Feasibility of Superficial Femoral Artery Intervention Using Mobile C-arms Compared to Fixed C-arms / 대한혈관외과학회지

PURPOSE: Endovascular therapy (ET) for peripheral arterial occlusive disease has increased dramatically in the past decade. ET is currently being performed by different specialists with available resources, with some of these resources being far superior to others, yet there have been no studies comparing the interventional outcomes according to the varying resources. The aim of this study was to analyze the outcomes of ET for superficial femoral artery (SFA) atherosclerosis using a mobile C-arm, in comparison to a historical control group. METHODS: Between March 2009 and December 2010, ET for SFA atherosclerosis was performed in 54 limbs from 47 patients using a mobile C-arm in the operation theater (mobile group). In contrast, a historical group for comparison consisted of 60 patients, for whom ET for SFA atherosclerosis was performed in 76 limbs using a fixed C-arm in the angiographic suite, between July 2003 and May 2008 (fixed group). The outcomes of ET for both groups were retrospectively analyzed by a medical chart review. RESULTS: There was no statistically significant difference in gender, age, risk factors, Trans-Atlantic Inter-Society Consensus (TASC) classification, intervention type, and postoperative blood creatinine levels between the two groups. However, procedural time was statistically higher in the mobile group. Patency rates at 1 year were 68.3% and 68.1% in the fixed and mobile group, respectively, which was not statistically significant. Subgroup analysis of 1 year patency rates for TASC A, B lesions and TASC C, D lesions were also similar. CONCLUSION: ET using the mobile C-arm in the operating theater is as effective as using the fixed C-arm, in the treatment of SFA atherosclerosis in terms of the technical success, patency, and early postoperative outcomes.

Drug-eluting Stent Implantation for a Below-the-knee Chronic Total Occlusion Lesion: A Case Report / 대한혈관외과학회지

For many years, surgical bypass has been considered mainstream therapy of below-the-knee peripheral arterial occlusive disease. The introduction of endovascular techniques and devices has made percutaneous transluminal angioplasty (PTA) and stenting feasible and safe in these patients. However, PTA has a significant risk of restenosis by elastic recoil and stenting is associated with restenosis by neointinal hyperplasia and vessel wall remodeling. With the advent of coronary artery drug eluting stent (DES), these limitations of PTA and stenting have been circumvented. Herein, we report a successful case of DES implantation for below-the-knee chronic total occlusion lesion. A 65-year-old male patient presented with severe claudication on his left leg. Computed tomography angiography showed long segment total occlusion involving the left distal superficial femoral, popliteal and proximal anterior tibial arteries. We tried to treat the lesion using endovascular surgery. During balloon angioplasty, flow limiting dissection developed in the proximal anterior tibial artery and we deployed a DES (Cypher, Cordis, Johnson & Johnson, USA) in that lesion. To our knowledge, this is the first report of DES for the treatment of below-the-knee chronic total occlusion lesion in Korea.

Outcomes of Endovascular Intervention and Bypass Surgery for Femoral Artery Atherosclerosis

PURPOSE: The main treatment modality of peripheral arterial occlusive disease (PAOD) of the lower extremities has shifted from traditional bypass surgery (BS) to a less invasive endovascular intervention (EI), but there is still conflicting data about the differences in long-term patency between the two modalities The purpose of this study was to analyze restenosis rates of femoral EI and to compare both anatomical and functional results between EI and femorodistal BS. METHODS: Between July 2003 and June 2009, 88 limbs (61 patients) and 47 limbs (43 patients) with femoral artery PAOD were treated with EI and BS, respectively. A retrospective analysis of prospectively collected data was performed by reviewing medical records, radiologic images and noninvasive vascular studies. Patient demographics and risk factors were analyzed. Technical outcomes such as restenosis rates, patency rates and functional outcomes using modified questionnaires were evaluated. RESULTS: The restenosis rates for EI at 6 months, 1 year, 2 years and 3 years were 10.4%, 20.1%, 41.1% and 52.7%, respectively, and the mean restenosis duration was 36.5+/-3.24 months. Comparison of patency rates between EI and BS showed no significant difference (P=0.204) in TASC C and D lesions. Functional outcome analysis showed that both EI and BS improved functional status after treatment, and comparison between the two groups showed that BS had a better functional improvement than EI (P=0.010). CONCLUSION: EI could provide equivalent patency rates compared with BS, but for TASC C and D lesions, BS is still a preferred treatment modality based on better functional outcomes.

Coronary Angiography with Multidetector row Computed Tomography: Part I - Technical Aspects

Various invasive and non-invasive imaging techniques have been used for the diagnosis of cardiac disease. The recently introduced multidetector row CT (MDCT) shows rapid scan speed, high temporal resolution and large volume coverage in a single breath-hold. MDCT opens a new horizon for cardiac imaging because noninvasive coronary artery imaging has become feasible using MDCT. In this article, we illustrate the technical aspects of coronary CT angiography using MDCT.

