Displaying publications 1 - 20 of 23 in total

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  1. Tan ZQ, Ooi EH, Chiew YS, Foo JJ, Ng EYK, Ooi ET
    Ultrasonics, 2023 May;131:106961.
    PMID: 36812819 DOI: 10.1016/j.ultras.2023.106961
    Sonothrombolysis is a technique that utilises ultrasound waves to excite microbubbles surrounding a clot. Clot lysis is achieved through mechanical damage induced by acoustic cavitation and through local clot displacement induced by acoustic radiation force (ARF). Despite the potential of microbubble-mediated sonothrombolysis, the selection of the optimal ultrasound and microbubble parameters remains a challenge. Existing experimental studies are not able to provide a complete picture of how ultrasound and microbubble characteristics influence the outcome of sonothrombolysis. Likewise, computational studies have not been applied in detail in the context of sonothrombolysis. Hence, the effect of interaction between the bubble dynamics and acoustic propagation on the acoustic streaming and clot deformation remains unclear. In the present study, we report for the first time the computational framework that couples the bubble dynamic phenomena with the acoustic propagation in a bubbly medium to simulate microbubble-mediated sonothrombolysis using a forward-viewing transducer. The computational framework was used to investigate the effects of ultrasound properties (pressure and frequency) and microbubble characteristics (radius and concentration) on the outcome of sonothrombolysis. Four major findings were obtained from the simulation results: (i) ultrasound pressure plays the most dominant role over all the other parameters in affecting the bubble dynamics, acoustic attenuation, ARF, acoustic streaming, and clot displacement, (ii) smaller microbubbles could contribute to a more violent oscillation and improve the ARF simultaneously when they are stimulated at higher ultrasound pressure, (iii) higher microbubbles concentration increases the ARF, and (iv) the effect of ultrasound frequency on acoustic attenuation is dependent on the ultrasound pressure. These results may provide fundamental insight that is crucial in bringing sonothrombolysis closer to clinical implementation.
    Matched MeSH terms: Endovascular Procedures*
  2. Saw ST, Feona SJ, Leong BDK
    Med J Malaysia, 2017 10;72(5):321-323.
    PMID: 29197893 MyJurnal
    Concurrent thoracic and abdominal aortic aneurysm is uncommon. It remains a formidable surgical challenge to vascular surgeons, as decision to treat in staged or simultaneous setting still debatable. We present, here, a case of a 62-year-old-man with asymptomatic concurrent thoracic and abdominal aortic aneurysms, which was successfully treated with two-stage hybrid endovascular repair. The aim of this case report is to discuss the treatment options available, possible associated complications and measures to prevent them.
    Matched MeSH terms: Endovascular Procedures
  3. Harunarashid H, Jasman WJ, Azim MM, Das S
    Clin Ter, 2012 Jul;163(4):311-2.
    PMID: 23007815
    Mycotic descending thoracic aneurysm with aortobronchial fistula is a rare condition which is associated with high mortality. Treatment in the era of minimally invasive procedure can often be controversial. The risk of graft infection should be considered as well as the unknown long term behavior of the endovascular stent. Here, we describe our initial experience of performing emergency thoracic endovascular aneurysm repair in an unstable patient presenting with haemoptysis.
    Matched MeSH terms: Endovascular Procedures*
  4. Ayob KA, Merican AM, Sulaiman SH, Hariz Ramli AR
    Jt Dis Relat Surg, 2021;32(1):239-244.
    PMID: 33463444 DOI: 10.5606/ehc.2021.77862
    Injuries to the pelvic vasculature during total hip arthroplasties are rare but have serious consequence. They demand urgent and early identification so that appropriate treatment can be instituted. If the bleeding is severe, cardiovascular compromise occurs intraoperatively and this will alert the surgeon of this possibility during acetabular screw placement. Alternatively, a delay in diagnosis can occur because the bleeding and the injured vessel are in the pelvic cavity and not visualized during the surgery. In this article, we report two cases from our center occurring within a six-month interval that sustained a vascular injury during acetabular drilling for screw placement for cementless cup fixation. Each case had a different vessel injury and different lessons can be learned from these rare injuries. The first case had an injury of the inferior gluteal artery following a breach of the sciatic notch. The vessel was treated with percutaneous embolization. The second case demonstrated a venous injury, following a medial protrusio technique for congenital hip dysplasia and a short anterosuperior screw, transecting the external iliac vein. This was subsequently repaired using an endovascular technique. We conclude the reasons for these vessel injuries after analyzing advanced imaging, discuss measures to avoid vessel injury and detail the minimally invasive method for their treatment.
    Matched MeSH terms: Endovascular Procedures/methods*
  5. Wan Ab Naim WN, Ganesan PB, Sun Z, Lei J, Jansen S, Hashim SA, et al.
    Int J Numer Method Biomed Eng, 2018 05;34(5):e2961.
    PMID: 29331052 DOI: 10.1002/cnm.2961
    Endovascular stent graft repair has become a common treatment for complicated Stanford type B aortic dissection to restore true lumen flow and induce false lumen thrombosis. Using computational fluid dynamics, this study reports the differences in flow patterns and wall shear stress distribution in complicated Stanford type B aortic dissection patients after endovascular stent graft repair. Five patients were included in this study: 2 have more than 80% false lumen thrombosis (group 1), while 3 others had less than 80% false lumen thrombosis (group 2) within 1 year following endovascular repair. Group 1 patients had concentrated re-entry tears around the abdominal branches only, while group 2 patients had re-entry tears that spread along the dissection line. Blood flow inside the false lumen which affected thrombus formation increased with the number of re-entry tears and when only small amounts of blood that entered the false lumen exited through the branches. In those cases where dissection extended below the abdominal branches (group 2), patients with fewer re-entry tears and longer distance between the tears had low wall shear stress contributing to thrombosis. This work provides an insight into predicting the development of complete or incomplete false lumen thrombosis and has implications for patient selection for treatment.
    Matched MeSH terms: Endovascular Procedures/methods*
  6. Zainal IA, Fuad NFN, Yang LY, Ismail NAN, Yaacob NY, Zakaria R
    J Egypt Natl Canc Inst, 2024 May 13;36(1):15.
    PMID: 38736004 DOI: 10.1186/s43046-024-00216-4
    BACKGROUND: Giant sacrococcygeal teratomas (SCTs) are at risk of perinatal morbidity and mortality due to their high vascularity. Pre-operative embolization of the feeding arteries, prior to complete surgical resection, may assist in minimizing the intraoperative blood loss by occluding these feeding arteries.

