Hiroki Sanda

Wakayama Medical University, Wakayama, Wakayama, Japan

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Publications (30)33.8 Total impact

  • Journal of vascular and interventional radiology: JVIR 09/2014; 25(9):1477-1478. · 1.81 Impact Factor
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    ABSTRACT: We describe an 85-year-old man suffering lower urinary tract symptoms, who underwent prostatic artery embolization (PAE) based on a prostate-supplying arteriogram created with multidetector-row computed tomography during pelvic arteriography. This arteriogram was synthesized from a background bone volume-rendered (VR) image, an aorta-pelvic artery VR image, and a prostate-supplying artery VR image. Because the bone background VR image is combined with the aorta-pelvic artery VR image, the prostate-supplying arteriogram can simultaneously show the pelvic branch arteries present on the ventral side, inside, and the dorsal side of the pelvic bone. It showed that the left prostatic artery supplied the urethra at the outlet of the urinary bladder. PAE of the left prostatic artery was performed with catheter navigation based on the prostate-supplying arteriogram. There was marked relief of the lower urinary tract symptoms at the 12-month follow-up.
    Japanese journal of radiology 05/2014; · 0.73 Impact Factor
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    ABSTRACT: To compare the inflammatory, coagulopathic, and fibrinolytic responses after endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm between two stent grafts. Fibrinogen degradation product (FDP) levels were compared between patients with or without an endoleak. EVAR was performed in 88 patients using an Excluder (37 patients) or a Zenith (51 patients). White blood cell count (WBC), C-reactive protein (CRP) levels, platelet count, and FDP levels were measured before and after EVAR. WBC and CRP increased and the platelet count decreased significantly on days 1 and 3 after EVAR in the Zenith group compared with the Excluder group. The change in FDP from baseline to 7 days after EVAR was -1.99 ± 7.46 vs. 8.59 ± 9.38 μg/mL in patients with (n = 24) vs. without (n = 64) an endoleak (p < 0.001). A change in FDP of 3.1 μg/mL was the optimal cutoff point for predicting the presence of an endoleak (accuracy 0.762; sensitivity 0.875; specificity 0.717). Inflammatory, coagulopathic, and fibrinolytic responses were greater in the Zenith group than in the Excluder group. A change in FDP of ≤3.1 μg/mL was predictive of an endoleak after EVAR.
    Japanese journal of radiology 04/2014; · 0.73 Impact Factor
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    ABSTRACT: We present a case of a patient with rapid deterioration of esophageal varices caused by portal hypertension accompanied by a large arterioportal shunt that developed after radiofrequency ablation of hepatocellular carcinoma. We used n-butyl cyanoacrylate (NBCA) as an embolic material to achieve pinpoint embolization of the shunt, because the microcatheter tip was 2 cm away from the shunt site. Under hepatic arterial flow control using a balloon catheter, the arterioportal shunt was successfully embolized with NBCA, which caused an improvement in the esophageal varices.
