Balloon-Assisted Portal Vein Embolization Using n-Butyl-2-Cyanoacrylate-Lipiodol-Iopamidol Mixture in Swine: A Comparison of 2 Formulations.

PURPOSE: To compare 2 ratios of n-butyl-2-cyanoacrylate (nBCA)-ethiodized oil (Lipiodol)-iopamidol (NLI) in balloon-assisted portal vein embolization (PVE) in swine. MATERIALS AND METHODS: In an in vitro study, NLI prepared at a ratio of 2:3:1 (NLI231) or 1:4:1 (NLI141) was injected into 2.5- or 10-mL syringes filled with swine blood, and the viscosity of NLI was measured to determine an appropriate balloon occlusion time. Two portal vein branches in 8 female swine (n = 16 vein branches) were embolized with NLI231 (n = 8) or NLI141 (n = 8) under balloon occlusion. Portal venography was performed before, immediately after, and 3 days after PVE to evaluate the migration of NLI and the recanalization of embolized portal vein branches. Then, the livers were removed for histopathologic evaluation. RESULTS: The times to peak viscosity of NLI231 in the 2.5- and 10-mL syringes were 55.8 seconds (SD ± 7.0) and 85.2 seconds (SD ± 6.3), and those to peak viscosity of NLI141 were 129.2 seconds (SD ± 11.8) and 254.0 seconds (SD ± 21.8), respectively. No migration of NLI231 was observed in all 8 procedures immediately or 3 days after PVE. Migration of NLI141 was observed in 6 of 8 procedures within 3 days after PVE. The migration frequency of the embolic material was lower in the NI231 group than in the NLI141 group (0/8 vs 6/8; P = .051). Histologically, NLI231 occupied the portal veins without any thrombi, whereas NLI141 was accompanied by thrombi in the portal veins. CONCLUSIONS: NLI231 may be more suitable than NLI141 for balloon-assisted PVE in swine.

Feasibility of the Glue-in-Plug Technique Using a Novel Liquid Embolic Material in a Swine Model.

PURPOSE: To evaluate the feasibility of the glue-in-plug (GIP) technique using n-butyl-2-cyanoacrylate‒Lipiodol (NL)-iopamidol (NLI) for short-segment embolization in swine. MATERIALS AND METHODS: The renal arteries, left external iliac artery, subclavian arteries, and common carotid arteries were each embolized in 4 swine using the GIP technique under general anesthesia. First, a type I Amplatzer vascular plug (AVP) (1-2 times the target vessel diameter) was deployed in the target artery. Next, the AVP was filled with NL mixture prepared at a ratio of 1:2 (NL12) (n = 11) or with NLI mixture prepared at a ratio of 2:3:1 (NLI231) (n = 11). Angiography was performed before, immediately after, and 1 hour after embolization to assess embolization and migration of the embolic materials. The embolized arteries were also evaluated histopathologically. RESULTS: The migration distance of the embolic material beyond the plug tip was significantly shorter in the NLI231 group than in the NL12 group immediately after embolization (6.5 mm ± 4.5 vs 1.0 mm ± 1.8, P = .0024) and 1 hour after embolization (8.4 mm ± 5.6 vs 1.0 mm ± 1.8, P = .0013). Angiography revealed no sign of recanalization of the target vessels in any artery in either group. Mild inflammatory cell infiltration was observed around the arterial wall at the embolization site in all arteries in both groups. CONCLUSIONS: The GIP technique using NLI231 may be a feasible procedure for short-segment embolization based on these short-term results.

Comparison of Soluble Gelatin Sponge Particles and Tris-acryl Gelatin Microspheres for Bariatric Arterial Embolization in Swine.

