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Approximately, 60-70% of patients with early-stage hepatocellular carcinoma (HCC) globally are ineligible for the recommended first-line procedures. This study aimed to compare conventional transcatheter arterial chemoembolization (cTACE) with a treatment, small drug-eluting bead TACE (DEB-TACE), in patients with stage 0/A HCCs.We retrospectively investigated 76 patients who underwent first-time cTACE (n = 40) or DEB-TACE using 75-150 µm DC BeadsThe study included 60 (78%) men and 16 (21%) women; participant mean age was 65.8 years. Objective response rates between the cTACE and DEB-TACE groups were similar (p 0.05). Complete and partial 1-month tumor response rates were 60.0% and 22.5%, respectively, in the cTACE group and 69.4% and 25.0%, respectively, in the DEB-TACE group. The abdominal pain grade was significantly lower with DEB-TACE than with cTACE (p = 0.001). AST and ALT levels after tumor treatment with DEB-TACE were significantly lower than those after treatment with cTACE (p = 0.018 and 0.006). Time to local progression, intrahepatic distal recurrence, progression-free survival, and overall survival were not significantly between the DEB-TACE group and the cTACE group (p 0.05).Time to local progression between groups was not significantly different; however, post-embolic syndrome occurred less frequently in the DEB-TACE group. DEB-TACE appears to be a feasible treatment for small HCCs.Level 3.

Abdominal aortic aneurysm (AAA) can be defined as an abnormal, progressive dilatation of the abdominal aorta, carrying a substantial risk for fatal aneurysmal rupture. Endovascular aneurysmal repair (EVAR) for AAA is a minimally invasive endovascular procedure that involves the placement of a bifurcated or tubular stent-graft over the AAA to exclude the aneurysm from arterial circulation. In contrast to open surgical repair, EVAR only requires a stab incision, shorter procedure time, and early recovery. Although EVAR seems to be an attractive solution with many advantages for AAA repair, there are detailed requirements and many important aspects should be understood before the procedure. In this comprehensive review, fundamental information regarding AAA and EVAR is presented.

Purpose We aimed to evaluate the utility of and complications associated with the double microcatheter technique for the treatment of wide-necked visceral and renal artery aneurysms (VRAAs). Methods Nine patients (mean age, 58 years; age range, 42-69 years; 4 men, 5 women) with wide-necked VRAAs who underwent treatment with the double microcatheter technique from January 2016 to July 2018 were included in the study. For all patients, anatomical features were confirmed using cone-beam computed tomography (CT) with rotational angiography. The aneurysmal location, size, volume, neck-to-dome ratio, number of coils used, and coil packing density were investigated. Technical success, complications (coil migration and organ ischemia), changes in the complete blood count or serum creatine level, and recurrence were also evaluated. Results Three renal artery aneurysms and 6 splenic artery aneurysms were treated by the double microcatheter technique. The mean size of the aneurysms was 26.09±4.76 mm, mean volume was 6.19±3.69 cm3, and mean neck-to-dome ratio was 1.53±0.24. The number of coils used ranged from 7 to 16. The mean packing density was 11.32%±3.72%. Technical success was achieved in all 9 patients. Renal ischemia occurred in two patients with renal artery aneurysm, one of whom showed minimal scar formation on follow-up CT after infarction. No coil migrations or disease recurrences were observed. Conclusion The double microcatheter technique for the treatment of wide-necked VRAAs appears to be relatively safe and useful. However, complex renal artery aneurysm should be carefully managed in order to prevent infarction.

Objectives: This study aims to evaluate the clinical effectiveness of a Korean medicine treatment on a traumatic spinal cord injury. Metohds : A 44-year-old male patient who had suffered a traumatic spinal cord injury was treated for two months. The effectiveness of complex Korean medicine treatment...

