Transcatheter Arterial Embolization of Renal VX-2 Carcinoma: Ethiodol-Ethanol Capillary Embolization Combined with Carboplatin

OBJECTIVE: We wanted to determine whether transcatheter Ethiodol-based capillary embolization in combination with carboplatin could improve the efficiency of a 1:1 Ethiodol-ethanol mixture (EEM) to ablate kidneys that been inoculated with VX-2 carcinoma. MATERIALS AND METHODS: The right kidney in 34 New Zealand white rabbits were inoculated with fresh VX-2 tumor fragments. One week later, the kidneys were subjected to transarterial treatment (4-5 rabbits/group): Saline infusion (Group 1); carboplatin infusion (5 or 10 mg, Groups 2A and 2B); carboplatin-Ethiodol (CE) alone (Group 3) and followed by main renal artery occlusion with ethanol (RAO) (Group 4); carboplatin-EEM (C-EEM) followed by RAO (Group 5); carboplatin infusion followed by EEM plus RAO (Group 6); and EEM followed by RAO (Group 7). The animals were followed for up to 3-weeks. The treated kidneys were evaluated angiographically and macroscopically. The kidneys that showed successful embolization macroscopically were entirely cut into serial sections, and these were examined microscopically. Histologically, the kidneys were evaluated on the basis of the residual tumor found in the serial sections. RESULTS: The results obtained with carboplatin infusion alone (Groups 2A and 2B) and CE without RAO (Group 3) were similar to those of the control animals (Group 1). Kidneys from Groups 4-7 demonstrated macroscopically successful embolization with histologically proven complete renal parenchyma infarction; however, some residual tumor was evident in all but one animal. CONCLUSION: None of the Ethiodol-based modalities combined with locoregional carboplatin were more efficacious for tumor ablation than EEM alone.

Emergent endovascular embolization of iatrogenic renal vascular injuries / 介入放射学杂志

Objective To evaluate the efficacy and safety of the interventional techniques for emergent treatment of iatrogenic renal injuries.Methods Nine patients with iatrogenic renal vascular injuries were treated with superselective renal arterial embolization.The causes of renal injury included post-renal biopsy in 5 patients,endovascular interventional procedure-related in 2,post-renal surgery in 1,and post-percutaneous nephrostomy in 1 patient.The patients presented clinically with hemodynamical unstability with blood loss shock in 7 patienrs,severe flank pain in 7,and hematuria in 8 patients.Perirenal hematoma was confirmed in 8 patients by CT and ultrasonography.The embolization materials used were microcoils in 7 and standard stainless steel coils in 2 patients,associated with polyvinyl alcohol particles(PVA)in 5,and gelfoam panicles in 2 cases.Results Renal angiogram revealed intra-renal arteriovenous fistula in 6 cases,intrarenal pseudoaneurysm in 2 cases,and the contrast media extravasation in 1 patient.The technical success of the arterial embolization was achieved in all 9 cases within a single session.All angiographies documented complete obliteration of the abnormal vessels together with all major intrarenal arterial branches maintaining patent.Seven patients with hemodynamically compromise experienced immediate relief of their blood loss related symptoms,and another 7 with severe flank pain got relief progressively.Hematuria ceased in 8 patients within 2-14 days after the embolization and impairment of renal function occurred after the procedure in 5 cases,including transient aggrevation(n=3)and developed new renal dysfunction(n=2).Two of these patients required hemodialysis.Perirenal hematoma were gradually absorbed on ultrasonography during 2-4 months after the procedures.Follow-up time ranged from 6-78 months(mean,38 months),4 patients died of other primary diseases of renal and multi-organ failures.Five patients are still alive without further intervention,and suffering no more of rebleeding and deterioration of renal function.Conclusions Transcatheter selective renal arterial embolization is safe and effective in the treatment of iatrogenic renal vascular injuries,resulting in permanent cessation of bleeding.(J Intervent Radiol,2007,16:807-810)

Ovarian Protection by Selective Coil Embolization of a Uteroovarian Anastomosis before Uterine Fibroid Embolization: A Report of Two Cases

Premature menopause can be developed as a result of undesired nontarget ovary embolization during the performance of uterine fibroid embolization. The etiology of ovarian failure after uterine fibroid embolization is not yet clearly defined, but one of the leading possibilities is nontarget embolization of the ovaries. We report here on two cases in which superselective coil embolization of distal uterine artery collateral pathways to the ovary was performed during uterine fibroid embolization.