The purpose of this study was to compare complications and the number of ghrelin-expressing cells (GECs) after bariatric arterial embolization (BAE) using soluble gelatin sponge particles (SGSs) or tris-acryl gelatin microspheres (MSs) in swine. Twelve swine underwent embolization of gastric fundal arteries with SGSs (n = 4) or MSs (n = 4) or underwent saline infusion (n = 4, control group). One week later, the number of gastric ulcers and the percentage of GECs were compared among the 3 groups. There were no ulcers in the SGS and control groups. Two swine in the MS group had 4 large ulcers (12-50 mm in size). The mean percentages of GECs were significantly lower in the SGS (2.7% ± 0.9%) and MS (2.5% ± 1.0%) groups compared with the control group (3.7% ± 1.3%; P = .038 and P = .016, respectively). SGSs may be safer than MSs for BAE while inducing a similar reduction of GECs in swine.

Prophylactic Intraoperative Embolization of Abdominal Aortic Aneurysm Sacs Using N-Butyl Cyanoacrylate/Lipiodol/Ethanol Mixture with Proximal Neck Aortic Balloon Occlusion during Endovascular Abdominal Aortic Repair.

PURPOSE: To determine the feasibility of prophylactic intraoperative abdominal aortic aneurysm (AAA) sac embolization using a mixture of N-butyl cyanoacrylate/Lipiodol/ethanol (NLE) with proximal neck aortic balloon occlusion during endovascular aneurysm repair (EVAR) to prevent the occurrence of endoleak and aneurysm sac expansion. MATERIALS AND METHODS: Prophylactic intraoperative AAA sac embolization was performed in 24 patients with an infrarenal neck angulation > 60° (n = 16) or AAA sac diameter > 60 mm (n = 17). AAA sac pressure was continuously measured with a 3-F catheter inserted into the AAA sac. The systolic sac pressure index (SPI) was calculated as the ratio of systolic AAA sac pressure to the simultaneously measured systolic aortic pressure, and was measured with and without proximal neck aortic balloon occlusion. The aneurysm sac was embolized with NLE during proximal neck aortic balloon occlusion immediately after EVAR. Endoleak and AAA sac diameter were evaluated by enhanced computed tomography and subtraction magnetic resonance imaging at 6 months and yearly after EVAR. RESULTS: Mean SPIs after EVAR with and without proximal neck aortic balloon occlusion were 0.36 and 0.57, respectively. There were no adverse events related to intraoperative sac embolization. Follow-up imaging (mean, 12.1 mo) revealed three minor endoleaks (12.5%) and no aneurysm sac expansion. CONCLUSIONS: Prophylactic intraoperative sac embolization with NLE during proximal neck aortic balloon occlusion was safe and feasible and may reduce endoleaks and prevent sac expansion after EVAR in patients with unfavorable anatomic factors.

Utility of 99mTc-human serum albumin diethylenetriamine pentaacetic acid SPECT for evaluating endoleak after endovascular abdominal aortic aneurysm repair.

OBJECTIVE: The purpose of this study was to assess the utility of (99m)Tc-human serum albumin diethylenetriamine pentaacetic acid ((99m)Tc-HSAD) SPECT in the detection of endoleaks after endovascular abdominal aortic aneurysm repair. SUBJECTS AND METHODS: Fifteen patients (11 men, four women) with aneurysm sac expansion of 5 mm or greater after endovascular abdominal aortic aneurysm repair underwent three-phase CT, (99m)Tc-HSAD SPECT, and CT during aortography. Sensitivity calculations for three-phase CT and (99m)Tc-HSAD SPECT were performed with CT during aortography as the reference standard. The volume of each endoleak was measured with CT during aortography. Seven subjects underwent embolization with N-butyl cyanoacrylate (NBCA)-Lipiodol (ethiodized oil, Guerbet and metallic coils. Three-phase CT and (99m)Tc-HSAD SPECT were repeated after embolization to assess their efficacy. RESULTS: Endoleaks were interpreted as perigraft radioisotope accumulation in 12 patients (80.0%) on (99m)Tc-HSAD SPECT images, in 13 patients (86.7%) on three-phase CT images, and in 15 patients (100%) on CT during aortography. The mean endoleak volume visualized with (99m)Tc-HSAD SPECT was 8.37 cm(3) (range, 5.2-15.1 cm(3)), and the volume not visualized was 3.47 cm(3) (2.5-4.6 cm(3)), a statistically significant difference (p = 0.019). In two patients, (99m)Tc-HSAD SPECT depicted endoleaks evident at delayed phase CT during aortography but not at three-phase CT, suggesting they were slow-filling endoleaks. Accumulation of (99m)Tc-HSAD corresponding to endoleaks disappeared after embolization, but CT evaluation of embolization was impeded by artifacts of NBCA-Lipiodol and metallic coils. CONCLUSION: Technetium-99m-labeled HSAD SPECT proved less sensitive than three-phase CT but depicted endoleaks with volumes 5.2 cm(3) or greater as perigraft radioisotope accumulation. Slow-filling endoleaks can be visualized with (99m)Tc-HSAD SPECT, which can be used to evaluate the efficacy of embolization.