OBJECTIVE. The purpose of this study is to quantitatively assess perfusion reductions occurring in hepatocellular carcinoma (HCC) during transcatheter arterial chemoembolization (TACE) using 2D perfusion angiography and to evaluate the relationships between various 2D perfusion angiography parameter changes and short-term tumor response. SUBJECTS AND METHODS. This prospective study included 172 patients (144 men and 28 women; mean [± SD] age, 65.4 ± 10.2 years) who underwent TACE for HCC between November 2015 and November 2017. Two-dimensional perfusion angiography was performed before and after TACE. Pre- and postprocedural CT images were also reviewed. Index lesions were defined as all discrete lesions 1.5 cm or larger. The tumor response was assessed using the modified Response Evaluation Criteria in Solid Tumors. Periprocedural 2D perfusion angiography parameters, including the arrival time, time to peak, wash-in rate, width, AUC, and mean transit time, were compared using the Wilcoxon signed rank test. Correlations between 2D perfusion angiography parameter changes and objective tumor response were evaluated using multivariate logistic regression analysis. RESULTS. A total of 187 lesions meeting the inclusion criteria were identified in 172 patients. All analyzed 2D perfusion angiography parameters were significantly different after versus before TACE (p < 0.001). A significant relationship between periprocedural change in AUC and short-term tumor response was found (odds ratio, 1.535; 95% CI, 1.314-1.793; p < 0.001). CONCLUSION. Two-dimensional perfusion angiography could objectively quantify perfusion reductions and predict short-term tumor response to TACE in patients with HCC.

Objectives Hataedock method is a Korean medical therapy which removes fetal toxin by orally administering herbal decoction to neonates. This study was to observe skin damage and anti-inflammatory effect via regulating IL-4 activity in NC/Nga mice which were induced atopic dermatitis (AD)-like skin l...

Purpose To determine the efficacy of embolization with super-selective catheterization of the internal iliac arterial branches to treat heavily injured trauma patients with pelvic arterial bleeding. Materials and Methods A retrospective analysis was performed using the medical records of 37 patients who underwent trans-arterial embolization for trauma-associated pelvic arterial hemorrhage in a regional trauma center between July 2010 and July 2013. In each patient, hemodynamic stability, embolization level, elapsed time for trans-arterial embolization, clinical outcome and embolization-related complications were evaluated. Comparison of elapsed time, and presence of complication was done according to embolization level. Results Transarterial embolization was conducted in 37 patients. Hemodynamic stability of each patient was classified into hemodynamic stable (n = 9), and unstable (n = 28). Twenty-nine of 37 patients underwent embolization after super-selective catheterization of more than 2nd order branch of internal iliac artery with a microcatheter, and 8 patients underwent proximal internal iliac artery embolization without super-selective catheterization. The mean elapsed procedure time for super-selective embolization (34.76 ± 20.0 minutes) was not significantly longer than proximal internal iliac artery embolization (33.87 ± 16.73 minutes, p = 0.215). Conclusion Pelvic arterial embolization with super-selective catheterization is a safe and feasible treatment for heavily injured patients with trauma-associated pelvic arterial bleeding.

A 62-year-old man was admitted with nonhealing wounds on his right toes. Computed tomography and angiography showed heavily calcified arteries in both lower extremities and steno-occlusive lesions of the right femoropopliteal artery. During Supera stenting, the catheter tip detached after adhering to the heavily calcified vessel wall. Endovascular removal of the detached tip was performed using ipsilateral peroneal access with a 5F angiographic catheter and a through-and-through wire. Contrast-enhanced computed tomography and angiography after 16 months showed patent Supera stents. Our report suggests that detachment of the Supera stent delivery catheter tip could occur, especially in patients with heavily calcified vessels associated with peripheral artery disease, and demonstrates the possibility for endovascular retrieval of the detached tip.

Purpose To evaluate the technical success and complication rates of tunneled-cuffed catheter insertions radiologically placed via the internal jugular vein in patients with different types of underlying diseases. Materials and Methods A total of 2153 tunneled-cuffed catheter insertions performed in 1926 patients between January 2008 and December 2012 were retrospectively reviewed. All procedures were conducted using sonography and fluoroscopy. The number of catheter maintenance days, technical success rates, and complication rates were analyzed based on radiologic and medical records. Results A total of 204809 catheter maintenance days (mean, 95.35 days; range, 0-1710 days) were recorded. Technical success was achieved in 2148 insertions (99.77%). A total of 185 complications (8.61%, 0.903/1000 catheter days) were observed, including 22 procedure-related complications (1.02%). A total of 143 catheters (6.66%) were removed due to complications. Significant differences in complication rates were observed between patients with or without underlying hematologic diseases (11.65% vs. 7.02%, respectively; p = 0.000). Significant differences in catheter thrombosis were observed between patients in which right-sided or left-sided venous approaches were used (0.81% vs. 2.70%, respectively; p = 0.010). Conclusion The very high technical success rates and very low procedure-related complication rates indicate insertion of a tunneled-cuffed catheter radiologically placed via the internal jugular vein is safe and effective.

