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1.
Radiology ; 294(2): 455-463, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31821120

ABSTRACT

Background Management of abdominal branches associated with Stanford type B aortic dissection is controversial without definite criteria for therapy after thoracic endovascular aortic repair (TEVAR). This is in part due to lack of data on natural history related to branch vessels and their relationship with the dissection flap, true lumen, and false lumen. Purpose To investigate the natural history of abdominal branches after TEVAR for type B aortic dissection and the relationship between renal artery anatomy and renal volume as a surrogate measure of perfusion. Materials and Methods This study included patients who underwent TEVAR for complicated type B dissection from January 2012 to March 2017 at 20 centers. Abdominal aortic branches were classified with following features: patency, branch vessel origin, and presence of extension of the aortic dissection into a branch (pattern 1, supplied by the true lumen without branch dissection; pattern 2, supplied by the true lumen with branch dissection, etc). The branch artery patterns before TEVAR were compared with those of the last follow-up CT (mean interval, 19.7 months) for spontaneous healing. Patients with one kidney supplied by pattern 1 and the other kidney by a different pattern were identified, and kidney volumes over the course were compared by using a simple linear regression model. Results Two hundred nine patients (mean age ± standard deviation, 66 years ± 13; 165 men and 44 women; median follow-up, 18 months) were included. Four hundred fifty-nine abdominal branches at the last follow-up were evaluable. Spontaneous healing of the dissected branch occurred in 63% (64 of 102) of pattern 2 branches. Regarding the other patterns, 6.5% (six of 93) of branches achieved spontaneous healing. In 79 patients, renal volumes decreased in kidneys with pattern 2 branches with more than 50% stenosis and branches supplied by the aortic false lumen (patterns 3 and 4) compared with contralateral kidneys supplied by pattern 1 (pattern 2 vs pattern 1: -16% ± 16 vs 0.10% ± 11, P = .002; patterns 3 and 4 vs pattern 1: -13% ± 14 vs 8.5% ± 14, P = .004). Conclusion Spontaneous healing occurs more frequently in dissected branches arising from the true lumen than in other branch patterns. Renal artery branches supplied by the aortic false lumen or a persistently dissected artery with greater than 50% stenosis are associated with significantly greater kidney volume loss. © RSNA, 2019 Online supplemental material is available for this article.


Subject(s)
Aorta, Thoracic/surgery , Aortic Aneurysm/surgery , Aortic Dissection/surgery , Endovascular Procedures/methods , Renal Artery Obstruction/complications , Renal Artery Obstruction/diagnostic imaging , Aged , Aortic Dissection/complications , Aortic Aneurysm/complications , Female , Humans , Japan , Kidney/diagnostic imaging , Kidney/pathology , Male , Renal Artery/diagnostic imaging , Renal Artery/pathology , Renal Artery Obstruction/pathology , Retrospective Studies , Tomography, X-Ray Computed/methods , Treatment Outcome
2.
Eur Radiol ; 29(3): 1400-1407, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30209591

ABSTRACT

PURPOSE: To compare image quality of abdominal arteries between full-iodine-dose conventional CT and half-iodine-dose virtual monochromatic imaging (VMI). MATERIALS AND METHODS: We retrospectively evaluated images of 21 patients (10 men, 11 women; mean age, 73.9 years) who underwent both full-iodine (600 mg/kg) conventional CT and half-iodine (300 mg/kg) VMI. For each patient, we measured and compared CT attenuation and the contrast-to-noise ratio (CNR) of the aorta, celiac artery, and superior mesenteric artery (SMA). We also compared CT dose index (CTDI). Two board-certified diagnostic radiologists evaluated visualisation of the main trunks and branches of the celiac artery and SMA in maximum-intensity-projection images. We evaluated spatial resolution of the two scans using an acrylic phantom. RESULTS: The two scans demonstrated no significant difference in CT attenuation of the aorta, celiac artery, and SMA, but CNRs of the aorta and celiac artery were significantly higher in VMI (p = 0.011 and 0.030, respectively). CTDI was significantly higher in VMI (p = 0.024). There was no significant difference in visualisation of the main trunk of the celiac artery and SMA, but visualisation of the gastroduodenal artery, pancreatic arcade, branch of the SMA, marginal arteries, and vasa recta was significantly better in the conventional scan (p < 0.001). The calculated modular transfer function (MTF) suggested decreased spatial resolution of the half-iodine VMI. CONCLUSION: Large-vessel depiction and CNRs were comparable between full-iodine conventional CT and half-iodine VMI images, but VMI did not permit clear visualisation of small arteries and required a larger radiation dose. KEY POINTS: ・Reducing the dose of iodine contrast medium is essential for chronic kidney disease patients to prevent contrast-induced nephropathy. ・In virtual monochromatic images at low keV, contrast of relatively large vessels is maintained even with reduced iodine load, but visibility of small vessels is impaired with decreased spatial resolution. ・We should be aware about the advantages and disadvantages associated with virtual monochromatic imaging with reduced iodine dose.