The use of technetium-99m-labeled human serum albumin diethylenetriamine pentaacetic acid single-photon emission CT scan in the follow-up of type II endoleak treatment.

An 84-year-old woman presented with persistent type II endoleak with sac expansion from 57 mm to 75 mm during 4-year follow-up after endovascular abdominal aortic aneurysm repair. The patient underwent transabdominal embolization with coils and N-butyl cyanoacrylate/ethiodized oil (Lipiodol; Guerbet, Villepinte, France) mixture (2.5 mL). Because of the anticipated embolization artifacts on follow-up computed tomography (CT), technetium-99m-labeled human serum albumin diethylenetriamine pentaacetic acid single-photon emission computed tomography ((99m)Tc-HSAD SPECT) was performed before and after the intervention. Perigraft accumulation on (99m)Tc-HSAD SPECT corresponding to the endoleak disappeared after embolization. CT scan performed 12 months after embolization showed no signs of sac expansion. (99m)Tc-HSAD SPECT may be useful for evaluating therapeutic effect after embolization for endoleak.

Successful coil embolization of post-hepatectomy arterioportal fistula that reduced ascites and improved liver function.

A 71-year-old man had previously undergone S7 + S8 dorsal segmentectomy and S5 partial hepatectomy for hepatocellular carcinomas. Six months later, he experienced abdominal distention. Abdominal computed tomography (CT) showed massive ascites and a significant hepatic arterioportal shunt. The ascites was thought to be caused by portal hypertension due to a high-flow hepatic arterioportal fistula (HAPF). The fistula, located between the right hepatic artery A7 and the right portal vein, was embolized with microcoils under flow control using a balloon catheter. After embolization, the shunt blood flow disappeared and the hepatopetal venous flow was restored. His body weight and abdominal circumference decreased immediately, and his liver function on blood tests improved after the procedure. CT performed 11 days after embolization showed decreased ascites. A HAPF after hepatectomy is extremely rare. Balloon-assisted embolization using microcoils is a useful endovascular procedure for treating a high-flow HAPF.

Successful endovascular treatment of iliac arteriovesical fistula with secondary stent-graft infection.

A 58-year-old woman initially presented with massive gross hematuria and iliac arteriovesical fistula (IAVF). Endovascular stent-graft repair achieved complete exclusion of the IAVF and controlled the bleeding, but sepsis subsequently developed because of endograft infection. Endovascular embolization of the infected stent graft was performed after extraanatomic bypass surgery. The patient recovered and showed no signs of graft infection or recurrent fistulization at 14 months after treatment. Endovascular embolization of infected stent grafts combined with extraanatomic bypass may be an acceptable treatment option for graft-related sepsis in cases that are resistant to conservative treatment and pose high surgical risk for graft excision.

