• Journal of Korean Neurosurgical Society
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• v.42 no.1
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• pp.59-63
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• 2007

Operative clipping after previous endovascular coiling in an aneurysm is a different problem from primary clipping procedure for neurosurgeons. With the increasing use of coil embolization, neurosurgeons will more and more face the similar situation. We report surgical clipping cases of intracranial aneurysm regrown after endovascular coiling. Three patients with a history of subarachnoid hemorrhage due to ruptured aneurysm underwent endovascular treatment (EVT) with detachable coils. The aneurysms were in the posterior communicating artery, the middle cerebral artery and distal anterior cerebral artery (DACA). Two near-total occlusions and one partial occlusion were achieved by EVT. After several months, angiographic follow-up revealed regrowth of the aneurysm requiring surgical clipping. Here, we report three cases in which surgical clipping was more difficult than a usual clipping procedure performed several months after EVT, because of adhesion and coil bulging into the aneurysmal neck. The difficulty of the treatment of the residual aneurysm after coiling is discussed, as are the surgical complications and limitations of clipping.

• Journal of Korean Neurosurgical Society
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• v.38 no.3
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• pp.190-195
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• 2005

Objective : This study is performed to evaluate the procedural complications, aneurysm occlusion rate, and mid-term outcome of endovascular treatments in intracranial aneurysms. Methods : We retrospectively investigated 135 patients with 161 cerebral aneurysms who were treated by endovascular means at our institute from March 1999 to December 2004. We statistically analyzed overall outcome, occlusion rate, and occurrence of complications according to the location, size, rupture history, and neck size of aneurysms. Results : Forty-nine patients [36.3%] had experienced acute intracranial or extracranial complications related to the procedure. Among these, there were 13cases of perforation of the aneurysm, 9 of local vasospasm, 8 of thromboembolism, 4 of coil migration, 3 of occlusion of parent vessels due to coil protrusion, and 1 of seizure. Extracranial complications occurred in 14cases including alopecia [9cases], femoral artery thrombosis [2cases], acute renal failure [2cases], and hypovolemic shock [1case]. One hundred twenty-six aneurysms [78.3%] had complete occlusion of the aneurysm and 35 [21.7%] incomplete occlusion at 6months angiographic follow-up. Postembolization clinical follow-up ranged from 1 to 60months [mean, 14.2months]. Seven of the 161 aneurysms underwent additional embolization and 2 incomplete embolized aneurysms required subsequent surgery. Conclusion : The procedural complications and incomplete occlusion rates are substantial. Therefore, endovascular treatment needs close and continued neurosurgical and neuroradiological concerns for the therapy of intracranial aneurysms.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.20 no.4
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• pp.241-247
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• 2018

Treatment of paraclinoid aneurysms weather by surgery, or endovascular embolization has a risk of visual loss due to optic neuropathy, or diplopia due to cranial nerve palsies. Visual complications occur immediately after the clipping, whereas they can occur variable time after endovascular coiling. Recently, endovascular coiling for paraclinoid aneurysm is regarded as a safe and feasible treatment. But it still has risks of acute thromboembolic complication, or cranial nerve palsies. A 45-year-old woman was referred from local hospital to our hospital due to ruptured large ICA dorsal wall aneurysm. A total of 12 coils (195 cm) were used for obliteration of aneurysm. Postoperative diffusion weighted image showed no abnormal signal intensity lesion and magnetic resonance angiography demonstrated no sign of vasospasm, or vessel narrowing. But, she complained visual problem 23 days after coil embolization. Ophthalmologist confirmed the left optic disc atrophy on fundoscopy. Although steroid was started, but monocular blindness did not recover completely. The endovascular embolization of paraclinoid aneurysm, especially projecting superiorly with large irregular shape, has the risk of progressive visual loss because of the proximity to optic nerve.

