Man-Deuk Kim

Selective coverage of the left subclavian artery without revascularization in patients with bilateral patent vertebrobasilar junctions during thoracic endovascular aortic repair.

OBJECTIVEnThe primary purpose of the current study was to evaluate the safety and effectiveness of selective coverage of the left subclavian artery (LSCA) without revascularization during thoracic endovascular aortic repair (TEVAR) in patients with bilateral patent vertebrobasilar junctions. The secondary purpose was to assess morphologic change of the vertebral artery (VA) after the procedure.nnnMETHODSnAmong 126 patients who underwent TEVAR between 2006 and 2011, 29 patients requiring LSCA coverage without preemptive revascularization were retrospectively analyzed in this study. The patients were a mean age of 63.1 years (range, 45-84 years). The mean follow-up period was 19.9 months (range, 1-63 months). Bilateral patent vertebrobasilar junctions were evaluated by contrast-enhanced computed tomography (CT), time-of flight magnetic resonance angiography, or conventional angiography. Neurologic complications, such as spinal cord ischemia (SCI) or cerebrovascular accidents, were analyzed. Preprocedural and postprocedural changes in VAs were evaluated on follow-up contrast-enhanced CT.nnnRESULTSnThe overall 30-day mortality was 6.9% (2 of 29). None of the patients had SCI or a stroke of posterior circulation alone. Cerebrovascular accidents from embolic infarctions occurred in two patients (7.4%). Transient left arm ischemic symptoms were present in five patients (18.5%), but none required secondary interventions. Delayed development of type I endoleak occurred due to stent deformity in one patient, who underwent surgery. One patient required reintervention after the 10-month follow-up contrast-enhanced CT showed a pseudoaneurysm had developed at the distal margin of the previously placed stent graft. Hypertrophy of the right VA after TEVAR was seen in seven of 27 patients (25.9%); two patients showed bilateral hypertrophy of VAs.nnnCONCLUSIONSnLSCA coverage without revascularization can be safely performed during TEVAR in patients with bilateral patent vertebrobasilar junctions. Hypertrophy of the right VA was noted in 25.9% of patients after LSCA coverage.

Degeneration of Leiomyoma in Patients Referred for Uterine Fibroid Embolization: Incidence, Imaging Features and Clinical Characteristics

Purpose Imaging features and clinical characteristics of degenerated leiomyoma in patients referred for uterine fibroid embolization (UFE) were analyzed to assess the incidence of degenerated leiomyoma. Materials and Methods Patients referred for UFE between 2008 and 2009 were retrospectively analyzed (n=276). Patients ranged in age from 27 to 51 years (mean 38.0 years). All patients underwent screening MRI with contrast enhancement. Medical histories and clinical symptoms were evaluated. Results Among the 276 patients who underwent MRI, 14 (5.1%) showed degenerated leiomyomas. Symptoms were abdominal pain (n=4, 26.7%), menorrhagia (n=5, 35.7%) and bulk-related symptoms (n=5, 35.7%) and no symptoms (n=5, 35.7%). Of the 14 patients with degenerated leiomyomas, 5 (42.9%) had a history of pregnancy in the past two years. For T1-weighted imaging (T1WI), a high signal intensity (SI) of the leiomyoma was the most common finding (n=9, 64.3%) and a hyperintense rim (n=4, 28.6%) was the second most common. On T2-weighted imaging (T2WI), a low SI of the leiomyoma was found in six patients (42.9%), a high SI in four (28.6%) and a heterogeneous SI in four (28.6%) patients. Conservative management was performed in 11 (78.6%) patients, surgery in 3 (21.4%) and uterine artery embolization in one (7.1%) patient. Conclusion The incidence of degeneration of leiomyoma in patients referred for UFE was 5.1%. Patients presented with variable clinical symptoms with or without a history of pregnancy. MR imaging showed a high SI on T1WI and various SIs on T2WI without contrast enhancement. An understanding of the degeneration of leiomyomata is essential when considering UFE.