    Korean journal of radiology: official journal of the Korean Radiological Society 01/2014; 15(2):250-253. · 1.32 Impact Factor
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    ABSTRACT: Aortography for detecting hemorrhage is limited when determining the catheter treatment strategy because the artery responsible for hemorrhage commonly overlaps organs and non-responsible arteries. Selective catheterization of untargeted arteries would result in repeated arteriography, large volumes of contrast medium, and extended time. A volume-rendered hemorrhage-responsible arteriogram created with 64 multidetector-row CT (64MDCT) during aortography (MDCTAo) can be used both for hemorrhage mapping and catheter navigation. The MDCTAo depicted hemorrhage in 61 of 71 cases of suspected acute arterial bleeding treated at our institute in the last 3 years. Complete hemostasis by embolization was achieved in all cases. The hemorrhage-responsible arteriogram was used for navigation during catheterization, thus assisting successful embolization. Hemorrhage was not visualized in the remaining 10 patients, of whom 6 had a pseudoaneurysm in a visceral artery; 1 with urinary bladder bleeding and 1 with chest wall hemorrhage had gaze tamponade; and 1 with urinary bladder hemorrhage and 1 with uterine hemorrhage had spastic arteries. Six patients with pseudoaneurysm underwent preventive embolization and the other 4 patients were managed by watchful observation. MDCTAo has the advantage of depicting the arteries responsible for hemoptysis, whether from the bronchial arteries or other systemic arteries, in a single scan. MDCTAo is particularly useful for identifying the source of acute arterial bleeding in the pancreatic arcade area, which is supplied by both the celiac and superior mesenteric arteries. In a case of pelvic hemorrhage, MDCTAo identified the responsible artery from among numerous overlapping visceral arteries that branched from the internal iliac arteries. In conclusion, a hemorrhage-responsible arteriogram created by 64MDCT immediately before catheterization is useful for deciding the catheter treatment strategy for acute arterial bleeding.
    SpringerPlus 01/2014; 3:67.
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    ABSTRACT: We herein present a rare case of acute appendicitis with intestinal malrotation. Coronal images of contrast-enhanced computed tomography (CT) revealed the small intestine on the right side and the large intestine on the left side, thus indicating intestinal malrotation (non-rotation type). In addition, an enhanced, tubular, fluid-filled structure was detected attached to the cecum, which was located superior to the urinary bladder, suggesting acute appendicitis. The present study shows that coronal CT images provide important information for the diagnosis and treatment of acute appendicitis in patients with intestinal malrotation.
    Internal Medicine 01/2014; 53(14):1511-3. · 0.97 Impact Factor
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    ABSTRACT: Scanning timing for multi-detector row computed tomography during thoracic aortography (MDCT-TA) was explored for depiction of arteries responsible for hemoptysis. The mean time (MT) from contrast medium (CM) injection to peak enhancement (PE) in the descending aorta at the level of the diaphragm on thoracic aortography was investigated. The MT to PE of the descending aorta at the level of diaphragm was 4.86 ± 0.42 s, with 30 mL CM at an injection rate of 10 mL/s. CM injection was completed 1.86 s before the final slice was obtained. The CM injection duration can be calculated as follows: 4.86 s + scan time - 1.86 s. The optimal scanning timing is a scan delay of approximately 5 s from the start of CM injection, and the CM injection duration is expressed as scan time plus 3 s. MDCT-TA depicted the branching sites of the bronchial arteries in all cases.
    Radiological Physics and Technology 12/2013;
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    ABSTRACT: The present report describes two cases of endoscopically unmanageable rectal varices that were treated by balloon-occluded antegrade transvenous sclerotherapy (BATS) followed by microcoil embolization. Follow-up endoscopy confirmed eradication of the rectal varices. Balloon-occluded rectal venography showed stasis of contrast material and sclerosing agent for 30 minutes in both cases of rectal varices, which indicated that the inflow vessel was a single dilated superior rectal vein without other minor inflow vessels. BATS appears to be a feasible therapeutic option for the treatment of rectal varices of this hemodynamic type.
    Journal of vascular and interventional radiology: JVIR 09/2013; 24(9):1399-403. · 1.81 Impact Factor
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    ABSTRACT: To compare the degree of uterine damage caused by uterine artery embolization (UAE) with gelatin sponge particles (GSPs) and N-butyl cyanoacrylate (NBCA) in swine. Fifteen swine were divided into three groups of five according to embolic material: group A (1-mm GSPs), group B (NBCA:Lipiodol = 1:1), and group C (NBCA:Lipiodol = 1:7). The uterine arteries were completely occluded bilaterally. The uteri were removed 3 days after embolization, and radiographs of the removed specimens were obtained in groups B and C to evaluate the distribution of the NBCA. The macroscopic necrosis rates of the uteri were calculated, and the uteri were evaluated histologically. Uterine necrosis rates were 4.9 ± 6.1, 1.3 ± 3.3, and 41.4 ± 28.8 % in groups A, B, and C, respectively, and were significantly higher in group C than in groups A (p = 0.0014) and B (p < 0.001). Uterine necroses were found in all 9 of the uteri with distal distributions of NBCA, and in only 1 of the 11 uteri with proximal distributions of NBCA. Dilute NBCA caused more damage to the uteri than GSPs and concentrated NBCA did. Distal embolization using NBCA caused large necroses. Therefore, proximal UAE using concentrated NBCA should be considered in clinical situations.
