Endoluminal Placement of Stent-Graft for the Treatment of Peripheral Saccular Aneurysm

PURPOSE: To determine the therapeutic effect of stent grafting in the treatment of saccular aneurysms of the peripheral artery. MATERIALS AND METHODS: Eight patients [M:F=7:1 ; age:22-72(mean, 47) years] with ten saccular aneurysms of the peripheral artery who underwent stent grafting were included in this study. The etiologies of the aneurysms were Behcet's disease in four patients, atherosclerosis in two, trauma in one and 'uncertain' in one; they were located at the common iliac artery in three cases, the renal artery in two, the subclavian artery in two, the anterior tibial artery in one, and at both the proximal and distal anastomotic sites of the common carotid-internal carotid bypass graft. In two cases, stent grafting and coils were used to embolize collateral vessels. Post-procedural evaluations involved the use of computed tomography, Doppler sonography and magnetic resonance imaging. The mean follow-up period was 14.7(range, 4-36) monthes. RESULTS: The saccular aneurysms were successfully excluded in all cases. Post-procedural angiography revealed minor leakage in two cases, but at follow-up these showed complete exclusion. Follow-up evaluation also revealed complete resolution in five cases and complete thrombosis accompanied by size reduction in three. In patients with aneurysms of the proximal and distal ends of a common carotid-internal carotid bypass graft, total occlusion occurred in the stent graft. CONCLUSION: Percutaneous stent-graft insertion is an effective and convenient method for the treatment of peripheral arterial aneurysms, and is an alternative to vascular surgery.

Thrombolytic Therapy in Deep Vein Thrombosis

PURPOSE: This investigation was to evaluate the efficacy of catheter-directed thrombolysis with urokinase in treating symptomatic deep vein thrombosis (DVT). METHODS: Eight patients with DVT underwent treatment for 8 affected limbs. The average urokinase dose was 487.5 million IU (range, 1.5 million to 6.5 million IU) infused over an average of 48 hour (range 24~72 hours). RESULTS: Lysis was complete in 5 (63%), and partial in 2 (25%), not achieved in 1 (12%). One chronically occluded proximal iliac vein through popliteal vein antegradely and tibial vein through internal jugular vein retrogradely could not be crossed with a guide wire. Angioplasty (n=3) and stent placement (n=1) were applied in three limbs with underlying venous stenosis. One limb among three limb of initial complete lysis was detected thrombus at femoral vein but this patient was asymptomatic at 6 month later. There were no major complications or clinically detectable pulmonary emboli. CONCLUSION: This initial experience suggests that catheter-directed thrombolysis with urokinase for treatment of symptomatic DVT is safe and effective.

Breast Parenchymal Change on Mammography Following Postmenopausal Hormone Replacement Therapy

PURPOSE: To determine the frequency and distribution of parenchymal changes on mammography before and after hormone replacement therapy. MATERIALS AND METHODS: Mammograms of 100 postmenopausal women who underwent hormone replacement therapy without breast disease were evaluated. Mammograms obtained annually after hormone replacement were analysed and compared with that of pretreatment. In addition, mammograms of control group and treatment group were compared. RESULTS: An increase in density of breast parenchyma was seen on the mammogram of 20 women(20%) receiving therapy. The mammograms from the control group showed no change. Mammographic changes were detected at first year in 13 women, 2nd year in 4 women, 3rd year in 2 women, and 4th year in 1 woman (average,19 months). CONCLUSION: We conclude that increase in mammographic density following postmenopausal hormone replacement therapy is not uncommon(20%).