Uterine Artery Embolization for Symptomatic Fibroids with High Signal Intensity on T2-Weighted MR Imaging

Objective To evaluate the effectiveness of uterine artery embolization (UAE) for treating symptomatic fibroids with high signal intensity (SI) on magnetic resonance (MR) T2-weighted imaging (T2WI). Materials and Methods A total of 537 cases, consisting of 14 patients with high SI fibroids on T2WI (T2 high group), were retrospectively included and compared with 28 randomly selected patients with low SI fibroids on T2WI (control group). High SI of a predominant fibroid on T2WI was defined as having the same or higher SI than the myometrium. Patient ages ranged from 28 to 52 years (mean, 38.1 years). All patients underwent MRI before and after UAE. Predominant fibroid and uterine volumes were calculated with MR images. Symptom status in terms of menorrhagia and dysmenorrhea was scored on a scale of 0-10, with 0 being no symptoms and 10 being the baseline, or initial symptoms. Results Of the patients in the T2 high group, 13 out of 14 (92.9%) patients demonstrated complete necrosis of the predominant fibroids. The mean volume reduction rates of the predominant fibroids in the T2 high group was 61.7% at three months after UAE, which was significantly higher than the volume reduction rates of 42.1% noted in the control group (p < 0.05). Changes in symptom scores for menorrhagia and dysmenorrhea after UAE (baseline score minus follow-up score) were 4.9 and 7.5 in T2 high group and they were 5.0 and 7.7 in control group, suggesting a significant resolution of symptoms (p < 0.01) in both groups but no significant difference between the two groups. Conclusion UAE is effective for uttering fibroids showing high SI on T2WI. The mean volume reduction rate of the predominant fibroids three months after UAE was greater in the T2 high group than in the control group.

Comparison of treatment outcomes between balloon-occluded retrograde transvenous obliteration and transjugular intrahepatic portosystemic shunt for gastric variceal bleeding hemostasis

Both balloon‐occluded retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunt (TIPS) are considered effective treatments for gastric variceal bleeding (GVB). In this study, outcomes of these two procedures were compared in managing patients with GVB.

Randomized Controlled Trial Comparing Radiologic Pigtail-Retained Gastrostomy and Radiologic Mushroom-Retained Gastrostomy

PURPOSEnTo prospectively compare 2 different types of percutaneous fluoroscopic gastrostomy procedures (pigtail-retained gastrostomy [PG] vs mushroom-retained gastrostomy [MG]).nnnMATERIALS AND METHODSnBetween March 2014 and February 2016, 100 patients were randomly assigned to receive 14-F PG or 20-F MG. Block randomization (block size 4) was performed, and sample size was calculated to assess the difference in minor complications. One patient withdrew from the study after allocation. Baseline characteristics were not significantly different between groups (P > .05). Technical success, defined as successful placement of gastrostomy tube, and procedural complications were evaluated. Procedural complications were divided into major and minor complications according to the Society of Interventional Radiology criteria.nnnRESULTSnTechnical success rate was 100%. In the PG group, the major complication rate was 2% (1 of 50); 1 patient had a misplaced PG in the peritoneal cavity between the gastric and abdominal walls and developed peritonitis that had to be surgically treated. The minor complication rate was 34% (17 of 50) in the PG group. In the MG group, the major complication rate was 0%, and the minor complication rate was 12.2% (6 of 49). The most common minor complication was tube occlusion. Minor complication rate was significantly higher in the PG group (Pxa0= .016). Mean fluoroscopy time was significantly longer in the MG group (Pxa0= .013).nnnCONCLUSIONSnBoth PG and MG demonstrated high technical success rates in all indications. MG had lower complication rates than PG at the cost of an increase in fluoroscopy times.

Crushed stent with acute occlusion in superficial femoral artery after enhanced external counterpulsation.

