Bowstring Phenomenon in Renal Artery Aneurysm Exclusion Using a Viabahn Stent Graft

Saiga, Atsushi; Yamamoto, Masayoshi; Kondo, Hiroshi; Kubota, Yoshihiro; Wada, Takeshi; Akutsu, Akira; Takeuchi, Takashi; Koizumi, Jun; Umemura, Takashi

doi:10.1177/1538574420975556

Cited by 1 publication

(3 citation statements)

References 8 publications

(12 reference statements)

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“…This technique is extremely effective in preventing the risk of vessel injury and facilitating distal advancement of the guiding sheath. 12 Miyayama et al 13 reported that ultraselective TACE was effective in controlling local recurrence, especially when accumulating dense iodized oil emulsion in HCC with a greater grade of portal vein visualization. As we routinely tried to advance the microballoon catheter as much as possible to the distal portion of the feeding artery (e.g., the distal subsegmental and distal sub-subsegmental tumor feeding branches), we performed CHA insertion in all patients.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, Kawaguchi et al 11 used this technique on endoscopic retrograde cholangiopancreatography with a large balloon catheter. In the field of abdominal surgery, we reported the BAT as a “balloon anchoring and squeezing technique” (Saiga et al 12 , p. 403) in a case of renal artery aneurysm exclusion using a stent graft. This technique is extremely effective in preventing the risk of vessel injury and facilitating distal advancement of the guiding sheath.…”

Section: Discussionmentioning

confidence: 99%

“…This technique is extremely effective in preventing the risk of vessel injury and facilitating distal advancement of the guiding sheath. 12 …”

Section: Discussionmentioning

confidence: 99%

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Prediction of common hepatic artery catheter insertion based on celiac trunk morphology

Saiga¹,

Yokota²,

Akutsu³

et al. 2023

Diagn Interv Radiol

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PURPOSEThis study aimed to predict the ability to insert a 4-5 French (Fr) catheter insertion with a guidewire into the common hepatic artery (CHA) based on celiac trunk morphology. METHODSThis retrospective study included 64 patients who underwent balloon-occluded transcatheter arterial chemoembolization (n = 56), transcatheter arterial chemotherapy (n = 2), or were fitted with an implantable port system (n = 6) between June 2019 and December 2019 in our institution. The morphology of the celiac trunk was classified into three types (upward, horizontal, and downward) based on celiac angiography. The aortic-celiac trunk angle was measured on sagittal images of preprocedural contrast-enhanced computed tomography (CT). We reviewed whether a 4-5-Fr shepherd's hook catheter could advance beyond the CHA using a 0.035-inch guidewire (Radifocus® Guidewire M; Terumo). Three patients were diagnosed with median arcuate ligament syndrome (MALS) based on the characteristic hook shape of the celiac artery on sagittal images of contrast-enhanced CT. The predictive ability of celiac angiography and preprocedural CT for CHA insertion success was evaluated. In unsuccessful cases, the balloon anchor technique (BAT) was attempted as follows: (1) a 2.7/2.8-Fr microballoon catheter (Attendant Delta; Terumo) was placed beyond the proper hepatic artery, and (2) the balloon was inflated as an anchor for parent catheter advancement. RESULTSUpward, horizontal, and downward celiac trunk types were noted in 42, 9, and 13 patients, respectively. The median CT angle was 122.83° (first quartile-third quartile, 102.88°-136.55°). Insertion in the CHA using the guidewire was successful in 56 of 64 patients (87.50%), and the success rate in the downward type was significantly lower than that in the upward type [42/42 (100%) vs. 7/13 (53.85%), P < 0.001]. The CT angle was significantly larger downward in the unsuccessful group than in the successful group (121.03° vs. 140.70°, P = 0.043). Celiac angiography had a significantly higher area under the curve (AUC) than preprocedural CT (AUC = 0.91 vs. AUC = 0.72, P = 0.040). All three cases of MALS showed unsuccessful CHA insertion. In all eight patients with unsuccessful insertion, the catheter could be advanced using the BAT [8/8 (100%)]. CONCLUSIONCeliac angiography and preprocedural CT could predict CHA catheter insertion using a guidewire, and celiac angiography had high predictability. CT could detect MALS, a risk factor for unsuccessful CHA insertion. KEYWORDSBalloon anchor technique, balloon-occluded transcatheter arterial chemoembolization, celiac trunk morphology, common hepatic artery insertion, the aortic-celiac trunk angle You may cite this article as: Saiga A, Yokota H, Akutsu A, et al. Prediction of common hepatic artery catheter insertion based on celiac trunk morphology. Diagn Interv Radiol.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%