• Journal of the Korean Society of Radiology
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• v.84 no.4
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• pp.792-808
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• 2023

Trauma to the head and neck region can have serious consequences for vital organs such as the brain, and injuries to blood vessels can cause permanent neurological damage or even death. Thus, prompt treatment of head and neck vessels is crucial. Although the level of evidence is moderate, an increasing amount of research indicates that endovascular treatments can be a viable alternative to traditional surgery or medical management. Embolization or reconstructive endovascular procedures can significantly improve patient outcomes. This article provides an overview of various endovascular options available for specific clinical scenarios, along with examples of cases in which they were employed.

• Journal of Chest Surgery
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• v.48 no.5
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• pp.371-374
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• 2015

We present a rare case of a patient with aortoiliac occlusive disease on the background of type A crossed renal ectopia, for whom open surgical intervention was required. Aortic exposure in patients with concomitant crossed renal ectopia can present technical challenges to the vascular surgeon. The knowledge of variations in the ectopic renal blood supply is of paramount importance when performing surgery to treat this condition and affects the choice of surgical exposure. We present and discuss the operative details of our patient and outline an approach to this subset of patients.

• Journal of Chest Surgery
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• v.47 no.6
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• pp.548-551
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• 2014

Type II chronic dissecting thoracoabdominal aortic aneurysms are a surgically challenging disease. The conventional thoracoabdominal aortic aneurysm repair technique using cardiopulmonary bypass is a high-risk procedure. However, a recently developed endovascular technique may be an alternative treatment for the disease, but faces the obstacle of lesional restriction. This new technique uses a hybrid strategy to overcome the limits of endovascular thoracoabdominal aortic aneurysm repair. Herein, we report on a successful outcome after performing the hybrid visceral debranching procedure.

• Journal of Chest Surgery
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• v.47 no.6
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• pp.552-555
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• 2014

Thoracic endovascular aortic repair has become a widespread alternative treatment option for thoracic aortic aneurysm. The debranching of arch vessels may be required to provide an acceptable landing zone for an endovascular stent graft. We report a case where the bypass graft used in the thoracic endovascular aortic repair procedure compressed the left internal jugular vein, causing acute thrombotic occlusion.

• Journal of Chest Surgery
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• v.44 no.2
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• pp.189-192
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• 2011

Mycotic aneurysm is a disease requiring immediate treatment because of the high risk of rupture. A difficult surgical approach, especially in the case of occurrence on the iliac artery, involving endovascular embolization and extra-anatomic bypass grafting, is known to be a suitable treatment. We performed extra-anatomic bypass grafting after endovascular embolization successfully in two patients. The postoperative computed tomography of both patients showed complete exclusion of the mycotic aneurysm.

• Journal of Chest Surgery
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• v.47 no.1
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• pp.71-74
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• 2014

For high-risk patients, endovascular aortic aneurysm repair (EVAR) is a good option but may lead to serious complications, which should be addressed immediately. A 75-year-old man with a history of abdominal surgery underwent EVAR for an aneurysm of the abdominal aorta and iliac arteries. During EVAR, iliac artery rupture and graft limb occlusion occurred, and they were successfully managed by the additional deployment of an iliac stent graft and balloon thrombectomy, respectively. We, herein, report a rare case of the simultaneous development of the two fatal complications treated by the endovascular technique.

• Journal of Korean Neurosurgical Society
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• v.46 no.3
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• pp.261-264
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• 2009

Vascular injury during lumbar disc surgery is a rare but potentially life-threatening complication. It has been managed by open vascular surgical repair. With recent technologic advance, endovascular treatment became one of effective treatment modalities. We present a case of a 32-year-old woman who suffered with common iliac artery injury during lumbar disc surgery that was treated successfully by endovascular repair with temporary balloon occlusion and subsequent insertion of a covered stent. Temporary balloon occlusion for 1.5 hours could stop bleeding, but growing pseudoaneurysm was identified at the injury site during the following 13 days. It seems that the temporary balloon occlusion can stall bleeding from arterial injury for considerable time duration, but cannot be a single treatment modality and requires subsequent insertion of a covered stent.