Pulmonary arteriovenous malformations (PAVMs) are rare congenital vascular anomalies characterized by a direct connection between pulmonary arteries and veins, resulting in right-to-left shunting, arterial hypoxemia, and an increased risk of paradoxical embolic events. Endovascular embolization has become the standard of care for the treatment of PAVMs, significantly reducing the risk of neurologic and hemorrhagic complications. However, optimal patient selection, choice of embolic materials, procedural strategies, and post-treatment surveillance remain areas of active evolution. This review provides an interventional radiologist–focused overview of contemporary practice in PAVM management. Key topics include the clinical relevance of hereditary hemorrhagic telangiectasia, current indications for treatment in adult and pediatric populations, and periprocedural strategies to minimize complications such as air embolism and catheter-related thrombosis. Advances in embolic materials, including detachable coils, venous sac embolization techniques, and vascular plugs, are discussed with an emphasis on their relative efficacy and impact on recanalization and reperfusion rates. Procedure-related complications and their management are reviewed, highlighting both common self-limiting events and rare but serious adverse outcomes. Finally, current approaches to post-embolization surveillance are summarized, with a focus on the role of computed tomography, metal artifact reduction techniques, and emerging dynamic imaging modalities such as time-resolved magnetic resonance angiography for detecting treatment failure. By integrating recent evidence and practical procedural considerations, this review aims to support interventional radiologists in optimizing the safety, durability, and long-term outcomes of PAVM embolization.

Transarterial chemoembolization (TACE) has long been the standard locoregional therapy for unresectable hepatocellular carcinoma, while transarterial radioembolization (TARE) using yttrium-90 microspheres has emerged as a promising alternative driven by advances in dosimetry and improved outcomes. TARE offers high complete response rates, durable local control, and minimal post-embolization syndrome, particularly in patients with localized or large tumors and preserved hepatic function. However, its broader use is limited by radiation-related toxicity, technical challenges, and socioeconomic factors, including high cost and limited repeatability. In contrast, TACE remains widely applicable, repeatable, and cost-effective, achieving excellent tumor control through refined superselective techniques, especially in Korea. Rather than competing modalities, TARE and TACE should be integrated within a tailored treatment strategy, with the choice determined by tumor characteristics, hepatic reserve, and institutional expertise.

Pyrrolizidine alkaloid–induced hepatic sinusoidal obstruction syndrome (PA-HSOS) is highly prevalent in Asia, primarily due to the widespread use of traditional herbal medicines containing hepatotoxic pyrrolizidine alkaloids. This condition poses significant clinical challenges, including diagnostic difficulties and limited therapeutic options, frequently leading to severe liver damage and portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) treatment has emerged as a key intervention for managing complications associated with PA-HSOS, such as refractory ascites and variceal bleeding, by reducing portal pressure and supporting liver function recovery. However, TIPS has not been widely accepted as a salvage therapy for severe PA-HSOS unresponsive to anticoagulation therapy, mainly due to concerns about post-TIPS complications, particularly hepatic encephalopathy. Consequently, careful patient selection and risk stratification are critical. This review synthesizes the current evidence on PA-HSOS in Asia, evaluates the clinical utility of TIPS, and discusses strategies to optimize outcomes while minimizing adverse effects. Specifically, we review the epidemiology, pathophysiology, and diagnostic advancement of PA-HSOS, with a particular focus on the evolving role of TIPS in its management.

<b>Purpose</b><br/>Transcatheter arterial embolization (TAE) is widely used for managing renal angiomyolipoma (AML) to prevent hemorrhage and control symptoms while preserving renal function. However, the optimal embolic material remains undetermined due to limited comparative data. This study aimed to compare the effectiveness of ethanol-based embolization versus polyvinyl alcohol (PVA) and to evaluate additional benefits of microcoil use in ethanol-based treatments. <br/><b>Materials and Methods</b><br/> We retrospectively analyzed 119 patients with single renal AML who underwent TAE at two tertiary centers between 2005 and 2023. Patients were grouped into ethanol-based (ethanol alone or ethanol plus microcoil, n = 93) and PVA (n = 26) cohorts. Subgroup analysis compared ethanol alone (n = 24) versus ethanol plus microcoil (n = 69). Inverse probability treatment weighting and linear mixed-effects models were used to assess tumor volume reduction and treatment response (≥50% volume reduction). <br/><b>Results</b><br/>After adjustment, the ethanol group demonstrated significantly greater tumor volume reduction than the PVA group at 6 and 12 months (adjusted mean difference = –23.9%, p = 0.002; –23.1%, p = 0.001) and a higher response rate (92.1% vs. 78.4%, p = 0.043). In the subgroup analysis, ethanol plus microcoil achieved higher response (91.3% vs. 73.8%; OR, 3.73; p = 0.038) and lower recurrence (7.1% vs. 30.2%; OR, 0.18; p = 0.008) compared with ethanol alone. <br/><b>Conclusion</b><br/>Ethanol-based embolization provides superior tumor control compared to PVA in renal AML, and the addition of microcoils enhances early volume reduction and reduces recurrence, supporting its use as an effective treatment strategy.