Se Hwan Kwon

Transcatheter Ovarian Vein Embolization Using Coils for the Treatment of Pelvic Congestion Syndrome

PurposeTo evaluate the therapeutic effectiveness of ovarian vein embolization using coils for pelvic congestion syndrome (PCS), a common cause of chronic pelvic pain in multiparous women.MethodsBetween November 1998 and June 2005, 67 patients were diagnosed with PCS and underwent ovarian vein coil embolization. Through medical records and telephone interviews, the pre-embolization pain level and post-embolization pain control were assessed. In addition, in those cases where pain persisted after embolization or where patients were dissatisfied with the procedure, additional treatments and subsequent changes in pain scores were also analyzed. Evaluation after coil embolization was performed within 3–6 months (nxa0=xa03), 6 months to 1 year (nxa0=xa07), 1–2 years (nxa0=xa013), 2–3 years (nxa0=xa07), 3–4 years (nxa0=xa07), 4–5 years (nxa0=xa013), or 5–6 years (nxa0=xa017).ResultsAmong a total of 67 patients, 82% (55/67) experienced pain reduction after coil embolization, were satisfied with the procedure, and did not pursue any further treatment. Twelve patients (18%, 12/67) responded that their pain level had not changed, or had become more severe. Among them, 9 patients were treated surgically and the remaining 3 patients remained under continuous drug therapy.ConclusionOvarian vein embolization using coils is a safe and effective therapeutic method for treatment of PCS. It is thought that surgical treatment should be considered in cases where embolization proves ineffective.

Prospective Study of Transcatheter Arterial Chemoembolization for Unresectable Hepatocellular Carcinoma: An Asian Cooperative Study between Japan and Korea

PURPOSEnTo evaluate the safety and efficacy of transcatheter arterial chemoembolization used for the treatment of unresectable hepatocellular carcinoma (HCC) with an Asian cooperative prospective study between Japan and Korea.nnnMATERIALS AND METHODSnPatients with unresectable HCC unsuitable for curative treatment or with no prior therapy for HCC were enrolled. The patients underwent transcatheter arterial chemoembolization with emulsion of Lipiodol and anthracycline agent, followed by embolization with gelatin sponge particles, which was repeated on an as-needed basis. The primary endpoint was 2-year survival rate, and the secondary endpoints were adverse events and response rate.nnnRESULTSnThe 2-year survival rate of 99 patients was 75.0% (95% confidence interval, 65.2%-82.8%). The median time-to-progression was 7.8 months, and the median overall survival period was 3.1 years. Of 99 patients, 42 (42%) achieved a complete response, and 31 (31%) had a partial response. The response rate was 73% using modified Response Evaluation Criteria in Solid Tumors. The grade 3-4 toxicities included increased alanine aminotransferase level in 36%, increased aspartate aminotransferase level in 35%, thrombocytopenia in 12%, and abdominal pain in 4% of patients. All other toxicities were generally transient.nnnCONCLUSIONSnAsian transcatheter arterial chemoembolization demonstrated sufficient safety and reasonable efficacy as a standard treatment for unresectable HCC. These results could be useful as reference data for future trials of transcatheter arterial chemoembolization.

Interventional Management of Gastrointestinal Fistulas

Gastrointestinal (GI) fistulas are frequently very serious complications that are associated with high morbidity and mortality. GI fistulas can cause a wide array of pathophysiological effects by allowing abnormal diversion of the GI contents, including digestive fluid, water, electrolytes, and nutrients, from either one intestine to another or from the intestine to the skin. As an alternative to surgery, recent technical advances in interventional radiology and percutaneous techniques have been shown as advantageous to lower the morbidity and mortality rate, and allow for superior accessibility to the fistulous tracts via the use of fistulography. In addition, new interventional management techniques continue to emerge. We describe the clinical and imaging features of GI fistulas and outline the interventional management of GI fistulas.

