IVR 会誌 Jpn J Intervent Radiol Vol.18 No.1 2003

State of the Art
Risk Management in IVR

1.Risk Management in IVR-What is the risk management?
Dept. of Therapeutic Radiology & Oncology, Kyoto University Graduate School of Medicine
Yasushi Nagata

 Recently, medical accidents have become a social problem, caused by the old fashioned hospital system in Japan. Therefore, risk management for medical procedures has been considered to be very important. In the field of IVR in the Department of Radiology, a specific characteristics are the management of radiation and the triangular relationship between patients, radiologists and other doctors and radiologists. In future, the definition between incident and accident in IVR should be clearly defined by the Society.
Key words
Key words
● Risk management
● Incident
● Accident

2.Risk Management in IVR-from the view of Radiologist
Department of Radiology, Kyoto Municipal Hospital
Katsumi Hayakawa

 It has become very important to obtain informed consent from patients after full disclosure of the risks, benefits, alternatives to the procedure, and risks if the procedure is not done, in all interventional radiological procedures. In this article, I discussed risk management in clinical Interventional Radiology and also introduced risk management in the United States using the articles published in American Journal of Roentgenology under the title of Malpractice Issues in Radiology. I emphasized how to obtain informed consent based on the actual medicolegal issues and lawsuits.
Key words
● Malpractice
● Informed consent
● Interventional Radiology

3.Risk Management in IVR-from the view of Radiological Technologists
Department of Radiology, Yokohama City University Hospital
Tatsumi Morita

From the view of Radiological Technologists, there are two main categories of incidents and accidents when the IVR is performed. The one is the mechanical accident itself of the apparatus, and the other is misoperation of them. We radiological technologists have to take IVR into consideration regarding invasiveness and risk. And we always make efforts to create a good system for the safety of the patients cooperating with doctors and nurses.
Key words
● Risk management
● Radiological technologist

4.Risk Management in IVR-from the view of Nurse
京都大学医学部附属病院 看護部 中央診療外来
Riju Kouno, et al.

5.Risk Management in IVR and Ethics
大阪市立大学名誉教授, ベルランド総合病院 顧問, 若弘会病院 顧問
Ryusaku Yamada

6.Risk Management in IVR-from the view of Lawyer
Narihito Maishi

Original Article
Development of a Wave-Shaped Hydrophilic-Coated Guidewire for Long Tube Insertion : Clinical Application and Sliding Resistance Test
Department of Radiology, St. Marianna University School of Medicine
Mitsuaki Saeki, Yoshikazu Hoshikawa, Yasuo Nakajima
Department of Radiology, Asahikawa Medical Collage
Tsutomu Inaoka

 Purpose : We developed a new hydrophilic-coated stiff guidewire for long tube insertion. The tip of the guidewire was soft and wave-shaped to avoid deviation of the guidewire through the side holes. Our purpose was to evaluate the safety and usefulness of the new guidewire for long tube insertion by the over-the-guidewire technique.
Materials and methods : Long tube insertion was performed in 140 patients with intestinal obstruction under fluoroscopy. We evaluated the initial success of long tube insertion, the fluoroscopy time during the procedures and complications related to the guidewire. A sliding resistance test was also performed using a silicon long tube without hydrophilic-coated lumen or a polyurethane long tube with hydrophilic-coated lumen and the new guidewire.
Results : The initial success rate of long tube insertion was 97.9%(137 of 140 patients). The average fluoroscopy time during the procedure was 21.8x(3 to 72x). The wave-shaped guidewire did not deviate through the side holes of long tubes in clinical cases. No complications related to the new guidewire were encountered. The sliding resistance test showed that the polyurethane long tube with hydrophilic-coated lumen produced less sliding resistance than the silicon tube without hydrophilic-coated lumen.
Conclusion : Our results suggest that the new wave-shaped guidewire is safe and useful for long tube insertion. The long tube with hydrophilic-coated lumen showed less sliding resistance.
Key words
●Intestinal obstruction
●Long tube

