There has been an improvement in the prognosis of the tumor thrombi invading the inferior vena cava (IVC) and the right atrium (RA) of the renal cell carcinoma with radical nephrectomy and tumor thrombectomy with the aid of a cardiopulmonary bypass. A 26 year old man was diagnosed with the right renal tumor with a tumor invading the right renal vein and the IVC above the right renal vein to the RA and right venticle. He was presented with dyspnea on the exertion, the ascites and the lower extremity edema due to IVC total obstruction. An acute hepatic failure occurred due to an obstruction of the hepatic vein. She received a radical nephrectomy and a removal of the tumor in the IVC and the right cardiac camber under a hypothermic total circulatory arrest using the cardiopulmonary bypass.
Ascites ; Carcinoma, Renal Cell ; Cardiopulmonary Bypass ; Circulatory Arrest, Deep Hypothermia Induced* ; Dyspnea ; Edema ; Heart Atria ; Heart Ventricles* ; Hepatic Veins ; Kidney Neoplasms ; Liver Failure, Acute ; Lower Extremity ; Nephrectomy ; Prognosis ; Renal Veins ; Sarcoma* ; Thrombectomy ; Vena Cava, Inferior*

Endovascular aneurysm repair (EVAR) has progressively become the preferred method for abdominal aortic aneurysm repair. Controlled studies have indicated that EVAR is related to decreased perioperative morbidity and mortality compared with open repair. However, long-term complications are more common. The most common complication following EVAR is an endoleak. Few studies on delayed type Ib endoleak with aortic rupture have been found in the literature. We report a case of a 92-year-old man with a delayed type Ib endoleak with aortic rupture that developed 7 years after EVAR. Lifelong surveillance after EVAR is mandatory.
Aneurysm ; Aortic Aneurysm, Abdominal* ; Aortic Rupture* ; Endoleak* ; Mortality ; Rupture

PURPOSE: This study suggests that venous calcification (VC) may occur within the arterialized vein (AV) of patients with chronic renal failure. VC may be the cause of arteriovenous fistula (AVF) failure. METHODS: Specimens of AV were obtained during the removal of AVF to study morphological changes in the AV wall. We retrospectively analyzed 27 patients with AV specimens prepared and stained with hematoxylin and eosin, Masson's trichrome and Verhoeff van Gieson stains. RESULTS: Of the 27 patients, only 7 (4 males and 3 females, mean age 49.4 years) had evidence of VC in the AV (5 patients media only, 2 patients intima and media involved). AVF removal was done due to aneurym (3 cases), stenosis (2 cases), and kidney transplantation (2 cases). The mean duration from AVF construction to the repair of AVF was 88 months (range, 50 to 144 months). There were two cases of diabetes mellitus and hypertension in patients with VC. CONCLUSION: VC may occur within the arterialized vein in chronic kidney disease patients after AVF construction.
Arteriovenous Fistula ; Constriction, Pathologic ; Diabetes Mellitus ; Eosine Yellowish-(YS) ; Female ; Fistula* ; Hematoxylin ; Humans ; Hypertension ; Kidney Failure, Chronic ; Kidney Transplantation ; Male ; Renal Dialysis* ; Renal Insufficiency, Chronic ; Retrospective Studies ; Veins

PURPOSE: Pulmonary thromboembolism (PTE) is one of the most critical complications of deep vein thrombosis (DVT). Studies on the incidence and the treatment of PTE are rare in Korea compared to western countries. This study analyzed the occurrence, risk factors and treatment of PTE in the patients diagnosed as acute DVT in a single center in Korea. METHODS: The study population was 84 patients diagnosed as acute DVT in Eulji University Hospital from August 2006 to March 2012. Of these patients, 51 patients who underwent chest computed tomography were finally included in this study. We performed a retrospective study and analyzed clinical characteristics, risk factors, and treatment of PTE. RESULTS: Among the 51 patients diagnosed as acute DVT, 22 patients (43.1%) had findings of PTE on chest computed tomography. PTE was more prevalent in male patients, when acute DVT occurred in the right lower extremity and proximal vein. All PTE patients were successfully treated with low molecular weight heparin. There was no mortality. CONCLUSION: Patients with acute DVT had similar incidence of PTE to western countries. However, PTE was successfully treated with conservative treatment. Therefore, expanding the indications of aggressive and invasive treatments, such as filter insertions, should be cautiously considered in Korean PTE patients.
Heparin, Low-Molecular-Weight ; Humans ; Incidence ; Korea ; Lower Extremity ; Male ; Pulmonary Embolism* ; Retrospective Studies ; Risk Factors ; Thorax ; Veins ; Venous Thrombosis*

