Endovascular treatment of postoperative hemorrhage after pancreatectomy: a retrospective study.

BACKGROUND: Ruptured aneurysm is a serious complication of distal pancreatectomy (DP) or pancreatoduodenectomy (PD) that can be life-threatening if not treated promptly. This study aimed to examine the efficacy of a Viabahn stent graft for stopping bleeding after pancreatectomy. METHODS: Between April 2016 and June 2022, we performed 245 pancreatectomies in our institution. Six patients experienced postoperative bleeding and underwent endovascular treatment. RESULTS: All six cases of bleeding occurred post-PD (3.7%). The bleeding was from gastroduodenal artery (GDA) pseudoaneurysms in three patients, and Viabahn stent grafts were inserted. All three patients did not show liver function abnormalities or hepatic blood flow disorders. One patient with a Viabahn stent graft experienced rebleeding, which required further management to obtain hemostasis. Of the six cases in which there was hemorrhage, one case of bleeding from the native hepatic artery could not be managed. CONCLUSIONS: Using the Viabahn stent graft is an effective treatment option for postoperative bleeding from GDA pseudoaneurysms following PD. In most cases, using this device resulted in successful hemostasis, without observed abnormalities in hepatic function or blood flow.

Coronary arterial repair in patients with stable angina pectoris or acute coronary syndrome after ultrathin biodegradable polymer sirolimus-eluting stent implantation at 1-year follow-up by coronary angioscopy.

BACKGROUND: Imaging modality-based evidence is limited that compares the extent of coronary arterial repair after percutaneous coronary intervention between patients with stable angina pectoris (SAP) and those with acute coronary syndrome (ACS). METHODS: Between December 2018 and November 2021, a single-center, nonrandomized, observational study was conducted in 92 patients with SAP (n = 42) or ACS (n = 50), who were implanted with Orsiro sirolimus-eluting stent (O-SES) providing a hybrid (active and passive) coating and underwent 1-year follow-up by coronary angioscopy (CAS) after implantation. CAS assessed neointimal coverage (NIC), maximum yellow plaque (YP), and mural thrombus (MT). RESULTS: Baseline clinical characteristics were comparable between the SAP and ACS groups. The follow-up periods were comparable between the two groups (390.1 ± 69.9 vs. 390.6 ± 65.7 days, p = 0.99). The incidences of MT at 1 year after implantation were comparable between the two groups (11.4% vs. 11.1%, p = 0.92). The proportions of "Grade 1" in dominant NIC grades were highest in both groups, and the proportions of maximum YP grades and MT were comparable between the two groups. CONCLUSION: O-SES-induced coronary arterial repair at the site of stent implantation, irrespective of the types of coronary artery disease.

Retracted: Chest digital dynamic radiography to detect changes in human pulmonary perfusion in response to alveolar hypoxia.

INTRODUCTION: Hypoxic pulmonary vasoconstriction optimises oxygenation in the lung by matching the local-blood perfusion to local-ventilation ratio upon exposure to alveolar hypoxia. It plays an important role in various pulmonary diseases, but few imaging evaluations of this phenomenon in humans. This study aimed to determine whether chest digital dynamic radiography could detect hypoxic pulmonary vasoconstriction as changes in pulmonary blood flow in healthy individuals. METHODS: Five Asian men underwent chest digital dynamic radiography before and after 60 sec breath-holding at the maximal inspiratory level in upright and supine positions. Alveolar partial pressure of oxygen and atmospheric pressure were calculated using the blood gas test and digital dynamic radiography imaging, respectively. To evaluate the blood flow, the correlation rate of temporal change in each pixel value between the lung fields and left cardiac ventricles was analysed. RESULTS: Sixty seconds of breath-holding caused a mean reduction of 26.7 ± 6.4 mmHg in alveolar partial pressure of oxygen. The mean correlation rate of blood flow in the whole lung was significantly lower after than before breath-holding (before, upright 51.5%, supine 52.2%; after, upright 45.5%, supine 46.1%; both P < 0.05). The correlation rate significantly differed before and after breath-holding in the lower lung fields (upright, 11.8% difference; supine, 10.7% difference; both P < 0.05). The mean radiation exposure of each scan was 0.98 ± 0.09 mGy. No complications occurred. CONCLUSIONS: Chest digital dynamic radiography could detect the rapid decrease in pulmonary perfusion in response to alveolar hypoxia. It may suggest hypoxic pulmonary vasoconstriction in healthy individuals.

