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Transileocolic obliteration (TIO) is a useful treatment for gastric, duodenal, or rectal varices. However, TIO for esophageal varices has not yet been reported. We herein report successful TIO performed for refractory esophageal varices with a large paraesophageal vein, with no subsequent recurrence of varices.

Purpose To investigate and compare venous sac and feeding artery embolization (VFE) with feeding artery embolization (FAE) alone for treatment of pulmonary arteriovenous malformations (PAVMs), based on difference in outcomes in decrease of the size of the draining vein. Materials and Methods Twenty-six patients (7 male and 19 female; median age [interquartile range], 58 years [46–65 years]) with 42 simple PAVMs treated with coil embolization between August 2005 and December 2018 were retrospectively evaluated. Twenty PAVMs were treated with FAE early in the study period and compared with 22 PAVMs treated with VFE later in the study period. Follow-up computed tomography images obtained 8–20 months after embolotherapy were used for outcome analysis. Data related to patient demographics; follow-up period; baseline diameters of the feeding artery, venous sac, and draining vein; draining vein diameter after treatment; and decrease in the size of the draining vein, including the number reaching a threshold of 70% decrease, were compared between the 2 groups. Results The draining vein decreased in size by a median of 46.4% in the FAE group and 66.3% in the VFE group, and the difference between the 2 groups was statistically significant (P = .009). There were no significant differences in the other parameters. Conclusions VFE leads to a greater decrease in the size of the draining vein than FAE, suggesting that VFE results in more complete occlusion than FAE for treatment of PAVMs.

Background In cT1 renal cell carcinoma (RCC), very few studies have compared oncological outcomes and renal function preservation rates in nephron-sparing robot-assisted partial nephrectomy (RAPN) and percutaneous cryoablation (PCA). Patients and methods We retrospectively analysed 126 patients with cT1 RCC treated with RAPN (n=78) and computed tomography-guided PCA (n=48) between March 2016 and November 2019. Clinical data and outcomes were compared for the two groups. Results There were no significant differences in the 3-year overall survival and relapse-free survival rates in the two groups (p=0.17 and p=0.093, respectively). The median percentage of estimated glomerular filtration rate preservation at 6 months after surgery was 91.8% and 91.4% in the RAPN and PCA groups, respectively (p=0.9). Conclusion In patients with cT1a RCC, oncological outcomes and renal function appear similar following RAPN and PCA.

To compare the efficacy and safety between epirubicin-loaded DC Beads (DCB-TACE) and conventional TACE (cTACE) used in transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).This retrospective study enrolled 64 patients (mean age, 73.3 years; 44 men, 20 women) who underwent initial DCB-TACE between 2014 and 2015, and 66 patients (mean age, 71.3 years; 38 men, 28 women) who underwent initial cTACE between 2011 and 2013 as historical controls. Treatment effects on the target lesions at 3 months after TACE, the period until re-treatment of the target lesion, and adverse events after TACE were compared between the groups. Univariate and multivariate analyses were also performed to estimate the factors influencing the treatment effects.Based on the Response Evaluation Criteria in Cancer of the Liver version 2015, treatment response of the target lesions equivalent to a complete response and termed as TE4, was 51.0% (53/104) in the DCB-TACE group and 74.4% (64/86) in the cTACE group (p0.001). Multivariate analysis revealed that the TACE procedure, Child-Pugh score, serum aspartate aminotransferase (AST) level, alpha fetoprotein level, and tumor size were independent significant predictors of TE4. The frequencies of elevated serum AST and alanine transaminase levels after TACE were significantly lower in patients in the DCB-TACE group (p0.001 each). No significant difference in biliary/liver damage was evident between the groups.The local efficacy of cTACE was higher than that of DCB-TACE. Adverse events were milder after DCB-TACE than after cTACE.

Background Retained products of conception (RPOC) with hemorrhage need intervention when RPOC persist and remain symptomatic. The safety and efficacy of uterine artery embolization (UAE) for RPOC using gelatin sponge (GS) alone, and fertility after UAE for RPOC remain unknown. The purpose of this study is to retrospectively investigate the efficacy of UAE for RPOC with bleeding and future pregnancy outcomes. Methods Between 2007 and 2016, 14 patients (mean age, 33 years old) diagnosed as RPOC with bleeding received UAE using GS at our institution. Pregnancy outcomes were vaginal delivery (n = 7), miscarriage (n = 4), and termination (n = 3). Four patients received dilation and curettage/evacuation (D&C/E) for treatment of RPOC before bleeding occurred. The mean time interval from the end of pregnancy to bleeding was 28 days. Technical success, clinical success, complications, angiographic features and fertility after UAE were retrospectively assessed. Results Technical success was achieved in 13 patients (93%) and clinical success was achieved in all 14 patients. No major complications occurred. The angiographic features of RPOC were tortuous feeders with flow into a focal blush of contrast (n = 14). Additional findings were pseudoaneurysm (n = 6), early venous return (n = 4), and extravasation (n = 2). Pseudoaneurysm was observed significantly more often in patients who received D&C/E before UAE compared to those who received conservative treatment alone (P = 0.015). The mean follow-up period was 29 months. Six patients achieved six pregnancies an average of 29 months after UAE. Conclusion UAE using GS may be an effective and safe treatment for RPOC with hemorrhage that can preserve fertility.

