Jpn J Intervent Radiol Vol.27 No.4 2012

State of the Art
Current status of IVR reports

An Introduction  
Atsushi Komemushi
Department of Radiology, Kansai Medical University

1. A New Current for Structured Report in the Field of Interventional Radiology

Department of Radioloy, St’Lukes International Hospital
Yukihisa Saida

Interventional radiology (IVR) reports should be written according to the time order of the processes. The first one is composed of the indication and choice, the second one is the actual method and process, and the last one is the outcome and result of the IVR prosedure. At the end of the report format, check boxes should be prepared in order to record the success rating (sufficient or insufficient) and associated adverse effects (presence or absence of complications). Through systematic accumulation in a longer period, the data could be utilized for improvement of IVR quality.

Key words

  • IVR report
  • Radiology reporting system
  • Quality control
  • Structured report

2. Effectiveness of Web Registry System by Japanese Society of Interventional Radiology: JSIR

Department of Diagnostic & Interventional Radiology, Nasu Red Cross Hospital
Kimiyoshi Mizunuma

The Medical record of IVR consists of the physician’s report, nursing care report, electric records of blood pressure, pulse rate, blood oxygen saturation, radiation exposure status & dose, and medical images from modalities such as digital subtraction angiography, computed tomography, and ultrasound. The unification of time in these records is necessary to the correct medical records, especially in emergency cases with trauma or stroke. Web registry system, which is managed by JSIR, is very available to get new insurance payment in IVR. Fine IVR report is useful to obtain the full fee of IVR procedure from the national insurance system.

Key words

  • Time unification
  • Web registry system
  • Fine IVR report

3. What Is the Operative Note for Interventional Radiology That Surgery Societies & National Clinical Database Need?

Department of Radiology, St.Marianna University School of Medicine
Yasunori Arai

Surgical operation needs operation note. This is decided legally, but its format has not been defined. Surgical societies established National Clinical Database (NCD) for accumulation of information, and effective use. Surgeons have registered many data on-line.
The procedures of interventional radiology (IR) are mostly classified as operations (Item K) by the Japanese National Health Insurance. It is generally interpreted that the procedures classified as Item K need operative note legally.
The note of IR has no regular format habitually or legally. The present time may be the turning point at which we should discuss and shape our opinion about the optimal form of an IR note.

Key words

  • Operative note
  • Interventional radiology
  • Surgery

4. Current Status of IVR reports in Japan and IR reports in the United States

Department of Radiology, Kansai Medical University
Department of Radiology, Brigham and Women’s Hospital 1)
Department of Radiology, Boston Medical Center/Boston University (2010-2011) 2)
Atsushi Komemushi, Alisa Suzuki Han 1), Meguru Watanabe 2), Shuji Kariya
Miyuki Nakatani, Rie Yoshida, Satoshi Suzuki, Akira Sano, Kiyomichi Tanaka
Shohei Kanno, Koshi Ikeda, Keita Utsunomiya, Yoko Harima, Noboru Tanigawa

The authors reported on the realities of IVR reports in Japan and IR reports in the United States. The usual IVR reports were collected from 30 institutions in Japan. The collected reports were analyzed by 2 interventional radiologists. The IVR reports did not have Standard in Japan in infinite variety.

Key words

  • IR report
  • IVR report
  • Reporting Standards

Case Reports

Treatment of Congenital Pelvic Arteriovenous Malformation with Iliac Compression Syndrome by Stent Implantation and Transarterial Embolization: A Case Report

Department of Radiology, and Vascular Surgery1),
Tokyo Medical and Dental University Hospital Faculty of Medicine
Yuko Takeguchi, Mitsuhiro Kishino, Hidetoshi Uchiyama1), Koji Yonekura1)
Takahiro Toyofuku1), Toshifumi Kudo1), Masatoshi Jibiki
Norihide Sugano1), Yoshinori Inoue1), Hitoshi Shibuya

Iliac compression syndrome is a clinical condition that occurs as a result of compression of the left common iliac vein by the overlying right common iliac artery. Iliac vein compression syndrome is also a cause of deep venous thrombosis. The congenital pelvic arteriovenous malformation (AVM) arises from dysplastic arteries and veins. Among the many kinds of AVMs, the pelvic AVMs, especially AVMs of internal iliac area, are rare and can give rise to problems in diagnosis and treatment. The combination of pelvic arteriovenous malformation and common iliac vein occlusion is very unusual, and so we report an effective treatment for this case by stent placement and transarterial embolization.

