• Title/Summary/Keyword: 혈관내 시술

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Transcatheter Intravascular Stent Placement in a Shih Tzu Dog with Refractory Pulmonic Stenosis (카테터를 통한 혈관스텐트 장착을 통한 심한 폐동맥협착증 치료 1례)

  • Kim, Hyun-Wook;Kim, Sung-Soo;Lee, Joon-Soek;Nam, So-Jeong;Choi, Ran;Hyun, Chang-Baig
    • Journal of Veterinary Clinics
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    • v.26 no.1
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    • pp.48-53
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    • 2009
  • A 4-year-old intact male Shih Tzu dog (5.4 kg of body weight) was referred with primary complaints of heart murmur and exercise intolerance. Diagnostic studies found severe valvular pulmonic stenosis (peak velocity of 6.4 m/s, pressure gradient 165 mmHg). The dog was treated with 3 cm (length) ${\times}$ 1.5 cm (diameter) of Palmaz biliary stent. The outcome of stent placement was favorable and remarkably reduced the severity of PS (6.4 m/s to 3.0 m/s of peak velocity). Clinical condition was remarkably improved with the absence of cardiac murmur, although mild pulmonic regurgitation existed from the day of stent placement. To our best knowledge, this case is the first clinical trial for treating PS with intravascular stent in Korea.

Surgical Management of Critical Pulmonary Stenosis -A case report- (중증 폐동맥협착증의 외과적 치료 -1례 보고-)

  • Jung, Tae-Yeol;Ban, Dong-Gyu;Kim, Hyuck;Kim, Young-Hak;Chung, Won-Sang;Kang, Jeong-Ho;Jee, Heng-Ok;Lee, Chul-Bum;Kim, Nam-Su;Seoh, Jung-Kuk
    • Journal of Chest Surgery
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    • v.33 no.12
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    • pp.963-967
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    • 2000
  • 정상심실중격의 폐동맥협착은 흔한 선천성 심장질환이지만 신생아기에 심한 증세를 보이는 위기적 폐동맥 협착은 드물며 예후도 대단히 나쁘다. 경피적 풍선 판막성형술의 발달과 함께 폐동맥협착의 외과적 치료는 더욱 줄어드는 추세이다. 본 증례는 정상심실중격의 위기적 폐동맥협착증으로 진단받은 생후 2일된 남자 신생아로 심한 청색증과 저산소증을 보여 응급실로 내원하였다. 환아는 산소공급 및 Prostaglandin E$_1$을 투여 후 동맥혈 산소 분압이 19 mmHg에서 54mmHg로 증가하였다. 경피적 풍선 판막성형술을 시도하였으나 유도도관(Guide wire)이 판막의 개구부를 통과하지 못하였고 시술도중 심낭내로 조영제가 고이는 소견을 보여 우심실 천공이 의심되었으므로 응급으로 정상체온의 체외순환하에서 폐동맥 절개후 폐동맥 판막절개술을 시행하였다. 수술 후 중환자실에서의 수술경과는 양호하였고 현재 수술 6개월째 외래 추적관찰중이다.

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Interventional Management for Pelvic Trauma (골반 외상 인터벤션)

  • Jung Han Hwang;Jeong Ho Kim;Suyoung Park
    • Journal of the Korean Society of Radiology
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    • v.84 no.4
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    • pp.835-845
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    • 2023
  • Traumatic pelvic injuries usually include high-energy crush injuries and are associated with significant morbidity and mortality. Mortality rates range from 6% to 15% and increase to 36%-54% in cases of fractures that result in increased pelvic volume. Therefore, retroperitoneal hemorrhage can spiral and progress to hemorrhagic shock. Pelvic hemorrhage most commonly occurs secondary to disrupted pelvic veins or fractured bones, and 10%-20% of cases involve arterial injuries. Owing to extensive bleeding and limitations of surgery for pelvic hemorrhage, interventional treatment is at the forefront of pelvic hemorrhage management. CT is an accurate indicator of active hemorrhage in patients with pelvic trauma that affects the diagnosis and management, including interventions. Identification of the site of hemorrhage is necessary for focused interventional treatment. The current trend toward a more conservative approach for treatment of pelvic trauma and advances in interventional radiology in the field of pelvic trauma may favor widespread use of interventional treatment for patients with pelvic injuries. In this review, we discuss therapeutic modalities available to the interventional radiologist and common angiographic treatment strategies and techniques.