Subject(s)
Aorta/diagnostic imaging , Celiac Artery/diagnostic imaging , Computed Tomography Angiography/methods , Image Enhancement/methods , Iodine , Mesenteric Artery, Superior/diagnostic imaging , Aged , Contrast Media , Female , Humans , Image Processing, Computer-Assisted/methods , Male , Radiation Dosage , Retrospective Studies
3.
AJR Am J Roentgenol ; 213(4): W153-W161, 2019 10.
Article in English | MEDLINE | ID: mdl-31166767

ABSTRACT

OBJECTIVE. The purpose of this study was to investigate whether, in the evaluation of unconscious patients in the emergency department, a new-generation CT scanner that acquires images in ultrafast scan mode (large coverage, fast rotation, high helical pitch) would reduce motion artifacts on whole-body CT images in comparison with those on images obtained with a conventional CT scanner. MATERIALS AND METHODS. Images of a total of 60 unconscious patients presenting to the emergency department were evaluated retrospectively. Of the 60 patients, 30 underwent CT with a new-generation scanner that acquires images in the ultrafast mode, and 30 underwent CT with a conventional scanner. Two radiologists independently evaluated motion artifacts in the aorta, lung, diaphragm, liver, and kidneys. The motion artifacts were graded in severity on a 4-point scale. A value of p < 0.05 was considered to indicate a statistically significant difference. RESULTS. Interobserver agreement on motion artifact ratings was good (κ = 0.80-0.93). Images obtained with the new-generation CT scanner showed a significant reduction in motion artifacts in the aortic root (p = 0.0003), lower lungs (p = 0.011), diaphragm (p = 0.0047), liver (p = 0.0026), and kidneys (p = 0.019). However, there were no significant differences between the two groups with respect to motion artifacts of the aortic arch, thoracic descending aorta, abdominal aorta, and upper lungs. CONCLUSION. CT images obtained in the ultrafast scan mode in the evaluation of unconscious patients had a significant reduction in motion artifacts. The ultrafast technique is expected to be useful for diagnostic CT in the emergency department.


Subject(s)
Artifacts , Coma , Tomography, X-Ray Computed/methods , Whole Body Imaging , Adult , Aged , Contrast Media , Emergency Service, Hospital , Female , Humans , Male , Middle Aged , Motion , Retrospective Studies , Tomography Scanners, X-Ray Computed
4.
Ann Vasc Surg ; 59: 36-47, 2019 Aug.
Article in English | MEDLINE | ID: mdl-31009715

