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Zeng CH, Cao CW, Shin JH, Kim GH, Kim SH, Lee SR, Lee SW. Safety and Clinical Outcomes of Two-Session Catheter-Directed Sclerotherapy Using Ethanol for Endometrioma. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03700-5. [PMID: 38528174 DOI: 10.1007/s00270-024-03700-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE To evaluate the safety and clinical outcome of two-session catheter-directed sclerotherapy (CDS) with 99% ethanol in patients with endometrioma. MATERIALS AND METHODS This prospective study was approved by the institutional review board with written informed consent obtained from all participants and was registered on clinicaltrial.gov. Consecutive patients with ovarian endometrioma between June 2020 and March 2023 were prospectively evaluated for two sessions of CDS. After successful transvaginal ultrasound-guided puncture of the endometrioma, the biopsy needle was exchanged for a 7- or 8.5-F catheter for aspiration and ethanol injection. The catheter was retained in situ for a second session the next day. Endometrioma volume was measured on ultrasound before and 1, 3, and 6 months after CDS, and volume reduction ratio (VRR) was calculated. Serum anti-Müllerian hormone (AMH) was measured before and 6 months after CDS to assess ovarian reserve. RESULTS Thirty-one endometriomas in 22 patients (mean age, 31.0 years; range, 19-44 years) were treated; 28 endometriomas were successfully treated with two-session CDS, while one session was incomplete in three endometriomas in three patients due to contrast medium leakage or pain. Minor procedure-related complications developed in four patients and resolved spontaneously before discharge on the same day of the second session. No recurrence was identified during follow-up. At the 6-month follow-up, the mean endometrioma diameter decreased from 5.5 ± 1.7 to 1.4 ± 0.9 cm (P < 0.001), and the serum AMH level was lowered without statistical significance (1.37 ± 0.96 ng/mL vs. 1.18 ± 0.92 ng/mL; P = 0.170). VRRs at 1, 3, and 6 months after CDS were 84.3 ± 13.7%, 94.3 ± 5.8%, and 96.4 ± 4.7%, respectively. CONCLUSION Two-session CDS with 99% ethanol is safe, feasible, and effective for treating endometrioma with the ovarian function well preserved.
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Affiliation(s)
- Chu Hui Zeng
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Chuan Wu Cao
- Department of Integrated Traditional Chinese and Western Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sung Hoon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sa Ra Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Shin Wha Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Kim Y, Kim JH, Kim JH, Kim GH, Ko HK, Chu HH, Shin JH, Gwon DI, Ko GY. Stent-graft placement for hepatic artery bleeding after pancreaticobiliary surgery: long-term clinical outcomes. J Vasc Interv Radiol 2024:S1051-0443(24)00243-4. [PMID: 38519001 DOI: 10.1016/j.jvir.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 03/24/2024] Open
Abstract
PURPOSE To evaluate the safety and long-term clinical outcomes of stent-graft placement to stop hepatic artery bleeding after pancreaticobiliary surgery. MATERIALS AND METHODS Outcomes were retrospectively evaluated in 61 patients (50 men, 11 women; mean age, 63) who underwent stent-graft placement for delayed arterial bleeding (after 24 hours) after pancreaticobiliary surgery from 2006 to 2023. Bleeding sites included the gastroduodenal artery stump (n=54), the common or proper hepatic artery (n=5), and right hepatic artery (n=2). The stent-graft used were Viabahn (n = 27), ComVi (n = 11), Jostent (n = 3), Covera (n = 11), and LifeStream (n = 7) vascular covered stents. Technical and clinical success, and adverse event (AE) were evaluated. After stent-graft placement, overall survival (OS), hemorrhage-free survival (HFS), and stent patency were evaluated. RESULTS The technical and clinical success rates of stent-graft placement were 97% and 93%, respectively. The severe AE rate was 12% and was significantly higher in patients who underwent pylorus-sacrificing than pylorus-preserving surgery (P = 0.001). None of the severe AEs were associated with patient mortality. Median OS after stent-graft placement was 854 days and median HFS was 822 days. The 1-, 3-, 5-, and 10-year stent patency rates were 87%, 84%, 79%, and 72%, respectively. CONCLUSION Stent-graft placement was safe and provided long-term control of hepatic artery bleeding after pancreaticobiliary surgery.
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Affiliation(s)
- Yonghun Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Radiology, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Ji Hoon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Radiology, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heung-Kyu Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Alali M, Cao C, Shin JH, Jeon G, Zeng CH, Park JH, Aljerdah S, Aljohani S. Preliminary report on embolization with quick-soluble gelatin sponge particles for angiographically negative acute gastrointestinal bleeding. Sci Rep 2024; 14:6438. [PMID: 38499668 PMCID: PMC10948793 DOI: 10.1038/s41598-024-56992-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/13/2024] [Indexed: 03/20/2024] Open
Abstract
Prophylactic embolization is usually performed using gelatin sponge particles, which are absorbed within several weeks, for managing angiographically negative gastrointestinal bleeding. This study aimed to evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) with quick-soluble gelatin sponge particles (QS-GSP) that dissolve in less than 4 h for treating angiographically negative gastrointestinal bleeding. We included ten patients (M:F = 7:3; mean age, 64.3 years) who underwent prophylactic TAE with QS-GSP for angiographically negative acute gastrointestinal bleeding between 2021 and 2023. The technical success rate of TAE, clinical outcomes focusing on rebleeding, and procedure-related complications were evaluated. The embolized arteries were the gastroduodenal (n = 3), jejunal (n = 4), and ileal (n = 3) arteries. QS-GSP (150-350 µm or 350-560 µm) were used alone (n = 8) or in combination with a coil (n = 1). A 100% technical success rate was accomplished. In 1 patient (10%), rebleeding occurred 2 days after prophylactic TAE of the gastroduodenal artery, and this was managed by repeat TAE. There were no procedure-related complications. The use of QS-GSP for prophylactic TAE appears to be safe and effective for controlling bleeding among patients with angiographically negative gastrointestinal bleeding. There were no cases of related ischemic complications of the embolized bowels likely attributable to recanalization of the affected arteries following biodegradation of QS-GSP.
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Affiliation(s)
- Meshari Alali
- Department of Radiology, Majmaah University, Almajmaah, Saudi Arabia
| | - Chuanwu Cao
- Department of Radiology, The Tenth People's Hospital, Shanghai, China
| | - Ji Hoon Shin
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Gayoung Jeon
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Chu Hui Zeng
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jung-Hoon Park
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Shakir Aljerdah
- Department of Radiology, Najran University, Najran, Saudi Arabia
| | - Sultan Aljohani
- Department of Radiology, King Salman Bin Abdulaziz Medical City, Medina, Saudi Arabia
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Hwang H, Kim JH, Ko E, Kim JY, Ko HK, Gwon DI, Shin JH, Kim GH, Chu HH. Chemoembolization as First-Line treatment for hepatocellular carcinoma invading segmental portal vein with tumor burden limited to a monosegmental level. Br J Radiol 2024:tqae052. [PMID: 38445658 DOI: 10.1093/bjr/tqae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/18/2024] [Accepted: 02/29/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVES To evaluate the safety and effectiveness of chemoembolization for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) confined to a monosegment of the liver. METHODS A total of 192 treatment-naive patients who received chemoembolization between March 2008 and January 2023 as a first-line treatment for locally advanced HCC with PVTT limited to a monosegment were retrospectively analyzed. Overall survival (OS) and the identification of pretreatment risk factors related to OS were investigated using Cox regression analysis. Complications, radiologic tumor response, and progression-free survival (PFS) following chemoembolization were investigated. RESULTS After chemoembolization, the 1-, 3-, and 5-year OS rates were 86%, 48%, and 39%, respectively, and the median OS was 33 months. Multivariable analyses revealed four significant pretreatment risk factors: infiltrative HCC (p = 0.02; HR, 1.60), beyond the up-to-11 criteria (p = 0.002; HR, 2.26), Child-Pugh class B (p = 0.01; HR, 2.35), and serum AFP ≥400 ng/mL (p = 0.01; HR, 1.69). The major complication rate was 5%. Of the 192 patients, 1 month after chemoembolization, 35% achieved a complete response, 47% achieved a partial response, 11% had stable disease, and 7% showed progressive disease. The median PFS after chemoembolization was 12 months. CONCLUSIONS Chemoembolization shows high safety and efficiency, and contributes to improved survival in patients with HCC with PVTT confined to a monosegment. Four risk factors were found to be significantly associated with improved survival rates after chemoembolization in patients with HCC with PVTT confined to a monosegment.
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Affiliation(s)
- Hyeonseung Hwang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunbyeol Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong-Yeon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heung-Kyu Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim GH, Kim JH, Shim JH, Kim SY, Kim PH, Ko HK, Gwon DI, Shin JH, Lee SJ, Chu HH, Won HJ, Shin YM, Kim N. Chemoembolization versus radiofrequency ablation for single small (≤ 3 cm) hepatocellular carcinoma: a propensity score matching analysis. Eur Radiol 2024:10.1007/s00330-024-10634-6. [PMID: 38329504 DOI: 10.1007/s00330-024-10634-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES To compare the efficacy of transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) for patients with single small (≤ 3 cm) hepatocellular carcinoma (HCC) and preserved liver function (Child-Pugh class A). MATERIALS AND METHODS The clinical features of treatment-naïve patients who underwent TACE and RFA as first-line treatment were balanced through propensity score matching (PSM). The primary endpoint was overall survival (OS), and the secondary endpoints were local tumor recurrence (LTR) and recurrence-free survival (RFS). RESULTS The analysis included 440 patients who received TACE, and 430 patients who received RFA. After PSM adjustment (323 pairs), the 5- and 10-year OS rates were 81% and 61%, respectively, in patients who underwent RFA, and 77% and 51%, respectively, for patients who underwent TACE (p = 0.021). Subgroup analyses showed that OS, LTR, and RFS were homogeneously better in the RFA group. CONCLUSION RFA was associated with better survival outcomes than TACE in patients with single small HCC and preserved liver function. CLINICAL RELEVANCE STATEMENT This large-scale comparative study provides evidence that radiofrequency ablation has a better overall survival rate than chemoembolization for small (≤ 3 cm) hepatocellular carcinomas. KEY POINTS • The relative effectiveness of transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) for early HCC is unclear. • Overall survival rate was significantly higher in the RFA group. • The effects of RFA on overall survival, local tumor recurrence, and recurrence-free survival were homogeneously better in all subgroups.
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Affiliation(s)
- Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
| | - Ju Hyun Shim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Heung-Kyu Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - So Jung Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Hyung Jin Won
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Yong Moon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Nayoung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim SH, Kim JH, Kim GH, Kim JH, Ko HK, Chu HH, Shin JH, Gwon DI, Ko GY, Yoon HK, Aljerdah S, Kim N. Intermediate-stage (BCLC stage B) infiltrative hepatocellular carcinoma: safety and efficacy of chemoembolization. Eur Radiol 2023; 33:8736-8744. [PMID: 37466704 DOI: 10.1007/s00330-023-09961-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES To evaluate the safety and efficacy of chemoembolization in patients with intermediate-stage infiltrative Hepatocellular carcinoma (HCC). MATERIALS AND METHODS This retrospective study evaluated outcomes in treatment-naïve patients who received chemoembolization as first-line treatment for intermediate-stage infiltrative HCC between 2002 and 2022. Of the 2029 treatment-naïve patients who received chemoembolization as first-line treatment for intermediate-stage HCC, 244 (12%) were identified as having the infiltrative type. After excluding two patients lost to follow-up, 242 patients were evaluated. RESULTS Median post-chemoembolization overall survival (OS) was 16 months. Multivariable Cox analysis identified four factors predictive of OS: Child-Pugh class B (hazard ratio [HR], 1.84; p = 0.001), maximal tumor size ≥ 10 cm (HR, 1.67; p < 0.001), tumor number ≥ 4 (HR, 1.42; p = 0.037), and bilobar tumor involvement (HR, 1.64; p = 0.003). These four factors were used to create pretreatment prediction models, with risk scores of 0-1, 2-4, and 5-7 defined as low, intermediate, and high risk, respectively. Median OS times in these three groups were 34, 18, and 8 months, respectively (p < 0.001). The objective tumor response rate following chemoembolization was 53%. The major complication rate was 9% overall and was significantly higher in the high-risk group (22%) than in the low (2%) and intermediate (3%) risk groups (p < 0.001). CONCLUSION Chemoembolization is safe and effective in selected patients with intermediate-stage infiltrative HCC. Chemoembolization is not recommended in high-risk patients with intermediate-stage infiltrative HCC because of poor OS and high rates of major complications. CLINICAL RELEVANCE STATEMENT A pretreatment prediction model was developed using four risk factors associated with overall survival following chemoembolization for intermediate-stage infiltrative hepatocellular carcinoma. This model may provide valuable information for clinical decision-making. KEY POINTS • Four risk factors (Child-Pugh score B, maximal tumor size ≥ 10 cm, tumor number ≥ 4, and bilobar tumor involvement) were used to create pretreatment prediction models, with risk scores of 0-1, 2-4, and 5-7 defined as low, intermediate, and high risk, respectively. • Median overall survival (OS) times and major complication rate in these three groups were 34, 18, and 8 months, and 2%, 3%, and 22%, respectively (p < 0.001). Chemoembolization is not recommended in high-risk patients with intermediate-stage infiltrative Hepatocellular carcinoma (HCC) because of poor OS and high rates of major complications.
