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Choi TW, Kim J, Won JH. Do Balloon Catheters have a Different Radial Force Along Their Longitudinal Axis? Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03716-x. [PMID: 38639779 DOI: 10.1007/s00270-024-03716-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE This experimental study was designed to compare radial forces between the central portion and both ends of balloon catheters when dilating stenosis. MATERIALS AND METHODS Three balloon catheters of 6 and 8 mm in diameter and of variable length were tested: Mustang, Conquest, and Genoss PTA. Cylindrical modules to position balloon catheters and install the measuring tip during radial force measurements were made using a 3D printer. The measuring tip created 20% stenosis at the inner lumen. Both ends and center of the balloon catheter were located at the measuring tip. The radial force was measured after inflating the balloon catheter to the rated burst pressure. RESULTS For the different diameters and lengths of balloon catheters and cylinder sizes, the median inccenter, the radial rease in radial force at the distal end compared to the center was 16.5% (range: 9.8-35.2%) for Mustang, 12.4% (range: 10.3-25.5%) for Genoss, and 7.4% (range: -0.3-13.1%) for Conquest balloon catheters. Similarly, compared to that at the force at the proximal end was 10.8% greater (range: -2.9-18.3%) for Mustang, 9.9% greater (range: 3.9-22.3%) for Genoss, and 7.3% greater (range: -1.3-12.4%) for Conquest catheters. CONCLUSION The radial force is greater at both ends of the balloon than at the central portion, especially at the distal end. Dilation using the distal end of the balloon catheter is a practical method that can be applied in clinical practice without additional devices when encountering resistant stenosis, especially with semi-compliant balloons.
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Affiliation(s)
- Tae Won Choi
- Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Republic of Korea.
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Bergh EP, Mann LK, Won JH, Nobles A, Johnson A, Papanna R. Anchoring device to prevent membrane detachment and preterm premature rupture of membranes after fetal intervention. Ultrasound Obstet Gynecol 2024. [PMID: 38514967 DOI: 10.1002/uog.27646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Anchoring the fetal membrane to the uterine wall via a novel suture delivery system could reduce the risk of preterm premature rupture of membranes (PPROM) after fetoscopic surgery. This study assesses the feasibility of using a novel device designed for minimally invasive suturing to anchor fetal membranes to the uterine wall and to close surgical defects after fetoscopy. METHODS We tested the suturing device both ex vivo and in vivo. In the ex vivo studies, 12-French trocar defects were created with a fetoscope in five specimens of human uterine tissue with fetal membranes attached. Specimens were examined for integrity of the anchoring stitch. For in vivo studies, trocar defects were created in the two uterine horns of three pregnant ewes, each carrying twins at ~79-90 days gestation. One trocar defect in each ewe was repaired using the suture device, and the other was left unrepaired as a control. The repair sites were examined for membrane anchoring integrity when the defect was created and at delivery. RESULTS Fetal membranes were successfully anchored to the uterine myometrium using this device in all five trials performed ex vivo. The in vivo trials also revealed successful membrane anchoring compared with controls both at the time of device deployment and five-to-eight weeks after the procedure. CONCLUSIONS We successfully anchored amniotic membranes to the underlying myometrium via suturing device both ex vivo and in vivo. Further studies are needed to evaluate the efficacy of the device and to determine whether it can successfully anchor fetal membranes percutaneously in human subjects. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- E P Bergh
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, McGovern Medical School at UTHealth Houston, The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - L K Mann
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, McGovern Medical School at UTHealth Houston, The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - J H Won
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, McGovern Medical School at UTHealth Houston, The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - A Nobles
- HeartStitch, Inc., Fountain Valley, CA, USA
| | - A Johnson
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, McGovern Medical School at UTHealth Houston, The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - R Papanna
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, McGovern Medical School at UTHealth Houston, The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
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Kim J, Bang DH, Choi TW, Won JH, Kwon Y. Lymphangiography and lymphatic embolisation for the treatment of chyle leaks after neck surgery: assessment of lymphangiography findings and embolisation techniques. Br J Radiol 2023; 96:20220831. [PMID: 37393535 PMCID: PMC10461271 DOI: 10.1259/bjr.20220831] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 05/21/2023] [Accepted: 06/09/2023] [Indexed: 07/03/2023] Open
Abstract
OBJECTIVE To assess lymphangiography findings and outcome of lymphatic embolisation to manage chyle leak after neck surgery. METHODS Consecutive cases of lymphangiography performed between April 2018 and May 2022 for management of chyle leaks related to neck surgery were retrospectively reviewed. Lymphangiography findings, techniques, and outcomes were analysed. RESULTS Eight patients (mean age: 46.5 years) were included. Six patients had undergone radical neck dissection for thyroid cancer, and two had undergone lymph node excision. Clinical presentations were: chyle drainage through Jackson Pratt catheters in five patients, lymphorrhea through surgical wounds in two, and enlarging lymphocele in one. Lymphangiography techniques included: inguinal lymphangiography in four patients, retrograde lymphangiography in three, and transcervical lymphangiography in one. Lymphangiography revealed leaks in the terminal thoracic duct in two patients, bronchomediastinal trunk in two, jugular trunk in three, and superficial neck channels in one. Embolisation techniques included: non-selective embolisation of terminal thoracic duct (n = 2), selective embolisation of the jugular trunk (n = 3), selective embolisation of the bronchomediastinal trunk (n = 2), and intranodal glue embolisation of superficial neck channels (n = 1). One patient underwent a repeat procedure. Chyle leak resolved in all patients over a mean of 4.6 days. No complication was encountered. CONCLUSION Lymphatic embolisation seems to be effective and safe in managing chyle leaks after neck surgery. Lymphangiography allowed for the categorisation of chyle leaks according to their location. Post-embolisation patency of the thoracic duct may be preserved in chyle leaks that do not directly involve the thoracic duct. ADVANCES IN KNOWLEDGE Lymphatic embolisation is safe and effective in managing chyle leaks after neck surgery. On lymphangiography, the location of contrast media extravasation may not be consistent. The technique for embolisation should be based on the location of the leak. Post-embolisation patency of the thoracic duct may be preserved in chyle leaks that do not directly involve the thoracic duct.
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Affiliation(s)
- Jinoo Kim
- Department of Radiology, Ajou University Hospital, Suwon, Gyeonggi-do, Republic of Korea
| | - Dong Ho Bang
- Department of Radiology, Ajou University Hospital, Suwon, Gyeonggi-do, Republic of Korea
| | - Tae Won Choi
- Department of Radiology, Ajou University Hospital, Suwon, Gyeonggi-do, Republic of Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University Hospital, Suwon, Gyeonggi-do, Republic of Korea
| | - Yohan Kwon
- Department of Radiology, Ajou University Hospital, Suwon, Gyeonggi-do, Republic of Korea
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Kim J, Kwon Y, Choi TW, Won JH. Management of Immature Arteriovenous Fistulas. Cardiovasc Intervent Radiol 2023; 46:1125-1135. [PMID: 37142801 DOI: 10.1007/s00270-023-03440-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/30/2023] [Indexed: 05/06/2023]
Abstract
In patients requiring long-term hemodialysis for chronic kidney disease, an arteriovenous fistula is the preferred mode of hemodialysis access over synthetic arteriovenous graft or hemodialysis catheters. The National Kidney Foundation recommended in their Kidney Dialysis Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines that the creation of an autogenous arteriovenous fistula should initially be sought whenever possible. In 2003, a program named the Fistula First Breakthrough Initiative was initiated in the U.S. to increase the use of arteriovenous fistula for hemodialysis and to ultimately surpass the goal of 50% fistula use in incident and 40% fistula use in prevalent hemodialysis patients per recommendation by KDOQI Guidelines. While this goal was achieved, the encouraged creation of arteriovenous fistulas saw a rise in fistulas that failed to mature. Researchers have focused on developing strategies to optimize fistula maturation. Studies have revealed that the presence of stenoses and accessory draining veins may contribute to unsuccessful fistula maturation. Endovascular treatment, including balloon angioplasty and accessory vein embolization, aim to correct anatomical factors that negatively affect the maturation process. This article reviews the techniques and outcomes of endovascular treatment in the management of immature fistulas.
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Affiliation(s)
- Jinoo Kim
- Department of Radiology, Ajou University Hospital, 164, World Cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Yohan Kwon
- Department of Radiology, Ajou University Hospital, 164, World Cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Tae Won Choi
- Department of Radiology, Ajou University Hospital, 164, World Cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University Hospital, 164, World Cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea.
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5
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Choi TW, Kwon Y, Kim J, Won JH. [Endovascular Treatment for Vascular Injuries of the Extremities]. J Korean Soc Radiol 2023; 84:846-854. [PMID: 37559804 PMCID: PMC10407075 DOI: 10.3348/jksr.2023.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/16/2023] [Accepted: 07/08/2023] [Indexed: 08/11/2023]
Abstract
Vascular injuries of the extremities are associated with a high mortality rate. Conventionally, open surgery is the treatment of choice for peripheral vascular injuries. However, rapid development of devices and techniques in recent years has significantly increased the utilization and clinical application of endovascular treatment. Endovascular options for peripheral vascular injuries include stent-graft placement and embolization. The surgical approach is difficult in cases of axillo-subclavian or iliac artery injuries, and stent-graft placement is a widely accepted alternative to open surgery. Embolization can be considered for arterial injuries associated with active bleeding, pseudoaneurysms, and arteriovenous fistula and in patients in whom embolization can be safely performed without a risk of ischemic complications in the extremities. Endovascular treatment is a minimally invasive procedure and is useful as a simultaneous diagnostic and therapeutic approach, which serve as advantages of this technique that is widely utilized for vascular injuries of the extremities.
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Kim YS, Won JH, Lee SJ. Blindsided: An Unusual Case of Ocular Ischemic Syndrome and Orthostatic Dizziness Caused by Brachiocephalic Trunk Stenosis. J Clin Neurol 2023; 19:324-326. [PMID: 37151144 PMCID: PMC10169915 DOI: 10.3988/jcn.2022.0366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/14/2022] [Accepted: 01/16/2023] [Indexed: 05/09/2023] Open
Affiliation(s)
- Yoon Seob Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Seong-Joon Lee
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea.