Ovarian Protection by Selective Coil Embolization of a Uteroovarian Anastomosis before Uterine Fibroid Embolization: A Report of Two Cases

Premature menopause can be developed as a result of undesired nontarget ovary embolization during the performance of uterine fibroid embolization. The etiology of ovarian failure after uterine fibroid embolization is not yet clearly defined, but one of the leading possibilities is nontarget embolization of the ovaries. We report here on two cases in which superselective coil embolization of distal uterine artery collateral pathways to the ovary was performed during uterine fibroid embolization.

Postpartum Bleeding: Efficacy of Endovascular Management

PURPOSE: To assess the effectiveness and safety of transcatheter arterial embolization for the treatment of massive postpartum bleeding. MATERIALS AND METHODS: Transcatheter arterial embolization was attempted in 25 patients with massive postpartum bleeding. After identification at bilateral internal iliac arteriography, the bleeding artery was embolized using gelfoam, polyvinyl alcohol particles or microcoils, and to prevent rebleeding through collateral pathways, the contralateral uterine artery or anterior division of the internal iliac artery was also embolized. Clinical success and complications were retrospectively assessed and documented. RESULTS: Active bleeding foci were detected in 13 patients (52%), and involved the unilateral (n=10) or bilateral (n=2) uterine artery and unilateral vaginal artery (n=1). Twelve (92%) of the 13 patients recovered completely following embolization, but one underwent hysterectomy due to persistent bleeding. The focus of bleeding was not detected in 12 patients (48%), but 11 (92%) of these also recovered following embolization of the bilateral uterine or internal iliac arteries. One patient, however, died due to sepsis. Two of the 12 patients underwent hysterectomy due to rebleeding on the 12th and 13th day, respectively, after embolization. CONCLUSION: Transcatheter arterial embolization is relatively safe and effective for the treatment massive postpartum bleeding.

Pseudoaneurysm after Pancreatoduodenectomy: Diagnosis and Embolization on Angiography

PURPOSE: To evaluate the efficacy of angiography in the diagnosis and treatment of pseudoaneurysm manifesting arterial hemorrhage as a significant complication following pancreatoduodenectomy. MATERIALS AND METHODS: For 51 months, of a total of 298 patients who had undergone pancreatoduodenectomy, 19 patients (6.4%) developed clinically significant hemorrhage and nine patients proved to have a pseudoaneurysm on angiography. These nine patients (3.0%) were managed by transcatheter arterial embolization. We analyzed clinical feature, angiographic findings and hemostatic effect of embolization retrospectively. RESULTS: In nine patients (3.0%), pseudoaneurysm was diagnosed on angiography (common hepatic artery in four, gastroduodenal artery in three, proper hepatic artery in one, and left gastroepoploic artery in one patient). The size ranged from 0.3 cm to 6.5 cm (mean 1.9 cm). And extravasation was noted in five patients (55.6%). The remained ten patients showed no evidence of bleeding on angiography. Those who manifested as early bleeding (within two weeks) or delayed bleeding (later than two weeks) were five and four patients respectively. Before the onset of major bleeding, among the nine pseudoaneurysm patients, seven patients (77.8%) had experienced percutaneous drainage due to intra-abdominal fluid collection with or without abscess resulting from anastomotic leak, and all nine patients had had preliminary minor bleeding. The angiogram demonstrated an exact site of bleeding as a pseudoaneurysm followed by transcatheter arterial embolization (microcoil in eight patients, gelfoam in one) and achieved complete hemostasis yielding a success rate of 100%. Overall, no patients experienced complications related directly to the transcatheter arterial embolization technique. During the follow-up period (72-1,336days, mean 640), no recurrence of bleeding was noted. CONCLUSION: Although pseudoaneurysm is a rare complication, it is important as a cause of hemorrhage after pancreatoduodenectomy. Angiography followed by transcatheter arterial embolization allows early diagnosis and hemostasis of pseudoaneurysm and minimizes the need for high-risk emergency surgery.

