• Journal of Trauma and Injury
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• 제29권2호
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• pp.47-50
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• 2016

Transcatheter arterial embolization (TAE) for blunt hepatic injury in children is not common and is especially rare after damage control surgery (DCS). We report a successful TAE after DCS on a child for massive bleeding from the left hepatic artery due to a motor vehicle accident. The car (a sport utility vehicle) ran over the chest and abdomen of a 4-year-old boy. On arrival, initial vital signs were as follows: blood pressure, 70/40 mmHg; heart rate, 149/min; temperature, $36.7^{\circ}C$; respiratory rate, 38/min. After resuscitation, computed tomography was done, and a suspicious contrast leakage from a branch of the left hepatic artery and a spleen injury (grade V) were found. TAE was performed successfully after DCS for a liver injury.

• 대한구순구개열학회지
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• 제13권2호
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• pp.85-92
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• 2010

Vascular malformations (VMs) in the head and neck region are present at birth and grow commensurately with the child, they can result in significant cosmetic problems for the patient, and some may lead to even serious life threatening hemorrhage. Although the molecular mechanisms underlying the formation of these VMs remain unclear, lesions are known to result from abnormal development and morphogenesis. Histologically, there are no evidence of cellular proliferation, but rather progressive dilatation of abnormal channels, which VMs are designated to their prominent channel types such as capillary, venous, lymphatic, arterial, and combined malformations. VMs with an arterial component are rheologically fast-flow, whereas capillary, lymphatic, and venous components are slow-flow. In this article, we review the clinical presentations, diagnosis, and management of VMs of facial regions with author's embolization and surgical treatment cases.

• Journal of Trauma and Injury
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• 제28권3호
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• pp.144-148
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• 2015

Purpose: Immediate identification of vascular injury requiring embolization in patients with pelvic bone fracture isn't an easy task. There have been many trials finding indicators of embolization for patients with pelvic bone fracture. Although Young and Burgess classification is useful in decision making of treatment, it is reported to have little value as indicator of embolization in major trauma patients. The aim of this study is to find out Young and burgess classification on predicting vessel injury by analzyng pelvic radiograph taken from major trauma patients with pelvic bone fracture. Methods: Among major trauma patients with injury severity scores (ISS) higher than 15 who visited our emergency room from January 2011 to June 2014, 200 patients were found with pelvic bone fracture in trauma series and thus pelvic CT angiography was taken. Setting aside patients with exclusion criteria, 153 patients were enrolled in this study for analysis of Young and Burgess classification. Results: The most common mechanism of injury was lateral compression in both groups. There was no statistical significant difference in Young and Burgess classification (p=0.397). The obturator artery was the most commonly injured artery in both groups. Six patients had more than one site of bleeding. Conclusion: Prediction of transcatheter angiographic embolization using Young and Burgess classification in severe trauma patients is difficult and requires additional studies.

• Journal of Korean Neurosurgical Society
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• 제44권6호
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• pp.364-369
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• 2008

Objective : The aim of this study was to evaluate the efficacy of endovascular therapy as a primary treatment for spinal dural arteriovenous fistula (DAVF). Methods : The authors reviewed 18 patients with spinal DAVFs for whom endovascular therapy was considered as an initial treatment at a single institute between 1993 and 2006. NBCA embolization was considered the primary treatment of choice, with surgery reserved for patients in whom endovascular treatment failed. Results : Surgery was performed as the primary treatment in one patient because the anterior spinal artery originated from the same arterial pedicle as the artery feeding the fistula. Embolization was used as the primary treatment modality in 17 patients. with an initial success rate of 82.4%. Two patients with incomplete embolization had to undergo surgery. One patient underwent multiple embolizations, which failed to completely occlude the fistula but relieved the patient's symptoms. Spinal DAVF recurred in two patients (one collateral development and one recanalization) during the follow-up period. The collateral development was obliterated by repeated embolization, but the patient with recanalization refused further treatment. The overall clinical status improved in 15 patients (83.3%) during the follow-up period. Conclusion : Endovascular therapy can be successfully used as a primary treatment for the majority of patients with spinal DAVFs. Although it is difficult to perform in some patients, endovascular embolization should be the primary treatment of choice for spinal DAVF.