PURPOSE: Symptomatic spontaneous isolated splanchnic artery dissection (SSISAD) is a rare disease entity. The treatment guideline for SSISAD has not been established. Isolated dissection of splanchnic artery can be clinically asymptomatic or symptomatic. Symptomatic dissection is more important because it can indicate ischemia of abdominal organ. METHODS: A retrospective study was conducted on 15 consecutive patients (mean age, 47.0 years; male, 87%) with SSISAD from January 2006 to July 2013. Each patient had acute onset abdominal pain and was diagnosed with SSISAD by abdominal-pelvic computed tomography. RESULTS: Median follow-up duration was 14.5+/-27.7 months (range, 1 to 79 months). Splanchnic arterial dissection involved celiac artery in three patients and superior mesentery artery in 12 patients. Conservative management (including bowel rest, hypertension medication, anticoagulation, and prophylactic antibiotics) was done in 14 patients. Endovascular treatment with stent insertion was performed in one patient. We experienced favorable clinical outcomes with SSISAD, even though one case needed endovascular treatment. CONCLUSION: Conservative management and selective revascularization could be a treatment option in patients with SSISAD.
Abdominal Pain ; Arteries* ; Celiac Artery ; Follow-Up Studies ; Humans ; Hypertension ; Ischemia ; Male ; Mesenteric Artery, Superior ; Mesentery ; Rare Diseases ; Retrospective Studies ; Stents

PURPOSE: The tortuosity of the iliac artery and length of the common iliac artery are considered to be limiting factors when performing endovascular aneurysm repair (EVAR). The aim of this study was to determine the anatomical features of the common iliac artery in patients who underwent EVAR. METHODS: Common iliac artery tortuosity was retrospectively assessed in 144 abdominal aortic aneurysm (AAA) patients (127 men; mean age, 70 years) treated from April 2007 to March 2011. Median luminal centerline measurements of 288 iliac arteries were made on preoperative computed tomography images using a three-dimensional workstation. RESULTS: The mean aneurysm diameter (+/-standard deviation) was 56.83+/-11.31 mm. The mean tortuosity index was 1.4287+/-0.1808. Five variables were significantly associated with the tortuosity ratio: age (r=0.216, P=0.009), diabetes mellitus (r=-0.215, P=0.010), smoking (r=-0.212, P=0.011), height (r=-0.169, P=0.043), and body mass index (r=-0.215, P=0.010). Procedure time and tortuosity were weakly correlated (r=0.166, P<0.05). Of the 70 cases with EVAR-related complications, there were 19 graft-related complications. There was no correlation found between iliac tortuosity and graft-related complications. CONCLUSION: A high degree of iliac artery tortuosity can be a limiting factor that increases the procedure time required for endovascular treatment of AAA. Measurement of iliac tortuosity is feasible and clinically meaningful, and its role in relation to human assessment must be further defined.
Aneurysm ; Aortic Aneurysm, Abdominal* ; Body Mass Index ; Diabetes Mellitus ; Endovascular Procedures* ; Humans ; Iliac Artery* ; Male ; Phenobarbital ; Retrospective Studies ; Smoke ; Smoking

