BACKGROUND Computed tomography (CT)-guided neurolytic splanchnic nerve block (NSNB) is used to treat pain in unresectable pancreatic cancers. Whether outcomes differ according to tumor site remains uncertain. AIM To evaluate the efficacy and safety of CT-guided NSNB in unresectable pancreatic cancer and explore differences by tumor site. METHODS This single-center retrospective cohort study included 22 patients who underwent initial CT-guided NSNB at the Oita Red Cross Hospital between 2007 and 2023. Clinical success comprised recorded pain relief or opioid reduction within 1 week; standardized pain scores were not routinely recorded. Technical success required bilateral retrocrural distribution. Adverse events were graded using the Common Terminology Criteria for Adverse Events (CTCAE). Proportions were reported with 95% confidence intervals (95%CIs); comparisons used Fisher’s exact and exact permutation Mann-Whitney U tests. RESULTS Technical and clinical success occurred in 17/22 (77.3%; 95%CI: 56.6%-89.9%) and 18/22 (81.8%; 95%CI: 61.5%-92.7%), respectively. The recorded duration was available for 13 clinical responders, with a median of 40 days (interquartile range: 19-144 days); four transfers and one death lacked an evaluable duration. The clinical success rates were 6/9 for head tumors and 12/13 for body/tail tumors. The available duration medians were 29.5 days and 117 days, respectively. Adverse events occurred in 6/22 (27.3%; 95%CI: 13.2%-48.2%), with no CTCAE grade ≥ 3 events. CONCLUSION CT-guided NSNB is associated with encouraging clinical responses at both tumor sites in this small retrospective cohort. Prospective studies should confirm these findings and clarify potential tumor-site differences.
Mesenteric ischaemia is a potentially life-threatening vascular disorder caused by impaired intestinal perfusion, with treatment selection requiring consideration of clinical presentation, bowel viability and lesion anatomy. This narrative review examines evidence informing interventional radiology decisions in arterial acute mesenteric ischaemia (AMI) and chronic mesenteric ischaemia (CMI). MEDLINE/PubMed was searched from inception to December 31, 2025, supplemented by reference-list screening and targeted guideline searches. Qualitative evidence synthesis considered patient selection, study design, adjunctive treatments, outcomes and follow-up. In AMI, endovascular techniques can restore perfusion, but predominantly retrospective evidence does not establish superiority over surgery in bowel preservation or survival. For CMI requiring revascularisation, European Society for Vascular Surgery guidelines recommend an initial endovascular approach, supported by Cardiovascular and Interventional Radiological Society of Europe consensus-based guidance. Observational comparisons associate endovascular treatment with lower perioperative morbidity, and surgery with less symptom recurrence. By linking individual treatment decisions to society guidance and supporting studies, this review complements existing comprehensive reviews and guidance documents. It distinguishes formal recommendations and consensus-based practice from technical feasibility and demonstrated comparative patient benefit, while identifying unresolved questions concerning AMI reperfusion strategies and device selection, in addition to antithrombotic therapy and restenosis management in CMI.