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Affiliation(s)
- Seong Ho Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea.
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Ji Hoon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Heung-Kyu Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Shakir Aljerdah
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Nayoung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yeon SK, Ahn Y, Shin JH, Oh SY, Kim GH. Efficacy and safety of transcatheter arterial embolization for hemodynamically unstable bleeding after percutaneous transthoracic needle biopsy. Diagn Interv Radiol 2023; 29:819-825. [PMID: 37650514 PMCID: PMC10679561 DOI: 10.4274/dir.2023.232253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of transcatheter arterial embolization (TAE) in controlling hemodynamically unstable bleeding following a percutaneous transthoracic needle biopsy (PTNB). METHODS A total of seven patients (four men and three women; mean age, 62 ± 12 years) who received TAE for post-PTNB bleeding between May 2007 and March 2022 were included. The observed types of bleeding were hemothorax (n = 3), hemoptysis (n = 2), and a combination of both (n = 2). In patients with active bleeding, the technical success of TAE was defined as superselective embolization of the target artery with no active bleeding visible on post-TAE angiography. Clinical success was defined as sustained cessation of bleeding without hemodynamic instability, requirement of repeat TAE, or the need for post-TAE hemostatic surgery during the initial admission. The metrics analyzed included technical and clinical success rates, complications, and 30-day mortality. RESULTS All seven patients achieved technical success, with a clinical success rate of 86% (6/7). Six patients were discharged alive, while one patient died of respiratory failure accompanied by hemothorax 19 days post-biopsy. The angiographic findings associated with bleeding were contrast media extravasation or pseudoaneurysm (n = 3) and vascular hypertrophy with tortuosity (n = 2). The implicated bleeding arteries included the intercostal artery (n = 2), bronchial artery (n = 2), and internal thoracic artery (n = 1). In two cases, no clear bleeding foci were identified; nonetheless, prophylactic embolization was performed on the right intercostal artery (n = 1) and right intercostobronchial trunk (n = 1). The embolic agents utilized included microcoils (n = 1), gelatin sponge particles (n = 2), polyvinyl alcohol (PVA) with gelatin sponge particles (n = 1), PVA with microcoils (n = 1), microcoils with gelatin sponge particles (n = 1), and microcoils with n-butyl-2-cyanoacrylate and gelatin sponge particles (n = 1). The 30-day mortality rate was 14% (1/7). No ischemic complications related to TAE were observed. CONCLUSION The study suggests that TAE is safe and effective for controlling hemodynamically unstable bleeding following a PTNB.
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Affiliation(s)
- Su Kyeong Yeon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Yura Ahn
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang Young Oh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Kim J, Gwon DI, Kim Y, Kim GH, Kim SH, Chu HH, Kim JH, Shin JH, Ko GY, Yoon HK. Preoperative Balloon-Occluded Transcatheter Arterial Chemoembolization Followed by Surgical Resection: Pathological Evaluation of Necrosis. Diseases 2023; 11:149. [PMID: 37987260 PMCID: PMC10660476 DOI: 10.3390/diseases11040149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/13/2023] [Accepted: 10/22/2023] [Indexed: 11/22/2023] Open
Abstract
This study investigates the clinical and pathological outcomes of preoperative balloon-occluded transcatheter arterial chemoembolization (B-TACE) in patients with single hepatocellular carcinoma (HCC). The data are from 25 consecutive patients who underwent sequential treatment of subsegmental B-TACE and hepatic surgery for single HCC. Radiological and pathological evaluation of oily subsegmentectomy, defined as the iodized oil-laden necrotic area that includes the entire HCC and surrounding liver parenchyma, were performed. Subsegmental B-TACE was technically successful in all patients. The major and minor complication rates were 8% and 24%, respectively. On the first follow-up computed tomography (CT), oily subsegmentectomy was observed in 18 (72%) out of 25 patients. Apart from one patient showing a partial response, the remaining 24 (96%) patients showed a complete response. Pathological complete necrosis of the HCC was observed in 18 (72%) out of 25 patients with complete or extensive necrosis of the peritumoral liver parenchyma. The remaining seven patients without peritumoral parenchymal necrosis had extensive necrosis of the HCCs. In conclusion, preoperative B-TACE can be a safe and effective method for the treatment of single HCC and a good bridge treatment for subsequent surgical resection. In addition, oily subsegmentectomy itself on the CT can be a good predictor of pathological complete necrosis of the HCC. The findings obtained from this study would provide a potential role of B-TACE in the treatment strategy for single HCC.
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Affiliation(s)
- Jihoon Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
- Ajou University Hospital, College of Medicine, Ajou University, Suwon 16499, Republic of Korea
| | - Dong Il Gwon
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Yonghun Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Gun Ha Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Seong Ho Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Hee Ho Chu
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Jin Hyoung Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Ji Hoon Shin
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Gi-Young Ko
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Hyun-Ki Yoon
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
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Choe J, Koo HJ, Ahn Y, Lee GD, Yang DH, Kang JW, Lee JE, Shin JH. Evaluation of Chylothorax Using Dynamic Contrast-Enhanced Magnetic Resonance Lymphangiography After Lung Cancer Surgery. Lymphat Res Biol 2023; 21:343-350. [PMID: 36880884 DOI: 10.1089/lrb.2022.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Background: To determine the role of dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) in the management of postoperative chylothorax after lung cancer surgery. Methods and Results: Between July 2017 and November 2021, patients who developed postoperative chylothorax following pulmonary resection and mediastinal lymph node dissection were assessed and those who underwent DCMRL for the evaluation of chyle leak were evaluated. The findings of DCMRL and conventional lymphangiography were compared. The incidence of postoperative chylothorax was 0.9% (50/5587). Among the patients with chylothorax, a total of 22 patients (44.0% [22/50]; mean age, 67.6 ± 7.9 years; 15 men) underwent DCMRL. Treatment outcomes were compared between patients with conservative management (n = 10) and those with intervention (n = 12). The patients demonstrated unilateral pleural effusion, ipsilateral to the operation site, and showed right-sided dominance. The most frequent site of thoracic duct injury showing contrast media leakage was visualized at the subcarinal level. No DCMRL-related complication occurred. DCMRL showed comparable performance to conventional lymphangiography in visualizing the central lymphatics, including cisterna chyli (DCMRL vs. conventional lymphangiography, 72.7% vs. 45.5%, p = 0.25) and thoracic duct (90.9% vs. 54.5%, p = 0.13), and in localizing thoracic duct injury (90.9% vs. 54.5%, p = 0.13). On follow-up, the amount of chest tube drainage after lymphatic intervention showed a significant difference over time from that after medical treatment only (p = 0.02). Conclusion: DCMRL can provide detailed information about the leak site and the central lymphatic anatomy in patients with chylothorax after lung cancer surgery. The findings of DCMRL can guide subsequent treatment planning for optimal outcomes.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology and University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology and University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Yura Ahn
- Department of Radiology and Research Institute of Radiology and University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology and University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology and University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Ja Eun Lee
- Department of Radiology and Research Institute of Radiology and University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology and University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Kim JH, Kim JH, Yoon HK, Ko GY, Shin JH, Gwon DI, Ko HK, Chu HH, Kim SH, Kim GH, Kim Y, Aljerdah S. Transarterial chemoembolization for advanced hepatocellular carcinoma without macrovascular invasion or extrahepatic metastasis: analysis of factors prognostic of clinical outcomes. Front Oncol 2023; 13:1072922. [PMID: 37346065 PMCID: PMC10281503 DOI: 10.3389/fonc.2023.1072922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
Objectives To evaluate the safety and efficacy of TACE and factors predicting survival in patients with advanced hepatocellular carcinoma (HCC) without macrovascular invasion (MVI) or extrahepatic spread (EHS). Methods This single-center retrospective study included 236 treatment-naïve patients who underwent TACE as first-line treatment for advanced HCC without MVI or EHS between January 2007 and December 2021. Results Following TACE, the median overall survival (OS) was 24 months. Multivariate Cox regression analyses revealed that tumor number ≥4 (risk point: 3), maximal tumor size >10 cm (risk point: 2), Child-Pugh class B (risk point: 2), alpha-fetoprotein (AFP) concentration ≥400 ng/mL (risk point: 2), and presence of HCC rupture (risk point: 2) were risk factors significantly associated with OS. The expected median OS among patients with <2, 2-4, and 5-9 risk points were 72, 29, and 12 months respectively. The major complication rates were significantly lower in patients with maximal tumor size ≤10 cm than in those with maximal tumor size >10 cm (4% [5/138] vs 21% [21/98], p = 0.001). Conclusion TACE may be safe and effective in selected patients with advanced HCC without MVI or EHS, with a median OS of 24 months. Patients with limited tumor burden, compensated liver function, absence of HCC rupture, and favorable biologic markers may benefit the most from TACE. TACE is not recommended for patients with huge HCCs (>10 cm) because of its high rate of major complications (21%).
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Affiliation(s)
- Ji Hoon Kim
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
- Ajou University Hospital, College of Medicine, Ajou University, Najran, Saudi Arabia
| | - Jin Hyoung Kim
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Hyun-Ki Yoon
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Gi-Young Ko
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Ji Hoon Shin
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Dong Il Gwon
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Heung-Kyu Ko
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Hee Ho Chu
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Seong Ho Kim
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Gun Ha Kim
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Yonghun Kim
- Asan Medical Center, College of Medicine, University of Ulsan, Songpa-Gu, Republic of Korea
| | - Shakir Aljerdah
- College of Medicine, Najran University, Najran, Saudi Arabia
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Cho Y, Lee HN, Shin JH, Park SJ, Lee S, Song JS. Double-Pigtail Drainage Catheter: A New Design for Efficient Pleural Drainage. Medicina (Kaunas) 2023; 59:1089. [PMID: 37374293 DOI: 10.3390/medicina59061089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/13/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: The novel double-pigtail catheter (DPC) has an additional pigtail coiling at the mid-shaft with multiple centripetal side holes. The present study aimed to investigate the advantages and efficacy of DPC in overcoming the complications of conventional single-pigtail catheters (SPC) used to drain pleural effusion. Materials and Methods: Between July 2018 and December 2019, 382 pleural effusion drainage procedures were reviewed retrospectively (DPC, n = 156; SPC without multiple side holes, n = 110; SPC with multiple side holes (SPC + M), n = 116). All patients showed shifting pleural effusions in the decubitus view of the chest radiography. All catheters were 10.2 Fr in diameter. One interventional radiologist performed all procedures and used the same anchoring technique. Complications (dysfunctional retraction, complete dislodgement, blockage, and atraumatic pneumothorax) were compared among the catheters using chi-square and Fisher's exact tests. Clinical success was defined as an improvement in pleural effusion within three days without additional procedures. Survival analysis was performed to calculate the indwelling time. Results: The dysfunctional retraction rate of DPC was significantly lower than that of the other catheters (p < 0.001). Complete dislodgement did not occur in any of the DPC cases. The clinical success rate of DPC (90.1%) was the highest. The estimated indwelling times were nine (95% confidence interval (CI): 7.3-10.7), eight (95% CI: 6.6-9.4), and seven (95% CI: 6.3-7.7) days for SPC, SPC + M, and DPC, respectively, with DPC showing a significant difference (p < 0.05). Conclusions: DPC had a lower dysfunctional retraction rate compared to conventional drainage catheters. Furthermore, DPC was efficient for pleural effusion drainage with a shorter indwelling time.
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Affiliation(s)
- Youngjong Cho
- Department of Radiology, University of Ulsan College of Medicine, Gangneung Asan Hospital, 38 Bangdong-gil, Gangneung 25440, Republic of Korea
| | - Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan 31151, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, 88 Olympic-ro 43-gil, Seoul 05505, Republic of Korea
| | - Sung-Joon Park
- Department of Radiology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan 15355, Republic of Korea
| | - Sangjoon Lee
- Vascular Center, The Eutteum Orthopedic Surgery Hospital, Paju 10905, Republic of Korea
| | - Jae-Seok Song
- Department of Preventive Medicine & Public Health, Catholic Kwandong University College of Medicine, 24 Beomil-ro 579beon-gil, Gangneung 25601, Republic of Korea
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Choi J, Shin JH, Chu HH. Transcatheter Arterial Embolization for Palliation of Uterine Body Cancer Bleeding. J Korean Soc Radiol 2023; 84:606-614. [PMID: 37324986 PMCID: PMC10265241 DOI: 10.3348/jksr.2022.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/07/2022] [Accepted: 08/06/2022] [Indexed: 06/17/2023]
Abstract
Purpose This study aimed to evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for bleeding due to uterine body cancer. Materials and Methods In this retrospective study, six patients with varying types of uterine body cancer who underwent TAE for bleeding control were investigated. Angiographic findings, cross-sectional images, TAE details, and clinical outcomes were studied. Technical and clinical success rates were calculated. Results The identified patients had endometrioid adenocarcinoma, sarcoma, and gestational trophoblastic neoplasia, and most were patients with advanced-stage cancer. In four patients, tumor bleeding presented as vaginal bleeding. Technical success was achieved in all seven TAE procedures in six patients. Two patients with recurrent masses who had undergone hysterectomy presented with hematochezia, and TAE was able to provide technical success in these patients as well. The clinical success rate was 50%, indicating bleeding control for > 1 week. Rebleeding was directly associated with death in one patient. On the following day, mild fever was observed in one patient. Conclusion TAE can be considered an effective and safe method of bleeding control for uterine body cancer, especially during critical periods throughout the disease course of patients with inoperable, advanced-stage cancer.
