American Journal of Interventional Radiology

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Authors: Scott P Patterson

This case report describes the chemoembolization of a small hepatocellular carcinoma employing a lipiodol drug delivery system utilizing a novel arterial pathway. Because the target lesion was precariously located adjacent to the inferior heart border and the diaphragm, it was unsuitable for imaging-guided microwave ablation. To achieve chemoembolization, several intraprocedural adaptations were necessary, given the variant anatomy encountered and difficulty accessing the left gastric artery through a celiac artery approach. The left gastric artery was selected from a superior mesenteric artery approach through the pancreaticoduodenal arcade (Rio Branco's arcade). This case illustrates the importance of a mastery of the vascular anatomy and variants of hepatic arterial flow.

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Authors: Nicholas Piening

Anomalous aortic origin of the left coronary artery (AAOLCA) is a rare occurrence. This anomaly may lead to myocardial ischemia and, therefore, surgical repair is recommended to improve long-term survival in these patients. We present a case of successful mobilization of an anomalous left main coronary artery, pulmonary artery translocation, and interposition graft to the right pulmonary artery with a late complication of right pulmonary artery graft occlusion. This case illustrates the difficulty in the recanalization of pulmonary artery graft occlusion and stenosis, and highlights the utility of treatment via a staged approach.

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Authors: William Akard

OBJECTIVE: Arterial access for endovascular revascularization in patients with debilitating peripheral arterial disease is commonly achieved via retrograde CFA approach. However, retrograde access presents multiple technical challenges, including long distance from the access site to the target lesion, and mechanical disadvantage of working over the aortic bifurcation and often-tortuous iliac vessels. Antegrade CFA access avoids these challenges but has been fraught with its own difficulties, particularly in obese patients. Antegrade SFA access provides the same mechanical advantages while avoiding the difficulties of antegrade CFA access, but a vascular closure device is required due to distance from the femoral head. This single-center study evaluates the safety and efficacy of the Angio-Seal device (St. Jude Medical, St. Paul, MN) in SFA punctures. METHODS: From May 2011 to January 2015, 140 antegrade SFA punctures were performed on 110 limbs in 88 patients for endovascular revascularization, all with ultrasound guidance. Complications and patient data including age, sex, BMI, Fontaine stage, sheath size, and intra-operative heparin doses were analyzed. RESULTS: In 140 antegrade SFA punctures, there were 11 access-related complications (7.9%). The majority were hematomas or pseudoaneurysms requiring nominal or no therapy. There were 3 major complications: two delayed access stenoses ultimately resulted in toe amputations, and one hemorrhage required extended hospitalization and transfusion. Patient data analysis showed a statistically significantly increased complication rate in females (20.7%) vs males (4.5%) (p=0.0105). CONCLUSIONS: Antegrade SFA access with Angio-Seal closure is safe and effective. An increased complication rate in females warrants cautious post-procedural followup.

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Authors: Ron Gaba

Animal models have become increasingly important in the study of hepatocellular carcinoma (HCC), as they serve as a critical bridge between laboratory-based discoveries and human clinical trials. Developing an ideal animal model for translational use is challenging, as the perfect model must be able to reproduce human disease genetically, anatomically, physiologically, and pathologically. This brief review provides an overview of the animal models currently available for translational liver cancer research, including rodent, rabbit, non-human primate, and pig models, with a focus on their respective benefits and shortcomings. While small animal models offer a solid starting point for investigation, large animal HCC models are becoming increasingly important for translation of preclinical results to clinical practice.

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Authors: Anisha Shetty BS

Aortoenteric fistulae (AEF) are a rare cause of life-threatening gastrointestinal hemorrhage. AEF are divided into primary and secondary types. Secondary fistulae are more common and occur after prior aortic interventions, namely aneurysm repairs.Less common is primary aortoenteric fistulae (PAEF), which most commonly arise denovo from trauma or underlying neoplastic, infectious, or rheumatologic conditions. Although PAEF are associated with high mortality and morbidity, there have been several case reports documenting temporization of PAEF with stent grafts. These measures are effective in acute settings, often with unstable patients. This approach also provides time for the patient, family and their care team to decide on definitive treatment. This is especially important as many of these patients have serious underlying pathology, or will need to undergo extensive treatment for definitive care. Here, we present a case of PAEF in a patent with Stage IV renal malignancy. The bleed was controlled with the use of a 12 mm VIATORR endoprosthesis (W. L. Gore and Associates, Inc., Flagstaff, Arizona, USA), typically used in transjugular intrahepatic portosystemic shunts. The report demonstrates how an endoprosthesis originally designed for hepatic interventions can serve as an endovascular stent graft in extenuating circumstances. This report also aims to highlight the importance of following endovascular principles and the post-treatment care of patients with PAEF.