PURPOSE: We wanted to evaluate the incidence of Giacomini vein and its association with lower extremity venous insufficiency by performing US. MATERIALS AND METHODS: From September 2006 to July 2007, 173 patients (58 males and 115 females, mean age: 52.7 years, age range: 22-72 years) who had been diagnosed with unilateral/bilateral varicose veins or telangiectasias were evaluated with duplex Doppler ultrasonography. The presence of Giacomini vein, superficial/deep vein reflux, the anatomical sites of the venous reflux and the abnormal perforating veins was investigated in 346 legs. RESULTS: Giacomini veins were found in 33 limbs (9.5%) of 21 patients (12.1%). Bilateral Giacomini veins were found in 12 patients. Of the 33 limbs that had Giacomini veins, 20 limbs had great saphenous vein (GSV) reflux and 4 limbs had small saphenous vein (SSV) reflux. The patients with Giacomini veins were classified into two groups according to the presence of Giacomini vein. There was no significant difference of the GSV reflux (p = 0.155), the SSV reflux (p = 0.760) and the mean velocity of the GSV reflux or the SSV reflux (p = 0.685, p = 0.431, respectively) between the two groups. CONCLUSIONS: Our results indicated that Giacomini vein is not associated with either GSV or SSV reflux, and this is contrary to conventional belief.
Extremities ; Female ; Humans ; Incidence ; Lower Extremity ; Male ; Saphenous Vein ; Telangiectasis ; Ultrasonography, Doppler, Duplex ; Varicose Veins ; Veins ; Venous Insufficiency

Mammary-type myofibroblastoma (MFB) is a rare, benign spindle cell neoplasm occurring along the milkline, with extension from the mid-axilla to the medial groin. It is histologically and immunohistochemically identical to MFB of the breast and is part of a spectrum of lesions that includes spindle cell lipoma and cellular angiofibroma. Recently, we experienced two cases of mammary-type MFB involving male patients aged 30 and 58 years, respectively. The tumors were located in the right scrotal sac and in the right axilla. Wide excisions were performed. Microscopically, the masses were composed of haphazardly arranged, variably sized fascicles of bland spindle cells and were admixed with mature fat tissue. The spindle cells in both cases showed immunopositivity for desmin and CD34 and negativity for smooth muscle actin. Loss of retinoblastoma (RB)/13q14 loci is a characteristic genetic alteration of mammary-type MFB, and we identified loss of RB protein expression by immunohistochemical staining. We emphasize the importance of awareness of this rare neoplasm when a spindle cell neoplasm is accompanied by desmin immunopositivity. The second patient was alive without recurrence for 20 months, and the first patient had not been followed.
Actins ; Angiofibroma ; Axilla ; Breast ; Desmin ; Groin ; Humans ; Lipoma ; Male ; Muscle, Smooth ; Neoplasms, Muscle Tissue* ; Recurrence ; Retinoblastoma ; Retinoblastoma Protein

BACKGROUND AND PURPOSE: Long-segmental thrombotic occlusion of the distal internal carotid artery (ICA) sparing the cervical segment proximally and the supraclinoid segment distally, which could be termed 'Carotid S occlusion', has an unusual clinical presentation. However, endovascular management of this lesion is challenging. The purpose of our study is to report our endovascular treatment clinical experience of the disease. METHODS: From March 2008 to June 2013, we could identify 14 patients (average age: 62.1, median age: 62, range: 50-79) with \'Carotid S occlusion', who underwent endovascular recanalization procedures. Patient's clinical presentations were collected and the imaging findings also analyzed. The technical success rate, 24-hour and follow-up imaging outcome, and the clinical outcome using the 90-day mRS (modified Rankin scale) score were evaluated. RESULTS: Patients presented with gradually progressing (n = 8), fluctuating (n = 3), transient ischemic attack (n = 2) and stationary (n = 1) symptoms. DWI showed internal and external border-zone lesions in six patients, only internal ICA border-zone lesions in three patients, and only external border-zone lesions in two patients. Underlying distal ICA stenosis was noted in 12 patients. The technical success rate was 92.8% (13/14). Luminal patency was noted in all patients (100%) after 24 hours and in nine of 10 (90%) on long-term follow-up (median: 6.5, average: 15.1, range: 1-39 months). A 90-day, good functional outcome (mRS < or = 2) was noted in 13 of 14 patients (92.8%). CONCLUSIONS: \'Carotid S occlusion' usually presented with border-zone infarction and endovascular management of the lesions was feasible. A relatively successful clinical outcome could be achieved after successful revascularization.
Angioplasty, Balloon ; Atherosclerosis ; Carotid Artery, Internal* ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Infarction ; Ischemic Attack, Transient ; Phenobarbital ; Stents ; Stroke