Usefulness of LacdiNAc-glycosylated Prostate-specific Antigen Density for Predicting Pathological Findings of Magnetic Resonance Imaging-transrectal Ultrasound Fusion Image-guided Prostate Biopsy for the Patients With Highest Prostate Imaging Reporting and Data System Category ≥3.

PURPOSE: This study aimed to evaluate the usefulness of the LDN-PSA (LacdiNAc-glycosylated-prostate specific antigen) in detecting clinically significant prostate cancer in patients suspected of having clinically significant prostate cancer on multiparametric magnetic resonance imaging. MATERIALS AND METHODS: Patients with prostate specific antigen levels ranging between 3.0 ng/mL and 20 ng/mL and suspicious lesions with PI-RADS (Prostate Imaging-Reporting and Data System) category ≥3 were included prospectively. The LDN-PSA was measured using an automated 2-step Wisteria floribunda agglutinin lectin-anti-prostate specific antigen antibody sandwich immunoassay. RESULTS: Two hundred four patients were included. Clinically significant prostate cancer was detected in 105 patients. On multivariable logistic regression analysis, prostate specific antigen density (OR 1.61, P = .010), LDN-PSAD (OR 1.04, P = .012), highest PI-RADS category (3 vs 4, 5; OR 14.5, P < .0001), and location of the lesion with highest PI-RADS category (transition zone vs peripheral zone) (OR 0.34, P = .009) were significant risk factors for detecting clinically significant prostate cancer. Among the patients with the highest PI-RADS category 3 (n=113), clinically significant prostate cancer was detected in 28 patients. On multivariable logistic regression analysis to predict the detection of clinically significant prostate cancer in patients with the highest PI-RADS category 3, age (OR 1.10, P = .026) and LDN-PSAD (OR 1.07, P < .0001) were risk factors for detecting clinically significant prostate cancer. CONCLUSIONS: LDN-PSAD would be a biomarker for detecting clinically significant prostate cancer in patients with prostate specific antigen levels ≤20 ng/mL and suspicious lesions with PI-RADS category ≥3. The use of LDN-PSAD as an adjunct to the use of prostate specific antigen levels would avoid unnecessary biopsies in patients with the highest PI-RADS category 3. Multi-institutional studies with large population are recommended.

Percutaneous Transhepatic Obliteration for Treating Stomal Variceal Bleeding Using a Microballoon Catheter with Systemic Drainage Vein Compression.

We report a case of successful treatment of stomal variceal bleeding with percutaneous transhepatic obliteration using a microballoon catheter concomitantly with drainage vein compression. A 72-year-old man with alcoholic cirrhosis was admitted to our hospital due to repeated hemorrhage of stomal varices. Percutaneous transhepatic obliteration was then selected for treatment because computed tomography revealed the stomal varices being fed by only two branches of the superior and inferior mesenteric veins. During microballoon inflation, 5% ethanolamine oleate with iopamidol was injected into each branch, and the systemic drainage veins were compressed by the gauze from the body surface near the stoma. No rebleeding from the stomal varices has been observed 14 months after the procedure.

Dose length product and outcome of CT fluoroscopy-guided interventions using a new 320-detector row CT scanner with deep-learning reconstruction and new bow-tie filter.

OBJECTIVES: To investigate the dose length product (DLP) and outcomes of CT fluoroscopy (CTF)-guided interventions using a novel 320-detector row CT scanner with deep-learning reconstruction (DLR) and a new bow-tie filter (i.e., Aquilion ONE Prism Edition) and compare with a 320-detector row CT system without DLR and the new bow-tie filter (i.e., Aquilion ONE Vision Edition) (Vision). METHODS: CTF-guided interventions performed using Prism and Vision were retrospectively investigated in terms of the technical success rates, clinical success rates of biopsies, complications, DLPs of total CT scans (total DLPs) from February 2019 to January 2021. The total CT scans included pre-interventional CT scans, CTF scans during the CTF-guided procedure, additional CT scans for additional treatment, CTF scans for additional treatment, and post-interventional CT scans. RESULTS: In this study, 87 and 85 CTF-guided interventions were performed using Vision (Vision group) and Prism (Prism group), respectively. There was no significant difference in the technical success rate (96.6% vs 98.8%, p = 0.621), clinical success rate of biopsies (92.9% vs 93.4%, p = 1.000), and minor (8.0% vs 7.1%, p = 0.807) and major (0% vs 3.5%, p = 0.119) complications between the Prism and Vision groups. The total DLPs for the Prism group were significantly lower than those for the Vision group regardless of the procedure (278 vs 548 mGy*cm, p < 0.001, in the biopsy and 246 vs 667 mGy*cm, p < 0.001, in the drainage and aspiration). CONCLUSIONS: CTF-guided interventions on Prism reduce the total DLP without performance degradation of the intervention. ADVANCES IN KNOWLEDGE: The total DLPs of biopsies and drainages/aspirations in the Prism group decreased by 49 and 63%, respectively.

