Deep vein thrombosis (DVT) is a common disease; however, it can result in significant disabilities from pulmonary embolism and postphlebitic syndrome, especially when the iliofemoral vein is involved. Although anticoagulation can prevent thrombus propagation and recurrent venous thrombosis, it cannot dissolve the occluding thrombus or reduce venous outflow obstruction, leaving the patients suffering from postphlebitic syndrome. Catheter-directed thrombolysis, with direct delivery of a concentrated lytic agent into the clot, has been proposed as an alternative therapy to anticoagulation. Recent studies have demonstrated that early clot lysis through this technique rapidly restores venous patency, more effectively preserves valvular function, and reduces a risk of postphlebitic syndrome. To decrease clot burden, duration of treatment, and bleeding complications, mechanical thrombectomy may work synergistically with catheter-directed thrombolysis. After clot removal through those therapies, balloon angioplasty and stent placement are needed in patients with venous stricture (eg, iliac vein compression syndrome). Short- and long-term outcomes of stenting in iliofemoral DVT appear to be favorable. When used in conjunction with each other and anticoagulation, these minimally invasive endovascular techniques allow a better resolution of venous clot burden and have the potential to lead to improved long-term outcomes in patients with DVT. This review introduces endovascular treatments of acute DVT in the lower extremities performed in the interventional radiology section.
Angioplasty, Balloon ; Constriction, Pathologic ; Endovascular Procedures ; Hemorrhage ; Humans ; Iliac Vein ; Lower Extremity* ; Postphlebitic Syndrome ; Pulmonary Embolism ; Radiology, Interventional ; Stents ; Thrombectomy ; Thrombosis ; Veins ; Venous Thrombosis*

Cystic lymphangioma is a congenital lymphatic malformation that occurs most commonly in the head and neck. Most lymphangiomas are asymptomatic, but progressive enlargement may cause feeding difficulty, airway, and cosmetic problems. According to the diameter of the majority of the cysts, lymphangiomas are divided into macrocystic (>1 cm), microcystic (<1cm), or mixed types. Sclerotherapy has been recommended as a primary treatment because surgery may result in severe tissue defect or functional complication. OK-432 is the most widely used sclerosant. Typical complications include fever, local inflammation, pain and swelling, which can usually be controlled conservatively. Bleomycin has potential risk of lung fibrosis, although there has been no such report in the literature. Acetic acid is a more potent sclerosant, which may be used as a secondary drug due to the risk of adjacent nerve damage in high concentration.The lesions are punctured with a 21 G needle under ultrasound guidance. In macrocystic lesions, we inserted 6-7 F catheters for drainage and instillation of sclerosant. While OK-432 and bleomycin are not removed, alcohol and acetic acid should be removed after indwelling for 20 minutes. Overall, an excellent response (over 90% resolution) rate of 48% was achieved. Response rate was higher in macrocystic type than microcystic type. There may be a risk of airway obstruction due to swelling and inflammation in cervical lesions. Preventive tracheostomy or intubation may be necessary in those lesions. In conclusion, sclerotherapy is a safe and effective for treatment of lymphangioma. It is recommended as a first line therapy.
Acetic Acid ; Airway Obstruction ; Bleomycin ; Catheters ; Drainage ; Fever ; Fibrosis ; Head ; Inflammation ; Intubation ; Lung ; Lymphangioma ; Lymphangioma, Cystic* ; Neck ; Needles ; Picibanil ; Sclerotherapy* ; Tracheostomy ; Ultrasonography

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.

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.

Pancreatic cancer has been identified as one of the most common malignant causes of upper gastrointestinal obstruction. Most common sites of obstruction include the pyloric region and second and third portions of the duodenum. If surgical gastrojejunostomy is not a viable option, metallic stent placement may be performed either by transoral or transgastric approach. Transgastric technique is considered to be more invasive and is often employed only in failed attempts to insert a stent using transoral technique. This report presents a 70-year-old patient with pancreatic cancer involving the proximal jejunum. Although this is a rarely described location for stenting, the patient was successfully treated using transgastric technique.
Aged ; Duodenum ; Fluoroscopy ; Gastric Bypass ; Humans ; Jejunum ; Pancreatic Neoplasms ; Stents*

PURPOSE: We retrospectively evaluated superselective embolization with Gelfoam for the management ofpost-traumatic arterial priapism. MATERIALS AND METHODS: Six male patients with post-traumatic priapism underwentpudendal angiography and embolization. We evaluated the time and incidence of detumescence after embolization andcompared normal erectile function and its duration with the results of other reports. In all patients, colorDoppler sonography was performed pre- and post-angiographically. RESULTS: On pudendal arteriography,intracavernosal arteriovenous fistulas were observed in all patients, and pseudoaneurysm of the cavernosal artery(or common penile artery) in three. Detumescence and normal erec-tile function were achieved in all patients aftersuperselective embolization. Using color Doppler sonography, the location of the lesion causing priapism wasfound, in four patients, to be the proximal or middle one-third of the cavernosal artery. CONCLUSION: Pudendalangiography with superselective embolization with Gelfoam is a safe and effective method for the correction ofpost-traumatic arterial priapism.
Aneurysm, False ; Angiography ; Arteries ; Arteriovenous Fistula ; Gelatin Sponge, Absorbable* ; Humans ; Incidence ; Male ; Priapism ; Retrospective Studies

