACS) and Hospital Information System (HIS) from a single center between January 2016 to January 2024. In total, 15 patients with obliterative main portal vein thrombosis were selected. These patients underwent Percutaneous transhepatic portal vein recanalization with transjugular intrahepatic portosystemic shunt to increase their transplant eligibility after a collaborative imaging examination by transplant surgery and interventional radiology team. Up until liver transplant LT, patients were monitored in the hepatology/transplant clinic, and thereafter in the posttransplant clinic. To confirm portal vein PV patency, serial ultrasound/Dynamic computed tomography/magnetic resonance imaging was done.

Results: Portal vein recanalization with transjugular intrahepatic portosystemic shunt was performed in 15 patients. Technical success, defined as the maintenance of patency in both the portal vein and the transjugular intrahepatic portosystemic shunt at the conclusion of the procedure, was achieved in all 15 cases (100%).

Conclusions: Patients with portal vein thrombosis may significantly benefit from portal vein recanalization with transjugular intrahepatic portosystemic shunt, enhancing transplantation candidacy and facilitating physiologic end-to-end anastomoses.

Prostatic artery embolization is a minimally invasive treatment for lower urinary tract symptoms caused by benign prostatic hyperplasia. We report our first case of prostatic artery embolization in a 74-year-old male with urinary retention requiring intermittent catheterization. Bilateral prostatic artery embolization using Embosphere microspheres was successful, with no major complications. By 2 months post-procedure, intermittent catheterization was no longer required, and at 6 months, symptoms and prostate volume showed marked improvement. A review of Asian studies confirmed prostatic artery embolization's safety and efficacy, with clinical success in 78%-100% of cases and technical success rates comparable to those in Western countries. Despite the smaller vessel sizes in Asians, outcomes were unaffected. Prostatic artery embolization appears to be an effective treatment for benign prostatic hyperplasia and requires further validation to support its broader use in Japan.

This study reports a case of a J-shaped guidewire entrapped in a Chiari network during central venous port insertion. A female patient in her 50s with breast cancer was referred for a single-lumen port placement. The subclavian vein was accessed using an 18 G needle under ultrasound guidance, and a 0.035-inch J-shaped guidewire was passed to the superior vena cava under fluoroscopy. Resistance was encountered in the right atrium when advancing to the inferior vena cava, and the J-shaped guidewire was difficult to retract. The 4F catheter on the J-shaped guidewire was towed, and the J-shaped guidewire was removed despite strong resistance. The removed catheter was significantly deformed, and the J-shaped guidewire tip was entangled in a white, hard tissue, likely a Chiari network. The patient was asymptomatic intra- and postoperatively.

Disruption of the central venous port catheter was identified on the chest radiograph of a 36-year-old woman who had undergone chemotherapy following resection of her colon cancer. Computed tomography revealed that the catheter was impacted in the peripheral pulmonary artery. Instead of using a snare wire, a balloon catheter was inserted into the lumen of the disrupted catheter due to its tight lodging in the pulmonary artery. The disrupted catheter was successfully removed without complications. This technique may prove useful when using a snare wire is deemed challenging, and a guidewire can be inserted into the catheter lumen.

Chronic mesenteric ischemia typically presents with postprandial abdominal pain and weight loss due to atherosclerotic stenosis of mesenteric arteries. Endovascular treatment has become the first-line management, demonstrating lower early mortality and fewer complications compared to open surgery. Recent evidence shows that covered stents provide superior long-term outcomes, with better primary patency and freedom from reintervention than bare-metal stents. While patient selection remains crucial, with endovascular treatment being preferred for older, higher-risk patients and shorter lesions, it offers shorter hospital stays and comparable survival rates to open surgery for most patients. This review provides a comprehensive overview of current endovascular management strategies for chronic mesenteric ischemia, including patient selection, technical considerations, and outcomes.