ABSTRACT

BACKGROUND: In situ fenestration of aortic stent grafts for treatment of aortic arch aneurysms is a new option for endovascular aortic arch repair. So far, only few reports have shown perioperative and short-term results of in situ fenestrations for aortic arch diseases. We present the multicenter experience with the aortic arch in situ fenestration technique documented in the AARCHIF registry for treatment of aortic arch aneurysms or localized type A aortic dissections and analyzed perioperative outcome and midterm follow-up. METHODS: Patients with aortic arch pathologies treated by aortic arch in situ fenestration with proximal stent graft landing in aortic arch Ishimura zones 0 and 1 were included in the registry. Stent-graft in situ fenestrations were created using needles or radiofrequency or laser catheters and completed by implantation of covered connecting stent grafts. Single in situ fenestrations for the left subclavian artery (LSA) were excluded. RESULTS: Between 06/2009 and 03/2017, twenty-five patients were treated by in situ stent-graft fenestrations for aortic arch pathologies at 9 institutions in 7 different countries, 3 of them as bailout procedures for stent-graft malplacement. In situ fenestrations were performed for the brachiocephalic trunk (n = 20), the left common carotid artery (n = 21) and the LSA (n = 9). Technical success for intended in situ fenestrations was 94.0% (47/50), with additional supraaortic bypass procedures performed in 14 patients. Perioperative mortality occurred in 1 (4.0%) patient, treated as a bailout procedure and 3 (12.0%) perioperative strokes were observed. One proximal aortic stent-graft nonalignment and 4 type III endoleaks, 2 early and 2 late, required reeintervention. During follow-up (1-118 months), the diameter of aortic arch aneurysms decreased from 61.5 ± 4.1 mm to 48.4 ± 3.2 mm (P = 0.02) and, so far, 6 patients died from diseases unrelated to their aortic arch pathologies with a mean survival time of 79.5 months and 3 endovascular reinterventions for distal aortic expansion were performed. Cerebrovascular event (n = 4) was the most relevant prognostic factor for mortality during midterm follow-up (P = 0.003). CONCLUSIONS: The aortic arch in situ fenestration technique for endovascular aortic arch repair seems to be valuable treatment option for selected patients, although initial consideration of other treatment options is mandatory. Data about long-term durability are required.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Endovascular Procedures/instrumentation , Stents , Adult , Aged , Aged, 80 and over , Aortic Dissection/diagnostic imaging , Aortic Dissection/mortality , Aortic Dissection/physiopathology , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/mortality , Aortic Aneurysm, Thoracic/physiopathology , Aortography/methods , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/mortality , Computed Tomography Angiography , Endovascular Procedures/adverse effects , Endovascular Procedures/mortality , Female , Humans , Male , Middle Aged , Postoperative Complications/etiology , Prosthesis Design , Registries , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
5.
J Endovasc Ther ; 25(6): 757-759, 2018 Dec.
Article in English | MEDLINE | ID: mdl-30301407

ABSTRACT

PURPOSE: To report an experimental study and clinical case using a coil packing technique that hastens occlusion of an Amplatzer Vascular Plug 1 (AVP1) in short-segment embolization of high-flow target vessels. TECHNIQUE: An experimental vascular stenosis model was made of 12-mm soft polyvinyl chloride tubing. Under continuous pulsatile flow, a 12-mm AVP1 was deployed in the 4-mm-diameter stenosis. Before detachment of the AVP1, a 2.2-F microcatheter was inserted into the AVP1 through its mesh via a 6-F delivery guiding sheath in parallel with the delivery wire. Hydrogel microcoils were deployed tightly in the AVP1 and the plug was detached. After the procedure, the pulsatile saline flow was nearly obliterated. In the first clinical case, a 64-year-old man with a thoracic aortic stent-graft and single vessel debranching for type B aortic dissection developed a residual type II endoleak via the left subclavian artery. This coil packing technique in an AVP1 was employed to successfully embolize the leak. CONCLUSION: Based on the experimental study and the first experience in vivo, tight coil packing of an AVP1 might be a robust technique for ultrashort-segment embolization.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Embolization, Therapeutic/methods , Endoleak/therapy , Endovascular Procedures/adverse effects , Blood Flow Velocity , Embolization, Therapeutic/instrumentation , Endoleak/diagnostic imaging , Endoleak/etiology , Endoleak/physiopathology , Humans , Male , Middle Aged , Models, Anatomic , Models, Cardiovascular , Regional Blood Flow , Treatment Outcome
6.
J Comput Assist Tomogr ; 42(6): 919-924, 2018.
Article in English | MEDLINE | ID: mdl-30015802