A New Liquid Embolic Agent(Embol) for Transcatheter Renal Artery Embolization: An Experimental Study in Rabbit

PURPOSE: To evaluate the effectiveness and safety of a new liquid embolic agent in renal arterial embolization in the rabbit, and its clinical applicability. MATERIALS AND METHODS: A new embolic agent, Embol, was obtained by partial hydrolysis of polyvinyl acetate and dissolved in a mixture of 45% ethanol and 55% non-ionic contrast medium. Its radioopacity was therefore good. An average of 0.8 cc(0.5-0.9 cc) of Embol was used to embolize the renal artery of one kidney in 15 rabbits. The immediate effect of this was examined angiographically 5 minutes after the procedure. To permit histologic examination, five rabbits in each group were sacrificed 3 days (I), 2 weeks (II), and 4 weeks (III) after embolization: prior to embolization and prior to sacrifice, one rabbit in each group underwent renal scanning, and prior to sacrifice all underwent follow-up angiography. In three rabbits, blood urea nitrogen (BUN), creatinine, sodium(Na), and potassium(K) levels were measured before and 1, 3, 5, 7 and 14 days after embolization. RESULTS: Embol was easy to use and its radiopacity was good. Five minutes after embolization, angiography showed that total occlusion of the main renal or interlobar artery had been achieved in all rabbits. Serum BUN, creatinine, Na and K levels were within normal limits. Follow-up angiogram obtained in each group showed persistent occlusion of the renal artery in all but one rabbit in group I and one in group III. Renal scans revealed no evidence of radionuclide uptake in embolized kidneys, which were slightly enlarged in group I but became gradually smaller in groups II and III. In all animals, histologic examination showed diffuse coagulation necrosis of the embolized kidneys and in group III the cortex of these was extensively calcified. In group I the renal artery showed an apparently fresh occluding thrombosis, and in groups II and III a completely organized thrombosis was present. In group III this was calcified. CONCLUSION: Because of its good radioopacity, Embol is easy to controa, and is effective for renal artery embolization. As a permanent embolic agent, it appears suitable for clinical applications.

Intraperitoneal Hemorrhage Due to Spontaneous Rupture of Hepatocellular Carcinoma: Comparisons of Tranarterial Oily Chemoembolization and Simple Embolization with Gelfoam

PURPOSE: To compare the safety and effectiveness of transarterial oily chemoembolization (TOCE) and transar-terial embolization (TAE) with Gelfoam in cases of ruptured hepatocellular carcinoma (HCC), and to describe the most important prognostic factors involved in emergency embolization. MATERIALS AND METHODS: Forty-two consecutive patients with spontaneously ruptured HCC underwent emergency TOCE (n = 22) or TGE (n = 20). In the TOCE group, Lipiodol (3 -10 cc), Adriamycin (20 -50 mg), and Mitomycin (2 -10 mg) were used, and these were followed by blockade of the hepatic arterial flow with gelatin sponge particles. In the TAE group, patients underwent only Gelfoam embolization. Using the Kaplan-Meier method, survival time from the time of embolization was estimated, and to analyze prognostic factors, Cox 's proportional hazard regression model was used. RESULTS: Successful hemostasis was achieved in 41 patients (97.6%). Mean survival time was 201 and 246 days in the TOCE and TAE group, respectively, but the difference was not tatistically significant (p > 0.05). Five of the TOCE group (22.7%) and three of the TAE group (15.0%) died of hepatic failure. Analysis of the prognostic factors showed that portal vein involvement by the tumor was the most important factor influencing survival. CONCLUSION: Although TOCE and TAE effectively controlled hemorrhaging from a ruptured HCC, the procedures involve a high risk of hepatic failure. Their goal should, therefore, be solely to achieve hemostasis, and thus decrease parenchymal injury.

Superselective Embolization with Microcoil in Acute Gastrointestinal Hemorrhage

PURPOSE: To evaluate the efficacy and safety of superselective arterial embolization using the microcoil in acute gastrointestinal hemorrhage. MATERIALS AND METHODS: We evaluated 11 of 42 patients who had undergone diagnostic angiography and tran-scatheter arterial embolization due to acute gastrointestinal hemorrhage and subsequently underwent superselective arterial embolization using the microcoil. Nine were males and two were females, and their age ranged from 33 to 70 (mean, 51) years. The etiologies were bleeding ulcer (n=5), pseudoaneurysm from pancreatitis (n=3), and postoperative bleeding (n=3). The symptoms were melena, hematemesis, and hematochezia, and the critical signs were decreased hemoglobin and worsening of vital signs. All patients underwent superselective embolization using the microcatheter and microcoil. RESULTS: Bleeding occurred in the gastroduodenal artery (n=5), inferior pancreaticoduodenal artery (n=2), left gastric artery (n=2), right hepatic artery (n=1), and ileal branch of the superior mesenteric artery (n=1). All cases were treated succesfully, without complications. In one case in which there was bleeding in the right he-patic artery, reembolization with a microcoil was needed because of persistent melena. During follow up, three patients died from complications arising underlying diseases, namely disseminated intravascular coagulopathy, chronic renal failure, and adult respiratory distress syndrome. Procedural complications, such as ischemia or infarction were not noted. CONCLUSION: Superselective arterial embolization using the microcoil is a safe and effective method for the treatment of acute gastrointestinal bleeding, and does not lead to complications.

