伴野 辰雄

Introduction: We report a case of aortocaval fistula successfully treated by hybrid operation. Case description: A 73-year-old female suffering from malignant lymphoma and painful leg edema was transferred to our institution. Computed tomography revealed an aortoiliac aneurysm. The inferior vena cava was compressed by displacement of the abdominal aortic aneurysm. The bilateral internal iliac and ovarian veins were markedly dilated. Diagnosis was an aortoiliac aneurysm with aortocaval fistula. The treatment options were open surgery or an intervention with bypass surgery. Because of narrow iliac access for a bifurcated stent graft, aorto-uni stentgraft treatment followed by bypass surgery was finally decided. Following stent graft insertion and iliofemoral artery bypass, the aneurysms and fistula were successfully excluded without endoleaks. To treat the inferior vena cava compression, the kissing technique was used to place bare metallic stents across the bilateral common iliac veins and inferior vena cava, which improved the clinical symptoms. Discussion and Evaluation: In this aortocaval fistula caused by AAA, a minimally invasive treatment of stentgraft and bypass surgery with venous flow recovery was chosen as a hybrid treatment. Intravascular intervention was the most suitable in this situation. Bare stent placement for venous occlusion was also effective for revascularization of vena cava flow. Conclusion: Recent advances in endovascular devices, including stent grafts and bare metallic stents, will be helpful for effective noninvasive treatment for aortocaval fistula circulation.

Purpose: The efficacy and safety of percutaneous transhepatic portal embolization (PTPE) with dehydrated ethanol was determined by measuring the liver lobe volume before and after the procedure. Materials and Methods: A total of 38 patients (25 men, 13 women mean age: 62.0 ± 10.8 years) who underwent PTPE with dehydrated ethanol between April 2005 and March 2011 participated in this study. Dehydrated ethanol containing 17% lipiodol was injected into the target portal vein branch under balloon occlusion, and the portal vein was subsequently embolized. The liver lobe volume was measured via contrast-enhanced computed tomography, and the percent increase in the unembolized lobe volume was then calculated. In addition, PTPE-related complications were surveyed, and the procedural safety was evaluated. Results: The mean percent increase in the unembolized lobe volume after PTPE was 33.8% ± 20.2%. The procedure could not be completed in one patient because of an insufficient increase in the unembolized lobe volume. No serious post- PTPE complications were observed. Conclusion: These data suggest that PTPE with dehydrated ethanol is a safe and effective method for enlarging the planned residual liver volume before extensive liver resection.

The purpose of this study was to assess the clinical features and characteristics of the blood flow in uterine vascular abnormalities using ultrasound and magnetic resonance imaging (MRI). A total of 17 women were diagnosed with uterine vascular abnormalities by ultrasound. The clinical characteristics of the patients and the distribution and waveform of the intrauterine vessels were examined using transvaginal gray-scale and Doppler ultrasonography, spin-echo MRI, and MR angiography. The average age of the 17 subjects was 44.3 years, and 5 were postmenopausal women. The number of pregnancies and deliveries was 2.0 and 1.7, respectively. Of the 17 subjects, 7 had a moderate or severe grade of dysmenorrhea and 7 had a history of vascular disease. In all subjects, vaginal ultrasound demonstrated tubular or numerous tortuous anechoic areas in the uterine wall, and Doppler ultrasound showed that the tubular or numerous dilated tortuous vessels had an atypical wave flow, unlike that of an artery or a vein. The distribution of displayed flow varied, and the waveforms of the Doppler ultrasound displayed three patterns. The averages of the pulse Doppler flow indices showed low impedance in the abnormal uterine vessel and the uterine artery, especially in cases of true arteriovenous malformations. MR angiography demonstrated distinct, tortuous, and coiled vascular channels in the pelvis during and just after the arterial phase. Characterization of the clinical features of uterine vascular abnormalities is considered to be valuable for obstetricians and gynecologists.

Although intraarterial steroid infusion therapy has previously been shown to be effective for inflammatory bowel disease, it has not yet been applied for the treatment of hemorrhagic radiation gastritis. We report herein a case of hemorrhagic radiation gastritis of gastric tube that occurred after chemoradiation therapy for postoperative peritoneal lymph node metastasis in a patient with esophageal carcinoma who had a history of esophagectomy reconstructed with a gastric tube. The hemorrhagic gastritis that occurred in the gastric tube was successfully treated with repeated intraarterial steroid infusions through the regional vessels to the reconstructed gastric tube. A 70-year-old Japanese woman received chemoradiation therapy for metastatic lymph nodes of the celiac axis. Four weeks after completion of chemoradiation therapy, acute persistent bleeding occurred in the gastric mucosa of the reconstructed gastric tube in the irradiated area. Despite application of available therapeutic modalities, her persistent bleeding was intractable, and a total of 50 units of blood transfusion was required to improve progressive anemia. Finally, intraarterial steroid infusion therapy was applied through the right gastroepiploic artery supplying the main blood flow to the gastric tube. Three repeated intraarterial steroid infusions through the right gastroepiploic artery were effective, and hemostasis was finally completed soon after the last dose of intraarterial steroid was given. This case highlights the clinical importance and significance of hemorrhagic radiation gastritis of the reconstructed gastric tube with posterior mediastinal route occurring after chemoradiation therapy. Repeated intraarterial steroid infusion could be one option that appears clinically useful to treat intractable bleeding from radiation gastritis. © 2007 Japan Esophageal Society and Springer-Verlag.