PURPOSE: It is sometimes difficult to evaluate the angiographic findings pertaining to spasm of the arteries in the hands and feet in patients with Raynaud's syndrome. The purpose of this study is to investigate the effectiveness of applying a hot bag to the hands and/or feet for the control of vasospasm in patients with Raynaud's syndrome during angiography. MATERIALS AND METHODS: Forty five cases (hands: feet=15:30) in forty patients (M:F=9:31, mean age; 39 years) with Raynaud's syndrome whose conventional angiography demonstrated the presence of vasospasm were included. First, digital subtraction angiography of the extremities was performed at room temperature (20 to 21 degrees Celsius). Then a hot bag was applied for 5 minutes on the hand or foot, and a post-hot bag angiography of the extremity was performed. The angiographic findings were classified into 6 grades in the case of the feet (0; anterior/posterior tibial artery, 1; dorsalis pedis /lateral plantar artery, 2; arcuate artery/plantar arch, 3; metatarsal artery, 4; digital artery, 5; blushing of toe tip) and 5 grades in the case of the hands (0; ulnar/radial artery, 1; palmar arch, 2; common palmar artery, 3; proper palmar artery, 4; blushing of finger tip) according to the level of the visualized vessels on the angiography. The time and the time difference to maximal visualization of the vessels between the measurements taken at room temperature and those taken after the hot bag application were calculated. RESULTS: In all cases, more vessels were visualized after the hot bag application than at room temperature. After the application of the hot bag, the grade of vessel visualization was increased in both the feet (range; 1-4, mean; 2.3) and hands (range; 1-2, mean; 1.4). The time to the maximal visualization of the vessels was faster after the hot bag application than at room temperature. The time difference between the two groups ranged from 1 to 33 seconds (mean; 12.3 seconds) in the feet and 2 to 26 seconds (mean; 11.8 seconds) in the hands. CONCLUSION: Angiography of patients with Raynaud's syndrome showed that the application of a hot bag provides a convenient and effective method of relieving the vasospasm of the vessels of the hands or feet.
Angiography* ; Angiography, Digital Subtraction ; Arteries ; Blushing ; Extremities* ; Fingers ; Foot ; Hand ; Humans ; Metatarsal Bones ; Spasm ; Tibial Arteries ; Toes

The incidence of intracranial complications of otitis media, including lateral sinus thrombophlebitis, has been significantly reduced since the advent of antibiotics. This entity is rarely encountered in clinical practice, and delay in its diagnosis and institution of appropriate therapy may lead to serious, or even fatal, consequences. The signs and clinical course of lateral sinus thrombophlebitis are non-specific and the final diagnosis rests upon radiological investigations including CT-scans and MRI. We have experienced a case of middle fossa and posterior fossa epidural abscess formation, lateral sinus thrombophlebitis that has developed secondary chronic otitis media with cholesteatoma in a 47 year-old female patient. We report this case which was successfully treated by middle fossa dura and posterior fossa dura drainage, lateral sinus thrombectomy with open mastoidectomy.
Anti-Bacterial Agents ; Cholesteatoma* ; Diagnosis ; Drainage ; Epidural Abscess* ; Female ; Humans ; Incidence ; Lateral Sinus Thrombosis* ; Magnetic Resonance Imaging ; Middle Aged ; Otitis Media* ; Otitis* ; Thrombectomy ; Transverse Sinuses*

PURPOSE: To investigate the effects of low-dose FP (5-Fluorouracil[5FU]+Cispatin[CDDP]) therapy through a percutaneously implanted intra-arterial port system in patients with advanced hepatocellular carcinoma(HCC). MATERIALS AND METHODS: Twenty-five patients with advanced HCCs and portal vein thrombosis, or large HCCs which were unresectable or for which transarterial chemoembolization was thought to be ineffective, underwent intra-arterial port implantation. The mean maxinal diameter of these tumors was 13.7 (range, 5-21.5) cm, and they were located at the right lobe (n=18), the left lobe (n=3), or throughout the liver (n=4). Tumor thrombosis was detected in the main (n=14), right (n=3) and left portal vein(n=1), the right portal vein and inferior vena cava(n=2), and the inferior vena cava(n=1). The four others patients had no portal vein thrombosis. All intra-arterial port implantations were performed percutaneously in the angiographic ward through the right or left common femoral artery. The port chamber was implanted in the inguinal area and fixed using histoacryl. For intra-arterial chemotherapy, 5-FU (250 mg/day) and CDDP (10 mg/day) were used for five days every four weeks. In order to observe changes in tumor size, follow-up CT scanning was performed every two months. RESULTS: Implantation of the port system was successful in all cases, and patients underwent between one and eleven (mean, 3.9) sessions of chemotherapy. Port and catheter-related complications, namely dislodgement of the catheter(n=2), wound infection(n=2), migration of the coil(n=1) and catheter occlusion(n=1) occurred in six patients (24%), and chemotherapy-related complications, namely liver failure(n=3) and gastric ulcer bleeding(n=1), in four (16%). A complete response, i.e. the disappearance of tumor thrombosis of the portal vein, was achieved in one patient (4%), a partial response in three (12%), and a minor response in four (16%); the overall response rate was 32% and the mean survival period was 7.6 months. CONCLUSION: Low-dose FP therapy through a percutaneous intra-arterial port system may be one way of effectively treating advanced HCC patients who cannot undergo surgery or effective trans-arterial chemoembolization.
Carcinoma, Hepatocellular* ; Catheters ; Drug Therapy* ; Enbucrilate ; Femoral Artery ; Fluorouracil ; Follow-Up Studies ; Humans ; Liver ; Portal Vein ; Stomach Ulcer ; Thrombosis ; Tomography, X-Ray Computed ; Venous Thrombosis ; Wounds and Injuries