ABSTRACT

OBJECTIVES: The aim of this study was to compare accuracy of measurement between virtual monochromatic imaging (VMI) in dual-energy computed tomography and conventional polychromatic 120-kVp computed tomographic scan in vascular models containing various densities of contrast material. METHODS: We evaluated measured diameters of 12 models of vessels of 4 inner diameters containing high, intermediate, and low densities of contrast material using software automation. RESULTS: Measurement errors with 70-keV VMI were significantly larger than or comparable to errors with 120-kVp scan for all models, and those with 50-keV VMI were significantly smaller than errors with 120-kVp scan for low-density models and larger for high-density models. CONCLUSIONS: Acquisition of images by VMI at low energy facilitates accurate measurement of diameters of poorly enhanced vessels with reduced iodine load but can increase measurement errors in other situations by decreasing spatial resolution, so VMI should be applied carefully to evaluate vessel diameter.


Subject(s)
Computed Tomography Angiography/methods , Radiographic Image Interpretation, Computer-Assisted/methods , Radiography, Dual-Energy Scanned Projection/methods , Contrast Media , In Vitro Techniques , Iopamidol , Phantoms, Imaging , Software
7.
J Card Surg ; 33(4): 190-193, 2018 Apr.
Article in English | MEDLINE | ID: mdl-29659089

ABSTRACT

A 48-year-old male developed a recurrent aortic-root pseudoaneurysm after surgical repair for acute dissection. Although the initial closure of the pseudoaneurysm was successfully managed by transcatheter endovascular occlusion and coiling utilizing a hybrid transapical and transfemoral approach, the pseudoaneurysm was recanalized after 3 months and a third-time surgical repair was required. The potential risk for recurrence of pseudoaneurysms should be considered when applying endovascular occlusion devices to treat aortic root anatomy.


Subject(s)
Aneurysm, False/surgery , Aorta/surgery , Aortic Aneurysm/surgery , Aortic Diseases/surgery , Aortic Dissection/surgery , Catheterization, Peripheral/methods , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Acute Disease , Aorta/anatomy & histology , Humans , Male , Middle Aged , Recurrence , Reoperation , Risk
8.
Kyobu Geka ; 71(5): 347-350, 2018 May.
Article in Japanese | MEDLINE | ID: mdl-29755086

ABSTRACT

The patient was a 66 year-old male. Computed tomography (CT) angiography showed a huge aneurysm(120 mm) in the aortic arch and chronic type B aortic dissection(45 mm) in the descending aorta. Echocardiography showed patent ductus arteriosus( PDA). Because of pulmonary hypertension due to PDA, it was considered unacceptable to put him under general anesthesia twice. We performed thoracic endovascular aortic repair (TEVAR) via the ascending aorta and total arch replacement (TAR) simultaneously to prevent paraplegia. After establishment of cardiopulmonary bypass( CPB), a stent graft was inserted via the ascending aorta to cover the dissection site of descending aorta, the aorta was opened under circulatory arrest, and PDA was suture closed. Another stent graft whose two proximal rows of Z-stent was removed, was inserted to descending aorta via the ascending aorta landing on the previous stent graft. The proximal end of this stent graft was anastomosed to the distal end of the prosthetic arch graft and arch branches were reconstructed as usual. The postoperative course was uneventful.


Subject(s)
Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures/methods , Stents , Aged , Anastomosis, Surgical/methods , Aortic Dissection/diagnostic imaging , Aortic Aneurysm, Thoracic/diagnostic imaging , Ductus Arteriosus, Patent/diagnostic imaging , Ductus Arteriosus, Patent/surgery , Humans , Male , Treatment Outcome
9.
Endocr J ; 64(3): 347-355, 2017 Mar 31.
Article in English | MEDLINE | ID: mdl-28132968

