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  • SAGE Publications  (11)
  • Ko, Gi-Young  (11)
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  • SAGE Publications  (11)
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  • 1
    Online Resource
    Online Resource
    Clinical Features and Management of Pseudoaneurysmal Bleeding after Pancreatoduodenectomy
    SAGE Publications ; 2012
    In:  The American Surgeon Vol. 78, No. 3 ( 2012-03), p. 309-317
    Details
    In: The American Surgeon, SAGE Publications, Vol. 78, No. 3 ( 2012-03), p. 309-317
    Abstract: A ruptured pseudoaneurysm is the most serious and life-threatening cause of post-pancreatoduodenectomy (PD) hemorrhages. We have evaluated the clinical course and management of pseudoaneurysms after PD. Of 586 patients who underwent PD for periampullary tumors in Asan Medical Center between March 2003 and March 2011, 27 experienced pseudoaneurysmal bleeding. Bleeding developed at a median of 21 days (range, 8 to 45 days) after surgery, including 9 patients who developed bleeding more than 4 weeks after surgery. Before development of bleeding, 26 patients showed pancreatic fistula. Bleeding was developed from the gastroduodenal artery stump in 12 patients, the common hepatic artery in eight, the proper hepatic artery in five, and the left hepatic artery in two. Of the angiographic group, 21 patients underwent with microcoil embolization, four underwent stent insertion, and one experienced technical failure. Only one patient required emergent laparotomy without angiography. Of 25 patients with angiographic procedures, all patients achieved hemostasis. The mortality rate was 22.2 per cent (6 patients). Delayed hemorrhage after PD is closely associated with pancreatic fistula and carried a significantly higher mortality rate. The patients with pancreatic fistula should be carefully monitored, even more than 4 weeks after surgery. Selective microcoil embolization or stent graft is effective for pseudoaneurysmal bleeding.
    Type of Medium: Online Resource
    ISSN: 0003-1348 , 1555-9823
    URL: Article
    DOI: 10.1177/000313481207800339
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
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  • 2
    Online Resource
    Online Resource
    Percutaneous biliary covered stent insertion in patients with malignant duodenobiliary obstruction
    SAGE Publications ; 2015
    In:  Acta Radiologica Vol. 56, No. 2 ( 2015-02), p. 166-173
    Details
    In: Acta Radiologica, SAGE Publications, Vol. 56, No. 2 ( 2015-02), p. 166-173
    Abstract: Although the use of polytetrafluoroethylene (PTFE)-covered biliary stents has proven to be feasible for the treatment of benign and malignant biliary disease, less is known regarding the outcomes of percutaneous placement of a covered stent in patients with malignant duodenobiliary obstruction. Purpose To investigate the technical and clinical efficacy of the percutaneous placement of a PTFE-covered biliary stent in patients with malignant duodenobiliary obstruction. Material and Methods From April 2007 to September 2012, the medical records of 45 consecutive patients with malignant duodenobiliary obstruction were retrospectively reviewed. All percutaneous biliary stent deployment was performed using PTFE-covered stents, whereas duodenal stent insertion was performed either fluoroscopically or endoscopically using covered or uncovered stents. Results Biliary stent deployment was technically successful in all patients. None of the stents migrated after deployment. Procedure-related minor complications, including self-limiting hemobilia, occurred in three (7%) patients. Successful internal drainage was achieved in 39 (87%) of the 45 patients. The median survival time after biliary stent placement was 62 days (95% confidence interval, 8–116 days), and the cumulative stent patency rates at 1, 3, 6, and 12 months were 96%, 92%, 75%, and 38%, respectively. The causes of biliary stent dysfunction included stent occlusion caused by a subsequently inserted duodenal stent ( n = 7), food impaction ( n = 3), and sludge incrustation ( n = 1). One patient developed acute cholecystitis 131 days after biliary stent placement and underwent percutaneous transhepatic gallbladder drainage. Conclusion Percutaneous insertion of a PTFE-covered stent is a safe and effective method for palliative treatment of patients with malignant duodenobiliary obstruction. If possible, subsequent biliary stent insertion is preferable in order to prevent possible biliary stent dysfunction caused by subsequent insertion of a duodenal stent.