Case Report
Transcatheter Arterial Embolization by Double-catheter Technique Using Anchoring Coils for Splenic Artery Aneurysm
Department of Radiation Technology, College of Medical Technology. Hokkaido University
Yutaka Morita
Department of Diagnostic Medicine(Radiology), Osaka University, Graduate School of Medicine
Munehiro Maeda
Department of Surgery1), Internal Medicine2) and Section of Radiological Technology3), Otaru Municipal Hospital
Jun Hamaguchi1), Kunihiro Hirose1), Toru Takahashi2), Nobuo Tomita3)
Hajime Mitsuhashi3), Toshio Abe3), Koichi Imai3), Teiji Yamamoto3)

 Acase of successful transcatheter arterial embolization by a double-catheter technique using anchoring coils for splenic artery aneurysm is reported. The double-catheter technique was planned for embolization of a markedly tortuous artery.
A 3Fr. catheter is inserted into the distal end of the aneurysm via the aneurysm and the tortuous artery through a 5Fr. catheter which is placed in the celiac or the splenic artery via the right femoral approach.
After withdrawal of the 5Fr. catheter only, alone 5Fr. catheter is inserted at the proximal end of aneurysm via the left femoral approach.
Anchoring coils and coils(corresponding to a 0.035 inch guide wire) are placed at the proximal end of the aneurysm through the 5Fr. catheter, and then microcoils(corresponding to a 0.018 inch guide wire) are placed at the distal end of aneurysm through a 3Fr. catheter. Finally, the 3Fr. catheter is withdrawn.
The advantages of this technique are its high technical success rate of embolization for a tortuous artery, limitation of embolized area, protection against coil migration and economical performance.
On the other hand, its disadvantages are the troublesome and highly invasive technique, but the use of a balloon catheter and/or Y-shaped sheath make up for these disadvantages.
Key words
●Splenic artery aneurysm
●Transcatheter arterial embolization
●Double-catheter technique for embolization
●Anchoring coil

Case Report
A Case of Endovascular Stent-graft Repair of the Pseudoaneurysm at the Anastomotic Site of Surgical
Graft-replacement of the Descending Aortic Aneurysm
Department of Radiology, Saga Medical School
Department of Cardiovascular Surgery, Saga Medical School1)

Koichi Matsumoto, Akira Kato, Akira Uchino
Sho Kudo, Kazuhisa Rikitake1), Tsuyoshi Ito1)

 We report a case of successful endovascular stent-graft placement for the anastomotic pseudoaneurysm of the descending aorta. The patient is a 76-year-old man who had undergone prosthetic reconstruction of the descending aorta 7 years before. Follow up chest radiograph revealed a pseudoaneurysm at the anastomotic site that increased in size rapidly. Because of the patient's respiratory problem, endovascular stent-graft placement was selected. We placed two stent-grafts to cover the descending aorta including the anastomotic site, and the pseudoaneurysm was completely thrombosed at the follow up CT. No procedure-related complications were observed.
Key words
●False aneurysm

Case Report
Transcatheter Arterial Embolization for a Splenic Artery Aneurysm Using an Occlusion Balloon Catheter
Department of Radiology, Hoshi General Hospital
Kazuo Miida
Department of Radiology, Jikei University
Masako Kimura, Hirokazu Saigusa

 We performed transcatheter arterial embolization(TAE) for a splenic artery aneurysm. Since involvement of pancreatitis was considered likely as its etiology, TAE was performed in consideration of the possibility of pseudoaneurysm. Although we tried embolization for the distal and proximal parent artery, proximal embolization was difficult because of the short length of the proximal parent artery and high-flow giant aneurysm and coils migrated into the aneurysm one after another.
To prevent coil migration, we tried coil placement under temporary arterial occlusion by using a balloon catheter and successful embolization was accomplished.
We conclude TAE for a splenic artery aneurysm should be the first therapeutic method and may be mode safer and easier by using an occlusion balloon catheter.
Key words
●Transcatheter arterial embolization
●Splenic artery aneurysm
●Occlusion balloon catheter

