Asako Kuhara

Follow-up of true visceral artery aneurysm after coil embolization by three-dimensional contrast-enhanced MR angiography.

PURPOSE We aimed to evaluate the outcomes of coil embolization of true visceral artery aneurysms by three-dimensional contrast-enhanced magnetic resonance (MR) angiography. MATERIALS AND METHODS We used three-dimensional contrast-enhanced MR angiography, which included source images, to evaluate 23 patients (mean age, 60 years; range, 28-83 years) with true visceral artery aneurysms (splenic, n=15; hepatic, n=2; gastroduodenal, n=2; celiac, n=2; pancreaticoduodenal, n=1; gastroepiploic, n=1) who underwent coil embolization. Angiographic aneurysmal occlusion was revealed in all cases. Follow-up MR angiography was conducted with either a 1.5 or 3 Tesla system 3-25 months (mean, 18 months) after embolization. MR angiography was evaluated for aneurysmal occlusion, hemodynamic status, and complications. RESULTS Complete aneurysmal occlusion was determined in 22 patients (96%) on follow-up MR angiography (mean follow-up period, 18 months). Neck recanalization, which was observed at nine and 20 months after embolization, was confirmed in one of eight patients (13%) using a neck preservation technique. In this patient, a small neck recanalization covered by a coil mass was demonstrated. The complete hemodynamic status after embolization was determined in 21 patients (91%); the visualization of several collateral vessels, such as short gastric arteries, after parent artery occlusion was poor compared with that seen on digital subtraction angiography in the remaining two patients (9%). An asymptomatic localized splenic infarction was confirmed in one patient (4%). CONCLUSION Our study presents the follow-up results from three-dimensional contrast-enhanced MR angiography, which confirmed neck recanalization, the approximate hemodynamic status, and complications. This effective and less invasive method may be suitable for serial follow-up after coil embolization of true visceral aneurysms.

A newly developed double lumen microballoon catheter with a side hole: initial experience of intraarterial infusion chemotherapy and/or embolization

PurposeTo introduce a newly developed double lumen microballoon catheter with a side hole for intraarterial infusion chemotherapy and/or embolization.Methods and materialsSeven patients with malignant tumors, for whom superselective catheterization was considered difficult or had failed, underwent intraarterial infusion chemotherapy and/or embolization with the 3.3-Fr microballoon catheter. The catheter has a double lumen and a side hole to facilitate infusion from the proximal end of the balloon. The balloon was placed on the distal side of the target artery branching site. Inflation of the balloon and occlusion of the main lumen with the tip of the occlusion device allowed for intraarterial infusion chemotherapy and/or embolization of the target artery via the side hole.ResultsSuccessful intraarterial infusion chemotherapy and/or embolization with the microballoon catheter was performed in all patients with no complications.ConclusionsThe newly developed microballoon catheter achieves intraarterial infusion chemotherapy and/or embolization without the need for superselective catheterization.

Ultraselective embolization using a 1.7-Fr catheter and soft bare coil for small intestinal bleeding.

Abstract Objective: We aimed to evaluate the safety and efficacy of embolization using a 1.7-Fr catheter and soft bare coil to treat acute small intestinal bleeding. Material and methods: Subjects were five consecutive patients who experienced onset of melena with small intestinal bleeding and underwent transcatheter arterial embolization with 1.7-Fr catheters and 0.010-inch detachable bare coils (five procedures in total). Technical success, clinical success, relative post-procedural complications, arterial bleeding source and cause, and relationship between coagulopathy and embolization efficacy were examined by capsule endoscopy. Results: We achieved 100% technical and clinical success for the five transcatheter arterial embolizations. All catheterizations of the vasa recta of the bleeding artery (jejunal artery, n = 2; ileal artery, n = 3) were possible with a 1.7-Fr catheter. We achieved high embolization efficacy in two patients with coagulopathy. No rebleeding, intestinal ischemia, or necrosis was observed on follow-up capsule endoscopy. We confirmed that peptic ulcers/ulcer scars were the cause of bleeding for all patients. Conclusion: Embolization with 0.010-inch coils using a 1.7-Fr catheter and catheterization of the vasa recta of bleeding vessels was effective and safe for treating small intestinal bleeding.