    Type of Medium: Online Resource
    ISSN: 0284-1851 , 1600-0455
    URL: Article
    DOI: 10.1177/0284185114523267
    RVK:
    XA 10000
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 2024579-8
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  • 3
    Online Resource
    Online Resource
    Practice patterns of retrievable inferior vena cava filters and predictors of filter retrieval in patients with pulmonary embolism
    SAGE Publications ; 2017
    In:  Vascular Medicine Vol. 22, No. 6 ( 2017-12), p. 512-517
    Details
    In: Vascular Medicine, SAGE Publications, Vol. 22, No. 6 ( 2017-12), p. 512-517
    Abstract: Retrievable inferior vena cava (IVC) filters are increasingly used in patients with venous thromboembolism (VTE) who have contraindications to anticoagulant therapy. However, previous studies have shown that many retrievable filters are left permanently in patients. This study aimed to identify the common indications for IVC filter insertion, the filter retrieval rate, and the predictive factors for filter retrieval attempts. To this end, a retrospective cohort study was performed at a tertiary care center in South Korea between January 2010 and May 2016. Electronic medical charts were reviewed for patients with pulmonary embolism (PE) who underwent IVC filter insertion. A total of 439 cases were reviewed. The most common indication for filter insertion was a preoperative/procedural aim, followed by extensive iliofemoral deep vein thrombosis (DVT). Retrieval of the IVC filter was attempted in 44.9% of patients. The retrieval success rate was 93.9%. History of cerebral hemorrhage, malignancy, and admission to a nonsurgical department were the significant predictive factors of a lower retrieval attempt rate in multivariate analysis. With the increased use of IVC filters, more issues should be addressed before placing a filter and physicians should attempt to improve the filter retrieval rate.
    Type of Medium: Online Resource
    ISSN: 1358-863X , 1477-0377
    URL: Article
    DOI: 10.1177/1358863X17726596
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2027562-6
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  • 4
    Online Resource
    Online Resource
    Portal vein stent placement with or without varix embolization of jejunal variceal bleeding after hepatopancreatobiliary surgery
    SAGE Publications ; 2017
    In:  Acta Radiologica Vol. 58, No. 4 ( 2017-04), p. 423-429
    Details
    In: Acta Radiologica, SAGE Publications, Vol. 58, No. 4 ( 2017-04), p. 423-429
    Abstract: Extrahepatic portal hypertension after surgery involving the duodenum or jejunum might result in massive ectopic variceal bleeding. Purpose To report the results of portal vein stent placement with the addition of variceal embolization. Material and Methods Between January 2000 and June 2015, portal vein stent placement was attempted in 477 patients. Of these, 22 patients (age, 63 ± 10 years) with jejunal variceal bleeding caused by portal vein obstruction after surgery were included in this study. Computed tomography (CT) findings before and after treatment and the rates of technical and clinical success, complications, and clinical outcomes were retrospectively evaluated. Results Stent placement was successful in 19 of 22 patients. Additional variceal embolization was performed in five cases. Clinical success, defined as the cessation of bleeding without recurrence within 1 month, was achieved in 18 of 19 patients with technical success. One patient developed recurrent bleeding 4 days after stent placement and was successfully treated with additional variceal embolization. There were no procedure-related complications. A regression of the jejunal varices was noted in 14 of 19 patients on follow-up CT scans. During the follow-up period (258 days; range, 7–1196 days), stent occlusion and recurrent bleeding occurred in six and four patients, respectively, of the 19 patients who achieved technical success. Statistical analyses revealed no significant differences regarding stent patency between benign and malignant strictures. Conclusion Percutaneous, transhepatic, portal vein stent placement with or without jejunal variceal embolization appears to be a safe and effective treatment for jejunal variceal bleeding after surgery.
