1. Carotid Artery Stenting-periprocedural Management and Follow-up for Outpatient
Department of Radiology and Interventional neuroradiology, Ishinkai Yao General Hospital
Katsutoshi Takayama, Kaoru Myouchin
Department of Radiology, Nara Medical University
Takeshi Wada, Kimihiko Kichikawa
Carotid artery stenting (CAS) for carotid stenosis has been effective not only in patients at high risk, but also those at conventional risk for carotid endarterectomy (CEA) and is becoming an alternative to CEA. However, the incidence of periprocedural stroke is higher with CAS than with CEA. Reducing the incidence of periprocedural stroke and other periprocedural complications also has become a necessary goal to permit CAS to be performed safely. On the other hands, CAS specific periprocedural complications including bradycardia, hypotension, stroke, hyperperfusion syndrome, and central retinal artery occlusion also exist. It is very important for CAS physicians to understand and manage CAS specific complications. Optimal management could reduce the periprocedural complication rate to a minimum. From our CAS experience of over 450 cases, we describe in detail how to manage the periprocedural periods and follow-up for out-patients after CAS.
- Carotid artery stenting
- Patient management
- Follow-up for outpatient
2. Endovascular Therapy for Patients with Chronic Lower Limb Arterial Obstruction
Department of Interventional and Diagnostic Radiology, Tsuchiya General Hospital
Endovascular therapy "EVT" has been recognized as a useful and low invasive technique for treating patients with PAD, especially critical limb ischemia patients. Most of these patients also have cardiovascular and/or cerebrovascular disease, and their prognosis is poor. To manage their general condition is quite important to avoid complications during the procedure. Antegrade ipsilateral approach is needed to recanalize chronic total occlusions of the superficial femoral artery and lower leg arteries. To recanalize long chronic total occlusion, a bidirectional approach is quite useful if antegrade recanalization fails. Additional distal puncture is needed in some cases. Trans-collateral wiring and catheterization can be done in some cases. Once the wires pass through the total occlusion, balloon angioplasty can be done without difficulty after wire rendez-vous technique. Angiosome related recanalization is sometimes very effective for ulcer healing. Though the long term patency of these recanalized arteries is not satisfactory, it is enough that those arteries are kept open until wound healing is obtained. EVT has an important role in the treatment of critical limb ischemia.
- Critical limb ischemia（CLI）
- Diabetic foot
- Endovascular therapy（EVT）
3. Perioperative Management and Outpatient Care of Acute Limb Ischemia That Interventional Radiologists Should Know
Department of Endovascular Treatment, General Foundation Institute for Training and Medical Seimeikai Narumi Hospital
For the treatment of acute lower limb ischemia, the most important issues are early evaluation, diagnosis, and revascularization. I described in this paper that in order to rescue patients with acute lower limb ischemia, interventional radiologists should recognize them. These include evaluation and diagnosis of acute lower limb ischemia, and perioperative patient care, and outpatient care for the prevention of recurrence for acute lower limb ischemia. Then, I believe that the interventional radiologists involved in perioperative management, trust from the surgeon will become strong.
- Acute limb ischemia
- Perioperative patients care
- Interventional radiologists
4. Care and Management of Patients with Abdominal Aortic Aneurysm Treated by Endovascular Aortic Aneurysm Repair
Department of Radiology, Nara Medical University
Shinichi Iwakoshi, Shigeo Ichihashi, Hirofumi Itoh, Kimihiko Kichikawa
Department of Stentgraft and Endovascular Therapy, Matubara Tokusyukai Hosipital
Masahide Takahashi, Shoji Sakaguchi
Department of Radiology, Okinawa Chubu Hospital
Endovascular aortic aneurysm repair (EVAR) has become widely used in the last decade in Japan. Many reports have demonstrated that EVAR is superior to open repair (OR) in terms of the early and mid-term outcomes. The techniques and technologies of EVAR are rapidly advancing and we must catch up with the trends. We should know not only techniques and technologies, but also the care and management of the patients treated by EVAR. A lot of randomized control trials and surveys tell us what to do and not to do for the patients of EVAR. In this paper, we introduce many of them and show our protocols.
- Care of patients
- Follow up
5. Vascular Access Interventional Therapy
Vascular Access Center, Sendai Social Insurance Hospital
Perioperative period management of Vascular Access Interventional Therapy (VAIVT).
In order to manage VAIVT efficiently, various systems including an STS hospital-and-clinic-cooperation path or clinical path of a "vascular access interventional therapy" have been created. In our hospital, a good relationship has been established between departments related to VAIVT. This cooperation is not something that can be established by IVRist alone. It is the result of efforts of the persons involved in many departments including not only kidney disease center, and vascular access center, dialysis room, but also vascular surgery which is taking a part of surgical reconstruction of VA at the time of VAIVT failure, outpatient department of kidney disease center, a hospital-and-clinic-cooperation room, etc.
IVRists should be actively involved in creating a good relationship with the other departments.
- Vascular access
- Clinical path
6. Periprocedural and Clinical Managements of Inferior Vena Caval Filters
Department of Diagnostic Radiology, Tokai University School of Medicine
Jun Koizumi, Chihiro Itou, Naoko Mori, Tatsuya Sekiguchi
Because anticoagulation remains the primary treatment for venous thromboembolism, vena caval filter placement is generally indicated for the patients with contraindications to, failure or adverse events of anticoagulation. After the report of the international cooperation of pulmonary embolism registry (ICOPER) II where vena caval filters were associated with a significant reduction in the 90-day mortality in the patients with massive pulmonary thromboembolism, the patients with severe pulmonary thromboembolism, persistent pulmonary hypertension and poor cardiopulmonary function reserve are included into the relative indications of vena caval filter placement. Several temporary filters were developed after PREPIC study, where the initial beneficial effect of vena caval filters for the prevention of pulmonary thromboembolism was counterbalanced by an excess of recurrent deep venous thrombosis without any mortality difference. However, unsatisfactory results of temporary filters including the migration, infection, difficulties in case of tough clots’ capture etc. facilitated the development and prevalence of retrievable (optional) filters. The indications and timing of the retrieval should be investigated in the future.
- Inferior vena cava filter
- Periprocedure and clinical management