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Chu HH, Gwon DI, Kim GH, Kim JH, Ko GY, Shin JH, Ko HK, Yoon HK. Balloon-occluded transarterial chemoembolization versus conventional transarterial chemoembolization for the treatment of single hepatocellular carcinoma: a propensity score matching analysis. Eur Radiol 2023; 33:2655-2664. [PMID: 36472699 DOI: 10.1007/s00330-022-09284-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/29/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To compare the safety and efficacy of balloon-occluded transarterial chemoembolization (B-TACE) and conventional TACE (C-TACE) in treating single hepatocellular carcinoma (HCC). METHODS This single-center retrospective study included 523 patients who underwent C-TACE and 44 who underwent B-TACE as first-line treatment for single HCCs between November 2017 and December 2019. After propensity score matching (PSM), initial tumor response rates, local tumor progression (LTP), and major complication rates were evaluated in the 32 pairs of PSM matched population. RESULTS In the 32 pairs of PSM cohort, B-TACE showed distinct superiority over C-TACE in treating single HCCs, with significantly higher initial complete response (CR) rates (93.8% vs. 62.5%, p = 0.005). During a median follow-up of 37 months (range, 12.7-46.5 months), 13 patients (40.6%) who underwent B-TACE and 16 (50%) who underwent C-TACE showed LTP of treated lesions. Size-based sub-group analysis showed that the median times to LTP in patients with medium- to large-sized tumors (> 3 cm) were significantly longer in the B-TACE (27 months; 95% confidence interval [CI], 19.7-34.3 months) than in the C-TACE (13 months; 95% CI, 3.9-22.1 months) group (p = 0.019). The major complication rate was similar between the two groups. CONCLUSIONS B-TACE had a higher initial CR rate than C-TACE in treating single HCCs. Moreover, size-based subgroup analysis showed that time to LTP was significantly longer in patients with medium- to large-sized HCCs (> 3 cm) who underwent B-TACE rather than C-TACE. KEY POINTS • B-TACE was superior to C-TACE in treating single HCC, with a significantly higher initial complete response rate after one session of treatment. • In size-based subgroup analysis, time to LTP was significantly longer in patients with medium- to large-sized HCCs (>3 cm) who underwent B-TACE rather than C-TACE. • B-TACE should be considered an alternative treatment option for medium- to large-sized single HCCs (>3 cm) in patients with a nonresectable condition and those who prefer nonsurgical treatment.
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Affiliation(s)
- Hee Ho Chu
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Dong Il Gwon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea. .,Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| | - Gun Ha Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jin Hyoung Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Gi-Young Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ji Hoon Shin
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Heung-Kyu Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hyun-Ki Yoon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
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Zeng CH, Kim SH, Kang JM, Park Y, Won DS, Kim JW, Ryu DS, Shim S, Kim DK, Shin JH, Park JH. Different routes of administering EW-7197 versus EW-7197⋅HBr for preventing peritoneal adhesion in a rat model. Surgery 2023; 173:1008-1014. [PMID: 36577598 DOI: 10.1016/j.surg.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/16/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The relatively low aqueous solubility of EW-7197 that was administered orally may have affected the desired concentration in the systemic circulation for treating peritoneal adhesion. This experimental study aimed to compare the efficacy of different routes of administering EW-7197 (2-fluoro-N-[(5-[6-methylpyridin-2-yl]-4-[(1,2,4)triazolo(1,5-a)pyridin-6-yl]-1H-imidazol-2-yl)methyl]aniline) and EW-7197·hydrobromide (HBr), with improved aqueous solubility, for inhibiting peritoneal adhesion in a rat model. METHODS After peritoneal adhesion induction, 30 male Sprague-Dawley rats were randomly divided into 5 groups with 6 rats in each: group A, sham control; group B, orally administered 25 mg/kg of EW-7197·HBr for 7 days; group C, locally administered 25 mg/kg of EW-7197·HBr; group D, orally administered 20 mg/kg of EW-7197 for 7 days; and group E, locally administered 20 mg/kg of EW-7197. Gross examination, histologic staining (hematoxylin and eosin and Masson's trichrome), and immunohistochemical analyses (Ki-67 and α-smooth muscle actin marker [α-SMA]) were performed to evaluate the efficacy of both drugs. RESULTS All procedures were technically successful. All treatment groups, except for group C, showed significantly reduced incidence, quality, tenacity, fibrosis, and collagen deposition scores and lowered expressions of Ki-67- and α-SMA-positive cells compared with group A. When comparing between groups, all scores were significantly lower in group B than in group C (all P < .001), whereas no significant difference was noted in any of the scores between groups D and E and groups B and E (all P > .05). CONCLUSION Orally administering EW-7197·HBr and both orally and locally administering EW-7197 significantly prevented peritoneal adhesion formation, and orally administering EW-7197·HBr was the most effective overall.
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Affiliation(s)
- Chu Hui Zeng
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea; Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Song Hee Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Jeon Min Kang
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Yubeen Park
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Dong-Sung Won
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Ji Won Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Dae Sung Ryu
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Soyeon Shim
- EWHA DrugDesignHouse, Seoul, Republic of Korea
| | - Dae-Kee Kim
- EWHA DrugDesignHouse, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Jung-Hoon Park
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea.
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Ahn Y, Koo HJ, Yoon HM, Choe J, Joo EY, Song MH, Yang DH, Kang JW, Shin JH. Dynamic Contrast-Enhanced Magnetic Resonance Lymphangiography and Lymphatic Interventions for Pediatric Patients with Various Lymphatic Diseases. Lymphat Res Biol 2023; 21:141-151. [PMID: 35984923 DOI: 10.1089/lrb.2021.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: To demonstrate the magnetic resonance lymphangiography (MRL) imaging findings of lymphatic diseases and the clinical outcomes of lymphatic embolization in pediatric patients. Methods and Results: This retrospective study included 10 consecutive pediatric patients who underwent MRL for lymphatic diseases between June 2017 and June 2021. Nine patients underwent dynamic contrast-enhanced MRL with bilateral inguinal lymph node injection of diluted gadolinium, and one patient underwent nonenhanced MRL with a heavily T2-weighted image. The etiology of lymphatic disease was classified into three categories based on the magnetic resonance findings. The resolution of chylous fluid and weight-adjusted amounts of chylous fluid collected from a drainage tube were evaluated as outcomes. Patients were classified as postoperative lymphatic leak (n = 3), pulmonary lymphatic perfusion syndrome (n = 3), central lymphatic flow disorder (CLFD; n = 3), and primary lymphatic dysfunction (Gorham-Stout syndrome; n = 1). Three patients underwent radiological lymphatic intervention, and one CLFD patient underwent surgical intervention. In patients with postoperative lymphatic leak, the median chest tube drainage decreased significantly after the intervention [from 87.9 to 12.4 mL/(kg·d); p = 0.02]. However, in one CLFD patient, the amount of chylous fluid did not decrease until 7 days after intervention. Conclusion: The etiology of lymphatic disease in pediatrics can be recognized on MRL, and lymphatic intervention can be performed for cessation of lymphatic leak, even though the treatment outcomes may differ according to the underlying etiology. MRL can play an important role in classifying lymphatic disease, and in planning treatment on the basis of the lymphatic anatomy and underlying etiology.
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Affiliation(s)
- Yura Ahn
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jooae Choe
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-Young Joo
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung-Hee Song
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Hwang JH, Kang JM, Park S, Park SH, Kim JH, Lee KH, Shin JH, Pak SY. Advanced virtual monoenergetic imaging algorithm for lower extremity computed tomography angiography: effects on image quality, artifacts, and peripheral arterial disease evaluation. Diagn Interv Radiol 2023; 29:175-182. [PMID: 36960598 PMCID: PMC10679588 DOI: 10.5152/dir.2022.21551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/01/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE To investigate the image quality of lower extremity computed tomography angiography (LE-CTA) using a reconstruction algorithm for monoenergetic images (MEIs) to evaluate peripheral arterial disease (PAD) at different kiloelectron volt (keV) levels. METHODS A total of 146 consecutive patients who underwent LE-CTA on a dual-energy scanner to obtain MEIs at 40, 50, 60, 70, and 80 keV were included. The overall image quality, segmental image quality of the arteries and PAD segments, venous contamination, and metal artifacts from prostheses, which may compromise quality, were analyzed. RESULTS The mean overall image quality of each MEI was 2.9 ± 0.7, 3.6 ± 0.6, 3.9 ± 0.3, 4.0 ± 0.2, and 4.0 ± 0.2 from 40 to 80 keV, respectively. The segmental image quality gradually increased from 40 to 70-80 keV until reaching its highest value. Among 295 PAD segments in 68 patients, 40 (13.6%) were scored at 1-2 at 40 keV and 13 (4.4%) were scored at 2 at 50 keV, indicating unsatisfactory image quality due to the indistinguishability between high-contrast areas and arterial calcifications. The segments exhibiting metal artifacts and venous contamination were reduced at 70-80 keV (2.6 ± 1.2, 2.7 ± 0.5) compared with at 40 keV (2.4 ± 1.1, 2.5 ± 0.7). CONCLUSION The LE-CTA method using a reconstruction algorithm for MEIs at 70-80 keV can enhance the image quality for PAD evaluation and improve mitigate venous contamination and metal artifacts.
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Affiliation(s)
- Jung Han Hwang
- Department of Radiology, Gachon University College of Medicine, Gil Medical Center, Incheon, South Korea
| | - Jin Mo Kang
- Department of Surgery, Gachon University College of Medicine, Incheon, South Korea
| | - Suyoung Park
- Department of Radiology, Gachon University College of Medicine, Gil Medical Center, Incheon, South Korea
| | - So Hyun Park
- Department of Radiology, Gachon University College of Medicine, Gil Medical Center, Incheon, South Korea
| | - Jeong Ho Kim
- Department of Radiology, Gachon University College of Medicine, Gil Medical Center, Incheon, South Korea
| | - Ki Hyun Lee
- Department of Radiology, Gachon University College of Medicine, Gil Medical Center, Incheon, South Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Seong Yong Pak
- Department of Biomedical Engineering, University of Ulsan College of Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, Seoul, South Korea
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Ahn JK, Won JH, Choi DS, Choi HC, Choi HY, Jo SH, Choi JH, Lee SH, Kim MJ, Park SE, Shin JH. Percutaneous nephrostomy for complex renal stones: Percutaneous renal access behind the stone versus renal calyx dilation. PLoS One 2022; 17:e0278485. [PMID: 36454857 PMCID: PMC9714915 DOI: 10.1371/journal.pone.0278485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To evaluate the technical success rate and complications associated with percutaneous nephrostomy (PCN) via percutaneous renal access behind the stone and renal calyx dilation in patients with complex renal stones. MATERIALS AND METHODS From January 2010 to February 2021, we identified 69 patients with 70 complex renal stones who underwent PCN. Complex renal stones were classified as simple (renal pelvis only) (27.1%, 19/70), borderline staghorn (8.6%, 6/70), partial staghorn (51.4%, 36/70), or complete staghorn (12.9%, 9/70). All PCNs were performed under ultrasound and fluoroscopic guidance using one of two renal-entry techniques: puncture behind the stone (56%, 39/70) or renal calyx dilation (44%, 31/70). Then, we retrospectively evaluated the technical success rates and complications associated with each renal entry access technique. RESULTS The overall technical success rate was 100%, and the complication rate was 20.0% (14/70). For those who underwent renal access behind the stone, the complication rate was 15.4% (6/39), and six patients (six PCNs) had transient gross hematuria. For those who underwent dilated renal calyx entry, the complication rate was 25.8% (8/31), and one patient had significant bleeding complications requiring transfusion. Furthermore, seven patients (seven PCNs) had transient gross hematuria. Overall, the complication rates did not differ between the technique groups (p = 0.279). CONCLUSION PCN for complex renal stones has a high technical success rate and an acceptable complication rate regardless of the specific technique. Renal entry behind the stone is as safe and feasible as approaching via a dilated renal calyx.
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Affiliation(s)
- Jae Kyeong Ahn
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Jung Ho Won
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
- * E-mail:
| | - Dae Seob Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Ho Cheol Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Hye Young Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Sa Hong Jo
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Jae Hwi Choi
- Department of Urology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Seung Hye Lee
- Department of Internal Medicine-Nephrology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Mi Ji Kim
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim SB, Yang EH, Shin JH. Percutaneous pericardial catheter drainage for symptomatic uremic pericardial effusions with narrow safety margins. PLoS One 2022; 17:e0276498. [PMID: 36315499 PMCID: PMC9621416 DOI: 10.1371/journal.pone.0276498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/08/2022] [Indexed: 11/07/2022] Open
Abstract
Background Percutaneous pericardial catheter drainage (PCD) for pericardial effusion is generally known to be limited by the high risk associated with effusions that are less than 10 mm thick. The objective was to report cases who underwent percutaneous PCD for symptomatic uremic pericardial effusions, which were less than 10 mm thick after cardiologist declined to perform the PCDs because of the narrow safety margins. Materials and methods Thirteen consecutive cases (11 patients) (median age, 56 years, range, 31–83) with symptomatic uremic pericardial effusion (thickness <10 mm) affecting the pericardial space anterior to the right ventricle underwent ultrasound- and fluoroscopy-guided percutaneous PCD between September 2015 and April 2022. Information regarding the clinical criteria, echocardiographic features, PCD details, nature of effusion, and outcomes, including success and complications were retrospectively evaluated. Results Pigtail catheter (8.5-Fr) insertion was successful for all patients, with a median procedure time of 7 minutes (range 4~12) without procedure-related complications. The median amount of drainage on the day of PCD was 700 mL (range, 250–1100). The median duration of catheter indwelling was 5 days (range, 1~32). In one case, the catheter was removed after 1 day due to chest pain. For all patients, pericardial effusion evacuation was achieved with relief of associated symptoms, representing 100% clinical success. Conclusion Percutaneous PCD may be safely performed for patients with symptomatic uremic pericardial effusions and narrow safety margins of less than 10 mm.
