Interventional Radiology
Online ISSN : 2432-0935
Current issue
Displaying 1-16 of 16 articles from this issue
Editorial
Review
  • Yozo Sato, Kiyoshi Matsueda, Yoshitaka Inaba
    Article type: REVIEW
    2024 Volume 9 Issue 3 Pages 80-85
    Published: November 01, 2024
    Released on J-STAGE: November 01, 2024
    Advance online publication: October 04, 2024
    JOURNAL OPEN ACCESS

    Ultrasound-guided needle puncture is essential for both vascular and nonvascular interventions. Ultrasound is widely available in various clinical settings, requires no ionizing radiation, offers color Doppler imaging, and enables real-time visualization of the needle position during puncture. However, ultrasound imaging has some limitations, such as signal attenuation in deeper tissues and the inability to penetrate bone or air, and it is a heavily operator-dependent modality. Here, we outline the basic techniques and technical tips for ultrasound-guided needle puncture.

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  • Haruyuki Takaki, Kaoru Kobayashi, Yasukazu Kako, Hiroshi Kodama, Atsus ...
    Article type: REVIEW
    2024 Volume 9 Issue 3 Pages 86-91
    Published: November 01, 2024
    Released on J-STAGE: November 01, 2024
    Advance online publication: June 03, 2024
    JOURNAL OPEN ACCESS

    Computed tomography-guided puncture is a useful technique for various interventional radiology procedures. Puncture from various locations and angles becomes possible using this technique. Moreover, bone and air do not interfere with the computed tomography image. Therefore, computed tomography-guided puncture is feasible even in difficult cases of ultrasonography-guided procedures. However, a computed tomography-guided procedure can cause radiation exposure to patient and operator. Therefore, utmost attention should be given to minimizing radiation exposure.

    This study aimed to provide a brief review of pre-procedural preparation and the technical tips for the computed tomography-guided puncture and introduce recent topics related to the radioprotection of computed tomography-guided puncture.

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  • Mayu Uka, Yusuke Matsui, Toshihiro Iguchi, Toshi Matsushita, Koji Tomi ...
    Article type: REVIEW
    2024 Volume 9 Issue 3 Pages 92-98
    Published: November 01, 2024
    Released on J-STAGE: November 01, 2024
    Advance online publication: December 14, 2023
    JOURNAL OPEN ACCESS

    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.

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  • Taku Yasumoto, Koichi Yamada, Hakketsu Koh, Ryoong-Jin Oh
    Article type: REVIEW
    2024 Volume 9 Issue 3 Pages 99-111
    Published: November 01, 2024
    Released on J-STAGE: November 01, 2024
    Advance online publication: October 04, 2024
    JOURNAL OPEN ACCESS

    This article emphasizes image-guided puncture, a common technique used by interventional radiologists. It focuses on ultrasound, fluoroscopy, computed tomography, and computed tomography fluoroscopy-guided procedures. While techniques vary, successful outcomes without complications still heavily rely on operators' skill and judgment. Operators need knowledge of needle characteristics and expert needle manipulation. Continual skill refinement through daily practice is essential, aiming maximum results with minimal invasiveness. This article examines challenging cases of percutaneous needle biopsy, biliary intervention, radiofrequency ablation, and percutaneous abscess drainage while referencing previous review articles and discusses how to succeed in these cases by employing various techniques and approaches in various image-guided procedures. This article aimed to provide interventional radiologists with a comprehensive and practical guide for enhancing their image-guided puncture techniques, ultimately leading to successful outcomes.

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  • Shuichi Tanoue, Masamichi Koganemaru, Asako Kuhara, Tomoko Kugiyama, J ...
    Article type: REVIEW
    2024 Volume 9 Issue 3 Pages 112-121
    Published: November 01, 2024
    Released on J-STAGE: November 01, 2024
    Advance online publication: October 04, 2024
    JOURNAL OPEN ACCESS

    Many pathological conditions involve the head and neck organs, which have complicated anatomy and functions. Recent advances in endovascular treatment have enabled clinicians to use it for treating various lesions, including hemorrhagic conditions, hypervascular tumors, and vascular malformations. Head and neck lesions may present with region-specific clinical manifestations, angioarchitecture, and complications, particularly regarding cosmetic, ingestion, respiratory, and neuronal functions. Therefore, the treatment strategy should consider cosmetic concerns and the preservation of critical functions. A detailed understanding of functional vascular anatomy and treatment techniques can help achieve successful management of head and neck lesions. This review summarizes the clinical manifestations of head and neck lesions, treatment strategies, and complications.