Radiologic Placement of Uncovered Stents for the Treatment of Malignant Colorectal Obstruction

PURPOSEnTo evaluate the effectiveness of radiologic placement of uncovered stents for the treatment of malignant colorectal obstruction.nnnMATERIALS AND METHODSnFrom May 2003 to January 2008, 116 radiologic placements of uncovered stents were attempted in 99 patients (M:F, 59:40; mean age, 65 years) with malignant colorectal obstructions. The location of stent insertion, technical and clinical success, complication rates, and patency rates of the stents in a palliative group were also evaluated. In the palliative group, the follow-up period was 2-455 days (mean, 100 +/- 129 days).nnnRESULTSnRadiologic stent placement was technically successful in 110 of 116 cases (94.8%). Fifty cases of stent placement were preoperative (45.5%, 50 of 110) and 60 (54.5%, 60 of 110) were performed with palliative intents. In five of six failed cases, the replacement of the stent was later performed with the assistance of colonoscopy. One patient underwent an emergency operation. In 98 of 110 cases, the symptoms of obstruction were relieved, for a clinical success rate of 89.1%. Of the 50 stents that were placed successfully with preoperative intent, 44 patients underwent surgery within a mean of 10.3 days. In the palliative group, the patency rates were 89.7% at 1 month, 85.6% at 3 months, 80.8% at 6 months, and 72.7% at 12 months.nnnCONCLUSIONSnThe radiologic placement of uncovered stents for the treatment of malignant colorectal obstruction is feasible and safe and provides acceptable clinical results not only for preoperative decompression but also for palliative cases, especially in left-sided colonic obstructions.

Efficacy of single-session percutaneous drainage and 50% acetic Acid sclerotherapy for treatment of simple renal cysts.

PurposeTo evaluate the efficacy and long-term results of single-session 50% acetic acid sclerotherapy for the treatment of simple renal cysts, and to compare the therapeutic results of 5 and 20 min sclerosant dwell techniques.MethodsDuring the past 9 years, 50% acetic acid sclerotherapy was performed on 67 cysts in 66 patients. An acetic acid volume corresponding to a mean of 23% of the aspirated cyst volume was injected into the cysts. A 20 min dwell time with position changes was performed in 32 cysts (31 patients; group I) and 8% of volume for a 5 min dwell time in 35 cysts (35 patients; group II). Three- and 6-month sonographic or CT follow-up was performed for a minimum of 1 year. Complete regression was defined as no remaining cyst measurable on sonography with or without a scar at the renal cortex. Partial regression was defined as a decreased cyst volume compared with that before sclerotherapy. The Mann-Whitney U-test was used to compare the therapeutic results between the two groups.ResultsFor 67 simple renal cysts, complete regression on follow-up was observed in 21 of 32 cysts (66%; group I) and 22 of 35 cysts (63%; group II); the remaining 24 cysts all showed partial regression. The partial reduction rate of the cyst’s volume was 97.4% (91.3–99.4%) in group I and 96.9% (90.8–99.5 %) in group II. There were no procedure-related major complications, and no statistically significant differences in the complete regression and partial volume reduction rates between the two groups (p > 0.05).ConclusionFifty percent acetic acid is an effective and safe sclerosing agent for simple renal cysts. Fifty percent acetic acid sclerotherapy with a 5 min sclerosant dwell time, using a volume of about 10% of the aspirated volume, is sufficient for satisfactory results of simple renal cyst sclerotherapy.

Successful Interventional Treatment of a Spontaneous Right Common Iliac Artery Dissection Extending Retrogradely into the Left External Iliac Artery

Spontaneous dissection of the iliac artery is very rare. In the present report, a patient presented with progressive right lower extremity pain and claudication and received a diagnosis of the even rarer condition of a spontaneous right common iliac artery dissection extending retrogradely into the contralateral left external iliac artery through the lower abdominal aorta. Treatment with primary stent-graft and stent placement followed by balloon angioplasty was successful.

Percutaneous placement of self-expandable metallic stents in patients with obstructive jaundice secondary to metastatic gastric cancer after gastrectomy.

