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.

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.

<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.

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.

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.

Urologic trauma encompasses a spectrum of injuries involving the kidney, ureter, bladder, and urethra, with management strategies increasingly emphasizing organ preservation through minimally invasive, image-guided approaches. The updated American Association for the Surgery of Trauma 2025 grading system provides the most recent guideline for renal trauma classification, reflecting evolving imaging standards and management principles. In parallel, interventional radiology (IR) has assumed an increasingly important role in contemporary trauma care, offering effective, organ-preserving solutions through endovascular and percutaneous techniques. Renal trauma, the most frequent form of genitourinary injury, is now primarily managed non-operatively in hemodynamically stable patients, with transcatheter arterial embolization and stent-based repair serving as cornerstones of hemorrhage control and renal salvage in high-grade lesions. Clinical evidence demonstrates that selective or superselective embolization achieves high technical success and renal preservation, consolidating IR as a key component of multidisciplinary trauma management. Injuries to the lower urinary tract remain complex, but minimally invasive, image-guided interventions are increasingly recognized as integral to modern care, particularly in controlling hemorrhage and preserving function. Superselective embolization, percutaneous urine diversion, and fluoroscopic urethral realignment exemplify how IR provides life-saving, organ-preserving options for ureteral, bladder, and urethral trauma. Collectively, these developments underscore the expanding impact of IR across the full spectrum of urologic trauma management.

We present a rare case of traumatic ureteric artery bleeding successfully treated with transcatheter arterial embolization. A 65-year-old male with blunt abdominal trauma and hypotension was found to have a left retroperitoneal hematoma with active extravasation on CT. Initial angiography showed no visible bleeding; however, cone-beam CT revealed active hemorrhage from a ureteric artery displaced by the hematoma. Selective embolization using n-butyl cyanoacrylate and ethiodized oil was performed, resulting in hemodynamic stabilization. Follow-up imaging demonstrated resolution of bleeding and positional change of the ureteric artery as the hematoma resolved. This case highlights the diagnostic value of cone-beam CT and the importance of considering ureteric artery injury in cases of unexplained retroperitoneal hemorrhage.