Tumor Response to Transcatheter Arterial Chemoembolization in Recurrent Hepatocellular Carcinoma after Living Donor Liver Transplantation

고흥규,고기영,윤현기,Kyu-Bo Sung 대한영상의학회 2007 Korean Journal of Radiology Vol.8 No.4

Objective: To evaluate the tumor response and patient survival rate following transcatheter arterial chemoembolization (TACE) in recurrent hepatocellular carcinoma (r-HCC) after living donor liver transplantation (LDLT). Materials and Methods: Twenty-eight patients with r-HCC underwent one or more cycles of TACE after LDLT (mean, 2.5 cycles). After a mixture of iodized oil and anti-cancer drugs was injected via the arteries feeding the tumors, these vessels were embolized with a gelatin sponge. Tumor response was determined by follow-up CT imaging on all patients four weeks after each TACE procedure. Patient survival was calculated using the Kaplan-Meier survival curve. Results: After TACE, targeted tumor reduced in size by 25% or more in 19 of the 28 study patients (67.9%). However, intrahepatic recurrence or extrahepatic metastasis occurred in 21 of the 28 patients (75.0%) during the 3-month follow-up period and in 26 of the 28 patients (92.9%) during the 6-month period following TACE. Extrahepatic metastasis was noted in 18 of the 28 patients (64.3%). The 1-, 3- and 5-year survival rates following TACE were 47.9, 6.0 and 0%, respectively, with a mean survival of nine months in all patients. There were no significant complications related to TACE. Conclusion: TACE produces an effective tumor response for targeted r-HCC after LDLT. However, the survival rate of patients with r-HCC after LDLT is poor due to extrahepatic metastasis and intrahepatic recurrence.

Efficacy of Prophylactic Uterine Artery Embolization before Obstetrical Procedures with High Risk for Massive Bleeding

고흥규,신지훈,고기영,권동일,김진형,한기창,이신화 대한영상의학회 2017 Korean Journal of Radiology Vol.18 No.2

Objective: To evaluate the safety and efficacy of prophylactic uterine artery embolization (UAE) before obstetrical procedures with high risk for massive bleeding. Materials and Methods: A retrospective review of 29 female patients who underwent prophylactic UAE from June 2009 to February 2014 was performed. Indications for prophylactic UAE were as follows: dilatation and curettage (D&C) associated with ectopic pregnancy (cesarean scar pregnancy, n = 9; cervical pregnancy, n = 6), termination of pregnancy with abnormal placentation (placenta previa, n = 8), D&C for retained placenta with vascularity (n = 5), and D&C for suspected gestational trophoblastic disease (n = 1). Their medical records were reviewed to evaluate the safety and efficacy of UAE. Results: All women received successful bilateral prophylactic UAE followed by D&C with preservation of the uterus. In all patients, UAE followed by obstetrical procedure prevented significant vaginal bleeding on gynecologic examination. There was no major complication related to UAE. Vaginal spotting continued for 3 months in three cases. Although oligomenorrhea continued for six months in one patient, normal menstruation resumed in all patients afterwards. During follow-up, four had subsequent successful natural pregnancies. Spontaneous abortion occurred in one of them during the first trimester. Conclusion: Prophylactic UAE before an obstetrical procedure in patients with high risk of bleeding or symptomatic bleeding may be a safe and effective way to manage or prevent serious bleeding, especially for women who wish to preserve their fertility.

Percutaneous Unilateral Biliary Metallic Stent Placement in Patients with Malignant Obstruction of the Biliary Hila and Contralateral Portal Vein Steno-Occlusion