Iatrogenic femoral pseudoaneurysm (IPA) is a troublesome complication related to the femoral arterial access site used for invasive cardiovascular procedures. Several therapeutic strategies have been developed to treat this complication. They include surgical repair, ultrasound-guided compression repair, and minimally invasive percutaneous treatments (thrombin injection, coil embolization, and insertion of covered stents). Traditionally, surgical repair has been the main treatment for IPA, particularly when the size of the pseudoaneurysm is larger than 4 cm or when anticoagulation or GP-IIb/IIIa inhibitors are extensively used during the procedure. However, if the site of the pseudoaneurysm, such as deep femoral artery, was more deeply located, thrombin injection might be simpler or more useful compared to surgical ligation. Here, we report the successful treatment of huge IPA by percutaneous thrombin injection in a case complicated with giant pseudoaneurysm of deep femoral artery after the endovascular intervention for peripheral arterial occlusive disease.
Aneurysm, False ; Arterial Occlusive Diseases ; Femoral Artery ; Ligation ; Thrombin

Mechanical closing devices were developed to shorten bed rest following percutaneous vascular intervention, and recently, the devices are replacing the conventional manual compression. Among the closing devices, the Perclose suture-mediated closure system (Perclose/Proglide) is known to be a safe and effective method that permits faster hemostasis and earlier ambulation compared with manual compression. However, with increased usage of femoral closure devices, reports of complications have emerged. Most reported complications are local bleedings, hematomas, and wound infections. Herein, we report a rare case: common femoral artery (CFA) stenosis after using Perclose suture-mediated closure system. After failure of secondary ballooning of the CFA stenotic segment, CFA was opened operatively and we found that snared atheroma by Perclose suture material was occupying the CFA lumen. Endarterectomy was performed for the lesion and the CFA stenosis was improved.
Angioplasty ; Bed Rest ; Constriction, Pathologic ; Endarterectomy ; Femoral Artery ; Hematoma ; Hemostasis ; Plaque, Atherosclerotic ; Sutures ; Walking ; Wound Infection

Spontaneous pseudoaneurysm of the superior mesenteric artery (SMA) is rare. However, it may have severe life-threatening complications such as ruptures or thrombosis. Our patient has developed a pseudoaneurysm, which was being misdiagnosed as superior mesenteric vein dissection by the computed tomography angiography. The pseudoaneurysm is revealed from branches of the SMA with no specific causes and is being treated by endovascular embolization after emergency exploratory laparotomy.
Aneurysm, False ; Angiography ; Embolization, Therapeutic ; Emergencies ; Humans ; Laparotomy ; Mesenteric Artery, Superior ; Mesenteric Veins ; Rupture ; Thrombosis

PURPOSE: Radiofrequency ablation (RFA) has been used as an alternative to conventional high ligation and stripping surgery for the treatment of saphenous vein insufficiency. A Korean clinical registry was established in 2012. The purpose of our study is to report the clinical outcomes of RFA from the Korean RFA Registry. METHODS: Data were collected in a multicenter, retrospective registry. All patients were treated before March 31, 2013. The indication for RFA was clinical, etiology, anatomy, and pathophysiology (CEAP) clinical class C2-C6 and patients with disease-associated symptoms, complications, or cosmetic concerns. We retrospectively reviewed the clinical outcomes, such as CEAP score, venous clinical severity score (VCSS), and quality of life (QoL) score after RFA using ClosureFAST (Covidien) catheter. The paired and independent t-test using IBM SPSS ver. 19.0 (IBM Co.) was used for the statistical analysis to evaluate the clinical improvement after treatment. RESULTS: There were 698 patients (890 limbs) treated with RFA at 5 centers in Korea. The average age was 53.7+/-12.0 years (range, 19 to 89 years) with a body mass index of 23.1+/-2.8 kg/m2, 58.2% of the patients were female. All saphenous veins with reflux > or =0.5 seconds were ablated simultaneously. The most common complication was ecchymosis, which occurred in 41 patients (5.9%). All clinical parameters were significantly improved. At the mean follow-up of 13.9 months, the occlusion rate was 94.6% in great saphenous vein and 94.5% in small saphenous vein. CONCLUSION: RFA is an effective modality in the treatment of saphenous vein insufficiency. The clinical parameters including CEAP class, VCSS and QoL score showed significant improvement after RFA.
Body Mass Index ; Catheter Ablation ; Catheters ; Ecchymosis ; Female ; Follow-Up Studies ; Humans ; Korea ; Ligation ; Quality of Life ; Retrospective Studies ; Saphenous Vein ; Varicose Veins