Although balloon angioplasty was initially limited to simple, focal lesions in peripheral arteries, the application of balloons in conjunction with stents, stent-grafts, laser-light, and advanced pharmacotherapies has allowed for widespread implementation of endovascular treatment, regardless of disease distribution or degree of ischemia. Further refinement of guidewires, sheaths, and adjunctive medications has allowed for traversal of even the longest lesions and has promoted technical success. In Korea, increasing numbers of endovascular therapies are being applied to iliac and femoral occlusive lesions by radiologists, vascular surgeons, and cardiologists. Although surgery remains the principal treatment for patients with lower limb ischemia, physicians must assess the benefits and risks associated with various treatment options, including endovascular therapy.
Angioplasty, Balloon ; Arteries ; Femoral Artery ; Humans ; Ischemia ; Korea ; Lower Extremity ; Risk Assessment ; Stents

Intravenous leiomyomatosis (IVL) is a rare, benign tumor that originates from the uterus. IVL is usually confined to the pelvic venous system, but it travels into the inferior vena cava (IVC) in 10% of cases and even into the heart in 3% of cases. We present a case of successful resection of recurrent IVL with right atrium extension. We used only an abdominal incision and transesophageal echocardiography (TEE) guidance. A 40-year-old female patient visited our hospital with recurrent IVL. She had a history of total abdominal hysterectomy and right salpingo-oophorectomy due to IVL performed one year prior. On computed tomography (CT) and ultrasonography, IVL was found to involve both ovarian veins, the left renal vein, and the IVC extending to the right atrial junction. Using intraoperative TEE monitoring, we could see that IVL was not attached to the vascular wall. After creating a midline abdominal incision, we removed the tumor through the enlarged ovarian vein and ovary. The patient had an uneventful recovery and was discharged home on the ninth postoperative day.
Adult ; Echocardiography, Transesophageal ; Female ; Heart ; Heart Atria ; Humans ; Hysterectomy ; Leiomyomatosis ; Ovary ; Renal Veins ; Uterus ; Veins ; Vena Cava, Inferior

An inferior vena cava (IVC) filter is a useful treatment to prevent a pulmonary embolism (PE) in patients with DVT. Since the introduction of IVC filters more than 30 years ago, there has been a steady improvement in the design, ease and safety of the delivery system. The use of a temporary filter has also increased as performing thrombolysis and thrombectomy has increased. Today all of the commonly used filters can be placed via a peripheral vein by using the standard percutaneous Seldinger (Ed note: check the spelling) technique. However this typically requires fluoroscopy, intravenous contrast agents, radiation exposure and transport of the patient to the interventional or operating suite. As the multiple trauma injured or critically-ill intensive care unit patients often require inotropic and ventilator support, transporting these patients to these facilities can be hazardous. The following report describes two cases of VTE patients who underwent percutaneous placement of an IVC filter with using duplex ultrasound guidance. Identification of the renal vein and artery is important to decide the infrarenal level. The first case was an 84 years female with right ilio-femoral DVT and pulmonary embolism. To prevent recurrence of PE, we decided to insert an IVC filter. The second case was a 47 years female with right femoral DVT together with left pulmonary embolism and infarction. She also had thrombocytopenia, which is a contraindication for anticoagulation. IVC filter insertion can be safely performed under ultrasound guidance. This technique will reduce the risk and complexity of inserting an IVC filter in selected multiple injured trauma patients.
Arteries ; Contrast Media ; Female ; Fluoroscopy ; Humans ; Infarction ; Intensive Care Units ; Multiple Trauma ; Pulmonary Embolism ; Recurrence ; Renal Veins ; Thrombectomy ; Thrombocytopenia ; Veins ; Vena Cava Filters ; Vena Cava, Inferior ; Ventilators, Mechanical

Citrobacter freundii is frequently isolated in antimicrobial-resistant nosocomial infections. Many strains of Citrobacter freundii are capable of producing an inducible broad-spectrum beta-lactamase. We report a case of an abdominal aortic aneurysm infected with Citrobacter freundii. A 55-year-old woman presented with acute lower back pain. Contrast enhanced computed tomography revealed a saccular aneurysm of the infrarenal abdominal aorta, with impending rupture. She underwent emergency surgery, during which a segment of aneurysmal aorta and infected tissue were completely removed and an in situ graft was placed for vascular reconstruction. The anastomotic site and inserted graft were wrapped with greater omentum. Citrobacter freundii was isolated by tissue culture from the resected aneurysmal wall.
Aneurysm ; Aorta ; Aorta, Abdominal ; Aortic Aneurysm, Abdominal ; beta-Lactamases ; Citrobacter ; Citrobacter freundii ; Cross Infection ; Emergencies ; Female ; Humans ; Low Back Pain ; Middle Aged ; Omentum ; Rupture ; Transplants

