Oral anticoagulants are used for prophylaxis or treatment of both arterial and venous thromboembolisms, and their use has increased with the increment of the aged population and cardiovascular disease. Oral anticoagulants, such as warfarin, are associated with a risk for bleeding, but small bowel necrosis by hemorrhage is a very rare complication of warfarin therapy. The combination of warfarin and an antiplatelet agent increase the risk of bleeding. A 70-year-old man with no prior symptoms was admitted to the emergency department with periumbilical pain. He had been taking warfarin and aspirin due to valve replacement therapy. He underwent an exploratory laparotomy due to sustained abdominal pain and fever. A macroscopic examination of the resected jejunum showed transmural hemorrhagic necrosis. We report a rare case of small bowel necrosis as a complication of warfarin therapy.
Abdominal Pain ; Aged ; Anticoagulants ; Aspirin ; Cardiovascular Diseases ; Emergencies ; Fever ; Hemorrhage ; Humans ; Jejunum ; Laparotomy ; Necrosis ; Thromboembolism ; Warfarin

Acute ischemic hepatitis and pancreatic abscess after aortic surgery are not common gastrointestinal complications. We report here on a case of ischemic hepatitis and pancreatic abscess that occurred sequentially after elective AAA (abdominial aortic aneurysm) repair. The patient recovered with careful supportive management and external drainage without the graft becoming infected.
Abscess ; Aortic Aneurysm, Abdominal ; Drainage ; Hepatitis ; Humans ; Transplants

PURPOSE: To analyze the causes, clinical features, and computed tomography (CT) images of atypical varicose veins in the popliteal fossa unrelated to small saphenous vein (SSV) reflux by three-dimensional CT venography (3D-CTV). METHODS: A total of 1,476 limbs in 794 consecutive patients with varicose veins who underwent surgery from 2005 to 2009 were enrolled. The medical records, duplex ultrasound, and 3D-CTV images were analyzed retrospectively. RESULTS: Varicose veins in the popliteal fossa (PFV) were found in 438 of 1,476 limbs; the PFV in 428 limbs (97.5%) were caused by SSV insufficiency. Ten limbs (2.5%) had atypical PFV unrelated to the SSV. Incompetent perforator of the PPF was found in six of ten limbs (four women and two men; median age, 58-years). The CEAP clinical classes were C2 in four limbs and C4 in two limbs. The PPF drained to the popliteal vein in five limbs and to the gastrocnemial vein in one limb. A perforator ligation was performed in all patients, and additional sclerotherapy was performed in one patient. Thigh or calf perforator insufficiency was found in three limbs (two women and one man; median age, 62.7-years). The CEAP clinical classes were C2 in two limbs and C3 in one limb. Great saphenous vein insufficiency with Giacomini vein reflux was found in one limb (woman, 67-years). CONCLUSION: An exact preoperative understanding of the anatomy and flow dynamics is essential for the proper treatment of rare atypical PFV. A preoperative evaluation with 3D-CTV can provide accurate anatomical information for the surgery.
Extremities ; Female ; Humans ; Ligation ; Medical Records ; Phlebography ; Popliteal Vein ; Retrospective Studies ; Saphenous Vein ; Sclerotherapy ; Thigh ; Varicose Veins ; Veins

PURPOSE: Untreated deep vein thrombosis (DVT) is associated with morbidity and mortality, such as pulmonary embolism and post-thrombotic syndrome. Anticoagulation therapy is efficient for reducing thrombus propagation but is insufficient for clot lysis or preventing post thrombotic syndrome. Current catheter-directed thrombolysis is an important DVT treatment. We compared the outcomes between anticoagulation therapy and DVT catheter-directed thrombolysis. The purpose of this study was to evaluate treatment outcomes in patients with symptomatic DVT who had undergone catheter-directed thrombolysis. METHODS: From January 2003 to January 2009, we retrospectively reviewed 91 patients who had been admitted and treated for DVT in our hospital. We divided 91 patients into two groups according to treatment method; 42 patients (46.2%) were treated with only anticoagulation, and 49 patients (53.8%) were treated with catheter-directed thrombolysis. We compared the results of the two treatments groups. The results included gender, symptom onset, age, location, complications, risk factors, days to improved patient symptoms and patency. All patients underwent Doppler sonography or CT-venography at 3 and 6 months to evaluate venous patency after treatment. RESULTS: 49 patients who underwent catheter-directed thrombolysis for DVT had more symptom-relief days (25.00 days, P<0.001). The 43 patients (88%) of the catheter-directed thrombolysis group showed more complete resolution on Doppler sonography or CT-venography after 6 months (P=0.001). We obtained better clinical outcomes in the catheter-directed thrombolysis group than in the anticoagulation only group. CONCLUSION: Catheter-directed thrombolysis is an effective treatment for acute DVT.
Humans ; Pulmonary Embolism ; Retrospective Studies ; Risk Factors ; Thrombosis ; Venous Thrombosis