ABSTRACT

We evaluated the influence of catheter sampling position and size on left adrenal venous sampling (AVS) in patients with primary aldosteronism (PA) and analyzed their relationship to cortisol secretion. This retrospective study included 111 patients with a diagnosis of primary aldosteronism who underwent tetracosactide-stimulated AVS. Left AVS was obtained from two catheter positions - the central adrenal vein (CAV) and the common trunk. For common trunk sampling, 5-French catheters were used in 51 patients, and microcatheters were used in 60 patients. Autonomous cortisol secretion was evaluated with a low-dose dexamethasone suppression test in 87 patients. The adrenal/inferior vena cava cortisol concentration ratio [selectivity index (SI)] was significantly lower in samples from the left common trunk than those of the left CAV and right adrenal veins, but this difference was reduced when a microcatheter was used for common trunk sampling. Sample dilution in the common trunk of the left adrenal vein can be decreased by limiting sampling speed with the use of a microcatheter. Meanwhile, there was no significant difference in SI between the left CAV and right adrenal veins. Laterality, determined according to aldosterone/cortisol ratio (A/C ratio) based criteria, showed good reproducibility regardless of sampling position, unlike the absolute aldosterone value based criteria. However, in 11 cases with autonomous cortisol co-secretion, the cortisol hypersecreting side tended to be underestimated when using A/C ratio based criteria. Left CAV sampling enables symmetrical sampling, and may be essential when using absolute aldosterone value based criteria in cases where symmetrical cortisol secretion is uncertain.


Subject(s)
Adrenal Glands/blood supply , Aldosterone/blood , Catheterization/instrumentation , Hydrocortisone/blood , Hyperaldosteronism/blood , Phlebotomy/instrumentation , Adrenal Cortex Neoplasms/diagnosis , Adrenal Cortex Neoplasms/metabolism , Adrenal Cortex Neoplasms/physiopathology , Adrenal Glands/drug effects , Adrenal Glands/metabolism , Adrenocortical Adenoma/diagnosis , Adrenocortical Adenoma/metabolism , Adrenocortical Adenoma/physiopathology , Aldosterone/agonists , Aldosterone/metabolism , Asymptomatic Diseases , Cosyntropin/pharmacology , Cushing Syndrome/diagnosis , Cushing Syndrome/physiopathology , Dexamethasone/pharmacology , Diagnosis, Differential , Female , Humans , Hydrocortisone/antagonists & inhibitors , Hydrocortisone/metabolism , Hyperaldosteronism/etiology , Hyperaldosteronism/metabolism , Hyperaldosteronism/physiopathology , Male , Middle Aged , Reproducibility of Results , Retrospective Studies , Severity of Illness Index , Veins , Vena Cava, Inferior
10.
Kyobu Geka ; 69(8): 638-43, 2016 07.
Article in Japanese | MEDLINE | ID: mdl-27440025

ABSTRACT

Total arch replacement and ascending aorta and arch replacement are the gold standard treatments for aortic arch aneurysm and are possible treatment strategies for chronic type A dissection, with good outcomes. However, because total arch replacement is alternative invasive, it can be difficult to perform in some patients. The thoracic endovascular aneurysm repair (TEVAR) landing on zone2 is a less invasive and suitable treatment for descending aortic aneurysm. We challenged to treat the more proximal region of aortic arch with TEVAR. The some type of fenestrated TEVAR were usefull technique for high risk patients. We present the various fenestrated TEVAR procedures. Especially, we designed an endovascular total arch repair procedure with use of in situ fenestration and commercially available devices, and we present our initial experience.