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Affiliation(s)
- Soon Bae Kim
- Division of Nephrology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eun Hye Yang
- Division of Nephrology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- * E-mail:
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Kim JH, Shin JH, Oh JS. Role of interventional radiology in the management of postoperative gastrointestinal leakage. Int J Gastrointest Interv 2022. [DOI: 10.18528/ijgii220039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ji Hoon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Suk Oh
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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20
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Kim BS, Lee Y, Shin JH. Impact of estimated pulse wave velocity on cardiovascular outcomes in a general population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Estimated pulse wave velocity (ePWV), a simple surrogate estimate of carotid-femoral pulse wave velocity which was gold standard for measuring aortic stiffness, has been demonstrated to predict cardiovascular (CV) outcome. However, there was limited data on its predictive capacity for CV outcomes in the general population. The study aim was to investigate the independent association between ePWV and CV outcomes in general population.
Methods
A total of 10,030 subjects aged between 40 and 69 years were followed over 18-year period in the Ansan-Ansung cohort study. Levels of ePWV, which was calculated from an equation based on age and mean blood pressure, were categorized according to quartiles. A major adverse cardiovascular event (MACE) was defined as a composite of myocardial infarction, coronary artery disease, stroke, heart failure, peripheral artery disease, and cardiovascular death.
Results
The incidence rates of CV death, and MACE were 7.0% and 22.1% in the fourth (highest) quartile of ePWV and 0.1% and 4.5% in the first (lowest) quartile of ePWV. After adjusting for relevant covariates, patients with third and fourth quartile of ePWV showed significantly higher risk of CV death (hazard ratio [HR] 3.92; 95% confidence intervals [CI] 1.09–14.15 in third quartile and HR 8.53; 95% CI 2.13–34.10 in fourth quartile), and MACE (HR 1.54; 95% CI 1.15–2.08 in third quartile and HR 1.56; 95% CI 1.05–2.32) compared to the reference of first (lowest) quartile of ePWV. However, there were no improvement of C statistic for CV death and MACE when adding ePWV to the Cox regression models with 10-year atherosclerotic cardiovascular disease (ASCVD) risk.
Conclusion
These results suggest that ePWV predicted CV death and MACE in general population. The value of ePWV, a simple and useful indicator of aortic stiffness, is expected to serve as a potential marker to identify high risk groups of CV event in general population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B S Kim
- Hanyang University Guri Hospital , Guri , Korea (Republic of)
| | - Y Lee
- Hanyang University Guri Hospital , Guri , Korea (Republic of)
| | - J H Shin
- Hanyang University Guri Hospital , Guri , Korea (Republic of)
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21
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Lee Y, Shin JH, Kim BS, Kim WH, Kook H, Park HC. Influence of concomitant percutaneous transluminal angioplasty with percutaneous coronary intervention on outcomes in patients with stable lower extremity artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with stable lower extremity artery diseases (LEAD) frequently present with coronary artery diseases; thus, concomitant percutaneous transluminal angioplasty (PTA) at the time of percutaneous coronary intervention (PCI) is often performed. We investigated the influence of concomitant PTA on both cardiovascular (CV) and limb outcomes in the Korean National Health Insurance Service registry.
Methods
Among 78,185 patients undergoing PCI between 2012 and 2015, 6,563 patients (279 for the PTA+PCI group vs. 6,284 for the PCI group) suffering from stable LEAD without limb ischemia were included. Major adverse CV events (MACEs) were defined as a composite of CV death, myocardial infarction (MI) and coronary revascularization. Patients were followed for at least 3 years.
Results
After 1:5 propensity score matching was conducted, 279 patients in the PTA+PCI group and 1,385 patients in the PCI group were compared. The risk of all-cause death was higher in the PTA+PCI group than in the PCI group, whereas the risks of MACE, MI, revascularization, stroke, CV death and bleeding event were not different between the 2 groups in the matched cohort. In contrast, the risks of end-stage renal diseases and unfavorable limb outcomes were higher in the PTA+PCI group than in the PCI group (Figure 1). Mediation analyses revealed that amputation and repeat Percutaneous transluminal angioplasty after discharge significantly mediated the association between the concomitant PTA and all-cause death (Figure 2).
Conclusions
CPTA at the time of PCI is not associated with an increased risk of CV events but may increase the risk of all-cause death by increasing unfavorable renal and limb outcomes in patients with stable LEAD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Lee
- Hanyang University, Division of Cardiology, Department of internal medicine , Seoul , Korea (Republic of)
| | - J H Shin
- Hanyang University, Division of Cardiology, Department of internal medicine , Seoul , Korea (Republic of)
| | - B S Kim
- Hanyang University Guri Hospital , Seoul , Korea (Republic of)
| | - W H Kim
- Hanyang University, Division of Cardiology, Department of internal medicine , Seoul , Korea (Republic of)
| | - H Kook
- Hanyang University, Division of Cardiology, Department of internal medicine , Seoul , Korea (Republic of)
| | - H C Park
- Hanyang University, Division of Cardiology, Department of internal medicine , Seoul , Korea (Republic of)
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22
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Shin JH. [Conflicts of Interest in Research and Clinical Practice]. J Korean Soc Radiol 2022; 83:771-775. [PMID: 36238922 PMCID: PMC9514588 DOI: 10.3348/jksr.2022.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Abstract
Recently, doctors and researchers are establishing relationships with interested parties from companies, research institutes, health care institutions, and academic journals, instead of conducting independent medical care or research work. They may have multiple interests as an advisor or a shareholder in the relevant company. Such a situation can foster a conflict of interest when their interests influence one's decision or judgment. Conflict of interest is an extremely important issue because it can infringe the integrity of research, endanger subjects or patients, pose a risk to the public, and deteriorate public perception of science. This brief review explores the definition, examples, and solutions to conflict of interest.
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Tsauo J, Shin JH, Kim GH, Chu HH. A Silicone-Covered Self-Expanding Metal Stent with Anti-migration Features for Treating Malignant Ureteral Obstruction. Cardiovasc Intervent Radiol 2022; 45:1503-1511. [PMID: 35676542 DOI: 10.1007/s00270-022-03174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the effectiveness and safety of the Urexel stent for treating malignant ureteral obstruction (MUO). MATERIALS AND METHODS This retrospective study included 129 patients (mean age: 57.9 ± 11.8 years; men: n = 64, 49.6%; ureteral units [UUs]: N = 175) who underwent Urexel stent placement to treat MUO between March 2013 and April 2021. The Urexel stent is a fully covered self-expanding metal stent. To reduce stent migration, the proximal end of the stent has an additional layer of stent mesh and is flared mildly. RESULTS Eighty-three patients (64.3%) had unilateral MUO (right side: n = 47, 36.4%; left side: n = 36, 27.9%), and 46 patients (35.7%) had bilateral MUO. Successful Urexel stent placement after successful guidewire passage of the obstructed ureteral segment was achieved in 172 UUs, rendering a technical success rate of 98.3%. Stent malfunction occurred in 37 UUs (21.4%) during follow-up, including tumor overgrowth (n = 29), tumor ingrowth (n = 3), stent migration (n = 3), and stent collapse (n = 2). A total of 120 patients (93.0%) died during a median follow-up of 4.1 months (range: 0.2 - 33.5). The median survival of the patients was 4.4 months (interquartile range [IQR] 2.0 - 8.8). The median malfunction-free survival of the patients was 3.6 months (IQR: 1.6 - 7.9). Fifteen grade 3 or higher complications occurred in 14 patients (10.9%), including flank pain (n = 10), gross hematuria (n = 4), and dysuria (n = 1). CONCLUSION Urexel stent placement may be effective and safe for treating MUO.
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Affiliation(s)
- Jiaywei Tsauo
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
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Chen CS, Cho YJ, Shin JH, Kim JH, Park S, Jeon GS, Ibrahim A, Li HL, Jeong B. Transcatheter arterial embolization for hemorrhage after gynecologic hysterectomy: a multicenter study. Acta Radiol 2022; 63:822-827. [PMID: 33878930 DOI: 10.1177/02841851211010395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transcatheter arterial embolization (TAE) is not common for hemorrhagic complications after gynecologic hysterectomy. PURPOSE To evaluate the effectiveness and safety of TAE for hemorrhage after hysterectomy for gynecologic diseases. MATERIAL AND METHODS This is a retrospective, multicenter study, which investigated 11 patients (median age = 45 years) who underwent TAE for hemorrhage after gynecologic hysterectomy between 2004 and 2020. RESULTS The median interval between surgery and angiography was one day (range = 0-82 days). Hemodynamic instability and massive transfusion were present in 6 (54.5%) and 4 (36.4%) patients, respectively. CT scans (n = 7) showed contrast extravasation (n = 5), pseudoaneurysm (n = 1), or both (n = 1). On angiography, the bleeding arteries were the anterior division branches of the internal iliac artery (IIA) (n = 6), posterior division branch (lateral sacral artery, n = 1), and inferior epigastric artery (n = 1) in eight patients with active bleeding. In the remaining three patients, angiographic staining without active bleeding foci was observed at the vaginal stump, and the feeders for staining were all anterior division branches of the IIA. Technical and clinical success rates were 100% and 90.9% (10/11), respectively. In one patient, active bleeding focus was successfully embolized on angiography, but surgical hemostasis was performed for suspected bleeding on exploratory laparotomy. Postembolization syndrome occurred in one patient. CONCLUSIONS TAE is effective and safe for hemorrhage after hysterectomy for gynecologic diseases. Angiographic findings are primarily active bleeding, but angiographic staining is not uncommon. A bleeding focus is possible in any branch of the IIA, as well as the arteries supplying the abdominal wall.
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Affiliation(s)
- Cheng Shi Chen
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Young-Jong Cho
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Gangwon Province, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Ho Kim
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Suyoung Park
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Gyeong Sik Jeon
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Alrashidi Ibrahim
- Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hai-Liang Li
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Boryeong Jeong
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Republic of Korea
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Ho Won J, Jin Yang W, Hoon Shin J, Woo Kim J, Ho Chu H, Min Lee S, Cheol Choi H, Eun Park S. Percutaneous nephrostomy for nondilated renal collecting system with ultrasound and fluoroscopic guidance: The results of a 10-year experience. Diagn Interv Radiol 2022; 28:244-248. [PMID: 35748207 PMCID: PMC9634922 DOI: 10.5152/dir.2022.20728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE This study aimed to evaluate the technical success rate, complications, and radiation doses of ultrasound- and fluoroscopy-guided percutaneous nephrostomy (PCN) in patients with a nondi- lated renal collecting system. METHODS Over a 10-year period, 50 patients were referred for PCN of 60 kidneys with a nondilated renal collecting system. The patients included 22 males and 28 females with a mean age of 63.2 years (range: 35-87 years). The most common reason for PCN in these patients was postoperative ure- teral leaks and/or fistula (21/50 patients). PCN was performed under ultrasound and fluoroscopic guidance. During PCN, intravenous contrast media or diuretics were not used. Technical success rate, complications, procedure time, and radiation exposure of the procedure were retrospec- tively evaluated. RESULTS Ultrasound- and fluoroscopy-guided PCN for nondilated renal collecting system showed a suc- cess rate of 83.3% (50/60 kidneys) in the initial attempt. Four PCNs were repeated and were suc- cessful after the initial PCN failure. There was 1 major complication of bleeding that required transfusion in 1.9% (1/54) PCNs and there were minor complications of transient gross hematuria through the PCN catheter in 31.5% (17/54) PCNs. Mean duration of the procedure was 15.97 ± 7.81 min and median fluoroscopy time was 4.2 min (range: 1.2-15.3 min). Median dose area product and cumulative dose were 345.37 μGy·m2 (range: 42.57-1659.76 μGy·m2) and 46.9 mGy (range: 7.7-267.8 mGy), respectively. CONCLUSION Ultrasound- and fluoroscopy-guided PCN for nondilated renal collecting system was feasible with acceptable technical success rate, complication rate, procedure time, and radiation exposure.