Comparative performance analysis of interventional devices for the treatment of ischemic disease in below-the-knee lesions: a systematic review and meta-analysis.

This meta-analysis aimed to evaluate the device performance of conventional balloon catheters (POBA), drug-coated balloons (DCB), bare-metal stents (BMS), and drug-eluting stents (DES) in below-the-knee (BTK) ischemic lesions with regard to lesion characteristics. Online searches of PubMed, Web of Science, and Cochrane databases (2010-2019) were conducted for each of the test devices. Primary patency rates (pp) and major amputation rates 1 year after the use of each device were analyzed using a random-effects meta-analysis model. Meta-regression analysis was conducted to test associations between the outcomes and lesion characteristics. The analysis included 18 studies reporting on 24 separate cohorts comprising 2,438 patients. DES demonstrated the best pp among the test devices (83.6%; 95% confidence interval = 78.4-88.8%, studies = 8; I2 = 66%, P = 0.005). A negative coefficient between lesion length and pp (P = 0.002) was obtained. The ratio of critical limb ischemia (CLI) patients impacted the amputation rates (P = 0.031), whereas no statistically significant difference was found between the devices. DES showed favorable pp in BTK lesions; however, as the lesion lengths using DES were short, pp in long lesions still needs to be evaluated. Shorter lesions gained better pp. A higher ratio of CLI patients resulted in increased amputation rates.

In Vitro Model for Simulating Drug Delivery during Balloon-Occluded Transarterial Chemoembolization.

BACKGROUND: Balloon-occluded transarterial chemoembolization (B-TACE) has emerged as a safe and effective procedure for patients with liver cancer, which is one of the deadliest types of cancer worldwide. B-TACE consist of the transcatheter intraarterial infusion of chemotherapeutic agents, followed by embolizing particles, and it is performed with a microballoon catheter that temporarily occludes a hepatic artery. B-TACE relies on the blood flow redistribution promoted by the balloon-occlusion. However, flow redistribution phenomenon is not yet well understood. METHODS: This study aims to present a simple in vitro model (IVM) where B-TACE can be simulated. RESULTS: By visually analyzing the results of various clinically-realistic experiments, the IVM allows for the understanding of balloon-occlusion-related hemodynamic changes and the importance of the occlusion site. CONCLUSION: The IVM can be used as an educational tool to help clinicians better understand B-TACE treatments. This IVM could also serve as a base for a more sophisticated IVM to be used as a research tool.

Analysis of oncological outcomes of whole-gland therapy with high-intensity focused ultrasound for localized prostate cancer in clinical and technical aspects: a retrospective consecutive case-series analysis with a median 5-year follow-up.

PURPOSE: This study aimed to analyze technical and clinical factors related to oncological outcomes in patients with localized prostate cancer (PC) who were treated with whole-gland high-intensity focused ultrasound (HIFU). MATERIALS AND METHODS: From 2007-2014, patients diagnosed with localized PC who underwent whole-gland HIFU were consecutively included retrospectively. Biochemical failure was defined according to the Phoenix ASTRO guidelines. The relationship between oncological outcomes and technical and clinical factors was evaluated. RESULTS: The study cohort included 428 patients. The median age was 67 years, and the median prostate-specific antigen level was 7.61 ng/mL. Patient risk classifications were low (n = 102), intermediate (n = 240), and high (n = 86). Biochemical disease-free survival rates of patients with HIFU for localized PC in the total, low-, intermediate-, and high-risk groups according to D'Amico risk groups over a median follow-up period of 5 years (range 9-144) were 68.4%, 80.4%, 65.6%, and 61.6%, respectively. In multivariate logistic regression analyses to predict biochemical failure of the treatment, neoadjuvant hormonal therapy (NHT) in the high-risk group (OR 0.225, p = 0.015), and compression method in the low- (OR 0.178, p = 0.030), intermediate- (OR0.291, p < 0.0001), and high-risk (OR 0.316, p = 0.049) groups were significant factors that reduced the risk of biochemical failure after treatment. There were no significant differences in complications between patients treated with compression and those treated conventionally. CONCLUSIONS: NHT may potentially improve oncological outcomes for patients in the high-risk group, and compression methods can improve the oncological outcomes of whole-gland therapy with HIFU.