Renal Artery Embolization Using a New Liquid Embolic Material Obtained by Partial Hydrolysis of Polyvinyl Acetate (Embol):Initial Experience in Six Patients

OBJECTIVE: To evaluate the therapeutic efficacy of a new liquid embolic materi-al,Embol, in embolization of the renal artery. MATERIALS AND METHODS: Embol is a new embolic material obtained by partial hydrolysis of polyvinyl acetate mixed in absolute ethanol and Iopromide 370 and manufactured by Schering Korea, Kyonggido, Korea. Six patients who underwent embolization of the renal artery using Embol were evaluated. Four were male and two were female and their ages ranged from 11 to 70 (mean, 53) years. Clinical and radiologic diagnoses referred for renal artery embolization were renal cell carcinoma (n = 3), renal angiomyolipoma (n = 2) and pseudoaneurysm of the renal artery (n = 1). After selective renal angiography, Embol was injected through various catheters, either with or without a balloon occlusion catheter. Changes in symptoms and blood chemistry which may have been related to renal artery embolization with Embol were analyzed. RESULTS: The six patients showed immediate total occlusion of their renal vas-cular lesions. One of the three in whom renal cell carcinoma was embolized with Embol underwent radical nephrectomy, and the specimen thus obtained revealed 40% tumor necrosis. In the two patients with angiomyolipomas, the tumors decreased in size and abdominal pain subsided. Bleeding from pseudoaneurysm of the renal artery was successfully controlled. Four patients showed symptoms of post-embolization syndrome, and one of these also showed increased levels of blood urea nitrogen and creatinine. One patient experienced transient hyperten-sion. CONCLUSION: Embol is easy to use, its radiopacity is adequate and it is a safe and effective embolic material which provides immediate and total occlusion of renal vascular lesions.

Transcatheter Arterial Embolizations of Arterial Bleeding in Patients with Pelvic Bone Fracture

PURPOSE: To evaluate the usefulness of transcatheter arterial embolization (TAE) of arterial bleeding in patients with pelvic bone fracture. MATERIALS AND METHODS: We retrospectively evaluated 13 injured arteries of seven patients with pelvic bone fracture. In order to evaluate the sites and types of arterial injuries, angiography was performed, followed by TAE using Gelfoam and a coil. The parameter of technical success is non-visualization of extravasation and pseudoaneurysm in injured arteries. We investigated (1) the survival rate and complications of TAE; (2) the relationship of arterial injuries to findings, as seen on plain film; and (3) the influence of BP on arrival and the time interval between trauma and TAE on prognosis. RESULTS: Angiography revealed (1) extravasation of contrast media in four patients; (2) extravasation and pseudoaneurysm in two; and (3) extravasation and abrupt cut-off of an artery in one. The injured arteries involved( n=13), were the internal iliac (n=3), superior gluteal (n=3), inferior gluteal (n=2), obturator (n=2), ili-olumbar (n=2), and internal pudendal (n=1). TAE was technically successful and in no case were there complications. Vital signs improved in four patients, but three others died due to hypovolemia. In five patients the site of arterial injury, as seen on plain films, was consistent pelvic bone fracture but in one patient more severe arterial injury was noted at the contralateral side of more severe pelvic bone fracture, and in one other arterial injury was observed only at the contralateral side of pelvic bone fracture. In this study, BP at arrival was a more important prognostic indication than was the time interval between trauma and TAE. CONCLUSION: For the management of arterial bleeding after blunt pelvic trauma, TAE is the procedure of choice.

