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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. · 2.20 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: 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.
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ABSTRACT: To determine which modification to a vascular puncture needle results in increased visualization during ultrasound (US)-guided vascular puncture.
We evaluated US images of a phantom made of degassed gelatin and each of the following four modified versions of a commercially available vascular puncture needle (18 G): re-cut needle, dimple needle, rough-surface needle (rough over the sections of needle located 3-6 mm from the tip), and a needle with four side holes (side holes covered by the sheath). An unmodified commercially available puncture needle was used as a control. Five interventional radiologists evaluated image quality according to the following classification grade: I, invisible; II, poor; III, moderate; IV, good; V, excellent.
The highest score for needle visualization was obtained for the needle with four side holes. The re-cut needle scored the same as the control. Multiple comparisons were conducted using overall evaluation scores among the commercially available needle, dimple needle, rough-surface needle (3-6 mm), and the needle with four side holes. A significantly higher score was obtained for the needle with four side holes (P < 0.05/6).
The needle with four side holes was prominently visualized and gained a significantly higher score (compared with the other needles) in a phantom evaluation.
World journal of radiology. 06/2012; 4(6):273-7.
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ABSTRACT: Aim: To compare the blood dynamics of anticancer drugs (cisplatin, mitomycin, epirubicin) and the negative effect on normal liver tissue among the following procedures: hepatic arterial infusion (HAI), HAI with lipiodol (Lp-HAI) and transcatheter arterial chemoembolization (TACE) with Lp plus particles (Lp-TACE). Methods: Nine swine were divided into three groups: (i) HAI group animals were infused with 5 mg/mL cisplatin, 1 mg/mL mitomycin and 4 mg/mL epirubicin in 0.1 mL/kg contrast medium; (ii) Lp-HAI group animals, with the same doses in 0.1 mL emulsified fluid (0.05 mL/kg, Lp); and (iii) Lp-TACE group animals, with the same doses in 0.1 mL emulsified fluid plus gelatin sponge particles. Outflow ratio (area under plasma concentration curve [AUC(0-60) ] / total infused dose of anticancer drug) and necrosis volume ratio (necrosis volume / total slice volume × 100) were explored. Results: Outflow ratios (AUC(0-60) /mg) of cisplatin, mitomycin and epirubicin, and the necrosis volume ratio (%) of the livers, were 2.30, 6.91, 0.97 and 0, respectively, in the HAI group; 1.71, 5.43, 0.79 and 1.37, respectively, in the Lp-HAI group; and 1.23, 3.37, 0.47 and 20.88, respectively, in the Lp-TACE group. The significantly lowest outflow ratio for each anticancer drug (P = 0.05/3) and the significantly highest necrosis volume ratio (P = 0.05/3) were found in Lp-TACE, followed by Lp-HAI and HAI. Conclusion: Although the necrosis volume ratio of the liver was tolerable, Lp-TACE caused the greatest delay in outflow ratio for each cancer drug and the greatest negative effect to liver in a swine model.
Hepatology Research 04/2012; · 2.20 Impact Factor
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Shinya Sahara,
Nobuyuki Kawai,
Morio Sato,
Akira Ikoma,
Hiroki Minamiguchi,
Motoki Nakai,
Hiroki Sanda,
Kouhei Nakata,
Taizou Takeuchi, Takami Tanaka,
Shintaro Shirai,
Tetsuo Sonomura
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ABSTRACT: To evaluate the washout (WO) pattern of serous cystadenomas (SCAs) compared with endocrine tumors (ETs) and intraductal papillary mucinous neoplasm (IPMN).
Patients with serous cystadenoma (n = 12), ET (n = 29), and IPMN (n = 35) underwent 4-phase computed tomography CT. Tumors were categorized as hyperdense or hypodense. Computed tomographic values measured were unenhanced attenuation (AU), pancreatic attenuation (A12, 12 seconds), portal attenuation (A35), and equilibrium (A158). Computed tomographic parameters calculated were wash-in (WI) = A12 - AU; WO = A12 - A35; and washout ratio (WOR) = WO/WI × 100/22.
Hyperdense SCAs had significantly higher WOR than did hyperdense ETs (P = 0.001). Among the 3 hypodense tumors, SCAs had the significantly highest WOR (P < 0.05/3). Relative to the pancreas, the WOR of SCAs were equivalent, whereas the WOR of ETs and IPMNs were significantly lower.
