Jpn J Intervent Radiol Vol.22 No.3 2007

State of the Art
Basis of Interventional Radiology for Nurses

1.Concept of Interventional Radiology and Current Status of IVR in Japan
Department of Radiology, Fukuoka University
Masatoshi Okazaki
Key words
・ 三位一体
・ 非侵襲的治療(IVR)
・ 血管造影

2. Anatomical Variation for Interventional Radiology
Department of Radiology, Osaka City University Medical School
Kenji Nakamura
Key words
・ 血管解剖
・ 臓器解剖
・ 分岐変異

3. Basis of Vascular Intervention for Nurses
Department of Radiology, Kyoto Second Red Cross Hospital
Masato Fujita
Key words
・ 血管造影
・ 動脈塞栓術
・ 血管拡張術
・ 看護

4. Basis of Non-Vascular Intervention for Nurses
Department of Radiology, Nara Prefectural Nara Hospital
Tetsuya Yoshioka
Key words
・ 非血管系
・ 看護

5. Risk Management in IVR
Department of Radiology, Kyoto City Hospital
Katsumi Hayakawa
Key words
・ インフォームドコンセント
・ リスクマネージメント

6. Informed Consent-The First Step and Pitfalls-
Department of Interventional Radiology & Radiation Therapy, Kochi Health Sciences Center
Yasuhiro Hata, Sojiro Morita, Yoshihiro Noda
Key words
・ インフォームド・コンセント
・ 告知

7. Patient and Staff Radiation -Protection in Interventional Procedures
Department of Radiology, Biwako Yohikuin Hospital
Kazuhiko Yoshimura
Department of Radiology, Kohga Public Hospital
Tsutomu Sakamoto
Key words
・ 放射線被曝
・ 被曝防護

8. Nursing Management before Interventional Procedures
Department of Radiology, Kohka Public Hospital
Kyoko Kurokawa, Michio Yamasaki
Key words
・ 術前看護
・ IVR看護師

9. Nursing Management during Interventional Procedures
Department of Radiology, Nara Medical University
Hiroshi Sakaguchi
Key words
・ 術中
・ 看護

10. Nursing Management after Interventional Procedures
Nursing part, Shiga University of Medical Science Hospital
Nobuko Kozaki
Key words
・ 看護
・ 術後

Original Article
Adrenal Vein Sampling in 22 Patients with Primary Aldosteronism
Department of Radiology and Endocrinology1), Kyoto City Hospital
Takaaki Kanamoto, Hiroyuki Ueda, Taizo Hiraoka
Hirofumi Ito, Katsumi Hayakawa, Hideki Chusho1)
Dr. Yoshimasa’s office
Takaaki Yoshimasa
Department of Radiology, Osaka Medical College
Masato Tanikake

We evaluated 22 patients who had been diagnosed with primary aldosteronism (PA) and undergone adrenal venous sampling (AVS) in our hospital. Blood sampling was technically successful in all patients and, in terms of results, endocrinologically successful in 20 and unsuccessful in 2. We achieved a success rate of over 90% by preoperatively confirming the vascular anatomy by MDCT, selecting a catheter suitable for insertion into the right adrenal vein, and using an extension tube for children at the time of sampling. Of the 14 patients diagnosed with aldosterone producing adenoma (APA) by AVS, 7 underwent adrenal adenomectomy, and achieved improvement in blood pressure and biochemical test results. Thus, AVS is useful for the diagnosis and treatment planning of PA, and the demand for it will grow in the future.

Key words
・Adrenal venous sampling
・Primary aldosteronism
・Adrenal adenoma
・Abdominal CT

Case Report
A Case Report : Successful Coil Embolization for Hyperammonemia Due to Superior Mesenteric Vein Intra Vena Cava Shunt in Non-hepatocirrhosis
Department of Radiology, Tokyo Medical University
Ryota Nishio, Kazuhiro Saito, Yoko Shimazaki, Kimihiko Abe
Department of Radiology and Medicine1), Tokyo Medical University Kasumigaura Hospital
Fumio Kotake, Syuhei Miura1), Yuzi Mizogami1)

A79-year-old man having anomalous behavior was admitted to our hospital with hyperammonemia. Abdominal CT showed a large, tortuous shunt vessel between the superior mesenteric vein and inferior vena cava. Transcatheter embolization was selected because of his age. Embolization therapy was successfully performed with coils. After embolization therapy, hyperammonemia and symptoms improved, probably due to increase of portal blood flow that was shown on CT images.

Key words
・ Non-hepatocirrhosis
・ Embolization
・ Hyperammonemia

Case Report
Transjugular Intrahepatic Portosytemic Shunt Creation Using a Gun-sight Approach
Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences
Sadao Hayashi, Yasutaka Baba, Kazuto Ueno, Aya Ikenoue
Hirofumi Nakayama, Takuro Kamiyama, Masayuki Nakajo
Department of Internal Medicine, Kagoshima Kouseiren Hospital1)
Yasushi Imamura

We report a case of successful transjugular intrahepatic portosytemic shunt(TIPS)creation using the gun-sight approach. A male patient in his early fifties with severe liver cirrhosis and hepatic hydrothorax had been treated for recurrent bleeding from esophageal varices. He was referred to our department for TIPS creation. The portal vein was cranially located and lay in the same plane as the hepatic veins on CT images. Therefore we thought that it would be difficult to create TIPS using the standard TIPS creation technique. We created the portosystemic shunt using the gun-sight approach reported by Haskal et al. We used 2 loop snares to target the portal vein and middle hepatic vein. After the gun-sight view of overlapping loops was obtained by turning the image intensifier, a Chiba needle was introduced percutaneously into the portal vein and advanced to the middle hepatic vein through the snares. The wire through the needle was then caught by the snare loop of the middle hepatic vein and pulled out from the transjugular sheath. The rest of the procedures were completed in a standard fashion. The portosystemic shunt procedures were successful without complications. We think that the portosystemic shunt creation using the gun-sight approach is a good alternative when a standard TIPS creation is difficult or impossible.

Key words
・ Liver cirrhosis
・ Portosystemic shunt
・ Gun-sight approach
・ Pleural effusion