Search

Purpose: To evaluate the influence of percutaneous cryoablation for renal cell carcinoma on function of the affected kidney., Materials and Methods: Between June 2016 and September 2017 at our institution, 12 inoperable patients underwent 15 cryoablation sessions for 17 small renal tumors. Of these, 9 patients who underwent 11 sessions of cryoablation were the focus of this study. For those patients, time-dependent changes in postoperative renal function were investigated by a retrospective review of clinical records. Evaluated were the estimated glomerular filtration rate (eGFR) and scintigraphy using 99m technetium-mercaptoacetyltriglycine (99mTc-MAG3) before and 1 week, 1-2 months, and more than 6 months after cryoablation., Results: Mean baseline eGFR was 76.88 ± 29.82 mL/min/1.73 m 2 (mean ± standard deviation; range, 23.4-112.5). Mean eGFR 1 week, 1-2 months, and more than 6 months after cryoablation were 74.56 ± 26.68 mL/min/1.73 m 2 (21.0-101.1), 69.5 ± 25.28 mL/min/1.73 m 2 (24.1-105.6), and 75.08 ± 26.25 mL/min/1.73 m 2 (29.0-107.3), respectively. Changes were statistically insignificant (P = .6044, P = .6699, and P = .9038, respectively). Regarding split renal function, the mean baseline contribution of the affected kidney determined by 99mTc-MAG3 was 47.27% ± 6.14 (38.8%-57.0%). Mean contributions of the affected kidney 1 week after, 1-2 months after, and more than 6 months after cryoablation were 44.40% ± 5.37 (38.3%-53.6%), 44.57% ± 6.52 (34.35%-55.0%), and 45.41% ± 7.77 (34.4%-56.5%), respectively. Differences from baseline were significant for the earliest 2 periods (P = .0473 and P = .0334, respectively) but not the later period (P = .2532)., Conclusions: Results suggested that total renal function does not worsen after cryoablation; however, function of the affected kidney worsened after cryoablation but later partially recovered., (Copyright © 2018 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: To explore optimal diagnostic criteria for localizing insulinomas with the selective arterial calcium injection (SACI) test using decision tree analysis., Materials and Methods: A retrospective study included 86 vessels of 18 patients (5 men, 13 women; mean age 67 y; range, 49-73 y) with insulinomas who underwent SACI test between June 2007 and May 2016. Of 27 insulinomas, 7 were found in the head, 13 in the body, and 7 in the tail of the pancreas. Two patients had multiple tumors. To identify optimal diagnostic criteria, decision tree analysis was performed, and sensitivity, specificity, and accuracy of the conventional and the proposed new diagnostic criteria (plasma insulin concentration after calcium injection [ICpost] > 2.0 × plasma insulin concentration before calcium injection [ICpre]) were compared., Results: The proposed new diagnostic criteria for insulinoma obtained by decision tree analysis were (i) ICpost > 2.7 × ICpre and maximum insulin concentration > 60.3 μIU/mL or (ii) ICpost > 2.7 × ICpre and maximum insulin concentration < 60.3 μIU/mL with ICpre being ≥ 7.5 μIU/mL. Sensitivity, specificity, and accuracy of the new criteria for the SACI test were 100%, 91.4%, and 94.2; sensitivity, specificity, and accuracy of conventional criteria were 100%, 69.0%, and 79.1%., Conclusions: New diagnostic criteria for localization of insulinomas with the SACI test yielded higher diagnostic performance than conventional criteria., (Copyright © 2018 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the characteristics of hepatocellular carcinomas (HCCs) fed by the right renal capsular artery and to assess the tumor response and complications in patients treated with transarterial therapy via the renal capsular arteries with or without other extrahepatic arteries and/or intrahepatic arteries., Materials and Methods: Between March 2006 and May 2012, 24 lesions in 19 patients were treated by transcatheter arterial chemoembolization (23 sessions), transcatheter arterial embolization (two sessions), or transcatheter arterial infusion (one session), with HCCs fed by the right renal capsular artery with or without intrahepatic arteries and/or other collateral arteries. Other intrahepatic lesions were concurrently treated if needed., Results: Tumor size ranged from 10 mm to 107 mm (mean, 30.5 mm). Of the 24 tumors, 12 were located in segment VI, 10 in segment VII, one in the posterior segment, and one in the anterior segment after posterior segment resection. Severe complication occurred in four patients: liver abscess (n = 2), pleural effusion (n = 1), and duodenal ulcer (n = 1). Pleural effusion might be related to chemoembolization via the right renal capsular artery. A complete response was obtained in six sessions and a partial response in eight; 10 sessions were associated with stable disease and two with progressive disease., Conclusions: Precise renal capsular artery knowledge would facilitate successful and safe transarterial therapy for HCCs fed by the renal capsular arteries., (© 2014 SIR Published by SIR All rights reserved.)