    CASE PRESENTATION: We present a case of a highly vascular giant SCT in a neonate, which was successfully embolized through an endovascular approach prior to surgery. The femoral artery approach was chosen, with access established using a Micropuncture introducer as a sheath. Embolization was performed using a combination of microcoils, Gelfoam slurry, and polyvinyl alcohol particles. The patient developed femoral artery spasm post-procedure, which resolved with the application of a glyceryl trinitrate patch.

    CONCLUSIONS: Performing pre-operative endovascular embolization on a giant sacrococcygeal teratoma presents particular challenges, primarily due to the difficulty in assessing small vessels and the potential complications associated with this procedure. Nevertheless, this technique proves exceptionally valuable in helping the surgeon minimize blood loss during surgery, thereby reducing the risks of morbidity and mortality. Comprehensive planning for the embolization procedure is essential, encompassing the identification of potential vascular access points and alternatives, along with careful selection of the appropriate catheter.

    Matched MeSH terms: Endovascular Procedures/methods
  7. Ambrosanio G, Arthimulam G, Leone G, Guarnieri G, Muto M, Muto M
    World Neurosurg, 2020 10;142:167-170.
    PMID: 32615295 DOI: 10.1016/j.wneu.2020.06.190
    BACKGROUND: Intracranial vascular malformations are increasingly being treated via the endovascular route. Though generally safe, a multitude of intraprocedural complications that potentially lead to disastrous clinical outcomes may arise. It is crucial for the operators to be well versed with the various techniques that are available to overcome any procedure-specific complications.