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  • Katsutoshi Takayama
    Article type: REVIEW
    2024 Volume 9 Issue 3 Pages 122-126
    Published: November 01, 2024
    Released on J-STAGE: November 01, 2024
    Advance online publication: February 09, 2023
    JOURNAL OPEN ACCESS

    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.

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  • Daisuke Yoshida
    Article type: REVIEW
    2024 Volume 9 Issue 3 Pages 127-133
    Published: November 01, 2024
    Released on J-STAGE: November 01, 2024
    Advance online publication: June 03, 2023
    JOURNAL OPEN ACCESS

    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.

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  • Yusuke Sakuhara
    Article type: REVIEW
    2024 Volume 9 Issue 3 Pages 134-141
    Published: November 01, 2024
    Released on J-STAGE: November 01, 2024
    Advance online publication: June 03, 2023
    JOURNAL OPEN ACCESS

    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.

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  • Masayoshi Yamamoto, Kentaro Yamada, Mitsuhiro Kinoshita, Hiroshi Kondo ...
    Article type: REVIEW
    2024 Volume 9 Issue 3 Pages 142-148
    Published: November 01, 2024
    Released on J-STAGE: November 01, 2024
    Advance online publication: February 09, 2023
    JOURNAL OPEN ACCESS

    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.

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  • Yutaka Koide, Takuya Okada, Masato Yamaguchi, Koji Sugimoto, Takamichi ...
    Article type: REVIEW
    2024 Volume 9 Issue 3 Pages 149-155
    Published: November 01, 2024
    Released on J-STAGE: November 01, 2024
    Advance online publication: August 11, 2023
    JOURNAL OPEN ACCESS

    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.

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  • Ryosuke Usui, Hiroshi Kondo
    Article type: REVIEW
    2024 Volume 9 Issue 3 Pages 156-163
    Published: November 01, 2024
    Released on J-STAGE: November 01, 2024
    Advance online publication: February 08, 2024
    JOURNAL OPEN ACCESS

    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.

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Original Research
  • Yoshisuke Kadoya, Hiroshi Demachi, Kentaro Mochizuki, Hitoshi Abo, Jun ...
    Article type: ORIGINAL RESEARCH
    2024 Volume 9 Issue 3 Pages 164-171
    Published: November 01, 2024
    Released on J-STAGE: November 01, 2024
    Advance online publication: July 24, 2024
    JOURNAL OPEN ACCESS

    Purpose: A membranous structure (MS) may be seen on ultrasound at a site of vascular access (VA) stenosis in patients on hemodialysis. It can also be encountered during percutaneous transluminal angioplasty (PTA) and be impassable from one side but easily passed from the other. This study aimed to examine the characteristics of MS cases and how to treat them.

    Material and Methods: Percutaneous transluminal angioplasty performed at our hospital for arteriovenous fistula-vascular access stenosis between July 2021 and June 2022 were identified. They were divided into two groups: membranous structure and nonmembranous structure. Data of patients such as age, history of dialysis and vascular access use, number of percutaneous transluminal angioplastys performed for vascular access, and diabetes status were collected. Membranous structure cases were examined in terms of puncture direction.

    Results: A total of 72 percutaneous transluminal angioplasty were performed in 37 patients. Membranous structure was identified in nine percutaneous transluminal angioplastys. Patients with membranous structure were older than those without membranous structure (mean age 75.3 ± 7.54 vs. 70.0 ± 10.8 years, P = 0.21) and tended to have a history of vascular access use (57.6 ± 106 vs. 48.4 ± 59.8 months, P = 0.28), a history of dialysis (152 ± 95.6 vs. 91.2 ± 116 months, P = 0.02), fewer percutaneous transluminal angioplasty procedures (1.44 ± 0.726 vs. 3.24 ± 2.69, P = 0.02), and lower incidence of diabetes (1 vs. 38 cases). In the nonmembranous structure group, all percutaneous transluminal angioplastys performed were successful. In the membranous structure group, six percutaneous transluminal angioplastys were successful, two were impassable, and one was acutely occluded. The successful cases and the acute obstruction case were passed by centrally directed puncture. Impassable cases involved peripheral directional puncture.