Clinical evaluation of transcatheter arterial chemoembolization with 2-day-soluble gelatin sponge particles for hepatocellular carcinoma-comparison with insoluble gelatin sponge particles.

PURPOSE: To compare therapeutic effect, adverse events, and embolized hepatic artery impairment in transcatheter arterial chemoembolization between Lipiodol plus insoluble gelatin sponge particles (Gelpart) and Lipiodol plus 2-day-soluble gelatin sponge particles (2DS-GSPs). MATERIALS AND METHODS: In a single-center, prospective, randomized controlled trial, patients with hepatocellular carcinoma were assigned to the 2DS-GSP group or the Gelpart group. Radiographic response at 3 months per modified Response Evaluation Criteria In Solid Tumors was evaluated as the primary endpoint; secondary endpoints were safety (per Common Terminology Criteria for Adverse Events, version 4.0) within 3 months and hepatic branch artery impairment at the time of repeat chemoembolization (grade 0, no damage; grade I, mild vessel wall irregularity; grade II, overt stenosis; grade III, occlusion of more peripheral branch artery than subsegmental artery; grade IV, occlusion of subsegmental artery). Grade II, III, or IV indicated significant hepatic artery impairment. RESULTS: Thirty-seven patients with 143 nodules were randomized to the 2DS-GSP group and 36 patients with 137 nodules were randomized to the Gelpart group. No significant differences in patient background existed between groups. Target lesion response and overall tumor response in the 2DS-GSP and Gelpart groups were 77.7% versus 76.9% and 78.3% versus 77.8%, respectively, with no significant differences. No significant difference in adverse events existed between groups. Hepatic artery impairment was observed in 5% of patients in the 2DS-GSP group (n = 32) and in 16% in the Gelpart group (n = 33; P< .001). CONCLUSIONS: Transcatheter arterial chemoembolization with 2DS-GSPs resulted in the same therapeutic and adverse effects as chemoembolization with Gelpart while causing significantly less hepatic artery impairment.

Percutaneous transsplenic venous embolization of elevated jejunal varices after pancreaticoduodenectomy: A case report.

Recent advances in chemotherapy and radiotherapy have led to an increase in the number of long-term survivors of pancreatic cancer. However, this has also increased the number of patients suffering from ectopic varices and bleeding owing to left-sided portal hypertension and thrombocytopenia caused by splenomegaly after pancreaticoduodenectomy combined with resection of the splenic vein. A 65-year-old woman with varices of the elevated jejunum due to left sided portal hypertension after pancreaticoduodenectomy had repeated melena, which started about 1 year before admission. We describe the first reported case of percutaneous transsplenic venous embolization using metallic coils, which successfully achieved hemostasis of refractory bleeding from the elevated jejunal varices after pancreaticoduodenectomy.

Duodenal bleeding outside covered stents identified by selective computed tomography during arteriography that was successfully treated by embolization: A case report.

The patient was a man in his 60s who previously underwent placement of covered stents in the duodenum for a duodenal stricture caused by pancreatic cancer invasion. He experienced multiple episodes of hematemesis and hematochezia during hospitalization. Emergency upper and lower gastrointestinal endoscopies were performed but were unable to reveal the bleeding source. Based on these findings, we suspected small intestinal bleeding and emergency angiography was performed for the purpose of hemostasis. Computed tomography during arteriography was performed from the superior mesenteric artery and revealed extravasation outside the covered stents in the descending portion of the duodenum. Angiography of the inferior pancreaticoduodenal artery revealed extravasation in the descending portion of the duodenum, and the inferior pancreaticoduodenal artery was embolized with n-butyl cyanoacrylate. There were no postoperative symptoms indicative of intestinal ischemia or pancreatitis, and there was no rebleeding after embolization. In patients with bleeding outside the duodenal-covered stents, it can be difficult to identify the bleeding source by upper gastrointestinal endoscopy. In this case, selective computed tomography during arteriography and angiography revealed bleeding outside the duodenal-covered stents that was successfully treated by arterial embolization with n-butyl cyanoacrylate.