Hyperdense SCAs had significantly higher WOR than did hyperdense ETs, and hypodense SCAs had the significantly highest WOR among the three.
Journal of computer assisted tomography 03/2012; 36(2):231-6. · 1.38 Impact Factor
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Shinya Sahara,
Nobuyuki Kawai,
Morio Sato, Takami Tanaka,
Akira Ikoma,
Kouhei Nakata,
Hiroki Sanda,
Hiroki Minamiguchi,
Motoki Nakai,
Shintaro Shirai,
Tetsuo Sonomura
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ABSTRACT: PURPOSE: To compare the efficacy of transcatheter arterial chemoembolization (TACE) using multiple anticancer drugs (epirubicin, cisplatin, mitomycin C, and 5-furuorouracil: Multi group) with TACE using epirubicin (EP group) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: The study design was a single-center, prospective, randomized controlled trial. Patients with unrespectable HCC confined to the liver, unsuitable for radiofrequency ablation, were assigned to the Multi group or the EP group. We assessed radiographic response as the primary endpoint; secondary endpoints were progression-free survival (PFS), safety, and hepatic branch artery abnormality (Grade I, no damage or mild vessel wall irregularity; Grade II, overt stenosis; Grade III, occlusion; Grades II and III indicated significant hepatic artery damage). A total of 51 patients were enrolled: 24 in the Multi group vs. 27 in the EP group. RESULTS: No significant difference in HCC patient background was found between the groups. Radiographic response, PFS, and 1- and 2-year overall survival of the Multi vs. EP group were 54% vs. 48%, 6.1 months vs. 8.7 months, and 95% and 65% vs. 85% and 76%, respectively, with no significant difference. Significantly greater Grade 3 transaminase elevation was found in the Multi group (p = 0.023). Hepatic artery abnormality was observed in 34% of the Multi group and in 17.1% of the EP group (p = 0.019). CONCLUSION: TACE with multiple anti-cancer drugs was tolerable but appeared not to contribute to an increase in radiographic response or PFS, and caused significantly more hepatic arterial abnormalities compared with TACE with epirubicin alone.
CardioVascular and Interventional Radiology 02/2012; · 2.09 Impact Factor
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ABSTRACT: To explore the anatomical relationships between bronchial artery and tracheal bifurcation using computed tomography angiography (CTA).
One hundred consecutive patients (84 men, 16 women; aged 46-85 years) who underwent CTA using multi-detector row CT (MDCT) were investigated retrospectively. The distance between sites of bronchial artery ostia and tracheal bifurcation, and dividing directions were explored. The directions of division from the descending aorta were described as on a clock face.
We identified ostia of 198 bronchial arteries: 95 right bronchial arteries, 67 left bronchial arteries, 36 common trunk arteries. Of these, 172 (87%) divided from the descending aorta, 25 (13%) from the aortic arch, and 1 (0.5%) from the left subclavian artery. The right, left, and common trunk bronchial arteries divided at -1 to 2 cm from tracheal bifurcation with frequencies of 77% (73/95), 82% (54/66), and 70% (25/36), respectively. The dividing direction of right bronchial arteries from the descending aorta was 9 to 10 o'clock with a frequency of 81% (64/79); that of left and common tract bronchial arteries was 11 to 1 o'clock with frequencies of 70% (43/62) and 77% (24/31), respectively.
CTA using MDCT provides details of the relation between bronchial artery ostia and tracheal bifurcation.
World journal of radiology. 01/2012; 4(1):29-35.
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ABSTRACT: To evaluate the safety and efficacy of n-butyl cyanoacrylate (NBCA) injection under fluoroscopy for iatrogenic femoral artery pseudoaneurysms under temporary balloon occlusion.
This treatment was approved by the Ethics Committee of our institute, and informed consent was obtained from the patients. Three male patients aged 82, 77, and 51 years developed femoral arterial pseudoaneurysms after catheterization. The pseudoaneurysms (diameter: 30, 12, and 15 mm; neck diameter: 1.8, 5.2, and 1.4 mm) were treated with percutaneous NBCA injection under fluoroscopy after failed ultrasound (US)-guided compression. First, a 4-Fr balloon catheter was inserted into the responsible femoral artery via the contralateral approach. An 18-gauge needle was placed in the pseudoaneurysm under US guidance, and a test injection of contrast medium was performed under fluoroscopic guidance to evaluate the extent of the pseudoaneurysm. NBCA-lipiodol (Lp) (ratio, 1:3) was then injected under balloon inflation. The balloon catheter was deflated and withdrawn after treatment.