PURPOSE: Splenic artery aneurysms (SAAs) are rare but have the potential risk of life threatening rupture. We conducted this study to define the natural history of SAAs and to compare the results of surgery and endovascular treatment for SAAs. METHODS: From July 2001 to August 2010, 23 patients were treated for SAAs in a single institution. A retrospective study was performed on these patients. RESULTS: No cases of rupture or mortality occurred during follow-up. Nine patients were observed without any intervention, and growth of an aneurysm was detected in only two patients with a mean growth rate of 0.02 cm/yr. Ten patients underwent open surgery and four underwent endovascular treatment. The indications for treatment were an aneurysm larger than 2 cm in nine patients, a symptomatic aneurysm in one patient, one enlarging aneurysm, one reproductive-age female, and aneurysm exclusion was performed during abdominal aortic aneurysm repair in one patient. In the treatment group, no case of recurrence of an aneurysm or restoration of blood flow was observed. Postembolization syndrome and a partial splenic infarct occurred in one patient who underwent endovascular exclusion for an aneurysm. CONCLUSION: Both open surgery and endovascular treatment are safe and effective treatment modalities for SAA with a low risk of complications or mortality. However, conservative management is another treatment option that should be considered for patients with a low risk of rupture.
Aneurysm ; Aortic Aneurysm, Abdominal ; Female ; Follow-Up Studies ; Humans ; Natural History ; Recurrence ; Retrospective Studies ; Rupture ; Spleen ; Splenic Artery

PURPOSE: Mesenteric vascular disease is a rare group of diseases including dissection, embolism, atherosclerosis, and venous thrombosis. Technical advances have led to increased diagnostic rates and new treatments with improved outcomes. The purpose of this study was to analyze the characteristics, methods of diagnosis, treatments, and outcomes of patients with mesenteric vascular diseases at our institution. METHODS: Between November 2003 and April 2010, 30 patients with mesenteric vascular disease diagnosed and treated at Seoul National University Bundang Hospital were reviewed retrospectively. Demographic data, etiology, treatment modality, and outcomes, including complications and mortalities, were analyzed. RESULTS: The mean age of the patients was 63.2 years (range, 43~91 years) and there was a male predominance (21 males vs. 9 females). The etiologies were superior mesenteric artery (SMA) dissection (n=13), SMA embolism (n=8), SMA atherosclerosis (n=5), and superior mesenteric vein thrombosis (n=4). Eleven patients underwent surgical treatment, while 11 patients underwent endovascular intervention and ten patients underwent conservative therapy with or without medication. No recurrence of symptoms or thrombosis was observed, except for one case of surgical thrombectomy, which underwent an endovascular aspiration thrombectomy with thrombolysis 9 days after the surgery. Two cases of technical endovascular treatment failure occurred, and one case of mortality after an endovascular stent insertion was observed. CONCLUSION: The incidence of mesenteric vascular diseases is increasing, and clinical manifestations and prognosis may vary from minor to life-threatening conditions. Early diagnosis is very important and the appropriate choice between endovascular intervention and a surgical approach may lead to good treatment results.
Atherosclerosis ; Early Diagnosis ; Embolism ; Humans ; Incidence ; Ischemia ; Male ; Mesenteric Arteries ; Mesenteric Artery, Superior ; Mesenteric Veins ; Prognosis ; Recurrence ; Retrospective Studies ; Stents ; Thrombectomy ; Thrombosis ; Treatment Failure ; Vascular Diseases ; Venous Thrombosis

