Reversed Approach through Lymphocele/Lymphatic Fluid Collection for Glue Embolization of Injured Lymphatic Vessels.

A total of 9 glue embolization procedures of injured lymphatic vessels with a reversed approach from the lymphocele/lymphatic fluid collection in 8 patients were retrospectively reviewed. The approach routes were via the indwelling chest tube for pleural effusion (n = 2), the drainage catheter tract for abdominopelvic lymphocele/lymphatic fluid collection/thigh lymphocele (n = 4), and the direct puncture of the lymphatic fluid collection at the operation bed (n = 2). All the procedures were technically successful without complications. The mean daily leakage rate decreased from 465 mL/d before the procedure to 42 mL/d after the procedure, and the drainage catheters could be removed after 8 procedures, achieving a clinical success rate of 88.9% (8 of 9 procedures).

Clinical Outcomes for Endovascular Repair of Thoracic Aortic Disease Using the Seal Thoracic Stent Graft: A Korean Multicenter Retrospective Study.

PURPOSE: To investigate the midterm outcomes of thoracic endovascular aneurysm repair (TEVAR) with the use of the Seal stent graft for four categories of thoracic aortic disease. MATERIALS AND METHODS: This retrospective multicenter study evaluated the records of 216 Korean patients who underwent TEVAR with the Seal stent graft during 2007-2010. The study outcomes were (i) perioperative death, (ii) endoleak, (iii) repeat intervention, (iv) aortic-related death, and (v) all sudden unexplained late deaths. RESULTS: The overall technical success rate was 94% (203 cases), and the disease-specific rates were 97% (88 cases) for aneurysms, 96% (71 cases) for dissections, 82% (32 cases) for traumatic aortic disease, and 100% (12 cases) for intramural hematoma and/or penetrating aortic ulcer. There were 6 acute surgical conversions (2 for aneurysms and 4 for dissections). There were 18 endoleaks, 4 retrograde ascending aortic dissections, and 6 stent graft-induced new entries. The 1-, 3-, and 5-year overall survival rates were 93% ± 3, 90% ± 4, and 90% ± 4, respectively. CONCLUSIONS: TEVAR with the Seal thoracic stent graft provided a high technical success rate and low mortality and complication rates during midterm follow-up. However, additional long-term studies are needed to evaluate the durability and late complications associated with this device.

Stenting as a Bridge to Surgery for Obstructive Colon Cancer: Does It Have Surgical Merit or Oncologic Demerit?

PURPOSE: To evaluate the surgical and oncologic outcomes of patients undergoing self-expandable metallic stent (SEMS) placement with elective curative surgery. METHODS: Data from patients admitted with obstructing colon cancer between 2000 and 2012 were analyzed retrospectively. Patients underwent either SEMS placement as a bridge to surgery (stent group, n = 67) or emergency surgery (surgery group, n = 35). Surgical and oncologic outcomes of the groups were compared. RESULTS: Placement of SEMS was technically successful in 98.5% and clinically successful in 89.6% of cases. There were eight (11.9%) stent-related complications, including three migrations (4.5%), four occlusions (6.0%), and one perforation (1.5%). The stent group had a higher laparoscopic resection rate (67.2 vs. 31.4%, p = 0.001) with a lower conversion rate (4.3 vs. 35.3%, p = 0.003). The wound infection rate was significantly higher in the surgery group (37.1 vs. 11.9%, p = 0.003) with no differences in the rate of other complications. The rates of local recurrence and distant metastasis, recurrence-free, and overall survival were not significantly different between the two groups. CONCLUSIONS: Stenting and elective surgery was associated with a higher laparoscopy rate, a lower conversion rate, and a lower wound infection rate compared to emergency surgery but did not affect recurrence or survival.

Cystic adventitial disease of the common femoral artery at a previous surgical dissection site.

Cystic adventitial disease (CAD) is a rare vascular disorder associated with nonatherosclerotic peripheral vessel disease and occurs when mucoid cysts in the adventitia compress the blood vessel. The underlying etiology and pathogenesis of CAD remain debatable as various theories have been suggested. This case is interesting because the cyst developed from the previous common femoral artery (CFA) dissection site. To our knowledge, this is the first report of CAD developed at a previous operation site. Thus, we report herein a case of CAD arising from a previous embolectomy dissection site in the CFA that was successfully treated with surgery.