A 60-year-old woman with hypertension was admitted because of the abrupt onset of resting pain in the left thigh, starting 2 weeks earlier. Three years ago, she received self-expanding nitinol stent implantation (overlapping stents, proximal 6xa0× 80 mm and distal 6xa0× 150 mm, SMART, Cordis

Catheter-directed Sclerotherapy for Ovarian Endometrioma: Short-term Outcomes

Purpose To evaluate the effectiveness of catheter-directed sclerotherapy (CDS) with 95% ethanol in patients with primary or recurrent ovarian endometriomas. Materials and Methods In this prospective study, 14 participants (mean age, 32 years; range, 20-44 years) who underwent CDS for ovarian endometrioma from March 2015 to December 2017 were evaluated. Diagnosis was based on symptoms and imaging studies. To assess the impact of CDS on ovarian reserve, serum anti-Müllerian hormone (AMH) was measured before CDS and 6 months after CDS. Serum cancer antigen 125 (CA-125) levels were also measured at the same time points. Follow-up US was performed 1, 3, and 6 months after CDS and biannually thereafter to monitor potential cyst size change and recurrence. Comparison of AMH, CA-125, and cyst size before and after CDS was performed by using the paired t test or Wilcoxon signed-rank test. Results Mean endometrioma size decreased from 5.8 cm ± 2.2 to 1.1 cm ± 1 (P ˂ .001). During a mean follow-up of 12.7 months (range, 6.1-23.0 months), there were no recurrences of endometrioma. Pain was relieved in all participants, with a decrease in serum CA-125 level (P = .001). There was no difference in serum AMH level before and 6 months after CDS, indicating well-preserved ovarian function (4.29 ng/mL ± 2.47 vs 4.36 ng/mL ± 1.94, respectively; P > .875). There were no procedure-related complications. Conclusion Catheter-based sclerotherapy with 95% ethanol can lead to better short-term clinical outcomes and well-preserved ovarian function for patients with endometriomas.

Uterine Artery Embolization for Pedunculated Subserosal Leiomyomas: Evidence of Safety and Efficacy

PURPOSEnTo evaluate safety and efficacy of uterine artery embolization (UAE) for pedunculated subserosal (PS) leiomyomas.nnnMATERIALS AND METHODSnOf 1,069 patients who underwent UAE for symptomatic leiomyomas or adenomyosis from 2007 to 2016, 55 patients (mean age 40.3 y ± 4.8) with 66 PS leiomyomas (mean diameter 6.61 cm ± 2.04) were enrolled. Each PS leiomyoma was categorized into 1 of 2 groups: high-risk PS leiomyoma (stalk diameter < 25% of diameter of leiomyoma) and low-risk PS leiomyoma (stalk diameter 25%-50% of diameter of leiomyoma). MR imaging was performed 3 months after UAE. Rates of infarction and volume reduction were compared between PS leiomyomas and non-PS dominant leiomyomas and between high-risk and low-risk PS leiomyomas. Complications related to PS leiomyomas were assessed.nnnRESULTSnAt a median follow-up of 96 days (range, 36-348 d) after UAE, none of the patients (0%) had complications related to PS leiomyomas, even among high-risk cases. Mean volume reductions of 38.2% and 38.4% were achieved for PS leiomyomas and non-PS dominant leiomyomas, respectively (Pxa0= .953). There were 3 (5.5%) minor adverse events, but none were related to PS leiomyoma. There was no significant difference in volume reduction and infarction rates between low-risk and high-risk PS leiomyomas.nnnCONCLUSIONSnUAE is safe and effective in patients with PS leiomyomas even for high-risk cases (stalk diameter < 25% of diameter of leiomyoma). PS leiomyoma should not be considered a contraindication for UAE.

The efficacy of combination of induction chemotherapy and irreversible electroporation ablation for patients with locally advanced pancreatic adenocarcinoma.

Irreversible electroporation (IRE) is a non‐thermal focal therapy that utilizes high voltage electric pulses to permanently rupture the cellular membrane and induce cell death. In this multi‐center study, we evaluated the safety and efficacy of IRE in patients with locally advanced pancreatic cancer (LAPC).

Real-time simultaneous endoscopic combined intrarenal surgery with intermediate-supine position: Washout mechanism and transport technique

Endoscopic combined intrarenal surgery (ECIRS) with simultaneous retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) has been proposed as a new surgical treatment to overcome the disadvantage of RIRS and PCNL monotherapies in the treatment of renal stone. One of advantages of ECIRS is that it can increase stone-free rates in complex renal stone within single-session. Intermediate-supine position in real-time simultaneous ECIRS can prevent an anesthesiologic problem, and patients burden is small even for long-term operation. Thus, we will share the experience and advantages of real-time simultaneous ECIRS and introduce techniques to increase the stone-free rate.