    Type of Medium: Online Resource
    ISSN: 0284-1851 , 1600-0455
    URL: Article
    DOI: 10.1177/0284185116654329
    RVK:
    XA 10000
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2024579-8
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  • 5
    Online Resource
    Online Resource
    Arterial dissections during transcatheter arterial chemoembolization for hepatocellular carcinoma: a 19-year clinical experience at a single medical institution
    SAGE Publications ; 2017
    In:  Acta Radiologica Vol. 58, No. 7 ( 2017-07), p. 842-848
    Details
    In: Acta Radiologica, SAGE Publications, Vol. 58, No. 7 ( 2017-07), p. 842-848
    Abstract: Arterial dissections during transcatheter arterial chemoembolization (TACE) procedures are not rare and can limit the successful treatment of unresectable hepatocellular carcinoma (HCC). Purpose To evaluate the incidence of arterial dissections during TACE procedures, the rate of spontaneous lumen recovery, and the predictive factors of dissecting stenosis during follow-up. Material and Methods Based on 69,651 TACE procedures from 1997 to 2016, patients who had procedure-related arterial dissections were identified by procedure report search. More than two months after the date of dissection, dissecting stenosis was evaluated using a three-grade scale: subclinical narrowing with diameter loss under 30%, overt stenosis with diameter loss over 30%, and occlusion. Pearson Chi-square and two-sample t-test were used to assess potential prognostic markers for dissecting stenosis. Results Eighty-four arterial dissections directly related to TACE were identified in 83 patients, resulting in an incidence of 0.12% (84/69651). After more than two months, normal or subclinical narrowing, overt stenosis, occlusion, and doubling were seen in 39 (46.4%), 26 (31.0%), 13 (15.5%), and one (1.2%) patients, respectively. No follow-up images were obtained for five (6.0%) patients. On univariate analysis, the dissection ratio (the ratio of the length to the diameter of the dissection) alone was related to dissecting stenosis ( P = 0.035). Conclusion The incidence of iatrogenic dissection during TACE was approximately 0.12%. Less than 50% of the iatrogenic dissections showed normal or subclinical narrowing during follow-up of at least two months. The dissection ratio alone was the predictive factor for dissecting stenosis during follow-up.
    Type of Medium: Online Resource
    ISSN: 0284-1851 , 1600-0455
    URL: Article
    DOI: 10.1177/0284185116676654
    RVK:
    XA 10000
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
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  • 6
    Online Resource
    Online Resource
    Endovascular management for significant iatrogenic portal vein bleeding
    SAGE Publications ; 2017
    In:  Acta Radiologica Vol. 58, No. 11 ( 2017-11), p. 1320-1325
    Details
    In: Acta Radiologica, SAGE Publications, Vol. 58, No. 11 ( 2017-11), p. 1320-1325
    Abstract: Despite conservative treatment, hemorrhage from an intrahepatic branch of the portal vein can cause hemodynamic instability requiring urgent intervention. Purpose To retrospectively report the outcomes of hemodynamically significant portal vein bleeding after endovascular management. Material and Methods During a period of 15 years, four patients (2 men, 2 women; median age, 70.5 years) underwent angiography and embolization for iatrogenic portal vein bleeding. Causes of hemorrhage, angiographic findings, endovascular treatment, and complications were reported. Results Portal vein bleeding occurred after percutaneous liver biopsy (n = 2), percutaneous radiofrequency ablation (n = 1), and percutaneous cholecystostomy (n = 1). The median time interval between angiography and percutaneous procedure was 5 h (range, 4–240 h). Common hepatic angiograms including indirect mesenteric portograms showed active portal vein bleeding into the peritoneal cavity with (n = 1) or without (n = 2) an arterioportal (AP) fistula, and portal vein pseudoaneurysm alone with an AP fistula (n = 1). Successful transcatheter arterial embolization (n = 2) or percutaneous transhepatic portal vein embolization (n = 2) was performed. Embolic materials were n-butyl cyanoacrylate alone (n = 2) or in combination with gelatin sponge particles and coils (n = 2). There were no major treatment-related complications or patient mortality within 30 days. Conclusion Patients with symptomatic or life-threatening portal vein bleeding following liver-penetrating procedures can successfully be managed with embolization.
