Jpn J Intervent Radiol Vol.23 No.2 2008

State of the Art
Interventional Radiology in Emergency

1. Endovascular Treatment for Ruptured Cerebral Aneurysm

Department of Neurosurgery, National Hospital Organization, Mito Medical Center
Yasunobu Nakai, Makoto Sonobe

The endovascular treatment of intracranial aneurysms has evolved over the last decade from an alternative to surgical clipping to a very well accepted universally expanding form of therapy. A recent randomized clinical trial (International subarachnoid aneurysm trial : ISAT) has legitimized the advantages of endovascular treatment over surgery. In the present article, we described the endovascular treatment for ruptured cerebral aneurysm, historical review, indications, technical considerations, and perioperative management.

Key words

  • Coil embolization
  • Ruptured cerebral aneurysm
  • Subarachnoid hemorrhage


2. The Role of Interventional Radiology in Acute Gastrointestinal Bleeding

Department of Radiology, Osaka City University Graduate School of Medicine
Kenji Nakamura

Blood loss due to acute gastrointestinal bleeding is a frequent cause of admission to critical care units. Rapid diagnosis and effective treatment are the determinant prognostic factors. The initial therapeutic approach in the acute settings consists of combined medical and endoscopic treatment. In the recent years, the development of interventional radiology techniques has offered to clinicians an alternative, effective and less invasive therapeutic approach for the treatment of acute blood loss. In this article, we will show the outstanding role of interventional radiology in the treatment of acute gastrointestinal bleeding and variceal bleeding.

Key words

  • Gastrointestinal bleeding
  • Portal hypertension


3. Emergency Interventional Radiology in the Management of Intraperitoneal Hemorrhage

Department of Radiology1) and Emergency medicine2), Kitasato University School of Medicine
Hiroshi Nishimaki1,2), Fumie Kashimi2), Reiko Woodhams1)
Tomomichi Kan’ou2), Saori Kawamura1), Keiji Matsunaga1), Kazui Soma2)

Intraperitoneal hemorrhage may be a life-threatening occurrence. Multislice computed tomography (MSCT) is the most commonly used modality in the initial work up of these patients. Recently, an increasing number of patients have been treated using transcatheter arterial embolization (TAE).
This review will describe the indications, pitfalls, and methods of TAE and other interventional radiology procedures in the management of hemoperitoneum caused by blunt abdominal trauma (hepatic, splenic, renal), postoperative, hepatocellular carcinoma, abdominal visceral aneurysm and coagulopathy.

Key words

  • TAE
  • Postoperative hemorrhage
  • Spontaneous extraperitoneal hemorrhage
  • Segmental arterial mediolysis


4. Bleeding from Other Sites : Bleeding from the Chest and an Urogenital Apparatus

Department of Radiology, Koshigaya Hospital, Dokkyo University School of Medicine
Mamoru Iimuro, Miwako Nozaki
Department of Diagnostic Imaging and Interventional Radiology, Tokyo Women’s Medical University Yachiyo Medical Center
Joe Toda

Some disorders resulting in hemorrhage requiring emergent hemostasis are curable. In the chest, such disorders include angioma and external injury, and in the urinary region, they include perirenal hematoma, hematuria, postpartum hemorrhage, emorrhage after undergoing gynaecological surgery and hemorrhage from uterine myomas. This study deals with the indication of intravascular therapy and the selection of catheter and embolizing material for such disorders.

Key words

  • Interventional radiology
  • Transcatheter arterial embolization
  • Emergency interventional radiology


5. Emergency Interventional Radiology for Acute Thrombosis of Superior Mesenteric Artery and Infrapopliteal Artery

Department of Radiology, The Jikei University School of Medicine
Masanori Nagase, Shunichi Sadaoka, Kunihiko Fukuda

Interventional radiology (IVR) techniques for the treatment of acute superior mesenteric artery (SMA) thrombosis and infrapopliteal artery (IPA) thrombosis are thrombectomy and thrombolysis under selective catheterization.
Acute SMA occlusion is one of the important causes of acute abdomen. Diagnosis of this condition is sometimes delayed due to its non-specific symptoms. This delay usually results in the need for surgical treatment. However, recent clinical use of MDCT has facilitated detection of SMA thrombosis at its early stage and its treatment by IVR.
In cases with acute iliac and femoral artery thrombosis, the success rate of IVR treatment is high. On the other hand, that for acute IPA occlusion is not still satisfactory. Therefore, treatment choice for acute IPA thrombosis exists between either surgery alone or combinations of IVR and surgical procedure.

