• 대한영상의학회지
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• 제82권3호
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• pp.512-526
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• 2021

말초동맥질환은 하지혈관을 흔히 침범하는 폐쇄성 질환이다. 대동맥-장골동맥 부위에서 이를 치료하기 위한 재개통술은 전통적으로 수술적인 접근을 통한 우회술을 근간으로 하였으며, 최근에는 국소적이고 단순한 병변들을 위주로 혈관 내 접근법을 통한 치료법이 우선 권고되고 있다. 혈관 내 접근법은 그 최소침습적인 특성으로 인하여 수술의 위험성이 높은 환자에 대해서 활용하는 것이 일반적이었으나, 근래의 다양한 기법 및 기구의 발전으로 보다 다양한 질병 상태를 가진 환자에서 활용되어 수술적인 치료에 근접하는 결과가 보고되고 있다. 이 종설에서는 말초동맥 질환에 대한 진단 및 대동맥-장골동맥 부위의 혈관 내 재개통술에 활용되는 기법 및 기구들에 대해 살펴보고 그 역할에 대해 살펴보고자 한다.

• Journal of Korean Neurosurgical Society
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• 제49권2호
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• pp.97-101
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• 2011

Objective : It is technically difficult to treat wide-necked intracranial aneurysms by the endovascular method. Various tools and techniques have been introduced to overcome the related technical limitations. The purpose of this study was to evaluate the radiologic and clinical results of widenecked intracranial aneurysm treatment using the endovascular method. Methods : Fifteen aneurysms in 15 patients were treated by the endovascular method from October 2009 to August 2010. Seven patients presented with subarachnoid hemorrhage (SAH), seven patients had unruptured aneurysms, and one patient had an intracerebral hemorrhage and intraventricular hemorrhage due to an incompletely clipped aneurysm. The mean dome-to-neck ratio was 1.1 (range, 0.6-1.7) and the mean height-to-neck ratio was 1.1 (range, 0.6-2.0). We used double microcatheters instead of a stent or a balloon for the first trial. When we failed to make a stable coil frame with two coils, we used a stent-assisted technique. Results : All aneurysms were successfully embolized. Eleven aneurysms (73%) were embolized by the double microcatheter technique without stent insertion, and four aneurysms (27%) were treated by stent-assisted coil embolization. One case had subclinical procedure-related intraoperative hemorrhage. Another case had procedure-related thromboembolism in the left distal anterior cerebral artery. During the follow-up period, one patient (7%) had a recanalized aneurysmal neck 12 months after coil embolization. The recurrent aneurysm was treated by stent-assisted coil embolization. Conclusion : We successfully treated 15 wide-necked intracranial aneurysms by the endovascular method. More clinical data with longer follow-up periods are needed to establish the use of endovascular treatment for wide-necked aneurysm.

• Journal of Korean Neurosurgical Society
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• 제60권3호
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• pp.335-347
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• 2017

Intravenous recombinant tissue plasminogen activator had been the only approved treatment for acute ischemic stroke since its approval in 1995. However, the restrictive time window, numerous contraindications, and its low recanalization rate were all limitations of this modality. Under those circumstances, endovascular stroke therapy went through a great evolution during the past two decades of intravenous thrombolysis. The results of the 2013 randomized trials for endovascular stroke therapy were neutral, although they were limited by insufficient imaging screening at enrollment, early-generation devices with less efficacy, and treatment delays. Huge progress was made in 2015, as there were five randomized clinical trials which all demonstrated the safety and efficacy of endovascular stroke treatment. Despite differences in detail patient enrollment criteria, all 5 trials employed key factors for good functional recovery; (1) screening with non-invasive imaging to identify the proximal occlusion and exclude a large infarct core, (2) using highly effective modern thrombectomy devices mainly with stent retriever, and (3) establishment of a fast workflow to achieve effective reperfusion. The results of those trials indicate that modern thrombectomy devices can allow for faster and more effective reperfusion, which can lead to improved clinical outcomes compared to intravenous thrombolysis alone. These advances in mechanical thrombectomy are promising in the global fight against ischemic stroke-related disability and mortality. Two current mainstreams among such mechanical thrombectomy techniques, "stent retriever thrombectomy" and "direct clot aspiration", are the topic of this review. Stent retriever thrombectomy using Solitaire and Trevo retriever will be firstly discussed. And, the commonalities and the differences between two major clot aspiration thrombectomy techniques; a direct aspiration first pass technique (ADAPT) and forced arterial suction thrombectomy (FAST), will be additionally explained. Finally, details regarding the combination of direct clot aspiration and stent retriever thrombectomy, the switching strategy and the Solumbra technique, will be described.

• Journal of Chest Surgery
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• 제47권2호
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• pp.167-170
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• 2014

Herein, we present a case of a successful treatment of persistent type 2 endoleaks associated with aneurysmal sac enlargement after endovascular aneurysm repair in an elderly patient. We confirmed the diagnosis by abdominal computed tomography and selective angiography revealing an 11.0-cm aneurysm sac with type 2 endoleaks. An attempt for the endovascular embolization of collateral arteries was unsuccessful due to anatomic variations and their multiple complex communications. Instead, transperitoneal sacotomy and direct suturing on the feeding target vessels was successfully performed without any endograft damage. In conclusion, sacotomy appears to be a feasible therapeutic substitute where endovascular or other techniques have a high risk of failure and lead to unsuccessful results.