To identify risk factors for clinical failure of uterine artery embolization (UAE) for postpartum hemorrhage (PPH), with particular attention to the uterine artery diameter.This retrospective study included 47 patients who underwent UAE for PPH between January 1, 2010, and January 31, 2021. Technical success was defined as the completion of embolization of the arteries thought to be the cause of the bleeding. Clinical success was defined as no recurrent bleeding or need for additional therapeutic interventions. Univariate and multivariate analyses were performed to examine the risk factors associated with clinical failure of UAE.Of the 47 patients, 6 had recurrent bleeding. Of the 6 patients, 4 underwent hysterectomy, and 2 underwent repeat embolization. The clinical success rate was 87.2% (41/47), with no major adverse events such as uterine infarction or death. In univariate analysis, there were slight differences in multiparity (P = .115) and placental abruption (P = .128) and a significant difference in the findings of a narrow uterine artery on digital subtraction angiography (DSA) (P = .005). In multivariate analysis, only a narrow uterine artery on DSA was a significant factor (odds ratio, 18.5; 95% confidence interval, 2.5-134.8; P = .004).A narrow uterine artery on DSA was a risk factor for clinically unsuccessful UAE for PPH. It may be prudent to conclude the procedure only after it is ensured that vasospasm has been relieved.

The objective of this study was to investigate the mid-term outcomes of embolization procedures for type II endoleak after endovascular abdominal aortic repair, and clarify the risk factors for aneurysm enlargement after embolization procedures.This was a retrospective multicenter registry study enrolling patients who underwent embolization procedures for type II endoleaks after EVAR from January 2012 to December 2018 at 19 Japanese centers. The primary end point was the rate of freedom from aneurysm enlargement, more than 5 mm in the aortic maximum diameter, after an embolization procedure. Demographic, procedural, follow-up, and laboratory data were collected. Continuous variables were summarized descriptively, and Kaplan-Meier analyses and a Cox regression model were used for statistical analyses.A total of 315 patients (248 men and 67 women) were enrolled. The average duration from the initial embolization procedure to the last follow-up was 31.6 ± 24.6 months. The rates of freedom from aneurysm enlargement at 3 and 5 years were 55.4 ± 3.8% and 37.0 ± 5.2%, respectively. A multivariate analysis revealed that a larger aortic diameter at the initial embolization procedure and the presence of a Moyamoya endoleak, defined as heterogeneous contrast opacity with an indistinct faint border, were associated with aneurysm enlargement after embolization management.The embolization procedures were generally ineffective in preventing further expansion of abdominal aortic aneurysms in patients with type II endoleaks after EVAR, especially in patients with a large abdominal aortic aneurysm and/or a presence of a Moyamoya endoleak.

Background Fibro-adipose vascular anomaly (FAVA) is a rare and new entity of vascular anomaly. Activating mutations in the phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) gene were identified at a frequency of 62.5% in FAVA cases. The PIK3CA mutations excessively activate mammalian target of rapamycin (mTOR) pathway, which promotes angiogenesis and lymphangiogenesis, implying that PIK3CA mutations may act as drivers of FAVAs. This study investigated the correlations between PIK3CA mutational status, clinicopathological features and immunohistochemical expression of the mTOR pathway in a series of FAVA. Methods We retrospectively evaluated the clinical and pathological findings of four FAVA cases. We performed next-generation sequencing (NGS) with a custom panel of genes associated with the mTOR pathway and genes responsible for other vascular anomalies; followed by direct sequencing and immunohistochemical analysis of the mTOR pathway. Results Two PIK3CA-mutation cases and two PIK3CA-wild-type (wt) cases exhibited similar typical clinical features of FAVA. Histological analysis revealed venous malformation, lymphatic malformation, nerves containing enlarged abnormal vessels and fibrofatty tissue were observed regardless of PIK3CA mutational status. In contrast to clinical and histological findings, the immunohistochemical expression of activated AKT and mTOR that are upstream of the mTOR pathway was detected in abnormal vessels of PIK3CA-mutation cases but not in those of PIK3CA-wt cases. However, activated eukaryotic translation initiation factor 4E-binding protein 1 (4EBP1) and ribosomal protein S6 kinase 1 (S6K1), both of which are downstream effectors of the mTOR pathway, were expressed in abnormal vessels of both PIK3CA-mutation and PIK3CA-wt cases. Furthermore, targeting NGS did not find any common genetic mutations involved in the mTOR pathway among PIK3CA-wt cases. Conclusions There was no significant association between the presence of PIK3CA mutations and the clinicopathological features of FAVA, suggesting that the PIK3CA gene is not necessarily involved in the onset of FAVA. FAVAs lacking PIK3CA mutations may be caused by other gene mutations that activate 4EBP1 and S6K1.

