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Since April 1977 percutaneous transhepatic cholangioscopy (PTCS) has been carried out in 428 cases comprising 213 cases of malignant disease and 215 benign cases. PTCS is performed through the dilated sinus track of percutaneous transhepatic biliary drainage. When irregularly dilated and tortuous vessels, which we called tumor vessels, are revealed on biliary strictures or polyps, a correct diagnosis of cancer can be made. Benign biliary strictures with or without gallstones, or polypoid lesions without tumor vessels such as granulomas, can be differentiated by cholangioscopic biopsy. The positive rate of cholangioscopic biopsy in 57 cases of bile duct cancer was 96%. PTCS should be used pre-operatively as a definitive diagnostic procedure for biliary tract strictures and polyps.

We treated a Japanese man with aneurysmal dilatation of the bovine graft transplanted for femorofemoral bypass. The reconstruction was performed successfully by the replacement with a Dacron graft 29 months after the first operation. Aneurysmal dilatation was observed over the entire length of the graft, and the wall of the graft was fragile. Disruption of collagen fibers and bleeding into the graft wall from the arteries which had been newly formed in abundance were extensive. The histological findings suggested that bovine grafts should be used for only a short period or for the replacement of small arteries.

Hepatic transcatheter arterial embolization was performed in two patients by blocking the gastroduodenal artery with finger compression on the abdominal surface. The embolizing material, which was injected into the common hepatic artery, did not enter the gastroduodenal artery. No postoperative complications were experienced. This method may be useful for patients in whom superselective catheterization of the proper hepatic artery is not feasible.