• Journal of Trauma and Injury
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• 제18권2호
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• pp.112-118
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• 2005

Background: N-Butyl Cyanoacrylate (NBCA) is a liquid embolic material that can be useful for transcatheter arterial embolization (TAE) of acute bleeding especially in patients with coagulopathy, because it does not depend on coagulation for its therapeutic effect. The aims of this study were to evaluate the clinical efficacy and safety of TAE with NBCA in acute bleeding patients. Methods: Between August 2003 and September 2004, TAE using NBCA for acute bleeding was performed in 23 patients (16 men, 7 women; mean age, 56.5years). The causes of bleeding were gastric ulcer (n=5), postoperative bleeding (n=4), post-biopsy bleeding (n=3), postpartum bleeding (n=3), duodenal ulcer (n=2), angiodysplasia (n=2), gastric lymphoma (n=1), iatrogenic injury (n=1), CMV gastritis (n=1), stab injury of the liver (n=1). TAE was performed using 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure-related complication and clinical outcomes were evaluated. Results: The angiographic and clinical success rate was 100% and 91.3% (21/23), respectively. There was no serious ischemic complication. Recurrent bleeding occurred in 2 patients (8.7%) and they were managed with successful second TAE (n=1) and endoscopic treatment (n=1). Nine patients (39.1%) had coagulopathy at the time of TAE and clinical success rate in this group of patients was 88.9% (8/9). Conclusions: TAE with NBCA is highly effective and safe treatment modality for acute bleeding patients, especially when the patient has a coagulopathy.

• 대한영상의학회지
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• 제81권3호
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• pp.726-732
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• 2020

신경섬유종증 1형은 상염색체우성질환으로 가장 흔한 유전 질환 중 하나이다. 혈관병증은 드물게 발생할 수 있으며, 신경섬유종증 1형 혈관병증은 동맥류, 협착, 동정맥기형의 형태로 나타난다. 동맥류의 경우 자연파열과 같은 치명적인 합병증을 유발할 수 있다. 신경섬유종증 1형과 연관된 하장간막동맥류의 파열로 인한 장간막출혈은 매우 드물게 보고되고 있다. 이에 저자들은 신경섬유종증 1형에 의한 방추형 상직장동맥류의 자발적 파열로 내원한 56세 여성환자에서 코일을 이용한 경도관 동맥 색전술을 시행하여 성공적으로 치료한 1예를 경험하였기에 이를 보고하고자 한다.

• 대한영상의학회지
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• 제82권3호
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• pp.682-687
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• 2021

체-폐동맥루는 주로 외상, 감염, 종양 등에 의해 유발될 수 있으나 위험 인자가 없는 환자에서 생기는 체-폐동맥루는 매우 드물다. 이들은 감염이나 출혈 혹은 폐 고혈압 등을 유발할 수 있어 치료가 필요하다. 호흡곤란을 주소로 내원한 67세 여자 환자에서 늑간동맥-폐동맥루가 발견되었다. 먼저 배출혈관인 확장된 폐동맥으로 역행성으로 접근하여 코일 색전술로 치료하였으나 5개월 후 인접폐동맥의 확장이 관찰되어 공급동맥인 늑간동맥을 N-butyl cyanoacrylate를 이용하여 색전하였다. 10개월 추적검사에서 환자의 증상과 확장된 폐동맥은 호전되었다. 체-폐동맥루를 치료에서 순차적 혹은 동시에 역방향과 순방향 접근으로 혈관 내 치료하는 것이 효과적일 수 있겠다.