Iatrogenic injuries of the superior vena cava (SVC) are infrequent but could bring severe complications. Perforation of the SVC may result in massive hemorrhage and hemodynamic instability. We report the case of a 58-year-old female with a right hemothorax after left subclavian central venous catheter (CVC) placement. Penetration of the SVC can be managed by coil embolization through left subclavian CVC. As a result, this injury was successfully managed. To our knowledge, this is the first report of management of SVC penetration using coil embolization.

Objectives. To evaluate the usefulness of real-time ultrasound (US) guidance in cannulating superficial femoral artery (SFA)flush and SFA in-stent occlusions. Methods. A total of 37 patients were treated under real-time US guidance, among whom 22 were treated for flush and 15 for stent occlusions. In all cases, the axial and longitudinal US images were examined to confirm the guidewire's location. Results. All attempts to cannulate lesions were successful. The initial and adjunctive procedures were conventional balloon angioplasty, catheter-directed thrombolysis with urokinase and conventional balloon angioplasty, stenting, stent grafting, drug-coated balloon (DCB) angioplasty, and rotational atherectomy and DCB angioplasty in 8, 4, 5, 2, 1, and 1 cases of the 22 flush occlusions, respectively, and in 9, 1, 0, 0, 2, and 0 cases of the 15 stent occlusions, respectively. No complications associated with the procedures occurred in any case. Conclusion. Real-time US guidance can be used for precise and effective cannulation of flush occlusions of SFA or totally occluded SFAin-stents with reduced extra-radiation exposure to the operator and patient.

Div. of Humanities and Social Medicine, School of Korean Medicine, Pusan National UniversityObjective : The aim of this study is to find out the significance of Chongu pulse diagnosis as the standard of measuring the result of the acupuncture on ‘the affected part of the pulse wave’ based on the literature.Method : ① The clear concepts of the ‘unaffected part’ and the ‘affected part’ were organized. ② The relation between the pulse diagnosis and the acupuncture in Hwangjenaekyung was studied. ③ The indications of Mu acupuncture treatment(繆刺法) and Geo acupuncture treatment(巨刺法) in Hwangjenaekyung was studied. ④ The types and changes of pulse diagnosis in Hwangjenaekyung was studied, especially based on the relation between Sambuguhu pulse diagnosis(三部九候脈診) and Chongu pulse diagnosis(寸口脈診). ⑤ By synthesizing these results, the significance of Chongu pulse diagnosis as the standard of measuring the result of the acupuncture on ‘the affected part of the pulse wave’ was found.Result & Conclusion : 1. When the affected part and the unaffected part are defined, it is necessary to make clear that which one of next three definitions is used ; Firstly, ‘the broad sense of definition of the affected part and the unaffected part of the symptom’, which contains the pulse wave. Secondly, ‘the narrow sense of definition of the affected part and the unaffected part of the symptom’, without the pulse wave. And thirdly, ‘the definition of the affected and the unaffected part of the pulse wave’, which has the only independent standard of the pulse wave.

Objectives : The purpose of this study was to report the clinical effects of catgut-embedding acupuncture therapy on plantar fasciitis. Methods : Two patients were treated mainly with catgut-embedding acupuncture therapy and partly with other Korean medicine modalities. Catgut-embedding acupuncture therapy was applied once a week for three weeks, and follow-up observation was conducted by telephone survey two months after the first treatment. Results : In these two cases, the pain numerical rating scale(NRS) gradually decreased from 8 to 1, and the pain relief as well as the improvement in ambulatory function was maintained at two-month follow-up. Conclusions : Catgut-embedding acupuncture therapy could be effective for pain-reduction and functional improvement in plantar fasciitis.

