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To develop an implantable port in which a microcatheter can be inserted for a combination therapy of repeated transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC) for advanced liver cancer. The design of a currently used implantable port was modified. A funnel part was constructed in the port. The septum was punctured by a 20-gauge indwelling needle, and 2.0-Fr non-tapered microcatheter was inserted into the port. In the in vitro studies, the advance of a microcatheter out of the funnel part was evaluated via seven different septum puncture sites. A 5-Fr indwelling catheter connected to the port was placed in a vascular model, and a microcatheter catheterization was evaluated. In an in vivo study, the port–catheter system was implanted in the hepatic artery in a pig. A microcatheter was percutaneously inserted through the port into the hepatic arterial branches, and embolization was performed. In the in vitro studies, the microcatheter was smoothly advanced out of the port and catheterizations into the hepatic arteries were successful via all septum puncture sites. In the in vivo study, repeated selective embolization through the port was successfully conducted on 7, 14 and 21 days after the implantation. The developed implantable port can be used for repeated catheter insertion into the hepatic artery. The combination of repeated TACE and HAIC could be possible using this device.

We evaluated the utility of intravenous digital subtraction angiography (IV DSA) for diagnosing lesions of the aortic arch and great vessels in 25 patients. Digital subtraction angiography (DSA) was found useful in evaluating congenital and acquired lesions of the arch and great vessel origins, and it proved adequate for follow-up of patients who had graft replacement. Cases examined included: right aortic arch, double arch, aortic coarctation, aberrant vascular origins, aortic aneurysm and pseudoaneurysm, changes in atherosclerotic great vessels, and revascularization procedures for patients with pulmonary atresia and aortic interruption. In our experience, DSA is a useful tool for screening and following patients with aortic arch or great vessel lesions; it is often the only diagnostic imaging examination necessary.

A rare source of potentially massive lower gastrointestinal hemorrhage in women is advanced gynecologic malignancy. Such patients can develop gastrointestinal hemorrhage with or without prior pelvic irradiation, due to arteriocolic fistulas. Angiography permits the correct diagnosis and subsequent embolotherapy.

Aorto-arteritis is one of the commonest vascular diseases in China as well as in Japan and other parts of Asia. The results of digital subtraction angiography (DSA) in 50 patients with aortoarteritis are reported, and the merits and demerits of intravenous (IV) DSA in the diagnosis of this entity are evaluated. Among the 51 studies performed on 50 patients, IV DSA was used in 48, intraarterial (IA) DSA in 3, and good-to-excellent visualization was obtained in 96% of patients. Aorto-arteritis of varying severity and involving the thoraco-abdominal aorta, the iliac arteries, and other major branches was clearly demonstrated by IV DSA. IV DSA, as compared to our previous experience with conventional arteriography in this entity, may be substituted for conventional arteriography in most patients. A large dose of contrast media needed for a complete study is a major deficiency of IV DSA, and it also has limitations for showing the intrarenal arterial branches.

Comparison of the relative values of the ankle-arm index (AAI) at rest and after exercise, angiography, and duplex ultrasonography for the follow-up of percutaneous transluminal angioplasty (PTA) in patients with peripheral vascular disease. Thirty-two patients were prospectively followed after technically and clinically successful PTA of a femoropopliteal occlusion. The patency of the femoropopliteal artery was assessed for 1 year using AAI measurements at rest and after exercise; duplex ultrasonography at 4, 12, 24, 36, and 52 weeks; and angiography at 3 and 12 months after PTA. Patency was highly dependent on the measurement technique. The cumulative patency after 1 year determined with the AAI at rest and during exercise, by angiography, and by duplex ultrasonography was 74%, 19%, 31%, and 32%, respectively. Seventy-five percent of the restenoses occurred at the site of the treated occlusion. Duplex ultrasonography is most suitable for this assessment, as it causes no patient discomfort and the specificity is better than AAI after exercise because vascular disease in other, proximal segments does not interfere with the results.