CT-guided bone biopsy using electron density maps from dual-energy CT.

Computed tomography (CT) -guided bone biopsy is a diagnostic procedure performed on the musculoskeletal system with a high diagnostic yield and low complications. However, CT-guided bone biopsy has the disadvantage that it is difficult to confirm the presence of tumor cells during the biopsy procedure. Recently, the clinical benefits of dual-energy CT (DECT) over single-energy CT have been revealed. DECT can provide material decomposition images including calcium suppression images, and effective atomic number (Zeff) and electron density (ED) maps. ED maps have been reported to indicate cellularity. A 61-year-old woman with a history of breast cancer surgery was admitted to our hospital and underwent a CT-guided bone biopsy of the right ilium using ED maps. As a result, she was diagnosed with breast cancer metastases of intertrabecular bone. A comparison of ED maps with a pathological specimen revealed that high ED values occurred exclusively in the tumor area with high cellularity. This study indicates that ED maps produced using DECT may have potential utility in the accurate identification of metastases with high cellularity in bone lesions.

Vessel Occlusion using Hydrogel-Coated versus Nonhydrogel Embolization Coils in Peripheral Arterial Applications: A Prospective, Multicenter, Randomized Trial.

PURPOSE: To evaluate the safety and effectiveness of hydrogel-coated coils for vessel occlusion in the body trunk. MATERIALS AND METHODS: A total of 77 patients with various peripheral vascular lesions, treatable by embolization with coils, were randomized (hydrogel group, n = 38; nonhydrogel group, n = 39). In the hydrogel group, embolization of the target vessel was conducted using 0.018-inch hydrogel-coated coils (AZUR 18; Terumo Medical Corporation, Tokyo, Japan) with or without bare platinum coils. The nonhydrogel group received both bare platinum coils and fibered coils without the use of hydrogel-coated coils. RESULTS: Complete target vessel occlusion was accomplished in 36 patients in the hydrogel group and 37 patients in the nonhydrogel group. No major adverse events were observed in either group. The median number of coils/vessel diameter and the median total coil length/vessel diameter were significantly larger in the nonhydrogel group than in the hydrogel group (P = .005 and P = .004, respectively). The median embolization length was significantly longer in the nonhydrogel group (31.95 mm) than in the hydrogel group (23.43 mm) (P = .002). If no expansion was assumed, the median packing density in the hydrogel group was 44.9%, which was similar to that in the nonhydrogel group (46.5%) (P = .79). With full expansion assumed, the median packing density in the hydrogel group was 125.7%. CONCLUSIONS: Hydrogel-coated coils can be safely used for peripheral vascular coil embolization, and hydrogel-coated and conventional coils in combination allow for a shorter embolization segment and shorter coil length.

Fabrication of Gd-DOTA-functionalized carboxylated nanodiamonds for selective MR imaging (MRI) of the lymphatic system.