    Japanese journal of radiology 08/2013; · 0.73 Impact Factor
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    ABSTRACT: PURPOSE: To investigate the midterm results of abdominal aortic aneurysm repair (EVAR) and compare the endoleak (EL) and abdominal aortic aneurysm (AAA) prognoses between instruction-for-use (IFU) patients and non-IFU patients. MATERIALS AND METHODS: Of 124 patients (104 men, 20 women; mean age 76.2 years; age range 58-93 years) with AAA who underwent EVAR with the Zenith (68 patients) or Excluder device (56) and were analyzed, 86 were IFU and 38 non-IFU. RESULTS: The mean absorbed dose of radiation exposure was 1907 mGy in the IFU group and 2283 mGy in the non-IFU group (p = 0.013). Thirty-five patients experienced EL: 8 (6.5 %) type I and 27 (21.8 %) type II. Type I ELs were observed in 3 patients in the IFU group (3.5 %) and 5 patients in the non-IFU group (13.2 %). Of the 14 patients with AAA diameter expansion of ≥5 mm, 6 (6/86, 7.0 %) belonged to the IFU group and 8 (8/38, 21.1 %) to the non-IFU group (p = 0.027). CONCLUSION: The frequency of AAA expansion ≥5 mm was higher in non-IFU patients than in IFU patients. Therefore, careful follow-up is necessary for non-IFU patients rather than IFU patients.
    Japanese journal of radiology 06/2013; · 0.73 Impact Factor
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    ABSTRACT: PURPOSE: To compare therapeutic effect, adverse events, and embolized hepatic artery impairment in transcatheter arterial chemoembolization between Lipiodol plus insoluble gelatin sponge particles (Gelpart) and Lipiodol plus 2-day-soluble gelatin sponge particles (2DS-GSPs). MATERIALS AND METHODS: In a single-center, prospective, randomized controlled trial, patients with hepatocellular carcinoma were assigned to the 2DS-GSP group or the Gelpart group. Radiographic response at 3 months per modified Response Evaluation Criteria In Solid Tumors was evaluated as the primary endpoint; secondary endpoints were safety (per Common Terminology Criteria for Adverse Events, version 4.0) within 3 months and hepatic branch artery impairment at the time of repeat chemoembolization (grade 0, no damage; grade I, mild vessel wall irregularity; grade II, overt stenosis; grade III, occlusion of more peripheral branch artery than subsegmental artery; grade IV, occlusion of subsegmental artery). Grade II, III, or IV indicated significant hepatic artery impairment. RESULTS: Thirty-seven patients with 143 nodules were randomized to the 2DS-GSP group and 36 patients with 137 nodules were randomized to the Gelpart group. No significant differences in patient background existed between groups. Target lesion response and overall tumor response in the 2DS-GSP and Gelpart groups were 77.7% versus 76.9% and 78.3% versus 77.8%, respectively, with no significant differences. No significant difference in adverse events existed between groups. Hepatic artery impairment was observed in 5% of patients in the 2DS-GSP group (n = 32) and in 16% in the Gelpart group (n = 33; P< .001). CONCLUSIONS: Transcatheter arterial chemoembolization with 2DS-GSPs resulted in the same therapeutic and adverse effects as chemoembolization with Gelpart while causing significantly less hepatic artery impairment.