Endovascular Treatment of Direct Carotid Cavernous Fistulas Using Detachable Balloon(s) and Coils

PURPOSE: To evaluate the merits of this technique and to provide a standard for comparison with futuretreatment alternatives. MATERIALS AND METHODS: We retrospectively reviewed the records of 52 patients withdirect CCF treated at the Yonsei Medical Center between 1983 and 1997 by transarterial or transvenous embolizationusing detachable balloon(s) and/or coils. RESULTS: Among the 52 cases, 51 were traumatic in origin, while onlyone was the result of a ruptured aneurysm. The three most common presentations were chemosis, bruit, andpulsatile proptosis. Forty-five patients were successfully treated with detachable balloon(s) and/or coils andinternal carotid blood flow was preserved in 35. When coils were used (1993-7), the ICA preservation rate washigher than when they were not used (1983-92). To confirm statistical significance, however, more studies areneeded. Four patients who initially presented with incomplete occlusion showed spontaneous occlusion on follow upangiography. In two patients, surgical ligation was performed because embolization failed and there was incompleteocclusion of the fistula. We experienced complications such as transient 3rd and 6th cranial nerve palsy,migration of deflated balloons and coils to the lung, and loss of vision. CONCLUSION: Transarterial andtransvenous embolization with detachable balloon(s) and/or coils provides a high rate of fistula obliteration withlow morbidity. In particular, the use of coils led to an increased rate of ICA preservation, thus and isconsidered as a good treatment modality for CCF obliteration.

Prognostic Factors in Transcatheter Arterial Chemoembolizationc of Hepatocellular Carcinoma: Analysis of Morethan 3 Year Survivors

PURPOSE: To determine which prognostic factors contribute to long-term survival after transcatheter arterialchemoembolization(TACE) of hepatocellular carcinoma. MATERIALS AND METHODS: In 100 patients who expired withinone year and 84 who survived or have survived for more than 3 years after TACE, prognostic factors wereretrospectively evaluated. TACE was accomplished by hepatic arterial infusion of a suspension of Lipiodol andanticancer drugs(Mitomycin-C and Adriamycin), either alone or followed by gelfoam embolization. Fisher 's exacttest of probability was used to determine which prognostic factors were statistically significant. RESULTS:Statistically significant prognostic factors were as follows: Child classification(p0.05). CONCLUSION: The prognosisof patients with hepatocellular carcinoma treated by TACE was affected favorably by good liver function(Childclassification A), low alphafetoprotein value, nodular or massive-type tumor, patent main and first-order portalvein, and hypervascular tumor.

Uterine Arterial Embolization for Uterine Leiomyoma: Efficacy and Clinical Outcome

PURPOSE: To determine the efficacy and clinical outcome of uterine arterial embolization as a new approach to the management of uterine leiomyomas MATERIALS AND METHODS: Uterine arterial embolization was performed in 21 patients aged 26-62(mean, 42) years. Twenty of these had menorrhagia, dysmenorrhea, and mass-related symptoms (low abdorminal discomfort, backache, urinary frequency, etc.) and one was diagnesed incidentally. Bilateral uterine arteries were selected individually and polyvinyl alcohol and/or gelfoam was used as an embolic material. RESULTS: Nineteen patients were followed up after embolization. Seventeen (89.5 %) reported satisfactory myoma volume. In 17 patients (89.5 %), the menstrual cycle returned to normal. All patients experienced pain after the procedure and other complications were vaginal bleeding (26.3%) and fever (23.8%). CONCLUSION: Uterine arterial embolization represents a new approach to the management of uterine leiomyoma-related symptoms. Further investigations and long-term follow-up are, however, equired.

Embolization of Seve re Arterioportal Shunts in the Patients with Hepatocellular Carcinoma: Safety and Influence on Patient Survival

PURPOSE: To evaluate the safety and the influence of embolization of severe arterioportal shunts, and the effect of the procedure on the survival rate of patients with hepatocellular carcinoma combined with portal vein tumor thrombosis. MATERIALS AND METHODS: This study involved a total of 54 patients with hepatocellular carcinoma in whom hepatic arteriography revealed severe arterioportal shunt. From among this total, 34 patients (embolization group) underwent chemoinfusion after shunt embolization, while 19 (control group) underwent chemoinfusion only. The embolic materials included PVA particles and/or Gelfoam pieces. The frequency of postembolization symptoms (Chi-squared test) and changes in laboratory values (paired t-test) were compared between the two groups, and shunt improvement was also evaluated. Patient survival was tested using the Kaplan-Meier method. RESULTS: Fever and RUQ pain were more frequent in the embolization group (p<0.001). The complications of embolization included severe postembolization syndrome (n=1), acute hepatic failure (n=2), hepatic infarction (n=1), and sepsis (n=1). There were no significant changes in laboratory values. Among the 28 patients (24 of embolization group and four of control group) who underwent follow-up angiography, arterioportal shunt became less severe or disappeared in ten of the embolization group. For the embolization and control groups, the mean survival interval was 29.5 +/-5.4 weeks and 10.3 +/-3.1 weeks (p=0.0002), respectively. The best results were seen in the PVA particle group (p=0.01). CONCLUSION: The embolization of severe arterioportal shunts is relatively safe and increases patient survival rate.

