TASC II 분류에 따른 최근 5년간 단일 병원에서 하지동맥 폐색성 질환의 치료방법의 변화

조원표,차혜정,공은미,전용선,조순구,김장용,홍기천,허윤석,이건영,김세중,조영업,안승익 대한혈관외과학회 2011 Vascular Specialist International Vol.27 No.1

Purpose: Endovascular treatment for peripheral arterial obstructive disease (PAOD) is replacing traditional arterial bypass in the western world. Yet there are few reports to evaluate the pattern of clinical practice pattern for PAOD in Korea. This study was conducted to evaluate the treatment pattern for PAOD between endovascular treatment and arterial bypass, and to compare their clinical characteristics. Methods: We conducted a retrospective study on the prospectively maintained database of patients who underwent endovascular treatment and arterial bypass for PAOD from March 2005 to December 2009 in Inha University Hospital. The aortoiliac lesions and femoropopliteal lesions were categorized by the Trans Atlantic Inter-Society Consensus (TASC) II classifications. Their treatments and clinical characteristics were compared between the former period (2005∼2007 y) and the latter period (2008∼2009 y). Results: Three hundred nine cases (178 patients) were treated for PAOD by either arterial bypass or endovascular treatment. The patients’ mean age was 69.1±11.3 year old. There was no difference in clinical characteristics between the two periods except for age. Endovascular treatments of both aortoiliac and femoropopliteal arterial lesions were increased in the latter period (P=0.023, P<0.001). Also, the endovascular treatments were increased in the TASC C and D aortoiliac and femoropopliteal lesions in the latter period (P=0.020, P<0.001). Conclusion: Endovascular treatment for PAOD is increasing in clinical practice and this shows feasibility in critically ill patient with TASC C and D lesions, although arterial bypass is still important.

The Advantage of Common Femoral Endarterectomy Alone or Combined with Endovascular Treatment

김준형,소병준,변승재,김경윤 대한혈관외과학회 2018 Vascular Specialist International Vol.34 No.3

Purpose: Although common femoral artery endarterectomy (CFAE) is regarded as the standard treatment modality for common femoral artery (CFA) disease, avail-ability of advanced endovascular techniques has resulted in an increased number of CFA disease being treated. We evaluated clinical outcomes in a contemporary series of patients who were treated for CFA disease using endarterectomy alone or combined with endovascular treatment.Materials and Methods: We retrospectively reviewed 46 patients from Novem-ber 2001 through December 2007. The treated lesions were divided into 4 groups based on operative procedure: group I (n=11), CFAE alone; group II (n=15), CFAE and iliac artery (IA) endovascular treatment; group III (n=6), CFAE and superficial femoral artery (SFA) endovascular treatment; group IV (n=14), CFAE and IA and SFA endovascular treatment or bypass surgery. Results: The degree of CFA steno-occlusion was not different among the groups. The 3-year primary patency rates of each group were 88.9±10.5%, 60.0±14.5%, 62.5±21.3%, and 83.9±10.4%, respectively. The 3-year primary assisted patency rates were 100%, 70.0±13.0%, 62.5±21.3%, and 89.3±10.4%, while 3-year sec-ondary patency rates were 100%, 80.0±13.0%, 62.5±21.3%, and 92.3±7.4%, re-spectively. There was no procedure-related mortality. Significant improvement of ankle-brachial index was achieved in all groups.Conclusion: CFAE alone is the treatment of choice for excellent patency and clini-cal improvement in steno-occlusive lesions confined to the CFA. In multiple steno-occlusive diseases, this procedure could be combined with endovascular procedures to reduce the operative risk in conditions with high morbidity.

뇌동맥류의 혈관내 Guglielmi Detachable Coil 치료

신용삼,이규창,김동익,허승곤,주진양,김동익 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.7

급성 장간막 허혈: 어떻게 치료할 것인가?