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Affiliation(s)
- Jung Ho Won
- From the Department of Radiology (J.H.W., S.M.L., H.C.C.), Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea; Department of Radiology (W.J.Y.), Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea Department of Radiology and Research Institute of Radiology (J.H.S. ✉ , J.W.K., H.H.C.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Radiology (S.E.P.), Gyeongsang National University College of Medicine and Gyeonsang National University Changwon Hospital, Changwon, Korea
| | - Woo Jin Yang
- From the Department of Radiology (J.H.W., S.M.L., H.C.C.), Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea; Department of Radiology (W.J.Y.), Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea Department of Radiology and Research Institute of Radiology (J.H.S. ✉ , J.W.K., H.H.C.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Radiology (S.E.P.), Gyeongsang National University College of Medicine and Gyeonsang National University Changwon Hospital, Changwon, Korea
| | - Ji Hoon Shin
- From the Department of Radiology (J.H.W., S.M.L., H.C.C.), Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea; Department of Radiology (W.J.Y.), Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea Department of Radiology and Research Institute of Radiology (J.H.S. ✉ , J.W.K., H.H.C.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Radiology (S.E.P.), Gyeongsang National University College of Medicine and Gyeonsang National University Changwon Hospital, Changwon, Korea
| | - Jong Woo Kim
- From the Department of Radiology (J.H.W., S.M.L., H.C.C.), Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea; Department of Radiology (W.J.Y.), Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea Department of Radiology and Research Institute of Radiology (J.H.S. ✉ , J.W.K., H.H.C.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Radiology (S.E.P.), Gyeongsang National University College of Medicine and Gyeonsang National University Changwon Hospital, Changwon, Korea
| | - Hee Ho Chu
- From the Department of Radiology (J.H.W., S.M.L., H.C.C.), Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea; Department of Radiology (W.J.Y.), Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea Department of Radiology and Research Institute of Radiology (J.H.S. ✉ , J.W.K., H.H.C.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Radiology (S.E.P.), Gyeongsang National University College of Medicine and Gyeonsang National University Changwon Hospital, Changwon, Korea
| | - Sang Min Lee
- From the Department of Radiology (J.H.W., S.M.L., H.C.C.), Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea; Department of Radiology (W.J.Y.), Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea Department of Radiology and Research Institute of Radiology (J.H.S. ✉ , J.W.K., H.H.C.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Radiology (S.E.P.), Gyeongsang National University College of Medicine and Gyeonsang National University Changwon Hospital, Changwon, Korea
| | - Ho Cheol Choi
- From the Department of Radiology (J.H.W., S.M.L., H.C.C.), Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea; Department of Radiology (W.J.Y.), Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea Department of Radiology and Research Institute of Radiology (J.H.S. ✉ , J.W.K., H.H.C.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Radiology (S.E.P.), Gyeongsang National University College of Medicine and Gyeonsang National University Changwon Hospital, Changwon, Korea
| | - Sung Eun Park
- From the Department of Radiology (J.H.W., S.M.L., H.C.C.), Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea; Department of Radiology (W.J.Y.), Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea Department of Radiology and Research Institute of Radiology (J.H.S. ✉ , J.W.K., H.H.C.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Radiology (S.E.P.), Gyeongsang National University College of Medicine and Gyeonsang National University Changwon Hospital, Changwon, Korea
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Kim S, Kim JH, Ko GY, Gwon DI, Shin JH, Yoon HK. Bronchial artery embolization for hemoptysis caused by metastatic hepatocellular carcinoma. Sci Rep 2022; 12:6906. [PMID: 35484185 PMCID: PMC9050675 DOI: 10.1038/s41598-022-10972-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/12/2022] [Indexed: 12/21/2022] Open
Abstract
Because of its extremely rare incidence, the safety and efficacy of bronchial artery embolization (BAE) for the treatment of hemoptysis caused by pulmonary metastasis from HCC are not well known. We therefore evaluated the safety and efficacy of BAE in these patients. Data from 18 patients with hepatocellular carcinoma (HCC) and pulmonary metastasis who received BAE for the treatment of hemoptysis between 2003 and 2021 were retrospectively reviewed. Technical and clinical success were achieved in 100% and 94% of patients, respectively. Of the 18 embolization procedures, six were performed using polyvinyl alcohol (PVA) particles only, five were performed using gelfoam only, three were performed using gelfoam plus microcoils, one was performed using PVA plus microcoils, one was performed using embospheres, one was performed using lipiodol plus PVA and gelfoam, and one was performed using hystoacryl with microballoon protection. In eight patients for whom CT just before BAE and at follow-up were available, the mean size of the largest metastatic tumor decreased from 5.1 to 3.7 cm (P = 0.035). Hemoptysis recurred in three patients (17%) during follow-up. The median overall and hemoptysis-free survival periods were 149 days and 132 days, respectively. BAE is an effective and safe option for the treatment of hemoptysis in patients with pulmonary metastasis from HCC, with a favorable clinical success rate and a low rate of hemoptysis recurrence. In addition, we also observed BAE to have a positive antitumor effect on pulmonary metastases from HCC, but this requires confirmation in a future study.
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Affiliation(s)
- Sungwon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea.
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
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Kim GH, Shin JH, Zeng CH, Park JH. Recent Updates in Gastrointestinal Stent Placement from the Esophagus to the Colon: A Radiological Perspective. Cardiovasc Intervent Radiol 2022; 45:425-437. [PMID: 35166883 DOI: 10.1007/s00270-022-03067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/24/2022] [Indexed: 11/02/2022]
Abstract
Fluoroscopic-guided stent placement has become an advantageous treatment option for diverse gastrointestinal disorders. In addition to palliative stent placement in patients with inoperable cancers, stenting has gradually expanded to other conditions, including as a bridge to surgery, as well as in patients' benign lesions and anastomotic strictures or leaks. This narrative review describes the indications, efficacy and safety of stent placement from the esophagus to the colon, including current recommendations, recent updates, and novel stents.
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Affiliation(s)
- Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea.
| | - Chu Hui Zeng
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea
| | - Jung Hoon Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea
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Nam IC, Lee ES, Shin JH, Li VX, Chu HH, Park SE, Won JH. Cardiac Arrest during Interventional Radiology Procedures: A 7-Year Single-Center Retrospective Study. J Clin Med 2022; 11:jcm11030511. [PMID: 35159963 PMCID: PMC8836515 DOI: 10.3390/jcm11030511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 12/29/2022] Open
Abstract
An intervention radiology (IR) unit collected cardiac arrest data between January 2014 and July 2020. Of 344,600 procedures, there were 23 cardiac arrest patients (0.0067%). The patient data was compared to a representative sample (N = 400) of the IR unit to evaluate the incidence and factors associated with cardiac arrest during IR procedures. Age, procedure urgency, American Society of Anesthesiologists (ASA) physical status, procedure type, and underlying medical conditions were identified as valuable predictors of a patient’s susceptibility to cardiac arrest during an IR procedure. The proportion of pediatrics was higher for cardiac arrest patients, and most required immediate procedures. The distribution of high ASA physical status (III or greater) was skewed compared to that of the non-cardiac arrest patients. Vascular procedures were associated with higher risk than non-vascular procedures. The patients who underwent non-transarterial chemoembolization arterial procedures demonstrated relative risks of 4.4 and 11.7 for cardiac arrest compared to biliary procedures and percutaneous catheter drainage, respectively. In addition, the six patients (26.1%) who died before discharge all underwent vascular procedures. Relative to patients with acute kidney injury, patients with malignancy, hypertension, and diabetes mellitus demonstrated relative risks of 3.3, 3.4, and 4.8 for cardiac arrest, respectively.
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Affiliation(s)
- In Chul Nam
- Department of Radiology, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea; (I.C.N.); (S.E.P.)
| | - Esther Sangeun Lee
- Harvard College, Harvard University, Cambridge, MA 02138, USA; (E.S.L.); (V.X.L.)
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea;
- Correspondence:
| | - Vincent Xinrui Li
- Harvard College, Harvard University, Cambridge, MA 02138, USA; (E.S.L.); (V.X.L.)
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea;
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea; (I.C.N.); (S.E.P.)
| | - Jung Ho Won
- Department of Radiology, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea;
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Shim DJ, Kim JW, Kim D, Ko GY, Gwon DI, Shin JH, Yang YJ. Effect of Stent Placement on Survival in Patients with Malignant Portal Vein Stenosis: A Propensity Score-Matched Study. Korean J Radiol 2022; 23:68-76. [PMID: 34983095 PMCID: PMC8743153 DOI: 10.3348/kjr.2021.0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Percutaneous portal vein (PV) stent placement can be an effective treatment for symptoms associated with portal hypertension. This study aimed to evaluate the effect of PV stenting on the overall survival (OS) in patients with malignant PV stenosis. Materials and Methods Two groups of patients with malignant PV stenosis were compared in this retrospective study involving two institutions. A total of 197 patients who underwent PV stenting between November 2016 and August 2019 were established as the stent group, whereas 29 patients with PV stenosis who were treated conservatively between July 2013 and October 2016 constituted the no-stent group. OS was compared between the two groups before and after propensity score matching (PSM). Risk factors associated with OS were evaluated using the Cox proportional hazards model. Procedure-associated adverse events were also evaluated. Results The stent group finally included 100 patients (median age, 65 [interquartile range, 58–71] years; 64 male). The no-stent group included 22 patients (69 [61–75] years, 13 male). Stent placement was successful in 95% of attempted cases, and the 1- and 2-year stent occlusion–free survival rate was 56% (95% confidence interval, 45%–69%) and 44% (32%–60%), respectively. The median stent occlusion–free survival time was 176 (interquartile range, 70–440) days. OS was significantly longer in the stent group than in the no-stent group (median 294 vs. 87 days, p < 0.001 before PSM, p = 0.011 after PSM). The 1- and 3-year OS rates before PSM were 40% and 11%, respectively, in the stent group. The 1-year OS rate after PSM was 32% and 5% in the stent and no-stent groups, respectively. Anemia requiring transfusion (n = 2) and acute thrombosis necessitating re-stenting (n = 1) occurred in three patients in the stent group within 1 week. Conclusion Percutaneous placement of a PV stent may be effective in improving OS in patients with malignant PV stenosis.
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Affiliation(s)
- Dong Jae Shim
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Woo Kim
- Department of Radiology, Chung-Ang University Health Care System, Hyundae Hospital, Namyangju, Korea.,Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Doyoung Kim
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yun-Jung Yang
- Institute of Biomedical Science, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea
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Chen CS, Kim JW, Shin JH, Li HL, Lee HJ, Ibrahim A, Jang EB. Usefulness of a long sheath in ureteral catheterization after failure of antegrade ureteral stent placement using a short sheath. Acta Radiol 2021; 62:1674-1678. [PMID: 33115243 DOI: 10.1177/0284185120969952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND When antegrade ureteral intervention fails due to severe ureteral stricture or tortuosity, a longer sheath can be used to facilitate ureteral catheterization. PURPOSE To evaluate the feasibility and effectiveness of the use of a long sheath in antegrade ureteral stent placement after failure of antegrade ureteral stent placement using a short sheath. MATERIAL AND METHODS Among 1284 procedures in 934 patients who received ureteral stent placement, a long sheath was used after stricture negotiation failure using a short sheath in 57 (4.4%) procedures in 53 patients. The data of these 53 patients were retrospectively reviewed. RESULTS The most common reasons for long sheath use were failure of balloon catheter (59.6%) or guidewire (29.8%) advancement across the stricture. Technical success, successful stricture negotiation after using a long sheath, was achieved in 50/57 (87.7%) procedures. In two of seven failed procedures, an additional TIPS sheath was used and the technical success rate improved to 91.2% (52/57). The technical success rate was significantly higher in the patients who have failed balloon catheter advancement (97.1%, 33/34) than the patients who have failed guidewire advancement (64.7%, 11/17) (Fisher's exact test, P = 0.004). Self-limiting hematoma occurred in one patient after use of the long sheath and was considered a minor complication. CONCLUSION Ureteral catheterization using a long sheath is feasible and effective when antegrade ureteral intervention using a short sheath fails. When using a long sheath, the technical success rate was higher when advancing the balloon catheter over the guidewire than when advancing the guidewire through tight stricture.
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Affiliation(s)
- Cheng Shi Chen
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hai-Liang Li
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Hyung Jin Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Alrashidi Ibrahim
- Department of Radiology, Prince Sultan Military Medical City, Riyadh. Saudi Arabia
| | - Eun Bee Jang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Lee Y, Shin J, Park JK, Shin JH, Kim HJ, Park HC, Heo R. Associations between changing patterns of ST-T waves morphologies in rest electrocardiography and cardiovascular risk in an asymptomatic low risk population: a report from Ansan-Ansung cohort study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
While clinical significance of ST-T wave abnormalities (STA) in rest electrocardiography (ECG) on long-term cardiovascular outcomes has been on debate, few studies have been reported on the association between the changes in ST-T waves in rest ECG and cardiovascular outcomes in low risk populations. We investigate the changing patterns of STA in rest ECG and the predictive value of the changes in ST-T wave in rest ECG for cardiovascular events in an asymptomatic general population.
Methods
A longitudinal community-based cohort study was conducted for 12 years. Koreans aged 40–69 years were followed biennially through scheduled revisit for comprehensive assessments. Among 10,030 participants, 6,648 participants who did not have any cardiovascular diseases, angina-related symptoms or pathologic Q waves in rest ECG at baseline were included for analysis. Changes in STAs were defined using the changes between ECG at baseline and that at the first revisit. A major adverse cardiovascular events was defined as a composite of cardiac death, myocardial infarction, clinical diagnosis of coronary artery disease and stroke.