Usefulness of Breath-hold T2-w d T2-weighted MR Imaging in Patients with Myocardial Infarction: Comparison with Delayed Enhancement

PURPOSE: To evaluate the usefulness of breath-hold T2-weighted MR imaging in patients with myocardial infarction. MATERIALS AND METHODS: We investigated 11 patients with myocardial infarction who shown delayed enhancement on MR imaging. Infarcted myocardium on T2-weighted MR imaging was classified as high, iso, and low signal area comparing with normal myocardium. The intensity and transmural extent of infracted myocardium was also analyzed. On the basis of clinical information, the stage of infracted myocardium on T2-weighted MR imaging was assessed. RESULTS: It was observed high signal area in 12 segments of 5 patients, low in 12 segments of 6 patients on T2-weighted MR imaging. The high signal intensity of infarcted myocardium was shown as 175+/-9% comparing with that of the normal myocardium, low signal intensity as 73+/-5% (p < 0.05). In the evaluation of transmural extent, the high signal areas on T2-weighted MR imaging were larger than infarct area on delayed enhancement imaging (100% vs. 49%+/-17%), whereas low signal areas on T2-weighted MR imaging correlated. High signal area was visualized on T2-weighted MR imaging within 11days, whereas low-signal area was seen after 7 months. CONCLUSION: Breath-hold T2-weighted MR imaging is useful in the evaluation of stage as well as edema and fibrous scar in patients with myocardial infarction.

Contrast Enhanced MR Angiography after Metallic Stent Placement: Experimental Study

PURPOSE: The purpose of this study was to evaluate the efficacy of contrast-enhanced MR angiography for follow-up examinations after metallic stent placement and to examine the effects of change of imaging parameters used for contrast-enhanced MR angiography. MATERIALS AND METHODS: After four metallic stents (Passager, Ninitol, Wallstent, and Memotherm) were placed in an abdominal aorta shaped vascular phantom, efGRE (enhanced fast gradient recalled echo) 3-D MR angiography was performed, using a 1.5T unit. The four metallic stents were graded 1-3 according to the width and length of their high signal intensity. Variations in the degree of high signal intensity were evaluated according to imaging parameters. RESULTS: The width and length of high signal intensity with the Passager stent and Nitinol stent were greater than with the Wallstent and Memotherm. The larger the field of view, the smaller the matrix number, the larger the flip angle, the greater the width and length of high signal intensity in the metallic stent. CONCLUSION: Contrast-enhanced MR angiography may be a useful follow-up procedure after the placement of Passager and Ninitol metallic stents. The signal intensity of stent lumen varies according to imaging parameters, and the selection of optimal parameters is therefore important.

2 Cases of Transcatheter Embolization Therapy of Massive Lower Gastrointestinal Bleeding due to Typhoid Fever / 대한내과학회지

Typhoid fever is still endemic in developing countries and the cause of much morbidity and mortality. Complications such as intestinal hemorrhage, intestinal perforation, hepatitis, pyelonephritis, cholecystitis, osteomyelitis are known to occur. The classical approach to management of intestinal hemorrhage due to typhoid ulceration has been conservative. In, however, the event of massive, persistent and life-threatening hemorrhage not responding to conservative measures, early surgical intervention is life-saving. But surgical intervention is difficult due to multiple bleeding sites and friable distal ileum and colon. These two cases are reported in order to draw attention to the usefulness of mesenteric arteriography and the effectiveness of transcatheter embolization therapy in massive intestinal hemorrhage due to typhoid fever.

Comparison of Experimental MR Imaging of Stainless Steel and Nitinol Stents in a Vascular Phantom

PURPOSE: To evaluate the usefulness of MR imaging for the follow-up of vessels in which a stainless steel ornitinol stent has been placed. MATERIALS AND METHODS: Stents were made with either stainless steel or nitinol,and inserted in a vascular-shaped rubber tube; this was then placed in an acryl bath. MR images of stainless steeland nitinol stents in the water-filled tube, both with and without flow, were obtained. As MRI pulse sequences, SET1WI, FSE T2WI, heavily T2WI, SE EPI, FMPSPGR, GRASS, FLAIR, 3D SSFP, 2D PC MRA and 2D TOF MRA were used. The MRimages obtained with each pulse sequence were compared, with special attention to the presence and location ofartifact and the ability to discriminate the stent from the wall of the vascular phantom or water. RESULTS: Inour study without water flowing, the stainless steel stent produced images with severe artifacts in all pulsesequences, but the nitinol stent produced excellent images without artifact in SE T1WI, FSE T2WI and heavily T2WI.With water flowing, the stainless steel stent produced a less severe artifact at the distal end of the stent on SET1WI, FSE T2WI, heavily T2WI, GRASS and FLAIR ; the nitinol stent produced excellent images without artifact in SET1WI, FSE T2WI, GRASS, FLAIR and 2D TOF MRA. CONCLUSION: For follow-up study of Patients with a nitinol stent,MRI can be useful.