Endoscopic ultrasonography-guided biliary drainage has been reported as an alternative technique when transpapillary endoscopic biliary drainage fails. This case study describes a case of pseudoaneurysm, one of the complications unique to endoscopic ultrasonography-guided biliary drainage. An 87-year-old woman who underwent endoscopic ultrasonography-guided hepaticojejunostomy with a partially covered metallic stent developed hematochezia. Contrast-enhanced computed tomography revealed a pseudoaneurysm of the left hepatic artery adjacent to the stent. During coil embolization, angiography revealed bleeding, passing through the covered portion of the stent into the jejunum, and coil embolization was successfully performed. In cases after bile duct stent placement, where a tamponade effect can be expected, hepatic artery pseudoaneurysm may occur as a complication of puncture, and embolization may be required.

Vascular access dysfunction remains a significant challenge in hemodialysis patients, primarily caused by stenosis and occlusion in arteriovenous fistulas and grafts. Recent advancements in percutaneous transluminal angioplasty have introduced innovative tools such as drug-coated balloons and stent grafts. Drug-coated balloons enhance patency by reducing neointimal hyperplasia through localized drug delivery, with superior outcomes demonstrated in randomized controlled trials. Stent grafts provide structural support and mitigates restenosis at venous anastomoses but faces challenges in maintaining long-term patency. Cutting balloons, a well-established device, offer a unique mechanism of controlled fibroelastic disruption, making them effective for resistant stenoses. This review evaluates the clinical impact of these devices, focusing on evidence from Japan, and emphasizes the importance of selecting the appropriate device based on individual lesion characteristics.

Purpose: A newly developed device, the Partially Automated Needle Direction Assistant, was designed to assist with computed tomography-guided oblique needle puncture. This device allows operators to accurately and in real-time determine the puncture angle based on the target lesion and needle entry point. The purpose of this report is to introduce the concept of Partially Automated Needle Direction Assistant and present results from an initial phantom study.

Material and Methods: Partially Automated Needle Direction Assistant integrates a 9-axis internal measurement unit for angle detection, transmitting real-time orientation data to a tablet application via Wi-Fi. Operators align the needle direction with a displayed guideline. A phantom study was conducted with two operators of differing interventional radiology experience levels (operator A: 1 year; operator B: 4 years) performing needle punctures into embedded targets. Success rates were evaluated based on a scoring system reflecting needle placement accuracy.

Results: Both operators successfully punctured all six sites, achieving a 100% success rate. Center hits were not influenced by target size, puncture direction, or operator experience level. Operator A tended to achieve higher scores than operator B (mean scores: 1.50 vs. 1.17; p = 0.073).

Conclusions: Partially Automated Needle Direction Assistant demonstrated high accuracy and usability in guiding oblique needle punctures, regardless of operator experience. This device has the potential to enhance safety, reduce radiation exposure, and streamline computed tomography-guided interventions.

Purpose: To determine how the anatomical morphology of the left subclavian artery and aortic arch affects the technical difficulty of navigating the aortic arch during left transradial access for visceral vascular interventions.

Material and Methods: We retrospectively evaluated 98 patients who underwent visceral vascular interventions using left transradial access from January 2022 to December 2022. Cannulation of the descending aorta was considered difficult when the time required to manipulate the catheter in the aortic arch exceeded 30 seconds. The morphologies of the left subclavian artery and aortic arch were evaluated by measuring [1] the angle between the left subclavian artery to the apex of the aortic arch, [2] the angle of incidence of the left subclavian artery in the horizontal direction, and [3] the distance from the left edge of the left subclavian artery origin to the apex of the aortic arch using computed tomography images. The values of [1], [2], and [3] were evaluated using the Mann-Whitney U test.

Results: The median and mean catheterization times were 26 seconds (range, 2-1,312) and 112.4 ± 226.0 seconds, respectively. For difficult (n = 44) and not-difficult (n = 54) cases, the mean values of [1], [2], and [3] were 111.8° vs. 140.8° (p < 0.001), 67.3° vs. 76.9° (p < 0.001), and 27.5 mm vs. 24.7 mm (p = 0.001), respectively.

Conclusions: Technical difficulty in passing the aortic arch during left transradial access is more likely in patients with steep angles of the left subclavian artery or steep angles between the left subclavian artery and the apex of the aortic arch.

Purpose: Standard methods for percutaneous transhepatic portal vein embolization have not yet been established. This study aimed to elucidate the effectiveness of balloon occlusion in percutaneous transhepatic portal vein embolization using gelatin sponges on the hypertrophy ratio of the future liver remnant volume.