    METHODS: We present 2 cases in which we encountered premature intravascular detachment of the microcatheter tip and coil migration while treating a dural arteriovenous fistula and aneurysm, respectively. We used a stentriever to remove the detached microcatheter tip and suction using the reperfusion catheter to remove the migrated coil, both techniques that have not been reported in the literature thus far.

    RESULTS: Detached microcatheter tip and migrated coil were successfully retrieved using a stentriever and aspiration catheter.

    CONCLUSIONS: These novel techniques could potentially reduce mortality and morbidity associated with neurointervention.

    Matched MeSH terms: Endovascular Procedures/adverse effects*; Endovascular Procedures/methods
  8. Tadipi S, Sadashiv R, Muralidharan S, Pimid M
    Malays J Med Sci, 2015 Nov;22(6):67-70.
    PMID: 28223889
    Variations in the urogenital vascular anomalies in the abdomen are very common. However, they warrant attention due to their importance in operative, diagnostic, and endovascular procedures. During routine dissection of abdomen in a male cadaver, unique urogenital vascular anomalies were observed. On the right side, the right renal artery was found to be originated from the abdominal aorta at the level of L2 and divided into five branches; the right testicular artery and inferior suprarenal artery originated from the lower branch. We also observed, accessory renal artery arising from abdominal aorta at the level of L3 and double renal veins on right side. On the left side, we found left renal artery originating from the abdominal aorta at the level of L2 and divided into two branches. Double testicular (medial and lateral) arteries were also observed. In addition to these vascular variations, bilateral kinking of ureter at the pelviureteric junction was also observed. Although the variations in the origin of urogenital vessels in the abdomen are common, deeper understanding of the urogenital vascular variations and their relations to adjacent structures is significant during surgical and radiological procedures.
    Matched MeSH terms: Endovascular Procedures
  9. Tang IP, Chai CK, Kumar G, Prepageran N, Waran V
    Br J Neurosurg, 2014 Jun;28(3):390-2.
    PMID: 23875880 DOI: 10.3109/02688697.2013.817535
    Isolated intrasellar pituitary mucocele following transsphenoidal sinus surgery is extremely rare. The clinical features resemble a pituitary tumor, therefore careful radiological interpretation is crucial to reach the correct diagnosis. We report a case of intrasellar mucocele who had transsphenoidal sinus surgery performed 15 years prior.
    Matched MeSH terms: Endovascular Procedures/methods
  10. Hamad M, Rajan R, Kosai N, Sutton P, Das S, Harunarashid H
    Ethiop J Health Sci, 2016 Jan;26(1):85-8.
    PMID: 26949321
    BACKGROUND: Complication following fracture of a central venous catheter can be catastrophic to both the patient and the attending doctor. Catheter fracture has been attributed to several factors namely prolong mechanical force acting on the catheter, and forceful removal or insertion of the catheter.

    CASE DETAILS: In the present case, the fracture was suspected during the process of removal. The tip of the catheter was notably missing, and an emergency chest radiograph confirmed our diagnosis of a retained fracture of central venous catheter. The retained portion was removed by the interventional radiologist using an endovascular loop snare and delivered through a femoral vein venotomy performed by the surgeon.

    CONCLUSION: Endovascular approach to retrieval of retained fractured catheters has helped tremendously to reduce associated morbidity and the need for major surgery. The role of surgery has become limited to instances of failed endovascular retrieval and in remote geographical locations devoid of such specialty.

    Matched MeSH terms: Endovascular Procedures/methods*
  11. Goh ZNL, Seak JC, Seak CK, Wu CT, Seak CJ
    Medicine (Baltimore), 2019 Aug;98(31):e16645.
    PMID: 31374036 DOI: 10.1097/MD.0000000000016645
    RATIONALE: Abdominal aortic aneurysm is an extremely rare cause of deep vein thrombosis. Here we report an elderly gentleman who presented with deep vein thrombosis and was found to have concomitant abdominal aortic aneurysm upon ultrasonographic screening. It illustrates the possibility of such an aetiology, and the importance of screening for such aneurysms in a select patient population before heparinization.