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Lee K, Won JH, Kwon Y, Lee SH, Bang JB, Kim J. Bare-Metal Stent in Dysfunctional Hemodialysis Access: An Assessment of Circuit Patency according to Access Type and Stent Location. J Korean Soc Radiol 2023; 84:197-211. [PMID: 36818700 PMCID: PMC9935964 DOI: 10.3348/jksr.2022.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/14/2022] [Accepted: 06/29/2022] [Indexed: 01/21/2023]
Abstract
Purpose To evaluate the circuit patency after nitinol bare-metal stent (BMS) placement according to the type of access and location of the stent in dysfunctional hemodialysis access. Materials and Methods Between January 2017 and December 2019, 159 patients (mean age, 64.1 ± 13.2 years) underwent nitinol BMS placement for dysfunctional access. The location of stents was as follows: 18 brachiocephalic vein, 51 cephalic arch, 40 upper arm vein, 10 juxta-anastomotic vein, 7 arteriovenous (AV) anastomosis, and 33 graft-vein (GV) anastomosis. Circuit patency was evaluated by the Kaplan-Meier method, and cox regression model. Results A total of 159 stents were successfully deployed in 103 AV fistula (AVF) and 56 AV graft (AVG). AVG showed lower primary and secondary patency at 12-months compared with AVF (primary patency; 25.0% vs. 44.7%; p = 0.005, secondary patency; 76.8% vs. 92.2%; p = 0.014). Cox regression model demonstrated poorer primary patency at 12 months after stenting in the cephalic arch and GV anastomosis compared with the other sites. Conclusion AVF showed better primary and secondary circuit patency at 12 months following the placement of BMS compared with AVG. Stents in the cephalic arch and GV anastomosis were associated with poorer primary patency at 12 months compared to those in other locations.
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Affiliation(s)
- Kyungmin Lee
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Yohan Kwon
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Su Hyung Lee
- Department of Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jun Bae Bang
- Department of Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
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Lee K, Chang SJ, Won JH, Kwon Y, Kim SH, Kim JE, Kim J. Intranodal Lymphangiography and Embolization for the Treatment of Early Postoperative Lymphatic Leaks after Pelvic Surgery. J Vasc Interv Radiol 2022; 34:591-599.e1. [PMID: 36526076 DOI: 10.1016/j.jvir.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 11/23/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess outcome and predictors of outcome after lymphatic embolization (LE) for early postoperative lymphatic leak after pelvic surgery. MATERIAL AND METHODS Lymphangiography (LG) procedures performed between May 2015 and February 2020 for postoperative intraperitoneal lymphatic leaks after pelvic surgery were reviewed. Treatment indication was lymphatic drainage of >500 mL/d persisting for >1 week. LE was performed by injecting glue into the iliac lymph node. Fisher exact and Wilcoxon rank-sum tests were used for comparative analysis, and logistic regression was used to assess predictors of outcome. RESULTS LG was performed in 71 patients. A leak was demonstrated in 69 patients who underwent LE. The mean drainage was 1,329 mL/d ± 773. Catheters were removed in 49 (69.0%) patients after 1 procedure and in 69 (97.2%) patients after a mean of 1.3 procedures. The mean drainage at the time of catheter removal was 157 mL/d ± 100. Failure occurred in 12 (16.9%) cases, including 2 (2.8%) cases of unsuccessful catheter removal and 10 (14.1%) cases of catheter reinsertion owing to recurrent ascites (n = 3) and lymphoceles (n = 7). Older age and drainage of >1,500 mL/d were associated with failure (P = .004). Drainage of >1,500 mL/d was associated with a post-LE catheter dwell time of longer than 1 week (P = .024). Minor adverse events were noted in 4 (5.6%) patients who presented with transient leg swelling. CONCLUSIONS LE was effective for treating pelvic surgery-related lymphatic leaks. Reintervention may be required. Drainage of >1,500 mL/d was associated with clinical failure and a post-LE catheter dwell time of longer than 1 week.
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Affiliation(s)
- Kyungmin Lee
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Suk-Joon Chang
- Department of Obstetrics and Gynecology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yohan Kwon
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seong Ho Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-Eun Kim
- Department of Radiology, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea.
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Ko YG, Choi D, Rha SW, Won JH, Do YS, Lee SW, Menk JS, Kum S. Long-term outcomes after paclitaxel-coated balloon angioplasty of femoropopliteal arteries in Asian patients of the IN.PACT Global Study. Catheter Cardiovasc Interv 2022; 100:1273-1283. [PMID: 36385562 PMCID: PMC10099943 DOI: 10.1002/ccd.30441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/05/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The long-term data on the use of drug-coated balloons (DCBs) for femoropopliteal atherosclerotic lesions in the real-world setting are limited, even more so for racially and geographically distinct populations. The present analysis reports the 5-year safety and effectiveness outcomes of a DCB in the Asian subset of the prospective, real-world IN.PACT Global Study. METHODS The IN.PACT Global Study was a prospective, multicenter, international, single-arm study designed to assess the long-term safety and effectiveness of the IN.PACT Admiral DCB in real-world participants with femoropopliteal artery disease. The present analysis included 114 Asian participants (138 lesions) treated in South Korea and Singapore. Assessments through 5 years included freedom from clinically driven target lesion revascularization, the safety endpoint (a composite of freedom from device- and procedure-related mortality through 30 days; and freedom from major target limb amputation and clinically driven target vessel revascularization within 60 months after the index procedure) and major adverse events. RESULTS In this prespecified Asian subset, there was a high incidence of diabetes mellitus (54.4%), hypertension (78.1%), coronary artery disease (43.9%), and concomitant below-the-knee vascular disease of target leg (39.5%). Mean lesion length was 17.4 ± 12.4 cm; 26.8% were in-stent restenosis, and more than half of the lesions were totally occluded (51.4%) and calcified (54.3%). The 5-year Kaplan-Meier estimate of freedom from clinically driven target lesion revascularization was 77.1% (95% confidence interval: 67.0%-84.5%). The safety composite endpoint was 76.0%; the cumulative incidence of all-cause mortality was 19.9%, and no major target limb amputations were reported through 5 years. CONCLUSIONS This subset analysis of Asian participants from the IN.PACT Global Study demonstrated consistent results with the previously reported data of the IN.PACT Admiral DCB. The data confirm the durable clinical effectiveness and safety profile of the DCB through 5 years for femoropopliteal atherosclerotic disease in this real-world population.
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Affiliation(s)
- Young-Guk Ko
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Woon Rha
- Division of cardiology, Korea University Guro Hospital, Seoul, Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University Hospital, Suwon, Gyeonggi-do, Korea
| | - Young-Soo Do
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Steven Kum
- Department of Surgery, Changi General Hospital, Singapore, Singapore
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Won JH. [General Treatment Strategy for Intervention in Lower Extremity Arterial Disease]. Taehan Yongsang Uihakhoe Chi 2021; 82:500-511. [PMID: 36238791 PMCID: PMC9432442 DOI: 10.3348/jksr.2021.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/09/2021] [Accepted: 04/17/2021] [Indexed: 11/19/2022]
Abstract
The prevalence of lower extremity disease is increasing with age. With recent technological advancements, endovascular treatment is being performed more frequently. The treatment goal of intermittent claudication is to improve walking and reduce claudication. To achieve these goals, anatomical durability and patency are important. In patients with critical limb ischemia, the lesions are diffuse and particularly severe in below-the-knee arteries. The treatment goal of critical limb ischemia is to promote wound healing and to prevent major amputation, which is evaluated by the limb salvage rate. Primary stenting using covered or bare metal stents is a widely accepted endovascular treatment. While drug-eluting technologies with or without atherectomy are widely used in the treatment of femoropopliteal disease, balloon angioplasty is the mainstay treatment for below-the-knee intervention. CT angiography provides a road map for planning endovascular treatment in patients without absolute contraindications.
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Huh J, Kim B, Lee JH, Won JH, Kim J, Kwon Y, Kim JK. Added Value of CT Arterial Subtraction Images in Liver Imaging Reporting and Data System Treatment Response Categorization for Transcatheter Arterial Chemoembolization-Treated Hepatocellular Carcinoma. Invest Radiol 2021; 56:109-116. [PMID: 33405431 DOI: 10.1097/rli.0000000000000714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to assess the benefit of adding arterial subtraction images from computed tomography (CT) to the Liver Imaging Reporting and Data System (LI-RADS) v2018 treatment response (LR-TR) categorization in patients treated with transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS This retrospective study included 115 patients with 151 HCCs treated by TACE using an emulsion of doxorubicin and iodized oil who underwent multiphasic CT protocol that additionally generated arterial subtraction images based on nonrigid anatomic correction algorithm. Of 151 HCCs, 67 (44.4%) were viable and 84 (55.6%) were nonviable. Two independent readers assessed the per-lesion LR-TR categories in set 1 of multiphasic CT images alone and set 2 including both set 1 and CT arterial subtraction images, besides diagnostic confidence, and the quality of subtraction images. The sensitivity and specificity of LR-TR viable category between the sets were compared using the generalized estimating equation. Interobserver agreements of LR-TR categorization in each set and the quality of subtraction images were assessed by Cohen κ. RESULTS The quality of subtraction images was mostly good to perfect (98.7%) with good interobserver agreement (κ = 0.71), and none were nondiagnostic. For detecting viable HCC, LR-TR viable category showed sensitivity of 53.7% to 56.7% and specificity of 96.4% to 98.8% in set 1. In comparison, set 2 showed significantly higher sensitivity of 88.1% to 89.6% (P < 0.002) and equivalent specificity of 94% to 95.2% (P > 0.13) for the same category. In sets 1 and 2, 31.3% to 34.3% and 9% to 10.4% of viable HCC were miscategorized as LR-TR nonviable, respectively. LR-TR equivocal category was less assigned in set 2 (1.3%) than in set 1 (6.6%-7.9%). Set 2 showed slightly higher level of confidence for LR-TR categorization compared with set 1 (3.4 ± 0.8 vs 3.8 ± 0.5). Interobserver agreement was excellent in both sets (κ = 0.85 in set 1 and 0.97 in set 2). CONCLUSIONS The LR-TR viable category is highly specific but inadequately sensitive for detecting viable tumor in TACE-treated HCC on conventional multiphasic CT. Adding arterial subtraction images to the conventional CT images significantly increases sensitivity without compromising the specificity and improves the diagnostic confidence of LR-TR viable category.