PURPOSE: A prosthetic graft infection is a rare but often disastrous complication during vascular surgery. Diagnosis of a prosthetic graft infection is not always easy, particularly with a low virulent bacterial infection or in a deeply placed graft in the retroperitoneal space. Recently, fludeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has been proposed as a diagnostic modality for prosthetic graft infection. However, some reports have indicated that high FDG uptake occur in grafts without infections. This study analyzed FDG uptake patterns in prosthetic grafts of asymptomatic patients. METHODS: We reviewed 14,545 patients who had received PET/CT in a tertiary hospital between July 2007 and March 2010. Of them, 11 patients who had undergone previous bypass surgery with a prosthetic graft were identified. Four underwent an aortic bypass and the others received lower extremity bypass grafting. PET/CT images and patient clinical data were reviewed retrospectively. The maximum standardized uptake value (SUVmax, A) in the graft, the mean SUV (SUVmean, B) of the blood-pool, and the target-to-background ratio (T/B, A/B) were calculated. RESULTS: The mean duration between bypass grafting and the PET/CT scan was 21 months (range, 1~80 months). No clinical evidence of graft infection was observed in any of the patients. PET/CT revealed an uneven, diffuse FDG uptake pattern on the grafts, and the mean T/B was 2.0 (range, 0.9~4.6). T/B was greater than 2.0 in six patients (55%). CONCLUSION: A prosthetic graft without an infection can result in increased FDG uptake during PET/CT. A further prospective study is necessary to evaluate the usefulness of FDG PET/CT for diagnosing a prosthetic graft infection.
Bacterial Infections ; Electrons ; Humans ; Lower Extremity ; Positron-Emission Tomography ; Retroperitoneal Space ; Retrospective Studies ; Tertiary Care Centers ; Transplants

Intimal hyperplasia is a feature of the normal adaptive response of vessels to hemodynamic stresses as well as a characteristic of the healing of vessel injuries. The events leading to intimal hyperplasia formation involve numerous cellular and molecular components. Various cellular elements of the vessel wall are involved as are leucocyte-endothelial interactions that trigger the coagulation cascade leading to localized thrombus formation. Subsequent phenotypic modification of the medial smooth muscle cells and their intimal migration is the basis of the lesion formation that is thought to be propagated by an immune-mediated reaction. Intimal hyperplasia in the region of endarterectomy, balloon angioplasty, and vascular bypass graft anastomosis is a major problem of long-term failure of vascular reconstruction. The underlying causes of intimal hyperplasia are proliferation and migration of vascular smooth muscle cells provoked by injury, inflammation, and stretch. This review discusses the cellular and molecular mechanisms in the pathophysiology of intimal hyperplasia, and the different anastomosing techniques to improve the patency of peripheral arterial bypass.
Angioplasty, Balloon ; Arteriosclerosis ; Endarterectomy ; Glycosaminoglycans ; Hemodynamics ; Hyperplasia ; Inflammation ; Muscle, Smooth, Vascular ; Myocytes, Smooth Muscle ; Thrombosis ; Transplants

The management of abdominal aortic aneurysms has dramatically changed since the endovascular aneurysm repair (EVAR) procedure was introduced in 1991 for the treatment of abdominal aortic aneurysm (AAA). EVAR is a less invasive alternative as compared to conventional open repair for abdominal aortic aneurysms. The use of EVAR has increased and is used in fit patients provided that they are regarded as anatomically suitable for a device. Endovascular repair has been shown to decrease the early mortality rate, shorten the hospital stay and decrease blood loss. However, EVAR has a higher rate of graft-related complications and fewer systemic complications. So, the patients who are treated by EVAR need close follow up and diligent graft surveillance. This review of endovascular complications will help physicians gain a thorough understanding of the complications and appropriate managements strategies of AAA.
Aneurysm ; Aortic Aneurysm, Abdominal ; Follow-Up Studies ; Humans ; Length of Stay ; Transplants

No abstract available.
Ischemia*