    PATIENT CONCERNS: A 73-year-old Asian gentleman with underlying hypertension, hyperlipidaemia, chronic renal failure, and history of chronic smoking presented to the emergency department with acute left lower limb swelling of 1 day. On examination, the patient was tachycardic (110 beats/minute) and hypertensive (168/84 millimeters mercury (mmHg)). The entire left lower limb was swollen with notable pitting oedema, tenderness, and warmth; left calf swelling was measured to be 4 centimeters (cm).

    DIAGNOSES: The patient's Wells score of 4 placed him in the high-risk group for deep vein thrombosis. Serum D-dimer was subsequently found to be elevated at 926 nanograms/milliliter (ng/ml). Compression ultrasonography revealed a thrombus in the left deep femoral vein, confirming the diagnosis of deep vein thrombosis. The ultrasonographic evaluation was extended to the abdominal aorta due to the patient's high risk of abdominal aortic aneurysm, and a 7-cm aneurysm was indeed found. Further computed tomography and magnetic resonance imaging localized it to the infrarenal region, with left common iliac vein compression resulting in stagnant venous return.

    INTERVENTIONS: Emergency endovascular repair was performed with insertion of an inferior vena cava filter.

    OUTCOMES: The patient was subsequently monitored in the intensive care unit and uneventfully discharged after 2 weeks.

    LESSONS: Such clinical presentations of deep vein thrombosis are rare, but physicians are reminded to consider screening for abdominal aneurysms and other anatomical causes before heparinization in patients who seemingly do not have thromboembolic risk factors. This is especially so for the high risk group of male deep vein thrombosis patients aged 65-75 years with a history of smoking who have yet to be screened for abdominal aortic aneurysms, in line with United States Preventive Services Task Force recommendations.