Bronchial Arterial Embolization for Hemoptysis: Analysis of Outcome in Various Underlying Causes

PURPOSE: To clarify the short-term effect and long-term results of bronchial arterial embolization forhemoptysis in three groups with tuberculosis, idiopathic bronchiectasis and lung cancer. MATERIALS AND METHODS:This study invo l ved 54 patients who underwent arterial embolization for the control of hemoptysis. Among 54, thecauses of hemorrhage were; pulmonary tuberculosis(n=32), idiopathic bronchiectasis (n=15), and lung cancer(n=7).In all patients, em-bolization was performed using Gelfoam particles and three underwent additional coilemboliza-tion. After the procedure, patients were followed up for between 1 and 95 (mean, 36.7) months. Short-termresults were assessed on the basis of careful observation of patients for 1 month after ar-terial embolization andwere classified as either; successful, indicating complete cessation of he-moptysis for 1 month, or failed,indicating continuing hemoptysis or recurrence within 1 month. Long-term results were evaluated in patients inwhom the procedure was successful in the short term and who could be followed up for at least 6 months. Patientsshowed either complete remis-sion(CR), indicating complete cessation of bleeding during the observation period;partial remis-sion(PR), indicating complete cessation of hemoptysis with recurrent bloody sputum during theobservation period; or recurrence, indicating recurrent hemoptysis, and were grouped accordingly. RESULTS: Noserious procedure related complications occurred except for mild chest pain or fever, of which showed spontaneousrelief within a few day s. The overall short-term success rate was 7 9 .6 %(43/54); individual rates were 84.4%for pulmonary tuberculosis (27/32), 80% for idiopathic bronchiectasis (10/15), and 57.1 % for lung cancer (4/7).Long-term follow-up showed that complete remission was achieved in 24 of 43 cases (55.8 %).The respectivelong-term remission and recur-rence rates were 75 % and 25 % for bronchiectasis, 70.4 % and 29.6 % for pulmonarytuberculosis. While four lung cancer patients whose initial outcome was successful showed no recurrence ofhe-moptysis, three died within 3 months of embolization. CONCLUSION: Embolization of bronchial arteries using aGelfoam sponge is effective as initial treat-ment for moderate or severe hemoptysis caused by benign disease.During long-term follow up, high remission rates were achieved in pulmonary tuberculosis and idiopathicbronchiectasis pa-tients, while the shortest bleeding control was in cases involving lung malignancy.

Therapeutic Effectiveness of the Superselective Arterial Gelfoam Embolization in Post-traumatic ArterialPriapism

PURPOSE: We retrospectively evaluated superselective embolization with Gelfoam for the management ofpost-traumatic arterial priapism. MATERIALS AND METHODS: Six male patients with post-traumatic priapism underwentpudendal angiography and embolization. We evaluated the time and incidence of detumescence after embolization andcompared normal erectile function and its duration with the results of other reports. In all patients, colorDoppler sonography was performed pre- and post-angiographically. RESULTS: On pudendal arteriography,intracavernosal arteriovenous fistulas were observed in all patients, and pseudoaneurysm of the cavernosal artery(or common penile artery) in three. Detumescence and normal erec-tile function were achieved in all patients aftersuperselective embolization. Using color Doppler sonography, the location of the lesion causing priapism wasfound, in four patients, to be the proximal or middle one-third of the cavernosal artery. CONCLUSION: Pudendalangiography with superselective embolization with Gelfoam is a safe and effective method for the correction ofpost-traumatic arterial priapism.