    Journal of vascular and interventional radiology: JVIR 05/2013; · 1.81 Impact Factor
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    ABSTRACT: CT during aortography (CTAo) using IVR 64-multidetector-row CT (IVR-64MDCT) enables the rapid and simultaneous depiction of both the hepatic and extrahepatic feeding arteries in hepatocellular carcinoma (HCC), and can be achieved using a reasonable volume of contrast medium. The scan time is approximately 6 s from the diaphragm to the kidney using CTAo with 64MDCT with a slice thickness and slice interval of 0.5 mm. The hepatoma feeding arteriogram appears in the angiographic monitor after CTAo, and can then be used to guide catheterization. We introduce the process for creating a hepatoma feeding arteriogram, synthesized from the following three volume-rendered images: background bone, aorta to hepatic-branch artery, and hepatoma to feeding artery. Uniquely, the hepatoma feeding arteriogram enables investigation of the feeding artery from the tumor side, rather than from the aorta side, and appears superior to selective arteriography in terms of detecting small HCC and its accompanying fine feeding arteries. Identification of these arteries by CT angiography with intravenous contrast medium injection is difficult because of the similarity in CT values between the feeding artery and the surrounding liver, thereby preventing the creation of a hepatoma feeding arteriogram. CTAo accelerates the process of deciding upon the catheter treatment strategy, shifting the decision to the point at which the feeding artery is investigated, because the hepatoma feeding arteriogram enables instant identification of the feeding artery and its connection to the hepatic branch artery. CTAo with IVR-64MDCT can potentially contribute to remarkable advances in IVR, especially transcatheter arterial chemoembolization for HCC.
    Japanese journal of radiology 05/2013; · 0.73 Impact Factor
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    ABSTRACT: In this report we introduce percutaneous transportal outflow-vessel-occluded sclerotherapy (PTOS) for gastric varices unmanageable by balloon-occluded retrograde transvenous obliteration (BRTO) in two cases and evaluate its safety and efficacy. The PTOS is a technique which could obstruct gastric varices subsequent to the occlusion of the outflow route, being based on the rationale of BRTO. In the PTOS procedure, coil embolization of the outflow vessel is first conducted through a microcatheter advanced beyond the gastric varices via the percutaneous transhepatic approach; sclerosing agent (5% ethanolamine oleate) is then injected into the gastric varices after confirmation of static blood flow in the varices. Two patients underwent initial BRTO that eventually failed because of the presence of numerous fine and abruptly angled outflow vessels (case 1), and the presence of a tortuous and elongated outflow vessel accompanied by numerous small collateral outflows that could not be occluded (case 2). Cases 1 and 2 received PTOS using 5% ethanolamine oleate (15 mL and 10 mL, respectively). Portal venous pressure following PTOS showed an increase from 29 to 34 mmHg in case 1 and remained at 24 mmHg in case 2. No major complication was encountered in either patient. One-year follow-up gastroendoscopy showed no recurrence of gastric varices in either patient. Although PTOS is slightly more invasive than BRTO, PTOS can be used as an alternative catheter treatment procedure for gastric varices that are unmanageable by BRTO.
    Hepatology Research 04/2013; 43(4):430-5. · 2.07 Impact Factor
  • Journal of vascular and interventional radiology: JVIR 03/2013; 24(3):445-7. · 1.81 Impact Factor
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    ABSTRACT: To compare the efficacy and safety of bronchial artery embolization (BAE) with n-butyl cyanoacrylate (NBCA) and gelatin sponge particles (GSPs). Six healthy female swine were divided into two groups to be treated with BAE using NBCA-lipiodol (NBCA-Lp) and using GSPs. The occlusive durability, the presence of embolic materials, the response of the vessel wall, and damage to the bronchial wall and pulmonary parenchyma were compared. No animals experienced any major complication. Two days later, no recanalization of the bronchial artery was observed in the NBCA-Lp group, while partial recanalization was seen in the GSP group. Embolic materials were not found in the pulmonary artery or pulmonary vein. NBCA-Lp was present as a bubble-like space in bronchial branch arteries of 127-1240 μm, and GSPs as reticular amorphous substance of 107-853 μm. These arteries were in the adventitia outside the bronchial cartilage but not in the fine vessels inside the bronchial cartilage. No damage to the bronchial wall and pulmonary parenchyma was found in either group. Red cell thrombus, stripping of endothelial cells, and infiltration of inflammatory cells was observed in vessels embolized with NBCA-Lp or GSP. NBCA embolization is more potent than GSP with regard to bronchial artery occlusion, and both materials were present in bronchial branch arteries ≥ 100 μm diameter.
