Kee Chun Hong

Iliac vein stenting as a durable option for residual stenosis after catheter-directed thrombolysis and angioplasty of iliofemoral deep vein thrombosis secondary to May-Thurner syndrome.

Introduction This study aims to evaluate the primary patency and clinical outcomes after stenting for residual iliac venous stenosis during catheter-directed thrombolysis treatment of acute iliofemoral deep vein thrombosis arising from May–Thurner syndome. Methods A retrospective study was done for the all patients who underwent iliac vein stenting after catheter-directed thrombolysis treatment of acute iliofemoral deep vein thrombosis due to May–Thurner syndrome from January 2005 to April 2011 in Inha University Hospital. Patient information was assembled from the electronic medical records, imaging and interview. The patency of iliac vein stent was evaluated with serial computed tomography. Results Fifty-one patients were enrolled. The median age was 70 years (range 44–86). There were 37 females (72.5%). The duration of symptoms of acute deep vein thrombosis before catheter-directed thrombolysis treatment was 6 days (median, range 1–33). Self-expanding stent was used for iliac vein stenting. Initial technical success rate was 94.1%. There were two complications (3.9%): an arteriovenous fistula formation in left popliteal area and a right inguinal hematoma. Mean follow-up was 15.6 months (range 6 days–80.8 months). Primary patency rate after iliac vein stenting was 95.8% at 6 months, 87.5% at 12 months and 84.3% at 24 months. Four patients had recurrent thrombotic occlusion (7.8%) during the follow-up. Conclusion Iliac vein stenting showed good primary patency rate with few complications. Iliac vein stenting is a durable option for residual stenosis after catheter-directed thrombolysis treatment of acute deep vein thrombosis in May–Thurner syndrome.

Relining technique for continuous sac enlargement and modular disconnection secondary to endotension after endovascular aortic aneurysm repair

Endotension is an unpredictable late complication of endovascular aortic aneurysm repair (EVAR). This case report will discuss the successful treatment of enlarged aneurysmal sac due to endotension using the relining technique. An 81-year-old male complained of nondecreasing huge aneurysm sac. He had undergone EVAR for infrarenal abdominal aortic aneurysm 7 years prior and no endoleak was found through follow-up. Initially computed tomography-guided sac aspiration was tried, but in vain, Relining using the double barrel technique and tubular endograft for modular diconnection, which was unexpectedly found in the original endograft, were performed sucessfully. During follow-up after the relining procedure, the size of aneurysm sac continued to decrease in size. The relining technique is effective mothod for treating endotension.

Mechanical thrombectomy-assisted thrombolysis for acute symptomatic portal and superior mesenteric venous thrombosis

Acute portal vein and mesenteric vein thrombosis (PVMVT) can cause acute mesenteric ischemia and be fatal with mortality rate of 37%-76%. Therefore, early diagnosis and prompt venous revascularization are warranted in patients with acute symptomatic PVMVT. Due to advances in catheter-directed treatment, endovascular treatment has been used for revascularization of affected vessels in PVMVT. We report two cases of symptomatic PVMVT treated successfully by transhepatic percutaneous mechanical thrombectomy-assisted thrombolysis.

Catheter-Directed Thrombolysis with Conventional Aspiration Thrombectomy for Lower Extremity Deep Vein Thrombosis

Purpose The purpose of this study is to evaluate treatment outcomes in patients with symptomatic deep vein thrombosis (DVT) who had undergone a catheter-directed thrombolysis with conventional aspiration thrombectomy for the treatment of lower extremity deep vein thrombosis. Materials and Methods The authors retrospectively reviewed the records of 74 patients (mean age 61 ± 15) that underwent a catheter-directed thrombolysis with conventional aspiration thrombectomy. A retrieval inferior vena cava (IVC) filter was placed to protect against a pulmonary embolism in 60 patients (81%). Stenting and balloon angioplasty were performed in 37 patients (50%) under the left common iliac vein compression. Results Sixty-seven patients (91%) showed a clinical improvement within 48 hours, but seven patients (9%) showed no improvement. Multi detector computerized tomographic venography (MDCT venography) at discharge showed no thrombus in 15 patients (20%) and partial thrombus in 52 (70%). Twenty-eight patients (38%) developed post-thrombotic syndrome at 3.0 ± 4.2 months postoperatively. Six patients (8%) were admitted due to DVT recurrence at a mean of 5.6 ± 7.4 months postoperatively. Sixty-nine patients underwent follow up MDCT venography at 5.7 ± 5.6 months. fifty (72%) of these showed no thrombus, 15 (22%) partial thrombus, and 4 (6%) showed obstruction. Twentyeight of 61 (46%) were asymptomatic, twentyeight (46%) had moderate improvement, and four (6%) were mildly improved by a telephone interview (81%) at 22.8 ± 10.7 months postoperatively. Conclusion Catheter-directed thrombolysis with conventional aspiration thrombectomy is an effective treatment for lower extremity deep vein thrombosis and produces satisfactory clinical results.

Stent fractures after superficial femoral artery stenting

Stent fracture is one of the major factors compromising implanted stent patency due to its consequences including in-stent restenosis, thrombosis, perforation, and migration. Stent fracture can occur from stress (extrinsic or intrinsic) and biomechanical forces at different implantation sites. We report on 2 cases of stent fractures and pertinent literature. One patient, a 75-year-old male, presented with recurrence of claudication 14 months after superficial femoral artery stenting; a femoral artery occlusion with stent fracture was found, and he underwent femoropopliteal bypass. The other patient, a 72-year-old male presented with recurrence of claudication; a stent fracture was found without femoral artery occlusion, and he was treated with additional femoral artery stenting to secure the fracture site.

