Feasibility and Safety of Sac Embolization Using N-Butyl Cyanoacrylate in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms or Isolated Iliac Artery Aneurysms.

PURPOSE: To evaluate the feasibility and safety of sac embolization with N-butyl cyanoacrylate (NBCA) in emergency endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (AAA) and iliac artery aneurysm (IAA) in comparison to EVAR without sac embolization. MATERIALS AND METHODS: Between February 2012 and December 2019, among 44 consecutive patients with ruptured AAA or IAA, 29 underwent EVAR. Of these, 22 patients (median age 77.5 years; 18 men) had concomitant sac embolization using NBCA; the remaining 7 patients (median age 88 years; 6 men) underwent EVAR without sac embolization and form the control group. The technical success, clinical success (hemodynamic stabilization), procedure-related complications, and mortality were compared between the groups. RESULTS: All EVAR procedures and embolizations were successful. The clinical success rates in the NBCA and control groups were 95% (21/22) and 71% (5/7), respectively (p=0.14). There was no complication related to the procedure. Type II endoleak occurred in 4 of 21 patients (19%) in the NBCA group vs none of the control patients. One patient (5%) died in the NBCA group vs 3 (43%) in the controls (p=0.034). CONCLUSION: Sac embolization using NBCA in emergency EVAR appears to be feasible and safe for ruptured AAA and IAA.

Use of a steerable triaxial system for challenging catheterization.

Purpose: A steerable triaxial system consisting of a small microcatheter, a high-flow steerable microcatheter, and a 4-Fr. catheter is currently used in clinical settings. The purpose of the present study was to evaluate the efficacy and safety of the steerable triaxial system for challenging catheterization.Material and methods: Sixteen patients underwent an interventional procedure with the steerable triaxial system. Medical records and images of the procedures were reviewed, and the technical success rate, clinical success rate, and complications related to the procedures were evaluated. Technical success was defined as successful catheterization to the target artery using the steerable triaxial system, and clinical success as completion of the aimed procedure.Results: Catheterization to the target artery was successfully performed with the steerable triaxial system in 14 out of 16 patients, but was unsuccessful in two. Therefore, the technical success rate was 88% (14/16). The procedure was successfully accomplished in the 14 technical success patients. Thus, the clinical success rate was 88% (14/16). There were no complications related to the procedures.Conclusions: The steerable triaxial system has potential as a useful and safe technique for challenging catheterization.

Preoperative transcatheter arterial embolization using a gelatin sponge for head and neck tumors.

Purpose: To evaluate the usefulness of preoperative transcatheter arterial embolization using a gelatin sponge for hypervascular head and neck tumors to reduce intraoperative blood loss (IBL).　　　　 Material and methods: Nineteen patients underwent preoperative transcatheter arterial embolization for hypervascular head and neck tumors using a gelatin sponge. The technical success rate, devascularization rate, IBL, and complications were evaluated. Angiography images obtained before and after preoperative embolization were compared in all patients, and the devascularization rate was assessed from the relative reduction rate of contrast agent volumes. Results: The technical success rate was 100%. The median devascularization rate was 95% (range, 75-100%). The median period between embolization and surgical resection was one day (range, 1-12 days). The median IBL was 122 ml (range, 0-3780 ml). Blood transfusions were required in three cases, and their IBL and devascularization rates were 850, 1959, and 3780 ml, and 75%, 90%, and 80%, respectively. There was a complication of cerebral embolism in one out of 19 cases (5%). Conclusions: Preoperative transcatheter arterial embolization using a gelatin sponge was feasible and may contribute to decreasing IBL.

Time-resolved magnetic resonance angiography as a follow-up method for visceral artery aneurysm treated with coil-embolisation.