    Matched MeSH terms: Endovascular Procedures/methods
  12. Ng JC, Churojana A, Pongpech S, Vu LD, Sadikin C, Mahadevan J, et al.
    Interv Neuroradiol, 2019 Jun;25(3):291-296.
    PMID: 30463501 DOI: 10.1177/1591019918811804
    Acute stroke care systems in Southeast Asian countries are at various stages of development, with disparate treatment availability and practice in terms of intravenous thrombolysis and endovascular therapy. With the advent of successful endovascular therapy stroke trials over the past decade, the pressure to revise and advance acute stroke management has greatly intensified. Southeast Asian patients exhibit unique stroke features, such as increased susceptibility to intracranial atherosclerosis and higher prevalence of intracranial haemorrhage, likely secondary to modified vascular risk factors from differing dietary and lifestyle habits. Accordingly, the practice of acute endovascular stroke interventions needs to take into account these considerations. Acute stroke care systems in Southeast Asia also face a unique challenge of huge stroke burden against a background of ageing population, differing political landscape and healthcare systems in these countries. Building on existing published data, further complemented by multi-national interaction and collaboration over the past few years, the current state of acute stroke care systems with existing endovascular therapy services in Southeast Asian countries are consolidated and analysed in this review. The challenges facing acute stroke care strategies in this region are discussed.
    Matched MeSH terms: Endovascular Procedures/statistics & numerical data
  13. Yong YL, Tan LK, McLaughlin RA, Chee KH, Liew YM
    J Biomed Opt, 2017 12;22(12):1-9.
    PMID: 29274144 DOI: 10.1117/1.JBO.22.12.126005
    Intravascular optical coherence tomography (OCT) is an optical imaging modality commonly used in the assessment of coronary artery diseases during percutaneous coronary intervention. Manual segmentation to assess luminal stenosis from OCT pullback scans is challenging and time consuming. We propose a linear-regression convolutional neural network to automatically perform vessel lumen segmentation, parameterized in terms of radial distances from the catheter centroid in polar space. Benchmarked against gold-standard manual segmentation, our proposed algorithm achieves average locational accuracy of the vessel wall of 22 microns, and 0.985 and 0.970 in Dice coefficient and Jaccard similarity index, respectively. The average absolute error of luminal area estimation is 1.38%. The processing rate is 40.6 ms per image, suggesting the potential to be incorporated into a clinical workflow and to provide quantitative assessment of vessel lumen in an intraoperative time frame.
    Matched MeSH terms: Endovascular Procedures/methods*
  14. Leong BD, Naresh G, Hanif H, Lee SK, Zainal AA, Sara CM
    Surg Today, 2013 Aug;43(8):918-22.
    PMID: 22987278 DOI: 10.1007/s00595-012-0330-6
    Open surgical repair of axillosubclavian artery injuries is technically demanding and associated with significant morbidity and mortality. Endovascular intervention has emerged as a valuable alternative to open surgical repair. This report presents three cases with axillosubclavian artery injuries managed with endovascular intervention. All three cases had a pseudoaneurysm of the axillosubclavian artery with one case associated with an arteriovenous fistula. They were successfully treated with endovascular stenting and balloon angioplasty. There were no observed acute complications. No complications or recurrence have occurred, with a mean follow-up of 26 months. Endovascular intervention for axillosubclavian artery injuries is less invasive, safe and effective; however, data concerning the long-term effects and complications associated with this technique are lacking.
    Matched MeSH terms: Endovascular Procedures/methods*
  15. Noor Khairiah AK, Mohamad Nazrulhisham MN, Hazman MN
    Med J Malaysia, 2018 12;73(6):407-409.
    PMID: 30647215
    Malignant intrathoracic disease is the commonest cause of superior vena cava (SVC) obstruction. Life threatening SVC obstruction with intense dyspnoea requires urgent treatment. SVC stenting has been developed in recent years which results in rapid relief of the obstruction. The Yconfiguration technique has been reported to provide support for all three limbs of the bifurcation to prevent restenosis. At present, there are limited reports on the use of Y-configuration stent in stent techniques for endovascular stenting in malignant SVC obstruction. We share our clinical experience of two patients who received balloon-mounted stents using this technique.
    Matched MeSH terms: Endovascular Procedures/instrumentation; Endovascular Procedures/methods
  16. Promphan W, Han Siang K, Prachasilchai P, Jarutach J, Makonkawkeyoon K, Siwaprapakorn W, et al.
    Catheter Cardiovasc Interv, 2020 09 01;96(3):E310-E316.
    PMID: 32299151 DOI: 10.1002/ccd.28892
    OBJECTIVES: To assess feasibility and early outcomes of using BeGraft Aortic stent in the treatment of aortic coarctation (CoA).

    BACKGROUND: BeGraft Aortic stent (Bentley InnoMed, Hechingen, Germany) allows large postdilation diameter up to 30 mm. With availability of lengths of 19-59 mm and lower stent profile, they can be used in native and recurrent CoA in adults and in pediatric patients.

    MATERIALS AND METHODS: This is a multicentre retrospective analysis of 12 implanted BeGraft Aortic stents in CoA between May 2017 and April 2019.

    RESULTS: Twelve patients aged 7.7-38 years (median 18.3 years) with body weight of 19.9-56 kg (median 45.5 kg). Eight patients (66%) had native juxtaductal CoA while four had recurrent CoA after previous surgical or transcatheter treatments. The stents were implanted successfully in all the patients with no serious adverse events. The length of the stents ranged from 27 to 59 mm and the implanted stent diameter varied from 12 to 18 mm. The median intraprocedural CoA pressure gradient decreased from 25 mmHg (range 16-66 mmHg) to 2 mmHg (range 0-13 mmHg). The mean follow-up duration was 10.2 months. Two patient (16.6%) had residual stent narrowing requiring staged redilation. One patient (8%) had pseudoaneurysm formation at 1 year cardiac CT follow-up.

    CONCLUSIONS: The BeGraft Aortic stent may be considered to be safe and effective in the short term in treatment of CoA from childhood to adulthood. Long-term follow-up is needed.