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Affiliation(s)
- Jimi Huh
- From the Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon
| | - Bohyun Kim
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jei Hee Lee
- From the Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon
| | - Je Hwan Won
- From the Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon
| | - Jinoo Kim
- From the Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon
| | - Yohan Kwon
- From the Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon
| | - Jai Keun Kim
- From the Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon
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Heo S, Won JH, Kim J, Kim JY, Joe HB. Efficacy and Safety of Ultrasound-Guided Supraclavicular Brachial Plexus Block during Angioplasty of Dysfunctional Arteriovenous Access: A Prospective, Randomized Single-Center Clinical Trial. J Vasc Interv Radiol 2019; 31:236-241. [PMID: 31883933 DOI: 10.1016/j.jvir.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/16/2019] [Accepted: 11/04/2019] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of the ultrasound-guided supraclavicular brachial plexus block (BPB) during angioplasty of dysfunctional arteriovenous access. MATERIALS AND METHODS Eighty study participants with dysfunctional arteriovenous access were enrolled in this prospective, randomized clinical trial between November 2016 and February 2018. Eighty patients were randomized to either the ultrasound-guided supraclavicular BPB group (mean age ± standard deviation [SD], 65.1 ± 12.4; male:female = 17:23) or the no regional anesthesia group (mean age ± SD, 64.0 ± 11.7; male:female = 25:15). Pain was assessed on the 10-point Visual Analogue Scale. Participant satisfaction was examined. Six-month clinical follow-up was done to evaluate arteriovenous access patency and long-term complications. RESULTS The BPB group showed a lower average pain score than the control group (mean ± SD, 0.9 ± 1.9 vs 6.4 ± 2.5; P < .001). Participant satisfaction (mean ± SD, 2.8 ± 0.5 vs 2.1±0.8; P < .001) was also higher in the BPB group. Six-month patency was 65% (26/40) in the BPB group and 59% (23/39) in the control group, with no significant difference between the 2 groups (P = .59). No major immediate or delayed complications were observed. CONCLUSIONS Ultrasound-guided BPB is highly effective in reducing pain during angioplasty of dysfunctional arteriovenous access with an acceptable safety profile.
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Affiliation(s)
- Subin Heo
- Department of Radiology, Ajou University School of Medicine, 206 Worldcup-ro, Yeongtong-gu, 443-749, Suwon, Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University School of Medicine, 206 Worldcup-ro, Yeongtong-gu, 443-749, Suwon, Korea.
| | - Jinoo Kim
- Department of Radiology, Ajou University School of Medicine, 206 Worldcup-ro, Yeongtong-gu, 443-749, Suwon, Korea
| | - Jong Yeop Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 206 Worldcup-ro, Yeongtong-gu, 443-749, Suwon, Korea
| | - Han Bum Joe
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 206 Worldcup-ro, Yeongtong-gu, 443-749, Suwon, Korea
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Hong SY, Hu XG, Lee HY, Won JH, Kim JW, Shen XY, Wang HJ, Kim BW. Longterm Analysis of Biliary Complications After Duct-to-Duct Biliary Reconstruction in Living Donor Liver Transplantations. Liver Transpl 2018; 24:1050-1061. [PMID: 29633539 DOI: 10.1002/lt.25074] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/22/2018] [Accepted: 05/20/2018] [Indexed: 02/07/2023]
Abstract
Biliary complication (BC) is still regarded as the Achilles' heel of a living donor liver transplantation (LDLT). This study aims to evaluate the longterm outcomes of the duct-to-duct (DD) biliary reconstruction using 7-0 suture and to identify the risk factors of BCs after LDLTs. Data of 140 LDLTs between 2006 and 2015 were analyzed. All biliary reconstructions were performed as DD anastomoses using 7-0 suture: 102 for the right lobe, 20 for the left lobe, and 18 for right posterior sector grafts. BC was defined as a bile leakage (BL) or a biliary stricture (BS), and the median follow-up time after LDLT was 65 months. A total of 19 recipients (13.5%) developed BCs (8 BLs and 16 BSs) after LDLT. The survival rates between recipients with and without BCs were 83% and 86.7%, respectively (P = 0.88). In univariate analyses, the risk factors for BC were small diameter of the graft's bile duct, long warm ischemic time, small graft-to-recipient weight ratio, and no use of external biliary stent (EBS). The graft's bile duct diameter ≤ 3 mm and no use of EBS were determined as independent risk factors (hazard ratios of 9.74 and 7.68, respectively) in multivariate analyses. The 116 recipients with EBS had no BL, 11 had BSs (9%), while 24 without EBS had 8 BLs (33%) and 5 BSs (21%). After a propensity score match between the recipients with and without EBS, the EBS group (24) developed only 1 BS (4%). In conclusion, DD anastomosis using 7-0 suture combined with EBS could provide favorable longterm outcomes after LDLT, which should thus be considered the surgical technique of choice for LDLTs.
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Affiliation(s)
- Sung Yeon Hong
- Department of Hepatobiliary Surgery and Liver Transplantation, Ajou University School of Medicine, Suwon, Korea
| | - Xu-Guang Hu
- Department of Hepatobiliary Surgery and Liver Transplantation, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Young Lee
- Clinical Trial Center, Ajou University School of Medicine, Suwon, Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jin Woo Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Xue-Yin Shen
- Department of Hepatobiliary Surgery and Liver Transplantation, Ajou University School of Medicine, Suwon, Korea
| | - Hee-Jung Wang
- Department of Hepatobiliary Surgery and Liver Transplantation, Ajou University School of Medicine, Suwon, Korea
| | - Bong-Wan Kim
- Department of Hepatobiliary Surgery and Liver Transplantation, Ajou University School of Medicine, Suwon, Korea
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14
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Kim SS, Cho HJ, Nam JS, Kim HJ, Kang DR, Won JH, Kim J, Kim JK, Lee JH, Kim BH, Lee MY, Cho SW, Cheong JY. Plasma MicroRNA-21, 26a, and 29a-3p as Predictive Markers for Treatment Response Following Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma. J Korean Med Sci 2018; 33:e6. [PMID: 29215815 PMCID: PMC5729641 DOI: 10.3346/jkms.2018.33.e6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/15/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We investigated an association between the levels of plasma microRNA (miRNA)-21, -26a, and -29a-3p and treatment outcomes following transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). METHODS A total of 198 patients with TACE-treated HCC were followed up for TACE refractoriness and liver transplantation (LT)-free survival. Pretreatment plasma miRNA-21, -26a, and -29a-3p levels were measured using quantitative real-time polymerase chain reaction. RESULTS During the mean follow-up of 22.3 (range, 0.7-79) months, 118 (59.6%) patients exhibited TACE refractoriness. Multivariate analyses showed that expression of a specific combination of miRNAs (miRNA-21 ≥ 2.5, miRNA-26a ≥ 1.5, and miRNA-29a-3p < 0.4) was associated with early TACE refractoriness (within 1 year; hazard ratio [HR], 2.32; 95% confidence interval [CI], 1.08-4.99; P = 0.031) together with tumor size (HR, 4.62; 95% CI, 1.50-14.21; P = 0.008), and macrovascular invasion (HR, 3.80; 95% CI, 1.19-12.20; P = 0.025). However, miRNA-21, -26a, and -29a-3p levels were not significantly associated with overall TACE refractoriness or LT-free survival. Additionally, large tumor size and macrovascular invasion were common predictive factor of overall TACE refractoriness and survival. CONCLUSION Combination of plasma miRNA-21, -26a, and -29a-3p expression could predict early TACE refractoriness in patients with TACE-treated HCC.
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Affiliation(s)
- Soon Sun Kim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Hyo Jung Cho
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Ji Sun Nam
- Human Genome Research & Bio-resource Center, Ajou University Medical Center, Suwon, Korea
| | - Hyun Ji Kim
- Office of Biostatistics, Ajou University School of Medicine, Suwon, Korea
| | - Dae Ryong Kang
- Center of Biomedical Data Science, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jai Keun Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jei Hee Lee
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Bo Hyun Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Mi Young Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Sung Won Cho
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Youn Cheong
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea.
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Yang MJ, Kim JH, Hwang JC, Yoo BM, Kim SS, Lim SG, Won JH. Usefulness of combined percutaneous-endoscopic rendezvous techniques after failed therapeutic endoscopic retrograde cholangiography in the era of endoscopic ultrasound guided rendezvous. Medicine (Baltimore) 2017; 96:e8991. [PMID: 29310413 PMCID: PMC5728814 DOI: 10.1097/md.0000000000008991] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The rendezvous approach is a salvage technique after failure of endoscopic retrograde cholangiography (ERC). In certain circumstances, percutaneous-endoscopic rendezvous (PE-RV) is preferred, and endoscopic ultrasound-guided rendezvous (EUS-RV) is difficult to perform. We aimed to evaluate PE-RV outcomes, describe the PE-RV techniques, and identify potential indications for PE-RV over EUS-RV.Retrospective analysis was conducted of a prospectively designed ERC database between January 2005 and December 2016 at a tertiary referral center including cases where PE-RV was used as a salvage procedure after ERC failure.During the study period, PE-RV was performed in 42 cases after failed therapeutic ERC; 15 had a surgically altered enteric anatomy. The technical success rate of PE-RV was 92.9% (39/42), with a therapeutic success rate of 88.1% (37/42). Potential indications for PE-RV over EUS-RV were identified in 23 cases, and either PE-RV or EUS-RV could have effectively been used in 19 cases. Endoscopic bile duct access was successfully achieved with PE-RV in 39 cases with accessible biliary orifice using one of PE-RV cannulation techniques (classic, n = 11; parallel, n = 19; and adjunctive maneuvers, n = 9).PE-RV uses a unique technology and has clinical indications that distinguish it from EUS-RV. Therefore, PE-RV can still be considered a useful salvage technique for the treatment of biliary obstruction after ERC failure.