PURPOSE: The purpose of this study is to assess the feasibility and usefulness of time-resolved magnetic resonance angiography (TR-MRA) for follow-up of visceral artery aneurysms (VAAs) after embolotherapy. MATERIAL AND METHODS: Twenty-one VAAs (11 splenic, six renal, three internal iliac, and one superior pancreaticoduodenal artery aneurysms) in 18 patients (median age, 64 years; range, 36-88 years) previously treated by embolisation with platinum coils, were evaluated. The mean size of the aneurysm was 10.5 cm3 (range, 0.3-132 cm3). Among them, 19 lesions were treated by aneurysmal packing with or without distal-to-proximal embolisation. For the remaining two lesions, distal-to-proximal embolization alone was performed. The mean observation period after embolotherapy was 35 weeks (range, 4-216). All patients underwent TR-MRA following an intravenous bolus injection of gadolinium chelate. Recanalisation was diagnosed when any portion of the aneurysmal sac was enhanced in the arterial phase. RESULTS: On TR-MRA, two lesions were diagnosed as recanalised. They were confirmed by transcatheter arteriography and re-treated by embolotherapy. For the remaining 19 lesions, there were no findings of recanalisation on TR-MRA. CONCLUSIONS: TR-MRA appears to be a feasible method for follow-up examination of VAAs treated by embolotherapy.

Preoperative transarterial embolization using gelatin sponge for hypervascular bone and soft tissue tumors in the pelvis or extremities.

BACKGROUND: Preoperative transcatheter arterial embolization for hypervascular bone and soft tissue tumors plays an important role in reducing intraoperative blood loss (IBL). PURPOSE: To evaluate the use of a gelatin sponge in preoperative transcatheter arterial embolization for hypervascular bone and soft tissue tumors in the pelvis or extremities. MATERIAL AND METHODS: Thirty-seven patients (21 men, 16 women; median age, 61 years; age range, 23-79 years) underwent preoperative transcatheter arterial embolization between April 2004 and January 2015. Medical records and images were reviewed, and the technical success rate, clinical success rate, and complications were evaluated. Technical success was defined as a devascularization rate of 75% or higher, and clinical success was defined as intraoperative blood loss (IBL) <1500 mL in cases undergoing surgery within 3 days of transarterial embolization and <3000 mL in cases operated 4 or more days later. RESULTS: Tumor sizes were in the range of 2.0-13.0 cm (median, 5.0 cm). The devascularization rate was decreased by >75% at follow-up angiography in all cases, and the technical success rate was 100 % (37/37). The median IBL was 491 mL (range, 30-3800 mL), and the clinical success rate was 89% (33/37). The minor complication of local pain was observed in 13 out of 37 cases (35%) during or after embolization, but was controllable by an analgesic. CONCLUSION: Preoperative transarterial embolization using a gelatin sponge appears to be feasible and safe, and may contribute to decreasing IBL.

Visualization of the Spinal Artery by CT During Embolization for Pulmonary Artery Pseudoaneurysm.

BACKGROUND: Spinal artery ischemia is a rare but serious complication of embolization for treatment of hemoptysis. When the spinal artery is visualized at angiography, embolization should not be performed. However, it has been reported that spinal artery feeders are not visible on angiography in patients with developing spinal infarction. CASE REPORT: A 70-year-old man with a history of pulmonary aspergillosis had hemoptysis and underwent contrast-enhanced CT, revealing a pulmonary artery pseudoaneurysm (PAP) in the left upper lobe. Systemic angiography from the fifth left intercostal artery showed the PAP at the distal site, but the access route to the PAP was very tortuous and long. Although the spinal branch could not be observed with that angiography, CT during angiography was performed, and it visualized the posterior spinal artery obviously. Thus, the artery distal and proximal to the PAP was then successfully coil-embolized from the pulmonary artery. CONCLUSIONS: CT during angiography may be useful to confirm the presence of the spinal artery for treatment of hemoptysis by embolization.

Reperfusion Rates of Pulmonary Arteriovenous Malformations after Coil Embolization: Evaluation with Time-Resolved MR Angiography or Pulmonary Angiography.