To evaluate the diagnostic value of dual-phase cone beam CT during hepatic arteriography (CBCTHA) for hepatocellular carcinoma (HCC).Thirty seven patients with unresectable HCC underwent the dual-phase CBCTHA prior to transarterial chemoembolization (TACE). Three blinded observers independently reviewed and compared the first phase CBCTHA images alone and the dual phase CBCTHA images. Diagnostic accuracy was evaluated by the alternative free-response receiver operating characteristic method (Area under the curve: Az value). Sensitivities were analyzed with the paired t test. The analysis was performed for overall HCCs, HCCs up to 1 cm and those larger than 1 cm.For all HCCs and HCCs up to 1 cm, Az value and sensitivity showed no significant difference between the first-phase CBCTHA alone and the dual-phase CBCTHA (Az: 0.81 vs 0.88, P = .07, 0.79 and 0.85, P = .14, sensitivity: 0.61 and 0.73, P = .11, 0.41 and 0.52, P = .33, respectively). For HCCs larger than 1 cm, the mean Az value and sensitivity for the dual-phase CBCTHA were significantly higher than those for the first phase CBCTHA alone (Az: 0.96 vs 0.92, P = .008, sensitivity: 0.85 vs 0.75, P = .013, respectively).The diagnostic accuracy of the dual-phase CBCTHA was superior to that of the first phase CBCTHA alone in the diagnosis of HCC larger than 1 cm.

Aska Toda,1 Kenjiro Sawada,1 Keigo Osuga,2 Noboru Maeda,2 Hiroki Higashihara,2 Tomoyuki Sasano,1 Noriyuki Tomiyama,2 Tadashi Kimura1 1Department of Obstetrics and Gynecology, 2Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan Aim: The aim of this study was to retrospectively analyze the efficacies of uterine artery embolization (UAE) using gelatin sponge for symptomatic uterine fibroids.Methods: A series of 60 consecutive premenopausal women underwent UAE using gelatin sponge particles or porous gelatin particles. Patients were routinely followed up at 1, 3, 6, and 12months after the procedure and asked to report any procedure-related complications. At each follow-up, an original clinical questionnaire was completed by the patients to evaluate changes in fibroid-related symptoms. Pelvic magnetic resonance imaging was performed before and at 3 and 12months after the procedure, and the changes in volume of the dominant fibroid were calculated.Results: Bilateral UAE was successfully performed in all the patients. Median age was 45years (range 34–53years), and median follow-up period was 25.2months (range 1–116months). At the 3- and 12-month follow-up, the dominant fibroid volumes were found to be significantly decreased by 33.4% (95% confidence interval [CI]: 24.9–41.1) and 48.4% (95% CI: 40.7–56.1) compared to baseline volumes, respectively. Excluding patients not having menorrhagia or bulk-related symptoms, at 12 months 49 of 50 (98%) women showed improvement in menorrhagia, and 45 of 47 (95.7%) women showed improvement in bulk-related symptoms. During the follow-up period, ten patients (16.7%) required further interventions including two patients who had undergone hysterectomy. No sequelae were experienced by any of the patients.Conclusion: UAE using gelatin sponge was associated with a high clinical success rate and good fibroid volume reduction compared to UAE using other embolic agents. Keywords: embolic agent, gelatin sponge, uterine artery embolization, uterine fibroid

Microscopic subinguinal varicocelectomy has a recurrence of less than 1%, and varicocele recurrence is supposed to be an uncommon post-surgery adverse event. At present, no guidelines exist for the management of recurrent varicoceles after surgery. In this report, we present two cases of post-surgery recurrent varicocele of the testis. Case_1 : A 23-year-old male patient who had undergone microscopic subinguinal varicocelectomy for a grade 3 varicocele was referred to our hospital because of recurrent varicocele. Retrograde venography revealed the persistence of dilated spermatic veins. The former surgeon preserved the dilated vas deferens vein, and this was considered a possible cause of persistence of dilated spermatic veins. The vein considered as vas deferens vein was actually an internal spermatic vein. Case_2 : A 28-year-old male patient complained of recurrence of varicocele two months after the original operation for a grade 3 varicocele. Internal spermatic vessels were slightly visualized on retrograde venography. The possible cause of persistence in this case was insufficient ligation of the internal spermatic vessels. We performed embolization in both cases of recurrent varicocele. Both cases were successfully treated, and there has been no recurrence. Our findings suggest that percutaneous transcatheter embolization of the testicular vein may be effective in the management of postsurgical recurrent varicocele of the testis.

Cryoablation is one of treatment modalities for kidney cancer and is expected to induce strong local immune responses as well as systemic T-cell-mediated immune reactions that may lead to the regression of distant metastatic lesions. Thus, the characterization of T cell repertoire and immune environment in tumors before and after treatment should contribute to the better understanding of the cryoablation-induced anticancer immune responses. In this study, we collected tumor tissues from 22 kidney cancer patients, before cryoablation and at 3 mo after cryoablation. In addition, blood samples were collected from 14 patients at the same time points. We applied a next generation sequencing approach to characterize T cell receptor β (TCRB) repertoires using RNAs isolated from tumor tissues and peripheral blood mononuclear cells. TCRB repertoire analysis revealed the expansion of certain T cell clones in tumor tissues by cryoablation. We also found that proportions of abundant TCRB clonotypes (defined as clonotypes with ≥ 1% frequency among total TCRB reads) were significantly increased in the post-cryoablation tissue samples than those of pre-cryoablation tumor samples. Some of these TCRB clonotypes were found to be increased in peripheral blood. Expression analysis of immune-related genes in the tissues of pre- and post-cryoablation showed significantly elevated transcriptional levels of CD8+, CD4+, Granzyme A (GZMA), and CD11c along with a high CD8/FOXP3 ratio in the post-cryoablation tissue samples. Our findings revealed that cryoablation could induce strong immune reactions in tumors with oligoclonal expansion of antitumor T cells, which circulate systemically.

