1. Central Venous Access
Department of Diagnostic Radiology, National Cancer Center
Keitaro Sofue, Yasuaki Arai, Yoshito Takeuchi, Masahide Takahashi
Central venous access is frequently used in various situations, including total parenteral nutrition, measuring central venous pressure, administration of vasoactive drugs, and continuous infusion of anticancer agents. Therefore, this is one of the most basic procedures that must be performed certainly and safely to carry out the standard treatment in any field. On the other hand, there have been a few reports of some complications associated with this procedure. Recently, image-guided puncture has become the standard of this procedure, and interventional radiologists perform it in many hospitals. Good practice of central venous access is an essential procedure for interventional radiologists. To maintain the pride of our profession, we should learn all kinds of techniques so to be able to complete this procedure in any situation.
- Central venous access
- Image-guided puncture
- Subclavian vein
2. Stent Therapy for Superior Vena Cava Syndrome
Department of Radiology and Interventional Radiology Center, Daiyukai General Hospital
Takeshi Nagata, Hideo Uchida
Department of Radiology, Nara Medical University
Shiro Makutani, Hiroshi Anai, Kimihiko Kichikawa
Superior vena cava syndrome（SVCS）is a distressing manifestation of benign or malignant disease obstructing the superior vena cava（SVC）. Almost all cases of SVC are caused by obstruction of SVC due to advanced unresectable malignant tumors such as lung cancer and mediastinal tumor. The stent placement for the obstructed portion is very effective to release immediately the obstruction of SVC and play an important role as palliative therapy to obtain an improved QOL. This paper reports the indications, procedure, therapeutic results and complications of stent therapy for SVC based on our experiences of 74 cases.
- Superior vena cava syndrome
- Unresectable malignant tumor
3. Update on Inferior Vena Cava Filters
Department of Radiology, Nippon Medical School
Ken Nakazawa, Hiroyuki Tajima
Inferior vena cava filter placement is an effective method to prevent recurrence of pulmonary thromboembolism. The indications of vena cava filter placement are still unclear, and so we need to examine validity in every individual case. We describe herein the variety, indications, methods and complications of inferior vena cava filter placement.
- Embolism, pulmonary
- Venae cavae, filters
- Thrombosis, venous
4. Interventional Radiology for the Treatment of Acute Massive Pulmonary Thromboembolism
Department of Radiology and Coronary Care Unit1), Nippon Medical School
Hiroyuki Tajima, Satoru Murata, Ken Nakazawa, Tsuyoshi Fukunaga, Shiro Onozawa, Takahiko Mine
Tatsuo Ueda, Masaki Tachi, Jyunko Shibukawa, Kazuo Ichikawa, Tsuyoshi Yamamoto1), Keiji Tanaka
Acute massive pulmonary thromboembolism is a life-threatening condition with a high mortality rate due to acute right ventricular failure and cardiogenic shock. Anticoagulation is the most traditional treatment for pulmonary thromboembolism, but may not be sufficient for massive thromboemboli. Systemic thrombolytic therapy and surgical embolectomy are the usual therapeutic options in this situation. Catheter directed thrombolysis and catheter embolectomy are now available to treat the most severe cases of massive pulmonary thromboembolism. There currently are 3 categories of catheter-tip embolectomy for removing or fragmenting pulmonary thromboemboli : (1) aspiration thrombectomy, (2) fragmentation, and (3) rheolytic thrombectomy. The success of these techniques depends on a thorough understanding of the mechanism of each devices and familiarity with the relevant catheterization techniques. Although no controlled clinical trials are available, data from cohort studies indicate that the clinical outcomes after surgical and catheter embolectomy may be comparable. We hereby present a review of currently available equipment and techniques, and describe our work with hybrid treatment using a combination of mechanical fragmentation, local fibrinolysis and clot aspiration.
5. Budd-Chiari Syndrome
Department of Radiology, The Jikei University School of Medicine
Shunichi Sadaoka, Hideomi Yamauchi, Hirokazu Ashida, Ken Koyama, Aakari Sadaoka, Masahiro Nagase
Budd-Chiari syndrome is a rare condition, which is thought to affect a couple of hundred patients in Japan per year. It is defined as portal hypertension owing to occlusion or stenosis of main hepatic vein or IVC intrahepatic portion. We will discuss this entity and write about our recent case. Budd-Chiari syndrome is divided into three categories : hepatic type, IVC type, or mixed type. The main strategy to treat this condition used to be medical management, or making shunts. But, recently TIPS, PTA, and transplantations are available. Among them IVR is coming to be the procedure of choice. Therefore we have to know about this condition.
- Budd-Chiari syndrome
- Interventional radiology（IVR）
- Percutaneous transluminal angioplasty（PTA）
6. Pelvic Venous Intervention : Ovarian Varices（Pelvic Congestion Syndrome）and Spermatic Varicocele
Department of Radiology, Aichi Medical University
Yuichiro Izumi, Tsuneo Ishiguchi, Akira Kitagawa, Eisuke Katsuda, Yukihiko Oshima
Joe Matsuda, Junko Kimura, Makiyo Hagihara, Seiji Kamei, Toshiki Kawamura
Pelvic congestion syndrome with an incompetent ovarian vein is a condition that in some particular patients carries significant morbidity. While incompetent and dilated ovarian vein is a common finding in routine CT and MR imaging, ovarian venography remains the “gold standard” for evaluation. Percutaneous transcatheter embolization offers a minimally invasive, safe, and effective treatment for pelvic congestion syndrome. Bilateral embolization, if necessary, using a sclerosing agent and coils has been shown to be associated with better results. Radiologists should be aware of the clinical manifestations of the pelvic congestion syndrome so that appropriate patients will be referred for the treatment.
Another subject is spermatic varicocele causing swelling and pain of the scrotum that may be associated with sperm abnormalities causing male infertility. Transcatheter embolization is a safe and effective treatment with a low recurrence rate. As a treatment for infertility, however, careful patient selection is mandatory because only patients with abnormal sperm parameters will benefit from treatment.
- Pelvic pain syndrome
- Pelvic venous incompetence
- Male infertility
7. Adrenal Venous Sampling
Department of Radiology and Second Division, Department of Medicine1), Hamamatsu University School of Medicine
Shuhei Yamashita, Hatsuko Nasu, Mika Kamiya, Kosuke Yogo1)
Miho Yamashita1), Yutaka Oki1), Harumi Sakahara
Primary aldosteronism has an estimated prevalence of 5〜10％ of all patients with hypertension. Aldostrone producing adenoma or unilateral hyperplasia is usually treated with unilateral laparoscopic adrenalectomy. Adrenal venous sampling is the standard reference for determining the indication of adrenalectomy. In this article, we describe the indications and technical procedure of adrenal venous sampling, and discuss the interpretation of the obtained results.
- Adrenal venous sampling
- Primary aldosteronism