Comparison of Renal Damage Following Renal Artery Embolization with Three Different Embolic Mixtures in Swine.

Purpose: Renal artery embolization is a minimally invasive and effective procedure for renal ablation, a complete necrosis of the renal parenchyma. This study aims to compare the extent of renal damage in swine following renal artery embolization with ethanol and N-butyl-2-cyanoacrylate, commonly used as embolic materials in renal ablation. Material and Methods: Three different embolic mixtures were prepared for renal artery embolization in swine: 33% ethanol-Lipiodol mixture (ethanol:Lipiodol = 1:2; Group A), 67% ethanol-Lipiodol mixture (ethanol:Lipiodol = 2:1; Group B), and 10% N-butyl-2-cyanoacrylate-Lipiodol mixture (N-butyl-2-cyanoacrylate:Lipiodol = 1:9; Group C). Three swine were assigned to each group and underwent embolization of the unilateral renal artery. Renal arteriography was performed before, immediately after, and two days after renal artery embolization. After two days, the kidneys were removed to determine the macroscopic necrosis rate and for histologic examination. Dark tissue regions were considered necrotic. Results: The macroscopic necrosis rate of the kidneys was 50.3%±7.4%, 100%±0%, and 100%±0% in Groups A, B, and C, respectively. The necrosis rates were higher in Groups B and C than in Group A. Histologically, the renal tubules were damaged in the necrotic areas. In addition, the glomeruli were damaged in Groups A and B but were preserved in Group C. Conclusions: Sixty-seven percent ethanol-Lipiodol mixture and 10% N-butyl-2-cyanoacrylate-Lipiodol mixture are effective embolic materials in renal artery embolization for renal ablation in swine. Also, ethanol caused partial glomerular necrosis, whereas N-butyl-2-cyanoacrylate preserved the glomeruli. Therefore, ethanol should be used for renal ablation.

Successful coil embolization of a ruptured aneurysm of the arc of Riolan artery.

The arc of Riolan (AOR) is an anastomosis between the middle and left colic arteries. Aneurysms of the AOR are very rare visceral artery aneurysms. A 44-year-old man presented with abdominal pain and loss of consciousness. Computed tomography and angiography showed hemorrhagic ascites around the liver and spleen. An irregularly dilated artery was visible within a hematoma in the upper left region of the abdomen, consistent with a ruptured pseudoaneurysm of the AOR. Transcatheter arterial embolization was performed with microcoils. The patient's abdominal pain disappeared after embolization, and no symptoms of intestinal ischemia were observed. To our knowledge, this is the first case of an AOR aneurysm with AOR dilation due to dissection of the celiac artery that was successfully treated by coil embolization.

Impact of anticancer drugs on the therapeutic efficacy and side effects of hepatic arterial embolization for hepatocellular carcinoma.

Background and Aim: Transcatheter arterial chemoembolization (TACE) using various anticancer drugs is often performed to treat hepatocellular carcinoma (HCC). We aimed to compare the therapeutic efficacy and side effects of TACE with anticancer drugs versus transcatheter arterial embolization (TAE) without anticancer drugs for HCC. Methods: Patients with HCC were randomized to either the TACE or TAE group. Up to five target nodules were treated in each patient. Lipiodol (Lp; 10 mL), contrast media (CM; 10 mL), epirubicin (40 mg), mitomycin C (10 mg), miliplatin (70 mg), and 1-2-mm 2-day soluble gelatin sponge particles (2D-SGS) were injected into the TACE group, whereas Lp (10 mL), CM (10 mL), and 2D-SGS were injected into the TAE group. Treatment effect (TE) of the target nodules was graded (TE1-TE4) and patient responses were assessed. Three months after treatment, blood tests were performed to compare tumor markers and adverse events. Results: Fifty-four patients and 161 target nodules were included; 75 nodules in 28 patients were treated by TACE, and 86 nodules in 26 patients were treated by TAE. The number of nodules graded TE1, TE2, TE3, and TE4 was 1, 28, 7, and 39, respectively, in the TACE group and 2, 25, 7, and 52, respectively, in the TAE group. The response rates were 89% (25/28) and 73% (19/26) in the TACE and TAE groups, respectively. There were no significant differences in TE, response rates, or blood test results between the two groups. Conclusion: In hepatic arterial embolization for HCC, anticancer drugs did not have any impact on the therapeutic efficacy or side effects at 3 months after embolization.