PURPOSE: To assess reperfusion rates after coil embolization for pulmonary arteriovenous malformations (PAVMs) using time-resolved magnetic resonance (MR) angiography or pulmonary angiography. MATERIALS AND METHODS: Patients with PAVMs who underwent embolization and met the following inclusion criteria were included: (a) embolization was performed using bare or fibered platinum microcoils or both, (b) the complete cessation of flow was confirmed by digital subtraction angiography, and (c) follow-up examinations were conducted with time-resolved MR angiography or pulmonary angiography. Coil embolization was performed in 16 patients with 24 untreated or reperfused PAVMs. Sac embolization was performed for 12 untreated PAVMs. Feeding artery embolization was performed as primary embolization in each of the 12 reperfused PAVMs. Five PAVMs were treated 2 to 4 times because of reperfusion. The study included 32 coil embolizations. Follow-up images were reviewed, and reperfusion rates were assessed. The relationships between reperfusion and the location of PAVM, size of PAVM (feeding artery and venous sac), coils (number and total length), timing of embolization (primary or repeat embolization), and types of coils used (with or without fibered coils) were examined. RESULTS: Reperfusion rates at 3, 6, 12, and 24 months were 8%, 27%, 36%, and 49%, respectively, for the 12 untreated PAVMs (primary embolization) and 50%, 50%, 92%, and 100%, respectively, for the 12 reperfused PAVMs (repeat embolization) (P = .0062). No significant differences were observed in the other parameters measured. CONCLUSIONS: When evaluated with time-resolved MR angiography or pulmonary angiography, reperfusion rates after coil embolization for PAVM were considerably high, particularly with repeat embolization.

Triaxial coil embolization using Guglielmi detachable coils with the voltage-dependent coil-detaching technique.

BACKGROUND: A triple co-axial (triaxial) system, consisting of a 1.9-Fr non-tapered microcatheter with one marker, a 2.7-Fr microcatheter, and a 4-Fr catheter, has been recently developed, and can be used in coil embolizations using 0.010-inch Guglielmi detachable coils (GDCs) with a voltage-dependent coil-detaching technique. PURPOSE: To describe this new technique and evaluate its technical feasibility and clinical efficacy. MATERIAL AND METHODS: Twenty patients underwent this procedure. Diseases were gastrointestinal bleeding in five patients, traumatic bleeding in three patients, and other diseases in 12 patients. The technical success rate, clinical success rate, and complications of this procedure were evaluated. Technical success was defined as the successful delivery and detachment of a GDC, and clinical success was defined as the immediate postembolic complete cessation of blood flow confirmed by digital subtraction angiography. RESULTS: A total of 140 GDCs were used and 20 arteries were embolized. The technical success rate was 94% (131/140) and clinical success rate was 95% (19/20). No major complications were reported. CONCLUSION: The triaxial system in coil embolization using a GDC by monitoring the voltage for coil-detaching appeared to be safe and effective.

Triaxial transarterial embolization for lower gastrointestinal bleeding: a retrospective case series.

OBJECTIVE: Superselective transcatheter arterial embolization (TAE) is important for lower gastrointestinal (GI) bleeding. A new 1.9-Fr. no-taper microcatheter has recently become available and can be inserted into a 2.7-Fr. microcatheter. We assessed the applicability of this new triple co-axial (triaxial) system to TAE for lower GI bleeding. MATERIAL AND METHODS: Five patients with lower GI bleeding underwent TAE with the triaxial system. The approach was via the femoral artery with a 4-Fr. sheath in all cases. The 4-Fr. catheter and triaxial system were inserted into the artery in which extravasation had occurred. Coil embolization was performed with 0.010-inch coils. We evaluated technical success rate, clinical success rate and complications. RESULTS: All five cases of bleeding occurred at the ascending colon, and were caused by diverticulosis in four cases, and an injury to the artery during polypectomy in one case. The 1.9-Fr. no-taper microcatheter could be inserted into the site of extravasation, the vasa recta, in all procedures and TAE was performed successfully. The disappearance of extravasation was confirmed in all cases following TAE. No patients exhibited any signs of recurrent bleeding or complication. CONCLUSION: The triaxial system appears to be effective and useful in superselective TAE for lower GI bleeding.