    World journal of radiology. 12/2012; 4(12):455-61.
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    ABSTRACT: To clarify the configuration change of N-butyl cyanoacrylate (NBCA) polymerization with increasing proportion of ethanol, the properties of a mixture of NBCA with lipiodol plus ethanol (NLE), and the feasibility of use of NLE for aneurysm packing in a swine model. The polymerization configuration of NLE was explored using ratios of 1-4 parts NBCA and 1-3 parts ethanol per 1 part of lipiodol; a 1:1 ratio of NBCA to lipiodol (NLE110) was used as a control. The distance that NLE migrated into saline flowing in a tube was measured. A carotid artery aneurysm was created in each of 18 swine. Aneurysmal packing with three configurations-NLE110, NLE at a ratio of 1:1:2 (NLE112), and NLE at a ratio of 1:1:3 (NLE113)-was attempted in six swine for each configuration. Regardless of NBCA composition, medium-sized droplets, a single large droplet, and a noodle-shaped extrusion were observed in NLE with lipiodol versus ethanol ratios of 1:1, 1:2, and 1:3. NLE110 migrated as viscous fluid to 190cm from the injection site, whereas NLE112 migrated for 81cm±11 and NLE113 migrated for 74cm±9. Instant outflow of NLE110 from the six aneurysms caused occlusion of the parent artery, with adhesion to the microcatheter. Packing was achieved with minimal adhesion for all six of the aneurysms packed with NLE112 or with NLE113. With high ratios of ethanol, the NLE polymerization configuration acquired solid-like properties with potent occlusive ability and negligible adhesion to the microcatheter, suggesting its feasibility for packing of aneurysms.
    Journal of vascular and interventional radiology: JVIR 11/2012; 23(11):1516-21. · 1.81 Impact Factor
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    ABSTRACT: PURPOSE: To evaluate the safety and the delivery function of cisplatin-conjugated-soluble gelatin sponge in a swine model. METHODS: Fifteen healthy young swine were assigned into three groups: transarterial cisplatin infusion group, transarterial chemoembolization (TACE) with cisplatin-conjugated 120-min soluble gelatin sponge (TACE-120) group, and TACE with cisplatin-conjugated 360-min soluble gelatin sponge (TACE-360) group. A total volume of 0.8 mL/kg cisplatin in each group and 8 mg/kg soluble gelatin sponge in TACE-120 and TACE-360 groups were injected from the left hepatic artery in small increments for 10 min. Common hepatic angiography and whole-blood sampling via the left hepatic vein were conducted to explore recanalization immediately after the procedure and again at 10, 30, 60, 90, 120, 180, 240, 300, 360, and 420 min later. The area under the plasma concentration curve (AUC) of non-protein-bound platinum was compared among the three groups. Each liver was removed and cut into 10-cm-thick sections for calculating liver-damaged volume ratio. RESULTS: Sequential angiography depicted gradual recanalization of the occluded hepatic artery and total recanalization at 120 and 360 min after embolization in the TACE-120 and TACE-360 groups, respectively. Of the three groups, AUC(0-30), AUC(30-120), and AUC(120-420) were significantly highest in the transarterial cisplatin infusion group (p < 0.001), the TACE-120 group (p < 0.001), and the TACE-360 group (p < 0.001), respectively. The liver-damaged volume ratio in the TACE-360 group was small (8.20 %) but significantly higher than that in the TACE-120 group (2.67 %, p = 0.014). CONCLUSION: Cisplatin-conjugated soluble gelatin sponge functions as a cisplatin carrier and is associated with tolerable liver damage.
