The reevaluation and surgical strategy of the superficial circumflex iliac artery perforator (SCIP) flap / 中华显微外科杂志

Objective To introduce the classification of the perforators of the superficial circumflex iliac artery(SCIA),and the superficial circumflex iliac artery perforator (SCIP) flaps based on different perforators have different characters and harvesting methods.To explore a set of coping strategy for the drawbacks of the SCIP flap.Methods Review 90 cases of SCIP flaps in August,2011 to June,2017.The pre-operative radiology navigation was conducted in all cases.Different surgical approaches were applied in flaps based on different perforators.The pedicle elongation method was adopted when necessary.The thickness of the flap,the length of the pedicle,the survival rate of the flap and the closure of the donor site were analyzed.Regular follow-up was performed after the operation.Results All flaps were followed-up for 6-15 months (average 8 months).Fifty-seven flaps were raised on the basis of the proximal perforators of the superficial branch of the SCIA,whereas 29 cases were based on the distal perforators from the deep branch,and in 4 cases,the pedicle was switched to the superficial inferior epigastric artery.In 8 cases,the arterial pedicle lengthen technique was applied with a maximum length of 10 cm.All donor sites were closed directly.Conclusion These surgical strategies simplified the intraoperative decision-making and conquered the shortcomings of the SCIP flap.It is believed that the SCIP flap can possibly become the new workhorse flap in the field of reconstructive surgery.

Endovascular aortic stent for thoracic and abdominal aortic aneurysm: imaging consequences and complications.

Background: Endovascular stent-graft implantation has been used as an alternative to conventional open surgery in treatment of aortic aneurysm. Computed tomographic angiography (CTA) has been requested for follow-up and evaluation of aortic stent complications. Objective: Find the incidence of endovascular aortic stent complications and analyze the CTA features of postendovascular aortic stent consequences. Methods: Two radiologists reviewed CTA images of 635 patients who attended King Chulalongkorn Memorial Hospital between Sep 1, 2003 and Aug 31, 2008. Thirty-eight patients had endovascular aortic stent installation with 95 CTA images. The incidence of endovascular aortic stent complications, the image appearances including consequences and time-interval of endoleak were analyzed. Results: There were 23 thoracic aortic stents, 10 abdominal aortic stents and five combined stents for thoracic and abdominal aortic aneurysms. Twenty-eight cases had aortic stent complications (73.7%). Two cases had immediately post procedural complication of groin hematomas (7.1%). Ten patients had more than one finding. Findings of the stent-graft complications were as follows: 19 endoleaks, 15 stent thrombosis, five stents without covered-dissection, two stent kinkings, two iatrogenic focal aortic dissection, two air within aneurysm after stent installation and one spreading infected aortitis. The most common complication was endoleaks (53.6%), which could progress, be persistent or resolvable. Time-interval to detect endoleak was between 1 and 464 days. Conclusion: CTA can be used as modality of choice in demonstration of stent location, consequences, and complications. The stent complication was still high in the first five-year experience.

The utility of computed tomographic angiography for final diagnosis of aortic dissection

Background: Aortic dissection is a common cause of vascular emergency. For examination of the entire aorta, multi-slice computed tomographic (CT) scanning is now used as the modality of choice instead of aortography. However, it was questionable whehter CT angiography (CTA) can be used for management decisions regarding aortic dissection. Objective: To prove that CTA can be used as the modality of choice for final diagnosis of and management decision of aortic dissection, and also to analyze CTA appearances of the aortic dissection. Methods: Aortic CTA images of 145 patients between Sept 1, 2003-Aug 31, 2005 at King Chulalongkorn Memorial Hospital (KCMH) were reviewed by two consensus radiologists. These patients’ history of management decisions and results of treatment were also reviewed. The incidence of aortic dissection and the image appearances were also analyzed. Results: The incidence of aortic dissection at KCMH was 31 cases in two years of wich 11 cases were classified as type A (35 %), while 20 cases into type B (65 %). No patient required another investigative modality after CTA diagnosis of aortic dissection. True/false lumens, intimal tear, peri-aortic fluid, pleural effusion, pericardial effusion, intramural hematoma and contrast leakage were imaging findings obtained in that order. Conclusion: CTA can replace theconventional invasive aortography and can be used as the modality of choice for management decision of aortic dissection.

Clinical Value of Computed Tomographic Angiography: Our Prospective Clinical Trial / 대한뇌혈관외과학회지

OBJECTIVES: Computed tomographic angiography (CTA) to diagnose intracranial aneurysms in patients with spontaneous subarachnoid hemorrhage (SAH) has been well documented and widely accepted. In this study, it was assessed whether aneurysm surgery can be performed in aneurysm patients by using CTA regardless of their status. METHODS: To assess the clinical value of CTA, we treated patients with SAH using it as the primary means of diagnosis. During the period between August 2001 and May 2003, a consecutive series of 82 cases of ruptured cerebral aneurysms were evaluated via both CTA and postoperative transfemoral cerebral angiography(TFCA), and we investigated the detectability of cerebral aneurysms. In cases of vague CTA findings, we performed TFCA preoperatively. We correlated the CTA results with operative findings and preoperative TFCA, when performed. RESULTS: In 82 patients, 100 aneurysms (96 aneurysms via CTA, 1 aneurysm via TFCA, 3 aneurysms via operation) were disclosed. The size of aneurysms detected by CTA ranged from 1.95 mm to 19.4 mm. Aneurysms that were not found via TFCA were detected by CTA in two patients. Three additional small multiple aneurysms that could not be confirmed via CTA were found through operation. No previously undiscovered aneurysms were found via postoperative TFCA. Corresponding to the operative findings, the sensitivity of CTA was 96%. CONCLUSION: According to our results, we hold that CTA is the first choice among diagnostic methods for the treatment of SAH.