SummaryObjectivesLumbar spinal stenosis (LSS) negatively affects patients’ quality of life. No systematic review evaluating the effects and safety of acupuncture for this population is available. We aimed to evaluate evidence indicating the effectiveness and safety of acupuncture for LSS.MethodsWe searched five English-language databases (EMBASE, MEDLINE, CENTRAL, CINAHL, and AMED) and one Chinese database (CAJ) for randomised controlled trials (RCTs) and non-randomised controlled clinical trials (CCTs) of needle acupuncture for LSS. CCTs were analyzed only in terms of safety and intervention-related information.ResultsSix RCTs (n=582) and six CCTs, which were all from China and reported in Chinese, were included. High or uncertain risk of bias and clinical heterogeneity due to different acupuncture techniques were observed. All RCTs compared different combinations or techniques of acupuncture. None of the included studies mentioned safety issues. Acupuncture combined with other interventions and/or with additional stimulation increased the number of improved patients compared with acupuncture alone or relatively simpler stimulation (n=582; relative risk, 1.16; 95% confidence interval 1.08–1.25). Pain intensity, overall symptoms, and functional outcomes related to LSS and quality of life showed significantly favourable improvement in the treatment group compared with the control group, which lasted for up to 6 months post-treatment.ConclusionsWe found no conclusive evidence of the effectiveness and safety of acupuncture for LSS because of high or uncertain risk of bias and the limited generalisability of the included studies. Future trials using rigorous methodology, appropriate comparisons and clinically relevant outcomes should be conducted.

Purpose To evaluate the safety and efficacy of transcatheter arterial chemoembolization used for the treatment of unresectable hepatocellular carcinoma (HCC) with an Asian cooperative prospective study between Japan and Korea. Materials and Methods Patients with unresectable HCC unsuitable for curative treatment or with no prior therapy for HCC were enrolled. The patients underwent transcatheter arterial chemoembolization with emulsion of Lipiodol and anthracycline agent, followed by embolization with gelatin sponge particles, which was repeated on an as-needed basis. The primary endpoint was 2-year survival rate, and the secondary endpoints were adverse events and response rate. Results The 2-year survival rate of 99 patients was 75.0% (95% confidence interval, 65.2%–82.8%). The median time-to-progression was 7.8 months, and the median overall survival period was 3.1 years. Of 99 patients, 42 (42%) achieved a complete response, and 31 (31%) had a partial response. The response rate was 73% using modified Response Evaluation Criteria in Solid Tumors. The grade 3–4 toxicities included increased alanine aminotransferase level in 36%, increased aspartate aminotransferase level in 35%, thrombocytopenia in 12%, and abdominal pain in 4% of patients. All other toxicities were generally transient. Conclusions Asian transcatheter arterial chemoembolization demonstrated sufficient safety and reasonable efficacy as a standard treatment for unresectable HCC. These results could be useful as reference data for future trials of transcatheter arterial chemoembolization.

A case is reported of unexplained unilateral thigh muscle atrophy and frequent falling with poor response to conventional conservative treatments in a patient with bipolar disorder who self-selected acupuncture treatment as a last resort. The patient experienced gradual improvements in lower extremity weakness and fewer falls during the 8-month treatment. No adverse event or aggravation of the bipolar disorder was observed. These outcomes suggest that acupuncture may be a feasible adjunct for reducing falling and restoring postural balances in patients with bipolar disorder.

Bilateral internal caroid artery agenesis is a very rare congenital anomaly, which may be accompanied by various types of associated vascular abnormalities, included intracranial aneurysms or dolichoectatic change of posterior circulation. In this article, we present unique, and to the best of our knowledge, the first case of bilateral internal carotid agenesis associated with basilar artery fenestration, which resembles intra-arterial floating thrombus.

Objective : The purpose of this case-control study was done to examine the relationship among the acute brain infarction, silent brain infarction and blood lipids. Methods : We compared the components of blood lipids among acute brain infarction patients group (n=99), silent brain infarction patients group(n=101) and controls group (n=153). The analysis of the data was done by Frequency Analysis, one-way ANOVA, Post Hoc Test(Duncan), Pearson’s Correlation. Results : The results were as follows. High density lipoprotein cholesterol(HDL-Chol) was significantly lower in patients of acute brain infarctions group. The blood levels of total cholesterol(T-Chol) was significantly higher in patients of silent brain infarctions. A study on the relationship among the significant variables ; In T-Chol and HDL-Chol, DM(No=0, Yes=1) and Age, they had positive correlation each other. Between Sex(Female=0, Male=1) and HDL-Chol, Age and HDL-Chol, DM and HDL-Chol, they had negative correlation each other. Conclusions : These results suggest that low HDL-Chol may be risk factor of acute brain infarction.