김성관,한영민,곽효성,유희철 대한영상의학회 2011 대한영상의학회지 Vol.65 No.4

목적: 급성 장간막 허혈의 치료 방법에 따른 효과를 평가하고 이를 토대로 적절한 치료 지침을 제시하고자 하였다. 대상과 방법: 2007년 1월에서 2010년 5월까지 14명의 급성 장간막 허혈 환자를 대상으로 하였다. 남자가 13명, 여자가 1명, 평균 연령은 52.1세였다. 모든 병변은 전산화단층촬영 및 혈관조영술로 확인하였다. 4명의 환자는 보존적 치료, 11명의 환자는 중재적 치료를 시행받았고 치료의 성공률 및 생존율을 분석하였다. 결과: 장간막 허혈의 원인은 혈전색전증이 6명, 장간막 동맥 박리가 8명이었다. 이 중 9명의 환자에서 전산화단층촬영 상 장 허혈 소견이 확인되었다. 동맥 박리가 있던 4명의 환자가 보존적 치료를 받았고 3명에서 증상이 재발하였다. 이 중 1명은 추가적으로 중재적 치료를 시행하였고 이를 포함한 총 5명의 환자가 중재적 치료를 받았으며 치료 성공률 및 1년 생존율은 100%였다. 6명의 혈전색전증 환자 모두가 중재적 치료를 받았고 치료 성공률은 83%였으나 1년 생존율은 40%였다. 시술의 골든 타임으로 20시간을 기준으로 하였을 때 통계학적으로 유의하게 예후가 좋았다(p = 0.0476). 결론: 경피적 혈관 내 중재술은 특히 20시간 이내에 시행될 경우 급성 장간막 허혈에 안전하고 효과적인 치료 방법이다. 그러나 더 많은 연구와 장기간의 추적 관찰이 필요하겠다. Purpose: To evaluate the effectiveness of treatment options for Acute Mesenteric Ischemia and establish proper treatment guidelines. Materials and Methods: From January 2007 to May 2010, 14 patients (13 men and 1 woman, mean age: 52.1 years) with acute mesenteric ischemia were enrolled in this study. All of the lesions were detected by CT scan and angiography. Initially, 4 patients underwent conservative treatment. Eleven patients were managed by endovascular treatment. We evaluated the therapeutic success and survival rate of each patient. Results: The causes of ischemia included thromboembolism in 6 patients and dissection in 8 patients. Nine patients showed bowel ischemia on CT scans, 4 dissection patients underwent conservative treatment, 3 patients had recurring symptoms, and 5 dissection patients underwent endovascular treatment. Overall success and survival rate was 100%. However, overall success was 83% and survival rate was 40% in the 6 thromboembolism patients. The choice of 20 hours as the critical time in which the procedure is ideally performed was statistically significant (p = 0.0476). Conclusion: A percutaneous endovascular procedure is an effective treatment for acute mesenteric ischemia, especially in patients who underwent treatment within 20 hours. However, further study and a long term follow-up are needed.

해면정맥동의 경막동정맥루에서 색전술로 치료한 환자에서의 뇌신경마비:단일기관 후향적 분석

정상준,권오기,오창완,이영진 대한뇌혈관외과학회 2011 Journal of Cerebrovascular and Endovascular Neuros Vol.13 No.3

Objective : Cranial nerve dysfunction is common after endovascular treatment of a cavernous sinus dural arteriovenous fistula and sometimes this symptom persists. We reviewed the treatment outcomes of the patients with cavernous sinus dural arterio-venous fistula and who were treated with endovascular technique, and we analyzed the characteristics of those patients who had cranial nerve palsy after treatment. Methods : Between May 2003 and July 2010, 25 patients were treated by an endovascular technique at our institution. Their medical records were reviewed and we analyzed their data, including the clinical presentation,the neurological deficits, the radiographic features and the treatment outcomes. Results : In our series, a total of 25 patients (28cases) received endovascular treatment. There were four male patients and twenty one female patients with an age range of 26-78 years (mean age : 57.4 years). Complete occlusion was observed in nineteen cases (67.9%) and 5 cases (17.9%) showed near complete occlusion. Additional procedures were required for four cases with fistulas that were partially occluded by pre-vious treatment. Twenty four patients (96%) showed improved symptoms during the follow up and only one patient suffered from persistent symptoms. Procedure-related complications were observed in 2 cases. New cranial nerve palsy was observed in four patients (16%) and two patients experienced aggravation of their existing cranial nerve palsy. One of them had persistent deficits at the final follow up. Conclusion : Sufficient occlusion and avoidance of over-compaction of coils are important to prevent cranial nerve palsy when performing endovascular treatment of cavernous sinus dural arteriovenous fistulas.