Technical Note
Using 20 French Long Introducer for System Stabilizing During Stenting of Duodenal and Colonic Obstruction
Department of Radiology, Asahikawa Kosei Hospital
Tatsuya Shonaka, Hiroya Saito, Akio Takamura, Kazuhide Hiramatsu

 Recently, reports show that implantation of expandable metallic stent(EMS) is useful, safe and efficacious for duodenum and colon stenosis. But owing to the length and tortuosity of the physiologic curvature, it is difficult to access the duodenum and upper colon with the use of the current technique for stent implantation. We developed a new device of stent placement using 20 French long introducers. After locating the proximal part of the stenosis by endoscopy, a guide wire was advanced from the working channel of the endoscope. Ultraflex with outer sheath of 20 French long introducers was introduced under fluoroscopic guidance. After advancing through the stenosis with the mounted outer sheath of 20 French long introducers, the outer sheath was removed and Ultraflex was released.
We experienced 5 cases, 3 at the duodenum and 2 at the colon. Stent placement was successful and immediate in all patients. Because outer sheath method had the minimal effect of tortuosity of physiologic curvature, it was simple and easy to perform.
Key words
●Stent and prostheses
●Interventional procedure
●Intestine, Stenosis or obstruction

Technical Note
Clinical Experience with Tru-Close Thoracic Vent for Treating Pneumothorax after Percutaneous Lung Biopsy
Department of Radiology, Fuchu Keijinkai Hospital
(*=Department of Radiology, Mitsui Memorial Hospital)

Toshitaka Tsukiyama*, Masaaki Shindou

 We described our experience with Tru-Close Thoracic Vent(Thoracic Vent) for treatment of pneumothorax after CT-guided lung biopsy. In all of 6 patients of our study group, Thoracic Vent was placed successfully. In 5 of 6 patients, pneumothorax was treated completely within 6 days(mean 3.6 days) of drainage. None of those patients needed continuous aspiration and no major complication except for slight pain was recognized during treatment of pneumothorax. In one of these patients, outpatient treatment was successful and no remarkable complication was recognized. On the other hand, in one of 6 patients, Thoracic Vent was removed without per-
mission, and treatment with conventional chest tube drainage was needed for extensive pneumothorax
and subcutaneous emphysema. In conclusion, Thoracic Vent is effective for the treatment of pneumothorax after CT-guided lung biopsy.
Key words
●CT-guided lung biopsy
●Tru-Close Thoracic Vent

Technical Note
Introduction of Liquid Crystal Display(LCD)to Fluoroscopy
(Clinical Evaluation of Newly Developed Monitor Fluoroscopy Using LCD)
Department of Radiology, Osaka City University Hospital
Takao Ichida, Hiroaki Kudoh, Kazuo Okuyama, Masachika Shougaki
Kenji Okusako, Norihisa Masai, Takayoshi Ogawa, Kouji Yokoyama
Department of Radiology, Osaka City University
Kenji Nakamura, Ryusaku Yamada

 Recently, liquid crystal display(LCD) technology has advanced greatly. Since 1998, we have been using an active matrix-type LCD as a supplementary monitor to observe fluoroscopy images. Based on this experience, we have replaced the cathode ray tube(CRT) monitors in an interventional room with LCDs suspended from the ceiling. The system incorporates three LCDs for the purpose of monitoring fluoroscopy images, supporting images and physiological signals. Each LCD monitor is mounted on a foldable-type support arm, for ease of positioning. This report describes our clinical experiences with the retractable LCD display system.
Key words
●Liquid crystal display(LCD)
●Monitor fluoroscopy
●Digital subtraction angiography(DSA)