Clinical significance of clusterin expression in pancreatic adenocarcinoma

BackgroundClusterin is known to be expressed in many human neoplasms, and is believed to participate in the regeneration, migration, and anti-apoptosis of tumor cells. However, few reports have addressed the relationship between the manifestation of clusterin and clinicopathologic parameters in pancreas cancer patients. In the present study, the authors investigated the expression of clusterin and its clinical significance in pancreatic adenocarcinoma.MethodsImmunohistochemical staining was performed for clusterin in tumor tissues obtained from patients who received pancreatic resection with radical intent, and the associations of clusterin expression with various clinicopathologic parameters were analyzed in addition to the relation between its expression and survival.ResultsImmunoreactivity for clusterin was observed in 17 of the 52 (33%) pancreatic adenocarcinomas examined. In addition, clusterin positivity was found to be associated with preoperative serum carcinoembryonic antigen level, perineural invasion, and, most strongly, lymph node metastasis. The survival analysis identified tumor differentiation and lymph node metastasis as the only significant prognostic factors.ConclusionAlthough not an independent prognostic factor, clusterin immunoreactivity can be used in conjunction with lymph node metastasis to predict survival in cases of pancreatic adenocarcinoma.

Can Pre-Retrieval Computed Tomography Predict the Difficult Removal of an Implementing an Inferior Vena Cava Filter?

Purpose: Implementing an inferior vena cava (IVC) filter is a relatively safe procedure but potential negative long-term effects. The complications for filter retrieval have been noted. We examined filter characteristics on pre-retrieval computed tomography (CT) that were associated with complicated retrieval (CR) of IVC filters. Materials and Methods: A retrospective review of IVC filter retrievals between January 2008 and June 2014 was performed to identify patients who had undergone a pre-retrieval CT for IVC filter retrieval. CR was defined as the use of nonstandard techniques, procedural time over 30 min, filter fractures, filter tip incorporation into the IVC wall, and retrieval failure. Pre-retrieval CT images were evaluated for tilt angle in the mediolateral and anteroposterior directions, tip embedding into the IVC wall, degree of filter strut perforation, and distance of the filter tip from the nearest renal vein. Results: Of seventy-six patients, twenty-four patients (31.6%) with CRs and 56 patients (73.7%) with non-CR were evaluated for pre-retrieval CT. For IVC filter retrieval with a dwelling time of over 45 days, a tilt of over 15 degrees, the appearance of tip embedding and grade 2 perforation were associated with CR on multivariate analysis. However, for IVC filter retrievals with a dwelling time of less than 45 days, there were no factors associated with CR. Conclusion: Pre-retrieval CTs may be more effective for IVC filters with a dwelling time of over 45 days. Therefore, a pre-retrieval CT may be helpful in predicting CR of IVC filters with long dwelling times.

Internal Iliac Artery Embolization during an Endovascular Aneurysm Repair with Detachable Interlock Microcoils

Objective The purpose of this study was to evaluate the effectiveness of detachable interlock microcoils for an embolization of the internal iliac artery during an endovascular aneurysm repair (EVAR). Materials and Methods A retrospective review was conducted on 40 patients with aortic aneurysms, who had undergone an EVAR between January 2010 and March 2012. Among them, 16 patients were referred for embolization of the internal iliac artery for the prevention of type II endoleaks. Among 16 patients, 13 patients underwent embolization using detachable interlock microcoils during an EVAR. Computed tomographic angiographies and clinical examinations were performed during the follow-up period. Technical success, clinical outcome, and complications were reviewed. Results Internal iliac artery embolizations using detachable interlock microcoils were technically successful in all 13 patients, with no occurrence of procedure-related complications. Follow-up imaging was accomplished in the 13 cases. In all cases, type II endoleak was not observed with computed tomographic angiography during the median follow-up of 3 months (range, 1-27 months) and the median clinical follow-up of 12 months (range, 1-27 months). Two of 13 (15%) patients had symptoms of buttock pain, and one patient died due to underlying stomach cancer. No significant clinical symptoms such as bowel ischemia were observed. Conclusion Internal iliac artery embolization during an EVAR using detachable interlock microcoils to prevent type II endoleaks appears safe and effective, although this should be further proven in a larger population.

Spontaneous intrahepatic portosystemic shunt managed by laparoscopic hepatic vein closure

Intrahepatic portosystemic shunt (IPSS) is uncommon and usually follows trauma or iatrogenic injury, but spontaneous shunts may also occur, in patients without the evidence of chronic liver disease. Although interventional endovascular management of the shunts is the treatment of choice, a surgical approach can be used when the percutaneous approach fails. We report here a case of symptomatic spontaneous IPSS between the posteroinferior branch of right portal vein and the right inferior hepatic vein, which was successfully managed with laparoscopic closure of the hepatic vein. To the best of our knowledge, this is the first case report of laparoscopic management of spontaneous IPSS.

Successful treatment of type I endoleak of common iliac artery with balloon expandable stent (Palmaz XL stent) during endovascular aneurysm repair

Type 1 endoleak of common iliac artery (type Ib endoleak) should be treated during endovascular aneurysm repair (EVAR). An 86-year-old female was diagnosed with abdominal aortic aneurysm measuring 6.6 cm in diameter and right internal iliac artery aneurysm measuring 4.0 cm in diameter. She underwent EVAR after right internal iliac artery embolization. There was type Ib endoleak, which was repaired by balloon-expandable stent, Palmaz XL stent (Cordis). We report successful treatment of type Ib endoleak with Palmaz XL stent, which may be considered as an alternative option for type Ib endoleak after EVAR.