PURPOSE: Bilateral inferior petrosal sinus sampling (IPSS) is a direct method of distinguishing between pituitary and ectopic ACTH secretion. We present unilateral femoral route technique avoiding bilateral femoral venous puncture using two 4F catheters into both sides of IPSS in these obese patients. MATERIALS AND METHODS: Unilateral femoral puncture using 9F guiding catheter allowed two 4F catheters which can be introduced in each side of inferior petrosal sinus. To reduce bleeding in the gap between 2 catheters at the diaphragm of the 9F femoral sheath, we introduced a short guidewire provided along with femoral sheath. After removing the 9F sheath after procedure, we applied manual compression as usual. We evaluated any technical difficulty and other complications including the presence of hematoma at the puncture site 1 day and 30 days later. RESULTS: Bilateral IPSS by using two 4F catheters in both inferior petrosal sinuses was possible via unilateral femoral route via 9F sheath. There was no technical difficulty introducing 4F catheters into each IPS of both sides. After removing 9F femoral sheath, there was no other complication and no hematoma at the puncture site at 1 day and 30 days later. CONCLUSION: Unilateral femoral venous approach with a 9-French sheath can be used in IPSS. This technique allowed to pass two 4F catheters for IPSS at both sides and could avoid unnecessary bilateral femoral puncture in these obese patients without any hematoma formation after the procedure.
Adrenocorticotropic Hormone ; Catheters ; Diaphragm ; Hematoma ; Hemorrhage ; Humans ; Petrosal Sinus Sampling ; Punctures

PURPOSE: Since we reported about a landmark technique to reopen an occluded subclavian artery, we have faced difficulty in using protection devices in the vertebral artery to protect against thromboembolism from the reversed steal phenomenon after angioplasty and stenting. Therefore, we are presenting an optimal solution in using a protection device while recanalizing the occluded subclavian artery. MATERIALS AND METHODS: Among 21 cases of stenting for subclavian artery steno-occlusion, we applied the landmark technique at the opposite end of an occluded segment in 4 patients and used a protection device in two patients. Because the embolic protection device was placed in the vertebral artery via the brachial artery, optimal angioplasty and stenting via the brachial route were limited. Therefore, angioplasty via the trans-brachial approach was needed to be followed by stenting through a trans-femoral approach. We estimated the safe and optimal steps for placement and retrieval of the protection devices in addition to stenting. RESULTS: The procedure was safely performed when a stent was introduced via the femoral artery and a protection device was used via the brachial artery. However, in cases when a guidewire wasn't passed via the transfemoral route, simultaneous use of two systems via the brachial route could cause friction of devices or trapping of protection devices in a stent. When a protection device was trapped in a deployed stent, we retrieved the protection device with a 4F angiocatheter by selectively rotating the catheter tip. To avoid such procedural difficulty, we recommend using a transbrachial angioplasty followed by trans-femoral stenting while placing the protection device in the vertebral artery via the trans-brachial route. CONCLUSION: If a guidewire is not passed through using a trans-femoral approach while performing the landmark technique, changing the stenting route from brachial to the femoral artery can be useful after securing the lumen in the occluded subclavian artery after angioplasty via the brachial artery.
Angioplasty ; Brachial Artery ; Catheters ; Embolic Protection Devices ; Endovascular Procedures ; Femoral Artery ; Friction ; Humans ; Stents ; Subclavian Artery ; Thromboembolism ; Vertebral Artery

