1. Intra-operative Patient Management in Interventional Radiology
Department of Radiology, Ohtawara Red Cross Hospital
Toshiya Kariyasu, Kimiyoshi Mizunuma, Kohki Kato, Makiko Tomabechi
Department of Radiology, Ebara Hospital
The main purpose of premedication in IVR is to relieve anxiety. The indications of atropine sulfate in non-vascular Interventional Radiology need to be discussed. Attainment of an immediate effect initiation against pain and hypotension is important.
- Intra-operative patient management
- Interventional Radiology
2. The Manner of Seldinger’s Method That We Think Best
Divison of Diagnostic Radiology, National Cancer Center
Yoshito Takeuchi, Hiroyuki Tokue, Keitaro Sofue, Noriaki Sakamoto
Percutaneous catheter technique is of course based on the epoch-making technique applied by Sven-Ivar Seldinger in 1953. The latest developments of interventional radiology have been made possible by this technique. Plastic needles, sheath introducers and other new devices have changed somewhat the original technique. Accordingly, the way of performing Seldinger’s technique is no longer uniform. We present the manner of Seldinger’s method that we think best.
- Seldinger’s method
- Common femoral artery
3. Gelatin Sponge : General Principles and Handling Characteristics
Department of Radiology, Iwate Medical University
Miyuki Sone, Akio Akahane, Tomohiro Suzuki, Kenichi Kato, Ryoichi Tanaka, Tatsuhiko Nakasato
Gelatin sponge particles have been used as temporary embolic materials for more than 30 years. This embolic material has wide therapeutic applications such as chemoembolization for hepatocellular carcinoma, uterine artery embolization for symptomatic leiomyomas, and bleeding control for trauma, gastrointestinal bleeding, or postpartum hemorrhage. Gelatin sponge has established safety and efficacy profiles based on extensive clinical experience. It remains an important tool in interventional radiology, : however, differences in properties between various preparation techniques should be noted to avoid specific complications. This article aimed to provide basic information and describe the handling characteristics of gelatin sponge particles.
- Gelatin sponge
- Embolic material
4. Metallic Coil Embolization
Department of Diagnositic Radiology, School of Medicine, Keio University
Embolization using metallic coils is one of the most fundamental techniques employed in interventional radiology. Metallic coils for percutaneous vascular occlusion were invented by Dr. Cesar Gianturco in 1975 and have gained widespread acceptance in the field of interventional medicine ever since. Recently, various types of pushable coil are available either in fibered or non-fibered forms. Mechanically detachable coils, electrically detachable coils and hydraulic detachable coils are also available to achieve controlled and more accurate placement. Metallic coil embolotherapy is applied in patients with arterial aneurysm, arterio-venous malformation and fistula, various bleeding disorders, patent ductus arteriosus and other congenital heart diseases, abdominal aortic aneurysm to cope with type 2 endoleak, hypersplenism, renovascular hypertension, nephrosis, autosomal dominant polycystic kidney disease, hepatic malignancy undergoing hepatic arterial infusion chemotherapy in an attempt to achieve hepatic arterial re-distribution or to avoid gastro-duodenal and pancreatic complications, porto-systemic shunt, and so on. Metallic coils are placed exactly at the desired target location using scaffold technique, anchoring technique, and coaxial technique, under flow control with use of an occlusion balloon catheter, or with the aid of a coil anchor. All interventional radiologists are required to gain familiarity with these techniques.
- Metallic coil
5. Basic Balloon Angioplasty for Peripheral Arterial Disease and Hemodialysis
Department of Radiology, The Jikei University School of Medicine
Shunichi Sadaoka, Masanori Nagase, Hirokazu Ashida, Ken Koyama, Shinsuke Takenaga
In interventional radiological history, the first percutaneous transluminal angioplasty（PTA）was attempted by the renowned radiologist Dr. Dotter. Recently, almost all procedures are performed with not only balloon PTA but also further techniques. But this balloon PTA is still one of the basic interventional techniques along with stenting or transarterial embolization, so now we often draw on this technique for periprocedures of stent placement, or dilatation for in-stent stenosis.
In principle, we cannot avoid a vascular accident like an elastic recoil or dissection, or long term restenosis. Therefore, we could use a newly designed balloon for an area like the lower popliteal one as it is one of the most difficult locations in which to place a stent.
In this article, we would like to explain the structure, principle and basic technique of the balloon PTA. In addition we have reviewed new balloon techniques including the cutting balloon, cryoplasty, and drug eluting balloon.
- Percutaneous transluminal angioplasty
- Balloon angioplasty
- Balloon catheter
- Critical limb ischemia
6. Basics of Vascular Stents and Stent grafts
Department of Radiology, Nara Medical University
Kimihiko Kichikawa, Shoji Sakaguchi, Wataru Higashiura, Hirofumi Itoh, Shigeo Ichihashi
Takeshi Nagata, Kiyoshi Nishimine, Katsutoshi Takayama, Hiroyuki Nakagawa
We describe here the basic interventional therapy using stents and stent grafts. Recently vascular stents and stent grafts have achieved significant advances in the treatment of peripheral arterial disease, renal and carotid artery stenosis and aortic aneurysms. Compared with surgical treatment, imaging is considered to be important for case selection, planning and device selection in interventional procedures. Eventually, commercial stents and stent grafts have become available with acceptable outcomes. Endovascular stent grafting shows potential as a safe and useful treatment for aortic disease, but further investigations should attempt to determine its efficacy over a longer follow-up period.
- Stent graft
- Vascular disease
7. Knowledge and Method of Administering Anticancer Agents for Intraarterial Infusion
Division of Diagnostic Radiology, Shizuoka Cancer Center
Takeshi Aramaki, Michihisa Moriguchi, Takahiro Tsushima
Akihiro Sawada, Kouiku Asakura, Masahiro Endo
As described previously in various reports, in the treatment of cancer, the effect of life prolongation by intraarterial infusion may be less evident than that by systemic chemotherapy. Furthermore, most reports indicate that it is unlikely to be applicable to first-line chemotherapy as well as standard chemotherapy. Meanwhile, it is well known that intraarterial infusion therapy achieves a high response rate and has been widely recognized as treatment in addition to the standard chemotherapy（systemic chemotherapy）.
Patients who undergo systemic chemotherapy have already been treated with high-dose anticancer agents, and they are more likely to be exposed to additional risks rendering them vulnerable to adverse events if they receive additional intraarterial infusions. Furthermore, some anticancer agents have a limited maximum dose. Such agents should not be used for intraarterial infusion if they have already been administered to patients for systemic chemotherapy. Among the anticancer agents, anthracycline, platinum anticancer agents, and mitomycin C have been commonly used for intraarterial infusion, but these agents may induce unique adverse reactions depending on the total dose.
- Intraarterial infusion chemotherapy
- Maximum total dose
- Anticancer agent