Objective To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. Materials and Methods Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated. Results The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL ± 6.8 before stent insertion, decreased to 4.58 mg/dL ± 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 ± 99 days, and the median patient survival was 179 ± 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009). Conclusion Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.

Congenitally corrected transposition of the great arteries in a 59-year-old man: ECG-gated 64-slice MDCT findings

A 59-year-old male patient was admitted to our hospital because of mild exertional dyspnea. A chest radiograph showed mesocardia (Fig. 1). The electrocardiogram showed a sinus rhythm with a rate 59 bpm, first degree AV block and T-wave inversion in the V2-6 leads. Physical examination revealed a blood pressure of 120/80 mm Hg and a respiratory rate of 20 bpm. There was no history of trauma, diabetes, or any operations. The patient also had no connective tissue disorders or any other systemic anomalies, and there was no significant family history of disease. ECG-gated 64-slice multidetector computed tomography (MDCT) was performed. The ascending aorta was anterior and to the left of the main pulmonary artery (Fig. 2a). The aorta arises from the ventricle that is positioned on the left. The noncoronary cusp was anterior and to the left of both the left and right coronary cusps (Fig. 2b). The left sided ventricle has a muscular outflow tract (infundibulum) that separated the atrioventricular and aortic valves (Fig. 3). Four-chamber view from 64-slice MDCT showed a normal atrial situs but abnormal apical displacement of the left sided atrioventricular valve (Fig. 4a). Moreover, the left sided

Multiple Giant Coronary Artery Aneurysms Due to Kawasaki Disease: Electrocardiogram-Gated 64-Slice Multidetector Row Computed Tomography Findings

A 12-year-old boy underwent multidetector row computed tomography (MDCT) angiography. At the age of 4.5 years, he was transferred to our institution after 7 days of high fever. Kawasaki disease was diagnosed together with multiple aneurysms of the right coronary artery (RCA) and the proximal left anterior descending coronary artery (LAD). Thereafter, echocardiography and selective coronary angiography were serially performed to monitor coronary wall changes. Despite intravenous gamma globulin, progressive giant coronary artery aneurysms developed. On the day of the boy’s admission, a standard 12-lead electrocardiogram showed a sinus rhythm of 75 bpm and no ischemia or dysrhythmias. Electrocardiogram-gated 64-slice MDCT angiography showed multiple giant coronary artery aneurysms of the RCA, left main artery, and proximal LAD (Figs. 1, 2 and Supplement 1–4). Kawasaki disease is an acute self-limiting vasculitis of unknown etiology that occurs predominantly in infants and

Partially unroofed coronary sinus found incidentally in adult patient

MOTS CLÉS Sinus coronaire ; Cardiopathie congénital ; Multidétecteur tomodensitométrie A 65-year-old woman visited our institution due to recurrent mild atypical chest pain and dizziness. The patient denied having any systemic disease in the past. Twelvelead surface electrocardiogram (ECG) showed normal sinus rhythm without evidence of chamber enlargement. Chest radiogram revealed clear lungs with normal heart size (not shown). Cardiac ECG-gated 64-slice multidetector-row computed tomography (MDCT) was arranged for further evaluation. Cardiac computed tomography (CT) was performed using an ECG-gated 64-slice MDCT scanner (Brilliance 64, Philips Medical Systems, Best, The Netherlands). The coronary sinus (CS) was partially unroofed and communicated with the left atrium (Figs. 1 and 2). The CS also drained normally into the right atrium, creating a mild left-to-right interatrial shunt through the CS. The interatrial septum was intact (Videos 1 and 2). No other congenital anomalies, including persistent left superior vena cava (LSVC), were identified by CT. Medical treatment alone controlled her symptoms and she was discharged. Unroofed CS is a rare congenital cardiac anomaly, in which there is partial (focal or fenestrated) or complete absence of the CS roof, which results in communication between the CS and the left atrium. Unroofed CS is the rarest type of atrial septal defect and is associated strongly with persistent LSVC, with or without a connection