Purpose: To investigate the feasibility, efficacy, and safety of transcatheter arterial embolization with N-butyl cyanoacrylate (NBCA) for gastroduodenal nonvariceal bleeding uncontrolled by endoscopic hemostasis., Materials and Methods: Between January 2006 and December 2011, a total of 317 patients underwent emergent endoscopic therapy for nonvariceal gastroduodenal bleeding, but hemostasis was not achieved in 20 cases. Emergent surgery was performed immediately following endoscopy in two patients. Arteriography was performed in the remaining 18 patients, and embolization with NBCA was performed in 15 patients (mean age, 71.3 y) in whom the bleeding site was detected on arteriography. For embolization, NBCA was mixed with iodized oil at a ratio of 1:1.5-1:4, and no other embolic material was used in the procedure. Technical and clinical success rates, recurrent bleeding, procedural time, complications, and clinical outcomes were determined for each procedure., Results: Embolization with NBCA was technically and clinically successful in all procedures, without major complications. No patient receiving embolization with NBCA experienced recurrent bleeding or required further treatment after the one-session procedure. All patients were discharged after clinical improvement. The time between puncture of the femoral artery and completion of embolization ranged from 25 to 240 minutes (mean, 66 min), and the time between the microcatheter reaching the ultimate catheter location selected for embolization and hemostasis ranged from 142 to 550 seconds (mean, 322s)., Conclusions: In this limited series, embolization with NBCA was found to be a safe, feasible, and effective treatment for gastroduodenal arterial bleeding when endoscopic hemostasis had failed., (Copyright © 2013. Published by Elsevier Inc.)

