Purpose: We evaluated the clinical usefulness and safety of radiofrequency ablation (RFA) for the treatment of lung tumors.
Materials and Methods: This retrospective study included patients who underwent RFA for the treatment of lung tumors at our institution from March 2006 to April 2015. Technical success, safety, local tumor progression, and survival were evaluated.
Results: In total, 41 patients (28 men and 13 women; median age, 69 years; range 37-88 years) with 51 malignant lung tumors measuring 0.6-6.8 cm (mean, 1.7 ± 1.2 cm) completed 46 planned RFA sessions. Lung tumors were primary in 22 patients and metastatic in 19 patients. Four tumors were not completely surrounded by an ablation zone on computed tomography immediately after RFA (technical success rate; 91.3%, 42/46). One of 41 patients (2.4%) died of pneumonia in the contralateral lung 26 days after RFA. Grade 2 symptomatic pneumothorax (n = 5) and hemothorax (n = 1) and grade 1 asymptomatic pneumothorax (n = 9) occurred during the procedure. Grade 3 pneumonia (n = 1) and grade 2 fever (n = 2) occurred within 30 days of follow-up. During a mean follow-up period of 20.3 ± 19.1 months, local tumor progression developed in 8 of 51 tumors (15.7%). Eleven patients (26.8%) died of cancer progression (n = 9) or pneumonia (n = 2). The 5-year overall survival rate was 53.5% (95% confidence interval, 31.1-75.9%). Tumor size was a significant prognostic factor on Cox proportional hazards analysis.
Conclusion: RFA was a safe and useful treatment option for malignant lung tumors.
Subclavian arteriovenous (AV) fistula formation is a rare complication of chronic deep vein thrombosis after pacemaker insertion. Here we present the case of an 80-year-old woman who developed a symptomatic arteriovenous fistula more than two years after cardiac pacemaker insertion, as a result of chronic thrombotic stenosis of the left subclavian vein. The defect was managed endovascularly by embolization, balloon angioplasty, and stent graft insertion, in order to both close the fistula and recanalize the subclavian vein to prevent recurrence. In this case report we present the endovascular procedure undertaken, followed by a discussion of the relevant pathophysiology, treatment options, and approach considerations.
Endovascular aortic repair (EVAR) is generally considered to be contraindicated in the presence of a shaggy aorta, because of the high risk of shower embolization. However, many patients who have abdominal aortic aneurysms (AAAs) with diffuse aortic atherosclerosis need EVAR because of high surgical risk. We report a case of AAA with massive aortic plaques that was treated with EVAR, using an extracorporeal shunt with a blood filter constructed from the femoral artery and vein during the procedure. The patient had an uneventful postoperative course. This method of sieving emboli in a filter in an external shunt is highly effective for EVAR of a shaggy aorta.
A 78-year-old man developed pain and swelling in his right groin. Computed tomography revealed a ruptured aneurysm of the right profunda femoris artery. Reconstruction of the profunda femoris artery was not required because the patient did not have any evidence of peripheral artery occlusive disease and the ipsilateral internal iliac artery was patent. Thus, transcatheter coil embolization was performed, followed by ligation of the proximal portion of the aneurysm. The patient's postoperative course was uneventful. The patient had no neurological complications. On postoperative day 19, the patient was discharged.
The patient was a 44-year-old man with gross hematuria and left lumbago. Computed tomography (CT) showed thickening of the left ureteral wall. Serum immunoglobulin (Ig) G4 level was high (348 mg/dl). To definitively diagnose IgG4-related disease, we initially planned CT-guided biopsy of the ureter. However, biopsy seemed to pose a risk of ureteral perforation. Iodinated contrast medium was therefore administered during the procedure. While contrast agent was discharged into the ureter, the biopsy needle was carefully advanced under CT fluoroscopy in a direction to avoid the visualized ureteral lumen. Tissue was successfully collected from the ureteral wall without causing any complications and a pathological diagnosis was reached. CT-guided biopsy was thus effective for IgG4-related disease of the ureter in this case.
Hepatic encephalopathy (HE) is a syndrome that occurs in patients with severe liver dysfunction or a portosystemic shunt. In patients with refractory HE caused by a portosystemic shunt, interventional closure of the shunt vessel is essential. Currently, transcatheter embolization is recognized as a less invasive and highly effective procedure, and it is considered as a first-choice method for the occlusion of shunt vessels. In this review, we discuss the role of a portosystemic shunt in the development of HE and describe the procedure and significance of transcatheter embolization of a portosystemic shunt.
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