Folded-Loop Guidewire Remodeling Technique: Catheterizing Markedly Angulated Branches during Intravascular Embolization.

Purpose: Practical challenges are encountered in percutaneous intravascular procedures when applied to markedly angulated branching vessels. Herein, we introduced a folded-loop guidewire remodeling technique-the guidewire-shaping technique-to overcome difficult catheterization. Materials and Methods: First, the tip of a 0.014-inch micro-guidewire was manually shaped like a pigtail loop. Second, the shaped guidewire was introduced into the microcatheter and was preloaded into the hollow metal introducer for suitability with the microcatheter hub. Gentle rotation of the guidewire after release from the microcatheter can create the preshaped pigtail loop configuration. On pulling back, the loop loosened, the configuration was changed to a small U-shaped tip, and the guidewire tip was easily introduced into the target artery. Results: Between December 2019 and January 2022, the described technique was used in 64 patients (male/female, 49/15; mean age, 66.8 ± 9.5 years) for selective arterial embolization, after failed attempts with the conventional selection technique. The technique was successful in 63/64 patients (98%). The indications of embolization include transcatheter arterial chemoembolization, gastrointestinal bleeding, hemoptysis, trauma-induced bleeding, and tumor bleeding. Conclusion: The folded-loop guidewire remodeling technique facilitates the catheterization of markedly angulated branching arteries; when usual catheterization method fails.

Melittin-loaded Iron Oxide Nanoparticles Prevent Intracranial Arterial Dolichoectasia Development through Inhibition of Macrophage-mediated Inflammation.

Rationale: In intracranial arterial dolichoectasia (IADE) development, the feedback loop between inflammatory cytokines and macrophages involves TNF-α and NF-κB signaling pathways and leads to subsequent MMP-9 activation and extracellular matrix (ECM) degeneration. In this proof-of-concept study, melittin-loaded L-arginine-coated iron oxide nanoparticle (MeLioN) was proposed as the protective measure of IADE formation for this macrophage-mediated inflammation and ECM degeneration. Methods: IADE was created in 8-week-old C57BL/6J male mice by inducing hypertension and elastase injection into a basal cistern. Melittin was loaded on the surface of ION as a core-shell structure (hydrodynamic size, 202.4 nm; polydispersity index, 0.158). Treatment of MeLioN (2.5 mg/kg, five doses) started after the IADE induction, and the brain was harvested in the third week. In the healthy control, disease control, and MeLioN-treated group, the morphologic changes of the cerebral arterial wall were measured by diameter, thickness, and ECM composition. The expression level of MMP-9, CD68, MCP-1, TNF-α, and NF-κB was assessed from immunohistochemistry, polymerase chain reaction, and Western blot assay. Results: MeLioN prevented morphologic changes of cerebral arterial wall related to IADE formation by restoring ECM alterations and suppressing MMP-9 expression. MeLioN inhibited MCP-1 expression and reduced CD68-positive macrophage recruitments into cerebral arterial walls. MeLioN blocked TNF-α activation and NF-κB signaling pathway. In the Sylvian cistern, co-localization was found between the CD68-positive macrophage infiltrations and the MeLioN distributions detected on Prussian Blue and T2* gradient-echo MRI, suggesting the role of macrophage harboring MeLioN. Conclusions: The macrophage infiltration into the arterial wall plays a critical role in the MMP-9 secretion. MeLioN, designed for ION-mediated melittin delivery, effectively prevents IADE formation by suppressing macrophage-mediated inflammations and MMP activity. MeLioN can be a promising strategy preventing IADE development in high-risk populations.

The Spectrum of CT Findings of COVID-19 Pneumonia: Acute Alveolar Insult and Organizing Pneumonia as Different Phases of Lung Injury and Repair.