    Conclusions: Vascular access stenosis can be caused by membranous structure and successfully treated by bidirectional puncture.

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  • Yuji Koretsune, Hiroki Higashihara, Satoshi Toyoda, Miho Yamakawa, Koj ...
    Article type: ORIGINAL RESEARCH
    2024 Volume 9 Issue 3 Pages 172-179
    Published: November 01, 2024
    Released on J-STAGE: November 01, 2024
    Advance online publication: August 07, 2024
    JOURNAL OPEN ACCESS

    Purpose: This study aimed to evaluate the clinical outcomes of placing Viabahn stent grafts in visceral arterial injuries and identify the risk factors associated with stent graft occlusion.

    Material and Methods: This multicenter, retrospective study included 29 procedures performed on 26 patients who underwent Viabahn stent graft placement between December 2017 and November 2022. We evaluated technical and clinical success rates, periprocedural complications, and stent graft patency using contrast-enhanced computed tomography. We conducted univariate analysis to examine the risk factors associated with Viabahn stent graft occlusion.

    Results: The technical success rate was 96.6% (28 of 29), and the clinical success rate was 86.2% (25 of 29). The periprocedural complication rate was 17.2% (5 of 29), consisting of 4 mild adverse events and 1 patient death. The stent graft patency rates at 1, 3, 6, 12, and 24 months were 85%, 84.2%, 77.8%, 66.7%, and 50%, respectively. Univariate analysis indicated significant correlations between the lack of antiplatelet medication (P = .00074) and SG oversize ≥ 20% (P = .047).

    Conclusions: This trial demonstrated the safety and effectiveness of Viabahn stent graft placement for visceral arterial injuries with high patency rates. Additionally, this study identified the lack of antiplatelet treatment and Viabahn oversize ≥ 20% as significant risk factors for Viabahn stent graft blockage in visceral arterial injuries.

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Case Report
Technical Note
  • Takeshi Wada, Jun Koizumi, Takashi Takeuchi, Akira Akutsu, Satoshi Tsu ...
    Article type: TECHNICAL NOTE
    2024 Volume 9 Issue 3 Pages 186-191
    Published: November 01, 2024
    Released on J-STAGE: November 01, 2024
    Advance online publication: July 24, 2024
    JOURNAL OPEN ACCESS

    Purpose: Distal transradial access through the anatomical snuffbox has been highlighted in recent research because it provides extremely low invasiveness. It has demonstrated its feasibility and safety for cardiac intervention. However, its characteristics for noncardiac intervention are not well known. This report aims to demonstrate the feasibility and safety of noncardiac intervention with distal transradial access, with identification of practical devices for procedures.

    Material and Methods: This retrospective study was conducted from May 2021 to December 2021 with consecutive patients who underwent distal transradial access for noncardiac intervention. This study analyzed patient physical information, procedural details, technical success rates, and distal transradial access-associated complications.

    Results: Nine patients (7 females, 2 males) aged 48-69 years (median: 57) were enrolled in this study. This study assessed 11 noncardiac procedures, such as transarterial infusion chemotherapy for head and neck malignancies (n = 4), embolization of visceral artery aneurysm (n = 2), embolization of renal angiomyolipoma (n = 2), percutaneous transluminal renal angioplasty (n = 1), bronchial artery embolization (n = 1), and diagnostic angiography (n = 1). The introducer sheath size was 4-6 French. Catheters respectively having nine tip shapes were used. Reverse curve catheters were used only in two cervical procedures. The technical success rate was 91% (10/11). Of the 11 procedures, only 1 (bronchial artery embolization) required conversion to transfemoral access. There was no complication associated with distal transradial access. Ultrasound evaluation after treatments revealed patent radial arteries in all patients.

    Conclusions: Results revealed that distal transradial access is feasible with commercially available catheters and is safe for various noncardiac interventions.

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