Yukihisa Ogawa

Candy-Plug Technique Using an Excluder Aortic Extender for Distal Occlusion of a Large False Lumen Aneurysm in Chronic Aortic Dissection.

Purpose: To describe the candy-plug technique using an Excluder aortic extender for distal occlusion of a large false lumen aneurysm in chronic aortic dissection. Technique: A 60-year-old female patient with a history of chronic type B aortic dissection and high-dose steroid use for Churg-Strauss syndrome developed a large 6.2 cm maximum diameter false lumen aneurysm. She underwent thoracic endovascular aortic repair from the left common carotid artery to the descending aorta to cover the proximal entry at the level of distal arch, with coil embolization of the left subclavian artery. To occlude the large false lumen from the reentry just below the level of the left renal artery ostium, a modified 32×45-mm Excluder aortic extender was deployed in the false lumen through the reentry, and a 16-mm Amplatzer Vascular Plug I was deployed in the waist of the modified Excluder aortic extender for complete occlusion. No obvious technical complication was seen. Contrast-enhanced computed tomography at 1 and 14 months revealed no endoleaks and showed complete false lumen thrombosis. Conclusion: The candy-plug technique using the Excluder aortic extender is feasible for occlusion of a large false lumen aneurysm in chronic aortic dissection.

A case of pseudoaneurysm of the deep femoral artery successfully treated by NBCA embolization under occlusion

Transcatheter embolization of bleeding from distal branches of small arteries can be difficult. N-butyl cyanoacrylate (NBCA) was originally used as a tissue adhesive material, and recent evidence suggests that it can also be used as an embolic material. This report describes a case in which a pseudoaneurysm arising from the distal portion of a small branch of the deep femoral artery was successfully embolized with NBCA using a new technique with a microballoon catheter. Advantages of this technique include its safely, short treatment time, good control of the embolization range, absence of fragmentation, favorable polymerization dynamics, and absence of glue reflux or excessive distal spread of the glue.

Clinical efficacy and value of redistributed subclavian arterial infusion chemotherapy for locally advanced breast cancer

PurposeThe aim of this study was to evaluate the efficacy and safety of redistributed subclavian arterial infusion chemotherapy (RESAIC). We have focused on the local response, quality of life (QOL), and complications. We have also investigated factors that influence the local response of RESAIC.Materials and methodsThe subjects were patients with locally advanced breast cancer whose tumors were resistant to standard systemic chemotherapy (at least more than two regimens), those who were physically unable to tolerate systemic chemotherapy, and patients with locally recurrent breast cancer. The registration period was between April 2006 and May 2009.ResultsA total of 24 cases in 22 patients (mean age 59.5 years, range 36–82 years) were entered in the study. The local response rate of RESAIC was 77.3% (17/22). The QOL score showed improvement on average. There were no serious complications during catheter port implantation, and there was hematological toxicity over grade 3 in 27.3% (6/22) of patients. A significant difference between responders and nonresponders was seen in patients with a replaced type tumor (on imaging, diffuse contrast enhancement was seen in whole quadrants) (P = 0.043), and the patients underwent radiotherapy (P = 0.043).ConclusionRESAIC is an effective, safe treatment for locally advanced breast cancer. Because it was reviewed in only a few cases, however, large-scale studies are warranted.

Percutaneous vertebroplasty performed by the isocenter puncture method

PurposeThe aim of this study was to clarify the usefulness of the isocenter puncture (ISOP) method.Materials and methodsWe investigated 73 vertebral bodies that had undergone percutaneous vertebroplasty (PVP) by the ISOP method, 118 vertebral bodies that had undergone the puncture simulation method, and 33 vertebral bodies that had undergone the conventional method. The items to be examined included the success rate (SR) of the median puncture of the vertebral body and the procedure time. The puncture accuracy and fluoroscopy time were also measured for the ISOP method.ResultsThe SR was significantly higher and the procedure time significantly shorter when using the ISOP method rather than the conventional method. However, no significant differences were observed between the ISOP method and the puncture simulation method. The errors between the puncture needle tip and the puncture target point in the ISOP method were an average of 1.52, 2.08, and 1.87 mm in each of the horizontal, ventrodorsal, and craniocaudal directions. The fluoroscopy time when operating on one vertebral body was an average of 5.8 min.ConclusionThe ISOP method is considered to be a useful approach while also reducing the puncture time and the fluoroscopy time.

N-Butyl Cyanoacrylate Is Very Effective for Massive Haemorrhage during the Perinatal Period

Objective The liquid embolic agent n-butyl cyanoacrylate (NBCA) is a tissue adhesive used as an immediate and permanent embolic agent when mixed with oil-based contrast medium. In this study, the preservation of fertility with TAE using NBCA for massive haemorrhage during pregnancy or the peripartum period and the utility of this therapy were investigated. Methods Cases from January 2005 to October 2010 in which TAE was performed for massive haemorrhage in pregnant women, particularly during the peripartum period, were investigated. Results TAE was performed in 27 pregnant women. The embolic agent used was GS only in five cases, NBCA only in 19 cases, and additional embolization with NBCA when the effect with GS was insufficient in three cases, one each of abruptio placentae, cervical pregnancy, and uterine atony.A comparison of mean blood loss when each embolic agent was used for haemostasis showed a significant difference between cases in which GS only was used and cases in which NBCA only was used. In a comparison of mean transfusion volume, a significant difference was seen between cases in which both GS and NBCA were used and cases in which NBCA only was used. In a postoperative follow-up survey, menses resumed in eight patients, including four patients who later became pregnant and three who delivered. Conclusions TAE with NBCA, which has an embolic effect unrelated to clotting dysfunction for massive haemorrhage during the peripartum period, is a minimally invasive and very effective treatment method for patients with severe DIC.