The present report describes three patients with portopulmonary venous anastomosis (PPVA) in whom balloon-occluded retrograde transvenous obliteration (B-RTO) of gastric varices was attempted. No patients had a gastrorenal shunt. In one patient, after an approach from the inferior phrenic vein (IPV), the PPVA was embolized with the use of microcoils. In another patient, after an approach from the IPV, the balloon catheter was advanced to a distal position from the PPVA. B-RTO was performed in these two cases without systemic infarction. In the remaining patient, after an approach from the azygos vein, the balloon catheter was not advanced distally from the PPVA, and therefore sclerotic agents were not infused., (Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: To elucidate changes in hemodynamics after balloon occlusion of the splenic artery during balloon-occluded retrograde transvenous obliteration (B-RTO)., Materials and Methods: In eight patients who had B-RTO for a gastric varix, the balloon-occluded venous pressure of the drainage vein was measured, and balloon-occluded retrograde venography (B-RTV) was performed with and without occlusion of the splenic artery during B-RTO. The pressure and the degrees of the variceal complex visualized on B-RTV were compared between those with and without occlusion of the splenic artery., Results: In seven of the eight patients, balloon-occluded venous pressure of the drainage vein decreased after balloon occlusion of the splenic artery. A paired t test showed that the mean decrease from 21.88 mm Hg to 18.38 mm Hg was statistically significant (P = .0033). From findings of B-RTV, the variceal complex was more extensively visualized after occlusion of the splenic artery in seven of the eight patients., Conclusions: Balloon occlusion of the splenic artery during B-RTO for gastric varices can produce changes in hemodynamics related to gastric varices and has the potential to prompt the sclerosing agent to distribute more extensively and evenly in the gastric varix., (Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: To retrospectively evaluate technical success, effectiveness, complications, patient survival, and prognostic factors with percutaneous radiofrequency (RF) ablation for pulmonary metastases resulting from hepatocellular carcinoma (HCC)., Materials and Methods: Thirty-two patients from six institutions were included, with a total of 83 pulmonary metastases treated in 65 sessions. RF ablation was always performed percutaneously with computed tomography (CT) guidance. Primary endpoints were technical success and technique effectiveness. Technique effectiveness was evaluated based on sequential follow-up CT images. Secondary study endpoints were complications, patient survival, and determination of prognostic factors. Complications were classified as major or minor. Prognostic factors were determined by analyzing multiple variables with the log-rank test., Results: Technical success rate was 100%. Primary technique effectiveness rates were 92% each at 1, 2, and 3 years. Major and minor complications occurred after 16 (25%) and 23 (35%) of the 65 sessions, respectively. The median follow-up period was 20.5 months. Overall survival rates were 87% at 1 year and 57% each at 2 and 3 years (median and mean survival times, 37.7 mo and 43.2 mo, respectively). Significantly better survival rates were obtained in cases of (i) no viable intrahepatic recurrence (P < .001), (ii) Child-Pugh class A disease (P < .001), (iii) absence of liver cirrhosis (P < .001), (iv) absence of hepatitis C virus infection (P = .006), and (v) α-fetoprotein level of 10 ng/mL or lower (P = .007) at the time of RF ablation., Conclusions: RF ablation appears effective, with an acceptable safety profile, in selected patients with pulmonary metastases resulting from HCC., (Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.)

Between March 1999 and March 2006, 292 patients at the authors' institution required placement of a percutaneously implantable port-catheter system through which repeated hepatic arterial infusion chemotherapy would be administered. In 10 patients, the port-catheter system was implanted through the superior mesenteric artery. In these patients, implantation through the superior mesenteric artery instead of the celiac artery was necessary because all hepatic arteries arose from the superior mesenteric artery or because the blood supply to almost all tumors was from a hepatic artery arising from the superior mesenteric artery. Implantation of the port-catheter system was successful without complications in these 10 patients.

A 68-year-old woman was admitted to the authors' hospital for hepatic encephalopathy. Her laboratory data and computed tomography findings were not suggestive of liver cirrhosis. Superior mesenteric angiography revealed an extrahepatic portal-systemic shunt with a main cause of hepatic encephalopathy. Despite treatment with branched-chain amino acid, lactulose, and kanamycin, hyperammonemia was prolonged, and the portal-systemic shunt was therefore treated with balloon-occluded retrograde transvenous obliteration. After the procedure, hyperammonemia was improved, and there were no signs of recurrent portal-systemic encephalopathy.

In four patients with a celiac artery that was too narrow through which to advance a catheter to the hepatic artery, a port-catheter system for hepatic arterial infusion chemotherapy was implanted with use of a pull-through technique. The indwelling catheter was advanced over a guide wire inserted from the femoral artery and through the celiac origin in a retrograde fashion via the superior mesenteric artery and pancreaticoduodenal collateral vessels. It was then pulled out via the infusion catheter access artery. In all cases, implantation with the fixed catheter tip technique was successful without complications.