To get the nutritional data of hot water extract from imported kangaroo tails, research was done about contents of collagen, chondroitin sulfate, protein, fat, mineral ions, and conjugated linoleic acid (CLA) in tails. Collagen content of sulfuric acid digested sample was way higher at bones than meats in both kangaroo tail and cow tail. Comparing kangaroo tail and cow tail, meat of kangaroo tail have 1.7 times higher collagen content than that of cow tail. Content of collagen in bone parts of kangaroo tail was also higher 1.2 times than that of cow tail. Meat sample of kangaroo tail (liquid extraction) have 1.3 times higher content of muco-polysaccharide than that of cow tail. In the born part, kangaroo tail was 2.4 times higher than cow tail in its content of muco-polysaccharide. The CLA content of the kangaroo tail showed the content that was higher than 0.9% of the cow tail for 4.9% and showed about 5.3 times high ratios. Especially in kangaroo tail, a band with high content of CLA was found between C18:1 and C18:2.

We report a case of iliac vein stent fracture due to hooking by a migrated retrievable inferior vena cava filter in a 55-year-old woman with acute deep venous thrombosis related to May-Thurner syndrome.

Positron emission tomography (PET) with fluorine 18 fluorodeoxyglucose (FDG) is used to diagnose, stage, and monitor breast cancer. FDG PET has the capability to depict abnormal metabolic activity before any anatomic change occurs; however, in the absence of identifiable anatomic structures on PET images, it may be impossible to identify the location of areas of increased radionuclide uptake. In such cases, the coregistration of PET images with images from computed tomography (CT) may help improve diagnostic accuracy and lead to better clinical management of patients with breast cancer. Although FDG PET/CT may have limited diagnostic value for detecting small primary breast tumors, well-differentiated breast cancer, or regional lymph node involvement, it is superior to conventional imaging modalities for detecting distant metastases and recurrences and for monitoring the response to therapy.

We have grown delta-doped In0.5Ga0.5As /In0.5Al0.5As heterostructures on GaAs substrate applying with InxAl1-xAs compositional graded-step buffers, called metamorphic structures, grown by molecular beam epitaxy. Three types of buffer layers with different compositional gradients and thicknesses have designed to investigate the influence of the strain relaxation process. We characterized the samples by using transmission electron microscopy, triple-axis X-ray diffraction and Hall measurement. Two samples with different compositional gradient show almost same results in electrical properties. On the other hand, it is found that samples with different step thicknesses had shown the large differences in epilayer tilt and mosaic spread in the step-graded buffers. These results indicate that there exists an interrelation between the strain-relaxed buffer and 2DEG transport properties.

International audience; OBJECTIVE:Greater flexibility and smaller sizes for introducer sheaths in the newest stent grafts increase the feasibility of endovascular aneurysm repair but raise concerns about long-term limb patency. The aim of the study was to determine the incidence of and predictive factors for limb occlusion after use of the Endurant stent graft (Medtronic Inc, Minneapolis, Minn) for abdominal aortic aneurysm.METHODS:The Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE) prospectively included 1143 patients treated with bifurcated devices who were observed for up to 2 years. Limb occlusions were evidenced by computed tomography, angiography, or ultrasound. To predict stent graft limb occlusion, a two-step model-building technique was applied. We first identified predictors from a total of 47 covariates obtained at baseline and in the periprocedural period. Subsequently, we reduced the set of potential predictors to key factors that are clinically meaningful. To handle large numbers of covariates, we used the Classification And Regression Tree (CART) method.RESULTS:Forty-two stent graft limbs occluded in 39 patients (3.4% of the patients). At 2 years, the rate of freedom from stent graft limb occlusion calculated by Kaplan-Meier plot was 97.9% (standard error [SE], 0.33%). Of the 42 occlusions, 13 (31%) were observed within 30 days and 30 (71%) within 6 months. The strongest independent predictors were distal landing zone on the external iliac artery, external iliac artery diameter ≤10 mm, and kinking. High-risk vs low-risk patients were identified according to a decision tree based on the strongest predictors. Freedom from stent graft limb occlusion was 96.1% (SE, 0.64%) in high-risk patients vs 99.6% (SE, 0.19%) in low-risk patients.CONCLUSIONS:After Endurant stent grafting, the incidence of limb occlusion was low. Classifying patients as high risk vs low risk according to the algorithm used in this study may help define specific strategies to prevent limb occlusion and improve the overall results of endovascular aneurysm repair using the latest generation of stent grafts.