Purpose: To analyze the findings and serial changes in chest CT lesions in 123 symptomatic patients with coronavirus disease 2019 (COVID-19). Materials and Methods: From February 19 to April 7, 2020, a total of 123 confirmed COVID-19 patients (male, 44; female, 79; mean age, 59.2 ± 18.6) were enrolled in this retrospective study. A total of 234 CT scans were reviewed for the following patterns: acute alveolar insult (AAI) patterns: ground-glass opacity (GGO), crazy-paving appearance, mixed pattern, and consolidation; organizing pneumonia (OP) patterns: perilobular patterns, band opacity, curvilinear opacity, reversed halo opacity, and small nodular consolidation; resolving patterns: pure GGO, remnant curvilinear, small nodular consolidation, and serial changes of lung abnormalities. We compared the proportions of AAI pattern, OP pattern, or resolving pattern with time progression and analyzed the association between the patterns and disease severity using Pearson chi-square and Fisher's exact test. Results: Predominant CT patterns were AAI pattern (87%) in the early hospital period group (0-10 days, after the onset of symptoms), OP pattern (45.7%) in the later hospital period group (after 10 days), and resolving pattern in discharge and follow-up group (47.2% and 84.8%, respectively). The difference in the proportions of predominant CT patterns with time progression was statistically significant (p < 0.001, Pearson's chi-square test). No statistically significant association was observed between the patterns and disease severity (p = 0.055, Fisher's exact test). No fibrous changes in the lesions were observed on follow-up CT scans. Conclusion: The serial CT scans of COVID-19 patients showed the spectrum of COVID pneumonia CT manifestations as different phases of lung injury and repair.

[Interventional Treatment of Chemical Pleuritis and Hemothorax Caused by Iatrogenic Internal Jugular Vein Perforation after Central Venous Port System Implantation: A Case Report]. / ì¤‘ì‹¬ì •ë§¥í¬íŠ¸ ì‚½ìž í›„ 의인성 ì†ëª©ì •ë§¥ 천공에 의한 í™”í•™ì  늑막염과 혈흉의 ì¤‘ìž¬ì  치료: 증례 ë³´ê³ .

The perforation of the intrathoracic internal jugular vein during the placement of an implantable central venous chemoport is a rare complication that is manifested by hemothorax or hemorrhagic shock. Furthermore, inappropriate instillation of a chemotherapeutic agent in the chemoport can cause chemical pleuritis, and the diagnosis of these complications prior to the instillation of chemotherapeutic agents and open thoracic surgery is mandatory. We report a patient with chemical pleuritis and hemothorax following an inappropriate instillation of a chemotherapeutic agent, through the perforated right internal jugular vein after placement of an implantable central venous chemoport. Treatment by embolization using coils and N-butyl cyanoacrylate, after percutaneous drainage, was successful.

[Undifferentiated Pleomorphic Sarcoma of the Thoracic Aorta Presenting with Ruptured Saccular Aneurysm: A Case Report]. / 소낭성 동맥류 파열로 발현된 흉부 대동맥에서 기원한 미분화성 다형성 ìœ¡ì¢ : 증례 ë³´ê³ .

Cases of undifferentiated pleomorphic sarcoma of the thoracic aorta are rare, and usually present with embolic events, renovascular hypertension, or back pain. Mural-based undifferentiated pleomorphic sarcomas that present as ruptured saccular aneurysms are extremely rare and are difficult to differentiate from mycotic aneurysms or penetrating atherosclerotic ulcers. Herein, we report a case of histopathologically proven undifferentiated pleomorphic sarcoma arising from the wall of the descending thoracic aorta that manifested as a mass after thoracic endovascular aortic repair for the treatment of a ruptured saccular aneurysm. We present findings obtained by CT and PET to provide helpful information for the accurate diagnosis and appropriate treatment of future cases.

[Successful Treatment of Duodenal Variceal Bleeding with Coil-Assisted Retrograde Transvenous Obliteration: A Case Report]. / 코일을 이용한 역행성 ê²½ì •ë§¥ íìƒ‰ìˆ ì— 의한 십이지장 ì •ë§¥ë¥˜ 출혈의 ì„±ê³µì  치료: 증례 ë³´ê³ .

Duodenal varices can develop in patients with portal hypertension secondary to liver cirrhosis. Although upper gastrointestinal bleeding is often severe and fatal, the definite treatment or guideline has not been established. Although endoscopy is the primary therapeutic modality, the use of radiologic interventions, such as transjugular intrahepatic portosystemic shunt, balloon or vascular plug-assisted retrograde transvenous obliteration, and percutaneous transhepatic variceal obliteration, can be considered alternative treatment methods for duodenal varices. Herein, we report a case of duodenal varix in a patient with poor hepatic functional reserve and vascular anatomy, which are contraindications for an occlusion balloon or a vascular plug, successfully treated with coil-assisted retrograde transvenous obliteration.