BACKGROUND AND PURPOSE: The diagnostic accuracy for unruptured intracranial aneurysms has increased, and incidental asymptomatic aneurysms have come to represent a substantial clinical burden because of their controversial natural history. However, their prevalence may be attributable to variations in evaluation methods and demographics. We therefore describe the prevalence and magnetic resonance angiography (MRA) findings of incidental intracranial saccular aneurysms over a 5-year period at a single large-volume center. METHODS: MRA images from 18,237 patients obtained between January 2001 and December 2005 were retrieved from the radiology report database. Patients diagnosed with incidental intracranial saccular aneurysms were identified and their MRA data were reviewed. Imaging and clinical follow-up data were evaluated. RESULTS: During the study period, 366 incidental intracranial saccular aneurysms were identified in 330 patients (prevalence, 1.8%; 95% confidence interval, 1.63%-2.01%; 115 men and 215 women; age range, 22-82 years; median age, 63 years). The prevalence was higher in women (215/8,112) than in men (115/10,125; P=0.02). The prevalence increased with age in women (P<0.01), but not in men (P=0.30). Aneurysm size ranged from 1.5 mm to 13 mm, with a median size of 4 mm. The most common location was the bifurcation of the middle cerebral artery (131/366; 35.8%). CONCLUSIONS: Our real world experience indicated a slightly lower overall prevalence of incidental intracranial saccular aneurysms than previously reported. The prevalence increased with age in women but not in men.
Aneurysm* ; Angiography* ; Demography ; Female ; Follow-Up Studies ; Head* ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Angiography ; Male ; Middle Cerebral Artery ; Natural History ; Prevalence

BACKGROUND AND PURPOSE: The diagnostic accuracy for unruptured intracranial aneurysms has increased, and incidental asymptomatic aneurysms have come to represent a substantial clinical burden because of their controversial natural history. However, their prevalence may be attributable to variations in evaluation methods and demographics. We therefore describe the prevalence and magnetic resonance angiography (MRA) findings of incidental intracranial saccular aneurysms over a 5-year period at a single large-volume center. METHODS: MRA images from 18,237 patients obtained between January 2001 and December 2005 were retrieved from the radiology report database. Patients diagnosed with incidental intracranial saccular aneurysms were identified and their MRA data were reviewed. Imaging and clinical follow-up data were evaluated. RESULTS: During the study period, 366 incidental intracranial saccular aneurysms were identified in 330 patients (prevalence, 1.8%; 95% confidence interval, 1.63%-2.01%; 115 men and 215 women; age range, 22-82 years; median age, 63 years). The prevalence was higher in women (215/8,112) than in men (115/10,125; P=0.02). The prevalence increased with age in women (P<0.01), but not in men (P=0.30). Aneurysm size ranged from 1.5 mm to 13 mm, with a median size of 4 mm. The most common location was the bifurcation of the middle cerebral artery (131/366; 35.8%). CONCLUSIONS: Our real world experience indicated a slightly lower overall prevalence of incidental intracranial saccular aneurysms than previously reported. The prevalence increased with age in women but not in men.
Aneurysm* ; Angiography* ; Demography ; Female ; Follow-Up Studies ; Head* ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Angiography ; Male ; Middle Cerebral Artery ; Natural History ; Prevalence

PURPOSE: Image-based computational models with fluid-structure interaction (FSI) can be used to perform plaque mechanical analysis in intracranial artery stenosis. We described a process in FSI study applied to symptomatic severe intracranial (M1) stenosis before and after stenting. MATERIALS AND METHODS: Reconstructed 3D angiography in STL format was transferred to Magics for smoothing of vessel surface and trimming of branch vessels and to HyperMesh for generating tetra volume mesh from triangular surface-meshed 3D angiogram. Computational analysis of blood flow in the blood vessels was performed using the commercial finite element software ADINA Ver 8.5. The distribution of wall shear stress (WSS), peak velocity and pressure was analyzed before and after intracranial stenting. RESULTS: The wall shear stress distributions from Computational fluid dynamics (CFD) simulation with rigid wall assumption as well as FSI simulation before and after stenting could be compared. The difference of WSS between rigid wall and compliant wall model both in pre- and post-stent case is only minor except at the stenosis region. These WSS values were greatly reduced after stenting to 15~20 Pa at systole and 3~5 Pa at end-diastole in CFD simulation, which are similar in FSI simulations. CONCLUSION: Our study revealed that FSI simulation before and after intracranial stenting was feasible despite of limited vessel wall dimension and could reveal change of WSS as well as flow velocity and wall pressure.
Angiography ; Arteries ; Atherosclerosis ; Blood Vessels ; Cerebral Arteries ; Characidae ; Constriction, Pathologic ; Glycosaminoglycans ; Hydrodynamics ; Magic ; Stents ; Systole

