The cranial venous system differs greatly in individuals with an abundance of variations. Without preoperative information on them, the neurovascular interventional treatment strategies for intracranial vascular lesions may be inappropriate leading to serious complications, e.g., an ill-advised or inadvertent injury to the dominant sinuses or superior jugular bulb may cause serious intracranial hemorrhage owing to venous congestion.
Mainly using contrast-enhanced MR venography and 3D-CT venography, we illustrate venous anatomy and variations regarding the dural sinuses and emissary veins in the posterior fossa, veins of the craniocervical junction, cavernous sinus including the connected intra- and extra-cranial venous groups, and internal jugular veins. Furthermore, a brief review of development in the fetal period may help to explain some of the variations.
In this way it is hoped that preoperative information will facilitate shortening of the procedure time for intervention and avoiding complications.

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The arteriovenous malformations/fistulas in the head and neck region show a complicated angioarchitecture. Embolotherapy for these lesions has been recognized as a safe and effective treatment. However, inappropriate treatment carries risks of incomplete obliteration, recurrence, and procedure-related complications. Transvenous embolization was established as a curative treatment technique for sinus type intracranial dural arteriovenous fistulas. Recently, this treatment technique has been applied also for the treatment of intra-and extracranial arteriovenous malformations. To achieve safe and effective treatments, physicians should pay attention to the angioarchitectures of the venous side of the malformations/fistulas. In this article, we demonstrate the treatment strategies and method focusing on the venous drainage.

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Transvenous embolization (TVE) is a standard treatment for cavernous sinus dural arteriovenous fistulas (CSDAVFs). Although the standard TVE technique, whole sinus packing with multiple coils, is highly effective, sinus packing can cause cranial nerve injury induced by the coil mass or disturbance of the normal venous drainage. Selective TVE, selective embolization of the shunted pouch, has been developed to deal with such complications, and it has been recently performed in selected cases of CSDAVF with localized shunted pouches. However, it has a potential risk of recurrence, and retreatment by TVE through the occluded inferior petrosal sinus (IPS) may be difficult. Angioplasty of the occluded IPS combined with selective TVE may reduce the difficulty of catheterization to the CS through the IPS when retreatment is required. Furthermore, angioplasty of the occluded IPS can reconstruct normal antegrade cerebral venous drainage through the IPS. In this paper, we will describe this combined technique, and some important anatomy of the cavernous sinus, inferior petrosal sinus, and relevant veins briefly.

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We review venous sampling of the parathyroid and cavernous sinus. Though these sampling tests are not performed as routine examinations, they can have a crucial impact in therapeutic decision making. Parathyroid venous sampling is useful in cases with discrepancy between the findings of 99mTc-MIBI scintigraphy and CT/US imaging, suspicion of ectopic parathyroid adenoma, or unknown origin. Cavernous sampling is useful in cases with differential diagnosis of Cushing disease and other causes (Cushing syndrome, especially in ectopic ACTH-producing tumor). In preparation for venous sampling, we recommend assessing venous anatomy such as level of junction, dominant vessels, and normal variants using thin-slice contrast enhanced CT or MRI images.

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This study aimed to investigate the cumulative radiation dose (CRD) of patients with hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolization (TACE). This survey was performed to examine the computed tomography (CT) and TACE radiation doses. A total of 369 cases (157 patients) underwent TACE from July 2012 to November 2018. Among them, 132 cases (66 patients) that underwent (i) TACE as the initial treatment, (ii) performed by a single physician, and (iii) whose total exposure information, was available were included in this study. Radiation doses for TACE, CT angiography during TACE, follow-up CT, and CT immediately before the first TACE were included in the survey. CRD was expressed using an effective dose, and was calculated by multiplying the dose area product (DAP) and dose length product (DLP) based on respective conversion factors.
CRD was 323.6±214.5 mSv, and CT accounted for 80% of CRD. CRD of follow-up CT was directly proportional to the survival time (r = 0.986, P < 0.001). Hence, CRD was affected by the survival time and TACE doses. Additionally, patients should undergo routine CT examination; thus, reducing the radiation dose in one examination effectively decreases CRD. In addition, some factors increased the total radiation dose in TACE; therefore, prior treatment planning may lead to dose reduction in these cases.

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We present the case of a septuagenarian man with obstructive jaundice due to bile duct cancer at the anastomosis of a choledoco-jejunostomy after pancreatoduodenectomy for carcinoma of the papilla of Vater. It was treated by percutaneous transhepatic cholangio-drainage (PTCD) and biliary stent placement. Eleven months after biliary stenting, expansion of the blind end of the jejunal limb and acute pancreatitis developed due to jejunal limb stenosis caused by enlargement of the anastomotic bile duct cancer. Pancreatitis was treated by decompression of the jejunal limb by percutaneous jejunostomy.
The jejunal limb stenosis was negotiated via the combination of the jejunostomy and PTCD route, and a metallic stent was placed for the jejunal limb stenosis.
The patient has been followed up at the outpatient department and remains in good condition five months after the procedure.

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[Case 1] This case was a man in his 60s. The patient’s right adrenal vein (RAV) was unclear on pre-procedural contrast enhanced computed tomography (CT) scan, and catheter cannulation was difficult during the adrenal vein sampling (AVS) procedure. Although the transarterial venography from the right inferior phrenic artery to identify the RAV was unsuccessful, CT scan taken during the procedure revealed the RAV with a unique anatomy; it ran parallel along the inferior vena cava (IVC). AVS was successfully performed using a microcatheter. The patient was diagnosed with bilateral primary aldosteronism. [Case 2] This case was a woman in her 60s. The patient’s RAV was unclear on CT scan, and catheter cannulation was difficult. CT during transarterial venography demonstrated that the right adrenal central vein had an acute angle, which caused difficulty in identifying the RAV. AVS was performed successfully. She was diagnosed with unilateral primary aldosteronism. These two successful cases highlight the use of AVS with transarterial venography to identify the RAV with unusual configurations. This method may be helpful in cases in which it is difficult to identify and cannulate a catheter in the RAV.

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Isolated abdominal aortic dissection is a rare type of aortic dissection. This disease may be accompanied by complications like abdominal pain, and intestinal and lower limb ischemia. We report a case of isolated abdominal aortic dissection with intermittent claudication which was successfully treated by an endovascular stent graft procedure. A man in his 90s was referred to our hospital with the complaint of intermittent claudication. His bilateral ankle-brachial pressure index (ABI) was approximately 0.65. Computed tomography (CT) scan revealed an isolated abdominal aortic dissection with true lumen compression which caused lower limb ischemia. Endovascular aortic repair was planned and a stent graft, VELATM Proximal Endograft (Endologix, Irvine, USA), was placed in the dissected abdominal aorta. The ABI was bilaterally restored to over 1.00, and the symptom of intermittent claudication has been absent since the endovascular aortic repair.

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