Subject(s)
Aortic Aneurysm, Thoracic , Aortic Dissection , Aorta, Thoracic , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Humans , Retrospective Studies , Stents , Treatment Outcome
12.
Kyobu Geka ; 68(1): 49-54, 2015 Jan.
Article in Japanese | MEDLINE | ID: mdl-25595161

ABSTRACT

Many of saccular aortic arch aneurysms exist near left subclabian artery(LSA). The thoracic endovascular aneurysm repair( TEVAR) landing on zone 2 is a less invasive and suitable procedure for this type of aneurysm. However, there are several cases with the aneurysm located close to LSA necessitate landing TEVAR on zone 1 or zone 0, otherwise the aneurysm could not be sealed completely. And this procedure seems to increase the invasiveness. In order to complete the sealing of the aneurysm and also keep the less invasiveness, we performed TEVAR using an axillo-axillary bypass or simple occlusion of LSA followed by an embolization using metal coil and NBCA through the catheter which detained in the saccular aneurysm beforehand. We report our experience of seven cases have been successfully treated by this procedure with good results.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Aged , Aged, 80 and over , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/therapy , Combined Modality Therapy , Enbucrilate/administration & dosage , Ethiodized Oil/administration & dosage , Humans , Imaging, Three-Dimensional , Male , Stents , Tomography, X-Ray Computed , Treatment Outcome
13.
Article in English | MEDLINE | ID: mdl-38490250

ABSTRACT

OBJECTIVES: Our goal was to evaluate early and mid-term outcomes of physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms from 10 Japanese aortic centres. METHODS: From January 2012 to March 2022, a total of 121 consecutive adult patients who underwent physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms were enrolled. We analysed early and mid-term postoperative outcomes, including postoperative complications and mortality. RESULTS: The pararenal and thoraco-abdominal aortic aneurysm groups included 62 (51.2%) and 59 (48.8%) patients, respectively. The overall in-hospital mortality rate was 5.8% (n = 7), with mortality rates of 3.2% (n = 2) and 8.5% (n = 5) in pararenal and thoraco-abdominal aortic aneurysm groups, respectively (P = 0.225). Type IIIc endoleaks occurred postoperatively in 18 patients (14.9%), with a significantly higher incidence (P = 0.033) in the thoraco-abdominal aortic aneurysm group (22.0%, n = 13) than in the other group (8.1%, n = 5). Major adverse events occurred in 7 (11.3%) and 14 (23.7%) patients in pararenal and thoraco-abdominal aortic aneurysm groups (P = 0.074), respectively. The mean follow-up period was 24.2 months. At the 3-year mark, both groups differed significantly in freedom from all-cause mortality (83.3% and 54.1%, P = 0.004), target aneurysm-related mortality (96.8% and 82.7%, P = 0.013) and any reintervention (89.3% and 65.6%, P = 0.002). Univariate and multivariate regression analyses demonstrated that ruptures, thoraco-abdominal aortic aneurysms and postoperative type IIIc endoleaks were associated with an increased risk of all-cause mortality. CONCLUSIONS: The mid-term outcomes of physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms were clinically acceptable and comparable with those in other recently published studies. Notably, pararenal and thoraco-abdominal aortic aneurysms represent distinct pathological entities with different postoperative outcomes.

14.
J Endovasc Ther ; 20(1): 34-8, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23391081

ABSTRACT

PURPOSE: To demonstrate a coaxial needle technique for direct percutaneous puncture embolization of type II endoleaks. TECHNIQUE: The technique is demonstrated in a 79-year-old woman and an 80-year-old man who developed type II endoleaks after endovascular repair of thoracic and internal iliac artery aneurysms, respectively. Expansion of the aneurysms required additional therapy. Fluoroscopy and cone-beam computed tomography-guided direct percutaneous endoleak sac embolization with n-butyl-2-cyanoacrylate (NBCA)-lipiodol was performed using the coaxial technique, which resulted in complete embolization of the endoleak sac. At 6 and 3 months after embolotherapy, respectively, the NBCA-lipiodol filled the endoleak sacs and the communicating channels up to the respective feeding arteries; no enlargement of the aneurysms was observed. CONCLUSION: Direct percutaneous sac embolization using a coaxial technique for type II endoleaks is a feasible treatment and yields good short-term results. More experience with this technique and longer follow-up of these patients is needed.