The total volume of the injected NBCA-Lp was 0.4-1.5 ml. In each case, angiography immediately after NBCA-Lp injection showed eradication of the pseudoaneurysm, and color Doppler US revealed no blood flow signal. No complications were observed. Color Doppler US showed no recurrence in the three patients at their last follow-ups at 6, 12, and 12 months.
Percutaneous NBCA injection under fluoroscopy with the support of balloon inflation was safe, feasible, and useful for eradicating iatrogenic femoral artery pseudoaneurysms in three cases following failed US compression.
Japanese journal of radiology 01/2012; 30(4):365-9. · 0.65 Impact Factor
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Akira Ikoma,
Nobuyuki Kawai,
Morio Sato, Takami Tanaka,
Tetsuo Sonomura,
Shinya Sahara,
Kouhei Nakata,
Isao Takasaka,
Hiroki Minamiguchi,
Motoki Nakai,
Ichiro Mori
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ABSTRACT: Histologic evidence of safety after bronchial arterial embolization (BAE) with N-butyl cyanoacrylate (NBCA) should be assured. The present report describes a 78-year-old man with massive hemoptysis from lung cancer who underwent surgical lobectomy 23 days after hemostasis had been achieved via BAE with NBCA. Pathologic examination revealed that NBCA filled the lumen of bronchial branch arteries 143-1,094 μm in diameter from the lobar bronchus to subsegmental bronchus but was not seen in the lumen of the pulmonary artery or pulmonary vein. NBCA induced occlusion of bronchial branch arteries but no necrosis of the bronchial wall or pulmonary parenchyma.
Journal of vascular and interventional radiology: JVIR 08/2011; 22(8):1212-5. · 1.81 Impact Factor
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Hiroki Minamiguchi,
Nobuyuki Kawai,
Morio Sato,
Akira Ikoma,
Munehisa Sawa,
Tetsuo Sonomura,
Shinya Sahara,
Kouhei Nakata, Takami Tanaka,
Isao Takasaka,
Motoki Nakai
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ABSTRACT: Two cases of portosystemic encephalopathy caused by an inferior mesenteric vein (IMV)-internal iliac vein shunt and an IMV-renal vein shunt are presented. IMV and systemic varicosity consisted of a first functional segment, a stagnant segment, and a second functional segment. Both patients underwent balloon occlusion retrograde transvenous obliteration (BRTO), using a microcatheter, to occlude the stagnant segment selectively. Although transient portal vein thrombosis was observed in case 1 and aggravation of esophageal varices was observed in case 2, these complications were tolerable. Following BRTO, the portosystemic encephalopathy in both cases resolved, and serum ammonia levels, although elevated, remained within the normal range.
Journal of vascular and interventional radiology: JVIR 07/2011; 22(7):1039-44. · 1.81 Impact Factor
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Nobuyuki Kawai,
Morio Sato,
Hiroyuki Minamiguchi,
Tomoki Nakai,
Akira Ikoma,
Munehisa Sawa,
Shinya Sahara,
Kouhei Nakata, Takami Tanaka,
Isao Takasaka,
Tetsuo Sonomura
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ABSTRACT: A 60-year-old woman presented with a conglomerate pulmonary arteriovenous malformation (PAVM) size 8.2 × 7.2 cm on chest X-ray. Feeding arteries were A(a)(7) and A(b)(7) , A(8), and A(10). The diameter and length of the A(b)(7) neck were 15.5 and 16 mm, respectively. After percutaneous transcatheter embolization of A(8) and A(10), PTE of A(a)(7) and A(b)(7) was conducted under balloon occlusion with interlocking detachable coils using a technique of dumbbell-shaped framing and filling, making a bridge from A(b)(7) to the trunk of A(9) and A(10)across A(7). Follow-up computed tomography 10 months after treatment showed marked shrinkage of the PAVM.
CardioVascular and Interventional Radiology 06/2011; 34(6):1320-4. · 2.09 Impact Factor