Magnetic resonance imaging (MRI) contrast agents with the particle diameter of around 3-10 nm hold the potential to be selectively uptaken by lymphatic vessels and be filtered in the kidney for final excretion. However, there are no existing MRI contrast agents based on gadolinium (Gd) complexes within the size of this range, and thus the selective imaging of the lymphatic system has not yet been achieved. In our previous report, we succeeded in fabricating nano-scale MRI contrast agents by complexing ordinary contrast agents (Gd-diethylenetriaminepentaacetic acid (DTPA)) with carboxylated nanodiamond (CND) particles to conquer this problem. However, DTPA has recently been reported to release Gd ions in the course of time, leading to the potential danger of severe side effects in the human body. In this study, we utilized cyclic-chained DOTA as an alternative chelating material for DTPA to fabricate CND-based MRI contrast agents for the selective lymphatic imaging. The newly fabricated contrast agents possessed the diameter ranging from 3 to 10 nm in distilled water and serum, indicating that these particles can be selectively uptaken by lymphatic vessels and effectively filtered in the kidney. Furthermore, the DOTA-applied CND contrast agents exhibited stronger MRI visibility in water and serum compared to DTPA-applied CND contrast agents. These results indicate that DOTA-applied CND contrast agents are promising materials for the selective MR imaging of lymphatic systems.

Novel pulmonary perfusion imaging using chest digital dynamic radiography for pulmonary artery sarcoma.

Chest digital dynamic radiography (DDR) is a novel method for evaluating pulmonary perfusion and ventilation. It could depict ventilation-perfusion mismatch in a pulmonary artery sarcoma with severe stenosis in the right pulmonary artery. This report is the first demonstration of ventilation-perfusion mismatch in a malignant neoplasm using DDR.

First experience of efficacy and radiation exposure in 320-detector row CT fluoroscopy-guided interventions.

OBJECTIVE: We investigated the efficacy and exposure to radiation in 320-detector row computed tomography fluoroscopy-guided (CTF-guided) interventions. METHODS: We analysed 231 320-detector row CTF-guided interventions (207 patients over 2 years and 6 months) in terms of technical success rates, clinical success rates, complications, scanner settings, overall radiation doses (dose-length product, mGy*cm), patient doses of peri-interventional CT series, and interventional CT (including CTF), as a retrospective cohort study. The relationships between patient radiation dose and interventional factors were assessed using multivariate analysis. RESULTS: Overall technical success rate was 98.7% (228/231). The technical success rates of biopsies, drainages, and aspirations were 98.7% (154/156), 98.5% (66/67), and 100% (8/8), respectively. The clinical success rate of biopsies was 93.5% (146/156). All three major complications occurred in chest biopsies. The median total radiation dose was 522.4 (393.4-819.8) mGy*cm. Of the total radiation dose, 87% was applied during the pre- and post-interventional CT series. Post-interventional CT accounted for 24.4% of the total radiation dose. Only 11.4% of the dose was applied by CTF-guided intervention. Multilinear regression demonstrated that male sex, body mass index, drainage, intervention time, and helical scan as post-interventional CT were significantly associated with higher dose. CONCLUSION: The 320-detector row CTF interventions achieved a high success rate. Dose reduction in post-interventional CT provides patient dose reduction without decreasing the technical success rates. ADVANCES IN KNOWLEDGE: This is the first study on the relationship between various interventional outcomes and patient exposure to radiation in 320-detector row CTF-guided interventions, suggesting a new perspective on dose reduction.

CT fluoroscopy-guided percutaneous intervertebral drain insertion for cervical pyogenic spondylodiscitis.

A 79-year-old man was admitted to our hospital with C6-C7 pyogenic spondylodiscitis with an epidural abscess. Since the cervical intervertebral space is narrower than the thoracolumbar intervertebral space, drain insertion into the cervical intervertebral space requires a more accurate procedure. Moreover, the specific anatomy of cervical vertebrae, which includes the transverse foramen through which the vertebral artery passes and the uncinate process on the side edges of the top surface of the bodies, makes it impossible to perform computed tomography (CT)-guided percutaneous intervertebral drain insertion through the posterolateral approach. Therefore, CT fluoroscopy-guided percutaneous cervical intervertebral drain insertion using a lateral approach, in which the needle is advanced between the carotid sheath and scalene muscle, and simultaneous intravenous contrast enhancement might be a safe and useful technique. There have been no papers on CT fluoroscopy-guided percutaneous intervertebral drain insertion for cervical pyogenic spondylodiscitis, while successful CT fluoroscopy-guided percutaneous intervertebral drain insertion for thoracolumbar pyogenic spondylodiscitis has been reported. Here, we successfully performed CT fluoroscopy-guided percutaneous intervertebral drain insertion for cervical pyogenic spondylodiscitis.

Pelvic local recurrence as first relapse predicts prognosis for clinical stage II/III lower rectal cancer: A clinicopathological investigation.

