1. Interventional Radiology for Hemoptysis
Department of Diagnostic Radiology, Kyoto City Hospital
Katsumi Hayakawa, Masato Tanikake
Massive hemoptysis is one of the most dreaded of all respiratory emergencies and can have a variety of underlying causes. Bronchial artery embolization (BAE) is a relatively safe treatment for refractory hemoptysis. However, non-bronchial systemic arteries can be a significant source of massive hemoptysis and a cause of recurrence after successful BAE. Moreover, a highly-advanced catheter technique is required because of the smaller arterial size, advanced patient’s age and a dangerous complication such as spinal cord injury. In this review, we discuss the indications and contraindications for IVR with the pathophysiologic features of massive bleeding, the importance of MD-CT and CTA before BAE, the technique with the characteristics of the various embolic agents used in the procedure, short-term and long-term results and possible complications.
- Bronchial artery embolization
- Non-bronchial systemic artery
2. IVR for Non-traumatic Arterial Bleeding of Gastrointestinal Tract
Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of Medicine, Tottori University
Non-traumatic arterial bleeding of gastrointestinal (GI) tract is associated with potential morbidity and mortality. When it fails to achieve hemostasis by an endoscopic measure, transcatheter arterial embolization (TAE) is a good treatment option with a high rate of hemostasis and a low rate of ischemic complication. Various kinds of embolic materials including gelatin sponge particles, metallic coils, and N-butyl-2-cyanoacrylate (NBCA) may be used. Each embolic agent has its own characteristics, benefits and drawbacks that interventionalists need to be familiar with. The choice of embolic agent depends on a combination of the bleeding location, vascular anatomy, achievable catheter position, and the operator’s preference. Evaluation of the angiographic findings is also important. Not only direct signs of GI bleeding like extravasation of contrast medium, but also indirect signs including pseudoaneurysm, vessel spasm or cutoff, and increased vascularity must not to be missed. Provocative angiography or empiric embolization may be useful when the bleeding site cannot be identified angiographically. Compared with TAE, intraarterial vasopressin infusion therapy has disadvantages of a high recurrent bleeding rate and a long-term placement of catheter, but is still probably preferable for diffuse lesions.
- Gastrointestinal tract bleeding
- Embolic materials
3. Interventional Radiology for Non-traumatic Hepatic and Pancreatic Bleeding
Department of Diagnostic Radiology, Japan Red Cross Kyoto Daiichi Hospital
Hiroyuki Morishita, Takaaki Itou
Department of Radiology, North Medical Center, Kyoto Prefectural University of Medicine
Vascular embolization is now used as a surgical alternative for non-traumatic and traumatic arterial bleeding.
In this report, we describe the outline of percutaneous hemostatic procedures for non-traumatic hepatic or pancreatic arterial bleeding.
4. Non-traumatic Spontaneous Retroperitoneal Hemorrhage
Department of Radiology and Center for Endovascular Therapy, Kobe University Graduate School of Medicine
Keitaro Sofue, Masato Yamaguchi, Naoto Katayama, Akhmadu Muradi
Eisuke Ueshima, Yutaka Koide, Takuya Okada, Koji Idoguchi, Koji Sugimoto
Spontaneous retroperitoneal hemorrhage (SRH) is defined as a retroperitoneal hemorrhage that occurs without proceeding trauma or any underlying pathology. Survival of patients with SRH depends on rapid and accurate diagnosis followed by imperative management, as the bleeding is often insidious and initially unrecognized. Management had mainly consisted of conservative treatment including cessation or reversal of the anticoagulation, fluid resuscitation, and transfusion previously. Although endovascular intervention of transarterial embolization (TAE) for retroperitoneal hemorrhage caused by trauma or iatrogenic injury is an established procedure, TAE for SRH has been controversial due to its unknown pathophysiology and occult diffuse microvascular bleeding. There is therefore no contemporary consensus to suggest when to attempt transarterial embolization in the treatment of SRH.
- Spontaneous retroperitoneal hemorrhage
- Contrast-enhanced computed tomography
- Transarterial embolization
5. Nontraumatic IR of Obstetric and Gynecology
Department of Radiology amd Obstetrics and Gynecology1), St. Marianna University School of Medicine
Misako Nishio, Shingo Hamaguchi, Yukihisa Ogawa, Yasunori Arai
Kazuki Hashimoto, Yasuo Nakajima, Suguru Igarashi1), Nao Suzuki1)
Transcatheter arterial embolization has become a major treatment modality in a variety of obstetric and gynecologic applications.
We describe three items mainly ①The pitfall in IR obstetric hemorrhage ②Selection of embolic material ③Bleeding by tumor necrosis.
- Gynecologic and obstetric hemorrhage