Subject(s)
Embolization, Therapeutic/methods , Endoleak/therapy , Aged , Cone-Beam Computed Tomography , Endoleak/classification , Endoleak/diagnostic imaging , Female , Humans , Punctures
15.
Kyobu Geka ; 66(2): 121-4, 2013 Feb.
Article in Japanese | MEDLINE | ID: mdl-23381358

ABSTRACT

Thoracic endovascular aneurysm repair(TEVAR) has been applied more and more frequently to an atherosclerotic distal aortic arch aneurysm. Even if the procedure is successful, extensive cerebral infarction might occur, especially in the left vertebral artery area. We therefore devised a new method to prevent embolic events using a thrombectomy catheter with an end hole, which was placed at the origin of the letf subclavian artery via the radial artery. This simple left subclavian artery balloon technique not only prevents cerebral embolism in the left vertebral artery system, but also provides a position marker under X-ray, and enables tight compaction of the embolization coils.


Subject(s)
Angioplasty, Balloon , Aortic Aneurysm, Thoracic/surgery , Cerebral Infarction/prevention & control , Endovascular Procedures/methods , Aged , Aged, 80 and over , Blood Vessel Prosthesis , Humans , Male , Middle Aged , Subclavian Artery
16.
J Magn Reson Imaging ; 35(2): 436-40, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22095487

ABSTRACT

PURPOSE: To investigate the feasibility of perfusion imaging using an arterial spin labeling (ASL) technique for breast cancer. MATERIALS AND METHODS: Thirteen female patients with primary breast cancers were included in this study. All examinations were performed on 1.5 Tesla MRI systems. Visual evaluations of the colored perfusion map and MRI perfusion values were assessed. MRI and computed tomography (CT) perfusion values were compared. RESULTS: Thirteen of 14 tumor lesions could be visualized on the colored perfusion map. CT perfusion examinations were performed in eight breasts, and the relationship between the blood flow values of CT perfusion and of MR perfusion showed a significant correlation. CONCLUSION: Nonenhanced MR imaging by an ASL technique is valid for depicting breast cancer, and the MR perfusion value is thought to be helpful for quantitative diagnosis of breast cancer.


Subject(s)
Breast Neoplasms/pathology , Magnetic Resonance Imaging/methods , Adult , Aged , Female , Humans , Image Enhancement/methods , Image Interpretation, Computer-Assisted/methods , Middle Aged , Spin Labels , Tomography, X-Ray Computed
17.
Radiol Case Rep ; 17(7): 2484-2487, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35586165

ABSTRACT

The middle mesenteric artery, also known as the third mesenteric artery, is a very rare anomaly. Several anatomical variations of middle mesenteric artery have been reported; in these reports, the right colic artery and/or middle colic artery often originate directly from the aorta. Here, we report a middle mesenteric artery in which the middle colic artery originated directly from the abdominal aorta. We also provide three-dimensional computed tomography and angiography findings and discuss anatomical and embryological considerations.

18.
Cardiovasc Intervent Radiol ; 45(3): 290-297, 2022 Mar.
Article in English | MEDLINE | ID: mdl-35088138

ABSTRACT

PURPOSE: To investigate the relationships between indications for thoracic endovascular aortic repair for acute/subacute complicated Stanford type B aortic dissection and clinical outcomes, and complications specific to thoracic endovascular aortic repair. MATERIAL AND METHODS: The J-predictive study retrospectively collected data of patients treated with thoracic endovascular aortic repair for complicated Stanford type B aortic dissection at 20 institutions from January 2012 to March 2017. From the database, those treated for acute/subacute complicated Stanford type B aortic dissection were extracted (n = 118; 96 men; average age, 66.1 years; standard deviation, ± 13) and classified into groups 1, 2, and 3 according to thoracic endovascular aortic repair indications (rupture, superior mesenteric artery malperfusion, and renal or lower extremity malperfusion, respectively). Primary and secondary measures were mortality (overall and aortic-related) and complications related to thoracic endovascular aortic repair, respectively. For each outcome, the risks of being in groups 1 and 2 were statistically compared with that of being in group 3 as a control using Fisher's exact test. RESULTS: Mortality rate (odds ratio, 5.22; 95% confidence interval [CI], 1.33-20.53) and prevalence of paraparesis/paraplegia (odds ratio, 30.46; confidence interval, 1.71-541.77) were higher in group 1 than in group 3. Compared to group 3, group 2 showed no statistically significant differences in mortality or complications related to thoracic endovascular aortic repair. CONCLUSIONS: Rupture as an indication for thoracic endovascular aortic repair for type B aortic dissection was more likely to result in worse mortality and high prevalence of spinal cord ischemia. LEVEL OF EVIDENCE: Level 4, Case series.