Perforation in colorectal stenting: a meta-analysis and a search for risk factors.

BACKGROUND: Recent studies suggest that there is a substantial risk of perforation after colorectal stent placement. OBJECTIVE: To identify risk factors for perforation from colonic stenting. DESIGN: A meta-analysis of 86 studies published between 2005 and 2011. SETTING: Multicenter review. PATIENTS: All patients who underwent colorectal stent placement. INTERVENTION: Colorectal stent placement. MAIN OUTCOME MEASUREMENTS: The occurrence of perforation with subgroup analyses for stent design, stricture etiology, stricture dilation, and concomitant chemotherapy, including the use of bevacizumab. RESULTS: A total of 4086 patients underwent colorectal stent placement; perforation occurred in 207. Meta-analysis revealed an overall perforation rate of 7.4%. Of the 9 most frequently used stent types, the WallFlex, the Comvi, and the Niti-S D-type had a higher perforation rate (>10%). A lower perforation rate (<5%) was found for the Hanarostent and the Niti-S covered stent. Stenting benign strictures was associated with a significantly increased perforation rate of 18.4% compared with 7.5% for malignant strictures. Dilation did not increase the risk of perforation: 8.5% versus 8.5% without dilation. The subgroup of post-stent placement dilation had a significantly increased perforation risk of 20.4%. With a perforation rate of 12.5%, bevacizumab-based therapy was identified as a risk factor for perforation, whereas the risk for chemotherapy without bevacizumab was 7.0% and not increased compared with the group without concomitant therapies during stent therapy (9.0%). LIMITATIONS: Heterogeneity; a considerable proportion of data is unavailable for subgroup analysis. CONCLUSIONS: The perforation rate of colonic stenting is 7.4%. Stent design, benign etiology, and bevacizumab were identified as risk factors for perforation. Intraprocedural stricture dilation and concomitant chemotherapy were not associated with an increased risk of perforation.

Fluoroscopic guide wire manipulation of malfunctioning peritoneal dialysis catheters initially placed by interventional radiologists.

PURPOSE: To assess the efficacy of fluoroscopic guide wire manipulation in patients with malfunctioning peritoneal dialysis (PD) catheters that were initially placed by interventional radiologists under fluoroscopic guidance. MATERIALS AND METHODS: From January 2002 to April 2012, 52 patients (mean age, 52.8 y ± 2.10s; range, 12-79 y) with malfunctioning PD catheters in whom fluoroscopic guide wire manipulation was performed were retrospectively reviewed. Technical success, clinical success, and complications were evaluated. Technical success was defined as fluoroscopically verified, successful catheter repositioning and adequate dialysate drainage after the procedure. Clinical success was defined as maintenance of PD catheter function for at least 30 days after the manipulation. RESULTS: During the study period, 72 manipulations (68 initial manipulations and 4 remanipulations) for malfunctioning PD catheters were done. The technical success rate was 74% (50 of 68) for initial manipulations and 75% (3 of 4) for remanipulations. The overall clinical success rate was 47% (32 of 68) for initial manipulations and 0% (0 of 4) for remanipulations. The primary causes of catheter malfunction were extraluminal obstruction by omental wrapping or adhesions in 43 of 68 cases (63.2%) and catheter malposition in 25 of 68 (36.8%) cases. There were no procedure-related major complications. CONCLUSIONS: Fluoroscopic guide wire manipulation in patients with malfunctioning PD catheters initially placed by interventional radiologists is a simple procedure, an effective way of prolonging PD catheter life, and a recommended procedure before invasive surgical procedures.

Prospective study of transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma: an Asian cooperative study between Japan and Korea.