Material and Methods: This retrospective study included 93 patients who underwent percutaneous transhepatic portal vein embolization for right hepatectomy between January 2018 and September 2022. Based on the embolization procedure, patients were divided into a balloon group (n = 13) and a non-balloon group (n = 80). The clinical factors and future liver remnant volume hypertrophy ratios were compared. Moreover, significant factors associated with the future liver remnant volume hypertrophy ratio between the groups were analyzed.

Results: The future liver remnant volume hypertrophy ratio was significantly higher in the balloon group than in the non-balloon group (1.44 [interquartile range, 1.37-1.89] vs. 1.29 [1.15-1.46], p = 0.011). The initial future liver remnant volume (289 [interquartile range, 259-454] vs. 400 [324-479] mL, p = 0.036) and number of gelatin sponge sheets (5 [interquartile range, 5-6] vs. 4 [3-5], p = 0.008) significantly differed. However, recanalization and severe complications were not different between groups. According to the multivariate linear regression analysis, diabetes mellitus (coefficient, −0.202, p = 0.009), initial future liver remnant volume (coefficient, −0.001, p < 0.001), and balloon occlusion (coefficient, 0.228, p = 0.007) were independent factors affecting the future liver remnant volume hypertrophy ratio.

Conclusions: Balloon occlusion may be effective in future liver remnant volume hypertrophy in percutaneous transhepatic portal vein embolization using gelatin sponges.

Thoracic duct embolization has emerged as an alternative treatment for refractory chylothorax, in addition to thoracic duct ligation. Thoracic duct embolization is typically performed via direct puncture of the cisterna chyli and cannulation of the thoracic duct, or via a retrograde approach to the thoracic duct through the venous angle. The former requires a long puncture through abdominal organs; the latter has anatomical limitations depending on the case. The reported success rates of both approaches are insufficient to provide a complete solution. We report a case of refractory chylothorax successfully treated with thoracic duct embolization using a catheter inserted through a chest tube to cannulate the leaking stump of the thoracic duct. This technique offers a less invasive treatment option that avoids additional punctures or surgical intervention.

Purpose: We retrospectively analyzed the effect of coil type on the number of coils used and the procedure time in pre-Fontan coil embolization of collateral arteries.

Material and Methods: Twelve patients with congenital heart disease underwent coil embolization before Fontan surgery between 2010 and 2021. They were divided into 2 groups. Group A comprised 6 patients who underwent coil embolization before the introduction of longer microcoils (≥30 cm) and group B comprised 6 patients who underwent embolization after the introduction of the microcoils. The primary endpoints (number of coils used, embolized area per patient and the internal thoracic artery, and procedure time) were compared between the 2 groups.

Results: The number of coils used per patient and internal thoracic artery (groups A vs. B: 36.5 vs. 18; p = 0.036, 11.7 vs 7.4; p = 0.047) and the procedure time (247 vs 180 minutes; p = 0.002) were significantly smaller in group B than in group A. The embolized area per internal thoracic artery was significantly larger in group B than in group A (45 vs. 93.5; p < 0.001). All patients underwent Fontan surgery at a mean of 24 days after embolization. Fontan circulation was established in nine of 12 patients. There were no major complications in either group.

Conclusions: In pre-Fontan coil embolization, a combination of longer microcoils (≥30 cm) may help reduce the number of coils used and the procedure time, which may decrease the health care cost and radiation exposure.

An 89-year-old woman presented with altered mental status. Computed tomography revealed multiple shunts between the portal (segment 3) and hepatic veins (left and middle hepatic veins); detailed vascular anatomy of the shunts could not be determined owing to its complexity. Blood tests revealed an elevated ammonia level. The patient was diagnosed with hepatic encephalopathy secondary to an intrahepatic portosystemic venous shunt. Transcatheter embolization was performed after unsuccessful conservative treatment. The peripheral left and middle hepatic veins downstream of the shunt vessels were embolized through an internal jugular vein approach using Amplatzer vascular plugs and coils. Computed tomography conducted 1 week later indicated occlusion of the shunts. The patient's ammonia levels were normalized. Thus, transcatheter embolization can be useful for treating complex intrahepatic portosystemic venous shunts causing hepatic encephalopathy.