Purpose: The present study was performed to determine the frequency of the complication of pneumothorax after radiofrequency (RF) ablation for lung neoplasms and risk factors affecting such pneumothoraces., Materials and Methods: The study was based on 129 consecutive sessions of percutaneous RF ablation of lung neoplasms under real-time computed tomographic fluoroscopic guidance performed in a single institution between May 2003 and November 2005 in 41 patients (17 women, 24 men; mean age, 63 years; age range, 29-82 y). Correlation was determined between the incidence of pneumothorax after RF ablation and multiple factors: sex, age, presence of emphysema, lesion size, lesion depth, contact of tumor with pleura, number of punctures, maximum power of RF generator, period of ablation, tissue temperature at the end of the RF ablation session, and patient position during the procedure. Management of each case of iatrogenic pneumothorax was reviewed., Results: Pneumothorax after RF ablation occurred in 38 of 129 RF ablation sessions (29.5%). Fourteen of the 38 cases were treated by manual aspiration, and 24 were simply observed. In five cases (3.9%), chest tube placement was required as therapy for pneumothorax. The risk of pneumothorax was significantly increased in patients with pulmonary emphysema., Conclusions: The frequency of pneumothorax after RF ablation in our experience is similar to the frequency of pneumothorax after lung biopsy reported in the literature. Various conditions for RF ablation did not influence the incidence of pneumothorax. Emphysema was the only individual factor that correlated significantly with the development of iatrogenic pneumothorax.

Purpose: To evaluate the feasibility and safety of a method to withdraw port-catheter systems implanted by the fixed catheter tip method., Materials and Methods: Retrospective review was conducted of 14 cases of unresectable advanced liver cancer in which it was necessary to attempt 15 withdrawals of percutaneously placed implantable port-catheter systems. Reasons for withdrawal, withdrawal success, complications, and subsequent treatment of patient were evaluated., Results: In 14 of the 15 procedures (93.3%), the port-catheter system was successfully retrieved. Because continuation of hepatic arterial infusion chemotherapy was necessary in 10 procedures, a second implantation was performed after withdrawal of the initial catheter. Only one complication occurred, in which the indwelling catheter was broken in the aorta during withdrawal., Conclusion: When retrieval of a port-catheter system implanted with the fixed catheter tip method is necessary, withdrawal can be accomplished safely with high frequency.

Few reports have described the influence of the retroportal artery on the distribution of anticancer drugs in the liver during repeated hepatic arterial infusion chemotherapy. This report describes two patients in whom poor distribution was observed in the right lobe of the liver, which was confirmed at superior mesenteric arteriography to be caused by inflow of the retroportal artery to the right hepatic artery. The retroportal artery was successfully embolized, resulting in improvement of distribution in the right lobe of the liver in both cases.

The present study evaluated the feasibility of combined therapy employing repeated hepatic arterial infusion chemotherapy (HAIC) via a port-catheter system and radiofrequency (RF) ablation for unresectable metastatic liver cancer from the colo-rectum. RF ablation was performed for six patients with liver malignancies that had been well controlled and had decreased in number and size with repeated HAIC. After RF ablation subsequent to repeated HAIC, all six patients had stable disease or complete or partial remission as documented by follow-up contrast-enhanced computed tomographic (CT) imaging. Fluorodeoxyglucose positron emission tomography (18F) showed complete response in all ablated lesions. In conclusion, RF ablation after a course of HAIC achieved complete necrosis in residual lesions after HAIC therapy.

Purpose: The stroke rate after left subclavian arterial port-catheter placement was compared in two groups: one with minimal redundancy of the catheter and one with pronounced redundancy in the aortic arch designed to minimize the likelihood of catheter dislocation., Materials and Methods: One hundred forty-eight patients (102 men, 46 women; age range, 26-83 years; mean age, 64.3 years) with inoperable advanced liver cancers underwent percutaneous implantation of port-catheter systems via the left subclavian artery. In 33 patients, a pronounced redundancy of the catheter was intentionally looped in the aortic arch. Redundancy was intentionally avoided in the remaining 115 patients. The rates of brain infarction complications in these two groups were retrospectively compared., Results: Among the 33 patients with pronounced redundant catheter looping, brain infarctions occurred in four cases (12.1%). In contrast, brain infarctions occurred in only three of the 115 patients with minimal redundant catheter looping (2.6%). The frequency of brain infarction complications was significantly higher in the patients with pronounced redundant catheter looping in the aortic arch than in patients with minimal pronounced redundant catheter looping (P = .044, Fisher exact test)., Conclusion: Catheter redundancy in the aortic arch increases the risk of stroke in patients undergoing implantation of port-catheter systems via a left subclavian arterial approach for repeated hepatic arterial infusion chemotherapy.