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Affiliation(s)
| | | | | | | | | | | | - Je Hwan Won
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea
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16
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Kim SJ, Won JH, Kim YB, Wang HJ, Kim BW, Kim H, Kim J. Plugged percutaneous biopsy of the liver in living-donor liver transplantation recipients suspected to have graft rejection. Acta Radiol 2017; 58:771-777. [PMID: 27754919 DOI: 10.1177/0284185116673121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Percutaneous biopsy is a widely-accepted technique for acquiring histologic samples of the liver. When there is concern for bleeding, plugged percutaneous biopsy (PPB) may be performed, which involves embolization of the biopsy tract. Purpose To evaluate the efficacy and safety of PPB of the liver in patients suspected to have graft rejection after living-donor liver transplantation (LDLT). Material and Methods During January 2007 and December 2013, 51 patients who underwent PPB of the liver under the suspicion of post-LDLT graft rejection were retrospectively analyzed. A total of 73 biopsies were performed. Biopsy was performed with a 17-gauge core needle and 18-gauge cutting needle. The needle tract was embolized using gelatin sponge (n = 44) or N-butyl cyanoacrylate (NBCA) (n = 29). The specimens were reviewed to determine their adequacy for histologic diagnosis. We reviewed all medical records after PPB. Results Specimens were successfully acquired in all procedures (100%). They were adequate for diagnosis in 70 cases (95.9%) and inadequate in three (1.3%). Average of 9.8 complete portal tracts was counted per specimen. One minor complication (1.4%) occurred where the patient had transient fever after the procedure. Conclusion PPB is easy and safe to perform in LDLT recipients and provides high diagnostic yield.
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Affiliation(s)
- Sung Jung Kim
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young Bae Kim
- Department of Pathology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hee-Jung Wang
- Department of Hepatobiliary Surgery and Liver Transplantation, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Bong-Wan Kim
- Department of Hepatobiliary Surgery and Liver Transplantation, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
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17
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Hahn HM, Jeong YS, Hong YS, Won JH, Lim SH, Kim J, Park MC, Park DH, Lee IJ. Use of revascularized artery as a recipient in microvascular reconstruction of the lower leg: An analysis of 62 consecutive free flap transfers. J Plast Reconstr Aesthet Surg 2017; 70:606-617. [DOI: 10.1016/j.bjps.2017.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 01/03/2017] [Accepted: 01/31/2017] [Indexed: 11/27/2022]
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18
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Kong TW, Chang SJ, Kim J, Paek J, Kim SH, Won JH, Ryu HS. Risk factor analysis for massive lymphatic ascites after laparoscopic retroperitonal lymphadenectomy in gynecologic cancers and treatment using intranodal lymphangiography with glue embolization. J Gynecol Oncol 2017; 27:e44. [PMID: 27171674 PMCID: PMC4864520 DOI: 10.3802/jgo.2016.27.e44] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/07/2016] [Accepted: 04/27/2016] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate risk factors for massive lymphatic ascites after laparoscopic retroperitoneal lymphadenectomy in gynecologic cancer and the feasibility of treatments using intranodal lymphangiography (INLAG) with glue embolization. Methods A retrospective analysis of 234 patients with gynecologic cancer who received laparoscopic retroperitonal lymphadenectomy between April 2006 and November 2015 was done. In June 2014, INLAG with glue embolization was initiated to manage massive lymphatic ascites. All possible clinicopathologic factors related to massive lymphatic ascites were determined in the pre-INLAG group (n=163). Clinical courses between pre-INLAG group and post-INLAG group (n=71) were compared. Results In the pre-INLAG group (n=163), four patients (2.5%) developed massive lymphatic ascites postoperatively. Postoperative lymphatic ascites was associated with liver cirrhosis (three cirrhotic patients, p<0.001). In the post-INLAG group, one patient with massive lymphatic ascites had a congestive heart failure and first received INLAG with glue embolization. She had pelvic drain removed within 7 days after INLAG. The mean duration of pelvic drain and hospital stay decreased after the introduction of INLAG (13.2 days vs. 10.9 days, p=0.001; 15.2 days vs. 12.6 days, p=0.001). There was no evidence of recurrence after this procedure. Conclusion Underlying medical conditions related to the reduced effective circulating volume, such as liver cirrhosis and heart failure, may be associated with massive lymphatic ascites after retroperitoneal lymphadenectomy. INLAG with glue embolization can be an alternative treatment options to treat leaking lymphatic channels in patients with massive lymphatic leakage.
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Affiliation(s)
- Tae Wook Kong
- Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.,Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Suk Joon Chang
- Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.,Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jiheum Paek
- Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.,Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Su Hyun Kim
- Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Hee Sug Ryu
- Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.,Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
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19
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Kim SS, Nam JS, Cho HJ, Won JH, Kim JW, Ji JH, Yang MJ, Park JH, Noh CK, Shin SJ, Lee KM, Cho SW, Cheong JY. Plasma micoRNA-122 as a predictive marker for treatment response following transarterial chemoembolization in patients with hepatocellular carcinoma. J Gastroenterol Hepatol 2017; 32:199-207. [PMID: 27194671 DOI: 10.1111/jgh.13448] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM Circulating microRNA (miR)-122 has recently been investigated as a potential biomarker of various hepatic diseases, such as chronic hepatitis and hepatocellular carcinoma (HCC). We investigated the association between plasma miR-122 levels and the treatment outcomes following transarterial chemoembolization (TACE) in HCC patients. METHODS We included 177 HCC patients treated with TACE in the study; TACE refractoriness and liver transplantation-free survival were evaluated during follow up. Pretreatment plasma miR-122 levels were assessed using quantitative real-time polymerase chain reaction. Relative quantification of miR-122 expression (fold change) was determined using the 2(-ΔΔCt) method. MiR-16 was used as an internal control for the normalization of miRNA data. RESULTS During the mean follow up of 22.4 (range, 1-79) months, 112 (69.5%) patients exhibited TACE refractoriness. Multivariate analyses showed that tumor number (hazard ratio [HR], 2.51; 95% confidence interval [CI], 1.43-4.41; P = 0.001) and tumor size (HR, 2.65; 95% CI, 1.62-4.32; P = 0.000) can independently predict overall TACE refractoriness. High miR-122 expression (> 100) was associated with early TACE refractoriness (within 1 year; HR, 2.77; 95% CI, 1.12-6.86; P = 0.028), together with tumor number (HR, 22.73; 95% CI, 2.74-188.66; P = 0.004) and tumor size (HR, 4.90; 95% CI, 1.99-12.06; P = 0.001). Univariate analyses showed that high miR-122 expression tends to be associated with poor liver transplantation-free survival (HR, 1.42; 95% CI, 0.95-2.11; P = 0.085). However, it was statistically insignificant in multivariate analysis. CONCLUSION High expression levels of plasma miR-122 are associated with early TACE refractoriness in HCC patients treated with TACE.
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Affiliation(s)
- Soon Sun Kim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Ji Sun Nam
- Human Genome Research and Bio-Resource Center, Ajou University Medical Center, Suwon, South Korea
| | - Hyo Jung Cho
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea
| | - Jin Woo Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea
| | - Jae-Hoon Ji
- Genomic Instability Research Center, Ajou University School of Medicine, Suwon, South Korea
| | - Min Jae Yang
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Joo Han Park
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Choong-Kyun Noh
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Sung Jae Shin
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Kee Myung Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Sung Won Cho
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Jae Youn Cheong
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
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Lee MH, Jang JH, Min HJ, Jang HI, Nah JH, Lyu CJ, Han KS, Won JH, Lee YH, Chong SY, Mun YC, Lee WS, Kim SJ, Kim I. Predictors of general discomfort, limitations in activities of daily living and intention of a second donation in unrelated hematopoietic stem cell donation. Bone Marrow Transplant 2016; 52:258-263. [PMID: 27819689 DOI: 10.1038/bmt.2016.260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 08/22/2016] [Accepted: 08/24/2016] [Indexed: 11/09/2022]
Abstract
We performed a retrospective study of 1868 consecutive unrelated donors to predict the risk factors related to general discomfort, limitations in activities of daily living (ADLs) and intention of a second donation in hematopoietic stem cell (HSC) donation. General discomfort and limitations in ADLs were assessed by numerical measurement (scores of 0-10) and donor's intention of a second donation by yes or no reply. The post-donation questionnaires were completed within 48 h after HSC collection and at 1 week, 4 weeks, and 4 months thereafter. Predictors of general discomfort included female sex (P<0.0001), bone marrow (BM) collection (P<0.0001) or PBSC collection through a central line (CL; P=0.0349), 2-day collection (P=0.0150) and negative or undetermined intention of a second donation on day 1 (P<0.0001). Predictors of limitations in ADLs included age group of 30-39 years (P=0.0046), female sex (P<0.0001), BM collection (P<0.0001) or PBSC collection through a CL (P<0.0001) and negative or undetermined intention of a second donation on day 1 (P<0.0001). The only predictor of positive intention of a second donation was male sex (P=0.0007). Age, sex and collection method and period should be considered risk factors when unrelated HSC donation is performed.
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Affiliation(s)
- M H Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - J H Jang
- Korea Marrow Donor Program, Seoul, South Korea
| | - H J Min
- Clinical Research Institute, Konkuk University Medical Center, Seoul, South Korea
| | - H I Jang
- Korea Marrow Donor Program, Seoul, South Korea
| | - J H Nah
- Korea Marrow Donor Program, Seoul, South Korea
| | - C J Lyu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - K-S Han
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - J H Won
- Department of Hematology-Oncology, Soon Chun Hyang University Hospital, Seoul, South Korea
| | - Y-H Lee
- Department of Pediatrics, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, South Korea
| | - S Y Chong
- Department of Internal Medicine, Bundang Cha Hospital, Seongnam, South Korea
| | - Y C Mun
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
| | - W S Lee
- Department of Hematology and Oncology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - S J Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - I Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
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Abstract
Chylous ascites occurs as a result of lymphatic leakage, which contains high concentration of triglycerides. The leakage is caused by various benign or malignant etiologies ranging from congenital lymphatic abnormality to trauma. Lymphangiography has been shown to be effective in the diagnosis of lymphatic leakage and has also been reported to have therapeutic outcome. The development of intranodal technique for lymphangiography has recently made the procedure more widespread. As an adjunctive procedure, percutaneous embolization may be performed which involves use of embolic agents such as N-butyl cyanoacrylate and coil to occlude the leak. Embolization in the lymphatic system was first made popular by the introduction of thoracic duct embolization by Cope et al and has recently led to the development of various techniques for percutaneous embolization. This article reviews the options and techniques for percutaneous treatment of lymphatic leaks in patients presenting with chylous ascites.