Key words

  • Acute thrombosis
  • Superior mesenteric artery
  • Infrapopliteal artery
  • Thrombectomy
  • Thrombolysis

Original Article
Biliary Tract Injury and Liver Damages Generated after Transcatheter Arterial Chemoembolization Using Porous Gelatin Particles(Gelpart R)

Department of Radiology, Wakayama Medical University
Hiroki Sanda, Nobuyuki Kawai, Akira Ikoma, Hideyuki Oda, Shinya Sahara
Isao Takasaka, Takuya Iwamoto, Motoki Nakai, Hiroki Minamiguchi
Hirohiko Tanihata, Morio Sato

Porous gelatin particles (GelpartR) were legally approved in 2006 in Japan for use as an embolic material in hepatic artery chemoembolization (HACE) for hepatocellular carcinoma (HCC). In our institution, gelatin sponge particles (GSP) with sizes of 1~2㎜ sliced by hand are being replaced by GelpartR. Of 81 cases who underwent HACE with Gelpart from October 2006 to April 2007, 4 cases (5%) encountered complications : biliary tract injury in 1 case, liver infarction in 1 case and liver abscess in 2 cases. In contrast, of 247 cases who underwent HACE with GSP from October 2005 to April 2007, 3 cases (1.2%) encountered complications : liver abscess in 2 cases and biloma in 1 case. This difference in the incidence of complications between the GelpartR and GSP cohorts was not statistically significant. Magnifying glass examination revealed that commercial 2㎜ size GelpartR was composed of variously shaped particles such as round-like, multi-angled and lobulated type and variable sizes (median 1.2㎜ ; range : 0.4~2.4), while 1㎜ sliced GSP was composed of four-angled form and less variable sizes (median 1㎜ ; range 0.8~1.6). Therefore, it should be recognized that GelpartR is not the same embolic material as GSP sliced by hand. In the use of GelpartR, embolization with GelpartR in small increments should be repeated to avoid overdosing.

Key words

  • Transcatheter arterial chemoembolization
  • Porous gelatin particles
  • Biliary tract injury
  • Liver damages

Case Report
Vertebral Artery Thrombus Formation during Subclavian Artery Stenting-A Case Report of Successful Rescue-

Department of Radiology, Nara Medical University
Kaoru Myouchin, Hiroyuki Nakagawa, Takeshi Wada, Masahiko Sakamoto
Toshiaki Taoka, Akio Fukusumi, Satoru Iwasaki, Kimihiko Kichikawa
Department of Endovascular Neuroradiology, Ishinkai Yao General Hospital
Katsutoshi Takayama

Vertebrobasilar ischemic events occur due to embolic, thrombotic and hemodynamic mechanisms. Embolic events are the most frequent cause, and mostly occur due to a vertebral artery (VA) ostial lesion. Percutaneous transluminal angioplasty and / or stenting represents a safe and effective therapeutic choice for extracranial VA atherosclerotic stenosis, particularly at the VA origin. Endovascular treatment at this location is commonly associated with a low risk of distal embolization. We encountered a case of VA thrombus formation during subclavian artery stenting that was successfully rescued by evacuation. We considered the mechanisms underlying VA thrombus formation.

Key words

  • Vertebral artery stenosis
  • Thrombus formation
  • Evacuation

Technical Note
Implantable Central Venous Port in Upper Arm

Department of Radiology, Nara Medical University Hospital
Masayoshi Inoue, Toshihiro Tanaka, Kiyosei Yamamoto, Kengo Morimoto
Hideyuki Nishiohuku, Satoru Sueyoshi, Kimihiko Kichikawa
Department of Radiology, Nara Prefectual Mimuro Hospital
Hiroshi Sakaguchi

We devised a new procedure to place an implantable central venous port in the upper arm. To avoid poor dropping due to bending of the cubital joint, we puncture the basilic vein and implant the port in the upper arm with the subcutaneous tunnel forming a loop-shape of the implanted catheter.
In our early experience of 49 cases, the procedure was successful in all cases, and no complications such as poor dropping or damage to the catheter due to bending of the cubital joint were encountered.
We conclude that this new procedure may be a useful method to place an implantable central venous catheter system.

Key words

  • Central venous access
  • Implantable port
  • Upper arm