Purpose The purpose of this study was to evaluate the usefulness of contrast-enhanced three-dimensional MR angiography using time-resolved imaging of contrast kinetics (TRICKS-MRA) to demonstrate extracranial arteriovenous malformations (E-AVMs). Materials and methods TRICKS-MRA was performed in 33 patients (adults; n = 30, children; n = 3) with E-AVMs. Four different scan protocols were arranged based on the size of E-AVM, and serial images were acquired from the start of contrast injection with a time frame ranging from 1.2 to 7.1 s. Demonstration of feeding arteries and drainage veins, and the extent of nidus was qualitatively graded using a three-point scale. In sixteen patients who underwent DSA 3 days to 15 months after TRICKS-MRA, the comparability of TRICKS-MRA to DSA was evaluated using a three-point scale. In each category, score of 3 or excellent was defined as the positive result. Results Demonstration of the feeding arteries, the drainage veins, and the extent of nidus were graded as excellent in 68%, 65%, and 58% of the patients, respectively. Comparability of TRICKS-MRA to DSA was excellent in 75%, 88%, and 88% of the sixteen patients who underwent DSA. Conclusion TRICKS-MRA is a feasible and useful vascular imaging technique to provide time-resolved analysis of angioarchitecture of E-AVMs.

Objectives: Digital refractory gangrene is rarely found in collagen diseases, including systemic sclerosis and is possibly caused by similar underlying vascular damage in peripheral arterial disease (PAD) such as arteriosclerosis obliterans (ASO) and/or thromboangiitis obliterans (TAO) by unclarified mechanisms other than vasculitis and thrombosis. This study evaluated the radiological imaging in patients with digital gangrene associated with collagen disease and compared the images with those of PAD based on the results of laboratory and histopathological examinations. Methods: Angiography, MR angiography and/or CT angiography were performed on 6 patients with refractory gangrene or extensive ulcers accompanied by scleroderma-spectrum disorders; 3 with diffuse systemic sclerosis, 1 with limited systemic sclerosis, 1 with overlap syndrome and 1 with Sj?gren’s syndrome. Results: Although the vascular alterations in collagen diseases were similar to those in PAD, the abnormal image findings (occlusion or stenosis of the arteries with smooth vessel walls) found in collagen diseases did not include atheromatous plaque, which are worm-like vessels that are characteristic of those observed in PAD. Conclusions: Some cases of digital gangrene seen in collagen diseases show similar vascular imaging patterns to those of PAD and comprehensive examinations including arterial imaging can be useful for the diagnosis of these unrecognized vascular changes other than vasculitis or digital thrombosis.

To investigate the validity of determining the contrast medium dose based on body surface area (BSA) for the abdominal contrast-enhanced multi-detector row CT comparing with determining based on body weight (BW).Institutional review committee approval was obtained. In this retrospective study, 191 patients those underwent abdominal contrast-enhanced multi-detector row CT were enrolled. All patients received 96 mL of 320 mg I/mL contrast medium at the rate of 3.2 mL. The iodine dose required to enhance 1 HU of the aorta at the arterial phase and that of liver parenchyma at portal venous phase per BSA were calculated (EUBSA) and evaluated the relationship with BSA. Those per BW were also calculated (EUBW) and evaluated. Estimated enhancement values (EEVs) of the aorta and liver parenchyma with two protocols for dose decision based on BSA and BW were calculated and patient-to-patient variability was compared between two protocols using the Levene test.The mean of EUBSA and EUBW were 0.0621 g I/m2/HU and 0.00178 g I/kg/HU for the aorta, and 0.342 g I/m2/HU and 0.00978 g I/kg/HU for the liver parenchyma, respectively. In the aortic enhancement, EUBSA was almost constant regardless of BSA, and the mean absolute deviation of the EEV with the BSA protocol was significantly lower than that with the BW protocol (P.001), although there was no significant difference between two protocols in the hepatic parenchymal enhancement (P=.92).For the aortic enhancement, determining the contrast medium dose based on BSA was considered to improve patient-to-patient enhancement variability.