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Affiliation(s)
- Jinoo Kim
- Department of Radiology, School of Medicine, Ajou University Hospital, Ajou University, Suwon-si, Gyeonggi-do, Republic of Korea.
| | - Je Hwan Won
- Department of Radiology, School of Medicine, Ajou University Hospital, Ajou University, Suwon-si, Gyeonggi-do, Republic of Korea
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You S, Won JH, Oh CK, Lee SH, Shim JJ, Kim J. Transjugular Access for Endovascular Treatment of Immature Autogenous Arteriovenous Fistulae. J Vasc Interv Radiol 2016; 27:1878-1884. [PMID: 27686398 DOI: 10.1016/j.jvir.2016.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/17/2016] [Accepted: 07/22/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To assess the feasibility and outcome of transjugular access for endovascular treatment of immature arteriovenous fistulae (AVFs). MATERIALS AND METHODS Between August 2013 and January 2016, 90 patients (mean age, 64.5 y ± 12.8) underwent endovascular treatment of immature AVFs via transjugular access. The mean age of fistulae was 3.3 months ± 1.8. Total procedure time and technical and clinical success rates of endovascular procedures were assessed. Primary and secondary patency rates were calculated according to the Kaplan-Meier method, and complications were assessed. RESULTS All patients had inflow lesions, among which 19 (21.1%) had occlusions. The juxtaanastomotic segment was the most common site (44.3%). Transjugular access was successful in 83 patients (92.2%), and 7 required additional standard or transarterial access. The mean procedure time was 36.5 minutes. Technical and clinical success rates were 98.9% and 90.5%, respectively. Mean primary and secondary patency durations were 14.3 months ± 1.7 and 31.0 months ± 0.7, respectively. Primary patency rates at 3, 6, and 12 months were 84.4%, 67.3%, and 48.8%, respectively. Secondary patency rates at 6 and 18 months were 98.6% and 95.5%, respectively. Venous rupture occurred as a result of balloon inflation in 9 patients (10%), and was managed by balloon tamponade. There were no complications related to transjugular access during a mean follow-up period of 12.6 months. CONCLUSIONS Transjugular access for angioplasty of immature AVFs is feasible and safe. Potential problems associated with access in the outflow vein could be avoided by transjugular access.
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Affiliation(s)
- Seulgi You
- Departments of Radiology, 164, World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 443-380, Republic of Korea
| | - Je Hwan Won
- Departments of Radiology, 164, World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 443-380, Republic of Korea
| | - Chang-Kwon Oh
- Surgery, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 443-380, Republic of Korea
| | - Su Hyung Lee
- Surgery, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 443-380, Republic of Korea
| | - Jong Joon Shim
- Departments of Radiology, 164, World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 443-380, Republic of Korea
| | - Jinoo Kim
- Departments of Radiology, 164, World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 443-380, Republic of Korea.
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Baek Y, Won JH, Kong TW, Paek J, Chang SJ, Ryu HS, Kim J. Lymphatic Leak Occurring After Surgical Lymph Node Dissection: A Preliminary Study Assessing the Feasibility and Outcome of Lymphatic Embolization. Cardiovasc Intervent Radiol 2016; 39:1728-1735. [DOI: 10.1007/s00270-016-1435-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/26/2016] [Indexed: 12/23/2022]
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S TJ, Orillaza, Kim J, Won JH. Percutaneous transgastric stenting of proximal jejunal obstruction secondary to direct invasion of a pancreatic carcinoma. Gastrointestinal Intervention 2016. [DOI: 10.18528/gii150033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Orillaza
- Department of Radiology, Philippine General Hospital, University of the Philippines, Manila, the Philippines
| | - Jinoo Kim
- Department of Radiology, Ajou University Hospital, Suwon, Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University Hospital, Suwon, Korea
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Kim JW, Gwon DIL, Han YM, Won JH, Hong HP, Ko GY, Yoon HK, Sung KB. A prospective, multicenter study of a double stent system for palliative treatment of malignant extrahepatic biliary obstructions. Acta Radiol 2015; 56:1209-15. [PMID: 25260418 DOI: 10.1177/0284185114550702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 08/18/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND A double stent system (covered stent in uncovered stent) was designed to provide long-term patency without tumor ingrowth or stent-related complications, such as stent migration, cholecystitis, or pancreatitis. PURPOSE To investigate the safety and efficacy of double stents in patients with malignant extrahepatic biliary obstructions. MATERIAL AND METHODS This prospective, nonrandomized, multicenter study enrolled 160 consecutive patients (102 men; mean age, 64 years; range, 33-91 years) with malignant extrahepatic biliary obstructions treated with a double stent system from January 2010 to March 2012. RESULTS The technical success rate of the double stent placement was 100%. No stent migration was observed. Procedure-related minor (self-limiting hemobilia [n = 6] and cholangitis [n = 2]) and major (pancreatitis [n = 16], cholecystitis [n = 3], and hepatic abscess [n = 2]) complications occurred in a total of 29 patients. The mean serum bilirubin level, which was 8.9 ± 5.6 mg/dL before drainage, decreased to 2.2 ± 4.6 mg/dL 1 month after stent placement (P < 0.001). Successful internal drainage was achieved in 148 patients (92.5%). During the mean follow-up period of 205 days, acute cholecystitis (n = 3) and hepatic abscess (n = 2) occurred in five patients. The median patient survival and stent patency time were 135 days (95% confidence interval [CI], 96-160 days) and 114 days (95% CI, 83-131 days), respectively. Of 153 patients, 22 (14.4%) presented with stent dysfunction due to sludge incrustation (n = 17), tumor overgrowth (n = 4), or blood clot (n = 1), and required repeat intervention. Tumor ingrowth was not observed in any of these patients. CONCLUSION Percutaneous treatment of malignant extrahepatic biliary obstruction using a double stent safely and effectively achieves internal biliary drainage.
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Affiliation(s)
- Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea
| | - Dong I l Gwon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea
| | - Young-Min Han
- Department of Radiology, Chonbuk National University Medical School and Hospital, Republic of Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University college of Medicine and Hospital, Republic of Korea
| | - Hyun Pyo Hong
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Republic of Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea
| | - Kyu-Bo Sung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea
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Affiliation(s)
- Seong Ho Eo
- Department of Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Su Hyung Lee
- Department of Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Chang-Kwon Oh
- Department of Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
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Kim EY, Won JH, Kim J, Park JS. Percutaneous Pericardial Effusion Drainage under Ultrasonographic and Fluoroscopic Guidance for Symptomatic Pericardial Effusion: A Single-Center Experience in 93 Consecutive Patients. J Vasc Interv Radiol 2015; 26:1533-8. [PMID: 26298485 DOI: 10.1016/j.jvir.2015.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 06/30/2015] [Accepted: 07/16/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of ultrasound-guided and fluoroscopically guided percutaneous pericardial effusion drainage as performed by interventional radiologists in patients with symptomatic pericardial effusion. MATERIALS AND METHODS From July 2002 to December 2013, 93 patients were treated with percutaneous pericardial effusion drainage. Pericardial effusion drainage was performed via 3 routes: apical, subxiphoid, and transhepatic routes. After puncturing the pericardial sac with a 22-gauge needle under ultrasound guidance, a drainage catheter was inserted under fluoroscopic guidance. Pericardial effusion was categorized according to its distribution in the pericardial cavity: "circumferential even," "circumferential uneven" (predominant site specified), and "loculated." Technical success, recurrence, and complication rates were assessed. RESULTS The technical success rate was 99%. Pericardial effusion drainage was performed via the subxiphoid approach in 54 procedures, transhepatic approach in 30 procedures, and apical approach in 13 procedures. The transhepatic approach was mainly performed in cases where the effusion was distributed posteriorly to the heart (80%). One patient died of uncontrolled hypotension without evidence of hemopericardium. CONCLUSIONS Ultrasound-guided and fluoroscopically guided pericardial effusion drainage is a safe and effective procedure for patients with symptomatic pericardial effusion. The transhepatic approach may be preferable for posteriorly distributed pericardial effusion that would otherwise be inaccessible by a traditional subxiphoid or apical approach.
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Affiliation(s)
- Eun Young Kim
- Departments of Radiology, , San 5, Woncheon-dong, Yeongtong-gu, Suwon 443-721, South Korea
| | - Je Hwan Won
- Departments of Radiology, , San 5, Woncheon-dong, Yeongtong-gu, Suwon 443-721, South Korea.
| | - Jinoo Kim
- Departments of Radiology, , San 5, Woncheon-dong, Yeongtong-gu, Suwon 443-721, South Korea
| | - Jin Sun Park
- Cardiology, Ajou University School of Medicine, San 5, Woncheon-dong, Yeongtong-gu, Suwon 443-721, South Korea
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Kim SS, Cho HJ, Won JH, Bae JI, Kang DR, Lee JD, Shin SJ, Lee KM, Yoo BM, Kim JK, Lee JH, Ahn SJ, Park JH, Cho SW, Cheong JY. Interleukin-8 level as a prognostic marker in patients with hepatitis B virus-associated hepatocellular carcinoma treated with transarterial chemoembolization. Cytokine 2015; 76:449-457. [PMID: 26163999 DOI: 10.1016/j.cyto.2015.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 06/19/2015] [Accepted: 07/01/2015] [Indexed: 02/07/2023]
Abstract
We investigated the association between serum interleukin (IL)-8 levels and post-transarterial chemoembolization (TACE) outcomes in patients with hepatitis B virus (HBV)-associated HCC. We enrolled 119 TACE-treated patients with HBV-associated HCC; TACE refractoriness and liver transplantation (LT)-free survival were evaluated during follow-up. Pre-TACE serum levels of various cytokines (epidermal growth factor [EGF], fibroblast growth factor 2, granulocyte-colony stimulating factor [G-CSF], interferon-γ, IL-8, IL-12, IL-17A, interferon-γ-inducible protein-10, monocyte chemotactic protein-1, tumor necrosis factor-α and vascular endothelial growth factor) were analyzed. During a mean follow-up of 24.3 (1-79) months, 91 patients (76.5%) exhibited TACE refractoriness. In multivariate analyses, multiple tumors (hazard ratio [HR], 2.37; 95% confidence interval [CI], 1.28-4.39; P=0.006), large tumor size (HR, 2.36; 95% CI, 1.38-4.03; P=0.002), and combination of alpha-fetoprotein and IL-8 levels (AFP>400 ng/mL or IL-8>32 pg/mL; HR, 1.72; 95% CI, 1.03-2.85; P=0.037) independently predicted overall TACE refractoriness. Higher EGF (>35 pg/mL) and lower G-CSF levels (⩽ 12.5 pg/mL) were associated with early TACE refractoriness (<1 year; HR, 3.47; 95% CI, 1.01-11.96; P=0.049 and HR, 6.25; 95% CI, 1.62-23.81; P=0.008, respectively). Furthermore, high IL-8 level (>32 pg/mL; HR, 1.68; 95% CI, 1.09-2.59; P=0.020) was associated with poor LT-free survival. In conclusion, pretreatment serum IL-8 is a useful prognostic marker for TACE refractoriness and LT-free survival in TACE-treated patients with HBV-associated HCC.
