Extrahepatic collateral supply from the Sappey superior artery of the right internal thoracic artery (RITA) is an uncommon but important source of perfusion to HCC located in segment IV. Preprocedural CT demonstrated a large segment IV HCC supplied by the Sappey superior artery. Initial transfemoral angiography confirmed tumor vascularization but failed to achieve superselective catheterization because of marked tortuosity of the aortic arch. The procedure was converted to a right transradial approach, which provided stable access to the RITA and enabled successful superselection of the Sappey superior artery. Y-90 radioembolization via the Sappey superior artery and hepatic artery was completed without complications.

In a 58-year-old man with HCC undergoing TACE, a segment III tumor was supplied by an accessory left hepatic artery arising from the left gastric artery (LGA). The dominant technical challenge shifted from acute angulation at the LGA origin to inadequate back support in distal branches. To overcome repeated dislodgement, the catheter was exchanged for a 5-Fr catheter with a hand-cut side hole, positioned at the LGA orifice while the tip was anchored in the celiac trunk. This technique allowed a microcatheter to traverse in a single well-supported pass, enabling successful superselective TACE without immediate complications. This case emphasizes the importance of distinguishing ostial angulation from back-support failure and highlights the utility of proximal side-hole anchoring in complex multivessel selection.

Variant right inferior adrenal arterial supply to caudate lobe HCC is rare and may be overlooked. We report a 53-year-old man with recurrent caudate lobe HCC after 12 TACE sessions. During the 13th TACE, cone-beam CT of the common hepatic artery did not reveal tumor vascularity. At the 14th TACE, performed 3 days later, the right inferior phrenic artery, the most common extrahepatic collateral feeder to caudate lobe HCC, showed no tumor supply. Angiography and cone-beam CT from a small aortic common trunk giving rise to a variant right inferior adrenal artery and the right renal capsular artery revealed predominant supply from the variant right inferior adrenal artery. Embolization through these branches achieved compact iodized oil uptake without immediate complications.

<b>Purpose</b><br/>This study aimed to evaluate the clinical efficacy and patency of stents placed for symptomatic iliac vein or IVC obstruction caused by malignant tumors. Material and Methods: A total of 34 consecutive patients with malignant iliac vein or IVC obstruction underwent stent placement. We reviewed their electronic medical records, pre- and post-procedural CT scans, and angiograms retrospectively, and evaluated technical success, clinical success, and patient-based and vessel-based reocclusion rates confirmed by follow-up cross-sectional images. The reocclusion rate difference between IVC and iliac stents was also assessed. <br/><b>Results</b><br/>All patients complained of leg and/or trunk edema. The stents were placed in the following locations: IVC (n = 9); iliac veins (n = 19); and both IVC and iliac veins (n = 6). Technical success rate was 100% and the clinical success rate was 87.5% during hospitalization. Cross-sectional area of the affected thigh was significantly decreased after stent placement (mean 11.7%, p = 0.003). The median follow-up period was 65 days (Q1–Q3, 28.5–227.3; IQR, 198.8). The patient-based reocclusion rate was 42.8%. The vessel- based reocclusion rates for IVC (12.5%) tended to be lower than those of iliac veins (45.0%), though the difference was not statistically significant (p = 0.194). <br/><b>Conclusion</b><br/>Stent insertion for iliac vein or IVC obstruction secondary to malignancy is technically feasible and can help to improve patients’ symptoms. IVC stents tend to achieve a higher rate of patency than iliac vein stents.

Complex hepatic cystic lesions with inconclusive imaging pose a recurring diagnostic problem: cyst-fluid cytology and conventional core-needle biopsy seldom capture the epithelial lining needed for a histological diagnosis, and current guidelines advise against simple cyst aspiration. We describe a sheath-assisted percutaneous forceps biopsy technique for direct cyst-wall sampling under ultrasound guidance, illustrated in two male patients (76 and 48 years). After Seldinger placement of an 8-Fr sheath into the cyst, rat-tooth forceps obtained direct biopsies of the wall epithelium, and the tract was embolized with Gelfoam. Technical success was achieved in both cases; histology showed columnar biliary epithelium consistent with mucinous cystic neoplasm, whereas fluid cytology was non-diagnostic. No complications occurred. This technique offers a feasible means of obtaining a histological diagnosis in complex hepatic cystic lesions when conventional methods are inconclusive.