This study was aimed to compare the accuracy, sensitivity, and positive predictive value of C-arm CT (CACT) during selective transcatheter angiography with those of multidetector CT (MDCT) in the detection of hepatocellular carcinoma (HCC).In this prospective study, 30 patients (mean age, 73 years) with unresectable HCC were examined with CACT before chemoembolisation. Images of a combination of CACT during arterial portography (CACTAP) and dual-phase CACT during hepatic arteriography (CACTHA) was obtained and images of intravenous contrast-enhanced, biphasic, dynamic, MDCT was also obtained beforehand. Three blinded observers independently reviewed CACT and MDCT. Diagnostic accuracy was evaluated by the alternative free-response receiver operating characteristic (AFROC) method. Sensitivities and positive predictive values (PPV) were analyzed with the paired t-test.In the mean area under the AFROC curve (Az), there was no significant difference between MDCT and CACT (MDCT, mean Az value, 0.83; CACT, 0.85, respectively) (P = 0.32). There was also no significant difference between the two techniques in sensitivity (MDCT, mean 0.65; CACT, 0.60) and PPV (MDCT, mean 0.98; CACT, 0.97) (P = 0.40, P = 0.68, respectively).The diagnostic accuracy of CACT was equivalent to that of biphasic CT in the diagnosis of HCC.C-arm CT helps detection of hepatocellular carcinoma (HCC) during interventional (TACE) treatment. C-arm CT for HCC seemed just as accurate as biphasic CT. TACE can be performed with greater confidence using C-arm CT.

We evaluated the location of porous gelatin particles (GP; Gelpart; Nippon Kayaku/Astellas, Tokyo, Japan) within the arterial vasculature and their acute effects on uterine necrosis and inflammation after uterine artery embolization (UAE) in swine.Adult nonpregnant pigs (n = 6) were allocated to either 1- (n = 3) or 2-mm GP (n = 3). Superselective and bilateral embolization of the uterine arteries was performed. All animals were killed 1 week after UAE. Macroscopic and microscopic findings, including the level of arterial occlusion and their effect on uterine necrosis and inflammation, were analyzed.All UAE procedures were completed without severe complications. The macroscopic necrosis was seen in two animals in the 2-mm group with an extent of50%. The location of the occluded arteries did not differ significantly between groups. The median diameters of the occluded arteries were 449 microm (95% confidence interval [CI] 417-538 microm) in the 1-mm GP group and 484 microm (95% CI 370-560 microm) in the 2-mm GP group. As for microscopic necrosis, no statistically significant difference was observed. The qualitative inflammatory reaction was significantly greater in the 2-mm GP group than in the 1-mm group (p0.001).Both 1- and 2-mm GP occluded the arteries relevant to the target diameter for UAE in porcine uterus, presumably due to the plastic deformity. Both sizes of GP were associated with limited areas of necrosis; however, evaluation of inflammatory reaction was preliminary. Further study with adequate evaluation of inflammatory reactions is suggested.

Purpose To find appropriate contrast media to load cisplatin into superabsorbent polymer (SAP) and to analyze the absorption and elution kinetics of cisplatin to and from SAP. Materials and Methods Three contrast media—ioxaglic acid 320 mg/mL, iohexol 300 mg/mL, and iopamidol 300 mg/mL—were tested for solubility of a new highly soluble cisplatin powder. The appropriate concentrations of cisplatin were predetermined according to the solubility in each contrast medium. For each concentration, we assessed the cisplatin elution kinetics with an atomic absorption spectrophotometer. The SAP particle diameters (106–150 μm dry size) before and after drug elution were also measured. Results The concentrations of cisplatin were predetermined as 2.5 mg/mL in ioxaglic acid, 2.5 mg/mL in iohexol, and 5.0 mg/mL in iohexol. At these concentrations, 100 mg of SAP carried 5 mg, 25 mg, and 50 mg of cisplatin dissolved in ioxaglic acid (2.5 mg/mL) and iohexol (2.5 mg/mL and 5.0 mg/mL), respectively. Cisplatin-loaded SAP in ioxaglic acid and iohexol exhibited similar elution profiles, with cisplatin fractions of 15%, 40%, 70%, and 95% at 1, 3, 6, and 24 hours, respectively. By drug elution, the mean particle diameter changed from 0.31 mm to 0.61 mm in ioxaglic acid (2.5 mg/mL), from 0.54 mm to 0.60 mm in iohexol 2.5 mg/mL, and from 0.63 mm to 0.59 mm in iohexol 5.0 mg/mL. Conclusions SAP was confirmed to absorb and elute cisplatin within 24 hours. When mixed with iohexol, SAP carried a ten times larger dose of cisplatin and expanded twice as large as when mixed with ioxaglic acid. Cisplatin-loaded SAP may have potential as a drug delivery system for the clinical treatment of liver tumors.

The purpose of this study was to investigate the clinical outcomes of bland embolization using superabsorbent polymer microspheres (SAP-TAE) as an initial therapeutic option for previously untreated hepatocellular carcinoma (HCC) ineligible for resection or ablation. Fifty-nine patients with previously untreated HCC unamenable to surgery or ablation underwent bland embolization using 100- to 200-mum reconstituted SAP particles (SAP-TAE) as the initial treatment. SAP-TAE was repeated as needed based on tumor response but was switched to chemoembolization when necessary to control residual or progressive tumor. Early tumor response was assessed by contrast-enhanced CT according to RECIST and EASL criteria 1 month after the initial SAP-TAE. The overall survival was calculated using the Kaplan-Meier method. The overall mean follow-up period was 30.6 months (range, 7-59 months). A total of 121 sessions of SAP-TAE were performed, with 1-5 sessions per patient (mean, 2.1 sessions). The mean period of repeated SAP-TAE was 15.6 months (range, 1-51 months), and it exceeded 1 and 2 years in 32 (54%) and 15 (25%) patients, respectively. Thirteen (22%) patients underwent repeated SAP-TAE alone, and the remaining 46 (78%) patients underwent subsequent chemoembolization. No major complication was observed and postembolization syndrome was minimal after SAP-TAE in all patients. Response rate was 14% and 66% by RECIST and EASL criteria, respectively. Overall survival rates were 100% and 83% at 1 and 2 years, respectively, and median survival time was 30 months. In conclusion, SAP-TAE was a safe and repeatable option as the induction therapy for HCC unamenable to surgery or ablation, despite the high incidence of converting to TACE during the total course.