• Journal of Korean Neurosurgical Society
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• 제58권2호
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• pp.155-158
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• 2015

The equipment and techniques associated with magnetic resonance imaging (MRI) have rapidly evolved. The development of 3.0 Tesla MRI has enabled high-resolution imaging of the intracranial vessel wall. High-resolution MRI (HRMRI) can yield excellent visualization of both the arterial wall and lumen, thus facilitating the detection of the primary and secondary features of intracranial arterial dissection. In the present report, we describe the manner in which HRMRI affected our endovascular treatment planning strategy in 2 cases with unruptured intracranial vertebral artery dissection aneurysm. HRMRI provides further information about the vessel wall and the lumen of the unruptured intracranial vertebral artery dissecting aneurysm, which was treated by an endovascular approach in the 2 current cases.

• Journal of Korean Neurosurgical Society
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• 제38권2호
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• pp.151-154
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• 2005

A 43-year-old woman was admitted with the chief complaint of progressive visual disturbance and her brain radiological studies disclosed well demarcated tumor at tuberculum sellae area and bilateral mirror image paraclinoid internal carotid artery saccular aneurysms. A larger left side aneurysm was pointing medialy and almost encased by the tumor. Although a brain tumor and intracranial aneurysm can be simultaneously treated by surgery, the high risk of intra-operative aneurysm rupture should be considered. Therefore, the author secondly performed tumor resection after the endovascular embolization of the aneurysm which was embedding the tumor using a Guglielmi detachable coil. After successful treatment of the patient with tuberculum sellae meningioma associated with bilateral mirror image paraclinoid aneurysms using endovascular and surgical techniques, the authors present the case with a review of the related literatures.

• 대한영상의학회지
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• 제84권2호
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• pp.483-488
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• 2023

경추 수술 중 발생한 척추 동맥 손상은 드물지만 중요하다. 중재적 혈관내 치료 기술의 발전으로 척추 동맥 손상에 대한 치료 접근 방식이 바뀌었지만 확립된 치료 방침은 아직 없다. 우리는 트리플 스텐트 시술 실패 후 플러그 앤 패치 방식으로 혈관내 코일 시술을 하여 척추 동맥 손상으로 인한 가동맥류를 성공적으로 치료한 사례를 보고하고자 한다.

• Archives of Plastic Surgery
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• 제50권2호
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• pp.182-187
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• 2023

We aim to provide our surgical techniques, and outcomes of functional scrotal reduction procedures with complete preservation of the genitourinary original anatomy in a simple way without using complicated skin grafting or skin advancement flaps in Patients with huge and long-standing scrotal lymphedema 18 patients ages ranged from 14-65 with a median of 30 years. Functional scrotal and penoscrotal reduction was attained in all cases, without distortion of the genitourinary anatomy and without the need for advancement, rotational or free flaps, maximal scrotal diameter was reduced from median of 61[48-92] cms to a median of 25[21-29] cms (P<0.0001) and remained almost unchanged at the end of the follow up period 26[22-34] cms (P<0.0001). Sexual performance and voiding capacity were improved in all patients, testicular vascularity was unaffected and the Glasgow Benefit Inventory (GBI) for the quality of life showed marked enhancement in the total 55.5[50-72], general 55.5[50-72], social 100[50-100] and physical 16.6[16-33] points subscales. According to our experience, surgery remains the gold standard treatment for management of huge scrotal lymphedema, successful preservation of the genitourinary functions can be attained despite the size in most cases with excellent cosmoses.

• 대한영상의학회지
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• 제84권4호
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• pp.846-854
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• 2023

상하지 혈관 손상은 높은 사망률과 관계가 있다. 사지 혈관 손상에 대한 전통적인 치료법은 수술이었으나 최근 기술과 시술법의 비약적인 발달로 인해 혈관 내 치료법(endovascular treatment)의 효용 및 임상 적용이 증가하고 있다. 상하지 혈관 손상에서 시행할 수 있는 혈관 내 치료는 크게 스텐트 그래프트(stent graft) 설치술과 색전술로 나눠볼 수 있으며 일반적으로 손상 혈관의 위치와 크기, 혈관 손상의 성격에 따라 치료법이 달라진다. 겨드랑-쇄골하동맥과 장골 동맥 손상의 경우 해부학적 위치상 수술적인 접근이 어려운 것으로 알려져 있으며 스텐트 그래프트 설치술이 수술을 대신할 수 있는 중요한 치료법으로 활용되고 있다. 활동성 출혈, 가성동맥류, 동정맥루 및 색전 시 허혈이 우려되지 않는 동맥의 손상에 대해서는 색전술을 고려해 볼 수 있다. 상하지의 혈관 손상에 대한 혈관 내 치료법은 최소침습적으로 진단과 치료를 동시에 할 수 있다는 장점이 있어 향후 그 적응증이 더 넓어질 것으로 기대된다.

• 대한영상의학회지
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• 제85권3호
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• pp.596-606
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• 2024

Purpose To examine the technical considerations of endovascular treatment for aortoiliac occlusive disease (AIOD) based on a 10-year experience in Songklanagarind Hospital. Materials and Methods This retrospective cohort study included 210 patients who underwent endovascular treatment for symptomatic AIOD between January 2010 and December 2020. The patients' clinical and lesion characteristics, including technical considerations of the procedure, were collected, analyzed, and stratified using the Transatlantic Inter-Society Consensus (TASC). Results Most patients (80%) in this study had chronic limb-threatening ischemia lesions, with an occlusion rate of 37%. The technical success rate of TASC C & D was lower than that of TASC A & B, 84.4% vs. 99.2% p ≤ 0.001. A technical success rate of 93.3% (14/15) was found for the femoral and brachial approach, compared with a success rate of 89.0% (57/64) for the unibifemoral approach in TASC C & D, without a statistically significant difference (p = 0.076). However, the puncture site complications in this route were up to 17.6%, which is the highest rate compared with other techniques. These complications could be treated either conservatively or minimally invasively. Conclusion In cases of failed femoral access, simultaneous femoral and brachial approaches improved the technical success rate of endovascular recanalization of TASC C & D aortoiliac occlusions.