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Affiliation(s)
- Soon Sun Kim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Hyo Jung Cho
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea
| | - Jae Ik Bae
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea
| | - Dae Ryong Kang
- Department of Medical Humanities & Social Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Jung-Dong Lee
- Office of Biostatistics, Ajou University School of Medicine, Suwon, South Korea
| | - Sung Jae Shin
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Kee Myung Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Byung Moo Yoo
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Jai Keun Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea
| | - Jei Hee Lee
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea
| | - Seon Joo Ahn
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Ju Han Park
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Sung Won Cho
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
| | - Jae Youn Cheong
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
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Cho H, Kim JW, Hong YS, Lim SH, Won JH. Stent Compression in Iliac Vein Compression Syndrome Associated with Acute Ilio-Femoral Deep Vein Thrombosis. Korean J Radiol 2015; 16:723-8. [PMID: 26175570 PMCID: PMC4499535 DOI: 10.3348/kjr.2015.16.4.723] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 03/23/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study was conducted to evaluate stent compression in iliac vein compression syndrome (IVCS) and to identify its association with stent patency. MATERIALS AND METHODS Between May 2005 and June 2014, after stent placement for the treatment of IVCS with acute ilio-femoral deep vein thrombosis, follow-up CT venography was performed in 48 patients (35 women, 13 men; age range 23-87 years; median age 56 years). Using follow-up CT venography, the degree of the stent compression was calculated and used to divide patients into two groups. Possible factors associated with stent compression and patency were evaluated. The cumulative degree of stent compression and patency rate were analyzed. RESULTS All of the stents used were laser-cut nitinol stents. The proportion of limbs showing significant stent compression was 33%. Fifty-six percent of limbs in the significant stent compression group developed stent occlusion. On the other hand, only 9% of limbs in the insignificant stent compression group developed stent occlusion. Significant stent compression was inversely correlated with stent patency (p < 0.001). The median patency period evaluated with Kaplan-Meier analysis was 20.0 months for patients with significant stent compression. Other factors including gender, age, and type of stent were not correlated with stent patency. Significant stent compression occurred most frequently (87.5%) at the upper end of the stent (ilio-caval junction). CONCLUSION Significant compression of nitinol stents placed in IVCS highly affects stent patency. Therefore, in order to prevent stent compression in IVCS, nitinol stents with higher radial resistive force may be required.
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Affiliation(s)
- Hun Cho
- Department of Radiology, Ajou University School of Medicine, Suwon 443-380, Korea
| | - Jin Woo Kim
- Department of Radiology, Ajou University School of Medicine, Suwon 443-380, Korea
| | - You Sun Hong
- Department of Thoracic & Cardiovascular Surgery, Ajou University School of Medicine, Suwon 443-380, Korea
| | - Sang Hyun Lim
- Department of Thoracic & Cardiovascular Surgery, Ajou University School of Medicine, Suwon 443-380, Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University School of Medicine, Suwon 443-380, Korea
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Jeong HH, Yoon JH, Oh S, Won JH, Min YG, Gravenstein N, Choi SC. A quantitative analysis of the relation between the clavicular tilt angle and subclavian central venous catheter misplacement. Clin Exp Emerg Med 2014; 1:114-119. [PMID: 27752562 PMCID: PMC5052831 DOI: 10.15441/ceem.14.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 08/01/2014] [Accepted: 08/08/2014] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of the present study was to investigate the relation between shoulder position and subclavian central venous (SCV) catheter misplacement. The shoulder position was estimated using clavicular tilt angle (CTA) values observed on anteroposterior chest X-ray images. Methods A retrospective case-control study was conducted on all adult patients who underwent SCV catheterization in the emergency department during a 12-month period. Collected data included patient age, sex, diagnosis, catheterization side, catheter misplacement, and physician’s level of experience in catheterization. The CTA and other radiological variables such as the ipsilateral transverse length of the thorax and thickness of the clavicle were investigated. Results Among all central venous catheterizations (n=1,599), the subclavian route was used 981 times (61.4%). There were 51 misplacements of SCV catheters (5.2%) during the study period. There were no differences in the sex, age, blood pressure, and diagnosis between the two groups. The CTA values were 28.5°±7.3° and 22.6°±6.3° in the misplacement group and control group, respectively (95% confidence interval, 3.6 to 8.1; P<0.001). Conclusion In this study, the CTA was found to be 5.9° larger in the misplacement group than in the control group. Assuming that CTA indicates the shoulder position, our findings suggest that the chance of SCV catheter misplacement may be reduced by avoiding the shoulder elevated.
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Affiliation(s)
- Hoe-Hwan Jeong
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Jung-Hoon Yoon
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Sungho Oh
- Daegu Research Center for Medical Device and Green Energy, Korea Institute of Machinery & Materials, Daegu, Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Gi Min
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Nikolaus Gravenstein
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Sang-Cheon Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
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Park SY, Kim J, Kim BW, Wang HJ, Kim SS, Cheong JY, Cho SW, Won JH. Embolization of percutaneous transhepatic portal venous access tract with N-butyl cyanoacrylate. Br J Radiol 2014; 87:20140347. [PMID: 25027034 PMCID: PMC4453156 DOI: 10.1259/bjr.20140347] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To evaluate the safety and feasibility of N-butyl cyanoacrylate (N-BCA) embolization of percutaneous transhepatic portal venous access tract and to establish an appropriate technique. METHODS 40 consecutive patients underwent percutaneous transhepatic portal venous intervention for various reasons. Embolization of percutaneous transhepatic portal venous access tract was performed after the procedure in all of the patients using N-BCA and Lipiodol® (Lipiodol Ultra Fluide; Laboratoire Guerbet, Aulnay-sous-Bois, France) mixture. Immediate ultrasonography and fluoroscopy were performed to evaluate perihepatic haematoma formation and unintended embolization of more than one segmental portal vein. Follow-up CT was performed, and haemoglobin and haematocrit levels were checked to evaluate the presence of bleeding. RESULTS Immediate haemostasis was achieved in all of the patients, without development of perihepatic haematoma or unintended embolization of more than one segmental portal vein. Complete embolization of percutaneous access tract was confirmed in 39 out of 40 patients by CT. Seven patients showed decreased haemoglobin and haematocrit levels. Other complications included mild pain at the site of embolization and mild fever, which resolved after conservative management. 16 patients died during the follow-up period owing to progression of the underlying disease. CONCLUSION Embolization of percutaneous transhepatic portal vein access tract with N-BCA is feasible and technically safe. With the appropriate technique, N-BCA can be safely used as an alternate embolic material since it is easy to use and inexpensive compared with other embolic materials. ADVANCES IN KNOWLEDGE This is the first study to investigate the efficacy of N-BCA for percutaneous transhepatic portal venous access tract embolization.
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Affiliation(s)
- S Y Park
- 1 Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
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Affiliation(s)
- Je Hwan Won
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
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Affiliation(s)
- Ji Dae Kim
- Department of Radiology; Ajou University School of Medicine; Suwon Korea
| | - Jae Ik Bae
- Department of Radiology; Ajou University School of Medicine; Suwon Korea
| | - Je Hwan Won
- Department of Radiology; Ajou University School of Medicine; Suwon Korea
| | - Jong Hoon Lee
- Department of Surgery; Ajou University School of Medicine; Suwon Korea
| | - Chang-Kwon Oh
- Department of Surgery; Ajou University School of Medicine; Suwon Korea
| | - Hyuna Jung
- Department of Surgery; Ajou University School of Medicine; Suwon Korea
| | - Hyun Young Lee
- Clinical Trial Center; Ajou University School of Medicine; Suwon Korea
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Chung HH, Kim MD, Won JY, Won JH, Cho SB, Seo TS, Park SW, Kang BC. Multicenter Experience of the Newly Designed Covered Metallic Ureteral Stent for Malignant Ureteral Occlusion: Comparison With Double J Stent Insertion. Cardiovasc Intervent Radiol 2013; 37:463-70. [DOI: 10.1007/s00270-013-0675-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/23/2013] [Indexed: 11/29/2022]
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Bae JI, Won JH, Han SH, Lim SH, Hong YS, Kim JY, Kim JD, Kim JS. Endovascular revascularization for patients with critical limb ischemia: impact on wound healing and long term clinical results in 189 limbs. Korean J Radiol 2013; 14:430-8. [PMID: 23690709 PMCID: PMC3655296 DOI: 10.3348/kjr.2013.14.3.430] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 01/02/2013] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the impact on wound healing and long-term clinical outcomes of endovascular revascularization in patients with critical limb ischemia (CLI). Materials and Methods This is a retrospective study on 189 limbs with CLI treated with endovascular revascularization between 2008 and 2010 and followed for a mean 21 months. Angiographic outcome was graded to technical success (TS), partial failure (PF) and complete technical failure. The impact on wound healing of revascularization was assessed with univariate analysis and multivariate logistic regression models. Analysis of long-term event-free limb survival, and limb salvage rate (LSR) was performed by Kaplan-Meier method. Results TS was achieved in 89% of treated limbs, whereas PF and CF were achieved in 9% and 2% of the limbs, respectively. Major complications occurred in 6% of treated limbs. The 30-day mortality was 2%. Wound healing was successful in 85% and failed in 15%. Impact of angiographic outcome on wound healing was statistically significant. The event-free limb survival was 79.3% and 69.5% at 1- and 3-years, respectively. The LSR was 94.8% and 92.0% at 1- and 3-years, respectively. Conclusion Endovascular revascularization improve wound healing rate and provide good long-term LSRs in CLI.
