• 대한영상의학회지
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• 제83권3호
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• pp.658-668
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• 2022

목적 혈액투석경로의 기능부전에 대한 인터벤션 치료 시 경요골 동맥 접근법의 유용성을 연구하고자 한다. 대상과 방법 2008년 1월부터 2019년 4월까지 73명의 환자에서(남성 43명, 여성 30명, 평균 연령 67.4세; 범위 42-92세) 경요골 동맥 접근법을 이용한 시술을 시행한 환자들에 대해 후향적 연구를 시행하였다. 환자들의 기본적인 특성과 병변의 특성, 경요골 동맥 접근을 통한 인터벤션 시술의 기술적 및 임상적 성공률, 시술과 연관된 합병증에 대해 조사하였고 장기 개통성에 대해서는 카플란-마이어 방법을 이용하여 분석하였다. 결과 모든 환자에서 요골 동맥을 통한 혈관조영술을 성공적으로 시행하였고, 기술적 성공률은 98.6%(72/73), 임상적 성공률은 91.7%(67/73)였다. 일차적 개통률의 중앙값은 18.8 ± 15.9개월이었고, 3, 6, 12개월 누적 개통률은 각각 82.1%, 68.6%, 그리고 63.9%였다. 모든 환자에서 손의 허혈과 같은 주요한 합병증은 발생하지 않았으며 경요골 동맥 천자와 연관한 즉각적인 합병증 또한 발생하지 않았다. 결론 혈액투석경로 기능 부전 환자에서 경요골 동맥 접근법을 통한 인터벤션 시술은 안전하고 임상적으로 유용한 방법으로 생각된다. 또한 선별된 환자에서 전통적인 경정맥 접근법에 대해 대안으로 기능할 수 있을 것으로 생각된다.

• Korean Journal of Radiology
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• 제23권10호
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• pp.949-958
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• 2022

Objective: To investigate the feasibility of using a deep learning-based analysis of auscultation data to predict significant stenosis of arteriovenous fistulas (AVF) in patients undergoing hemodialysis requiring percutaneous transluminal angioplasty (PTA). Materials and Methods: Forty patients (24 male and 16 female; median age, 62.5 years) with dysfunctional native AVF were prospectively recruited. Digital sounds from the AVF shunt were recorded using a wireless electronic stethoscope before (pre-PTA) and after PTA (post-PTA), and the audio files were subsequently converted to mel spectrograms, which were used to construct various deep convolutional neural network (DCNN) models (DenseNet201, EfficientNetB5, and ResNet50). The performance of these models for diagnosing ≥ 50% AVF stenosis was assessed and compared. The ground truth for the presence of ≥ 50% AVF stenosis was obtained using digital subtraction angiography. Gradient-weighted class activation mapping (Grad-CAM) was used to produce visual explanations for DCNN model decisions. Results: Eighty audio files were obtained from the 40 recruited patients and pooled for the study. Mel spectrograms of "pre-PTA" shunt sounds showed patterns corresponding to abnormal high-pitched bruits with systolic accentuation observed in patients with stenotic AVF. The ResNet50 and EfficientNetB5 models yielded an area under the receiver operating characteristic curve of 0.99 and 0.98, respectively, at optimized epochs for predicting ≥ 50% AVF stenosis. However, Grad-CAM heatmaps revealed that only ResNet50 highlighted areas relevant to AVF stenosis in the mel spectrogram. Conclusion: Mel spectrogram-based DCNN models, particularly ResNet50, successfully predicted the presence of significant AVF stenosis requiring PTA in this feasibility study and may potentially be used in AVF surveillance.

