The Official Journal of the Japanese Society of Interventional Radiology
Online ISSN : 2185-6451
Print ISSN : 1340-4520
ISSN-L : 1340-4520
Current issue
Showing 1-12 articles out of 12 articles from the selected issue
State of the Art
Interventional Radiology for Lymphatic System
  • Yusuke Ichijo
    2020 Volume 34 Issue 3 Pages 165
    Published: 2020
    Released: February 18, 2020
    JOURNALS RESTRICTED ACCESS
    Download PDF (497K)
  • Shuji Kariya, Miyuki Nakatani, Takuji Maruyama, Yasuyuki Ono, Yutaka U ...
    2020 Volume 34 Issue 3 Pages 166-171
    Published: 2020
    Released: February 18, 2020
    JOURNALS RESTRICTED ACCESS
    Treatment of lymphatic system disorders includes drainage, Denver shunt, pleurodesis, abla-tion of lymphocele, and embolization for lymphatic vessel or thoracic duct. In most cases, the interventional treatment is for lymph leakage. In order to identify the leakage site, a combi-nation of survey of fluid collection by drainage and lymphatic imaging is required. Knowledge of lymphatic anatomy and imaging are necessary to start lymphatic intervention. In the technique of pedal lymphangiography which is the traditional method, a tiny lymphatic duct in the dorsal legs must be exposed and then this duct is punctured using a small bore needle. Recently, it is difficult to learn this technique, and pedal lymphangiography has been replaced by intranodular lymphangiography. However, this technique is sometimes required in cases in which the in-guinal or femoral lymph nodes cannot be detected or the leakage site is in a lower limb.
    In this paper, we will present the anatomy of the lymphatic system and pedal lymphan-gio­graphy.
    Download PDF (1076K)
  • Masayoshi Yamamoto
    2020 Volume 34 Issue 3 Pages 172-176
    Published: 2020
    Released: February 18, 2020
    JOURNALS RESTRICTED ACCESS
    Intranodal lymphangiography (IL) a recently introduced technique provides a diagnostic and therapeutic method of lymphatic disorders. The benefits of this technique include reduced technical difficulty and shorter procedure duration, as compared to traditional pedal lym-phangiography (PL). The scope of this lecture is to understand the fundamentals and advanced techniques of performing lymphangiography as well as important points for safe and proper use of Lipiodol®.
    [Intranodal lymphangiography] The original procedure of IL first described in 1952 by Bruun et al. is characterized by a direct puncture of enlarged lymph nodes under palpation. As it was not performed under ultrasound guidance, the indications for IL were limited and less preferred than PL. However, the circumstances changed after 45 years when Rajebi et al. and Nadolski et al. reported the effectiveness of IL in the pediatric field; they started to perform IL under US guidance, and since then, IL has become popularized as a simple method for evaluation and intervention of lymphatic disorders.
    [Direct Puncture Retrograde Thoracic Duct Access] This technique is an alternative method of thoracic duct (TD) intervention first reported in 2016 by Carlos J. et al. It is characterized by direct insertion into the venous system at the base of the left neck during lymphangiography or US guidance. This technique is especially useful to visualize the terminal portion of the TD, which is located between the internal jugular vein and the left vertebral vein. The superficial location of the TD and the high accuracy in identifying the TD in the left neck under US guidance provides sufficiently high visibility to access the TD under iodine-based lymphan-giography. Thus, this method is safely applicable for cases with right-left shunt without taking the risk of systemic embolization.
    Download PDF (1225K)
  • Tomohiro Matsumoto, Kosuke Tomita, Shunsuke Kamei, Kazunobu Hashida, S ...
    2020 Volume 34 Issue 3 Pages 177-181
    Published: 2020
    Released: February 18, 2020
    JOURNALS RESTRICTED ACCESS
    Loss of chyle into the thoracic/peritoneal cavity can lead to serious life-threatening conse-quences because of the significant loss of fluid, plasma protein, fats and immunoregulatory lymphocytes, and clinical features of severe malnutrition, hyponatraemia, acidosis, hy-pocalcaemia and susceptibility to infection. We reported that lymphangiography was effective not only for diagnosis but also as treatment for various chyle leakages. Since then, reports on lymphatic interventions including therapeutic lymphangiography for lymphatic leaks and thoracic duct embolization (TDE) for postoperative chylothorax have been increasing in number. However, postoperative lymphatic leakage remains a challenging clinical problem with high mortality in post esophageal surgery. Despite this clinical problem, an animal model for lymphatic interventions has not been developed so far. There have been a few reports on a swine model of lymphangiography and TDE. It is true that a swine model mimics the human lym-phatics. However, a swine model has higher maintenance costs and is harder to handle. Spe-cialized infrastructure and trained personnel are needed for experimental study in swine. On the other hand, rabbits are inexpensive, easy to manage in a laboratory setting and have an organ system like that of humans. For lymphatic interventions and future lymphatic imaging, detailed lymphatic anatomical features in a rabbit model should be elucidated. Here, we would like to introduce therapeutic lymphangiography for various lymphatic leaks, and feasibility of lym-phangiography and the visibility of the lymphatic system on post-lymphangiographic multi-detector row CT for preclinical lymphatic interventions in a rabbit model.