The present study investigated the association between the mode of tumor recurrence and prognosis in 123 patients with clinical stage II/III rectal cancer. In the past 10 years, patients received systemic chemotherapy following radical (R0, with no macroscopic residual tumor lesions) resection using total or tumor-specific mesorectal excision. Patients with rectosigmoid cancer and T4 + chemoradiation therapy were excluded from the present study. The 5-year relapse-free survival rate (5Y-RFS), 5-year overall survival rate (5Y-OS), and associations between early post-operative complications, recurrence mode and prognosis, as well as the 5Y-OS of patients with relapsed cancer, were calculated. The overall 5Y-RFS and 5Y-OS were 71.4 and 83.5%, respectively, and the overall recurrence rate was 22.8% (28/123 patients). Among relapses, remote metastases were observed in 17/123 patients (13.8%): The lung in 8 patients (6.5%), the liver in 5 patients (4.1%) and elsewhere in 4 patients (3.3%). A total of 11 patients (8.9%) had pelvic local recurrence as the first relapse, which was located anterior to the sacrum in 7 patients (5.7%), at the anastomosis site in 2 patients (1.6%), and in the inner pelvis in 2 patients (1.6%). Among relapsed patients, the 5Y-OS was 69.3% in those with distant metastases and 27.3% in those with local relapse (P=0.02; no significant differences in patient demographics). The results indicated that advanced rectal cancer and control of pelvic local recurrence are manageable by R0 resection and postoperative chemotherapy. However, for patients whose initial relapse was pelvic local recurrence, the relapsed tumor initiated a new metastatic cascade to organs, such as the lung and liver, and affected prognosis.

Safety and Efficacy of Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Multicenter Retrospective Study in Japan.

Purpose: Bone cement enhancement by percutaneous vertebroplasty (PVP) for the treatment of osteoporotic vertebral compression fractures remains unapproved, as it has not been fully evaluated in Japan. The current multicenter study was conducted in Japan to verify the safety and efficacy of PVP in patients with painful osteoporotic vertebral fractures. Material and Methods: In this retrospective study, we referred to previous studies to evaluate the non-inferiority of PVP to balloon kyphoplasty (BKP). We reviewed consecutive patient data from April 2017 to March 2018 from four institutions based on the medical records of the intervention. We statistically investigated the adverse events due to cement leakage or other factors associated with PVP, and new vertebral compression fractures after PVP were evaluated for safety, pain relief, and gait improvement. Results: This study included 485 patients; most of whom were in the middle- to oldest- age groups (mean age, 81.4 years). No serious adverse events were reported in patients available for safety evaluation (n = 485). Cement leakage and new vertebral compression fractures occurred in 35.7% and 18.6% (26.2%-38.4% and 8.9%-20.7%) of the patients undergoing PVP, respectively, both of which were also judged to be equivalent to those of BKP. The pain score improved in those undergoing PVP, and this improvement was maintained during a one-year follow-up. Of the 206 patients who had difficulty walking at baseline, 156 had restored walking at discharge. Conclusions: PVP was shown to be a safe and effective treatment, even in elderly patients with painful osteoporotic vertebral fractures.

Snuff box radial access in transcatheter arterial embolization for unruptured renal angiomyolipoma.

OBJECTIVE: We report the first three cases in which the feasibility and safety of the left snuff box radial access in transcatheter arterial embolization (TAE) for unruptured renal angiomyolipoma (AML) were evaluated. MATERIAL AND METHODS: Three patients with unruptured renal AMLs underwent TAE via the left snuff box radial artery. We retrospectively evaluated the characteristics of the AMLs, technical success rate, clinical success rate, and complications. Technical success and clinical success were defined as successful insertions of microballoon catheters selectively via the left distal radial artery into all intended arteries in a treatment session and shrinkage of tumor size as evaluated by CT or MRI after the procedure, respectively. RESULTS: The median size of the renal AMLs was 49 mm. TAE was successfully performed in all cases and all feeding arteries were successfully selected with a microballoon catheter through the left snuff box radial artery. The median amount of the mixture of ethanol and Lipiodol was 1.8 mL. Tumor shrinkage was confirmed in all with a median follow-up period of 6 months. The clinical success rate was 100%. No major complications occurred. CONCLUSION: The left snuff box access in TAE for an unruptured renal AML is safe and feasible.