OBJECTIVE. The purpose of this pictorial essay is to show the imaging features of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) and radiofrequency thermal ablation on CT, MRI, and contrast-enhanced sonography and to describe the advantages and limitations of each imaging technique in evaluating the therapeutic effect on HCC.CONCLUSION. CT is the standard imaging technique for monitoring the effectiveness of TACE and radiofrequency ablation. Contrast-enhanced sonography and MRI can complement CT in evaluating the therapeutic response.

The study goal was to evaluate the efficacy, safety, and clinical outcome of transarterial embolization for postoperative hemorrhage after abdominal surgery. Thirty-three patients were referred for angiography because of gastrointestinal or intra-abdominal bleeding after abdominal surgery. Urgent angiography and transarterial embolization was performed in all 33 patients. The clinical and angiographic features were retrospectively reviewed. Angiography revealed a discrete bleeding focus in 26 (79%) of 33 patients. Transarterial embolization was technically successful in 24 (92%) of 26 patients with a discrete bleeding focus. Rebleeding occurred in four (17%) of 24 patients. They were successfully managed with repeat embolization. There was no procedure-related complication during follow-up period. Angiography has a high detection rate of bleeding site in patients with postoperative hemorrhage after abdominal surgery. Transarterial embolization is considered to be an effective and safe means in the management of postoperative hemorrhage.

Nonsurgical treatment has become the standard of care in hemodynamically stable patients with blunt liver trauma. The use of helical computed tomography (CT) in the diagnosis and management of blunt liver trauma is mainly responsible for the notable shift during the past decade from routine surgical to nonsurgical management of blunt liver injuries. CT is the diagnostic modality of choice for the evaluation of blunt liver trauma in hemodynamically stable patients and can accurately help identify hepatic parenchymal injuries, help quantify the degree of hemoperitoneum, and reveal associated injuries in other abdominal organs, retroperitoneal structures, and the gastrointestinal tract. The CT features of blunt liver trauma include lacerations, subcapsular or parenchymal hematomas, active hemorrhage, juxtahepatic venous injuries, periportal low attenuation, and a flat inferior vena cava. It is important that radiologists be familiar with the liver injury grading system based on these CT features that was established by the American Association for the Surgery of Trauma. CT is also useful in the assessment of delayed complications in blunt liver trauma, including delayed hemorrhage, hepatic or perihepatic abscess, posttraumatic pseudoaneurysm and hemobilia, and biliary complications such as biloma and bile peritonitis. Follow-up CT is needed in patients with high-grade liver injuries to identify potential complications that require early intervention.

To assess the effectiveness of endovascular stenting for the palliation of superior vena cava (SVC) syndrome, endovascular stent insertion was attempted in 10 patients with symptomatic occlusion of the SVC. All the patients had known malignant disease of the thorax. Eight patients had been treated previously with chemotherapy and radiotherapy (n=5), chemotherapy alone (n=2), or pneumonectomy and radiotherapy (n=1). After developing SVC syndrome, all the patients were stented before receiving any other treatment. After single or multiple endovascular stents were inserted, five of eight patients were treated with chemotherapy and radiotherapy (n=2) or chemotherapy alone (n=3). Resolution of symptoms was achieved in nine patients within 72 hr (90%). In one patient, the symptoms did not disappear until a second intervention. At follow up, symptoms had recurred in two of ten patients (20%) after intervals of 15 and 60 days. Five patients have died from their cancers, although they remained free of symptoms of SVC occlusion until death. In conclusion, endovascular stent insertion is an effective treatment for palliation of SVC syndrome. Endovascular stent insertion can be considered the first choice of treatment, due to the immediate relief of symptoms and excellent sustained symptomatic relief.

Objective: To determine the feasibility of transcaval transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins. Materials and Methods: Transcaval TIPS, performed in six patients, was indicated by active variceal bleeding (n=2), recurrent variceal bleeding (n=2), intractable ascites (n=1), and as a bridge to liver transplantation (n=1). The main reasons for transcaval rather than classic TIPS were the presence of an unusually acute angle between the hepatic veins and the level of the portal bifurcation (n=3), hepatic venous occlusion (n=2), and inadequate small hepatic veins (n=1). Results: Technical and functional success was achieved in all patients. The entry site into liver parenchyma from the inferior vena cava was within 2 cm of the atriocaval junction. Procedure-related complications included the death of one patient due to hemoperitoneum despite the absence of contrast media spillage at tractography, and another suffered reversible hepatic encephalopathy. Conclusion: In patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins, transcaval TIPS creation is feasible.