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Affiliation(s)
- Jae-Ik Bae
- Department of Radiology, Ajou University School of Medicine, Suwon 443-721, Korea
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Ahn SJ, Bae JI, Han TS, Won JH, Kim JD, Kwack KS, Lee JH, Kim YC. Percutaneous biliary drainage using open cell stents for malignant biliary hilar obstruction. Korean J Radiol 2012; 13:795-802. [PMID: 23118579 PMCID: PMC3484301 DOI: 10.3348/kjr.2012.13.6.795] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 05/14/2012] [Indexed: 12/17/2022] Open
Abstract
Objective To evaluate the feasibility, safety and the effectiveness of the complex assembly of open cell nitinol stents for biliary hilar malignancy. Materials and Methods During the 10 month period between January and October 2007, 26 consecutive patients with malignant biliary hilar obstruction underwent percutaneous insertion of open cell design nitinol stents. Four types of stent placement methods were used according to the patients' ductal anatomy of the hilum. We evaluated the technical feasibility of stent placement, complications, patient survival, and the duration of stent patency. Results Bilobar biliary stent placement was conducted in 26 patients with malignant biliary obstruction-T (n = 9), Y (n = 7), crisscross (n = 6) and multiple intersecting types (n = 4). Primary technical success was obtained in 24 of 26 (93%) patients. The crushing of the 1st stent during insertion of the 2nd stent occurred in two cases. Major complications occurred in 2 of 26 patients (7.7%). One case of active bleeding from hepatic segmental artery and one case of sepsis after procedure occurred. Clinical success was achieved in 21 of 24 (87.5%) patients, who were followed for a mean of 141.5 days (range 25-354 days). The mean primary stent patency period was 191.8 days and the mean patient survival period was 299 days. Conclusion Applying an open cell stent in the biliary system is feasible, and can be effective, especially in multiple intersecting stent insertions in the hepatic hilum.
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Affiliation(s)
- Sun Jun Ahn
- Department of Radiology, Ajou University School of Medicine, Suwon 443-380, Korea
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Lee JH, Won JH, Oh CK, Jung HA. Clinical significance of upper-arm cephalic vein patency in autogenous radial-cephalic wrist fistulas for hemodialysis. Eur J Vasc Endovasc Surg 2012; 44:514-20. [PMID: 23022033 DOI: 10.1016/j.ejvs.2012.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 08/28/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate the significance of upper-arm cephalic veins (UACVs) in radial-cephalic arteriovenous fistulas (RCAVFs), the medical records of 183 patients who had undergone RCAVF creation were reviewed retrospectively. METHODS The patients were divided into two groups according to the status of the UACV upon preoperative venography: group A of 153 cases (83.6%) with a patent UACV and group B of 30 cases (16.3%) with a stenosed or occluded UACV. The clinical outcomes were compared. RESULT RCAVFs in group B had a significantly higher maturation failure rate (26.7% vs. 9.8%, p = 0.009) and lower primary/secondary patency rates (log-rank test, p < 0.0001) than those in the group A. The patients in group B required more frequent endovascular intervention to maintain access function (p = 0.002). The most common stenosis site was a draining vein in group B, in comparison to juxta-anastomosis in group A. In the multivariate analyses, the status of the UACV was an independent predictor of the primary and secondary patency rates of RCAVFs (p < 0.005). CONCLUSION UACV patency has a significant impact on clinical outcome for RCAVFs. When planning an RCAVF placement, venous status including the UACV should be considered.
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Affiliation(s)
- J H Lee
- Department of Surgery, Ajou University School of Medicine, Wonchon-Dong, Yeongtong-Gu, Suwon, Republic of Korea
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Lee JH, Won JH, Oh CK. Impact of the ratio of graft kidney volume to recipient body surface area on graft function after live donor kidney transplantation. Clin Transplant 2011; 25:E647-55. [PMID: 21906170 DOI: 10.1111/j.1399-0012.2011.01502.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Functioning nephron mass is a determinant of the graft function of kidney transplant recipients. The graft kidney volume and its weight have been reported to be surrogates of the nephron mass. To investigate the impact of the ratios of the surrogates to recipient body surface area (BSA) and body weight on the graft function within six months post-transplantation, we measured the graft kidney volume, using computed tomography with 3-dimensional reconstruction before transplantation, and measured the graft kidney weight during surgery. Ninety-four cases of live donor kidney transplants were included in this study. The graft kidney volume/recipient BSA ratio was correlated with the glomerular filtration rate (GFR) of recipients at one and six months post-transplantation (r = 0.416, p < 0.001 and r = 0.381, p < 0.001, respectively). We found a difference in the graft function between recipients with a graft kidney volume/recipient BSA ratio of ≥90.9 mL/m(2) and those with a ratio of <90.9 mL/m(2) (p < 0.001). Multivariate analysis demonstrated that the graft kidney volume/recipient BSA ratio and donor age are independent predictors of recipient GFR at one and six months post-transplantation (p < 0.05). During living donor and recipient matching, both the potential volume of the donated kidney and the body size of recipient should be considered.
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Affiliation(s)
- Jong Hoon Lee
- Department of Surgery, Kwandong University College of Medicine, Myongji Hospital, Goyang, Korea
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Yang MJ, An SY, Moon EJ, Lee MS, Hwang JA, Cheong JY, Won JH, Kim JK, Wang HJ, Cho SW. [Comparison of radiofrequency ablation and transarterial chemoembolization for the treatment of a single hepatocellular carcinoma smaller than 4 cm]. Korean J Hepatol 2010; 15:474-85. [PMID: 20037266 DOI: 10.3350/kjhep.2009.15.4.474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND/AIMS Radiofrequency ablation (RFA) is an established curative therapeutic modality for unresectable hepatocellular carcinoma (HCC), and transarterial chemoembolization (TACE) has been used as a palliative treatment for inoperable HCC. It is still unknown whether RFA and TACE are equally effective for improving the survival of patients with unresectable HCC that is amenable to either treatment. The aim of this retrospective study was to compare the clinical impacts of two treatments, and analyze the prognostic factors for recurrence and survival. METHODS Ninety-three patients with a single HCC smaller than 4 cm who showed complete responses (complete ablation or complete lipiodol tagging) after treatment with RFA (n=43) or TACE (n=50) between January 2002 and February 2009 were investigated. Univariate and multivariate analyses were performed for 13 potential prognostic factors using the Cox proportional-hazards model. RESULTS The time-to-recurrence rates at 1, 2, and 3 years after treatment were 32.9%, 44.3%, and 55.4%, respectively, for the RFA group, and 42%, 68.3%, 71.7% for the TACE group. The probability of survival at 1, 2, and 3 years was 97.7%, 77.4%, and 63.1%, respectively, for the RFA group, and 95.9%, 76.1%, and 60.2% for the TACE group. The time-to-recurrence and overall survival rates did not differ significantly between the two treatment groups. A multivariate Cox proportional-hazards model revealed that a tumor size larger than 3 cm and lower serum albumin levels were independent risk factors for recurrence, and that being male, being seropositive for hepatitis B surface antigen, and having a higher serum albumin level were independent favorable prognostic factors for survival. CONCLUSIONS TACE and RFA exhibited similar therapeutic effects in terms of recurrence and survival for patients with a single HCC smaller than 4 cm, if they could exhibited complete responses.
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Affiliation(s)
- Min Jae Yang
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
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Lee JH, Won JH, Bae JI, Kim JH, Lee HS, Jung SM. Chemical Ablation of the Gallbladder with Acetic Acid. J Vasc Interv Radiol 2009; 20:1471-6. [DOI: 10.1016/j.jvir.2009.07.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Revised: 06/19/2009] [Accepted: 07/13/2009] [Indexed: 10/20/2022] Open
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Kim BW, Bae BK, Lee JM, Won JH, Park YK, Xu WG, Wang HJ, Kim MW. Duct-to-duct biliary reconstructions and complications in 100 living donor liver transplantations. Transplant Proc 2009; 41:1749-55. [PMID: 19545721 DOI: 10.1016/j.transproceed.2009.02.097] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 02/23/2009] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We evaluated the risk factors for biliary complications and surgical procedures for duct-to-duct reconstructions in adult living donor liver transplantation (LDLT). PATIENTS AND METHODS From February 2005 to March 2008, we performed 100 cases of adult LDLT with duct-to-duct biliary reconstruction, using 64 right lobe grafts, 33 left lobe grafts, and 3 right lateral grafts. We employed 4 types of duct-to-duct procedures: all interrupted 6-0 Prolene suture (group 1, n = 9); continuous posterior and interrupted anterior wall 6-0 Prolene suture (group 2, n = 49); all continuous 7-0 Prolene suture (group 3, n = 26); and all continuous 7-0 Prolene suture with external stent (group 4, n = 16). Biliary complications were defined as an anastomosis stricture or a leakage. RESULTS Thirty-four patients experienced biliary complications during the follow-up period (median, 27 months). The incidence of stricture was 27% and that of leakage, 8%. There were no perioperative, intraoperative, or anatomic risk factors for biliary complications, except the type of duct-to-duct procedure. Group 1 and 2 patients showed higher incidences of biliary strictures than groups 3 and 4 (43.1% vs 4.7%; P = .00). Group 3 patients experienced a higher incidence of bile leakage than the other groups (23.1% vs 2.7%; P = .004). CONCLUSIONS The type of biliary reconstruction is a factor affecting biliary complications following duct-to-duct anastomosis in LDLT. Duct-to-duct biliary anastomosis with 7-0 monofilament suture and a small external stent is a feasible procedure in LDLT that significantly reduces the incidence of biliary complications.
