Seung Boo Yang

Sonographic Differentiation of Benign and Malignant Cystic Lesions of the Breast

The purpose of this study was to subdivide the types of sonographic findings of benign versus malignant cystic masses and to determine appropriate patient care according to the sonographic findings with pathologic correlation.

Magnetic Resonance Imaging of Breast Cancer and Correlation with Prognostic Factors

Background: Prognostic factors of breast cancer have been used for the prediction of clinical outcome or selection of patients for complementary treatment. Some of the imaging features of breast cancer, e.g. magnetic resonance imaging (MRI), are associated with these prognostic factors. Purpose: To evaluate the relationship between dynamic enhanced MR features and prognostic factors of clinical outcome of breast cancer. Material and Methods: A total of 136 patients with 151 breast cancers underwent 1.5T dynamic MR imaging with the use of a dynamic T1-weighted three-dimensional fast low-angle shot (FLASH) subtraction imaging technique. Morphological and kinetic analyses of MR features were evaluated using the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) MRI lexicon. Pathological prognostic factors were correlated with MR imaging characteristics, including tumor size, histological grade, lymph node status, expression of estrogen receptor (ER), expression of progesterone receptor (PR), expression of c-erbB2, determination of Ki-67 index, and microvascular density (MVD), using univariate and multivariate statistical analyses. Results: Based on univariate and multivariate analyses, spiculated tumor margins correlated significantly with lower histological grade (I–II) and positive PR expression. Rim enhancement was significantly correlated with high histological grade, presence of axillary lymph node metastasis, large tumor size, increased Ki-67 index, and increased MVD. Early peak enhancement, as seen on the first scan after contrast medium injection, was correlated with negative ER expression. Conclusion: The presence of a lesion with a spiculated margin may predict a relatively good prognosis, and the presence of a lesion with rim enhancement may predict a relatively poor prognosis.

Selective Uterine Artery Embolization for Management of Interstitial Ectopic Pregnancy

Interstitial ectopic pregnancy is a rare condition of pregnancy and may be very dangerous if not identified and treated urgently. We report a case of successful treatment of an interstitial pregnancy using selective uterine artery embolization. A 27-year-old woman with interstitial pregnancy was treated by uterine artery embolization after failure of systemic methotrexate treatment. Her serum beta-human chorionic gonadotropin (β-hCG) was undetectable one month after the therapeutic embolization and transvaginal sonography 31 days after embolization showed normal endometrium and cornu. The patient achieved a normal pregnancy eight months after embolization.

Use of a Rösch-Uchida Needle for Recanalization of Refractory Dialysis-Related Central Vein Occlusion

OBJECTIVE The purpose of this study was to evaluate our experience with the use of a Rösch-Uchida needle technique to recanalize central vein occlusion that cannot be traversed with a guidewire. MATERIALS AND METHODS We retrospectively evaluated 33 recanalization procedures performed with a Rösch-Uchida needle on 20 men and 13 women with central vein occlusion during the period January 1999-December 2008. The occlusions were in the subclavian vein (n = 29) and the brachiocephalic vein (n = 4). A 9- or 10-French Rösch-Uchida introducer sheath was advanced centrally to abut the occlusion. The Rösch-Uchida needle was directed and advanced toward a transfemoral angiographic catheter placed on the central side of the occlusion. After passage of a guidewire through the occlusion, balloon angioplasty and stent insertion were performed. The outcome measures evaluated were technical success rate, primary and secondary patency, and complication rate. RESULTS The mean occlusion length was 1.73 +/- 0.8 cm. The rate of technical success of recanalization was 93.9% (31 of 33 procedures). The 3-, 6-, and 12-month primary patency rates were 43.6%, 24%, and 8%, and the 3-, 6-, and 12-month secondary patency rates were 77.4%, 68.8% and 55.9%. One patient reported shoulder pain lasting 2 weeks, which resolved with conservative treatment. CONCLUSION Use of a Rösch-Uchida needle to recanalize central vein occlusion refractory to a traditional procedure is feasible and safe and can preserve the involved extremity for long-term hemodialysis.

Fogarty balloon application technique in dislodging residual thrombus on the single sheath entry point at the apex of thrombosed loop grafts.