Cost-Effectiveness Analysis of Percutaneous Vertebroplasty for Osteoporotic Compression Fractures.

Study Design: Single-center, single-arm, prospective time-series study. Objective: To assess the cost-effectiveness and improvement in quality of life (QOL) of percutaneous vertebroplasty (PVP). Summary of Background Data: PVP is known to relieve back pain and increase QOL for osteoporotic compression fractures. However, the economic value of PVP has never been evaluated in Japan where universal health care system is adopted. Methods: We prospectively followed up 163 patients with acute vertebral osteoporotic compression fractures, 44 males aged 76.4±6.0 years and 119 females aged 76.8±7.1 years, who underwent PVP. To measure health-related QOL and pain during 52 weeks observation, we used the European Quality of Life–5 Dimensions (EQ-5D), the Rolland-Morris Disability Questionnaire (RMD), the 8-item Short-Form health survey (SF-8), and visual analogue scale (VAS). Quality-adjusted life years (QALY) were calculated using the change of health utility of EQ-5D. The direct medical cost was calculated by accounting system of the hospital and Japanese health insurance system. Cost-effectiveness was analyzed using incremental cost-effectiveness ratio (ICER): &Dgr; medical cost/&Dgr; QALY. Results: After PVP, improvement in EQ-5D, RMD, SF-8, and VAS scores were observed. The gain of QALY until 52 weeks was 0.162. The estimated lifetime gain of QALY reached 1.421. The direct medical cost for PVP was ¥286,740 (about 3061 US dollars). Cost-effectiveness analysis using ICER showed that lifetime medical cost for a gain of 1 QALY was ¥201,748 (about 2154 US dollars). Correlations between changes in EQ-5D scores and other parameters such as RMD, SF-8, and VAS were observed during most of the study period, which might support the reliability and applicability to measure health utilities by EQ-5D for osteoporotic compression fractures in Japan as well. Conclusions: PVP may improve QOL and ameliorate pain for acute osteoporotic compression fractures and be cost-effective in Japan.

Erratum to: Preliminary findings of arterial embolization with balloon-occluded and flow-dependent histoacryl glue embolization in a swine model

Purpose To evaluate the potential usefulness of the balloon-occluded histoacryl glue embolization (B-glue) technique.

Development of a New Support Method for Transpedicular Punctures of the Vertebral Body: The Isocenter Puncture Method

Recently, the percutaneous transpedicular puncture of vertebral body under fluoroscopic guidance using a singleplane or biplane C-arm radiographic system has gained acceptance for percutaneous vertebroplasty (PVP) and vertebral bone biopsy [1–4]. PVP is usually performed by bilateral transpedicular puncture to gain uniform distribution of the injected cement in the vertebral body. However, if the tip of the puncture needle is advanced to the midline of the vertebral body, PVP by unilateral transpedicular puncture can be achieved. The unilateral transpedicular approach has advantages over the bilateral transpedicular approach, such as reduction of procedure time, cost, and radiation exposure [5, 6]. However, advancing the needle to the midline under fluoroscopic guidance is technically difficult, as is vertebral bone biopsy of a small lesion in the vertebral body. Currently, the CT-guided approach is used for this purpose [7, 8]. To advance the puncture needle to the target in the vertebral body under fluoroscopic guidance, we developed a new puncture method called the isocenter puncture (ISOP) method using the isocenter of the C-arm radiographic system. The purpose of this paper is to describe the ISOP method and our initial clinical results. The ISOP Concept

A case of retained placenta increta successfully treated via uterine arterial embolization using N-butyl 2-cyanoacrylate.

A 29-year-old woman with placenta increta with hemorrhage underwent uterine artery embolization using 12.5% NBCA (N-butyl 2-cyanoacrylate) diluted with iodized oil (Lipiodol). Complete resolution of placenta increta without performing curettage was obtained. The uterus returned to its normal shape, with restored endometrium, junctional zone, and myometrium. Menstruation resumed after 3 months. In cases of retained placenta due to placenta accreta, and even those with placenta increta, uterine artery embolization using NBCA is a useful treatment.

Bilateral approach of redistributed subclavian arterial infusion chemotherapy for locally advanced breast cancer spreading to the contralateral chest wall.

A catheter port system technique called redistributed subclavian arterial infusion chemotherapy (RESAIC) for locally advanced breast cancer was reported and seemed to be effective for local control and as a palliative treatment. However, when the cancer spreads beyond the medial line to the contralateral chest wall, ipsilateral RESAIC would not achieve a favorable drug distribution. We report on two patients with advanced breast cancer spreading to the contralateral chest wall in whom bilateral RESAIC was attempted. In summary, when advanced breast cancer spreads to the contralateral chest wall, bilateral RESAIC may be useful for local control or palliation.