Pancreaticoduodenectomy (PD) is one of the most challenging procedures in gastrointestinal surgery. However, the 90-day postoperative mortality rate for PD has improved from 3.0% in 2012 to 1.6% in 2021. We believe that this improvement is largely attributable to the centralization of pancreatic surgery and advances in the management of postoperative complications. Notably, in our department, of the 898 pancreatic resections performed between 2010 and 2024, including pancreaticoduodenectomies, the 90-day postoperative mortality rate and in-hospital mortality rate were both zero.

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Pancreatectomy is an extremely difficult operation involving anastomosis of the pancreatic duct to the gastrointestinal tract, with multiple resection techniques depending on the site of the lesion. Many serious complications can occur after pancreatectomy, including bleeding due to incomplete ligation during surgery, bleeding from a pancreatic fistula, infection, or vascular injury due to drain placement, and complications due to portal vein stenosis. Appropriate imaging and IVR treatment are crucial for early detection of these postoperative complications and prevention of serious complications. This article describes the typical complications that occur after pancreatectomy, including risk factors based on the surgical technique and pathophysiology, as well as key points for image interpretation.

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Acute pancreatitis is classified into interstitial edematous pancreatitis and necrotizing pancreatitis based on the presence or absence of necrosis. The mortality rate of infected pancreatic necrosis is high, and interventional treatment is recommended. In recent years, endoscopic and interventional radiological approaches have shown good treatment outcomes. The step-up approach, which starts with minimally invasive drainage and progresses to necrosectomy if necessary, has become the standard recommendation. Endovascular treatment is widely used as the first-choice treatment for pseudoaneurysms and hemorrhage after chronic or acute pancreatitis.
In follow-up after acute or chronic pancreatitis, diagnostic imaging plays a crucial role in identifying local complications. When local complications occur, timely intervention is important, and the interventional radiologist should be familiar with the indications and approaches. This article provides an overview of the key points of imaging diagnosis and appropriate timing and methods for interventional treatment, focusing on local complications after acute and chronic pancreatitis.

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Interventional radiology (IVR) plays an important role in the management of bleeding after pancreatectomy or due to pancreatitis. In pancreatectomy, the mortality rate and complications are lower in high-volume centers, and cases tend to be concentrated in high-volume centers in recent years. They require advanced IVR techniques such as stent graft insertion to preserve arteries, as well as embolization for postoperative hemorrhage. However, many radiologists/IVR physicians need to be familiar with embolization for hemorrhage and pseudoaneurysms caused by pancreatitis. Each institution must collaborate closely with surgeons and physicians to perform IVR promptly and accurately.

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Peripancreatic fluid collection (PFC) is a local complication of acute pancreatitis, and when accompanied by infection, drainage is required. In recent years, endoscopic ultrasound-guided peripancreatic fluid drainage (EUS-PFD) has become a widely adopted first-line treatment, with its effectiveness increasingly reported. In this review, to facilitate the understanding of radiologists who do not perform endoscopic ultrasound (EUS) themselves, the approach to interpreting convex-type EUS images is first described. Although EUS-PFD is an established minimally invasive treatment for PFC, appropriate patient selection and optimization of the treatment strategy remain essential. A solid understanding of EUS images is crucial to achieving successful outcomes. More evidence is needed in this field.

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In recent years, computed tomography (CT)-guided interventional radiology (IVR) procedures, including lung biopsy, drainage, and radiofrequency ablation (RFA), have been increasingly performed due to their clinical effectiveness. During CT-guided procedures, both the operator and healthcare staff, such as nurses and clinical engineers, are exposed to radiation. However, though radiation exposure to the operator has been studied, little data exist on staff exposure.
This study aimed to assess real-time radiation exposure to both operators and healthcare staff during CT-guided IVR procedures using the RaySafe i3 system. The device recorded radiation dose rates every second, and video recordings were used to track staff positioning and movements. Data were analyzed for biopsies (33 cases), RFA (32 cases), and cryoablation (23 cases).
The results showed that cumulative radiation doses were the highest in cryoablation cases due to the longer procedure times. Nurses had higher dose rates when positioned near the patient’s head, especially when administering medication or providing care. Clinical engineers generally had lower exposure due to the use of protective barriers. In some cases, staff dose rates exceeded those of the operator. These findings highlight the need for enhanced radiation protection measures for healthcare staff in CT-guided IVR procedures.

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The case of a woman in her 40s with a renal arteriovenous malformation (AVM) is described. Renal angiography showed an aneurysmal-type AVM with feeding artery stenosis and multiple tortuous vessels that resembled cirsoid-type renal AVMs. These tortuous vessels were connected to the feeding artery of the aneurysmal-type AVM, indicating that they were not true cirsoid-type AVMs, but collateral vessels that developed secondary to the feeder stenosis.
Coil embolization of the shunt and percutaneous transluminal angioplasty (PTA) for the stenosis were performed. Following embolization and PTA, the tortuous vessels disappeared.
In conclusion, collateral formation was likely induced by pressure gradients caused by the aneurysmal-type AVM and proximal arterial stenosis.

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Brachial artery aneurysms are a rare type of peripheral artery aneurysm. Although surgical intervention is the standard treatment, interventional radiology may be considered for high-risk patients, such as older adults.
The patient was a woman in her 80s who was transferred to our clinic with sudden onset of coldness in her right upper extremity. Contrast-enhanced computed tomography (CT) showed an aneurysm with a mural thrombus in the right brachial artery and occlusion of the distal brachial artery. She was diagnosed with acute right upper limb ischemia due to distal embolization of a thrombus originating from a brachial artery aneurysm.
To prevent the progression of ischemia and tissue necrosis in the right upper extremity, stent graft placement and thrombectomy were performed. Eight months after the treatment, contrast-enhanced CT showed stent graft occlusion and migration of its distal end into the aneurysm. Although type Ib and II endoleaks persisted, there was no recurrence of distal embolism in the right upper limb.

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