Lower extremity artery disease affects more than 230 million people worldwide, leading to significant cardiovascular and limb-related complications. Recent advancements in endovascular treatment, driven by technological innovations and increasing patient prevalence due to aging populations and lifestyle diseases, has contributed to a growing demand for endovascular treatment. In Japan, the number of endovascular treatment procedures has increased specifically among cardiologists, whereas the involvement of interventional radiology physicians remains limited. This review explores the latest trends and clinical outcomes of endovascular treatment, and the importance of multidisciplinary collaboration, including the role of interventional radiology physicians. The findings encourage greater involvement of interventional radiology physicians in endovascular treatment.

Purpose: To investigate the risk factors for local maxillary sinus squamous cell carcinoma recurrence/residual tumor after superselective intra-arterial cisplatin infusion and concomitant radiotherapy.

Material and Methods: The protocol of superselective intra-arterial cisplatin infusion and concomitant radiotherapy was as follows: cisplatin was administered once per week for 7 weeks, and the dose of every procedure was 100 mg/m². Radiation was administered during the same period using intensity-modulated radiation therapy, with a total dose of 70 Gy (2 Gy/35 fractions). The risk factors for local recurrence/residual tumor were retrospectively analyzed using the Cox hazard model in 31 advanced primary maxillary sinus squamous cell carcinoma cases treated with superselective intra-arterial cisplatin infusion and concomitant radiotherapy from October 2016 to 2022. The analyzed risk factors were age, sex, T- and N-factors, invasion of the pterygoid muscle, tumor heterogeneity on imaging modality, tumor signal intensity on diffusion-weighted imaging (b = 1000), tumor-brain stem signal ratio on diffusion-weighted imaging (b = 1000), therapeutic response after the fourth infusion, and complete superselective intra-arterial cisplatin infusion and concomitant radiotherapy or not. We also compared overall survival between the recurrence/residual tumor and non-recurrence groups.

Results: This study included 31 patients. Non-complete superselective intra-arterial cisplatin infusion and concomitant radiotherapy was the only risk factor that showed a statistically significant difference among all the analyzed risk factors. Overall survival was favorable in the non-recurrence/residual tumor group; however, there was no statistical difference compared to the recurrence/residual tumor group.

Conclusions: Complete superselective intra-arterial cisplatin infusion and concomitant radiotherapy was the only factor that prevented local recurrence/residual tumor. Therefore, all health careers involved in superselective intra-arterial cisplatin infusion and concomitant radiotherapy should avoid interrupting whenever possible.

A 74-year-old man who had received Bacillus Calmette-Guérin therapy for bladder cancer developed vasovagal syncope. Contrast-enhanced computed tomography showed multiple pseudoaneurysms in the left internal carotid artery, aorta, and right common femoral artery, which were considered to be infected aneurysms. Parent artery occlusion was planned for the left internal carotid artery, but the balloon occlusion test was not possible because of the patient's restlessness; therefore, the patient was treated with a Viabahn stent graft. Approximately 1 month later, another ruptured pseudoaneurysm occurred in the right internal carotid artery, which was also treated with a Viabahn stent graft. The patient did not experience rebleeding or complications such as cerebral infarction. Viabahn may be an effective alternative for the management of carotid artery-infected aneurysms.

This case report describes a 56-year-old woman with autosomal dominant polycystic kidney disease and chronic renal failure who underwent transcatheter arterial embolization with N-butyl-2-cyanoacrylate-Lipiodol before renal transplantation. Both kidneys were significantly enlarged, necessitating transcatheter arterial embolization to reduce renal volume and create space for transplantation. The right kidney volume decreased from 2520 to 1150 mL within 9 months after transcatheter arterial embolization, enabling successful transplantation. Long-term (37 months) follow-up demonstrated continued shrinkage of the transcatheter arterial embolization-treated right kidney and a spontaneous reduction in the non-transcatheter arterial embolization-treated left kidney. The reduction in renal volume achieved with transcatheter arterial embolization exceeded that reported for conventional methods using metal coils or ethanol. This case highlights the potential of as an effective embolizing agent for patients with autosomal dominant polycystic kidney undergoing renal transplantation.

