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1. 서, 배선. Traumatic arterial dissection of the lower extremity: computed tomography findings and endovascular management.

Degree: 2018, Ajou University

Introduction: To report imaging findings and endovascular management in traumatic arterial dissection of lower extremity. Material and Methods: Nine patients who underwent endovascular treatment for traumatic arterial dissection of the lower extremity from January 2010 to July 2016 were retrospectively reviewed. Pre-procedural multiphasic CT angiography or single-phase abdomen CT was performed. Balloon angioplasty was primarily performed while stenting was reserved for cases of ineffective initial balloon angioplasty. Computed tomography (CT) findings, treatment results, and patient outcomes were assessed. Technical success was defined as recanalization of injured vessels in completion angiography, and clinical success as an improvement of ischemic signs. Results: On contrast enhanced CT, segmental occlusion accompanied by the ‘crescent sign’ was seen in seven patients while dissection flaps were clearly visible in two. Progressive contrast filling in the segment with ‘crescent sign’ was noted on delayed phase of enhancement. Types of endovascular procedures included balloon angioplasty alone (n=5), bare-metal stent insertion (n=2), and stent-graft insertion (n=2). The technical success rate was 100% and the clinical success rate was 88.9%. All treated vessels were patent on follow-up CT angiogram. Pseudoaneurysm was seen in one patient during follow-up. Conclusion: Characteristic features on CT angiography may aid diagnosis of traumatic arterial dissection, in which case balloon angioplasty can be attempted initially and stenting can be reserved as a bailout strategy.

서론: 외상으로 인한 하지의 동맥 박리에서의 전산화 단층 촬영 (CT) 소견과 혈관 중재시술의 방법 및 환자 예후에 대해 보고하고자 한다. 연구방법: 2010년 1월부터 2016년 7월까지 외상으로 인한 하지 동맥 박리 환자 중 혈관 중재시술로 치료를 받은 환자 9명을 후향적으로 분석하였다. 환자는 시술 전에 다중위상 혈관조영 CT 또는 조영 증강 복부 단층 촬영을 시행하였다. 박리된 혈관에 대해 모든 환자에서 풍선 혈관성형술을 우선적으로 시행하였으며, 효과가 없는 경우 스텐트 삽입술을 시행하였다. CT 소견, 치료 결과 및 환자 예후를 분석하였다. 기술적 성공은 시술 후 혈관조영술에서 손상된 혈관이 성공적으로 재개통 된 경우로 정의하였고, 임상적 성공은 하지의 허혈성 증상이 개선된 경우로 정의하였다. 연구결과: 조영 증강 CT에서 7명의 환자에서 분절형 폐쇄와 동반된 초승달 모양의 동맥 내경이 관찰되었으며, 2명의 환자에서는 일자형의 박리판이 관찰되었다. 다중위상 혈관조영 CT을 시행한 4명의 환자에서는 초승달 모양의 동맥 내경을 보인 손상 부위가 점진적으로 조영 증강되는 모습을 보였다. 5명의 환자에서는 풍선 성형술만으로 재개통 되었으며, 2명에서는 금속 스텐트 삽입, 나머지 2명에서 인조혈관 스텐트 삽입으로 재개통 되었다. 기술적 성공률은 100%, 임상적 성공률은 88.9%로 확인되었다. 치료받은 모든 혈관에서 추적 관찰 시 시행한 CT상 혈관 개통이 유지되었으며, 1명의 환자에서 합병증으로 가성동맥류가 발생하였다. 결론: 분절형 폐쇄와 동반된 초승달 모양의 동맥 내경 또는 일자형의 박리판으로 관찰되는 특징적인 CT 소견은 하지의 외상성 동맥 박리를 진단하는데 도움이 될 수 있다. 풍선 혈관성형술이 우선적으로 시행될 수 있고, 효과적이지 않은 경우 스텐트 삽입술이 도움이 되겠다.

ABSTRACT i TABLE OF CONTENTS iii LIST OF FIGURES iv LIST OF TABLES v INTRODUCTION 1 MATERIAL AND METHODS 1 A. Patient selection 1 B. CT techniques and image interpretation 2 C. Endovascular techniques 2 D. Outcome analysis 3 RESULTS 4 A. Patient demographics and lesion characteristics 4 B. CT findings 6 C. Endovascular treatment 8 D. Patient outcomes 10 DISCUSSION 12 CONCLUSION 14 REFERENCES 15 국문요약 17

Master

Advisors/Committee Members: 대학원 의학과, 201624076, 서, 배선.

Subjects/Keywords: Trauma; Dissection; Lower extremity; CT; Endovascular; 외상; 동맥 박리; 하지; 전산화 단층 촬영; 중재시술

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

서, . (2018). Traumatic arterial dissection of the lower extremity: computed tomography findings and endovascular management. (Thesis). Ajou University. Retrieved from http://repository.ajou.ac.kr/handle/201003/16594 ; http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000027803

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16th Edition):

서, 배선. “Traumatic arterial dissection of the lower extremity: computed tomography findings and endovascular management.” 2018. Thesis, Ajou University. Accessed January 23, 2019. http://repository.ajou.ac.kr/handle/201003/16594 ; http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000027803.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

MLA Handbook (7th Edition):

서, 배선. “Traumatic arterial dissection of the lower extremity: computed tomography findings and endovascular management.” 2018. Web. 23 Jan 2019.

Vancouver:

서 . Traumatic arterial dissection of the lower extremity: computed tomography findings and endovascular management. [Internet] [Thesis]. Ajou University; 2018. [cited 2019 Jan 23]. Available from: http://repository.ajou.ac.kr/handle/201003/16594 ; http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000027803.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

서 . Traumatic arterial dissection of the lower extremity: computed tomography findings and endovascular management. [Thesis]. Ajou University; 2018. Available from: http://repository.ajou.ac.kr/handle/201003/16594 ; http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000027803

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

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