PURPOSE: To evaluate the safety and efficacy of transcatheter arterial chemoembolization used for the treatment of unresectable hepatocellular carcinoma (HCC) with an Asian cooperative prospective study between Japan and Korea. MATERIALS AND METHODS: Patients with unresectable HCC unsuitable for curative treatment or with no prior therapy for HCC were enrolled. The patients underwent transcatheter arterial chemoembolization with emulsion of Lipiodol and anthracycline agent, followed by embolization with gelatin sponge particles, which was repeated on an as-needed basis. The primary endpoint was 2-year survival rate, and the secondary endpoints were adverse events and response rate. RESULTS: The 2-year survival rate of 99 patients was 75.0% (95% confidence interval, 65.2%-82.8%). The median time-to-progression was 7.8 months, and the median overall survival period was 3.1 years. Of 99 patients, 42 (42%) achieved a complete response, and 31 (31%) had a partial response. The response rate was 73% using modified Response Evaluation Criteria in Solid Tumors. The grade 3-4 toxicities included increased alanine aminotransferase level in 36%, increased aspartate aminotransferase level in 35%, thrombocytopenia in 12%, and abdominal pain in 4% of patients. All other toxicities were generally transient. CONCLUSIONS: Asian transcatheter arterial chemoembolization demonstrated sufficient safety and reasonable efficacy as a standard treatment for unresectable HCC. These results could be useful as reference data for future trials of transcatheter arterial chemoembolization.

Successful Interventional Treatment of a Huge Pseudoaneurysm of the Popliteal Artery Caused by a Percutaneous Balloon Angioplasty Complication: A Case Report.

Pseudoaneurysms are among the most serious complications of percutaneous balloon angioplasty. Although pseudoaneurysm rupture rarely happens, when it does, the result can be fatal; thus, early detection and management are crucial. In this report, we disclose the case of a 34-year-old male with end-stage renal disease who presented with a huge symptomatic pseudoaneurysm of the left popliteal artery, following percutaneous balloon angioplasty three months prior. The pseudoaneurysm was successfully excluded using interventional treatment. The patient recovered well, and the follow-up was uneventful, with excellent patency of the covered stent.

Epigenomic landscape exhibits interferon signaling suppression in the patient of myocarditis after BNT162b2 vaccination.

After the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, a novel mRNA vaccine (BNT162b2) was developed at an unprecedented speed. Although most countries have achieved widespread immunity from vaccines and infections, yet people, even who have recovered from SARS-CoV-2 infection, are recommended to receive vaccination due to their effectiveness in lowering the risk of recurrent infection. However, the BNT162b2 vaccine has been reported to increase the risk of myocarditis. To our knowledge, for the first time in this study, we tracked changes in the chromatin dynamics of peripheral blood mononuclear cells (PBMCs) in the patient who underwent myocarditis after BNT162b2 vaccination. A longitudinal study of chromatin accessibility using concurrent analysis of single-cell assays for transposase-accessible chromatin with sequencing and single-cell RNA sequencing showed downregulation of interferon signaling and upregulated RUNX2/3 activity in PBMCs. Considering BNT162b2 vaccination increases the level of interferon-α/γ in serum, our data highlight the immune responses different from the conventional responses to the vaccination, which is possibly the key to understanding the side effects of BNT162b2 vaccination.

Successful Interventional Management of Common Carotid Artery Rupture during Recurrent Parathyroid Cancer Surgery: A Case Report.

Common carotid artery (CCA) rupture during parathyroid cancer surgery is extremely rare and is generally life-threatening. We present a case of successful management of a ruptured CCA following the emergency placement of stent-graft in a 59-year-old male diagnosed with recurrent parathyroid cancer. During recurrent parathyroid cancer surgery, his right CCA ruptured unexpectedly, and his vital signs deteriorated rapidly despite surgical management. After stent replacement, his unstable vital signs improved and, thereafter, he was discharged without any complications.

Single-cell sequencing of PBMC characterizes the altered transcriptomic landscape of classical monocytes in BNT162b2-induced myocarditis.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been the most dangerous threat to public health worldwide for the last few years, which led to the development of the novel mRNA vaccine (BNT162b2). However, BNT162b2 vaccination is known to be associated with myocarditis. Here, as an attempt to determine the pathogenesis of the disease and to develop biomarkers to determine whether subjects likely proceed to myocarditis after vaccination, we conducted a time series analysis of peripheral blood mononuclear cells of a patient with BNT162b2-induced myocarditis. Single-cell RNA sequence analysis identified monocytes as the cell clusters with the most dynamic changes. To identify distinct gene expression signatures, we compared monocytes of BNT162b2-induced myocarditis with monocytes under various conditions, including SARS-CoV-2 infection, BNT162b2 vaccination, and Kawasaki disease, a disease similar to myocarditis. Representative changes in the transcriptomic profile of classical monocytes include the upregulation of genes related to fatty acid metabolism and downregulation of transcription factor AP-1 activity. This study provides, for the first time, the importance of classical monocytes in the pathogenesis of myocarditis following BNT162b2 vaccination and presents the possibility that vaccination affects monocytes, further inducing their differentiation and infiltration into the heart.