Results
Among 5,924 participants without STA at baseline, only 187 participants (3.2%) developed new STA. Among 724 patients (10.9%) with STA at baseline, 274 patients (37.8%) persistently showed STA at the first revisit. MACEs occurred more frequently in the participants persistently with STA and those with newly-developed STA than in the participants persistently without STA (Figure 1). Multivariate Cox-proportional hazard models showed that a higher risk of MACE was only associated with the persisted STA (HR 1.69; 95% CI 1.10–2.63). In participants with baseline STA, persisted T-wave flattening was associated with a higher risk of MACE, whereas T-wave inversion, either persisted or fluctuated was not associated with a higher risk of MACE, compared with persistent absence of STA (Figure 2). In the participants without baseline STAs, multivariate Cox-proportional hazard model showed that newly-developed T-wave flattening (HR 1.85; 95% CI 0.20–2.84), not T-wave inversion (HR 1.50; 95% CI 0.85–2.65) was associated with a higher risk of MACE. Survival receiver operating curve analysis showed that the changes in STAs had a C-index of 0.538 (95% CI 0.511–0.558), a sensitivity of 13.0% and a specificity of 92.5% and add only a small value to the predictive power of 10-year atherosclerotic cardiovascular diseases risk estimator (C-index without STA changes 0.708 [0.681–0.736] vs. C-index with STA changes 0.721 [0.694–0.748]).
Conclusions
STAs uncommonly developed while frequently disappeared spontaneously in the asymptomatic general population. Persisted STA and newly developed STA in rest ECG were predictive of future cardiovascular events in the asymptomatic general population. However, the changes in STAs did not significantly improve the predictive value of the conventional risk estimator, when added.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research Foundation of Korea Figure 1Figure 2
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Affiliation(s)
- Y Lee
- Hanyang University Guri Hospital, Seoul, Korea (Republic of)
| | - J Shin
- Hanyang University, Division of Cardiology, Department of internal medicine, Seoul, Korea (Republic of)
| | - J K Park
- Hanyang University, Division of Cardiology, Department of internal medicine, Seoul, Korea (Republic of)
| | - J H Shin
- Hanyang University, Division of Cardiology, Department of internal medicine, Seoul, Korea (Republic of)
| | - H J Kim
- Hanyang University, Division of Cardiology, Department of internal medicine, Seoul, Korea (Republic of)
| | - H C Park
- Hanyang University, Division of Cardiology, Department of internal medicine, Seoul, Korea (Republic of)
| | - R Heo
- Hanyang University, Division of Cardiology, Department of internal medicine, Seoul, Korea (Republic of)
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Lee Y, Shin J, Shin JH, Kim HJ, Ryu MH, Park HC, Lim HY, Park JK, Heo R, Kim WH. Simulation and validation for count-based binary decision of target blood pressure achievement in home blood pressure monitoring data analysis for clinical practice. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Home blood pressure monitoring (HBPM) is a useful tool to identify hypertension and to decide whether a patient's blood pressure (BP) is controlled. The use of automatized oscillometric BP measurement devices has become increasingly popular with help of information technology and internet of things to the devices. However, applying HBPM to daily clinical practices is still challenging, because most patients with hypertension are in age groups not familiar to digital devices and internet and high BP criteria using average home BP values are often useless in outpatient clinics without easily accessible average BP calculation tools. Therefore, we developed a simple and straightforward method to interpret HBPM through counts of BP ≥135/85 mmHg.
Methods
We simulated 400 cases of HBPM using a random number generator function in statistical software. The simulated average home systolic BP (SBP) and its standard deviation (SD) were 125±15 mmHg and 12±5 mmHg and the number of HBP readings was 24 times. The simulated diastolic BP (DBP) was randomly selected to 50–75% of the SBP. The validation of the binary interpretation method was conducted using actual HBPM data from 386 subjects in a rural area of South Korea. Receiver operating characteristics curve analysis was conducted, and linear regression and logarithmic models were fitted between the numbers of home BP ≥135/85 mmHg and mean BP. Hypertension was defined with average home BP ≥135/85 mmHg.
Results
In the simulated cohort, hypertension was presented in 197 cases (49.3%). The C-index of the numbers of BP readings ≥135/85 mmHg was 0.994 (95% confidence interval [CI] 0.990–0.998), and ≥12 of 24 BP readings ≥135/85 mmHg showed a sensitivity of 95.4%, a specificity of 95.1% and an accuracy of 95.3% for the diagnosis of hypertension. In validation cohort, the numbers of home BP measurements varied from 8 to 81 times. The validation cohort similarly showed that the C-index of the ratio between the number of high BP readings (≥135/85 mmHg) to the number of BP measurements (R-NHBP/NBP) was 0.985 (95% CI, 0.976–0.994) and the best accuracy was shown at R-NHBP/NBP of ≥0.45. R-NHBP/NBP of ≥0.5 showed a sensitivity of 0.957, a specificity of 0.907 and an accuracy of 0.927. The accuracy of the R-NHBP/NBP of ≥0.5 decreased as SD and the range of SBP increased, whereas it did not change with the number of measurements (Figure 1). R-NHBP/NBP <0.2 predicted normotension and R-NHBP/NBP >0.8 predicted hypertension in 95% confidence. Mean widths of the 95 prediction intervals for the average SBP and DBP were 18.2 mmHg and 12.6 mmHg, respectively (Figure 2).
Conclusion
Counting the number of BP ≥135/85 mmHg can provide accurate assessments for the BP levels. R-NHBP/NBP of ≥0.5 is a simple and accurate marker of high BP in HBPM, and R-NHBP/NBP could be a useful tool to assess BP levels in patients practicing HBPM.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- Y Lee
- Hanyang University Guri Hospital, Seoul, Korea (Republic of)
| | - J Shin
- Hanyang University, Division of Cardiology, Department of internal medicine, Seoul, Korea (Republic of)
| | - J H Shin
- Hanyang University, Division of Cardiology, Department of internal medicine, Seoul, Korea (Republic of)
| | - H J Kim
- Hanyang University, Division of Cardiology, Department of internal medicine, Seoul, Korea (Republic of)
| | - M H Ryu
- Hanyang University Guri Hospital, Seoul, Korea (Republic of)
| | - H C Park
- Hanyang University, Division of Cardiology, Department of internal medicine, Seoul, Korea (Republic of)
| | - H Y Lim
- Hanyang University, Division of Cardiology, Department of internal medicine, Seoul, Korea (Republic of)
| | - J K Park
- Hanyang University, Division of Cardiology, Department of internal medicine, Seoul, Korea (Republic of)
| | - R Heo
- Hanyang University, Division of Cardiology, Department of internal medicine, Seoul, Korea (Republic of)
| | - W H Kim
- Hanyang University, Division of Cardiology, Department of internal medicine, Seoul, Korea (Republic of)
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Choi W, Gwon DI, Kim JW, Kim JH, Shin JH, Ko GY, Hur J. Percutaneous cholecystostomy for acute cholecystitis after stent insertion in patients with malignant biliary obstruction: clinical outcomes of 107 patients. Acta Radiol 2021; 63:1315-1322. [PMID: 34623186 DOI: 10.1177/02841851211041816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The outcome of percutaneous cholecystostomy (PC) in malignant patients with acute cholecystitis (AC) after biliary stent insertion has not been investigated in a large group. PURPOSE To evaluate the clinical outcomes of PC for AC after stent insertion in patients with malignant biliary obstruction. MATERIAL AND METHODS From April 2007 to February 2019, 107 patients (57 men, 52 women; mean age = 67.5 years; age range = 27-93 years) who had undergone PC for AC after biliary stent insertion were retrospectively evaluated. Of the 107 patients, 86 underwent biliary stent insertion by the endoscopic approach and the remaining 21 patients by the percutaneous approach. All patients were classified into three groups: those with stent-induced AC; those with cancer-induced AC; and those with AC without mechanical cause (biliary stent, GB stone, or cancer invasion). The mean survival time, recurrence rate, symptom improvement, and cystic duct patency in each patient group were analyzed. RESULTS Stent-induced AC (n = 40, 37.4%) developed with a mean onset time of six days (range = 0-14 days), AC without mechanical cause (n = 27, 25.2%), 87 days (range = 15-273 days), and cancer-induced AC (n = 40, 37.4%), 137 days (range = 15-447 days) after stent insertion. Symptom resolution and significant improvement in laboratory test values were achieved in 95 patients (88.8%) within four days after PC. CONCLUSION PC is a technically safe and effective method for the treatment of AC after biliary stent insertion in patients with malignant biliary obstruction.
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Affiliation(s)
- Woosun Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Joonho Hur
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Kim GH, Kim PH, Shin JH, Nam IC, Chu HH, Ko HK. Ultrasound-guided sclerotherapy for the treatment of ovarian endometrioma: an updated systematic review and meta-analysis. Eur Radiol 2021; 32:1726-1737. [PMID: 34580747 DOI: 10.1007/s00330-021-08270-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/24/2021] [Accepted: 08/12/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the efficacy and safety of ultrasound (US)-guided sclerotherapy for the treatment of ovarian endometrioma through a systematic review and meta-analysis. METHODS MEDLINE and EMBASE databases were searched for studies reporting outcomes in patients with endometrioma who were treated with US-guided sclerotherapy. Meta-analyses of recurrence, pain resolution, pregnancy, technical success, and complication rates were analyzed. Subgroup analyses were conducted regarding the indwelling time of sclerotherapy (≤ 10 min vs > 10 min). RESULTS Twenty-eight studies (1301 patients) were included. The pooled technical efficacy was 98.3%. The pooled estimates of recurrence, pain resolution, and pregnancy rate were 13.8%, 85.9%, and 37.6%, respectively. The pooled major complication rate was 1.7%. A sclerotherapy time > 10 min had a lower pooled recurrence rate than a time ≤ 10 min (11.2% vs 20.9%; p = 0.106). Direct comparisons showed that the recurrence rate was significantly lower with sclerotherapy > 10 min than with sclerotherapy ≤ 10 min (OR, 0.2; p = 0.015). Regarding pregnancy rates, sclerotherapy of > 10 min showed no significant difference compared with sclerotherapy of ≤ 10 min (35.9% vs 38.8%; p = 0.664). Direct comparisons with surgery showed that sclerotherapy increased the pregnancy rate compared with surgery (OR, 2.0; p = 0.042). There was no significant difference in AMH level before and after sclerotherapy (p = 0.951). There was no significant difference in major complication rates between sclerotherapy > 10 min and ≤ 10 min (p = 0.837). CONCLUSION US-guided sclerotherapy seems to be an effective and safe therapeutic option regarding recurrence, pain resolution, and pregnancy for patients with ovarian endometrioma. KEY POINTS • US-guided sclerotherapy seems to be an effective and safe therapeutic option regarding recurrence, pain resolution, and pregnancy for patients with ovarian endometrioma. • Sclerotherapy of more than 10 min had a lower recurrence rate than sclerotherapy less than or equal to 10 min. There was no significant difference in major complication rates between sclerotherapy of > 10 min and ≤ 10 min. • Future randomized controlled trials are warranted to compare the outcomes of US-guided sclerotherapy with surgery.
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Affiliation(s)
- Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, College of Medicine, Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea
| | - Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, College of Medicine, Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, College of Medicine, Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea.
| | - In Chul Nam
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Changwon, Korea
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, College of Medicine, Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea
| | - Heung-Kyu Ko
- Department of Radiology and Research Institute of Radiology, College of Medicine, Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea
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Yang WJ, Kang D, Shin JH, Jang EH, Noh SY, Park S, Chu HH, Kim JW. Author Correction: Comparison of different techniques for the management of venous steno-occlusive lesions during placement of peripherally inserted central catheter. Sci Rep 2021; 11:17448. [PMID: 34433842 PMCID: PMC8387376 DOI: 10.1038/s41598-021-96542-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Woo Jin Yang
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Gangnam-gu, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olymphic-ro 43 gil 88, Songpa-Gu, Seoul, 05505, Republic of Korea.
| | - Eun Ho Jang
- Department of Radiology, Ulsan City Hospital, 1007, Saneop-ro, Buk-gu, Ulsan, 44238, Republic of Korea
| | - Seung Yeon Noh
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Suyoung Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Hee Ho Chu
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olymphic-ro 43 gil 88, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Jong Woo Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olymphic-ro 43 gil 88, Songpa-Gu, Seoul, 05505, Republic of Korea
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Cao C, Kim SY, Kim GH, Shin JH, Nam IC, Alali M, Chu HH, Ko HK. Comparison of transradial and transfemoral access for transcatheter arterial embolization of iatrogenic renal hemorrhage. PLoS One 2021; 16:e0256130. [PMID: 34415949 PMCID: PMC8378688 DOI: 10.1371/journal.pone.0256130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are few reports of renal artery embolization (RAE) via transradial access (TRA) for renal hemorrhage, and none have compared outcomes of RAE via TRA and transfemoral access (TFA). The objective was to compare technical and clinical outcomes in patients undergoing RAE via TRA or TFA for iatrogenic renal hemorrhage. MATERIALS AND METHODS This study included 45 RAE procedures (16 TRA and 29 TFA) for iatrogenic renal hemorrhage in 43 patients performed at a tertiary referral center between October 2018 and December 2020. Information regarding underlying diseases, coagulation status, angiographic and embolization procedure details, technical and clinical successes, and complications were retrospectively evaluated. RESULTS There were no differences in demographics, underlying diseases, updated Charlson comorbidity scores, angiographic findings, and volume of contrast material between the TRA and TFA groups. By contrast, prothrombin time and international normalized ratio were significantly lower in the TRA than in the TFA group. Embolic materials differed significantly in the two groups. Procedure duration, fluoroscopy time, digital subtraction angiography number, and dose area product were slightly lower in the TRA than in the TFA group, but the differences were not statistically significant. Technical and clinical success rates in the TRA and TFA groups were 100% and 96.6%, and 100% and 96.6%, respectively. No patient in either group experienced procedure-related complications during a 4 week follow-up period. CONCLUSION RAE via TRA in the management of iatrogenic renal hemorrhage was safe and feasible, with similar procedure duration and radiation exposure to RAE via TFA. TRA may be an acceptable alternative to TFA in these patients.