    CardioVascular and Interventional Radiology 10/2012; · 2.09 Impact Factor
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    ABSTRACT: We report two patients who developed a tracheo-innominate artery fistula (TIF) after tracheostomy. Contrast-enhanced computed tomography revealed a pseudoaneurysm of the innominate artery protruding into the trachea. Stent grafts were deployed for the innominate artery via two different access routes: the transfemoral approach and the right carotid artery approach. Endovascular stent-graft repair resulted in complete exclusion of the TIF and control of the bleeding from the tracheal stoma. At 12- and 16-month follow-ups, neither patient had clinical signs of graft infection, recurrent fistulization, or ischemic complications. It is feasible and useful to employ the carotid artery approach for stent-graft implantation in patients who have vascular anatomical limitations for the transfemoral approach. Endovascular repair of TIF by stent grafting is a minimally invasive treatment that can be tolerated by patients in poor clinical condition, and is a feasible alternative to surgical treatment.
    Japanese journal of radiology 10/2012; · 0.73 Impact Factor
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    ABSTRACT: PURPOSE: This study aimed to predict the persistence of endoleaks (ELs) using patterns and volumes evaluated by computed tomography during aortography (CTDA) performed immediately after endovascular abdominal aortic aneurysm repair (EVAR). MATERIALS AND METHODS: CTDA immediately after EVAR and at the 6-month follow-up CT were performed in 52 patients. ELs were classified as localized-type pattern (LTP; <180° around the center of the aneurysmal lumen) or circumferential-type pattern (CTP; >180°). The proportion of EL volume in the aneurysmal sac, excluding mural thrombus, was classified as grade A (≤5 %), B (5-10 %), or C (≥10 %). The 6-month follow-up residual rates were evaluated, and volume ratios (follow-up CT aneurysmal volume including mural thrombus/CTDA aneurysmal volume) were calculated. RESULTS: The residual rate (5.3 %) and mean volume ratio (83.9 %) of ELs with LTP were significantly lower than those of ELs with CTP (72.2 and 99.3 %, respectively); there was no significant difference in residual rate or mean volume ratio among EL grades (A: 17.6, 88.1 %; B: 55.6, 89.7 %; C: 54.5, 97.8 %). CONCLUSION: ELs with LTP generally disappear over time after EVAR, with a concomitant reduction in aneurysm volume, whereas those with CTP persist, indicating that patients with EL with a CTP should be followed up carefully.
    Japanese journal of radiology 10/2012; · 0.73 Impact Factor
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    ABSTRACT: Two cases with a pancreaticoduodenal arterial aneurysm accompanied with superior mesenteric artery (SMA) stenosis were previously described and both were treated surgically. However, for interventional treatment, securing a sufficient blood supply to the SMA should be a priority of treatment. We present the case of a 71-year-old male with a 20 mm diameter pancreaticoduodenal arterial aneurysm accompanied by SMA stenosis at its origin. The guidewire traverse from SMA to the aneurysm was difficult because of the tight SMA stenosis; however, the guidewire traverse from the celiac artery was finally successful and was followed by balloon angioplasty using a pull-through technique, leading to stent placement. Thereafter, coil packing through the SMA achieved eradication of the aneurysm without bowel ischemia. At the last follow-up computed tomography 8 mo later, no recurrence of the aneurysm was confirmed. The pull-through technique was useful for angioplasty for tight SMA stenosis in this case.
    World journal of radiology. 08/2012; 4(8):387-90.