Introduction Single-site laparoscopic colectomy (SLC) is a promising minimally invasive and safe treatment for colorectal cancer. Improvements of the working instruments and procedures for SLC have helped to overcome challenges regarding the difficulty of operation, supporting the gradual acceptance of this technique. In contrast, narrow working space of the abdominal cavity sometimes prevents securing an adequate surgical view. To obtain precise anatomical information and enable complete mesocolic excision (CME), we routinely perform three-dimensional computed tomography prior to SLC. Case presentation A 69-year-old Japanese woman was clinically diagnosed with rectosigmoid cancer. Unexpectedly, preoperative examination revealed asymptomatic stenosis of the great artery, which was diagnosed as middle aortic syndrome. Because radical colectomy requires dissection of vessels that supply blood flow to the legs, a vascular stent was inserted prior to operation. We chose SLC due to the reduced risk of damaging epigastric arteries, which may eventually become collaterals in the event of stent re-stenosis. We accomplished SLC with CME, and the patient was discharged on the tenth day after operation without complications. Conclusion The present case is the first to proceed by SLC for colorectal cancer complicated by vascular obstructive disease. Preoperative imaging enabled us to identify an unexpected rare disease and to still accomplish SLC with CME, thus reinforcing the importance of preoperative imaging to optimize the use of SLC. In addition, SLC may become one of the most adequate procedures for patients complicated by vascular obstructive disease.

Transcatheter embolotherapy (TCE), a common procedure for interventional radiologists, comprises transcatheter delivery of embolic agents into target vessels in order to eliminate lesions or lesion-associated symptoms. Good knowledge of delivery catheters and embolic agents is essential to optimize embolization techniques and to obtain the desired therapeutic outcomes. In this review, we describe the principles and techniques of TCE for peripheral arterial and venous lesions featuring visceral aneurysms, peripheral and pulmonary arteriovenous malformations (AVMs), and varicoceles.

Objective To find the optimal scan timing for early arterial phase hepatic CT with adequate arterial enhancement after the aortic contrast arrival. Methods Sixty patients were divided randomly into three groups, each of which received 2.0 mL/kg of the 300 mgI/mL contrast medium with an injection duration of 30 seconds (Group A, mean rate 3.6 mL/sec); of 25 seconds (B, 4.6 mL/sec); of 30 seconds (3.6 mL/sec) followed by a saline chaser (C). Results After the contrast arrival, aortic enhancement increased rapidly for 6-15 seconds (mean, 10 seconds) to the initial peak enhancement in all groups, and then, increased moderately to the maximum aortic enhancement over the following 19, 13, and 21 seconds, respectively. The mean maximum aortic enhancement in Group B (392 HU) and C (360 HU) were significantly higher than that in A (326 HU), respectively. The difference between the initial and maximum aortic enhancement was less than 50 HU. Conclusion The optimal timing of the early arterial phase for hepatic CT arteriography is 10-15 seconds after the aortic arrival.

Tubo-ovarian abscess is a rare but potentially serious event that can occur after uterine artery embolization (UAE). We describe herein two cases of severe inflammatory tubo-ovarian abscesses. Two women presented with severe abdominal pain, cramping, and fever several months after UAE. Abdominal computed tomography demonstrated an enlarged tubo-ovarian mass, suggestive of an abscess. Percutaneous catheter drainage was performed. In one patient, tubo-ovarian abscess completely disappeared after the drainage, but the other patient eventually required hysterectomy and salpingo-oophorectomy. It is important for clinicians to be aware of tubo-ovarian abscess as a rare complication. Percutaneous drainage might be a useful treatment option.