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Affiliation(s)
- Chuanwu Cao
- Department of Radiology, The Tenth People’s Hospital, Shanghai, China
| | - So-Yeon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- * E-mail:
| | - In Chul Nam
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Changwon, Korea
| | - Meshari Alali
- Department of Radiology, Majmaah University, Almajmaah, Saudi Arabia
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Heung-Kyu Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Chen C, Kim SW, Shin JH, Chu HH, Li HL. Technical Notes on Fluoroscopy-Guided Removal of Metallic Ureteral Stents. J Vasc Interv Radiol 2021; 32:1615-1622. [PMID: 34391931 DOI: 10.1016/j.jvir.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/23/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022] Open
Abstract
This manuscript describes various techniques for fluoroscopy-guided removal of metallic ureteral stents. Fifteen patients underwent 17 fluoroscopy-guided removal procedures of 22 metallic ureteral stents. The simple or modified snare or retrieval hook technique was primarily used for antegrade access, whereas the loop snare technique was primarily used for retrograde access. Overall 64.7% of the stents were removed using the initial retrieval technique, and 82.4% were removed using an adjunct technique. Procedure-related complications included hematuria in 41.2% of cases and resolved spontaneously in all patients. Fluoroscopy-guided removal of metallic ureteral stents is safe and effective.
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Affiliation(s)
- Chengshi Chen
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Sung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China; Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea.
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Hai-Liang Li
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
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Zheng L, Cho YC, Shin JH, Park JH, Jang EB, Ibrahim A, Li HL, Kim JW. Percutaneous antegrade removal of foreign bodies in the urinary tract: a 20-year, single-center experience. Acta Radiol 2021; 62:1097-1103. [PMID: 32811158 DOI: 10.1177/0284185120950127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND While removing urinary tract foreign bodies is mostly performed through retrograde cystoscopy, antegrade removal using interventional procedures is reported less frequently. PURPOSE To evaluate the safety and effectiveness of percutaneous antegrade removal of urinary tract foreign bodies. MATERIAL AND METHODS A total of 14 consecutive patients (age range 9-80 years) who percutaneous antegrade removal of urinary tract foreign bodies between January 2001 and March 2020 were reviewed. Detailed removal procedures and complications were reviewed retrospectively. RESULTS Types of foreign bodies were sheared percutaneous nephrostomy (PCN) catheters (n = 5), sheared double J stents (n = 3), migrated ureteral catheters (n = 3), embolization coils (n = 2), and a 0.018-inch guide wire (n = 1). The mean and median indwelling times (range 0-306 days) of the foreign bodies were 58.3 and 1.5 days, respectively. Computed tomography (CT) scans were conducted in six patients, and the extent and nature of the foreign bodies were well-visualized on CT scans. The removal access was new PCN access (n = 8), the tract missing PCN catheter (n = 3), pre-existing PCN access (n = 2), and percutaneous dissection (n = 1). The removal success rate was 92.9% (13/14) with either a simple (n = 8) or modified (n = 4; combination of a snare and guide wire is used) snare technique or a direct forceps grasp (n = 1). The mean procedure time for successful cases was 14.2 min (range 7-25 min). Procedure-related hematoma with (n = 2) or without (n = 1) renal pelvis injury occurred in three patients, which were all self-limited within one week. CONCLUSION Percutaneous antegrade removal is safe and effective for urinary tract foreign bodies.
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Affiliation(s)
- Lin Zheng
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Young Chul Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Hoon Park
- Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Bee Jang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Alrashidi Ibrahim
- Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hai-Liang Li
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Alrashidi I, Kim TH, Shin JH, Alreshidi M, Park M, Jang EB. Efficacy and safety of transcatheter arterial embolization for active arterial esophageal bleeding: a single-center experience. ACTA ACUST UNITED AC 2021; 27:519-523. [PMID: 34313237 DOI: 10.5152/dir.2021.20253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The study aimed to evaluate the safety and clinical efficacy of transcatheter arterial embolization (TAE) for the treatment of arterial esophageal bleeding. METHODS Nine patients (8 male, 1 female; mean age, 62.3±7.5 years) who underwent TAE for arterial esophageal bleeding between January 2004 and January 2020 were included. Preceding endoscopic treatment was unsuccessful in five patients and was not attempted in four patients due to the non-cooperation of the patients in endoscopic treatment. The etiologies of bleeding were esophageal cancer (n=4), Mallory-Weiss syndrome (n=3), erosive esophagitis (n=1), and esophageal ulcer (n=1). Technical and clinical success, recurrent bleeding, procedure-related complications, and clinical outcomes were retrospectively reviewed. RESULTS The angiographic findings for bleeding were contrast media extravasation (n=8) or tumor staining without a definite bleeding focus (n=1). The bleeding focus at the distal esophagus (n=8) was the left gastric artery, whereas that at the middle esophagus (n=1) was the right bronchial artery. Technical success was achieved in all patients. The embolic agents were n-butyl cyanoacrylate (NBCA, n=5), gelatin sponge particles (n=2), microcoils (n=1), and NBCA with gelatin sponge particles (n=1). Clinical success was achieved in 77.8% of cases (7/9); two patients with recurrent bleeding one day after the first TAE showed culprit arteries different from the bleeding foci at the first TAE. One patient who underwent embolization of both the left and short gastric arteries died of gastric infract/perforation one month after TAE. CONCLUSION TAE can be an alternative to the treatment of arterial esophageal bleeding. TAE can be attempted in the treatment of recurrent bleeding, but there is a risk of ischemia/infarct in the gastrointestinal tract involved.
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Affiliation(s)
- Ibrahim Alrashidi
- Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Tae-Hyung Kim
- Department of Radiological Science, College of Health Science, Kangwon National University, Samcheok-si, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | | | - Minho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eun Bee Jang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Tsauo J, Noh SY, Shin JH, Gwon DI, Han K, Lee JM, Jeon UB, Kim YH. Retrograde transvenous obliteration for the prevention of variceal rebleeding in patients with hepatocellular carcinoma: a multicentre retrospective study. Clin Radiol 2021; 76:681-687. [PMID: 34140137 DOI: 10.1016/j.crad.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/14/2021] [Indexed: 12/14/2022]
Abstract
AIM To evaluate the effectiveness and safety of retrograde transvenous obliteration (RTO) for the prevention of variceal rebleeding variceal rebleeding in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS This multicentre retrospective study enrolled 79 patients with HCC who underwent RTO for the prevention of variceal rebleeding. Successful occlusion of the gastrorenal shunt and obliteration of the gastric varices were achieved in 74 patients, with a technical success rate of 93.7%. Of the remaining 74 patients (mean age, 64.9±10.3 years; 56 men), 66 (90.4%) had gastroesophageal varices and seven (9.6%) had isolated gastric varices. Thirty-two patients (43.8%) underwent balloon-occluded RTO, 40 patients (54.8%) underwent plug-assisted RTO, and one patient (1.4%) underwent coil-assisted RTO. No patients had major procedural complications. RESULTS Rebleeding occurred in seven patients (9.6%) during the follow-up period. The 6-week and 1-year actuarial probabilities of patients remaining free of rebleeding were 90.8±3.6% and 88.6±4.1%, respectively. The median survival was 12.6 (95% confidence interval [CI] 8-17.3) months. The 6-week, 1-year, and 3-year actuarial probabilities of survival were 83.2±4.4%, 51.1±6.6%, and 32.7±7%, respectively. New or worsening ascites and oesophageal varices occurred in 12 (16.4%) and 13 patients (17.8%), respectively, during the follow-up period. Overt hepatic encephalopathy occurred in one patient (1.4%) during the follow-up period. The Child-Pugh score remained comparable to that at baseline at 1 and 3 months. CONCLUSION RTO was effective and safe in preventing variceal rebleeding in patients with HCC.
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Affiliation(s)
- J Tsauo
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - S Y Noh
- Department of Radiology, Kyung Hee University Seoul Hospital, Seoul, South Korea
| | - J H Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - D I Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - K Han
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - J M Lee
- Department of Radiology, Soonchunhyang University Hospital, Bucheon, South Korea
| | - U B Jeon
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Y H Kim
- Department of Radiology, Daegu Catholic University Medical Center, Daegu, South Korea
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Alrashidi I, Shin JH. Percutaneous Transhepatic and Translumbar Sclerotherapy of a Thoracic Duct Cyst: A Case Report. The Arab Journal of Interventional Radiology 2021. [DOI: 10.1055/s-0041-1730116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractA 58-year-old male presented with chronic abdominal pain lasting 5 years and a 15 × 6-cm multicystic thoracic duct cyst with three compartments, located in the right retrocrural and retrocardiac regions from T5/T6 to T12/L1. A transhepatic route was selected to sclerose the middle and lower compartments. Subsequent contrast injection showed minimal contrast passage into the upper compartment through a narrow neck, but the guidewire could not pass into this compartment. The contrast-filled upper compartment was punctured with a 22-g Chiba needle using a translumbar approach under cone-beam computed tomography (CT) guidance and ethanol sclerotherapy was performed. Six-month follow-up CT revealed decreased thoracic duct cyst size (5×3 cm) and no pain. This case illustrates successful percutaneous transhepatic and translumbar sclerotherapy for retrocardiac and retrocrural thoracic duct cysts, which are very difficult to remove surgically.
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Affiliation(s)
- Ibrahim Alrashidi
- Department of Radiology, University of Ulsan, College of Medicine Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, University of Ulsan, College of Medicine Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
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Zheng L, Lee IJ, Shin JH, Chu HH, Li HL. Endovascular Management of Gastric Conduit Hemorrhage following Transthoracic Esophagectomy. J Vasc Interv Radiol 2021; 32:1144-1149. [PMID: 34022402 DOI: 10.1016/j.jvir.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/29/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022] Open
Abstract
Seven patients underwent angiography and attempted embolization for massive hemorrhage of the gastric conduit after transthoracic esophagectomy. Endoscopy revealed ulcers in 5 patients, tumor recurrence in 1 patient, and unknown etiology in 1 patient. Arteriography revealed extravasation, pseudoaneurysm, or tumor blush arising from the intercostal artery (n = 4) or right gastric artery (n = 2), which were successfully embolized. The bleeding source was not identified in 1 patient, who died from persistent hemorrhage.
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Affiliation(s)
- Lin Zheng
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - In Joon Lee
- Department of Radiology, National Cancer Center, Goyang-si, Gyeonggi-do, Korea
| | - Ji Hoon Shin
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China; Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea.
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Hai-Liang Li
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
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Cho YC, Kang JM, Park W, Kim DH, Shin JH, Kim DH, Park JH. Photothermal therapy via a gold nanoparticle-coated stent for treating stent-induced granulation tissue formation in the rat esophagus. Sci Rep 2021; 11:10558. [PMID: 34006988 PMCID: PMC8131374 DOI: 10.1038/s41598-021-90182-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/05/2021] [Indexed: 01/17/2023] Open
Abstract
Minimally invasive therapies using stent technology are currently limited by stent-induced granulation tissue formation adjacent to the stent. The effectiveness of photothermal therapy (PTT) using a gold nanoparticle (AuNP)-coated stent for treating stent-induced granulation tissue formation in the rat esophagus was investigated. All experiments were approved by the animal research committee of our institution. An AuNP-coated, self-expandable metallic stent (SEMS) was produced to conduct PTT under near-infrared laser irradiation. Forty rats were randomly divided into four groups (10 rats each). The animals in group A (non-coated SEMS) and group B (AuNP-coated SEMS with local heating at 65 °C at 4 weeks) were sacrificed 4 weeks after stent placement. The rats in group C (AuNP-coated SEMS with local heating at 65 °C at 4 weeks) and group D (AuNP-coated SEMS with local heating at 65 °C at 4 and 8 weeks) were sacrificed 8 weeks after stent placement. The effectiveness of local heating was assessed by histopathology. All procedures were successful in all of the animals. Seven rats were excluded because of stent migration (n = 2) and death (n = 5). Granulation tissue formation-related variables were significantly higher in group A than in groups B-D (all p < 0.05). Heat-shock protein 70 (HSP70) and TUNEL expression were significantly lower in group A than in groups B-D (all p < 0.05). Granulation tissue formation-related variables were significantly higher in group C than in groups B and D (all p < 0.05). PTT using AuNP-coated SEMS successfully treated granulation tissue formation after stent placement in the rat esophagus.