Endovascular Treatment of Bilateral Cavernous Sinus Dural Arteriovenous Fistula: Therapeutic Strategy and Follow-Up Outcomes

Jong Kook Rhim,Young Dae Cho,유동현,Hyun-Seung Kang,Won-Sang Cho,Jeong Eun Kim,Min Jae Cho,황교준,O-Ki Kwon,한문희 대한영상의학회 2018 Korean Journal of Radiology Vol.19 No.2

Objective: Bilateral cavernous sinus dural arteriovenous fistula (CSdAVF) is very rare, even in Asian countries. The research intended to present clinical and radiologic outcomes of treating such fistulas through endovascular embolization. Materials and Methods: Data was obtained from 220 consecutive patients, with CSdAVF, who were treated from January 2004 to December 2015. Bilateral CSdAVF was identified in 17 patients (7.7%). The clinical and radiologic outcomes of the fistulas were assessed with an emphasis on the technical aspects of treatment. Results: At the time of treatment, 7 and 10 patients presented with bilateral and unilateral symptoms, respectively. In the former cases, 4 patients had progressed from unilateral to bilateral symptoms. Bilateral fistulas were treated with a single-stage transvenous embolization (TVE) in 15 patients, via bilateral inferior petrosal sinuses (IPS) (n = 9) and unilateral IPS (n = 6). In the other 2 patients with one-sided dominance of shunting, only dominant fistula was treated. Two untreated lesions were found on follow-up to have spontaneously resolved after treatment of the dominant contralateral fistula. Of the 34 CSdAVF lesions, complete occlusion was achieved in 32 lesions after TVE. Seven patients (41.2%) developed worsening of cranial nerve palsy after TVE. During the follow-up period, 4 patients obtained complete recovery, whereas the other 3 remained with deficits. Conclusion: With adjustments of endovascular procedures to accommodate distinct anatomical configurations, endovascular treatment for bilateral CSdAVF can achieve excellent angiographic occlusion results. However, aggravation of symptoms after TVE may occur frequently in bilateral CSdAVF. In the patients with one-sided dominance of shunt, treatment of only dominant fistula might be an alternative option.

뇌동정맥기형의 치료에 있어서 색전술의 역할 : Experience of 15 Cases

이상형,김봉수,심기범,성정남,박인성,한문희,한대희 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.2

The authors report the results of treatment in 15 patients with intracranial arteriovenous malformations(AVM's) who underwent embolization with n-butyl cyanoacrylate(NBCA) and poly vinyl alcohol(PVA) particle between March. 1990 and August. 1992 at Seoul National University Hospital and discuss about role of endovascular treatment in the management of intracranial AVM' s. Seven patients(46.7%) had pre-operative embolization, microsurgery was done in six patients and radiosurgery was done in one patient In patients with pre-operative embolization. endovascular treatment had helped microsurgery in dissection, diminution of blood transfusion, and shorter time of surgery. AVM's of two patients(l2.5%) were totally occluded by embolization alone. But they had morbidity after embolization due to inadvertent occlusion. AVM's of six patied40 % were partially occluded and recurrence of previous symptoms bleeding revascularization, increase of AVM nidus developed during follow up. It is concluded that role of endovascular treatment is in tracranial AVM's ajuvant. definite, palliative. Except surgical resection after embolization, embolization alone should be done very cautiously in definite and palliative treatment.

Angiographic Follow-Up for Small Ruptured Intracranial Aneurysm Treated by Endovascular Treatment : Follow-Up Plan and Long-Term Follow-Up Results

Tae Hyung Kim,Jung Ho Ko,Jaewoo Chung 대한신경외과학회 2022 Journal of Korean neurosurgical society Vol.65 No.5

Objective : Although endovascular treatment for intracranial aneurysms is considered effective and safe, its durability is still debated. Also, few studies have described angiographic follow-up plan after endovascular treatment of intracranial aneurysm, especially in ruptured cases. Hence, we report the long-term results of follow-up angiography protocol. Methods : Radiological records of 639 cases of coil embolization with ruptured aneurysms from March 2003 to December 2016 were retrospectively reviewed. Patients who received treatment of a saccular aneurysm less than 7 mm resulted with near complete occlusion were included. Two hundred thirty-eight aneuryms which received the follow-up angiography at least once were enrolled. We classified four periods of follow-up as follows : post-treatment 1 year (defined as the first period), from 1 to 2 years (the second period), 2 to 5 years (the third period), and over 5 years (long-term). Results : We identified 14 cases (6.4%) of recurrence from 218 aneurysms in follow-up angiography in the first period. Among 143 aneurysms in the second period, five cases (3.5%) of recurrence were identified. There were no findings suspicious of recanalization in 97 patients in the third period. Of the total 238 cases, there were 19 recurrences, for a recurrence rate of 8.0%. Six (31.6%) out of 19 recurrences showed a tendency toward repeat recurrences even after additional treatment. Twenty-eight received long-term follow-up over 5 years and there was no recurrence. Conclusion : Most of the recurrence were found during the first and the second year. We suggest that at least one digital subtraction angiography examination may be necessary around post-treatment 2 years, especially in ruptured cases. If the angiographic results are favorable at 2 years post-treatment, long-term result should be favorable.