Triaxial system in re-embolization for recanalization of pulmonary arteriovenous malformations.

BACKGROUND: Recanalization occurs occasionally, following coil embolization of pulmonary arteriovenous malformations (PAVM), and can lead to ischemic stroke; therefore re-embolization is important. A 1.9-Fr. no-taper microcatheter that can be inserted into a 2.7-Fr. microcatheter (named the triaxial system) has recently become available, and contributes to super-selective catheterization for small or tortuous vessels. The aim of this study was to evaluate the usefulness of re-embolization for recanalization of PAVM using the triaxial system. MATERIAL/METHODS: Recanalization was diagnosed in 8 patients with 13 PAVMs between June 2011 and November 2012, and re-embolization was attempted with a conventional microcatheter at first in all 13 PAVMs. However, in three of them it failed with the conventional microcatheter, and then the system was exchanged to the triaxial system. Thus, re-embolization using the triaxial system was performed in 3 PAVMs of 3 female patients, with a median age of 63 years (range, 46-73 years). We assessed technical success, complications, and outcome. RESULTS: The disappearance of recanalization was confirmed by angiography in all re-embolization procedures (technical success rate was 100%). Re-embolization was then successfully achieved inside the original coils, and no branch artery of normal lung tissue was embolized. There were no complications related with this procedure. The blood flow of recanalization was decreased in all cases in a follow-up of 27-33 months (median, 31). CONCLUSIONS: Triaxial system appears to be useful for recanalization of PAVM, especially in difficult cases with a conventional system.

Feasibility of time-resolved MR angiography for detecting recanalization of pulmonary arteriovenous malformations treated with embolization with platinum coils.

PURPOSE: To assess the feasibility of time-resolved magnetic resonance (MR) angiography as a follow-up method after embolization for pulmonary arteriovenous malformations (PAVMs). MATERIALS AND METHODS: Evaluation of 28 PAVMs in 10 patients previously treated with embolization with platinum coils was performed. The mean observation period after embolization was 49 months. All patients underwent unenhanced chest computed tomography (CT) and time-resolved MR angiography followed by transcatheter digital subtraction angiography within 5 weeks for a definite diagnosis. Two radiologists reviewed the CT and time-resolved MR angiography findings using a blinded method. On CT, the draining veins of the PAVMs were measured before and after embolization, and shrinkage rates were calculated. On time-resolved MR angiography, recanalization was diagnosed when the draining vein or aneurysmal sac or both were enhanced in the pulmonary arterial phase. Correlations between recanalization, the shrinkage rate of the draining vein, and the diagnostic accuracies of CT and time-resolved MR angiography were assessed and compared with digital subtraction angiography. RESULTS: Five lesions could not be measured on CT because of metallic artifacts. The mean shrinkage rates of the draining vein for recanalized and occluded PAVMs were 23% ± 19 (SD) for recanalized PAVMs and 47% ± 21 for occluded PAVMs (P = .001). The sensitivity and specificity were 93% and 53%, respectively, when the shrinkage rate threshold was set to 50%. On time-resolved MR angiography, the sensitivity and specificity were 93% and 100%, respectively, for Reader 1 and 100% and 93%, respectively, for Reader 2. The κ coefficient was 0.86. CONCLUSIONS: Time-resolved MR angiography appears to be a feasible method for PAVM follow-up examinations and to provide a more accurate diagnosis of recanalization compared with unenhanced CT.

Triaxial system for embolization of type II endoleak after endovascular aneurysm repair.