손락채,권동일,고흥규,김종우,고기영 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.3

To investigate the outcomes of percutaneous unilateral metallic stent placement in patients with a malignant obstruction of the biliary hila and a contralateral portal vein steno-occlusion. Sixty patients with a malignant hilar obstruction and unilobar portal vein steno-occlusion caused by tumor invasion or preoperative portal vein embolization were enrolled in this retrospective study from October 2010 to October 2013. All patients were treated with percutaneous placement of a biliary metallic stent, including expanded polytetrafluoroethylene (ePTFE)-covered stents in 27 patients and uncovered stents in 33 patients. A total of 70 stents were successfully placed in 60 patients. Procedural-related minor complications, including self-limiting hemobilia (n = 2) and cholangitis (n = 4) occurred in six (10%) patients. Acute cholecystitis occurred in two patients. Successful internal drainage was achieved in 54 (90%) of the 60 patients. According to a Kaplan-Meier analysis, median survival time was 210 days (95% confidence interval [CI], 135–284 days), and median stent patency time was 133 days (95% CI, 94–171 days). No significant difference in stent patency was observed between covered and uncovered stents (p = 0.646). Stent dysfunction occurred in 16 (29.6%) of 54 patients after a mean of 159 days (range, 65–321 days). Unilateral placement of ePTFE-covered and uncovered stents in the hepatic lobe with a patent portal vein is a safe and effective method for palliative treatment of patients with a contralateral portal vein steno-occlusion caused by an advanced hilar malignancy or portal vein embolization. No significant difference in stent patency was detected between covered and uncovered metallic stents.

Percutaneous Radiologic Gastrostomy Using the One-Anchor Technique in Patients after Partial Gastrectomy

박정훈,신지훈,고흥규,김진형,송호영,Soo Hwan Kim 대한영상의학회 2014 Korean Journal of Radiology Vol.15 No.4

Objective: The purpose of our study was to assess the feasibility of performing percutaneous radiologic gastrostomy (PRG) in patients who had undergone partial gastrectomy and to evaluate factors associated with technical success. Materials and Methods: Nineteen patients after partial gastrectomy, who were referred for PRG between April 2006 and April 2012, were retrospectively analyzed. The remnant stomach was punctured using a 21-gauge Chiba-needle. A single anchor was used for the gastropexy and a 12-Fr or 14-Fr gastrostomy tube was inserted. Data were collected regarding the technical success, procedure time, and presence of any complications. Univariable analyses were performed to determine the factors related to the technical success. Results: Percutaneous radiologic gastrostomy was technically successful in 10 patients (53%), while a failed attempt and failure without an attempt were observed in 5 (26%) and 4 (21%) patients, respectively. Percutaneous radiologic jejunostomy was successfully performed in 9 patients who experienced technical failure. In the 10 successful PRG cases, the mean procedure time was 6.35 minutes. Major complications occurred in 2 patients, tube passage through the liver and pneumoperitonum in one and severe hemorrhage in the other. The technical success rate was higher in patients with Billroth I gastrectomy (100%, 6/6) than in patients with Billroth II gastrectomy (31%, 4/13) (p = 0.011). Conclusion: Percutaneous radiologic gastrostomy can be successfully performed using the one-anchor technique in approximately half of the patients after partial gastrectomy.

간경변증 환자에서 혈흉으로 발현된 자발성 비장동맥 출혈 1예

송승민,이단비,고흥규,피규영 대한내과학회 2018 대한내과학회 추계학술대회 Vol.2018 No.1

Lymphangiography to Treat Postoperative Lymphatic Leakage: A Technical Review

Edward Wolfgang Lee,신지훈,고흥규,박지홍,Soo Hwan Kim,성규보 대한영상의학회 2014 Korean Journal of Radiology Vol.15 No.6

In addition to imaging the lymphatics and detecting various types of lymphatic leakage, lymphangiography is a therapeutic option for patients with chylothorax, chylous ascites, and lymphatic fistula. Percutaneous thoracic duct embolization, transabdominal catheterization of the cisterna chyli or thoracic duct, and subsequent embolization of the thoracic duct is an alternative to surgical ligation of the thoracic duct. In this pictorial review, we present the detailed technique, clinical applications, and complications of lymphangiography and thoracic duct embolization.