Segmental Liver Stiffness Evaluated with Magnetic Resonance Elastography Is Responsive to Endovascular Intervention in Patients with Budd-Chiari Syndrome

Peng Xu,Lulu Lyu,Haitao Ge,Muhammad Umair Sami,Panpan Liu,Chunfeng Hu,Kai Xu 대한영상의학회 2019 Korean Journal of Radiology Vol.20 No.5

Objective: To assess segmental liver stiffness (LS) with MRI before and after endovascular intervention in patients with Budd-Chiari syndrome (BCS). Materials and Methods: Twenty-three patients (13 males and 10 females; mean age, 42.6 ± 12.6 years; age range, 31–56 years) with BCS as a primary liver disease were recruited for this study. Two consecutive magnetic resonance elastography (MRE) examinations were performed before the endovascular treatment. Fifteen patients who underwent endovascular intervention treatment also had follow-up MRE scans within three days after the procedure. LS was measured in three liver segments: the right posterior, right anterior, and left medial segments. Inter-reader and inter-exam repeatability were analyzed with intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Segmental LS and clinical characteristics before and after the intervention were also compared. Results: Within three days of the endovascular intervention, all three segmental LS values decreased: LS of the right posterior segment = 7.23 ± 0.88 kPa (before) vs. 4.94 ± 0.84 kPa (after), LS of the right anterior segment = 7.30 ± 1.06 kPa (before) vs. 4.77 ± 0.85 kPa (after), and LS of the left medial segment = 7.22 ± 0.87 kPa (before) vs. 4.87 ± 0.72 kPa (after) (all p = 0.001). There was a significant correlation between LS changes and venous pressure gradient changes before and after treatments (r = 0.651, p = 0.009). The clinical manifestations of all 15 patients significantly improved after therapy. The MRE repeatability was excellent, with insignificant variations (inter-reader, ICC = 0.839–0.943: inter-examination, ICC = 0.765–0.869). Bland–Altman analysis confirmed excellent agreement (limits of agreement, 13.4–19.4%). Conclusion: Segmental LS measured by MRE is a promising repeatable quantitative biomarker for monitoring the treatment response to minimally invasive endovascular intervention in patients with BCS.

Endovascular Treatment of Wide-Necked Intracranial Aneurysms Using Balloon-Assisted Technique with HyperForm Balloon

Youn, Sang-O,Lee, Jae-Il,Ko, Jun-Kyung,Lee, Tae-Hong,Choi, Chang-Hwa The Korean Neurosurgical Society 2010 Journal of Korean neurosurgical society Vol.48 No.3

Objective : To assess the feasibility, safety, and effectiveness of the balloon-assisted technique with HyperForm balloon in the endovascular treatment of wide-necked intracranial aneurysms. Methods : A total of 34 patients with 34 wide-necked intracranial aneurysms were treated with endovascular coil embolization using balloon-assisted technique with Hyperform balloon. Twenty-nine aneurysms (85.3%) were located in the anterior circulation. The group of patients was comprised of 16 men and 18 women, aged 33 to 72 years (mean : 60.6 years). The size of aneurysms was in the range of 2.0 to 22.0 mm (mean 5.5 mm) and one of neck was 2.0 to 11.9 mm (mean 3.8 mm). The dome to neck ratio was ranged from 0.83 to 1.43 (1.15). Sixteen patients were treated for unruptured aneurysms and the remaining 18 presented with a subarachnoid hemorrhage. Results : In the 34 aneurysms treated by the remodeling technique with HyperForm balloon, immediate angiographic results consisted of total occlusion in 31 cases (91.2%) and partial occlusion in three cases (8.8%). There were five procedure-related complications (14.7%), including two coil protrusions and three thromboembolisms; Except one patient, all were successfully resolved without permanent neurologic deficit. No new bleeding occurred during the follow-up. Twenty patients (59%) underwent angiographic follow-up from 2 to 33 months (mean 9.2 months) after treatment. Focal recanalization with coil compaction of the neck portion was observed in 5 cases (25%). Only one case showed major recanalization and underwent stent-assisted coil embolization. Conclusion : The balloon-assisted technique with Hyperform balloon is a feasible, safe, and effective endovascular treatment of wide-necked cerebral aneurysms.