PURPOSE: The use of drug-eluting stent (DES) to treat intracranial stenosis has shown short-term success. However, there are no reports regarding the long-term results of DES. We present the long-term clinical outcome after DES stenting for symptomatic severe intracranial stenosis. MATERIALS AND METHODS: Our study included a consecutive series of 11 patients who underwent intracranial stenting using DES between March and July, 2006, during the time when bare metal stents were not available at our medical institution. The mean patient age was 59 years. Lesion location was the middle cerebral artery in five patients, the intradural vertebral artery in three, the basilar artery in one, the vertebrobasilar junction in one, and the cavernous internal cerebral artery in one patient. We evaluated the technical success, defined as reduction of residual stenosis < or =30% in the target lesion) as well as the clinical and imaging outcomes as long as 75 months following the procedure. In addition to a cerebral angiogram (n = 2), follow-up study was obtained by CT angiography (n = 6) or intracranial Doppler imaging (n = 2) during a mean time of 55 months after the procedure (range, 24 to 73 months). Three patients refused imaging follow-up and accepted only clinical follow-up. The mean clinical follow-up period was 67 months (range, 47-75 months). RESULTS: Stenting in all patients was technically successful and without periprocedural complications. There was thrombus formation during the procedure in one patient who experienced no further complications. There were no new neurological events during the mean follow-up period of 5.6 years. No patients were found to have restenosis > or =50% at during the mean follow-up period of 55 months. One patient died of a sudden heart attack 59 months following the procedure which was regarded as unrelated to the cerebral lesion. CONCLUSION: Our study demonstrates that DES shows long-term stability and safety, and results in good clinical outcomes with a low rate of restenosis.
Angiography ; Atherosclerosis ; Basilar Artery ; Caves ; Cerebral Arteries ; Constriction, Pathologic ; Drug-Eluting Stents ; Follow-Up Studies ; Heart ; Humans ; Middle Cerebral Artery ; Stents ; Thrombosis ; Vertebral Artery

PURPOSE: Wingspan is the only FDA approved self-expanding stent for intracranial artery and known to have better delivery compared to balloon expandable stent. However, some delivery failure has been reported but incidence and mechanism of the failure have not been completely elucidated. We present the cause and mechanism of Wingspan deployment failure experienced in our Institute. MATERIALS AND METHODS: We experienced deployment failure in seven patients (8.8%) out of 80 patients who underwent Wingspan stenting since 2007. Mean age of the patients was 62 (range 47~78) and male to female ratio was 6:1. We evaluated the cause and mechanism why the deployment was not successful and how we could manage it subsequently. RESULTS: We categorized failures occurred in seven patients into three categories: delivery failure (n = 3), deployment failure of stent (n = 3), retrieval failure of dual tapered (olive) tip of the inner body through the deployed the stent (n = 1). The technical failure in using Wingspan stent (delivery, deployment and retrieval failures) are related to tortuousness of the proximal (n =4) as well as distal (n =1) cerebral vessels to the stenotic lesion and bulky profile of the olive tip (n =2). CONCLUSION: The technical failure in using Wingspan stent (delivery, deployment and retrieval failures) are related to tortuousness of the proximal as well as distal cerebral vessels to the stenotic lesion and bulky profile of the olive tip. To avoid device-related complication, complete understanding of the stent design is mandatory before using the stent.
Arteries ; Atherosclerosis ; Female ; Humans ; Incidence ; Male ; Olea ; Stents