Purpose: N-butyl cyanoacrylate is a liquid embolic material used to treat bleeding. Rebleeding may occur after N-butyl cyanoacrylate embolization due to vasospasm and dilation of the embolized artery. However, the impact of vasospasm on N-butyl cyanoacrylate embolization has not been fully investigated. Therefore, we investigated the impact of vasospasm on the effects of N-butyl cyanoacrylate embolization in swine arteries.

Material and Methods: Using a swine bleeding model, 24 arteries (hepatic/splenic/both renal/cranial mesenteric) in 5 swine were divided into vasoactive and control groups. The recanalization rates after embolization with 20% N-butyl cyanoacrylate and the volume of N-butyl cyanoacrylate used for embolization were compared between the 2 groups. Arteries in the vasoactive group were constricted by constant venous infusion of vasopressin and an arterial injection of noradrenaline just before embolization and then dilated by arterial injection of papaverine and lidocaine immediately after embolization. Angiography was performed to evaluate recanalization of the embolized arteries immediately and at 5, 15, 30, 45, and 60 minutes after embolization. Recanalization was defined as complete recanalization within 60 minutes or partial recanalization at 60 minutes.

Results: Angiography revealed recanalization in a significantly greater proportion of arteries in the vasospasm group (11/12 arteries [91.7%]) than in the control group (2/12 arteries [16.7%]) (p = 0.0006). The median volume of N-butyl cyanoacrylate used during embolization was significantly lower in the vasoactive group (0.32 mL) than in the control group (0.78 mL) (p = 0.0037).

Conclusions: Vasospasm during N-butyl cyanoacrylate embolization increased the recanalization rate of the embolized arteries and reduced the embolization effect in swine.

A 75-year-old man with a history of open surgical repair for a thoracoabdominal aortic aneurysm presented with an aortic pseudoaneurysm at the anastomosis and a celiac artery aneurysm. During endovascular treatment, multiple celiac artery branches were embolized, and an aortic stent graft was placed to cover the aortic anastomosis and celiac artery origin. Four days post-treatment, a computed tomography scan revealed poor enhancement and fluid collection in the pancreatic body and tail, indicating acute ischemic pancreatitis with pancreatic necrosis. Computed tomography 22 days after treatment indicated enlargement of the fluid collection, leading to endoscopic ultrasound-guided drainage of the collection. Despite the low risk of ischemic complications, recognizing the risk of ischemic pancreatitis and splenic infarction when multiple celiac artery branches are embolized to treat celiac artery aneurysms is crucial.

Endoleak is a significant complication of endovascular aortic repair, associated with adverse long-term outcomes. This review discusses the classification, mechanisms, and imaging diagnosis of endoleaks. Five types of endoleaks are described, each with distinct characteristics and management approaches. Imaging modalities for endoleak detection include computed tomography, magnetic resonance imaging, ultrasonography, and angiography, each with unique advantages and limitations. Computed tomography remains the gold standard, but magnetic resonance imaging and contrast-enhanced ultrasound show promise in specific scenarios. The article details imaging findings for each endoleak type, emphasizing the importance of multimodality imaging for accurate diagnosis. While computed tomography is essential for early postoperative evaluation and reintervention planning, a tailored approach using various imaging techniques may optimize long-term surveillance. Future research should focus on establishing cost-effective, radiation-minimizing protocols for lifelong post-endovascular aortic repair monitoring.

Arterial esophageal hemorrhage, a relatively rare condition, necessitates prompt therapeutic intervention. The esophageal arteries, originating directly from the aorta and being extremely narrow, are often difficult to identify through angiography alone. We report two cases of arterial esophageal hemorrhage related to esophageal cancer in which the esophageal arteries were identified by contrast-enhanced computed tomography prior to angiography, enabling successful transcatheter arterial embolization. Arterial esophageal hemorrhage requires rapid treatment intervention due to its complex blood supply. Preoperative evaluation with computed tomography appears to be effective.