• Journal of Korean Neurosurgical Society
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• 제38권4호
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• pp.269-272
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• 2005

Objective : The object of this study is to present the treatment experience of the 6cases of scalp arteriovenous malformations[AVMs] focus on treatment strategy. Methods : Six patients with scalp AVM were treated during past 12years. We analysis the clinical characteristics of the lesions, treatment methods and management outcomes. Results : The lesions were located on temporal in 2patients, parietal in 2patients, frontal and occipital area in each one. Four of six patients had a trauma history on scalp. The presenting symptoms were progressive enlarged pulsating mass with or without bruit. Four of the six lesions had the large fistula in the lesion. Two patients were treated with surgical resection alone, three patients with proximal feeding artery balloon[s] occlusion followed by surgical resection, and one patient with coil embolization through trans-venous route alone. We obtained good results in all patients. Conclusion : Most of scalp AVM can be completely cured by Judicious selection and a combination of treatment modalities, i.e., surgery only, or embolization only, or embolization plus surgical therapy. Although embolization became a primary therapy for this sort of scalp AVM recently, the selection of treatment modality should be chose based on the size, angioarchitecture, and clinical presentations of the lesion.

• Korean Journal of Radiology
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• 제21권11호
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• pp.1239-1247
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• 2020

Objective: To report the mid-term results of a single-center randomized controlled trial comparing drug-coated balloon angioplasty (DBA) and plain balloon angioplasty (PBA) for the treatment of dysfunctional radiocephalic arteriovenous fistulas (RCAVFs). Materials and Methods: In this prospective study, 39 patients (mean age, 62.2 years; 21 males, 18 females) with RCAVFs failing due to juxta-anastomotic stenosis were randomly assigned to undergo either both DBA and PBA (n = 20, DBA group) or PBA alone (n = 19, PBA group) between June 2016 and June 2018. Primary endpoints were technical and clinical success and target lesion primary patency (TLPP); secondary outcomes were target lesion secondary patency (TLSP) and complication rates. Statistical analysis was performed using the Kaplan-Meier product limit estimator. Results: Demographic data and baseline clinical characteristics were comparable between the groups. Technical and clinical success rates were 100% in both groups. There was no significant difference between the groups in the mean duration of TLPP (DBA group: 26.7 ± 3.6 months; PBA group: 27.0 ± 3.8 months; p = 0.902) and TLSP (DBA group: 37.3 ± 2.6 months; PBA group: 40.4 ± 1.5 months; p = 0.585). No procedural or post-procedural complications were identified. Conclusion: Paclitaxel-coated balloon use did not significantly improve TLPP or TLSP in the treatment of juxta-anastomotic stenosis of dysfunctional RCAVFs.

• Journal of Chest Surgery
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• 제25권12호
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• pp.1563-1569
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• 1992

From Jan. 1981 to Dec. 1991, we had treated 25 patients with congenital coronary art-eriovenous fistulas [CAVF] in Seoul National University Hospital. A retrospective review was made to delineate the course and the management of CAVF and to clarify the role of surgical treatment. Fifteen patients were male and 10 were female with The mean age of 17.4 years[from 3 months to 58 years]. The most frequent symptom was dyspnea on exertion[56%]. Other symptoms were angina and palpitation. Sixty-eight percent of the patients were symptomatic. Fifty-three percent of patients less than 20 years old were symptomatic and 100% of patients over 20 years old were symptomatic. Three patients had multiple CAVFs. The fistula drained into the right ventricle in 13, pulmonary artery in 9, left ventricle in 4, right atrium in 2, and left atrium in 1. Thirteen patients had other associated cardiac lesions. The mean pulmonary-to-systemic blood flow[Qp /Qs] in the isolate CAVF group was 2.19. All patients were operated on to correct the fistulas and other associated cardiac lesions. All patients were followed from 1 month to 11 years without late death. Postoperative complication rate was 24% -significant arrhythmia [3], recurred CAVF[1], psychosis[1], pneumonia [1]. Symptomatic improvement was evident postoperatively. Below 20 years old, 94% of patients were asymptomatic, but above 20 years old, symptoms persisted in 25%. In summary, early elective repair of CAVF is indicated in all patients because of higher complication rate and frequent persistent symptoms in older patients.