Endovascular stenting and stent-graft repair of a hemorrhagic superior mesenteric artery pseudoaneurysm and dissection associated with pancreaticoduodenectomy.

This report presents a 73-year-old woman with intraperitoneal bleeding from a superior mesenteric artery (SMA) pseudoaneurysm and dissection after pancreaticoduodenectomy (PD). A self-expanding bare metal stent was placed in the distal SMA across the area of dissection, and a stent-graft was subsequently placed across the pseudoaneurysm emerging from the proximal site by overlapping the bare stent, resulting in complete exclusion of the pseudoaneurysm and control of the dissection. Bleeding was controlled after the endovascular procedure. The combination of endovascular stenting and stent-graft repair is feasible and useful in comorbid cases of SMA pseudoaneurysm and dissection.

PI-RADS v2 Findings of MRI and Positive Biopsy Core Percentage would Predict Pathological Extraprostatic Extension in Patients who Underwent Robot Assisted Radical Prostatectomy: A Retrospective Study.

PURPOSE: This study aimed to examine whether preoperative Prostate Imaging Reporting and Data System v2 (PI-RADS v2) can predict pathological extracapsular extension (EPE) after radical prostatectomy. We also studied the preoperative factors which can predict EPE. MATERIALS AND METHODS: In our institute, 294 patients underwent robot assisted radical prostatectomy (RARP) between December 2012 and August 2016. In this era, we performed MRI after biopsy to determine clinical stage before surgery. PI-RADS v2 scores were retrospectively reviewed using biparametric MRI and EPE in pathological mapping of resected specimens for each lobe. RESULTS: In the excised specimen, EPE was observed in 73 lobes (12%). The percentage of EPE by PI-RADS v2 score was score '1': 6% (17/297 lobes), '2': 3% (1/33 lobes), '3': 12% (8/67 lobes), '4': 19% (27/139 lobes), and '5': 38% (20/52 lobes). The higher the PI-RADS score, the higher the percentage of EPE (P <0.01). When classified as PI-RADS score ≥4 and <4, the positive predictive value (PPV) was 24.6% (47/191 lobes, 95%CI: 0.187 - 0.313) and negative predictive value (NPV) was 93.5% (371/397 lobes, 95%CI: 0.906 - 0.957). By multivariate analysis, positive biopsy core percentage ≥60%, and PI-RADS score ≥4 were independent factors for predicting EPE. The positive rate of EPE in lobes with zero, one and two factors (PI-RADS ≥4 and positive biopsy core percentage ≥60%) was 4%, 19%, and 38%, respectively. CONCLUSION: PPV and NPV of PI-RADS ≥4 for predicting pathologic EPE were 24.6% and 93.5%, respectively. PI-RADS ≥4 and positive biopsy core percentage ≥60% were independent risk factors for predicting EPE. The positive rate of EPE in lobes with zero, one and two factors (PI-RADS ≥4 and positive biopsy core percentage ≥60%) was 4%, 19%, and 38%, respectively.

Usefulness of ethiodized oil and gelatin sponge particles for delaying the washout of indocyanine green from the liver in swine.

