Use of Reversed Iliac Leg Stent-Graft for the Treatment of Isolated Aneurysm of Internal Iliac Artery

This is to report the technique of reversed iliac leg stent-graft in endovascular treatment for isolated internal iliac artery (IIA) aneurysm, which had significant size discrepancy between the common iliac artery (CIA) and external iliac artery (EIA) in 3 patients from different hospitals. Three patients were a 85- and two 82-year-old men. Treated were right IIA aneurysms, sized 6.5x6.2 cm, 5.0x4.0 cm, and 4.1 cm in longest diameter, respectively. The diameters of the right CIA and right EIA measured 21 mm/11 mm, 15 mm/11 mm, and 20 mm/10 mm, respectively. In all cases, reversed iliac leg stent-grafts were prepared on-site; unsheathed and mounted upside-down manually, and deployed in each right CIA. Post-stent-graft angiograms showed complete exclusion of the aneurysms, except for minimal type 1 endoleak in one case. This technique is a useful treatment option in patients with isolated IIA aneurysm.

Endovascular abdominal aortic aneurysm repair in patients with renal transplant / 대한외과학회지

The repair of abdominal aortic aneurysm (AAA) in patients with functioning renal transplant is critical because it is important to avoid ischemic and reperfusion injury to the transplanted kidney. Endovascular aneurysm repair (EVAR) avoids aortic cross clamping and can prevent renal graft ischemia. Here we report the endovascular management and outcome of AAA in two renal transplant patients using a bifurcated aortic stent graft. One patient underwent EVAR using a small amount of contrast (30 mL) due to decreased renal function resulting from chronic rejection. Another patient had EVAR performed with iliac conduit because of the heavily calcified, stenotic lesion of external iliac artery. EVAR in patients with a renal transplant is a feasible option without impairing renal arterial flow.

Simultaneous Laparoscopic Cholecystectomy and Endovascular Abdominal Aortic Aneurysm Repair / 대한혈관외과학회지

Concomitant cholelithiasis and abdominal aortic aneurysm (AAA) is not uncommon. Cholecystectomy at the time of aneurysm repair was delayed in patients with asymptomatic cholelithiasis due to the possibility of the graft infection. If a patient is subjected to a high risk of aneurysmal rupture and symptomatic cholelithiasis, the combined cholecystectomy and aneurysm repair should be performed. With the advent of the minimally invasive surgery, minimal invasive approach is widely adopted in patients with cholelithiasis and AAA. We reported one patient who had symptomatic cholelithiasis and AAA, successfully treated with the laparoscopic cholecystectomy and endovascular AAA repair.

Usefulness of a Guiding Sheath for Fluoroscopic Colorectal Stent Placement

OBJECTIVE: To investigate the technical feasibility, clinical usefulness, and safety of a guiding sheath in fluoroscopic stent placement for patients with malignant colorectal obstructions. MATERIALS AND METHODS: Between June 2007 and January 2011, fluoroscopic placement of a dual colorectal stent was attempted in a total of 97 patients with malignant colorectal obstructions. A polytetrafluoroethylene guiding sheath was used in patients in whom a stent delivery system failed to reach the obstruction. Usefulness of the sheath was evaluated depending on whether the sheath could successfully assist the stent delivery system reach its area of interest. RESULTS: The guiding sheath was needed in 22 patients (15 men, 7 women; age range, 33-77 years; mean age, 59 years). The overall success rate for passing the sheath to the area of interest was 100%. There were no procedure-related deaths or major complications. The majority of the patients reported mild discomfort. In 2 of 22 patients with successful passing of the sheath to the area of interest, stent placement failed because of failure in the negotiation of a guide wire through the obstruction. CONCLUSION: Using a guiding sheath seems to be easy, safe and useful in fluoroscopic stent placement for patients with malignant colorectal obstructions.

Duplex Criteria for Carotid Artery Stenosis / 대한혈관외과학회지

PURPOSE: Various duplex criteria have been used to predict hemodynamically significant carotid artery stenosis. Clinicians have relied on published institutional experience for carotid duplex ultrasound interpretation. Duplex parameters for interpreting carotid artery stenosis severity consist of peak systolic velocity (PSV) and end-diastolic velocity of the internal carotid artery (ICA), the ratio of ICA PSV and end-diastolic velocity (EDV) to common carotid artery (CCA) PSV (PSVICA/CCA) and EDV (EDVICA/CCA). This study was performed to elucidate which duplex parameter can predict the severity of the carotid artery stenosis more accurately. METHODS: The carotid duplex ultrasound and angiographic results of 121 carotid arteries were analyzed. Receiver operater characteristic (ROC) curves were used to compare PSV, EDV, and both ratios in detecting > or =50%, > or =60%, and > or =70% stenosis of the internal carotid artery. RESULTS: The PSVICA/CCA ratio can accurately detect > or =50%, > or =60%, and > or =70% stenosis of the internal carotid artery. To detect > or =50% angiographic stenosis, a PSVICA/CCA ratio of 1.2 has a sensitivity of 83% and specificity of 77%. A PSVICA/CCA ratio of 1.8 can detect > or =60% angiographic stenosis with a sensitivity of 80% and specificity of 79%. Finally, a PSVICA/CCA ratio of 2.2 can detect > or =70% angiographic stenosis with a sensitivity and specificity of 70 and 89%, respectively. CONCLUSION: The PSVICA/CCA ratio can be used for detecting internal carotid artery angiographic stenosis. PSVICA/CCA ratios of 1.2, 1.8, and 2.2 are proper criteria for interpreting 50%< or =, 60%< or = and 70%< or = stenosis, respectively.