Cryoablation is one of promising treatment modalities for kidney cancer and expected to induce strong local immune response as well as systemic T cell-mediated immune reaction that may lead to regression of distant metastatic lesions. In this study, we collected tumor tissues from 14 kidney cancer patients, at the time points of pre-cryoablation and 3 months after cryoablation. In addition, blood samples were collected from 8 kidney cancer patients at the same time points. We applied a next generation sequencing approach to characterize T cell receptor beta (TCRB) repertoires using mRNA isolated from tumor tissues and peripheral blood mononuclear cells. To assess clonality of T cells, the diversity index of TCRB was calculated according to complementarity-determining region 3 sequences. Through TCRB repertoire analysis, we demonstrated expansion of certain T cell clones in tumor tissues by cryoablation. In addition, we found that proportions of abundant TCRB clonotypes (≥ 1% frequency among total TCRB reads) were significantly increased in the post-cryoablation tissue samples than those of pre-cryoablation tumor samples, suggesting that cryoablation could induce strong immune reactions in tumors with oligoclonal expansion of anti-tumor T cells. Interestingly, some of these TCRB clonotypes were also increased in peripheral blood, indicating that certain numbers of T cell clones may also circulate systemically and then attack tumor cells in distant regions. We also measured mRNA expression levels of immune-related genes in the tissue samples of pre- and post- cryoablation and found significantly elevated expression levels of CD8, CD4, Granzyme A, and CD11c along with high CD8/FOXP3 ratio in the post-cryoablation tissue samples. Furthermore, immunohistochemical analysis confirmed infiltration of a large number of CD11c-positive cells, probably representing macrophages and dendritic cells into the post-cryoablation tissues. Collectively, our findings revealed that cryoablation could induce both local and systemic immune responses associated with CD11c-positive cells infiltration and oligoclonal expansion of anti-tumor T cells. For the translation into clinics, unique TCR sequences identified in post-cryoablation tissues in individual patients can be applied to personalized TCR-engineered T cell therapy. Citation Format: Taigo Kato, Tomoyuki Iwasaki, Motohide Uemura, Akira Nagahara, Hiroki Higashihara, Keigo Osuga, Yuji Ikeda, Kazuma Kiyotani, Jae-Hyun Park, Norio Nonomura, Yusuke Nakamura. Characterization of the cryoablation-induced immune response in kidney cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4687. doi:10.1158/1538-7445.AM2017-4687

The purpose of this study is to retrospectively evaluate the clinical outcomes and to identify the predictors ofpatient satisfaction after percutaneous sclerotherapy for venous malformations (VMs) in the extremities. A totalof 48 patients with VMs in the extremities over 10 years of age underwent sclerotherapy to relieve symptoms, such as pain, swelling, functional limitations, and cosmetic problems. Self-assessment questionnaires were sentto rate the degree of symptom improvement and level of satisfaction. Clinical and imaging data from medicalrecords were analyzed to obtain information about VMs and sclerotherapy. The predictors for patientsatisfaction were determined by univariate and multivariate analysis of clinical variables. Forty patients (meanage, 28.2 years; range, 11-69 years) responded to the survey. Sixteen patients had VMs in the upper extremities, and 24 patients had VMs in the lower extremities. In 12 patients (30%), adjacent bone change was seen. After amean of 2.6 (range 1-10) sclerotherapy sessions, good response to pain, swelling, dysfunction, and cosmeticproblems was obtained in 83%, 74%, 79%, and 50% of patients, respectively. Thirty-two patients (80%) weresatisfied with their outcomes. On univariate analysis, absence of adjacent bone change, maximum diameter (

This study aimed to evaluate the impact of the preventive administration of antiemetic drugs on the risk of acute nausea and vomiting induced by transcatheter arterial chemoembolization(TACE)in patients with hepatocellular carcinomas(HCCs). From January 2007 to June 2009, a total of 536 patients with HCCs who underwent TACE with a mixture of iodized oil, epirubicin, and porous gelatin particles were included in this retrospective study. Of those patients, 23 out of 357(6.4% ) who had received the 5-HT(3) receptor antagonist before TACE, and 18 out of 179(10.1% )without the medication, experienced vomiting. The multivariate logistic regression model with a predictive success of 92. 4% for vomiting identified significant associations between female gender(odds ratio: 3.73, p0.001 ), the number of tumors(1.29, p0.01 ), and administration of pentazocine(11.70, p0.05)with the risk of vomiting. In contrast, the preventive administration of antiemetic drugs was not included in the model as a significant predictive variable. We therefore conclude from this retrospective study that the 5-HT(3) receptor antagonist did not significantly contribute to preventing the TACE-induced emesis.

Purpose: Computed Tomography (CT) with contrast material is often used for preoperative assessment and planning of embolotherapy in the treatment of Pulmonary Arteriovenous Malformations (PAVMs). However, pulmonary vasculature is well demonstrated in the lung window setting without the need for contrast material; thus, risks of adverse effects of contrast material itself or paradoxical emboli through PAVMs can be avoided. The purpose of this study was to determine the usefulness of non-enhanced 3-Dimentional (3D)-CT angiography for planning of embolotherapy for PAVMs. Materials and methods: Between February 2004 and October 2011, 20 patients (nine males, 11 females) with 41 PAVMs underwent non-contrast CT using a multi-detector-row CT prior to coil embolotherapy. A high-resolution tailored 3D-CT angiogram was reconstructed on a workstation with partial Maximum Intensity Projection (MIP) in the lung-window to assess the angioarchitecture of the lesions for preoperative planning of embolotherapy. For each lesion, location, number, and diameter of feeding arteries and draining veins were measured. It was determined whether there was any side branch close enough to the sac to anchor the first coil to prevent coil migration. The difference between the diameter of the first coil and the feeding artery was measured. Based on findings, diagnostic pulmonary angiography and coil embolotherapy were performed. The depiction of the side branch of the feeding artery close to sac between preoperative partial MIP 3D-CT images and selective pulmonary angiography was evaluated by using the un-weighted κstatistical analysis. Results: A total of 49 feeding arteries were embolized. Mean diameter of the feeding arteries and drainage veins were 3.6 mm and 4.6 mm, respectively. Sixteen and eighteen feeding arteries with a side branch to anchor were depicted on CT and angiography, respectively. In the depiction of the side branch of the feeding artery close to sac between preoperative partial MIP images and selective pulmonary angiography, excellent agreement was obtained (κ=0.91). The mean difference between diameter of the first coil and the feeding artery was 1.5 ± 1.47 mm. All 41 lesions could be identified on angiography, and embolization procedures could be executed as planned based on partial MIP images. Conclusion: Non-enhanced tailored partial MIP 3D-CT in the lung window appears to be a feasible and useful vascular imaging technique for planning coil embolotherapy of PAVMs.