Completely Thrombosed Contralateral Internal Carotid Artery Aneurysm Combined with Ruptured Anterior Communicating Artery Aneurysm: Case Report / 대한뇌혈관학회지

Giant intracranial aneurysm, approximately 5-7% of all intracranial aneurysm, is defined as aneurysm with a maximal sac diameter reaching or exceeding 25 mm. Its high incidence of thrombus formation causes difficulty in diagnosis through imaging studies. Recently, we have experienced a giant contralateral internal carotid artery aneurysm that was completely thrombosed and negative in imaging studies. It was only verified during surgery for clipping of an anterior communicating artery aneurysm. On initial cerebral angiography, authors had not found any other aneurysm except a small-sized anterior communicating artery aneurysm. There was no evidence of aneurysm or mass on right internal carotid artery even though in postoperative computed tomographic angiography (CTA). We emphasize the fact that another completely thrombosed aneurysm may be present as a hidden lesion during initially planned aneurysmal surgery.

Usefulness of Computed Tomographic Angiography(CTA) in the Evaluation of Cerebral Aneurysms

In this study we have demonstrated the usefulness of the 3D-computed tomography in the evaluation of cerebral aneurysms as well as presenting the technical considerations and problems in its practical use. Between September 1994 and February 1995, we carried out computed tomographic angiography(CTA) in 29 patients using helical CT(General Electric HiSpeed Advantage unit). There were 15 females and 14 males, aged between 28 and 71 years. The CT angiography was performed for the following five reasons: 1) Further evaluation of a failed conventional cerebral angiography(three cases). 2) impermissible condition of conventional cerebral angiography(six cases). 3) suspicion of aneurysm or subarachnoid hemorrhage on conventional CT scan(eleven cases). 4) Further evaluation of proven subarachnoid hemorrhage with no or suspicious cerebral angiographic finding(seven cases). 5) Follow-up of residual aneurysm sac(two cases). This early experience of computed tomographic angiography using helical CT was encouraging in aspect to its usefalness in the evaluation of cerebral aneurysms in the arteries around the circle of Willis.

Comparative Analysis of MIP & SSD Imaged in Diagnosis of intracranial Aneurysms

There is an increasing tendency to use three dimentional computed tomographic angiography(CTA) in diagnosis of intracranial aneurysm. The authors have planned to get a better CTA image through comparing of the maximum intensity projection(MIP) and shaded surface display(SSD) techniques. Eighteen patients were evaluated who had been studied with conventional cerebral angiography(CCA), CTA and received aneurysmal surgery, all together. Original spiral CT images were studied with helical CT scanner with 120ml of non-ionic contrast material, 3ml/sec injection rate, 1mm collimation and 1mm reconstruction interval. MIP and SSD images of CTA were reconstructed with diting by using a standard processing algorithm of volume rendering technique and three dimensional technique. There were 3 cases(12%) of false negatives in both MIP and SSD images among the ottal 25 cases of saccular aneurysms. There were 2 cases(8%) of false positives in SSD images that were actually negative for aneurysm in MIP and CCA. Our results have demonstrated that CTA is a quick, reliable and relatively simple diagnostic tool or screening of intracranial aneurysms, and superior to CCA in evaluating configuration, direction and its associated vascular anatomy. The MIP image was better to reveal vasospasm, calcification, neck shape and adjacent vascular anatomy. On the other hand, the SSD image showed higher false positive rate due to pseudo-saccular fusion and superior to glance over the external configuration and for planning of surgery.

Comparative Analysis of MIP & SSD Imaged in Diagnosis of intracranial Aneurysms

There is an increasing tendency to use three dimentional computed tomographic angiography(CTA) in diagnosis of intracranial aneurysm. The authors have planned to get a better CTA image through comparing of the maximum intensity projection(MIP) and shaded surface display(SSD) techniques. Eighteen patients were evaluated who had been studied with conventional cerebral angiography(CCA), CTA and received aneurysmal surgery, all together. Original spiral CT images were studied with helical CT scanner with 120ml of non-ionic contrast material, 3ml/sec injection rate, 1mm collimation and 1mm reconstruction interval. MIP and SSD images of CTA were reconstructed with diting by using a standard processing algorithm of volume rendering technique and three dimensional technique. There were 3 cases(12%) of false negatives in both MIP and SSD images among the ottal 25 cases of saccular aneurysms. There were 2 cases(8%) of false positives in SSD images that were actually negative for aneurysm in MIP and CCA. Our results have demonstrated that CTA is a quick, reliable and relatively simple diagnostic tool or screening of intracranial aneurysms, and superior to CCA in evaluating configuration, direction and its associated vascular anatomy. The MIP image was better to reveal vasospasm, calcification, neck shape and adjacent vascular anatomy. On the other hand, the SSD image showed higher false positive rate due to pseudo-saccular fusion and superior to glance over the external configuration and for planning of surgery.