Auxiliary partial orthotopic liver transplantation for adult onset type II citrullinemia / 대한외과학회지

Adult-onset type II citrullinemia (CTLN2) is a disorder caused by an inborn error of metabolism affecting the liver. CTLN2 is an autosomal recessive disorder characterized by recurrent encephalopathy with hyperammonemia due to highly elevated plasma levels of citrulline and ammonia, caused by a deficiency of argininosuccinate synthetase in the liver. A small number of patients have undergone liver transplantation with favorable results. In Korea, the limitations of the deceased donor pool have made living donor liver transplantation a common alternative treatment option. We report the case of a patient with type II citrullinemia who was treated successfully with auxiliary partial orthotopic liver transplantation (APOLT) from a living donor. This is the first description of an APOLT for a patient with adult onset type II citrullinemia in Korea.

A Case of Ruptured Left Gastric Artery Pseudoaneurysm Complicating Percutaneous Endoscopic Gastrostomy (PEG) / 대한소화기내시경학회지

Percutaneous endoscopic gastrostomy (PEG) is an effective method for delivering enteral nutrition to patients with dysphagia, cerebrovascular accidents, Parkinsonnism, dementia, and head and neck cancer. PEG is generally regarded as safe and it is associated with low risks of morbidity and mortality. The complications of the PEG are known to be mostly minor and they include wound infection, gastric leakage, bleeding, ileus, pneumoperitoneum and aspiration pneumonia. We recently experienced a ruptured pseudoaneurysm of the left gastric artery, which was occurred as a complication during PEG insertion in a 73-year-old female. To the best of our knowledge, this is the first case report in Korea about successful angiographic embolization for a ruptured pseudoaneurysm of the left gastric artery and this was associated with a PEG procedure.

The Usefulness of the Transabdominal Ultrasonography as a Screening Examination in the Evaluation of the Patient with Suspicious Gastric Disease

PURPOSE: To evaluate the usefulness of transabdominal ultrasonography as a screening examination in patients with suspicious gastric disease. MATERIALS AND METHODS: We selected 141 patients with epigastric pain and who were found to have antral gastric wall thickening of more than 5 mm in transabdominal ultrasonography, and who underwent gastroscopy immediately following the ultrasonography examination, because we suspected that these patients had gastric disease. We measured the full thickness of the five layers of the gastric wall and evaluated the preservation of this fivelayered structure. We respectively compared the gastric wall thickness and the preservation of gastric layers in 26 normal, 91 gastritis, 12 gastric ulcer, and 12 gastric cancer patients, who were classified based on the gastroscopy results. RESULTS: The mean thicknesses of the gastric wall in the normal, gastritis, gastric ulcer and gastric cancer patients were 5.13+/-0.14 mm, 6.71+/-1.33 mm, 8.08+/-2.80 mm, and 12.45+/-3.70 mm, respectively. The gastric walls in the gastritis, gastric ulcer and gastric cancer patients were significantly thicker than that in the normal patients (p 0.01). Except for two patients with gastritis and three patients with gastric ulcer, the stratification of the gastric wall was preserved in all of the normal, gastritis and gastric ulcer patients, whereas it was disrupted in all of the patients with gastric cancer. CONCLUSION: Transabdominal ultrasonography in the fasting state may be a helpful and convenient modality, which can serve as a screening examination in the evaluation of gastric disease. Therefore, careful attention and effort are needed to evaluate the gastric wall during transabdominal ultrasonography.

Giant Presacral Schwannoma: A Case Report

Most giant sacral schwannomas are associated with moderate to massive bone destruction before they extend into the presacral space. These lesions can, on rare occasions, manifest as a giant tumor in the presacral space without bone destruction. We report here on the image findings of a presacral giant schwannoma in a 65-year-old man. On ultrasound and CT, the tumor appeared as an inhomogenous, well-demarcated mass that demonstrated some cystic changes and peripheral calcifications without sacral bone destruction. On the MR imaging, the tumor showed as an inhomogeneous, encapsulating mass with low signal intensity on both the T1 and T2-weighted images, except for some areas that showed cystic change.

Incidental Finding of a Precaval Right Renal Artery on CT: A Case Report

The right renal artery passing anterior to the inferior vena cava is a rare variant of the normal renal arterial anatomy, and identifying this anomaly is important for the planning of minimally invasive renal surgery. The presence of this precaval right renal artery was detected on the contrast-enhanced CT scan by identifying the right renal artery passing anterior to the inferior vena cava. We report here on a case of a precaval right renal artery as a main supplying artery, and this was incidentally found on CT.

Radiologic Findings in Cases Involving Complications Arising from Total Knee Arthroplasty

Total knee arthroplasty(TKA) has been used for the treatment of knee joint pain, deformity, and instability caused by osteoarthritis, rheumatoid arthritis, or tuberculous arthritis, and by virtue of good results and rapid development, the procedure has been increasingly employed. With the development of total knee prosthesis, complications have also increased, however, and due to complications occurring up to six years after surgery, fusion occurs in about 2% of all replaced knees. The most common complication of TKA is loosening, followed by infection. Others are thrombosis, subluxation, dislocation and fracture, and complications may be divided into four groups: biologic, technical, specific to type of components, and associated with certain diagnosis. Where these complications occur, a patient must undergo a second procedure, but the success rate is lower than for the initial procedure. Exact etiological evaluation important clinically and radiologically. We illustrate the etiologies and radiologic characteristics of TKA complications according to classification.