To evaluate the correlation between packing density and the incidence of coil compaction or recanalization of visceral artery aneurysms (VAAs) after coil packing.Between July 2004 and April 2012, coil packing was performed for 46 true visceral aneurysms (16 splenic, 11 pancreaticoduodenal, eight renal, six hepatic, three superior mesenteric, one right gastric, and one gastroepiploic) in 42 patients. The size and volume of the aneurysm, packing density, and the incidences of compaction and recanalization were evaluated retrospectively.The mean follow-up period was 37 months ± 8 (range, 11-80 mo). The mean packing density was 19% ± 8 (range, 5%-42%), mean aneurysm size was 19 mm ± 8 (range, 5-40 mm), and mean volume was 4,108 mm(3) ± 5,435 (range, 72-26,235 mm(3)). Compaction and recanalization occurred in two (4%) and 12 aneurysms (26%), respectively. The mean packing density was significantly lower in aneurysms with compaction or recanalization than in unaffected aneurysms (12% vs 22%; P = .00014). There was a significant difference in mean packing density between small (20 mm; 22%) and large (≥ 20 mm) aneurysms (15%; P = .0045). The mean size and volume were significantly larger for coil-compacted or recanalized aneurysms than for unaffected aneurysms (P.05). In aneurysms with a packing density of at least 24%, no compaction or recanalization occurred.Coil compaction or recanalization after coil packing for VAAs more often occurs after insufficient embolization with low packing density and in patients with large aneurysms.

Gelatin sponge and polyvinyl alcohol particles have been the most popular particulate embolic agents for transarterial chemoembolization (TACE) of liver tumors. Over the last decade, calibrated microspheres have been introduced and increasingly used in liver tumor embolization in Western countries. In addition, drug-eluting beads (DEB) have been introduced for sustained local drug release. Such long-awaited spherical embolic agents will be introduced in Japan in the near future. The advantages of these microspheres are that particles are uniform in size and shape, and easy to inject through a microcatheter. They can travel distally to vessels corresponding to the particle size; in other words, the occlusion level can be predicted according to the particle size chosen. Thus, new bland microspheres and DEB may bring a significant advancement to embolization for primary liver tumors as well as hepatic metastases from various cancers. However, at this point, the published data suggests that both conventional TACE and DEB-TACE are equally effective for treatment of unresectable hepatocellular carcinoma, when patients are carefully selected. Therefore, indication, patient selection, and embolization techniques will be essential in order to individually adapt newer embolic agents based on oncological, anatomical and technical considerations.

The purpose of this retrospective study was to investigate the efficacy of transarterial chemoembolization (TACE) using cisplatin as a second-line treatment for advanced hepatocellular carcinoma (HCC) unresponsive to TACE using epirubicin–Lipiodol emulsion at our institution. Between January 2006 and March 2009, 51 patients with unresectable HCC underwent TACE using cisplatin. All patients had shown persistent viable tumor or tumor progression after at least 2 sessions of TACE using epirubicin–Lipiodol emulsion. TACE procedures consisted of arterial injection of a mixture of Lipiodol and cisplatin (30–100 mg [mean 57 ± 21]) (n = 29) or arterial infusion of cisplatin (30–100 mg [mean 87 ± 19]) solution (n = 22) followed by injection of 1-mm porous gelatin particles. Early tumor response was assessed by contrast-enhanced computed tomography (CT) according to Response Evaluation Criteria in Solid Tumors (RECIST) and European Association for the Study of the Liver (EASL) criteria. Overall survival and progression-free survival was calculated using the Kaplan–Meier method. Toxicity was assessed according to NCI-CTCAE version 3 criteria. Response rates were 11.8 and 27.5% by RECIST and EASL criteria, respectively. Overall survival rates were 61.9, 48.2, and 28.9% at 1, 2, and 3 years, respectively, and the median survival time was 15.4 months. Progression-free survival rate was 35.2% at 1 year, and median progression-free survival time was 3.1 months. No major complications were observed, and the occurrence of postembolization syndrome was minimal. Grade 3 to 4 toxicities included thrombocytopenia (5.8%), increased aspartate aminotransferase (AST) level (35.3%), and increased alanine aminotransferase (ALT) level (23.5%). Switching the TACE anticancer drug from epirubicin to cisplatin might be the feasible option for advanced HCC, even when considered resistant to the initial form of TACE.