Takayasu arteritis (TA) is a chronic systemic inflammatory disease that most commonly affects the aorta and its major branches. TA-induced renal artery stenosis (TARAS) can result in malignant hypertension, severe renal dysfunction, cardiac decompression and premature death. Surgical management for TARAS has been proved to be effective and safe, especially in the medically or interventionally-intractable cases. We report here on a 39-year-old patient with recently deteriorating hypertension and renal function because of a recurred RAS, for which he underwent "y-shaped" aorto-birenal reconstruction surgery 20 years ago. CT angiography showed bilateral diffuse calcified stenosis in the previous renal graft and there was a partial rupture of a pseudoaneurysm in the suprarenal abdominal aorta segment between the celiac axis and the renal graft. We performed descending thoracic aorto-abdominal aortic bypass together with a graft-renal bypass and exclusion of the pseudoaneurysm. The renal function was normalized and the blood pressure became stable without any antihypertensive medication. He recovered and was discharged without any complications.
Adult ; Aneurysm, False ; Angiography ; Aorta ; Aorta, Abdominal ; Axis, Cervical Vertebra ; Blood Pressure ; Constriction, Pathologic ; Decompression ; Humans ; Hypertension ; Hypertension, Malignant ; Hypertension, Renovascular ; Mortality, Premature ; Renal Artery Obstruction ; Rupture ; Takayasu Arteritis ; Transplants

Endovascular aneurysm repair (EVAR) is used with increasing frequency in the management of high-risk abdominal aortic aneurysm (AAA) patients. We report a delayed open repair for a persistent type I endoleak after EVAR in a patient with co-morbidities. An infrarenal AAA with a transverse diameter of 9.86 cm was detected on CT angiography; it extended from 8 mm below the renal artery to both common iliac arteries. The infrarenal angle was 90 degrees. After insertion of a Zenith stent graft (COOK, USA), a type I endoleak was detected on aortography, and several balloon dilatations were performed. The procedure was finished with a sustained type I endoleak. The endoleak persisted after 5 days on Doppler ultrasound, so open repair was performed. Total operative time was 240 minutes, and the duration of supra-celiac aorta clamping was approximately 35 minutes. The patient suffered an acute myocardial infarction on postoperative day 7 and recovered with conservative management. The patient was discharged on postoperative day 29.
Aneurysm ; Aorta ; Aortic Aneurysm, Abdominal ; Aortography ; Constriction ; Dilatation ; Endoleak ; Humans ; Iliac Artery ; Myocardial Infarction ; Operative Time ; Renal Artery ; Stents ; Transplants

Endovascular aneurysm repair (EVAR) has become increasingly popular since Parodi reported the first endovascular repair in 1991. Aortobiiliac stent grafting has gained popularity as an endovascular technique for managing abdominal aortic aneurysms (AAA), but the use of aortouniiliac stenting with femorofemoral bypass increases the proportion of patients treatable by endovascular techniques. The Zenith AAA Endovascular Graft Converter is used to convert a bifurcated graft to an aortouniiliac graft. We report successful EVAR using an aortouniiliac stent graft and converter in a 66-year-old man with an AAA and right common iliac artery occlusion. The preoperative CT angiography showed an infrarenal AAA 78 mm in diameter and right common iliac artery occlusion with recanalization by a collateral epigastric artery. The converter was deployed after placement of the main body, and the iliac leg extension was placed in the left external iliac artery. No postoperative complications occurred, and no endoleak was seen on follow-up CT angiography.
Aged ; Aneurysm ; Angiography ; Aortic Aneurysm, Abdominal ; Arteries ; Endoleak ; Endovascular Procedures ; Epigastric Arteries ; Follow-Up Studies ; Humans ; Iliac Artery ; Leg ; Postoperative Complications ; Stents ; Transplants