• Tuberculosis and Respiratory Diseases
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• 제40권6호
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• pp.677-682
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• 1993

연구배경 : 대량객혈은 높은 치명률을 보이는 임상증상이다. 흔한 원인질환으로 결핵, 기관지확장증, 악성종양, 폐국균종등을 들 수 있으며 이러한 폐질환을 가진 환자에서 대량객혈 또는 반복되는 객혈로 생명에 위협을 주는 경우, 원인이 되는 혈관을 찾아 동맥색전술을 시행함으로써 일시적 혹은 영구적인 지혈을 기대할 수 있다. 방법 : 1989년 6월부터 1992년 8월까지 본원에 대량객혈로 입원하여 기관지동맥색전술을 시행받은 환자 20명의 병록과 혈관조영술사진을 조사하여 기저질환, 출혈부위, 색전술의 부위, 합병증 및 재발여부에 대하여 조사하였다. 결과: 1) 대량객혈의 기저질환으로는 폐결핵(14예), 기관지확장증(3예), 폐국균종(2예), 폐흡충증(1예)가 있었다. 2) 색전물질로는 gelform(7예), Ivalon(11예), 그리고 2예에서는두가지를 함께 사용하였다. 3) 색전을 시행한 혈관은 15예에서 기관지동맥, 5예에서는 기타동맥에서 시행하였다. 4) 기관지동맥색전술후 17예(85%)에서는 즉각적인 지혈이 이루어졌고 시행직후 재발한 3예를 포함한 재발율은 50%이었다. 재발한 경우 3예에서 폐엽절제를 시행하였고 1예는 대량객혈로 인한 질식으로 사망하였으며 나머지 6예는 보존적인 치료만으로 추적기간(1~29개월)동안 더 이상의 출혈의 재발이 없었다. 결론 : 기관지동맥색전술은 대량객혈과 재발성 객혈의 경우 즉각적으로 지혈시킬 수 있는 효과적인 방법이다. 특히 만성적인 폐질환 등으로 수술의 위험이 큰 환자에서도 용이하게 일차적으로 시행할 수 있는 방법으로 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제43권1호
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• pp.96-101
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• 1996

저자들은 과거력상 반복되는 구강내 아프타성 궤양 및 결절홍반양 피부병변이 있었고, 객혈을 주소로 내원한 37세 남자환자에서 혈관조영술상 다발성 폐동맥류, 심부 정맥의 협착 및 폐색소견이 관찰되었고, 조직학적으로는 폐혈관염 소견을 보여, Hughes-Stovin 증후군으로 진단하였으며, 코일을 이용한 폐동맥색전술로 폐동맥류를 성공적으로 치료하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제46권3호
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• pp.226-231
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• 2009

Objective : We describe our clinical experiences and outcomes in patients who had thromboembolic complications occurring during endovascular treatment of intracerebral aneurysms with a review of the literature. The types of thromboembolic complications were divided and the treatment modalities for each type were described. Methods : Between August 2004 and March 2009 we performed endovascular embolization with Guglielmi detachable coils for 173 patients with 189 cerebral aneurysms, including ruptured and unruptured aneurysms at our hospital. Sixty-eight patients were males and 105 patients were females. The age of patients ranged from 22-82 years (average, 58.8 years). We retrospectively evaluated this group with regard to complication rates and outcomes. The types of thromboembolic complications were classified into the following three categories: mechanical obstruction, distal embolic stroke, and stent-induced complications, which corresponded to types I, II, and III, respectively. A comparison of the clinical results was made for each type of complication. Results : Only eight patients had a thromboembolic complication during or after a procedure (4.6%). Of the eight patients, two had a mechanical obstruction as the causative factor; the other three patients had distal embolic stroke as the causative factor. The remaining three patients had stent-induced complications. In cases of mechanical obstruction, recanalization occurred due to the use of intra-arterial thrombolytic agents in one of two patients. Nevertheless, a poor prognosis was seen. In the cases of stent-induced complications, in one of three patients in whom a thrombus developed following stent insertion, a middle cerebral artery territory infarct developed with a poor prognosis despite the use of wiring and an intra-arterial thrombolytic agent. In the cases of distal embolic stroke, all three patients achieved good results following the use of antiplatelet agents. Conclusion : Treatment for thromboemboic complications due to mechanical obstruction and stent-induced complications include antiplatelet and intra-arterial thrombolytic agents; however, this cannot guarantee a sufficient extent of effectiveness. Therefore, active treatments, such as balloon angioplasty, stent insertion, and clot extraction, are helpful.