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Affiliation(s)
- B W Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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Nam SC, Han SH, Lim SH, Hong YS, Won JH, Bae JI, Jo J. Factors affecting the validity of ankle-brachial index in the diagnosis of peripheral arterial obstructive disease. Angiology 2009; 61:392-6. [PMID: 19759029 DOI: 10.1177/0003319709348295] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We evaluated 158 legs from 79 consecutive patients who had undergone both ankle-brachial index (ABI) measurements and angiography for claudication symptoms between January 2007 and December 2008. The diagnosis of peripheral arterial disease (PAD) in the individual legs was established by angiography. Ankle-brachial index was considered abnormal if it was <0.9. The sensitivity and specificity of ABI was 61% and 87%, respectively. To assess the factors affecting the validity of ABI in the diagnosis of PAD, multivariate logistic regression analysis was conducted. The odds ratios (ORs) for the false negative result of ABI were 4.36 (95% confidence interval [CI] 1.36-13.92) in patients with diabetes mellitus (DM), 3.41 (95% CI 1.10-10.48) in patients with distal lesions, 3.02 (95% CI 1.07-8.49) in elderly patients, and 1.13 (95% CI 0.34-3.42) in patients with mild stenosis. Although ABI is the method of choice for the primary diagnosis of PAD, other supplementary investigations should be considered when there is clinical suspicion of PAD but an ABI <0.9.
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Affiliation(s)
- Su Chung Nam
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Youngtong-gu, Suwon, Kyounggi-do, Korea
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Jeon GS, Won JH, Lee BM, Kim JH, Ahn HS, Lee EJ, Park SI, Park SW. The Effect of Transarterial Prostate Embolization in Hormone-induced Benign Prostatic Hyperplasia in Dogs: A Pilot Study. J Vasc Interv Radiol 2009; 20:384-90. [DOI: 10.1016/j.jvir.2008.11.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 11/05/2008] [Accepted: 11/10/2008] [Indexed: 12/17/2022] Open
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Lee J, Won JH, Kim HC, Soh EY. Emergency dilation by self-expandable tracheal stent for upper airway obstruction in a patient with a giant primary thyroid lymphoma. Thyroid 2009; 19:193-5. [PMID: 19191750 DOI: 10.1089/thy.2008.0166] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Lee JH, Won JH, Park SI, Won JY, Lee DY, Kang BC. Transcatheter arterial chemoembolization of hepatocellular carcinoma with hepatic arteriovenous shunt after temporary balloon occlusion of hepatic vein. J Vasc Interv Radiol 2008; 18:377-82. [PMID: 17377183 DOI: 10.1016/j.jvir.2007.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Hepatocellular carcinoma with hepatic artery to hepatic vein (AV) shunt has increased risk of pulmonary complications during transcatheter arterial chemoembolization (TACE). The purpose of this study is to assess temporary balloon occlusion as a means of preventing pulmonary complications during TACE of hepatocellular carcinoma with AV shunt. MATERIALS AND METHODS Eleven hepatocellular carcinoma patients (M: F = 9:2; mean age, 48 years) with angiographically evident AV shunt underwent TACE with occlusion of the shunt-draining hepatic veins using temporary occlusion balloon catheters. All tumors were in the right lobe, and all AV shunts were between the right hepatic artery and right hepatic vein. The occlusion balloon was inserted via femoral (n = 6) or jugular (n = 5) venous access. The balloon diameter ranged from 8.5 to 11.5 mm and time of ballooning was 3 to 15 minutes (mean, 9.5 minutes). TACE was performed using emulsion of iodized oil and doxorubicin, followed by Gelfoam embolization. The balloon was deflated immediately after chemoembolization, and physical examination and chest radiography were performed. Follow-up computed tomography was performed within 2 weeks after TACE to evaluate the result and pulmonary complications. RESULTS The technical success rate was 100%. There was no symptom, sign, or radiographic evidence of pulmonary complication. Follow-up computed tomography revealed complete iodized oil uptake by the tumor in eight patients and incomplete uptake by the tumor in three patients. There was no iodized oil uptake in the lungs. CONCLUSIONS Temporary balloon occlusion of the hepatic vein in hepatocellular carcinoma with AV shunt allowed completion of TACE using conventional method while preventing pulmonary complications.
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Affiliation(s)
- Jong Hyeog Lee
- Department of Diagnostic Radiology, Ajou University College of Medicine, Woncheon-dong, Paldal-gu, Suwon-si, Gyeonggi-do 442-721, Republic of Korea
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Noh HW, Park KJ, Sun JS, Won JH, Kwack KS, Choi H, Lee KB, Park JH. Primary pulmonary malignant fibrous histiocytoma mimics pulmonary artery aneurysm with partial thrombosis: various radiologic evaluations. Eur Radiol 2008; 18:1653-7. [DOI: 10.1007/s00330-008-0922-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 01/02/2008] [Accepted: 01/28/2008] [Indexed: 12/01/2022]
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Affiliation(s)
- Je Hwan Won
- Department of Diagnostic Radiology, Ajou University School of Medicine, Korea.
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Kim BM, Cho JH, Won JH, Lee DY, Lee JT, Kim HC, Park SI. Altered findings of hepatic arteriography after radiofrequency ablation of hepatocellular carcinoma: comparison of pre-ablation and post-ablation angiograms. ACTA ACUST UNITED AC 2006; 32:332-8. [PMID: 16933116 DOI: 10.1007/s00261-006-9059-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Accepted: 05/26/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the altered findings of hepatic arteriography after radiofrequency (RF) ablation of hepatocellular carcinoma which can potentially influence subsequent transcatheter arterial chemoembolization. MATERIALS AND METHODS Hepatic arteriograms of 26 index hepatocellular carcinomas in 24 patients treated only by RF ablation (M:F = 22:2, mean age 55 years), in which hepatic arteriography was performed before and after RF ablation, were retrospectively compared for the altered findings. RESULTS The altered findings of hepatic arteriography after RF ablation of the hepatocellular carcinoma were arterio-portal shunt (n = 3), periablational enhancement (n = 5), varied caliber of the feeding artery to the index tumor (n = 12) among which eight decreased, and occlusion of an adjacent arterial branch (n = 8). Residual unablated or locally progressed tumor was not detected in post-RF ablation arteriography (n = 5) due to the arterio-portal shunt (n = 2) or the periablational enhancement (n = 3). The possibility of not detecting the residual unablated or locally progressed tumor was higher within 24 weeks after RF ablation (Mann-Whitney test, P = 0.041). CONCLUSION The findings of hepatic arteriography are altered after RF ablation, and the altered findings may increase the difficulty in performing super-selective transcatheter arterial chemoembolization due to undetected tumor staining, decreased caliber, or occlusion of the feeding artery.
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Affiliation(s)
- Byung Moon Kim
- Department of Diagnostic Radiology, Kangbuk Samsung Hospital, Seoul, Korea
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Won JH, Park SI, Park KJ, Oh YJ, Hwang SC. Microcatheter placement through a side hole created in a 5-F catheter into proximal subclavian arterial branches causing hemoptysis. J Vasc Interv Radiol 2006; 15:881-4. [PMID: 15297595 DOI: 10.1097/01.rvi.0000136996.50373.e4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Five patients with moderate to massive hemoptysis who had a bronchial artery of anomalous origin or a nonbronchial systemic artery originating from the proximal subclavian artery underwent microcatheter placement through a created side hole of a 5-F catheter. All patients had pulmonary tuberculosis and had undergone bronchial artery embolization for hemoptysis. The side holes were made in the lesser (n = 2) or greater curvature sides (n = 3) of 5-F nonbraided Headhunter catheters. A microcatheter was passed through the side hole of the 5-F catheter into the target artery for embolization. Polyvinyl alcohol particles were used as the embolic material. The technical success rate was 100%, and immediate control of hemoptysis was achieved in all patients without complication.
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Affiliation(s)
- Je Hwan Won
- Department of Diagnostic Radiology, Soonchunhyang University, Cheonan Hospital, Cheonan, Republic of Korea.
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Lim TY, Cheong JY, Cho SW, Sim SJ, Kim JS, Choi SJ, Choi JW, Kwon HC, Lee KM, Kim JK, Won JH, Yoo BM, Lee KJ, Hahm KB, Kim JH. [Effect of low dose 5-fluorouracil and cisplatin intra-arterial infusion chemotherapy in advanced hepatocellular carcinoma with decompensated cirrhosis]. Korean J Hepatol 2006; 12:65-73. [PMID: 16565607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND/AIMS Advanced hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) has a poor prognosis. The aim of this study was to evaluate the efficacy and safety of repeated arterial infusions of low dose cisplatin and 5-fluorouracil (FU) in patients with advanced HCC with decompensated cirrhosis. METHODS Between January 1995 and December 2003, a total of 79 decompensated cirrhotic patients having HCC and PVT were enrolled and divided into 2 groups. Group 1 (n=40) received intra-arterial infusion chemotherapy with cisplatin (10 mg for 5 days) and 5-FU (250 mg for 5 days) via an implanted chemoport every 4 weeks' and group 2 (n=39) was managed with only conservative treatment. RESULTS The two groups were well matched with respect to the features relating to the prognosis, including age, gender and the Child- Pugh class. Although diffuse tumor involvement, main portal vein tumor thrombosis and bi-lobar involvement were more frequent in group 1, the median survival period of group 1 was significantly longer than group 2 (5 months vs. 3 months, respectively, P=0.016). Also, the 1-year survival rate of group 1 (7.5%) was higher than that of group 2 (5.1%) (P=0.016). When we analyzed the patients with the Child class B, the survival benefits of intra-arterial chemotherapy were more significant (P=0.008). CONCLUSIONS Intra-arterial chemotherapy consisting of low dose 5-FU and cisplatin achieved favorable results for advanced HCC patients who had decompensated cirrhosis, and it showed better survival in selected patients. This therapy may be useful as a palliative treatment for HCC patients with decompensated cirrhosis.
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Affiliation(s)
- Tae Young Lim
- Department of Gastroenterology, Genomic Research Center for Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
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