[Comparative Analysis of Image Quality and Adverse Events between Iopamidol 250 and Ioversol 320 in Hepatic Angiography for Transcatheter Arterial Chemoembolization]. / 경동맥 í™”í•™ìƒ‰ì „ìˆ ì„ 위한 간동맥 í˜ˆê´€ì¡°ì˜ìˆ ì—ì„œ Ioversol 320ê³¼ 비교한 Iopamidol 250의 영상 화질 비교 분석과 ì¡°ì˜ì œ ìœ í•´ë°˜ì‘ 평가.

Purpose: This study aimed to compare the image quality and adverse events between Iopamidol 250 and Ioversol 320 usage during transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Materials and Methods: Medical records and hepatic angiography from 113 patients who underwent TACE with Iopamidol 250 (44 patients) and Ioversol 320 (69 patients) were retrospectively reviewed. Vessel perception on hepatic angiography was graded into three categories by two radiologists for hepatic subsegmental arteries, the right gastroepiploic artery, right gastric artery, and pancreaticoduodenal artery. Imaging concordance was assessed by comparing the number of detected HCCs on hepatic angiography and CT. The adverse events before and after hepatic angiography were evaluated. Results: The mean vessel perception scores were 2.92 and 2.94 for Iopamidol 250 and Ioversol 320, respectively. The imaging concordance was 31 (70.5%) and 46 (66.7%) patients for Iopamidol 250 and Ioversol 320, respectively. There were no statistical differences in vessel perception or imaging concordance (p > 0.05). One and six patients experienced nausea for Iopamidol 250 and Ioversol 320, respectively. There was no statistical difference in adverse events (p = 0.24). Conclusion: Iopamidol 250 can be used in hepatic angiography for TACE without significant difference in image quality or occurrence of adverse events from Ioversol 320.

[Transcatheter Arterial Embolization of a Ruptured Superior Rectal Artery Aneurysm in Type 1 Neurofibromatosis: A Case Report]. / ì‹ ê²½ì„¬ìœ ì¢ ì¦ 1형에서 발생한 파열된 상직장동맥류의 경도관 동맥 ìƒ‰ì „ìˆ : 증례 ë³´ê³ .

Neurofibromatosis type 1 (NF1) is a common autosomal-dominant disorder. Vasculopathies associated with NF1 are rare and can cause aneurysms, stenoses, and arteriovenous malformations. Aneurysms may rupture spontaneously, which could be fatal. Spontaneous mesenteric hemorrhage due to rupture of an inferior mesenteric artery aneurysm associated with NF1 has rarely been reported. Herein, we report a case of spontaneous rupture of a fusiform aneurysm in the superior rectal artery in a 56-year-old woman with NF1 who was successfully treated with transcatheter arterial embolization.

Efficacy and Safety of AMPLATZER Vascular Plug Type IV for Embolization of Pulmonary Arteriovenous Malformations.

PURPOSE: To assess the efficacy and safety of the AMPLATZER Vascular Plug type IV for pulmonary arteriovenous malformation (PAVM) treatment. MATERIALS AND METHODS: Between June 2013 and January 2018, 13 patients with 26 PAVMs were treated with the type IV AVP. Patients without follow-up computed tomography (CT) were excluded. Technical success was defined as flow occlusion on angiography. Plug-to-sac distance was measured on angiographic images. Feeding artery and venous sac diameter changes were measured on preprocedural and follow-up CT. Successful embolization was defined as > 70% sac size regression. Procedure time, device migration, and complications were evaluated. RESULTS: Nine female patients (mean age, 49 y; range, 40-71 y) with 19 PAVMs were enrolled. Four patients with 7 PAVMs were lost to follow-up. Nineteen PAVMs were treated in 11 sessions, and the mean procedure time was 29 min. The technical success rate was 100%. Mean feeding artery diameter was 3.1 mm ± 0.7 (range, 2.1-4.9 mm). Mean plug-to-sac distance was 5.4 mm ± 4.9 (range, 0-13.3 mm). The mean CT follow-up period was 14 months ± 7 (range, 6-30 mo). Sixteen of 19 PAVMs (84%) were successfully embolized. Minor complications (tachycardia and chest discomfort) arose in 2 of 11 sessions. No device migrations or major complications occurred. CONCLUSIONS: The type IV AVP showed an 84% treatment success rate based on 70% sac size regression criteria in small PAVMs. There were no device migrations or major complications.