PURPOSE: To demonstrate the utility of a triaxial catheter system for embolization of type II endoleak after endovascular aneurysm repair. TECHNIQUE: The technique is illustrated in 2 patients with sac enlargement owing to persistent type II endoleak of lumbar artery origin. In both cases, the access to the iliolumbar and lumbar arteries was very long and tortuous. For selective catheterization in this situation, a 4-F catheter is advanced through the access site, and 2.7-F microcatheter is inserted into the iliolumbar artery, followed by a 1.9-F untapered microcatheter. The latter is advanced along with a 0.014-inch microguidewire into the feeding artery. Supported by the 2.7-F microcatheter, the no-taper microcatheter is then navigated through the endoleak to the draining vessel for embolization. CONCLUSION: This simple-to-use triaxial catheter system seems well suited for superselective embolization of type II endoleaks with very long and tortuous access routes. If glue is used and multiple doses are required, access to the feeding artery is not lost if the smaller microcatheter has to be replaced.

Dual microcather-dual detachable coil technique in embolization for a congenital intrahepatic portosystemic venous shunt (IPSVS).

We report a 14-year-old boy with a large intrahepatic portosystemic venous shunt. The shunt seemed to be difficult to coil embolize because it was so large and short. However, it was successfully treated by coil embolization with a new dual microcatheter-dual detachable coil technique.

[Basic research for development of pinhole camera using a Geiger Mueller counter].

To visualize the scattered X-ray distribution in the diagnosis domain, we examined whether a Geiger Mueller (GM) counter could be applied to a pinhole camera as an X-ray detector. The GM counter detects radiation at certain detection points. To obtain two-dimensional images using the GM counter, the detector needs to be moved two-dimensionally. We constructed an apparatus using industrial actuators to move the detector. To investigate the usability of the developed apparatus, the scattered X-rays from the phantom were measured using the GM counter. The images obtained were then compared with those measured using the phosphor plate. Our results demonstrated that the GM counter can detect low count-rate radiation, but further research will be needed to obtain clear two-dimensional images. In this paper, we propose that the GM counter can be used as a complementary detector to a phosphor plate.

Time-resolved Magnetic Resonance Angiography for assessment of recanalization after coil embolization of visceral artery aneurysms.

BACKGROUND: Follow-up imaging after coil embolization of visceral artery aneurysms is important for detecting recanalization. However, CT examination is susceptible to coil artifacts, which sometimes makes it difficult to assess recanalization. We report 2 cases where recanalization was successfully visualized using time-resolved magnetic resonance angiography after coil embolization of visceral artery aneurysms (one case of right internal iliac artery aneurysm and one case of splenic artery aneurysm). Repeat coil embolization was successfully performed. CASE REPORT: Case 1. An 80-year-old male patient with right internal iliac artery (IIA) aneurysm underwent coil embolization. Aneurysm was located at the bifurcation of the right IIA and therefore, after making a femorofemoral bypass, the distal part of the right IIA, aneurysm and the common iliac artery were embolized with a coil. One year later, the size of the aneurysm seemed to have increased on CT. However, the details were not determined because of metal artifacts. Thus, time-resolved MRA was performed and showed minute vascular flow inside the aneurysm. Angiography was subsequently performed and blood flow inside the aneurysm was visualized similar to the findings in time-resolved MRA. Coil embolization was performed once more and vascular flow inside the aneurysm disappeared. Case 2. A 36-year-old male patient with a splenic artery aneurysm underwent coil packing with preservation of splenic artery patency. Four years later, coil compaction was suspected in a CT scan, but CT could not evaluate recanalization because of severe metal artifacts. Angiography was subsequently performed, showing recanalization of the aneurysm as did the time-resolved MRA. Therefore, coil embolization of the aneurysm and splenic artery was performed again. CONCLUSIONS: Follow-up imaging after coil embolization of visceral artery aneurysms is important for detecting recanalization. However, it is sometimes difficult to assess recanalization with CT because of artifacts caused by metal. In our cases, recanalization of aneurysms was clearly shown by time-resolved MRA and re-embolization was successfully performed. In conclusion, time-resolved MRA appears to be useful in assessment of recanalization of visceral artery aneurysms after coil embolization.