Comparison of Femoropopliteal Bypass and Superficial Femoral Artery Stenting for Treating Femoral Artery Occlusive Disease (대퇴동맥 폐색증에서 대퇴동맥-슬와동맥 우회술과 대퇴동맥 스텐트 삽입술의 비교)

  • Lee, Gun;Lim, Chang-Young;Kim, Man Deuk;Lee, Hyeon-Jae
    • Journal of Chest Surgery
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    • v.42 no.1
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    • pp.53-58
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    • 2009
  • Background: The goal of this study was to compare the patency and complications of femoropopliteal bypass with superficial femoral artery stenting for patients with atherosclerotic superficial femoral artery occlusive disease. Material and Method: Between July 2005 and July 2008, we reviewed 29 femoropopliteal bypass procedures (24 patients) with prosthetic grafts (the bypass group) and 19 superficial femoral artery stentings (15 patients) with nitinol stent (the stent group). There were 35 male patients (89.7%) and the mean age of the patients was 69.2 years (range: 48~84). The number of patients who had DM, hypertension and a smoking history was 25 patients (64.1%), 17 patients (43.6%) and 30 patients (76.9%), respectively. 23 (59.0%) patients had skin ulceration or tissue gangrene at admission. Result: There were 27 cases (93.0%) of TASC C&D lesion in the bypass group and 16 cases (84.2%) of TASC A&B lesion in the stent group. There were significant differences for the indications for a procedure between the two groups (p<0.01). The primary patency rates at 6 months, 12 months and 24 months were 91.9%, 79.7% and 79.7% for the bypass group and 93.3%, 86.2% and 86.2% for the stent group, respectively. There were no statistical difference between the two groups (p=0.48). Conclusion: There were no significant differences in the outcome between two groups. TASC C&D lesion and failed intervention therapy should be treated with femoropopliteal bypass surgery, and TASC A&B lesion and the high-risk patients should be treated with femoral artery stent insertion.

Clinical Outcomes and Prognosis of Patients with Stent Fracture after Successful Drug-Eluting Stent Implantation (관상동맥 약물 방출 스텐트 삽입 후 스텐트 골절에 대한 임상결과 및 예후)

  • Kim, In-Soo;Han, Jae-Bok;Jang, Seong-Joo
    • Journal of radiological science and technology
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    • v.37 no.2
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    • pp.109-116
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    • 2014
  • Many studies have suggested that in the era of Drug-Eluting Stents(DES) are one of the causes of In-Stent Restenosis(ISR) of Stent Fracture(SF). The present study sought to evaluate clinical characteristics of patients with stent fracture after successful DES implantation. The 4,701 patients were selected for analysis who underwent a follow-up coronary angiography irrespective of ischemic symptoms. The overall incidence of SF was 32 patients(male:female=19:13, Av. age $62.44{\pm}9.8$year, 0.68%). Fractures of Sirolimus-Eluting Stents(SES), Paclitaxel-Eluting Stents(PES), Biolimus A9-Eluting Stents(BES), Everolimus-Eluting Etents(EES), Endothelial Progenitor Cell Capture Stent(EPC) and Zotarolimus-Eluting Stents(ZES) are accounted for 19(59.4%), 9(28.1%), 2(6.3%), 1(3.1%), 1(3.1%) and 0(0%) respectively. SF developed in the left Anterior Dscending(LAD) artery in 16 patients(50%) and in complex(type B2, C) lesions in 25 patients(69.4%). Ten patients were treated with heterogenous DES, the rest being treated with either homogenous DES(3 patients), plain old balloon angioplasty(3 patients), or conservative medical treatment(17 patients). None of the patients with SF suffered from cardiac death during a follow-up period of $32.9{\pm}12.4$ months. The overall rate of DES fracture over up to 3.7 years of follow-up was 0.68% with higher incidence in SES than in PES. SF frequently occurred in the LAD artery and in complex lesions. Of the patients with SF, coronary intervention was performed only when the binary restenosis lesion was significant. During the follow-up, patients with SF have continued on combination antiplatelet therapy. There is a very low rate of major adverse cardiac events(post-detection of SF), especially cardiac death associated with SF.