Type II endoleak is the most common complication after endovascular abdominal aortic aneurysm repair. Type II endoleak with aneurysm sac growth is not benign for long-term outcomes of endovascular abdominal aortic aneurysm repair and should be treated to prevent secondary stent graft-related complications and aneurysm rupture. The current consensus is to consider treatments for persistent type II endoleak with significant aneurysm sac growth. For complete embolization of type II endoleak to obliterate the endoleak cavity with the elimination of all supplying arteries, it is necessary to select and combine the treatment options. Although the treatment techniques for type II endoleak have advanced, clinical outcomes remain unsatisfactory. To overcome this clinical discrepancy, the optimal patient-tailored treatment strategy is required in clinical practice, with an understanding of the current status and limitations of treatment for type II endoleak.

Preemptive side branch embolization may help prevent type II endoleak, reduce reintervention rates, and promote early aneurysm sac shrinkage after endovascular aneurysm repair. However, evidence of its effectiveness in preventing aneurysm rupture, reducing aneurysm-related mortality, ensuring safety, and maintaining cost-effectiveness is limited. The 2024 European Society for Vascular Surgery guidelines do not recommend routine preemptive embolization due to a lack of high-quality evidence. Concerns about radiation exposure and financial costs remain unresolved. Further research is needed to identify patients who would benefit most from preemptive embolization, as well as to evaluate its long-term impact on clinical outcomes, safety, and cost-effectiveness.

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.

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.

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.

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.

A woman in her 40s was found to have a sewing needle within the right lumbar erector spinae muscle on imaging. The needle tip nearly reached the first lumbar vertebra and was close to the intervertebral foramen. An 8-gauge bone marrow biopsy needle was advanced under local anesthesia and biplane fluoroscopic guidance. The inner needle was withdrawn, while the outer needle was gently advanced to capture the proximal end of the sewing needle. The sewing needle was successfully grasped and removed using the endoscopic biopsy forceps. She was discharged without symptoms. Under biplane fluoroscopy guidance, percutaneous coaxial removal of the intramuscular sewing needle was successfully performed minimally invasively and at a low cost using an 8-gauge bone marrow biopsy needle and endoscopic forceps.

We report a case of lumbar spinal hematoma caused by balloon-occluded retrograde transvenous obliteration for gastric varices in a woman in her 60 s with liver cirrhosis due to non-alcoholic steatohepatitis. The patient presented to the emergency department with a chief complaint of sudden nausea and hematemesis. Endoscopic sclerotherapy was performed, followed by balloon-occluded retrograde transvenous obliteration for residual varices. During balloon-occluded retrograde transvenous obliteration, she complained of back pain and subsequently developed thigh pain. CT and MR scans revealed subdural hematoma and subarachnoid hemorrhage within the spinal canal at the thoracolumbar level. It is presumed that balloon-occluded retrograde transvenous obliteration altered blood flow in the paravertebral plexus, causing an intraspinal canal hemorrhage. To our knowledge, this study is the first to report a case of an iatrogenic spinal hematoma caused by balloon-occluded retrograde transvenous obliteration.

Postoperative hepatic lymphorrhea is a rare complication that can lead to refractory ascites. During surgery with lymph node dissection of the hepatoduodenal ligament, leakage of liver lymph into the abdominal cavity can occur. Due to the development of interventional radiology for various lymphatic leaks in recent years, the pathogenesis of hepatic lymphatic leakage has become more evident. Percutaneous transhepatic lymphangiography is important for the diagnosis of hepatic lymphorrhea. Although there have been case reports of percutaneous embolization and sclerotherapy treatments for hepatic lymphorrhea in recent years, there have been no case studies. However, the standard treatment for this condition remains unknown. This study discusses the anatomy of hepatic lymphatics and the pathogenesis, diagnosis, and treatment of hepatic lymphorrhea, including the latest literature on interventional radiology.

In the current systemic therapy era, such as immunotherapy and molecular targeted therapy, treatment strategy of hepatocellular carcinoma is changing. Transarterial chemoembolization is more expected as a curative treatment option than before. Therefore, it is important to learn key techniques of transarterial chemoembolization procedures to achieve complete response. This article delineates the current indications for transarterial chemoembolization and several techniques used for its implementation.