A disposable OSL dosimeter for in vivo measurement of rectum dose during brachytherapy.

PURPOSE: We aimed to develop a disposable rectum dosimeter and to demonstrate its ability to measure exposure dose to the rectum during brachytherapy for cervical cancer treatment using high-dose rate 192 Ir. Our rectum dosimeter measures the dose with an optically stimulated luminescence (OSL) sheet which was furled to a catheter. The catheter we used is 6 mm in diameter; therefore, it is much less invasive than other rectum dosimeters. The rectum dosimeter developed in this study has the characteristics of being inexpensive and disposable. It is also an easy-to-use detector that can be individually sterilized, making it suitable for clinical use. METHODS: To obtain a dose calibration curve, phantom experiments were performed. Irradiation was performed using a cubical acrylic phantom, and the response of the OSL dosimeter was calibrated with the calculation value predicted by the treatment planning system (TPS). Additionally, the dependence of catheter angle on the dosimeter position and repeatability were evaluated. We also measured the absorbed dose to the rectum of patients who were undergoing brachytherapy for cervical cancer (n = 64). The doses measured with our dosimeters were compared with the doses calculated by the TPS. In order to examine the causes of large differences between measured and planned doses, we classified the data into common and specific cases when performing this clinical study. For specific cases, the following three categories were considered: (a) patient movement, (b) gas in the vagina and/or rectum, and (c) artifacts in the X-ray image caused by applicators. RESULTS: A dose calibration curve was obtained in the range of 0.1 Gy-10.0 Gy. From the evaluation of the dependence of catheter angle on the dosimeter position and repeatability, we determined that our dosimeter can measure rectum dose with an accuracy of 3.1% (k = 1). In this clinical study, we succeeded in measuring actual doses using our rectum dosimeter. We found that the deviation of the measured dose from the planned dose was derived to be 12.7% (k = 1); this result shows that the clinical study included large elements of uncertainty. The discrepancies were found to be due to patient motion during treatment, applicator movement after planning images were taken, and artifacts in the planning images. CONCLUSIONS: We present the idea that a minimally invasive rectum dosimeter can be fabricated using an OSL sheet. Our clinical study demonstrates that a rectum dosimeter made from an OSL sheet has sufficient ability to evaluate rectum dose. Using this dosimeter, valuable information concerning organs at risk can be obtained during brachytherapy.

Advanced monoenergetic reconstruction technique for dual-energy computed tomography to evaluate endoleaks after endovascular stent-graft placement.

PURPOSE: To evaluate the usefulness of the advanced monoenergetic imaging (AMI) reconstruction technique for dual-energy computed tomography to evaluate endoleaks after endovascular stent-graft placement. MATERIALS AND METHODS: Ninety-five dual-phase (early and delayed phases) enhanced CT examinations were performed for 60 patients who underwent endovascular stent-graft placement. AM images were reconstructed at 40 keV and compared with the standard 120-kVp images (SI). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the aorta and endoleak were measured. Two radiologists subjectively assessed endoleak delineation and contrast enhancement conditions using a 5-point Likert scale (1: poor-5: excellent). RESULTS: Mean SNRs of the aorta were higher by AMI (early; 34.7 ± 10.2 [SD], delay; 11.4 ± 3.2) than by SI (early; 23.1 ± 6.3, delay; 8.6 ± 2.2) (P < 0.001). SNRs of the endoleak were higher by AMI (early; 26.3 ± 7.5, delay; 10.5 ± 3.1) than by SI (early; 18.2 ± 4.7, delay; 8.3 ± 2.1) (P < 0.001). CNRs by AMI (early; 32.9 ± 9.8, delay; 8.9 ± 2.8) were higher than those by SI (early; 19.5 ± 6.0, delay; 4.7 ± 1.6) in both phases (P < 0.001). Endoleak delineation and contrast enhancement conditions by AMI (4.4 ± 1.0 and 4.5 ± 0.6) were higher than those by SI (3.4 ± 1.0 and 3.3 ± 0.8) in the delayed phase (P < 0.001). There was no difference in the early phase. CONCLUSION: AMI may be useful for evaluating endoleaks after endovascular stent-graft placement.