Surgical Treatment for Renovascular Hypertension and Iliac Artery Occlusion (신혈관성 고혈압 및 장골동맥 폐쇄에 대한 수술)

  • Ryu, Kyoung-Min;Ryu, Jae-Wook;Park, Seong-Sik;Kang, Tae-Soo;Kim, Seok-Kon;Seo, Pil-Won
    • Journal of Chest Surgery
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    • v.40 no.8
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    • pp.582-586
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    • 2007
  • A 48-year old male patient visited our hospital with uncontrolled hypertension and pair of the left leg. CT angiography shows atherosclerotic occlusion of both renal artery orifices and the left common iliac artery. Despite of medical treatment for 2 months, the clinical condition of the patient worsened. We performed the surgical revascularization with both renal arteries and aorto-left femoral artery bypass with using an 8 mm artificial vascular graft. He lived well without hypertension with using only angiotensin receptor blocker and an anticoagulant for 10 postoperative months. Using surgical revascularization for renovascular hypertension has decreased due to the development of intervention technology and medication, but this surgery is indicated in cases of renovascular hypertension with extensive atherosclerotic lesions. We report here on a case of surgical revacularization for medically Intractable atherosclerotic renovascular hypertension together with left common iliac artery occlusion.

Placement of a Subclavian Tunneled Hemodialysis Catheter with the Patient's Arm Raised May Reduce the Risk of Complications: Two Cases Report (쇄골하정맥을 통한 매립혈액투석카테터 삽입시 상지 거상법의 유용성: 2예 보고)

  • Jimin Yoo;Dong Jae Shim;Doyoung Kim;Seung Hwan Baek;Chang Suk Park;Jeong Whee Lee
    • Journal of the Korean Society of Radiology
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    • v.84 no.2
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    • pp.477-482
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    • 2023
  • The subclavian vein is an uncommon route for tunneled hemodialysis catheter (tHDC) placement because of its potency for future dialysis access. However, when favored access routes have been exhausted because of repeated catheterization or limited life expectancy, the subclavian vein can be used for urgent hemodialysis. A subclavian catheterization has a technical problem. The subclavian vein often forms a right angle with the vena cava, and advancing stiff peel-away sheath can cause a vascular injury. However, raising the patient's arm can alter the position of the guidewire and, therefore, change the angle of the vein favorable for tHDC placement. Herein, we report two patients who underwent subclavian catheterization; one experienced an injury to the superior vena cava after undergoing the conventional procedure, whereas the other patient with raised arm during the catheterization procedure had safe catheter placement.

Direct Action of Relaxin on the Pig Mammary Glands to Promote Development of the Alveoli and Remodeling of the Extracellular Matrix (Relaxin Hormone의 직접젇인 작용에 의한 돼지 유선상피세포의 발달과 세포외간 기질의 분해개조 촉진)