풀 테크닉(Pull Technique)을 이용한 투시유도하 경피적 위루술

엄창욱,원종윤,유정식,고흥규,이광훈,이도연,이종태 대한영상의학회 2008 대한영상의학회지 Vol.58 No.4

목적: 내시경유도나 위고정술없이 풀 테크닉(pull technique)을 이용한 X선투시 유도하 경피적 위루술(fluoroscopy-guided percutaneous gastrostomy: FPG)의 안전성과 유용성을 알아보고자 하였다. 대상과 방법: 2005년 3월에서 2007년 2월까지 시행한 25명의 환자를 대상으로 하였으며 환자는 근위축성 측삭 경화증 또는 이행성 근이영양증 18명, 뇌혈관성 사지마비 5명, 파킨슨씨병 1명, 전이암에 의한 연하곤란 1명이었다. 시술은 내시경 유도나 위고정술 없이 X선투시 유도 하에 환자의 입으로 삽입한 24F pull type 튜브(tube)를 스내어(snare)를 이용하여 상복부 천자부위로 빼내는 풀 테크닉을 이용하였다. 시술의 기술적 성공률, 합병증 발생 여부 및 임상경과 등을 조사하였다. 결과: 기술적 성공률은 100%였다. 튜브 거치 기간은 1개월에서 24개월(평균: 6.5) 이었는데 이 기간에 모든 환자에서 튜브는 정상 위치 및 기능을 유지하고 있었다. 시술과 관련된 사망은 없었으며, 합병증으로 1명의 환자(4%)에서 시술 후 복수 발생 및 복수의 도관 주위 누출로 복수 배액을 시행하였는데 위 내용물의 누출이나 복막염의 증거는 없었다. 결론: 24F 튜브를 이용한 풀 테크닉 FPG는 기술적 성공률이 높고, 합병증이 적은, 유용한 방법이다.

Covered Stent Placement for the Treatment of Malignant Superior Vena Cava Syndrome: Is Unilateral Covered Stenting Safe and Effective?

조영훈,권동일,고기영,고흥규,김진형,신지훈,윤현기,성규보 대한영상의학회 2014 Korean Journal of Radiology Vol.15 No.1

Objective: To evaluate the safety and efficacy of unilateral covered stent placement in patients with malignant superior vena cava (SVC) syndrome. Materials and Methods: Between October 2008 and November 2012, expanded polytetrafluoroethylene-covered stent placement for malignant SVC syndrome was performed in 40 consecutive patients (35 men and five women; mean age, 61.4 years; range, 35-81 years). All covered stents were unilaterally placed within the SVC or across the venous confluence when needed to relieve venous obstruction and prevent tumor overgrowth, regardless of patency of contralateral brachiocephalic veins. Results: Stent placement was technically successful in all patients. There were no major complications. Of the 37 patients symptomatic prior to stent placement, 34 (92%) experienced complete symptomatic relief 1-8 days after stent placement. Of the 29 patients who underwent covered stent placement across the venous confluence, nine patients had patent contralateral brachiocephalic veins prior to stent placement. However, no sign of SVC obstruction or contralateral upper extremity venous thrombosis was observed during the follow-up period. Kaplan-Meier analysis revealed median patientsurvival of 163 days. Stent occlusion occurred in four (10%) of 40 patents. Cumulative stent patency rates at 1, 3, 6, and 12 months were 95%, 92%, 86%, and 86%, respectively. Conclusion: Unilateral covered stent placement appears to be a safe and effective method for treating malignant SVC syndrome, despite the location of SVC occlusion.