<b>Purpose</b><br/>The use of adhesive-pad stabilization devices (SDs) instead of suture fixation (SF) may affect dislocation or infection rates. This study aimed to investigate the impact of SDs compared with SF for securing central venous catheters (CVCs). <br/><b>Materials and Methods</b><br/>This multicenter retrospective study was conducted in three tertiary institutions. Two institutions secured CVCs using sutures, whereas one used SDs, between February 2021 and July 2022. Rates of inadvertent dislocation and central line– associated bloodstream infection (CLABSI) were compared using incidence rate ratios (IRRs) from Poisson regression and Kaplan-Meier analysis after propensity-score matching. Factors associated with dislocation and CLABSI were evaluated using Cox proportional hazards analysis. <br/><b>Results</b><br/>A total of 2,110 patients (1,045 female; median age, 61 years [IQR, 50 to 72]) underwent CVC placement (SD, 854; SF, 1,256). After propensity-score matching (455 SD, 666 SF), dislocation occurred more frequently in the SD group (5.85 vs. 2.17 per 1,000 catheter-days; IRR, 2.64; 95% CI, 1.36 to 5.34). CLABSI occurred less frequently in the SD group (IRR, 0.19; 95% CI, 0.04 to 0.54). Kaplan-Meier analysis showed similar results. In multivariable analysis, SD was an independent risk factor for dislocation (adjusted HR [aHR], 2.23; 95% CI, 1.11 to 4.48). SD use showed a protective trend against CLABSI but did not reach statistical significance (aHR, 0.49; 95% CI, 0.13 to 1.82). When dislocation was modeled as a competing event, this protective association reached statistical significance (subdistribution HR, 0.19; 95% CI, 0.05 to 0.66). <br/><b>Conclusion</b><br/>Securement of CVCs with SDs was associated with a higher rate of catheter dislocation. Although SD use was associated with lower CLABSI rates, this finding requires further validation.

Type 2 endoleak (T2EL) is the most common complication after endovascular aneurysm repair (EVAR), occurring in 10%–25% of patients. Although many T2ELs follow a benign course, persistent T2EL is associated with sac expansion, secondary endoleaks, rupture, and aneurysm-related mortality. Endovascular treatment is indicated in cases of progressive sac growth and is broadly divided into the transarterial approach and the direct sac puncture approach—the latter encompassing transabdominal, translumbar, and transcaval routes. Each approach has distinct technical advantages and limitations, and selection should be tailored to the source vessel of the endoleak, sac location, surrounding anatomy, and patient-related factors. Coils, N-butyl cyanoacrylate, and ethylene vinyl alcohol copolymer (Onyx) constitute the principal embolic agents, with liquid embolics showing improved durability over coils alone in recent comparative studies. Prophylactic embolization of the inferior mesenteric artery, lumbar arteries, or the aneurysm sac during EVAR has recently emerged as a promising preventive strategy. This review summarizes the current approaches, embolic materials, prophylactic strategies, and clinical outcomes of T2EL management from the perspective of the interventional radiologist.

Chronic limb-threatening ischemia represents the most severe form of peripheral artery disease and is associated with high risks of limb loss and mortality. It is closely associated with below-the-knee arterial disease, with substantial overlap between the two conditions, particularly in patients with diabetes. Endovascular treatment plays a central role in restoring distal tibial and pedal perfusion, which is critical for wound healing and limb salvage. However, it remains technically challenging due to small vessel size, diffuse disease, and heavy calcification, which limit luminal expansion and predispose to recoil, dissection, and restenosis. Procedural success requires a structured approach integrating access strategy, guidewire crossing, and subsequent treatment. Crossing strategies, including subintimal tracking, retrograde tibio-pedal access, and bidirectional techniques such as controlled antegrade and retrograde tracking, are often required in complex lesions. Plain balloon angioplasty remains the most broadly applicable treatment, whereas drug-coated balloons show inconsistent benefit. Drug-eluting stents provide favorable outcomes in selected short focal lesions, whereas other technologies have more limited evidence. Overall, treatment should be individualized based on lesion characteristics and clinical context.

<b>Purpose</b><br/>This study aims to investigate the clinical outcomes and safety of a standardized two-session catheter-directed ethanol sclerotherapy protocol for peritoneal inclusion cysts. <br/><b>Materials and Methods</b><br/>Between November 2020 and July 2025, six women (median age, 32.5 years) with symptomatic peritoneal inclusion cysts underwent ethanol sclerotherapy. After complete drainage using an 8.5-Fr or 10.2-Fr pigtail catheter, two sessions of sclerotherapy were performed on consecutive days. In each session, 99.5% ethanol (50% of the aspirated volume, up to 150 mL) was instilled and retained for 20 minutes. Follow-up ultrasound was performed at 1, 3, and 6 months. Technical success was defined as successful completion of both sessions with a 20-minute ethanol retention time, and clinical success was defined as symptom improvement with a >50% decrease in cyst diameter at 3 months. <br/><b>Results</b><br/>Technical success was achieved in all cases (6/6, 100%). The median maximum cyst diameter significantly decreased from 14.0 cm (range, 6.0 to 20.0 cm) to 5.25 cm (range, 2.0 to 8.0 cm) at the follow-up within 1 month (p = 0.03). Clinical success was achieved in all cases at 3 months (6/6, 100%). No residual cysts were visualized on follow-up ultrasound at 6 months in all patients (6/6, 100%). Anti-Müllerian hormone levels measured in four patients showed heterogeneous changes, precluding definitive conclusions regarding the impact on ovarian reserve. No major complications occurred. <br/><b>Conclusion</b><br/>Two-session catheter-directed ethanol sclerotherapy appears to be a safe and effective minimally invasive alternative to surgery for peritoneal inclusion cysts, providing a high rate of complete resolution.