The Peripheral Immune Landscape in a Patient with Myocarditis after the Administration of BNT162b2 mRNA Vaccine.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has posed a serious threat to global public health. A novel vaccine made from messenger RNA (mRNA) has been developed and approved for use at an unprecedented pace. However, an increased risk of myocarditis has been reported after BNT162b2 mRNA vaccination due to unknown causes. In this study, we used single-cell RNA sequencing and single-cell T cell receptor sequencing analyses of peripheral blood mononuclear cells (PBMCs) to describe, for the first time, changes in the peripheral immune landscape of a patient who underwent myocarditis after BNT162b2 vaccination. The greatest changes were observed in the transcriptomic profile of monocytes in terms of the number of differentially expressed genes. When compared to the transcriptome of PBMCs from vaccinated individuals without complications, increased expression levels of IL7R were detected in multiple cell clusters. Overall, results from this study can help advance research into the pathogenesis of BNT162b2-induced myocarditis.

Radiologic placement of uncovered stents for the treatment of malignant colorectal obstruction.

PURPOSE: To evaluate the effectiveness of radiologic placement of uncovered stents for the treatment of malignant colorectal obstruction. MATERIALS AND METHODS: From May 2003 to January 2008, 116 radiologic placements of uncovered stents were attempted in 99 patients (M:F, 59:40; mean age, 65 years) with malignant colorectal obstructions. The location of stent insertion, technical and clinical success, complication rates, and patency rates of the stents in a palliative group were also evaluated. In the palliative group, the follow-up period was 2-455 days (mean, 100 +/- 129 days). RESULTS: Radiologic stent placement was technically successful in 110 of 116 cases (94.8%). Fifty cases of stent placement were preoperative (45.5%, 50 of 110) and 60 (54.5%, 60 of 110) were performed with palliative intents. In five of six failed cases, the replacement of the stent was later performed with the assistance of colonoscopy. One patient underwent an emergency operation. In 98 of 110 cases, the symptoms of obstruction were relieved, for a clinical success rate of 89.1%. Of the 50 stents that were placed successfully with preoperative intent, 44 patients underwent surgery within a mean of 10.3 days. In the palliative group, the patency rates were 89.7% at 1 month, 85.6% at 3 months, 80.8% at 6 months, and 72.7% at 12 months. CONCLUSIONS: The radiologic placement of uncovered stents for the treatment of malignant colorectal obstruction is feasible and safe and provides acceptable clinical results not only for preoperative decompression but also for palliative cases, especially in left-sided colonic obstructions.

Abdominal aortic aneurysm rupture with vertebral erosion presenting with severe refractory back pain in Behçet's disease.

Behçet's disease is a chronic recurrent inflammatory disorder that affects many organs. A 48-year-old man with known Behçet's disease was admitted to the emergency department with aggravating severe back pain and left lower quadrant pain. A contained rupture of infrarenal abdominal aortic aneurysm (AAA) was discovered with a maximum diameter of 10 cm. The patient's severe back pain was due to erosion of the third lumbar vertebra.

[Basic Arterial Anatomy and Interpretation of CT Angiography for Intra-Abdominal or Gastrointestinal Bleeding: Correlation with Conventional Angiographic Findings for Beginners]. / 복강 내 혹은 소화기계 출혈을 이해하기 위한 ê¸°ë³¸ì ì¸ 혈관해부학과 í˜ˆê´€ì¡°ì˜ìˆ ì˜ 해석: ìž ë¬¸ìžë¥¼ 위하여.

It is essential to identify the causative artery in case of active intra-abdominal or gastrointestinal bleeding. A thorough understanding of the basic arterial anatomy is required to identify the causative artery on contrast-enhanced CT angiography and conventional catheter angiography. If one is familiar with the basic arterial anatomy, obtaining access to the bleeding artery will be easier, despite the variations in the origin and course of the vessels. We describe the basic arterial anatomy that will help beginners in diagnostic radiology to identify the blood vessels that can cause active intra-abdominal or gastrointestinal bleeding.

Lymphatic imaging and intervention for chylothorax following thoracic aortic surgery.