PURPOSE: To assess the effect of ethiodized oil (EO) and gelatin sponge particles (GS) on delaying the washout of indocyanine green (ICG) from the liver in swine. METHODS: Fifteen swine were divided into 3 groups: injection of a mixture of ICG and water-soluble contrast medium (CM) followed by embolization with GS (group A), injection of a mixture of ICG and EO (group B) and injection of a mixture of ICG and EO followed by embolization with GS (group C). The liver surface was observed using an infrared camera system during and at 1, 2, 3, and 6 h after the procedure to measure ICG contrast. Livers were removed at 6 h for histopathological examination. RESULTS: The contrast ratio between injected and non-injected regions at 6 h was 1.45 ± 0.44 in group A, 1.89 ± 0.37 in group B, and 3.62 ± 0.76 in group C. The contrast ratio in group C was significantly greater than that in groups A and B (P = 0.032 and 0.033, respectively). CONCLUSIONS: EO and GS delayed the washout of ICG from the liver in swine and may extend intraoperative navigation in clinical use. Indocyanine green (ICG) mixed with ethiodized oil (EO) was injected into the left hepatic artery in swine, and the artery was embolized with gelatin sponge particles (GS). We confirmed that ICG remained in the liver parenchyma up to 6 h after the procedure. EO and GS delayed the washout of ICG from the liver in swine.

Comparison of Uterine Necrosis After Uterine Artery Embolization with Soluble Gelatin Sponge Particles or Tris-acryl Gelatin Microspheres in Swine.

PURPOSE: To compare the recanalization of the uterine arteries and uterine necrosis after uterine artery embolization (UAE) using either soluble gelatin sponge particles (SGS), which dissolve in saline, or tris-acryl gelatin microspheres (MS), which are permanent embolic materials, in swine. METHODS: Fourteen uteri in seven swine were divided into two groups for embolization with either 500-1000 µm SGS (SGS group) or 500-700 µm MS (MS group) (seven uteri per group). The uterine arteries were embolized using SGS or MS, and angiography was performed to evaluate recanalization of the uterine arteries immediately, 1, 2, 3, 4, 5, and 6 h, and 3 days after embolization. On day 3, the uteri were removed to determine the macroscopic necrosis rate and for histopathologic examination. RESULTS: In the SGS group, four uterine arteries were completely recanalized, two were partially recanalized, and one was still occluded 5 h after embolization. In contrast, all seven uterine arteries in the MS group were still occluded 6 h after embolization. The complete recanalization rate at 3 days was significantly greater in the SGS group than in the MS group (100.0% vs. 14.3%, respectively; P = .0047). The mean uterine necrosis rate was not significantly different between the SGS and MS groups (15.0 ± 15.7% vs. 26.8 ± 13.3%, respectively; P = .096). The mean smallest arterial diameter containing embolic materials was 48.2 ± 22.0 µm (range 21-109 µm) for SGS and 446.7 ± 107.0 µm (range 352-742 µm) for MS (P < .0001). CONCLUSION: The uterine arteries recanalized earlier in the SGS group than in the MS group and the uterine necrosis rates were similar in both groups. SGS have the potential for a more distal penetration in comparison with MS.

Hepatic Arterial Embolization with an Indocyanine Green-LipiodolⓇ Mixture before Laparoscopic Anatomical Liver Resection.

Here, we report a case of hepatocellular carcinoma detected on computed tomography and treated with laparoscopic anatomical liver resection in a 69-year-old woman who was being followed-up for hepatitis C. Intraoperative liver segmentation is necessary to accomplish laparoscopic anatomical liver resection. Therefore, the day before surgery, hepatic artery embolization was performed with an indocyanine green-LipiodolⓇ mixture and GelpartⓇ containing indocyanine green to mark the region for hepatectomy. The next day, surgeons visually confirmed the resection segments on indocyanine green fluorescence imaging and performed laparoscopic anatomical liver resection. No major complications resulted from this method. In conclusion, hepatic artery embolization with an indocyanine green-LipiodolⓇ mixture is effective and safe for liver segment identification during laparoscopic anatomical liver resection.