Cross femoro-femoral venous bypass (the Palma operation) is one way of treating iliofemoral venous occlusion in patients with deep vein thrombosis (DVT). We reviewed five patients (four men and one woman, two right legs and three left legs) who underwent the Palma operation. Three patients underwent surgery secondary to severe suprapubic and scrotal varicosities; one patient underwent surgery for symptomatic pain and swelling; and one patient underwent surgery for acute severe DVT. Four patients showed good patency and flow through the venous bypass during follow-up. The suprapubic and scrotal varicosities disappeared after surgery. Our results suggest that the Palma operation is an effective treatment for selected cases of DVT.
Female ; Femoral Vein ; Follow-Up Studies ; Humans ; Leg ; Male ; Transplants ; Varicose Veins ; Veins ; Venous Thrombosis

PURPOSE: To evaluate the effectiveness and complications of temporary inferior vena cava filters in deep vein thrombosis. METHOD: We retrospectively evaluated the clinical data of 35 patients who underwent percutaneous insertion of a temporary, retrievable IVC filter during treatment of deep vein thrombosis between 2003 and 2006. A Tulip(R) was used in 25 patients, and an OptEase(R) was used in 10 patients. Indications for filter insertion included thrombolytic therapy (n=29), long floating IVC thrombosis (n=4), and pulmonary thromboembolism history with recurrent venous-thromboembolism (n=2). Deep vein thrombosis was treated with an endovascular procedure in 33 patients and anticoagulation therapy in 2 patients. RESULT: Complete symptom resolution was achieved in all patients. The temporary IVC filters were successfully retrieved in 28 of 35 patients (mean duration of filter placement: 9.57 days), but retrieval failed in 7 patients (thrombus in filter, 3 cases; remnant IVC thrombosis, 1 case; remnant iliac vein thrombosis/venous stenosis in high risk patient, 2 cases; in-hospital mortality due to underlying heart disease, 1 case). There were no cases of pulmonary embolism and no serious IVC filter-related complications during insertion, retraction, or remnant IVC filter follow-up. CONCLUSION: Temporary, retrievable IVC filters were effective in the prevention of pulmonary embolism. Further investigations are necessary to determine long-term outcome data for filters left in place.
Constriction, Pathologic ; Endovascular Procedures ; Heart Diseases ; Hospital Mortality ; Humans ; Iliac Vein ; Pulmonary Embolism ; Retrospective Studies ; Thrombolytic Therapy ; Thrombosis ; Veins ; Vena Cava Filters ; Vena Cava, Inferior ; Venous Thrombosis

PURPOSE: Takayasu's arteritis is a chronic disease characterized by nonspecific inflammation of the aorta and its branches, and cerebral ischemia has been considered to be the most life-threatening complication of this disorder. METHOD: We performed a retrospective review of 13 patients who underwent 16 procedures between 1996 and 2006 secondary to cerebrovascular symptoms in Takayasu's arteritis (median follow-up=52.5 months). RESULT: Study subjects included 10 females and 3 males, with a median age of 36.5 years. Procedures included 7 bypasses (2 aorto-bicarotid artery, 1 axillo-axillary artery, 2 subclavian-common carotid artery, 1 common carotid-internal carotid artery, and 1 axillo-vertebral artery), 4 carotid endarterectomies (CEA), and 5 stents (4 common carotid artery [1 for the treatment of re-stenosis of CEA] and 1 vertebral artery). All patients were relieved of their cerebral ischemic symptoms and remained stroke-free during the follow-up period. Re-stenosis was seen in two cases of stenting. Occlusion or stenosis of arterial reconstruction occurred more frequently in patients who had elevated erythrocyte sedimentation rates (ESR) preoperatively (P<0.05). CONCLUSION: Surgical treatment was effective in stroke prevention and elimination of cerebrovascular symptoms. The patency of the reconstruction was related to the progression of the disease as indicated by elevated ESR and [18F]fluorodeoxyglucose positron emission tomography, which are useful tools for evaluating disease activity.
Aorta ; Arteries ; Blood Sedimentation ; Brain Ischemia ; Carotid Arteries ; Carotid Artery, Common ; Cerebrovascular Disorders ; Chronic Disease ; Constriction, Pathologic ; Endarterectomy, Carotid ; Female ; Follow-Up Studies ; Humans ; Inflammation ; Male ; Positron-Emission Tomography ; Retrospective Studies ; Stents ; Stroke ; Takayasu Arteritis