    Type of Medium: Online Resource
    ISSN: 0284-1851 , 1600-0455
    URL: Article
    DOI: 10.1177/0284185117693458
    RVK:
    XA 10000
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
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  • 7
    Online Resource
    Online Resource
    Transcatheter renal artery embolization with N -butyl cyanoacrylate
    SAGE Publications ; 2012
    In:  Acta Radiologica Vol. 53, No. 4 ( 2012-05), p. 415-421
    Details
    In: Acta Radiologica, SAGE Publications, Vol. 53, No. 4 ( 2012-05), p. 415-421
    Abstract: Despite its long history, the application of N-butyl cyanoacrylate (NBCA) has been limited compared to other materials such as particulate agents and coils. This possibly owes to a widespread misconception that NBCA is difficult to handle and carries a high risk of complications due to its liquid nature and rapid polymerization time. However, recent reports have shown that, with knowledge and experience, NBCA is safe and effective to use in visceral arteries. Purpose To review the outcome of transcatheter embolization of the renal artery using NBCA for varied etiologies in the kidney. Material and Methods Fourteen patients with varied etiologies in the kidney underwent renal artery embolization using NBCA as the sole embolic agent (64%) or in combination with an additional embolic material (36%). A review of medical charts and images were performed to gather information regarding underlying etiologies, clinical presentation, and outcome of embolization. Results Technical success was achieved in all patients (100%) while clinical success was achieved in 12 (85.7%). One failed case was managed by repeat embolization using microcoils, while the other underwent partial nephrectomy after failed reattempt at embolization. Three patients with recurrent bleeding after previously having undergone embolization using microcoils or gelatin sponge particles were successfully managed the second time using NBCA. NBCA embolization was also effective in three patients with hemostatic abnormality. Complications attributable to NBCA embolization were renal atrophy in one patient and microcatheter tip fracture in another. Conclusion The application of NBCA for transcatheter embolization of varied etiologies involving the renal artery is feasible and safe in the hands of an experienced interventional radiologist. It offers immediate and effective occlusion of the pathologic vessel and, while it can be used exclusively on its own, it can also be used to complement other embolic materials.
    Type of Medium: Online Resource
    ISSN: 0284-1851 , 1600-0455
    URL: Article
    DOI: 10.1258/ar.2012.110595
    RVK:
    XA 10000
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
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  • 8
    Online Resource
    Online Resource
    Percutaneous unilateral placement of biliary covered metallic stent in patients with malignant hilar biliary obstruction and contralateral portal vein occlusion
    SAGE Publications ; 2012
    In:  Acta Radiologica Vol. 53, No. 7 ( 2012-09), p. 742-749
    Details
    In: Acta Radiologica, SAGE Publications, Vol. 53, No. 7 ( 2012-09), p. 742-749
    Abstract: Unilateral biliary metallic stent placement in the lobe with patent portal vein seemed to be a safe and effective palliative treatment of patients with contralateral portal vein occlusion caused by advanced hilar malignancy, obviating bilateral stent placement in these patients, because the hepatic lobe with portal vein occlusion ceases to produce bile due to interruption of enterohepatic circulation. Purpose To investigate the safety and efficacy of percutaneous unilateral expanded polytetrafluoroethylene (ePTFE)-covered stent placement in malignant hilar biliary obstruction with contralateral portal vein occlusion. Material and Methods From February 2008 to March 2011, 24 consecutive patients with malignant hilar biliary obstruction and unilobar portal vein occlusion were enrolled in this prospective study. All patients were treated by percutaneous placement of ePTFE-covered stents. Results Stent deployment was technically successful in all patients. Two (8%) patients experienced minor self-limiting hemobilia. No major complication was noted. Successful internal drainage was achieved in 22 (91.6%) patients. Mean serum bilirubin level, which was 12.5 mg/dl ± 8.4 before drainage, decreased significantly to 2.7 mg/dl ± 3.4, 1 month after stent placement ( P 〈 0.001). Median survival was 191 days (95% CI, 94–288 days) and cumulative stent patency rates at 1, 3, 6, 9, and 12 months were 100%, 95%, 95%, 95%, and 71%, respectively. Two (8%) patients presented with stent occlusion due to sludge incrustation. Aside from two patients who had died within 30 days after stent placement, the other 22 patients demonstrated slight decrease in diameter of undrained lobe and did not experience cholangitis nor jaundice. Conclusion Unilateral placement of ePTFE-covered stent in the lobe with patent portal vein seems to be a safe and effective method for palliative treatment of patients with contralateral portal vein occlusion. In addition, ePTFE-covered stent placement can prevent tumor ingrowth without functional occlusion of segmental bile ducts.
