In Wook Choo

Ethanol Embolotherapy of Pelvic Arteriovenous Malformations: an Initial Experience

Objective We retrospectively assessed the results of performing ethanol embolization for pelvis arteriovenous malformations (AVMs). Materials and Methods During the past 10 years, eight patients (8 females, age range: 27-52 years) with AVMs in the pelvic wall (n = 3) and uterus (n = 5) underwent staged ethanol embolizations (range: 1-5, mean: 2.5) under general anesthesia. Ethanol embolization was performed by the use of the transcatheter and/or direct puncture techniques. Clinical follow-up was performed for all of the patients, and imaging follow-up was available for seven patients. The therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms, as well as the degree of devascularization observed on post-procedural angiography. Results During the 20 sessions of ethanol embolization, the solitary transarterial approach was used 14 times, the transvenous approach was used three times and direct puncture was used once. For two patients, the transarterial and transvenous or direct puncture approaches were used together in one session. For four patients, ethanol and coils were used as embolic agents, and n-butyl cyanoacrylate (NBCA) and ethanol were used in one patient. Seven (88%) of eight patients were cured of their AVMs and one patient (12%) displayed improvement. Major complications were seen in two patients (25%). Conclusion Ethanol embolization is effective for the treatment of pelvic arteriovenous malformations, though there is a chance of a major complication.

Clinical outcome and predictors of treatment response in foam sodium tetradecyl sulfate sclerotherapy of venous malformations.

AbstractObjectivesTo evaluate clinical outcomes and their predictors in patients with venous malformation (VM) treated with foam sodium tetradecyl sulfate (STS) sclerotherapy.MethodsWe retrospectively evaluated clinical outcomes of foam STS sclerotherapy in 86 patients with 91 VMs to assess reduction in pain and mass after treatment. Univariate and multivariate analysis was performed to determine possible predictors of clinical outcome with foam STS sclerotherapy.ResultsA positive response of 49.5xa0% in pain reduction and 52.7xa0% in mass reduction was observed. The numerical rating scale (NRS) score improved from 4.36u2009±u20092.64 to 1.74u2009±u20091.57, and VM mass volume decreased to 41.7u2009±u200935.52xa0% of the initial size. On multivariate analysis, a high baseline NRS score (odds ratio: 1.12, 95xa0% confidence interval: 1.09–1.15) and VM location in the trunk versus the head and neck (odds ratio: 1.30, 95xa0% confidence interval: 1.00–1.69) were positive predictors of pain improvement. Minor complications occurred in 11 (12.1xa0%) patients and recurrence in 12 (13.2xa0%) patients.ConclusionsFoam STS sclerotherapy is an effective treatment in venous malformation, with low complication risk. A high baseline NRS score and location in the trunk versus the head and neck were positive predictors in improvement of pain.Key Points• Foam STS sclerotherapy is effective in VM, with low risk of complications.n • Relief of pain tends to be dramatic in patients with severe pain.n • Location of VM is a predictor of pain improvement.n • The presence of a draining vein does not affect foam sclerotherapy.

Use of double-occlusion balloon catheter: preoperative portal vein embolization for induction of future remnant liver hypertrophy.

AbstractPurpose: To evaluate the efficacy andnsafety of using double-occlusion balloon catheters in preoperativenportal vein embolization (PVE) to induce future remnant livernhypertrophy. Materials and Methods: PVE was achievednwith gelatin sponges by using double-occlusion balloon catheter innseventeen patients with hepatobiliary malignant tumors. The ipsilateralnapproach was used in thirteen patients and the contralateral approachnin four patients due to large size of tumor in the right hepatic lobe.nSurgery was performed in 15 patients, 14–27 days (mean, 21.9 days)nafter PVE. Computed tomographic liver volumetric studies were performednbefore embolization and before surgery. The changes in aspartatenaminotransferase (AST), alanine aminotransferase (ALT), prothrombinntime (PT), and total bilirubin levels before and after the PVE werenevaluated. Complications were evaluated after PVE. nResults: PVE using double-occlusion balloon catheter wasnsuccessful in all cases, irrespective of approach technique. The futurenremnant liver (FRL) volumes were 251–920 cm3 (mean, 437ncm3) before PVE and 281–1042 cm3 (mean, 555ncm3) after PVE. The mean increase in the volume of the FRLnwas 28.6%; this represented 37% of the preresection volume of thenliver. Clinical and biologic tolerance of PVE was mandatory. There werenno complications. nConclusions: PVE using thendouble-occlusion balloon catheter is safe and well-tolerated and can benperformed technically with ease. This hypertrophy allows hepatectomy tonbe performed safely when the FRL volume is initially insufficient innpatients with hepatobiliary tumors.

Opacification of the Intrahepatic portal veins during CT hepatic arteriography

Purpose The purpose of this study was to ascertain the cause of opacification of the portal veins during CT hepatic arteriography (CTHA). Method A total of 155 consecutive patients with hepatocellular carcinoma were evaluated with CTHA as preoperative staging. The opacification of the portal veins during CTHA was categorized as opacification of the main portal vein, right or left branches of the main portal vein (generalized), and segmental or subsegmental portal veins (localized). Hepatic angiography was compared and possible causes were evaluated. Results One hundred eight (70%) of 155 patients showed intrahepatic portal vein opacification at CTHA: generalized in 60 patients (39%) and localized in 48 patients (31%). Intrahepatic causes were arterioportal shunts due to hepatocellular carcinoma in 20 (19% of 108 patients), previous liver biopsy in 9 (8%), and portal vein thrombosis in 4 (4%). Extrahepatic cause was counted in 57 cases (53%) and was due to inflow of contrast material via nonmesenteric portal circulation through the gastric antrum, duodenum, and/or pancreas. Conclusion Intrahepatic portal veins are frequently opacified during CTHA, and the causes were arterioportal shunts through hepatocellular carcinoma, postbiopsy shunt, portal vein thrombosis, and inflow of contrast material via the nonmesenteric portal circulation.

A Novel Foam Contrast Agent Suitable for Fluoroscopic Interventional Procedure: Comparative Study of Physical Properties and Experimental Intervention in Animal Model

In fluoroscopic contrast study for interventional procedure, liquid contrast agent may be diluted in body fluid, losing its contrast effect. We developed a novel contrast agent of “foam state” to maintain contrast effect for enough time and performed a comparative study of physical properties and its usefulness in experimental intervention in animal model. The mean size of microbubble of foam contrast was 13.8 ± 3.6u2009µm. The viscosity was 201.0 ± 0.624u2009cP (centipoise) and the specific gravity was 0.616. The foam decayed slowly and it had 97.5 minutes of half-life. In terms of the sustainability in a slow flow environment, foam contrast washed out much more slowly than a conventional contrast. In experimental colonic stent placement, foam contrast revealed significantly better results than conventional contrast in procedure time, total amount of contrast usage, and the number of injections (p < 0.05). Our foam contrast has high viscosity and low specific gravity and maintains foam state for a sufficient time. Foam contrast with these properties was useful in experimental intervention in animal model. We anticipate that foam contrast may be applied to various kinds of interventional procedures.