Use of 0.014-in. pushable bare platinum coils in super-selective embolization through the 1.6-Fr. microcatheter of the triaxial system.

BACKGROUND: A triple-coaxial (triaxial) system, which consists of a small microcatheter, a large microcatheter, and a 4-Fr. catheter, has been reported to allow super-selective catheterization. A 1.6-Fr. microcatheter has recently become available as the small microcatheter for the triaxial system, in addition to 0.014-in. pushable bare platinum coils that may be introduced into the 1.6-Fr. microcatheter. PURPOSE: The purpose of the present study was to evaluate the feasibility of 0.014-in. pushable bare platinum coils in embolization through the 1.6-Fr. microcatheter of the triaxial system. MATERIAL AND METHODS: Between November 2015 and October 2019, 19 embolizations were performed on 18 patients, 9 males and 9 females with a median age of 77 years (range, 41-88 years), using 0.014-in. pushable bare platinum coils through the 1.6-Fr. microcatheter of the triaxial system. The technical success rate, clinical success rate, and complications associated with the procedure were assessed. Technical success was defined as the successful delivery and placement of 0.014-in. pushable bare platinum coils, and clinical success as the immediate postembolic complete cessation of blood flow confirmed by digital subtraction angiography. RESULTS: Eighty-four 0.014-in. pushable bare platinum coils were delivered and 19 arteries were successfully embolized. The median number of 0.014-in. pushable bare platinum coils was 4 (range, 1-12). The technical success rate was 100% (84/84) and the clinical success rate was also 100% (19/19). There were no complications associated with the procedures. CONCLUSION: The use of 0.014-in. pushable bare platinum coils in super-selective embolization through the 1.6-Fr. microcatheter of the triaxial system appears to be feasible and safe.

A case of persistent Müllerian duct syndrome with sertoli cell tumor and hydrometra in a dog.

A 10-year-old Miniature Schnauzer with bilateral cryptorchidism and male external genitalia was referred with a history of abdominal enlargement. Upon exploratory laparotomy, two tumors and a connecting structure similar to fluid-filled uterus were recognized. After cytological and bacterial examinations of the fluid and histological examination, this dog was diagnosed with bilateral Sertoli cell tumor with hydrometra. The karyotype of this dog was 78, XY and the sry gene was detected positive by PCR. We diagnosed this dog as a case of persistent Müllerian duct syndrome (PMDS), which is male pseudohermaphroditism. This is the first report regarding the incidence of PMDS in Miniature Schnauzers in Japan, and it suggests the involvement of a gene carrier.

Staged coil embolization after thoracic endovascular stent grafting for aneurysmal chronic type B aortic dissection: A case report.

We herein describe a 38-year-old woman with Marfan syndrome and chronic type A aortic dissection. Computed tomography showed that the sinus of Valsalva and thoracoabdominal aorta had a diameter of 62 and 55 mm, respectively. After 7 months of a Bentall operation and total arch replacement with the elephant trunk technique, we performed thoracic endovascular aortic repair for an aneurysm of the descending aorta, but we preserved the retrograde flow into the false lumen because it supplied vessels perfusing the spinal cord. Computed tomography angiography 14 months after thoracic endovascular aortic repair showed that the thoracic aortic diameter had increased to 68 mm. We then performed partial (proximal only) coil embolization of the false lumen. After 6 months, the thoracic aortic diameter had decreased to 60 mm and the spinal cord remained perfused via the distal false lumen. Staged coil embolization after thoracic endovascular aortic repair for aneurysmal chronic type B aortic dissection is feasible and can be beneficial.