    Type of Medium: Online Resource
    ISSN: 0284-1851 , 1600-0455
    URL: Article
    DOI: 10.1258/ar.2012.120185
    RVK:
    XA 10000
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
    detail.hit.zdb_id: 2024579-8
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  • 9
    Online Resource
    Online Resource
    Endovascular treatment for the control of active vaginal bleeding from uterine cervical cancer treated with radiotherapy
    SAGE Publications ; 2018
    In:  Acta Radiologica Vol. 59, No. 11 ( 2018-11), p. 1336-1342
    Details
    In: Acta Radiologica, SAGE Publications, Vol. 59, No. 11 ( 2018-11), p. 1336-1342
    Abstract: Endovascular treatment has become a significant therapeutic option for the management of intractable bleeding in gynecologic malignancies. However, the endovascular treatment types were almost never mentioned when active bleeding from different arteries was identified. Purpose To present angiographic details and evaluate clinical efficacy of endovascular treatments to control active vaginal bleeding in uterine cervical cancer patients treated with radiotherapy. Material and Methods In this retrospective study, six, consecutive cervical cancer patients treated with radiotherapy who underwent endovascular treatment for active vaginal bleeding were included. Angiographic findings, endovascular treatment details, and clinical outcomes were obtained. Results Ten endovascular procedures were technically successful, in which bleeding arteries were the internal iliac artery/its branches (n = 5), external iliac artery (EIA) (n = 3), uterine artery (n = 1), and superior rectal artery (n = 1), and bleeding manifested as contrast extravasation (n = 6), pseudoaneurysm (n = 1), or both (n = 3). Three of the four repeated procedures showed different bleeding sites from the primary ones. Stent graft was inserted to preserve the patency of the bleeding EIA in two patients. For another EIA rupture, both proximal and distal embolization were performed, followed by femoral-to-femoral bypass to preserve blood flow. Bleeding control within one month was achieved in 80% (8/10). One minor complication, mild transient pelvic pain, occurred in one patient. Conclusions Various endovascular treatment was feasible and effective to control active vaginal bleeding from cervical cancer. Repeated procedures showed commonly different bleeding foci and stent graft insertion was effective for preserving the patency of the large bleeding artery.
    Type of Medium: Online Resource
    ISSN: 0284-1851 , 1600-0455
    URL: Article
    DOI: 10.1177/0284185118758133
    RVK:
    XA 10000
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2024579-8
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  • 10
    Online Resource
    Online Resource
    Percutaneous cholecystostomy for acute cholecystitis after stent insertion in patients with malignant biliary obstruction: clinical outcomes of 107 patients
    SAGE Publications ; 2022
    In:  Acta Radiologica Vol. 63, No. 10 ( 2022-10), p. 1315-1322
    Details
    In: Acta Radiologica, SAGE Publications, Vol. 63, No. 10 ( 2022-10), p. 1315-1322
    Abstract: The outcome of percutaneous cholecystostomy (PC) in malignant patients with acute cholecystitis (AC) after biliary stent insertion has not been investigated in a large group. Purpose To evaluate the clinical outcomes of PC for AC after stent insertion in patients with malignant biliary obstruction. Material and Methods From April 2007 to February 2019, 107 patients (57 men, 52 women; mean age = 67.5 years; age range = 27–93 years) who had undergone PC for AC after biliary stent insertion were retrospectively evaluated. Of the 107 patients, 86 underwent biliary stent insertion by the endoscopic approach and the remaining 21 patients by the percutaneous approach. All patients were classified into three groups: those with stent-induced AC; those with cancer-induced AC; and those with AC without mechanical cause (biliary stent, GB stone, or cancer invasion). The mean survival time, recurrence rate, symptom improvement, and cystic duct patency in each patient group were analyzed. Results Stent-induced AC (n = 40, 37.4%) developed with a mean onset time of six days (range = 0–14 days), AC without mechanical cause (n = 27, 25.2%), 87 days (range = 15–273 days), and cancer-induced AC (n = 40, 37.4%), 137 days (range = 15–447 days) after stent insertion. Symptom resolution and significant improvement in laboratory test values were achieved in 95 patients (88.8%) within four days after PC. Conclusion PC is a technically safe and effective method for the treatment of AC after biliary stent insertion in patients with malignant biliary obstruction.
    Type of Medium: Online Resource
    ISSN: 0284-1851 , 1600-0455
    URL: Article
    DOI: 10.1177/02841851211041816
    RVK:
    XA 10000
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2024579-8
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