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Affiliation(s)
- Young Chul Cho
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jeon Min Kang
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Wooram Park
- Department of Biomedical-Chemical Engineering, The Catholic University of Korea, 43 Jibong-ro, Bucheon-si, Gyeonggi, 14662, Republic of Korea
| | - Dong-Hyun Kim
- Department of Radiology, Feinberg School of Medicine, and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, 60611, USA
| | - Ji Hoon Shin
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Do Hoon Kim
- Departments of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Jung-Hoon Park
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Yang WJ, Kang D, Shin JH, Jang EH, Noh SY, Park S, Chu HH, Kim JW. Comparison of different techniques for the management of venous steno-occlusive lesions during placement of peripherally inserted central catheter. Sci Rep 2021; 11:10234. [PMID: 33986427 PMCID: PMC8119704 DOI: 10.1038/s41598-021-89780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 02/18/2021] [Indexed: 12/01/2022] Open
Abstract
The purpose of this study is to investigate strategies for peripherally inserted central catheter (PICC) placement in patients with venous steno-occlusive lesion (VSOL). We performed a retrospective cohort study in adults with central or peripheral VSOL who underwent PICC placement procedures from January 2015 to December 2018. Four different strategies [selecting alternative pathway/over the wire (SAP/OTW), percutaneous transluminal angioplasty (PTA), re-puncture in ipsilateral arm (RIA), and catheter placement in the contralateral arm (CICA)] were analyzed and we compared the clinical outcomes by strategy and compared the strategy between central and peripheral VSOLs. During 4 years, 258 PICC procedures performed in patients with VSOLs, 100 PICC were included in the analysis. The overall technical success rate of initial attempt with SAP/OTW was 32.2%. As a second-line technique, PTA was most frequently used in both central (100%) and peripheral (68.2%) VSOL groups. The clinical success rates within 2 months of SAP/OTW, PTA, RIA, CICA were 55.2%, 43.2%, 14.3%, and 33.3%, respectively (P = 0.24). In conclusion, when the SAP/OTW failed, the PTA can be preferred as a second-line technique for both central and peripheral VSOLs. When guidewire passage fails, the operator could adopt the RIA or CICA technique as an alternative method.
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Affiliation(s)
- Woo Jin Yang
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Gangnam-gu, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olymphic-ro 43 gil 88, Songpa-Gu, Seoul, 05505, Republic of Korea.
| | - Eun Ho Jang
- Department of Radiology, Ulsan City Hospital, 1007, Saneop-ro, Buk-gu, Ulsan, 44238, Republic of Korea
| | - Seung Yeon Noh
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Suyoung Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Hee Ho Chu
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olymphic-ro 43 gil 88, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Jong Woo Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olymphic-ro 43 gil 88, Songpa-Gu, Seoul, 05505, Republic of Korea
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Kim CY, Shin JH. Recent update of percutaneous radiologic jejunostomy. Int J Gastrointest Interv 2021. [DOI: 10.18528/ijgii210009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Charles Y. Kim
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
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Chen CS, Ahn H, Shin JH, Li HL, Kim JW, Ibrahim A, Chu HH. Renal artery embolization for spontaneous hemorrhage in patients with acquired cystic kidney disease: A 20-year single-center experience. Pak J Med Sci 2021; 37:1111-1117. [PMID: 34290792 PMCID: PMC8281160 DOI: 10.12669/pjms.37.4.3999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/15/2020] [Accepted: 02/25/2021] [Indexed: 01/20/2023] Open
Abstract
Objectives To evaluate the safety and effectiveness of transcatheter arterial embolization for controlling spontaneous hemorrhage in patients with acquired cystic kidney disease (ACKD). Methods This retrospective study included 18 patients with ACKD (M:F=13:5; mean age, 56 years) who underwent renal artery embolization to control spontaneous hemorrhage between January 2001 and September 2020. The underlying etiology and clinical presentations were reviewed and previous computed tomography (CT) findings were analyzed. Furthermore, angiographic and embolization details, technical and clinical successes, and complications were assessed. Results Subcapsular, perirenal, and pararenal hematomas were observed on CT scans for all patients. Contrast extravasation was observed in 15 / 17 patients (88%) on contrast-enhanced CT scans. Angiography showed active bleeding in 14 patients (78%; contrast extravasation [n=6], pseudoaneurysm [n=3], and both [n=5]), suspicious bleeding in 1 (5%), and no bleeding in 3 (17%). The technical and clinical success rates were 100% and 94% (17/18), respectively. Total and partial embolization was performed in 14 (78%) and 4 (22%) cases, respectively. Subsequent surgical nephrectomy was required for one patient with clinical failure due to recurrent bleeding despite total embolization. Procedure-related complications included mild post-embolization syndrome in one patient and contrast-induced nephropathy in five patients (28%) without long-term complications. Conclusions Renal artery embolization is safe and effective for controlling spontaneous renal hemorrhage in patients with ACKD.
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Affiliation(s)
- Cheng Shi Chen
- Cheng Shi Chen, MD. Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Hyemin Ahn
- Hyemin Ahn, MD. Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Ji Hoon Shin
- Ji Hoon Shin, MD. Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Hai-Liang Li
- Hai-Liang Li, MD. Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Jong Woo Kim
- Jong Woo Kim, MD. Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Alrashidi Ibrahim
- Alrashidi Ibrahim, MD. Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hee Ho Chu
- Hee Ho Chu, MD. Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
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Park S, Jeong B, Shin JH, Jang EH, Hwang JH, Kim JH. Transarterial embolisation for gastroduodenal bleeding following endoscopic resection. Br J Radiol 2021; 94:20210062. [PMID: 33861138 DOI: 10.1259/bjr.20210062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Transcatheter arterial embolisation (TAE) is widely used to treat gastrointestinal bleeding. This paper reports the safety and efficacy of TAE for bleeding following endoscopic resection, including endoscopic mucosal resection and endoscopic submucosal dissection. METHODS Fifteen consecutive patients (13 males, two females; mean age 62.2 years) from two tertiary medical centres who underwent TAE for gastroduodenal bleeding after endoscopic resection from November 2001 to December 2020 were included. Patient demographics, clinical presentations, angiographic findings, and TAE details were retrospectively reviewed. RESULTS Immediate bleeding during endoscopic resection was noted in four patients. Delayed bleeding 1-30 days after endoscopic resection in nine patients presented with haematochezia (n = 4), haematemesis (n = 6) and melaena (n = 1). Endoscopic haemostasis was attempted in 11 patients (73.3%) but failed due to continued bleeding despite haemostasis (n = 6), failure to secure endoscopic field (n = 3) and unstable vital signs (n = 2). Eleven patients had positive angiographic findings for bleeding, and all bleeding arteries were embolised except one owing to failed superselection of the bleeder. In the other four patients with negative angiographic findings, the left gastric artery with/without the right gastric artery or the accessory left gastric artery was empirically embolised using gelatin sponge particles. Both technical and clinical success rates were 93.3% (14/15). No procedure-related complications occurred during follow-up. CONCLUSIONS TAE is safe and effective in the treatment of immediate and delayed bleeding after endoscopic resection procedures. ADVANCES IN KNOWLEDGE This is the first and largest 20-year bicentric study published in English on this topic. Empirical TAE for angiographically negative bleeding sites was also effective without significant complications.
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Affiliation(s)
- Suyoung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Olympic-ro 43gil, Seoul, Republic of Korea
| | - Boryeong Jeong
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Olympic-ro 43gil, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Olympic-ro 43gil, Seoul, Republic of Korea
| | - Eun Ho Jang
- Department of Radiology, Ulsan City Hospital, 1007, Saneop-ro, Buk-gu, Ulsan, Republic of Korea
| | - Jung Han Hwang
- Department of Radiology, Gil Medical Centre, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea
| | - Jeong Ho Kim
- Department of Radiology, Gil Medical Centre, Gachon University College of Medicine, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea
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Hur J, Jeong B, Shin JH, Bae JI, Lee SH, Kim SB, Won Chang J, Kim JY, Kim JE. Transrenal Hemodialysis Catheter Insertion and Replacement in Patients with Upper Extremity Central Venous Access Exhaustion. Cardiovasc Intervent Radiol 2021; 44:1121-1126. [PMID: 33851264 DOI: 10.1007/s00270-021-02769-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Patients undergoing long-term hemodialysis may suffer upper extremity central venous access failure and require an alternative route. This study aimed to evaluate the safety and efficacy of transrenal hemodialysis catheter insertion/replacement in patients with upper extremity central venous access failure. MATERIALS AND METHODS A multicenter retrospective cohort study was made of transrenal hemodialysis catheter insertion/replacement performed between 2014 and 2020. The history of renal replacement therapy and central venous catheters and the technical details of transrenal hemodialysis catheter insertion/replacement, patency, removal and complications were obtained for all patients. RESULTS Six insertion and four replacement procedures involving transrenal hemodialysis catheters were evaluated in six patients (M:F = 3:3; median age, 49.5 years). Percutaneous transrenal (right:left = 1:5) hemodialysis catheter insertion was technically successful without complication in all six patients. In two patients, the tract was not lost because the safety guidewire was still in place, so no second puncture was required. The mean procedure time was 33.0 ± 9.2 min. The mean primary patency duration was 107.3 ± 70.9 days. During the mean follow-up duration of 141.2 ± 137.1 days, four hemodialysis catheter replacement procedures were successfully performed for catheter malfunction (n = 2) and dislodgement (n = 2). Catheter removal was successfully performed in four patients after confirming normal coagulation, followed by subsequent renal replacement therapy. CONCLUSION Percutaneous insertion/replacement of transrenal hemodialysis catheters is feasible, safe, and effective when upper extremity central venous access is exhausted, and the catheters can be maintained for a reasonable period of time. LEVEL OF EVIDENCE Level 4, Case Series.
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Affiliation(s)
- Joonho Hur
- Department of Radiology, College of Medicine Asan Medical Center 86, Chung-Ang University Hospital, Seoul, Korea
| | - Boryeong Jeong
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Korea.
| | - Jae-Ik Bae
- Department of Radiology, Mint Hospital, Seoul, Korea
| | - Sang Hwan Lee
- Department of Radiology, H Plus Yangji Hospital, Seoul, Korea
| | - Soon Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jai Won Chang
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Young Kim
- Department of Radiology, Asan Chungmu Hospital, Asan, Korea
| | - Ji Eun Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Korea
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Chen C, Kim JW, Shin JH, Kwon Y, Kim J, Lee IJ. Management of life-threatening aortoesophageal fistula: experiences learned from eight patients. Acta Radiol 2021; 62:447-452. [PMID: 32551870 DOI: 10.1177/0284185120933228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare but fatal condition causing massive upper gastrointestinal bleeding. PURPOSE To report our experiences in the management of life-threatening AEF. MATERIAL AND METHODS A total of eight patients (seven men, one woman; mean age = 59.4 years; age range = 43‒76 years) presenting with AEF between 2005 and 2018 were recruited from three different Korean hospitals. The medical records of these patients were reviewed for patient demographics, clinical features, diagnostic and therapeutic modalities, and outcomes. RESULTS Two patients died as a result of massive hemorrhage before endovascular or surgical treatment could be undertaken. Of the six patients who were treated, five underwent endovascular interventions: embolization of the fistula using n-butyl cyanoacrylate (NBCA) and subsequent thoracic endovascular aortic repair (TEVAR) in two patients; TEVAR alone in two patients; and NBCA embolization alone in one patient. Among them, three patients who received TEVAR with or without NBCA embolization in a timely fashion recovered and were discharged. One patient who received delayed TEVAR died of disseminated intravascular coagulation, and one who received NBCA embolization alone died of hemorrhagic shock, both dying within three days of treatment. The remaining patient who underwent surgical aortic repair is alive after 13 years. CONCLUSION Rapid identification and surgical treatment are necessary to increase the likelihood of survival, if emergency surgery is feasible. TEVAR in a timely fashion facilitates hemodynamic stabilization by rapidly controlling hemorrhage and saves the patient's life.
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Affiliation(s)
- Chengshi Chen
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yohan Kwon
- Department of Radiology, Ajou University Hospital, Suwon, Republic of Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University Hospital, Suwon, Republic of Korea
| | - In Joon Lee
- Department of Radiology, National Cancer Center, Goyang, Republic of Korea
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Chen CS, Shin JH, Li HL, Guo CY, Kim JW, Zheng L, Yao QJ, Geng X, Wang T. Analysis of the factors influencing retrograde removal of double J ureteral stents using a simple snare technique in female patients. Ann Transl Med 2021; 9:674. [PMID: 33987372 PMCID: PMC8106078 DOI: 10.21037/atm-21-1113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background To identify the factors related to the effectiveness of retrograde removal of double J ureteral stents using a simple snare technique in female patients. Methods It was a retrospective observational study. From 2012 to 2017, 128 female patients underwent fluoroscopy-guided, retrograde double J stent removal with or without replacement using a simple snare technique. The position of the tip of the double J stent in the urinary bladder was classified according to position types A, B, C, and D, corresponding to the ipsilateral lateral, ipsilateral medial, contralateral medial, and contralateral lateral quadrants of the urinary bladder, respectively. The factors influencing the fluoroscopy time upon removal of the double J stent were analyzed. Results Technical success rate of 312 procedures performed was 97.44% (304/312) with the mean fluoroscopy time of 12.68±7.34 minutes. Eight double J stent removal procedures failed, and all of these occurred in the position type D patients. The position type and the number of curls of the double J stent had a significant influence on the fluoroscopy time (P<0.05). In addition, multiple regression analysis demonstrated that the position type and number of curls in the double J stent were factors independently influenced the fluoroscopy time (P=0.001). Type D exhibited the longest fluoroscopy time followed by types B and C, and type A had the shortest fluoroscopy time. There were only minor complications consisting of urethral orifice pain (5.1%, 16/312) or gross hematuria (3.2%, 10/312), all resolved conservatively within 24 hours. Conclusions The position type and the number of curls in a double J stent have a significant influence on the effectiveness of retrograde removal of double J stents using a simple snare technique in female patients.
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Affiliation(s)
- Cheng-Shi Chen
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Ji Hoon Shin
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China.,Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hai-Liang Li
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Chen-Yang Guo
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Lin Zheng
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Quan-Jun Yao
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiang Geng
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Tan Wang
- Department of Interventional Radiology, Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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