PURPOSE We aimed to evaluate the effectiveness of the Fogarty balloon application in dislodging residual thrombus at the sheath entry point in a graft by using single apex puncture to declot thrombosed hemodialysis loop grafts. MATERIALS AND METHODS The apex puncture technique was used in 520 cases to declot 376 hemodialysis loop grafts (male/female, 150/226; mean age, 58 years). The Fogarty balloon application technique, which uses the Fogarty balloon to the apex, was used to compress or displace the sheath entry point residual thrombus that did not wash away spontaneously by arterial . The frequency of the use of the technique, technical success, complications, and primary patency were evaluated. RESULTS Sheath entry point thrombi were washed away spontaneously in 281 of 520 procedures (54%), and 184 procedures (35.4%) underwent a Fogarty balloon application. For a variety of reasons, the Fogarty balloon application technique was not performed in the remaining 55 procedures (10.6%). The technique was successful in 171 of 184 procedures (92.9%), and failed in 13 procedures, which required additional sheath insertion for the removal of sheath entry point thrombus. Complications included sheath dislodgment from the apex during Fogarty ballooning in one procedure and puncture site bleeding in one procedure. Primary patency was 60%, 35.2%, and 15.3% at 3, 6, and 12 months postprocedure, respectively. CONCLUSION The Fogarty balloon application technique is safe and useful for the removal of residual thrombus at the apical, peri-sheath zone when declotting occluded hemodialysis loop grafts.

Thromboaspiration of arteriovenous hemodialysis graft thrombosis using Desilets-Hoffman sheath: single-center experience

Purpose The purpose of this study was to evaluate the feasibility, efficacy and safety of percutaneous thromboaspiration with a 7F Desilets-Hoffman sheath compared with previously established percutaneous mechanical thrombectomy techniques in occluded hemodialysis grafts. Materials and Methods One thousand three hundred five patients (767 women, 538 men; mean age, 61.04±13.09 years; mean graft age, 36.64±30.80 mo) with 2,531 episodes of hemodialysis graft thrombosis underwent percutaneous thromboaspiration with a 7F Desilets-Hoffman sheath using criss-cross or apex puncture technique. Technical success rate, procedure time, complications and patency rates were analyzed. Results Technical success was achieved in 2,426 of 2,531 procedures (95.9%). Average procedure time of the intervention was 42.87±22.77 minutes. Primary patency rate was 61.9% at 3 mo, 41.2% at 6 mo and 19.6% at 1 year. Major complications occurred in 4.1% of cases (23 graft outflow rupture; 68 arterial emboli; 1 arterial dissection; 3 symptomatic pulmonary embolism; 1 stent migration) and minor complications occurred in 7.7% of cases (196 cases). These results were comparable to previously reported mechanical thrombectomy techniques in occluded hemodialysis grafts. Conclusions Percutaneous thromboaspiration of occluded hemodialysis grafts with a Desilets-Hoffman Sheath is an effective and safe method.

Aberrant Ovarian Artery Arising from the Common Iliac Artery: Case Report

A 46-year-old Vietnamese woman received embolization therapy in order to control postpartum hemorrhage. Angiography revealed an aberrant ovarian artery arising from the right common iliac artery. Superselective catheterization and subsequent embolization of the aberrant ovarian artery and bilateral uterine arteries were performed. Precise knowledge of the anatomic variations of the ovarian artery is important for successful embolization.

Comparison of Open-Cell Stent and Closed-Cell Stent for Treatment of Central Vein Stenosis or Occlusion in Hemodialysis Patients

Background Central vein stenosis or occlusion is a common complication that can lead to significant morbidity and dysfunction of access in the hemodialysis patient. More lesions can develop over time, and preserving access becomes a challenge as life expectancy of the hemodialysis patient increases. Objectives The goal was to compare long-term results and determine the outcomes of open-cell stent versus closed-cell stent for central vein stenosis or occlusion in hemodialysis patients. Patients and Methods From 1997 to 2015, in 401 hemodialysis patients, stent placement for central vein stenosis or occlusion was performed if balloon angioplasty was unsatisfactory, due to elastic recoil or occurrence of restenosis within 3 months. When thrombus was present, primary stenting was performed. A total of 257 open-cell stents and 144 closed-cell stents were used. Angiographic findings including lesion site, central vein stenosis or occlusion, and presence of thrombosis and complication were evaluated. Primary patency rate and mean patency rate of the stent were compared between two stent groups by Kaplan-Meier survival analysis. Results For the open-cell stent group, 159 patients were diagnosed as central vein stenosis and 98 were occlusion. For the closed-cell stent group, 78 were stenosis and 66 were occlusion. There were two complications for central migration and two for procedure-related vein rupture. Open-cell stents and closed-cell stents had mean patency rates of 10.9 ± 0.80 months and 8.5 ± 10.87 months, respectively (P = 0.002). Conclusion The open-cell stent is effective and its performance is higher than that obtained with the closed-cell stent for treating central vein stenosis or occlusion in hemodialysis patients.