    Download PDF (861K)
  • Alisa Suzuki-Han
    2020 Volume 34 Issue 3 Pages 182-186
    Published: 2020
    Released: February 18, 2020
    JOURNALS RESTRICTED ACCESS
    The number of publications regarding thoracic duct embolization is booming. It was only 2250 papers between 1975-2000, doubled (4720) between 2000-2010 and has now reached nearly 7000 papers published within the last 8 years.
    The thoracic duct is the body's largest lymphatic conduit, draining upwards of 75% of lym-phatic fluid and extending from the cisterna chyli to the left jugulovenous angle. Thoracic duct embolization for chylous thoracic effusion is emerging as a result of the increasing popularity of minimally invasive neck and thoracic area surgery.
    Chylous leakage and chylous ascites may result in significant morbidity and mortality. Although conservative dietary treatments and invasive open surgery methods exist, the majority of tho-racic duct injury require embolization in the interventional suite.
    Thoracic duct embolization requires a combination of very basic angiography and interventional radiology skills, such as fluoroscopic guidance, ultrasound guidance, percutaneous access of cisterna chyli or lower thoracic duct followed by wiring and cannulation, embolization with coils and glue. Thoracic duct embolization is an emerging technique; however, the required skills are all well known to us. Once one understands the anatomy and pitfalls of this procedure, Thoracic duct embolization should not be a challenging procedure.
    Download PDF (944K)
  • Masanori Inoue, Hideyuki Torikai, Nobutake Ito, Masashi Tamura, Ryo Og ...
    2020 Volume 34 Issue 3 Pages 187-192
    Published: 2020
    Released: February 18, 2020
    JOURNALS RESTRICTED ACCESS
    One of the important functions of the lymphatic system is maintenance of fluid balance, and lymphatic leakage after surgery potentially becomes a critical condition.
    Interventional techniques could not treat lymphatic leakage effectively mostly due to the lack of clinical imaging. However, the recently developed intranodal lymphangiography provides new insight into lymphatic intervention. At first, thoracic duct embolization has become the method of choice for the treatment of patients with chylothorax. Abdominal lymphatic leakage as a complication of abdominal and pelvic surgery is an uncommon but difficult-to-treat condition when conservative measures have failed. Embolization and sclerotherapy are also very useful for refractory lymphatic leakage. These current advances will open up new treatments and diag-nostic opportunities for abdominal lymphatic leakage.
    Download PDF (1249K)
Case Reports
  • Yukari Nakamura, Tsuyoshi Tajima, Tomoyuki Noguchi, Yoshitaka Shida, T ...
    2020 Volume 34 Issue 3 Pages 193-197
    Published: 2020
    Released: February 18, 2020
    JOURNALS RESTRICTED ACCESS
    A man in his 60s was admitted to our hospital for the treatment for post-operative intrahepatic recurrence of hepatocellular carcinoma with transcatheter arterial chemoembolization (TACE). During hepatic arteriography, angiospasm of the common hepatic artery occurred. We then performed intra-arterial injection of epirubicin-lipiodol suspension via the right inferior phrenic artery as an alternative treatment for TACE. Anorexia appeared at 12 days after the initial an-giography; contrasted-enhanced CT revealed a 17-mm aneurysm in the pancreatic head, a hematoma around the aneurysm, and a passage disorder in the third portion of the duodenum. Emergency superior mesenteric arteriography demonstrated a saccular aneurysm of the anterior inferior pancreatico-duodenal artery near the pancreatic head. Coil embolization was performed for the ruptured aneurysm using the isolation technique. Contrast-enhanced CT after coil embolization proved disappearance of the peripancreatic hematoma, and the passage of the duodenum improved.
    In this case, it was considered that retrograde blood flow in the pancreatic arterial arcade increased due to angiospasm of the hepatic artery, and an aneurysm developed in a very short period.
    Download PDF (1181K)
feedback
Top