    Matched MeSH terms: Endovascular Procedures/adverse effects; Endovascular Procedures/instrumentation*
  17. Palur, Ravikant
    Medical Health Reviews, 2009;2009(1):15-42.
    MyJurnal
    The brain is considered the most eloquent organ in the human body as its activities impacts on all other systems. Though protected physically (in a bony covering), physiologically through the blood-CSF barrier (from invading organisms and toxins) and hemodynamically through the phenomenon of cerebral autoregulation; the brain is open to insults of various kinds which can critically damage this structure. Intracellular Ca++ accumulation, excessive activation of excitatory amino acid receptors, lipid peroxidation and free radical releaserelated damage are but a few of the pathological processes that occur at the neuronal level leading to damage. The mechanism by which the brain can be provided protection when it is in a compromised state or likely to be compromised is known as cerebral protection. There are various modalities of pharmacologic (use of barbiturates, etomidate, isoflurane, steroids, Ca++, corticosteroids etc) and non-pharmacologic therapies (hypothermia, hyperventilation, induced hypotension, electrophysiologic monitoring, endovascular management etc) available for cerebral protection which finds place in the armamentarium of clinicians managing the critically injured brain. Our knowledge of the functioning of the brain at the molecular level and the various biochemico-pathological processes that are set into motion during critical states continues to evolve. This review article attempts to explain present understanding of the biochemical and pathological processes involved in neuronal damage while also looking at current available therapies (pharmacologic & nonpharmacologic) being utilized in different clinical settings.
    Matched MeSH terms: Endovascular Procedures
  18. Rajadurai A, Aziz AA, Daud NAM, Wahab AFA, Muda AS
    Malays J Med Sci, 2017 Dec;24(6):107-112.
    PMID: 29379394 DOI: 10.21315/mjms2017.24.6.14
    Introduction: Venous aneurysms are not as common as their arterial counterpart. The choice of management is debatable. Case Report: We present the case of a teenage boy with left external jugular vein aneurysm treated by endovascular technique. Embolisation was done using pushable microcoils with access via the femoral vein and direct puncture.

    Conclusion: This form of treatment provides a less-invasive option with a more concrete evaluation of the venous abnormality and its drainage during venous aneurysm occlusion.

    Matched MeSH terms: Endovascular Procedures
  19. Kawarada O, Zen K, Hozawa K, Ayabe S, Huang HL, Choi D, et al.
    Cardiovasc Interv Ther, 2018 Oct;33(4):297-312.
    PMID: 29654408 DOI: 10.1007/s12928-018-0523-z
    The burden of peripheral artery disease (PAD) and diabetes in Asia is projected to increase. Asia also has the highest incidence and prevalence of end-stage renal disease (ESRD) in the world. Therefore, most Asian patients with PAD might have diabetic PAD or ESRD-related PAD. Given these pandemic conditions, critical limb ischemia (CLI) with diabetes or ESRD, the most advanced and challenging subset of PAD, is an emerging public health issue in Asian countries. Given that diabetic and ESRD-related CLI have complex pathophysiology that involve arterial insufficiency, bacterial infection, neuropathy, and foot deformity, a coordinated approach that involves endovascular therapy and wound care is vital. Recently, there is increasing interaction among cardiologists, vascular surgeons, radiologists, orthopedic surgeons, and plastic surgeons beyond specialty and country boundaries in Asia. This article is intended to share practical Asian multidisciplinary consensus statement on the collaboration between endovascular therapy and wound care for CLI.
    Matched MeSH terms: Endovascular Procedures/methods*
  20. Yew KL, Anderson S, Farah R, Lim SH
    Asian Cardiovasc Thorac Ann, 2014 Oct;22(8):979-80.
    PMID: 24887840 DOI: 10.1177/0218492313491583
    Central vein stenosis is not uncommon in hemodialysis-dependent patients as a result of mechanical damage to the vessel walls from prior cannulation. It can cause ipsilateral upper limb swelling and pain, resulting in suboptimal hemodialysis. It is unfortunate for bilateral central vein stenosis to develop concomitantly, and rare in the setting of an in-situ pacemaker. This case illustrates the successful ligation of a nondependent left arteriovenous fistula and stenting of the right subclavian vein with functioning ipsilateral arteriovenous fistula, to overcome the problem of symptomatic bilateral upper limb swelling.
    Matched MeSH terms: Endovascular Procedures/instrumentation
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