Impact of CT imaging on predicting the surgical management of acute diverticulitis.

PURPOSE: The incidence of colonic diverticular disease is increasing, and several grading systems based on CT findings have been developed. The objective of this study was to define the impact of various CT findings of colonic diverticulitis and to demonstrate which factors affect the need for operative treatment. METHODS: Three hundred fifty-seven patients diagnosed with colonic diverticulitis from January 2010 to July 2016 were retrospectively evaluated. Patients were excluded if pure diverticulosis, diverticular bleeding, colon cancer, or relevant data deficiencies, and the remaining patients (n = 178) were reviewed. Patients were categorized into a successful nonoperation group and an operation group. The operation group was then matched 1:2 with the nonoperative group based on age, gender, American Society of Anesthesiologists physical status classification, and body mass index. RESULTS: After propensity score matching, there were no significant differences regarding patients' demographic characteristics between the 2 groups. Left location was more associated with need for operation than the right side (79.2% vs. 31.3%, P < 0.001). CT findings such as distant intraperitoneal air, pericolic air, and free fluid were significantly more apparent in the operation group. When these factors were evaluated in a multivariate analysis, distant intraperitoneal air showed statistical significance (P = 0.046) and pericolic air and left location a significant trend (P = 0.071 and P = 0.067, respectively). CONCLUSION: This study suggests that distant intraperitoneal air is the most important factor in the need for surgery in patients with colonic diverticulitis. Further study will be able to identify more detailed CT findings and verify their significance, and will be helpful in designing practical scoring and classification systems.

Effect of Acupuncture on Postoperative Ileus after Distal Gastrectomy for Gastric Cancer.

PURPOSE: Acupuncture has recently been accepted as a treatment option for managing postoperative ileus (POI) and various functional gastrointestinal disorders. Therefore, we conducted a prospective randomized study to evaluate the effect of acupuncture on POI and other surgical outcomes in patients who underwent gastric surgery. MATERIALS AND METHODS: Thirty-six patients who underwent distal gastrectomy for gastric cancer from March to December 2015 were randomly assigned to acupuncture or non-acupuncture (NA) groups at 1:1 ratio. The acupuncture treatment was administered treatment once daily for 5 consecutive days starting at postoperative day 1. The primary outcome measure was the number of remnant sitz markers in the small intestine on abdominal radiograph. The secondary outcome measure was the surgical outcome, including the times to first flatus, first defecation, start of water intake, and start of soft diet, as well as length of hospital stay and laboratory findings. RESULTS: The acupuncture group had significantly fewer remnant sitz markers in the small intestine on postoperative days 3 and 5 compared to those in the NA group. A significant difference was observed in the numbers of remnant sitz markers in the small intestine with respect to group differences by time (P<0.0001). The acupuncture group showed relatively better surgical outcomes than those in the NA group, but the differences were not statistically significant. CONCLUSIONS: In this clinical trial, acupuncture promoted the passage of sitz markers, which may reflect the possibility of reducing POI after distal gastrectomy.

[A Case of Gastro-Gastric Intussusception Secondary to Primary Gastric Lymphoma].

In adults, most intussusceptions develop from a lesion, usually a benign or malignant neoplasm, and can occur at any site in the gastrointestinal tract. Intussusception in the proximal gastrointestinal tract is uncommon, and gastro-gastric intussusception is extremely rare. We present a case of gastro-gastric intussusception secondary to a primary gastric lymphoma. An 82-year-old female patient presented with acute onset chest pain and vomiting. Abdominal CT revealed a gastro-gastric intussusception. We performed upper gastrointestinal endoscopy, revealing a large gastric mass invaginated into the gastric lumen and distorting the distal stomach. Uncomplicated gastric reposition was achieved with endoscopy of the distal stomach. Histological evaluation of the gastric mass revealed a diffuse large B cell lymphoma that was treated with chemotherapy.