  • Min, G.S.
    • Journal of Animal Science and Technology
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    • v.46 no.4
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    • pp.585-592
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    • 2004
  • Our previous studies demonstrated that relaxin in concert with estrogen promotes development of the mammary parenchyma during the last third of gestation in gilts, and the specific relaxin-binding sites were present in the mammary gland. This study was conducted to determine if relaxin-binding sites in the mammary gland were functional relaxin receptors. Three cycling cross-bred gilts were bilaterally ovariectomized on day 0 of the experiment. Beginning on day 15 and continuing through day 29 post-surgery, the gilt received an im. injection of estradiol benzoate at 12-hr intervals. Beginning on day 22 post-surgery, highly purified porcine relaxin was administered(lug/hr) into the left fourth mammary gland from the anterior end via miniature osmotic pump. Physiological saline was administered to the right fourth mammary gland. The gilt was sacrificed on day 29 post-surgery and histological characteristics of the mammary parenchyma were examined. The mammary glands treated locally with saline showed little, if any, lobulo-alveolar development, whereas the mammary glands treated with relaxin showed not only marked lobulo-alveolar development but also prominent secretions in the alveoli. The saline-treated glands were characterized by relatively dense and highly organized collagen fiber bundles. Whereas, in the relaxin-treated mammary glands, collagen fiber bundles were dispersed and loosely organized. In conclusion, relaxin-binding sites in the mammary gland are functional relaxin receptors and relaxin acts directly on the pig mammary gland to promote development of the alveoli and remodeling of the extracellular matrix.

Transcatheter Arterial Embolization for Palliation of Uterine Body Cancer Bleeding (자궁체부암 출혈에 대한 보존적 치료로써의 경카테터 동맥 색전술)

  • Jaeyeon Choi;Ji Hoon Shin;Hee Ho Chu
    • Journal of the Korean Society of Radiology
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    • v.84 no.3
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    • pp.606-614
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    • 2023
  • Purpose This study aimed to evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for bleeding due to uterine body cancer. Materials and Methods In this retrospective study, six patients with varying types of uterine body cancer who underwent TAE for bleeding control were investigated. Angiographic findings, cross-sectional images, TAE details, and clinical outcomes were studied. Technical and clinical success rates were calculated. Results The identified patients had endometrioid adenocarcinoma, sarcoma, and gestational trophoblastic neoplasia, and most were patients with advanced-stage cancer. In four patients, tumor bleeding presented as vaginal bleeding. Technical success was achieved in all seven TAE procedures in six patients. Two patients with recurrent masses who had undergone hysterectomy presented with hematochezia, and TAE was able to provide technical success in these patients as well. The clinical success rate was 50%, indicating bleeding control for > 1 week. Rebleeding was directly associated with death in one patient. On the following day, mild fever was observed in one patient. Conclusion TAE can be considered an effective and safe method of bleeding control for uterine body cancer, especially during critical periods throughout the disease course of patients with inoperable, advanced-stage cancer.

Responsiveness of Muscarinic and Alpha Adrenergic Activation on Endothelial Cell in Isolated Canine Renal Arteries (개 신동맥 내피세포의 무스카린성 및 알파 아드레날린성 수용체에 대한 작용)

  • Chung, Soo-Youn;Chang, Ki-Churl;Lim, Jung-Kyoo
    • The Korean Journal of Pharmacology
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    • v.25 no.1
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    • pp.43-51
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    • 1989
  • Responsiveness of muscarinic and alpha adrenoceptor activation on endothelial cells was studied in isolated canine renal artery rings. Ach (10-100 nM), dose dependently, relaxes endothelial intact rings precontracted with phenylephrine ($IC_{50}$ of Ach was 34.5 nM). Selective mechanical destruction of the endothelium transformed the activity of this substance from vasodilatation to vasoconstriction. Acetylcholine induced relaxations could be selectively inhibited competitively by atropine, but could not be inhibited by cyclooxygenase inhibitor. Methylene blue, however, an inhibitor of soluble guanylate cyclase activity, inhibited Ach as well as sodium nitroprusside (SNP) induced relaxation. Relaxation produced by prostacyclin was not modified by methylene blue. On the other hand, alpha adrenoceptor agonist did not relax but contract canine renal artery rings possessing an intact intima precontracted with U-46619. Clonidine, however, selective alpha-2 adrenergic agonist, is more susceptible than phenylepherine, selective alpha-1 adrenergic agonist, to the inhibitory effect of contraction. These results suggest that in canine renal artery rings, 1) muscarinic receptor is responsible for releasing endothelium dependent relaxation factor (EDRF). 2) alpha-1 and alpha-2 adrenergic receptors are present in canine renal artery. 3) relaxation via EDRF is antagonized by methylene blue, providing further evidence that EDRF acts through a cGMP mechanism.

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