풀 테크닉(Pull Technique)을 이용한 투시유도하 경피적 위루술

엄창욱,원종윤,유정식,고흥규,이광훈,이도연,이종태 대한영상의학회 2008 대한영상의학회지 Vol.58 No.4

목적: 내시경유도나 위고정술없이 풀 테크닉(pull technique)을 이용한 X선투시 유도하 경피적 위루술(fluoroscopy-guided percutaneous gastrostomy: FPG)의 안전성과 유용성을 알아보고자 하였다. 대상과 방법: 2005년 3월에서 2007년 2월까지 시행한 25명의 환자를 대상으로 하였으며 환자는 근위축성 측삭 경화증 또는 이행성 근이영양증 18명, 뇌혈관성 사지마비 5명, 파킨슨씨병 1명, 전이암에 의한 연하곤란 1명이었다. 시술은 내시경 유도나 위고정술 없이 X선투시 유도하에 환자의 입으로 삽입한 24F pull type 튜브(tube)를 스내어(snare)를 이용하여 상복부 천자부위로 빼내는 풀 테크닉을 이용하였다. 시술의 기술적 성공률, 합병증 발생 여부 및 임상경과 등을 조사하였다. 결과: 기술적 성공률은 100%였다. 튜브 거치 기간은 1개월에서 24개월(평균: 6.5) 이었는데 이기간에 모든 환자에서 튜브는 정상 위치 및 기능을 유지하고 있었다. 시술과 관련된 사망은 없었으며, 합병증으로 1명의 환자(4%)에서 시술 후 복수 발생 및 복수의 도관 주위 누출로 복수 배액을 시행하였는데 위 내용물의 누출이나 복막염의 증거는 없었다. 결론: 24F 튜브를 이용한 풀 테크닉 FPG는 기술적 성공률이 높고, 합병증이 적은, 유용한 방법이다.

시술 후 생긴 의인성 가성동맥류의 경피적 트롬빈 주입요법 치료

박소희,신지훈,고기영,권동일,고흥규,김종우 대한영상의학회 2019 대한영상의학회지 Vol.80 No.5

목적 대퇴동맥를 포함한 말초 혈관에서 생긴 의인성 가성동맥류를 트롬빈 주입으로 치료한10명의 환자에 대해 보고하고, 풍선과 코일 등의 보조기법의 효용성에 대해 고찰해 보고자한다. 대상과 방법 2007년 9월부터 2017년 6월 사이에 초음파 유도 트롬빈 주입요법을 시행 받은 10 명의 환자를 대상으로 하였고, 가성동맥류의 원인이 되었던 시술, 위치, 트롬빈 주입요법의성공률과 합병증 등에 대해 조사하였다. 결과 8예의 대퇴동맥과 2예의 상완동맥에서 가성동맥류가 치료되었는데, 치료의 기술적 성공률은 100%였으며(10/10), 임상적 성공률은 70%였다(7/10). 합병증으로 10명 중 2명의 환자에서 원위부 혈관에 급성 혈전증이 생겼다. 보조 요법으로 10명 중 7명의 환자에서 가성동맥류가 기원하는 혈관에 풍선폐쇄술을 병행하여 트롬빈을 주입하였고, 그중 1명의 환자는 코일을 이용한 말단 가지 색전술을 함께 시행하였다. 결론 대퇴동맥 및 상완동맥에서 다양한 원인으로 생긴 의인성 가성동맥류에 대해 트롬빈 주입을 통해 안전하고 효과적으로 폐쇄시킬 수 있으며, 경우에 따라 풍선폐쇄술이나 코일 색전술을 함께 시행해 트롬빈의 유출을 막는 것이 가능하다 Purpose To report our clinical experience of thrombin injection for iatrogenic pseudoaneurysms of peripheral arteries with or without balloon dilatation and coil embolization as adjunctive techniques. Materials and Methods A total of 10 patients undergoing thrombin injection for iatrogenic pseudoaneurysms from September 2007 to June 2017 were retrospectively investigated. The causative procedures, location of pseudoaneurysms, and complications were recorded, and technical and clinical success rates of the treatment were assessed. Results The femoral and brachial arteries were treated in eight and two patients, respectively. Technical success was confirmed in all cases, and a clinical success rate was 70% (7/10) was noted. Two patients presented with a complication of acute thrombosis at the distal arteries. In 7 patients, balloon occlusion was performed before injection of thrombin to prevent the spread of thrombin. Coil embolization of the distal branch was also performed in one of these patients. Conclusion For pseudoaneurysms of the femoral and brachial arteries that develop after various vascular procedures, thrombin injection is a safe and efficient treatment choice. In some cases, where there is concern for thrombin leakage, balloon occlusion and coil embolization could be performed together.