• Journal of Chest Surgery
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• 제33권11호
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• pp.894-897
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• 2000

배경: 의학의 발전으로 인하여 만성신부전 환자의 생존율이 향상되고 2차적인 동정맥루술을 시행하여야 하는 경우가 증가하였다. 이 논문은 2차적인 동정맥루 조성술의 하나인 Revision이 다른 방법과 마찬가지의 성공률 및 개존율을 나타내는가를 알고자 작성하였다. 대상 및 방법: 1995년 1월부터 1998년 9월까지 총 365례의 동정맥루술을 시행하였으며 이중revision하여 동정맥루를 만든 62명의 환자를 대상으로 그 결과를 관찰하였다. 결과: Revision한 62명의 6개월 개존율이 78.8%, 12개월 개존율이 72%, 24개월 개존율이 63%, 36개월 개존율이 56.9%이었다. 결론: Revision에 의한 수술방법은 2차적 재수술시 우선적으로 고려해보아야할 수술방법이다.

• Journal of Korean Neurosurgical Society
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• 제46권5호
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• pp.498-500
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• 2009

Dual origin and fenestration of the vertebral artery (VA) are very rare anomalies. Understanding of these variations, however, is important because they can be misdiagnosed as a VA dissection. A 42-year-old woman presented with motor weakness and sensory disturbance of the right upper extremity. Radiologic evaluations showed ectatic change in the right VA and an arteriovenous fistula between the right VA and the vertebral vein. We decided on endovascular occlusion of the proximal right VA and its fistulous portion. During the endovascular procedure, we had misunderstood the dual origin and fenestration of the VA as a dissection. Thus, failure to recognize these anomalies might result in unnecessary anticoagulation or therapeutic intervention. Clinicians should be alert to such VA variations when making a diagnosis and when planning any intervention or surgery involving the proximal VA.

• Journal of Korean Neurosurgical Society
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• 제55권2호
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• pp.96-98
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• 2014

Vascular complications after percutaneous angiography include hematoma, pseudoaneurysm, arteriovenous fistula, thromboembolism, arterial laceration and infection. Hematomas may occur in the groin, thigh, retroperitoneal, intraperitoneal, or abdominal wall. A 54-year-old female underwent percutaneous transfemoral angiography for the evaluation of cerebral aneurysm. Renal subcapsular hematoma developed 3 hours after the procedure. Renal subcapsular hematoma after percutaneous angiography is very rare. We investigated the possible causes of renal subcapsular hematoma. To avoid this rare complication, we need to perform guide-wire passage carefully from the beginning of the procedure under full visual monitoring.

• Journal of Yeungnam Medical Science
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• 제32권1호
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• pp.22-25
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• 2015

Spasticity is a common impairment in patients with central nervous system disease. Clinical observation has demonstrated that spasticity can be aggravated by various factors such as emotional state as well as noxious stimuli. A 51-year-old male patient was scheduled for arteriovenous fistula surgery. He had right hemiplegia including motor weakness and spasticity. It was decided that the surgery would be performed under an axillary brachial plexus block (BPB). He appeared nervous when blockade was terminated. The spasticity of the right shoulder increased after ipsilateral BPB. However, when we administered sedative drugs and performed interscalene BPB 2 days later, spasticity did not occur. Exacerbation of spasticity might be evoked by an anxious emotional state. Thus, it seems to be good to consider removing of anxiety and using an appropriate approach when it is tried to perform nerve blocks in individuals with spasticity.

• 한국임상수의학회지
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• 제5권2호
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• pp.111-118
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• 1988

One four-month-old female shepherd mongrel dog with chief complaints of abdominal distension and dysponea was referred. The authors performed physical examination, hematological examination, X-ray examination, exploratory laparotomy, electrocardiography and angiography as antemortem investigation in addition to postmortem examination. This patient revealed complicated congenital cardiac anormaly including patent ductus arteriosus, both atrial and ventricular hypertrophy, distension in the base of the pulmonary artery, pulmonary stenosis, aortic insufficiency, patent foramen ovate and coronary arteriovenous fistula.