Subject(s)
Aortic Dissection , Endovascular Procedures , Aged , Aortic Dissection/diagnostic imaging , Aortic Dissection/surgery , Endovascular Procedures/adverse effects , Female , Humans , Japan/epidemiology , Male , Postoperative Complications/epidemiology , Retrospective Studies , Risk Factors , Treatment Outcome
19.
Jpn J Radiol ; 39(11): 1127-1132, 2021 Nov.
Article in English | MEDLINE | ID: mdl-34057688

ABSTRACT

PURPOSE: This study aimed to create an animal model of type Ia endoleak that creates persistent problems after thoracic endovascular aortic repair. MATERIALS AND METHODS: In six swine, thoracic aortic aneurysms were created using the harvested jugular vein. We created a type Ia endoleak using a composite stent-graft comprising the first stent-graft (reverse-tapered: thicker part, 16 mm; thinner part, 10 mm) and the second stent-graft (tapered: thicker part, 18-20 mm; thinner part, 16 mm). This double-component stent-graft was deployed in the abdominal aorta and then moved upward to the proximal entry site of the thoracic aneurysm using the inflated balloon for precise positioning. After the surgical procedure and on postoperative day 8, aortography was performed to detect residual endoleak, and then the swine were euthanized. RESULTS: A stable aneurysm (mean size of all aneurysms, 16.8 ± 1.72 mm × 11.8 ± 2.32 mm) and type Ia endoleak were successfully observed in all swine. A single stent-graft was sufficient in one of the six swine. CONCLUSION: A novel technique to create a type Ia endoleak model can be successfully developed in swine.


Subject(s)
Blood Vessel Prosthesis Implantation , Endovascular Procedures , Animals , Aorta, Thoracic/surgery , Aortography , Blood Vessel Prosthesis , Endoleak/diagnostic imaging , Endoleak/surgery , Reoperation , Stents , Swine , Time Factors , Treatment Outcome
20.
Medicine (Baltimore) ; 100(20): e26024, 2021 May 21.
Article in English | MEDLINE | ID: mdl-34011107

ABSTRACT

ABSTRACT: To evaluate the rib fracture detection performance in computed tomography (CT) images using a software based on a deep convolutional neural network (DCNN) and compare it with the rib fracture diagnostic performance of doctors.We included CT images from 39 patients with thoracic injuries who underwent CT scans. In these images, 256 rib fractures were detected by two radiologists. This result was defined as the gold standard. The performances of rib fracture detection by the software and two interns were compared via the McNemar test and the jackknife alternative free-response receiver operating characteristic (JAFROC) analysis.The sensitivity of the DCNN software was significantly higher than those of both Intern A (0.645 vs 0.313; P < .001) and Intern B (0.645 vs 0.258; P < .001). Based on the JAFROC analysis, the differences in the figure-of-merits between the results obtained via the DCNN software and those by Interns A and B were 0.057 (95% confidence interval: -0.081, 0.195) and 0.071 (-0.082, 0.224), respectively. As the non-inferiority margin was set to -0.10, the DCNN software is non-inferior to the rib fracture detection performed by both interns.In the detection of rib fractures, detection by the DCNN software could be an alternative to the interpretation performed by doctors who do not have intensive training experience in image interpretation.


Subject(s)
Deep Learning , Radiographic Image Interpretation, Computer-Assisted , Rib Fractures/diagnostic imaging , Tomography, X-Ray Computed , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Predictive Value of Tests , ROC Curve , Retrospective Studies , Software , Young Adult
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