Key words

  • Iliac compression syndrome
  • Venous stenting
  • Arteriovenous malformation (AVM)

Case Reports

A Case of Superselective Arterial Embolization of Arterial Hemorrhage after Prostate Biopsy

Department of Radiology, Kurume University School of Medicine
Masashi Kusumoto, Masamichi Koganemaru
Ryoji Iwamoto, Toshi Abe, Naofumi Hayabuchi
Department of Radiology, Tobata Kyoritsu Hospital
Daiji Uchiyama
Department of Urology, Kurume University School of Medicine
Kojiro Saito, Kei Matsuoka

Here we report a case of arterial hemorrhage in the prostate gland during trans-rectal biopsy, which was successfully treated by superselective transcatheter arterial embolization (TAE). A 52-year-old man with elevated prostate-specific antigen levels underwent trans-rectal prostate biopsy, which was complicated by prostatic hemorrhage confirmed by computed tomography (CT). TAE was promptly performed using polyvinyl alcohol particles and the hemorrhage was successfully terminated. Arterial embolization of branches of the internal iliac arteries is generally safe. Prostatic arteries, however, branch off the inferior vesical artery, which in some patients communicates with the rectal artery, in which case embolization carries the risk of bowel ischemia. C-arm CT enabled a visual assessment of blood flow from the prostatic artery, which helped to safely avoid bowel ischemia during the embolization procedure.

Key words

  • Prostate biopsy
  • Hemorrhage
  • Embolization

Case Reports

Hemorrhage from a Pseudoaneurysm after Pancreatoduodenectomy Successfully Treated with Coronary Covered Stent

Department of Radiology, and Surgery1),
National Hospital Organization Kure Medical Center and Chugoku Cancer Center
Naoko Akiyama, Naoyuki Toyota, Masashi Hieda, Ryosuke Watanabe
Akiko Nishitani1), Yukinobu Yoshikawa1)
Department of Radiology, Hiroshima University
Yuko Nakamura

Arterial hemorrhage after pancreatoduodenectomy is a life-threatening complication associated with a high mortality rate. Even when successfully treated with transarterial embolization, liver infarction, liver abscess or liver failure sometimes occurs after common/proper hepatic artery embolization. Decrease of potential collateral routes for hepatic artery due to surgical ligature or lymphadenectomy increases the risk of ischemia of the liver and biliary system. We report a 50’s-year-old male successfully treated with coronary covered stent to preserve hepatic arterial flow. A 3×16-mm balloon-expandable coronary covered stent was placed in the common hepatic artery to cover a pseudoaneurysm of a gastroduodenal artery stump. Postdilatation was performed using a 4×15-mm PTA balloon catheter. No recurrent bleeding or liver functional damage was observed after the procedure. Patency of the stent was confirmed during 2-year follow-up. Covered stent placement was considered to be a useful option for hemorrhage from the proximal side of the hepatic artery, especially in high-risk cases of liver infarction.

Key words

  • Covered stent
  • Pseudoaneurysm
  • Hepatic artery

Case Reports

A Case of Common Hepatic Arterial Occlusion Following Pancreaticoduodenectomy Successfully Treated with Percutaneous Transluminal Recanalization

Departments of Radiology and Gastroenterological Surgery1), Akita University School of Medicine
Makoto Koga, Satoshi Takahashi, Makoto Sugawara, Koichi Ishiyama
Osamu Watanabe, Takahiro Otani, Tomoyuki Asano, Manabu Hashimoto
Hiroshi Uchinami1), Go Watanabe1), Yuzo Yamamoto1)

Hepatic arterial occlusion can occur as a complication after pancreaticoduodenectomy (PD), sometimes causing severe hepatic damage. A case of common hepatic arterial occlusion after PD that caused acute hepatic damage and was successfully treated with percutaneous transluminal recanalization (PTR) followed by selective intra-arterial heparin administration is reported. A 60-year-old man underwent PD because of a tumor located in the papilla of Vater. On the second postoperative day, the liver enzyme values increased suddenly. Contrast-enhanced computed tomography (CT) showed thrombosis in the common hepatic artery, and emergent PTR to this occlusive lesion was performed. Since this had developed in the perioperative period, given the hemorrhagic risk, it was treated with mechanical clot fragmentation using a guidewire without thrombolytic agents. Selective intra-arterial heparin administration was continued for 4 days through a catheter placed in the common hepatic artery immediately after PTR. Since digital subtraction angiography (DSA) showed that the common hepatic artery was patent, the catheter was removed. Nineteen months after PTR, 3D-CT angiography (CTA) showed that the common hepatic artery was patent.

Key words

  • Common hepatic arterial occlusion
  • Percutaneous transluminal recanalization (PTR)