Comparison of Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) Using Ethanolamine Oleate (EO), BRTO Using Sodium Tetradecyl Sulfate (STS) Foam and Vascular Plug-Assisted Retrograde Transvenous Obliteration (PARTO).

PURPOSE: To compare the clinical outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) using ethanolamine oleate (EO), BRTO using sodium tetradecyl sulfate (STS) foam, and vascular plug-assisted retrograde transvenous obliteration (PARTO). MATERIALS AND METHODS: From April 2004 to February 2015, ninety-five patients underwent retrograde transvenous obliteration for gastric varices were analyzed retrospectively. BRTO with EO was performed in 49 patients, BRTO with STS foam in 25, and PARTO in 21. Among them, we obtained follow-up data in 70 patients. Recurrence of gastric varices was evaluated by follow-up endoscopy or CT. Medical records were reviewed for the clinical efficacy. Statistical analyses were performed by Kaplan-Meier method, Chi-square, Fisher's, and Kruskal-Wallis tests. RESULTS: Technical and clinical success was 94.7 %. As major complications, a hemoglobinuria and a death due to disseminated intravascular coagulation (DIC) were occurred in two patients with BRTO using EO. Recurrence occurred more frequently in PARTO group (P < 0.05). Recurrence occurred in three patients in BRTO using EO group and four patients in PARTO group with 3.2 and 32.8 % of each expected 1-year recurrence rates. There was no recurrence in BRTO using STS group. Abdominal pain occurred more frequently in BRTO using EO than BRTO using STS foam and PARTO (P < 0.05). Procedure time of PARTO was shorter than two conventional BRTOs (P < 0.05). CONCLUSIONS: BRTO using STS foam or PARTO is better than BRTO using EO for treatment of gastric varices in terms of complication or procedure time. However, PARTO showed frequent recurrence of gastric varices during the long-term follow-up rather than BRTO.

Endovascular stent graft for treatment of complicated spontaneous dissection of celiac artery: report of two cases.

We report 2 cases of complicated spontaneous dissection of the celiac artery, which were successfully treated by a stent graft. The first patient was a 47-year-old man who presented with acute abdominal pain. CT scan showed ruptured saccular aneurysm with surrounding retroperitoneal hematoma. The second patient was a 57-year-old man with progressive dissecting aneurysm. Endovascular stent graft was placed in the celiac trunk to control bleeding, and to prevent rupture in each patient. Follow-up CT scans showed complete obliteration of a dissecting aneurysm.

The value of gadoxetate disodium-enhanced MR imaging for predicting posthepatectomy liver failure after major hepatic resection: a preliminary study.

PURPOSE: To investigate whether preoperative gadoxetate-disodium-enhanced MR imaging predicts posthepatectomy liver failure (PHLF) in patients who underwent major hepatic resection. MATERIALS AND METHODS: Twenty nine patients who underwent preoperative gadoxetate-disodium-enhanced MR imaging and following major hepatic resection were enrolled. Hepatic parenchymal signal intensity (SI) on pre-contrast T1-weighted imaging and 20min hepatocyte phase was measured at each of the four liver segments by two observers using region of interest measurements. The mean value was calculated and used at each phase. The relative contrast enhancement index (RCEI) was calculated: (20min hepatocyte phase SI-pre-contrast SI)/pre-contrast SI. PHLF was determined by the International Study Group of Liver Surgery 2011 guidelines. Correlation analysis was performed between preoperative liver function test and RCEI. Diagnostic accuracy of RCEI for predicting PHLF was calculated with receiver operating characteristic curve analysis. The reproducibility of the RCEI measurement was evaluated. RESULTS: There was a significant correlation between preoperative albumin (r=0.496, P=0.006), T-bilirubin (r=-0.383, P=0.041), and RCEI. Seven patients (24%) experienced PHLF, and one of these patients (3%) died. The diagnostic accuracy of RCEI was 0.838 (sensitivity 85.7%, specificity 77.3%, cut-off value: 0.7508, 95% confidence interval: 0.654, 0.947). The 95% limits of agreement and ICC between repeated RCEI measurements were 18.4% of the mean and 0.94, respectively, and between RCEI measurements by the two observers were 21.7% and 0.929, respectively. CONCLUSION: Our results show that preoperative gadoxetate-disodium-enhanced MR imaging can predict PHLF in patients who underwent major hepatic resection.