Reports on lymphatic intervention for chylothorax complicating thoracic aortic surgery are limited. We aimed to evaluate technical and clinical outcomes of lymphangiography and thoracic duct embolization (TDE) for chylothorax complicating thoracic aortic surgery.Nine patients (mean age, 38.9 years) who underwent chylothorax interventions after thoracic aortic surgery (aorta replacement [n = 7] with [n = 2] or without [n = 5] lung resection, and vascular ring repair [n = 2]) were reviewed retrospectively. Magnetic resonance (MR) lymphangiograms were obtained in 5 patients. The median interval between surgery and conventional lymphangiography was 9 days (range, 4-28 days). TDE clinical success was defined as lymphatic leakage resolution with chest tube removal within 2 weeks.MR lymphangiograms revealed contrast leakage from the thoracic duct (n = 4) or no definite leakage (n = 1), which correlated well with conventional lymphangiogram findings. The technical success rate of conventional lymphangiography was 88.9% (8/9); 8 patients showed contrast leakage, while the patient without definite leakage on MR lymphangiography had small inguinal lymph nodes, and thoracic duct visualization by conventional lymphangiography failed. The technical success rates of antegrade and retrograde TDE via pleural access were 75% (6/8) and 100% (3/3), respectively. Clinical outcomes after embolization, as judged by the tube-removal day, were similar between low- (<500 mL/day) and high-output (≥500 mL/day) chylothorax patients. The drainage amount decreased significantly after lymphangiography/TDE, from 710.0 mL/day to 109.7 mL/day (p < .05). The clinical success rate of TDE was 87.8% (7/8).Conventional lymphangiography and TDE yielded high technical success rates and demonstrated encouraging clinical outcomes for chylothorax complicating thoracic aortic surgery.

Fluoroscopically guided peritoneal dialysis catheter placement: long-term results from a single center.

OBJECTIVE: Despite percutaneous fluoroscopy ensuring appropriate placement of peritoneal dialysis (PD) catheters, the efficacy of this method is not well known. Therefore, we evaluated our long-term experience with fluoroscopy-assisted placement of PD catheters. PATIENTS AND METHODS: We retrospectively reviewed 134 PD catheters in 114 PD patients that were treated in the PD center of a university-based hospital. We evaluated complications related to PD catheters, causes for catheter removal, and catheter survival. We used the multivariate Cox proportional hazard model to identify independent factors related to PD catheter survival. RESULTS: Early complications related to insertion included 1 case of pericatheter bleeding; there were no placement failures. Early complications occurred in 8.5% of patients. Most late complications were migration and leakage, which occurred in 10.4% and 9.7% of patients respectively. The most common cause for catheter removal was intractable and recurrent peritonitis. The 12- and 24-month survival rates of the catheters were 80.0% and 74.9%. The most significant prognostic factor of percutaneous fluoroscopy-assisted PD catheter survival was late leakage (p < 0.01). CONCLUSIONS: In addition to the advantages of simplicity, minimal invasiveness, and relative safety, the survival rate of PD catheters placed using the percutaneous fluoroscopy-assisted method was comparable to that of more invasive methods. Percutaneous fluoroscopy-assisted placement of PD catheters should be considered when available, and may be preferred to other placement methods.

Endovascular repair of a spontaneous right common iliac artery--inferior vena cava fistula due to infrarenal aortoiliac aneurysm.

Most abdominal aortic aneurysms are asymptomatic, but 1% to 4% of cases present with a life-threatening complication. A spontaneous right common iliac artery-inferior vena cava fistula, a rare condition caused by infrarenal aortoiliac aneurysm, is reported. In this case, the condition was successfully managed with primary endovascular stent-graft treatment.

Interventional management of gastrointestinal fistulas.

Gastrointestinal (GI) fistulas are frequently very serious complications that are associated with high morbidity and mortality. GI fistulas can cause a wide array of pathophysiological effects by allowing abnormal diversion of the GI contents, including digestive fluid, water, electrolytes, and nutrients, from either one intestine to another or from the intestine to the skin. As an alternative to surgery, recent technical advances in interventional radiology and percutaneous techniques have been shown as advantageous to lower the morbidity and mortality rate, and allow for superior accessibility to the fistulous tracts via the use of fistulography. In addition, new interventional management techniques continue to emerge. We describe the clinical and imaging features of GI fistulas and outline the interventional management of GI fistulas.