Emergent interventional approach for aortogastric tube fistula with massive gastrointestinal bleeding

This report describes the successful endovascular treatment of a rare case of aortogastric tube fistula with massive gastrointestinal haemorrhage. The patients history included oesophageal reconstruction for oesophageal carcinoma using a gastric tube. Emergent angiography revealed extravasation from the thoracic aorta into the thinner aortogastric tube fistula. A microcatheter was inserted into the aortogastric tube with the aortic approach for embolisation with a mixture of n-butyl cyanoacrylate and iodised oil to enable fluoroscopic visualisation. Aortography confirmed the complete absence of extravasation after embolisation, after which a stent graft was placed. This procedure demonstrated that transcatheter embolisation of the aortogastric tube fistula was possible, and that the technique can be used as an emergency option. CT imaging was performed 21 days after the procedure, and revealed no trace of extravasation or inflammation. There were no complications during the 14 months following the endovascular treatment; the patient remains in stable condition.

Management of visceral artery embolization using 0.010-inch detachable microcoils.

Transcatheter coil embolization is used primarily to treat arterial hemorrhages, tumors, aneurysms, and vascular malformations. However, conventional microcatheter systems cannot always be employed in difficult cases. In this technical note, we describe how small-diameter primary coils and microcatheter tips that are thinner than normal can be used to increase the safety and reliability of coil embolization.

Late-occurring coil migration into the duodenum.

A 74-year-old man presented with hypovolemic shock due to acute arterial haemorrhage from his abdominal drainage tube, which was placed at the choledochojejunostomy, at 12 days following surgical resection of bile duct carcinoma. Postoperative abscess formation was noticed at the same region, and urgent parent artery embolisation using 0.018-inch fibred platinum microcoils was performed from the distal to proximal ends of the pseudoaneurysm arising from the gastroduodenal artery (figure 1). The …

A Retrograde Transvenous Embolization Technique with Balloon-Assisted Arterial Aspiration for a Peripheral Arteriovenous Malformation with a Venous Pouch

Management of arteriovenous malformations (AVMs) is challenging, and there is no consensus regarding either the ideal approach or the treatment timing. Percutaneous embolization is the most frequent approach currently used and is considered the first-line technique for AVMs. There is an ongoing discussion about the best technical approach to embolize AVMs. AVMs associated with a dominant outflow vein (DOV) are rare. Embolization of both the DOV and the nidus is considered more effective. Herein, we report a novel technique of transvenous embolization of a DOV under negative pressure from an arterial balloon catheter in a case of a peripheral AVM. This technique allows the embolization of the DOV and the nidus retrogradely.

Successful transcatheter lumbar arterial embolization of traumatic hemothorax

Traumatic hemothorax associated with the lumbar artery is extremely rare. In addition to tube thoracostomy, active hemostatic intervention is necessary in life-threatening massive hemothorax cases. Here we report a case of hemothorax resulting from a lumbar arterial injury accompanied by vertebral fracture, which was successfully treated with transcatheter lumbar arterial embolization. Most sources of hemothorax include the lung parenchyma, chest wall, or mediastinum. In cases of life-threatening massive hemothorax not responding to initial tube drainage, urgent surgical intervention is strongly recommended [1]. Furthermore, transcatheter arterial embolization (TAE) has emerged as an effective intervention for hemothorax [2–4]. Here, we report a rare case of traumatic hemothorax related to lumbar arterial injury, which was successfully treated with TAE. A74-year-old man hit by an automobile in his back was transferred to the emergency department. On admission, the patient’s airway was patent, and his respiratory rate was 16 breaths per minute with 96% oxygen saturation on oxygen inhalation. Initial blood pressure was 88/52 mm Hg with a pulse rate of 47 beats per minute. The patient had a Glasgow Coma Scale of 13/ 15 (E3V4M6) without anisocoria. The focused assessment with sonography for trauma was positive in the right intrapleural space, and chest radiograph showed a whole hypolucent area on the right lung field. Contrast-enhanced computed tomography (CT) revealed brain contusion, right hemothorax, and first lumbar vertebral fracture with extravasation of the contrast medium into the retroperitoneum (Fig. 1). Conventional tube drainage was performed for the right hemothorax, with immediate evacuation of 1000 mL of blood. However, bleeding from the chest tube persisted that necessitated blood transfusion to maintain hemodynamic stability. Thus, emergency angiographywas performed followingtracheal intubation. The aortography and selective right first lumbar arteriogram revealed a pseudoaneurysm sac and contrast extravasation (Fig. 2). Transcatheter arterial embolization with gelatin sponge particles and microcoils was performed for the right first lumbar artery, resulting in the complete disappearance of the pseudoaneurysm sac and contrast extravasation. Noncontrast CT image recorded 20 minutes after TAE showed the evidence of hemothorax because of injury to the right first lumbar artery; a high-density area, likely the contrast agent from angiography, extending from the embolic site to the right thoracic cavity via the right crus of diaphragmwasobserved(Fig.3).Thepatientreceived10Uofpackedredblood