IVR 会誌 Jpn J Intervent Radiol Vol.19 No.3 2004

Original Article
Combined Iliac Stent Placement and Femoro-Popliteal Bypass for Arteriosclerosis Obliterans : Usefulness of Our Method
Department of Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences
Department of Radiology, University of Occupational and Environmental Health, School of Medicine*
Osamu Ikeda, Yukunori Korogi*, Yasuyuki Yamashita
Departments of Radiology, Department of Surgery1), Kumamoto City Hospital
Hiroya Yamashita1), Hidemi Hasegawa, Yuka Ozaki, Akinori Tsuji, Tadamasa Yasunaga

We evaluated the usefulness of initial iliac stent placement and second-look femoro-popliteal bypass surgery in patients with arteriosclerosis obliterans. Fourteen iliac lesions in 10 patients were treated with percutaneous stent placement from May, 2000 to June, 2001. Percutaneous stent placement and femoro-popliteal bypass surgery was successful in all lesions. The mean stenosis ratio of the iliac arteries on the angiography decreased from 86% to 1%. Femoro-popliteal bypass surgery was performed immediately after stent placements in four patients, because their symptoms did not improve. Six patients whose symptoms improved after stent placement were followed up, and three of them underwent second-look femoro-popliteal bypass because of delayed aggravation of symptoms. During follow-up of 10-34 months(mean, 21 months), femoro-popliteal bypass was not necessary in the remaining three patients. The ankle-brachial index improved in six cases after femoro-popliteal bypass, but did not improve in one case with poor run-off. Two patients showed complications ; one case had thrombus at the site of stenting, and the other showed dissection at the distal site of stenting. Initial iliac stent placement with second-look femoro-popliteal bypass surgery seems useful and may be able to avoid unnecessary bypass surgery.
Key words
●Initial iliac stenting
●Second-look F-P bypass

Case Report
Transjugular Intrahepatic Portosystemic Shunt for Variceal Hemorrhage in a Patient with Primary Biliary Cirrhosis and Hyper-bilirubinemia : A Case Report
Department of Radiology, Department of Internal Medicine1), Fukuiken Saiseikai Hospital
Shigeyuki Takamatsu, Shiro Miyayama, Tetsuya Komatsu, Keiichi Taki
Tetsuya Minami, Rieko Shinmura, Chiharu Ito, Miki Kobayashi
Daisyu Toya1), Nobuyoshi Tanaka1)
Department of Radiology, Kanazawa University Graduate School of Medicine
Osamu Matsui

We report a 39-year-old male with primary biliary cirrhosis(PBC) and hyper-bilirubinemia treated by transjugular intrahepatic portosystemic shunt(TIPS).
The patient had esophageal varices, and rupture occurred. Although hemorrhage was successfully stopped by endoscopic variceal ligation, risk of further variceal rupture persisted despite repeated endoscopic procedures. TIPS creation was considered the only available therapeutic option, although the patient’s serum bilirubin level was 20.7m/q. After we explained that TIPS creation was a high-risk procedure, written informed consent was obtained. TIPS was created between the right portal vein and right hepatic vein. Esophageal varices were reduced after TIPS creation, and no further therapy was needed. Furthermore, ascites was simultaneously diminished. There was no deterioration of hepatic functional reserve following TIPS creation. The patient died of pulmonary embolism caused by deep vein thrombosis 10 months after TIPS creation, without variceal hemorrhage.
Comparison of the history of this patient and predicted survival from the model of Japanese Liver Transplantation Society indicated that TIPS creation did not shorten the life expectancy of this patient.
This case showed that more discussion of the indications for TIPS in PBC patients is needed.
Key words

Technical Note
Physicochemical Compatibility between Degradable Starch Microspheres and Pharmaceutical Products Frequently used for Combined Therapy
Department of Radiation Oncology, Department Radiology, Tokai University School of Medicine1)
Chieko Murayama, Yoshiro Iwata1), Naoko Gyoda
Yutaka Imai1), Yukio Ohizumi

Degradable Starch Microspheres(DSM) are spherical starch microspheres prepared from partially hydrolysed potato starch and then cross-linked by epichlorohydrin. Spherex is a transient embolic material prepared by suspending 60m/p of DSM in physiological saline, frequently administered via the hepatic artery in combination with other drugs, such as anticancer drugs, contrast medium and anticoagulant drugs. The aim of this study was to investigate the physicochemical compatibility between DSM and other injectable drugs frequently used in association. Physicochemical properties of DSM mixture with different drugs, including color, clarity, pH and size(particle diameter and distribution) of DSM were observed or measured before and after(up to 48 hours) mixing at room temperature. Results showed that the association of DSM with different drugs did not cause, up to 48 hours from mixing, any significant variation in the physicochemical parameters mentioned above.
Key words
●Degradable Starch Microspheres
●Physicochemical compatibility
●Anticancer drug