Acute SVC syndrome caused by extensive thrombosis requires prompt endovascular intervention. We report a 48-year-old female with colon cancer presenting with massive chemoport-related thrombosis involving the SVC, right atrium (RA), and bilateral brachiocephalic veins. Due to the lack of an embolic protection filter landing zone, we performed a novel plug-assisted thrombectomy (PAT) technique. A 20-mm vascular plug was positioned at the SVC-RA junction as a temporary tethered filter without detachment. Following mechanical thrombectomy, plug retrieval, and adjunctive balloon dilatation, the patient recovered and was discharged on day 12. This case demonstrates the technical feasibility of PAT as a proof-of-concept approach for embolic protection in patients with extensive SVC thrombosis where conventional filter placement is anatomically precluded.

Hemodialysis vascular access dysfunction remains a major cause of morbidity and repeated interventions. Stenosis related to neointimal hyperplasia and altered hemodynamics leads to access flow limitation and thrombosis, particularly in AVFs. While percutaneous transluminal angioplasty is the standard first-line treatment, durability is often limited, resulting in frequent reinterventions. Drug-coated balloons, most commonly paclitaxel-based, have been introduced to inhibit restenosis and have demonstrated improved target lesion patency compared with conventional balloon angioplasty in several randomized trials, though outcomes vary by lesion location and study design. This narrative review summarizes the current evidence for drug-coated balloon angioplasty in dysfunctional arteriovenous access, discusses key trial endpoints, reviews safety and practical considerations, and highlights ongoing controversies and future directions.

We report a 54‑year‑old woman with chronic pancreatitis, duodenal obstruction, massive ascites, and refractory thrombocytopenia who developed septic obstructive cholangitis after occlusion of a plastic common bile duct (CBD) stent. Endoscopic exchange failed and PTBD was prohibitively risky. Transjugular intrahepatic biliary stenting (TIBS) provides an alternative route that avoids transperitoneal hepatic capsule puncture. Via right internal jugular access, the right hepatic vein was catheterized, a posterior sectoral bile duct punctured, and a guidewire crossed the distal CBD stricture. A 12 × 80 mm self‑expandable metallic stent was deployed and the transhepatic tract embolized with coils. The patient experienced rapid clinical and biochemical recovery (bilirubin, 13.3 to 1.37 mg/dL) over 9 days postprocedure without any hemorrhagic complications. TIBS is a decisive, life‑saving alternative when standard routes are not possible.

<b>Purpose</b><br/>Tumor location influences the effectiveness and safety of RFA. This study evaluated RFA outcomes as first-line therapy for HCC <3 cm, focusing on tumor location impact. <br/><b>Materials and Methods</b><br/>In this retrospective cohort study, 281 patients with newly diagnosed HCC <3 cm in up to three lesions treated with RFA between 2003 and 2019 were analyzed. The tumor location was categorized as superficial (outer third), mid-portion (middle third), or deep (near vena cava), using an imaginary line from the liver surface to the vena cava. Perivascular tumors were defined as those abutting portal or hepatic veins. Recurrence-free survival (RFS) among location groups was compared with risk factors analyzed via Cox regression. <br/><b>Results</b><br/>Patients (mean age, 61.1 ± 11.1 years) were predominantly male (73.3%), hepatitis B virus surface antigen–positive (66.2%), and of Child-Pugh class A (97.5%). Deep tumors had shorter RFS than superficial/mid-portion tumors (HR, 1.87; 95% CI, 1.20 to 2.93; p = 0.005), as did perivascular versus non-perivascular tumors (HR, 1.87; 95% CI, 1.16 to 3.00; p = 0.008). Group C (deep + perivascular, n = 10) had shorter RFS than group A (no risk factors: HR, 3.12; 95% CI, 1.50 to 6.45; p = 0.002) and group B (one risk factor: HR, 1.59; 95% CI, 1.05 to 2.40; p = 0.028). Multivariable analysis identified tumor depth, perivascular location, size >2 cm, creatinine, and prothrombin time as independent predictors of shorter RFS. <br/><b>Conclusion</b><br/>Tumor depth and proximity to vasculature independently predict RFS in small HCCs treated with RFA, highlighting the role of tumor location in determining patient prognosis.