Purpose: For therapeutic effectiveness of repeated hepatic arterial infusion chemotherapy (HAIC) for unresectable advanced liver malignancies, distribution of anticancer drugs via an indwelling catheter should be uniform throughout the entire liver. It was investigated how an extrahepatic artery entering the posterior segment or caudate lobe of the liver influences performance of repeated HAIC., Materials and Methods: One hundred ninety-five patients with unresectable advanced liver cancer underwent placement of a percutaneously implantable port-catheter system and were followed arteriographically with and without computed tomography (CT). The frequency of poor distribution in the posterior segment or caudate lobe of the liver was observed on CT during arteriography via the port for HAIC. The correlation between poor distribution and various factors including the number of intrahepatic arteries was studied, and the management of such poor distribution is described., Results: In 34 of 195 patients (17.4%), poor distribution was observed in the posterior segment and/or caudate lobe of the liver. The rate of poor distribution was significantly higher in those with two or more hepatic arteries than in those with one (13 of 35 vs 21 of 160; P = .0007, chi2 test). Other evaluated factors were not significantly correlated with such poor distribution. The right inferior phrenic artery was successfully embolized in 22 patients with tumors in segments with poor distribution. Good distribution throughout the entire liver was achieved in 21 patients (95.5%)., Conclusion: Inflow of the right inferior phrenic artery into the liver occasionally prevents distribution of anticancer drugs throughout the entire liver during performance of long-term HAIC.

Purpose: The goal of this study was to evaluate the efficacy of simple aspiration of air from the pleural space to prevent increased pneumothorax and avoid chest tube placement in cases of pneumothorax after computed tomography (CT)-guided lung biopsy., Materials and Methods: This retrospective study was based on experience with 283 consecutive percutaneous needle lung biopsies with real-time CT fluoroscopic guidance. While patients were on the CT scanner table, percutaneous manual aspiration was performed in all those with moderate or large pneumothorax demonstrated on postbiopsy chest CT images regardless of symptoms. The authors evaluated the frequency of biopsy-induced pneumothorax, management of each such case, and factors that influenced the incidence of worsening pneumothorax that required chest tube placement despite manual aspiration., Results: Of the 104 (36.7%) pneumothoraces occurring after 283 biopsy procedures, 52 were treated with manual aspiration immediately after biopsy. In 95 of the 104 pneumothoraces (91.3%), the pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement. Only nine patients (3.2% of the entire series; 8.7% of those who developed pneumothorax) required chest tube placement. Requirement of chest tube insertion significantly increased parallel to the increased volume of aspirated air. The optimal cutoff level of aspirated air on which to base a decision to abandon manual aspiration alone and resort to chest tube placement was 543 mL., Conclusion: Percutaneous manual aspiration of biopsy-induced pneumothorax performed immediately after biopsy may prevent progressive pneumothorax and eliminate the need for chest tube placement. However, in cases in which the amount of aspirated air is large (such as more than 543 mL in this study), the possibility of required chest tube placement increases.

The present study evaluated the feasibility of interventional radiologic treatments for hepatic arterial occlusion after hepatic arterial infusion chemotherapy (HAIC) via an implanted port-catheter system. Treatment for hepatic arterial occlusion was attempted in seven patients with unresectable liver cancer. In six, the obstructed hepatic artery was recanalized. In three patients, the recanalized hepatic artery again became obstructed. However, by performing additional interventional radiologic procedures, secondary patency of the hepatic artery was successfully obtained in two patients. In conclusion, when hepatic arterial occlusion occurs, HAIC can be resumed in the attempt to recanalize the hepatic artery.

The purpose of the present study is to evaluate the feasibility of a method developed to withdraw a port-catheter system that had been implanted with use of the fixed catheter tip technique. Withdrawal of an implanted catheter was required in four patients with advanced liver cancer in whom port-catheter systems had been implanted for performance of repeated hepatic arterial infusion. In all patients, port-catheter systems were successfully removed without complications. In conclusion, an implanted port-catheter system can be removed even when implanted with the fixed catheter tip technique.