Endovascular Treatment of Anterior Communicating Artery Aneurysms with Guglielmi Detachable Coils

PURPOSE: To evaluate the usefulness, results, and technical problem of endovascular treatment in anteriorcommunicating artery(Acom) aneurysm using a Guglielmi detachable coil(GDC). MATERIALS AND METHODS: We evaluated 18patients with Acom aneurysm who underwent endovascular treat-ment with GDC. Their clinical presentations weresubarachnoid hemorrhage (n=14), decreased visual acuity (n=2), and remnant aneurysm after surgical clipping (n=2).Hunt and Hess grades of 16 pre-surgical patients were Grade 0 in two patients, Grade I in three, Grade II in five,Grade III in one, Grade IV in three and Grade V in two. The size of aneurysms was 20mm in one lesion that wasclassified as large, while other lesions with diameters ranging from 3 to 12mm were classified as small.Theoutcome of treatment and technical complica-tions were analyzed. Clinical results were evaluated using the Glasgowoutcome scale(GOS). RESULTS: Treatment was successful in 13 patients. Complete occlusion was observed in tenpatients and partial occlusion in three. In five patients, the procedure failed to occlude the aneurysms becauseof proximal arterial tortuousity (n=2), wide neck (n=2) or coil fracture during the procedure (n=1). Technicalcomplications in-cluded thromboembolism (n=1) and coil fracture during the procedure (n=1). Among the 13 patientswho were treated successfully, 11 were GOS I. Two patients died after treatment because of procedure-relatedthromboembolism in one patient and progressive vasospasm, demonstrated on angiography before treatment, in theother. CONCLUSIONS: Treatment of Acom aneurysm using a GDC is useful and has many advantages compared tosur-gical clipping. Because of the anatomical characteristics of the Acom, however, technical failure may be morelikely than in the case of posterior circulation aneurysm. Meticulous evaluation of aneurysms and adjacentar-teries on angiography, as well as careful patient selection, is needed.

The Results of Embolization of Dural Arteriovenous Fistula

PURPOSE: To assess the embolization effect of dural arteriovenous fistula(DAVF). MATERIALS AND METHODS: Weevaluated 23 patients with DAVF who were diagnosed using digital subtraction angiography and treated bytransarterial and/or transvenous emobolization. The locations of DAVFs, as seen on angiography were as follows: 16in the cavernous sinus, four in the major dural sinuses, two in the jugular bulb, one in the torcula Herophili,and one in the tentorium cerebelli. On the basis of venous drainage patterns, Cognard's classification of DAVF wasused. Among our 23 patients, 13 underwent transarterial embolization, six underwent transvenous embolization, andfour underwent both. After embolization, three patients underwent other treatment: surgery, one ; gammairradiation, one ; and both. One. Polyvinyl alcohol particles or glue was used in transarterial embolization, andtungsten, platinum, or Guglielmi detachable coils in transvenous embolization. To analyse the residual lesion inDAF, we compared pre- and post-treatment angiograms ; patients were followed up for 2 to 48 months, and theircondition was assessed as cured, improved, not changed, or aggravated. RESULTS: Nine patients were found to beCognard type I, two were IIa, four were IIa+b, and eight were type III. Of our 23 patients, 12 were cured, tenimproved, and one was aggravated ; of the 13 who underwent transarterial embolization, four were cured, eightimproved, and one was aggravated ; of the six who underwent transvenous embolization, five were cured and oneimproved. The condition of a patient with a lesion in the torcular herophili was aggravated despite surgery andgamma irradiation after embolization. CONCLUSION: DAVF can be managed successfully with endovascular treatment.The outcome of the transvenous approach appears to be better than that of the transarterial approach alone. In acase involving a lesion in the torcular herophili, the outcome was poor and more aggressive treatment wasrequired.

Survival Rates in Hepatocellular Carcinoma Patient Treated by Transarterial Chemoembolization: Comparison withOperable and Inoperable Cases

PURPOSE: To pr6edict the prognosis of hepatocellular carcinoma (HCC) patients who underwent transarte6rialchemoembolization(TACE). MATERIALS AND METHODS: The study unvestigated the one- and two-year survival rates of 211patients who were divided into two groups : 74 operable Child's grade A or B cases, and 137 inoperable casesinvolving Child's grade C or poor prognostic factors such as metastasis, main portal thrombus, and total bilirubinabove 2.0mg/dl. Cumulative survival curves were obtained by the Kaplan-Meier method, beginning with the day of thefirst TACE. RESULTS: The one- and two-year cummulative survival rates were 80.8% and 47.9% for the 74 operablecases and 37.6% and 14.0% for the 137 inoperable cases, respectively(P<0.01). CONCLUSION: The prognosis of HCCpatients who underwent TACE can be predicted by classifying then into two groups, operable or inoperable cases.