Radical nephrectomy with tumor thrombectomy for advanced renal cell carcinoma is an oncologically relevant approach that can achieve long-term survival even in the presence of distant metastases. However, the surgical techniques pose significant challenges. The objective of this clinical review was to present technical recommendations for tumor thrombectomy in the vena cava to facilitate surgical treatment. Transesophageal echocardiography is required to prepare for this procedure. Cardiopulmonary bypass should be considered when the tumor thrombus has invaded the cardiac chamber and clamping is not feasible because of the inability to milk the intracardiac chamber thrombus in the caudal direction. Prior to performing a cavotomy, it is crucial to clamp the contralateral renal vein and infrarenal and suprahepatic inferior vena cava (IVC). If the suprahepatic IVC is separated from the surrounding tissue, it can be gently pulled down toward the patient’s leg until the lower margin of the atrium becomes visible. Subsequently, the tumor thrombus should be carefully pulled downward to a position where it can be clamped. Implementing the Pringle maneuver to reduce blood flow from the hepatic veins to the IVC during IVC cavotomy is simpler than clamping the hepatic veins. Sequential clamping is a two-stage method of dividing thrombectomy by clamping the IVC twice, first suprahepatically and then midretrohepatically. This sequential clamping technique helps minimize hypotension status and the Pringle maneuver time compared to single clamping. Additionally, a spiral cavotomy can decrease the degree of primary closure narrowing. The oncological prognoses of patients can be improved by incorporating these technical recommendations.

Cardiovascular disease (CVD) remains a global health challenge, primarily due to atherosclerosis, which leads to conditions such as coronary artery disease, cerebrovascular disease, and peripheral arterial disease. Mitochondrial dysfunction initiates endothelial dysfunction, a key contributor to CVD pathogenesis, as well as triggers the accumulation of reactive oxygen species (ROS), energy stress, and cell death in endothelial cells, which are crucial for atherosclerosis development. This review explores the role of PTEN-induced protein kinase 1 (PINK1) in mitochondrial quality control, focusing on its significance in cardiovascular health. PINK1 plays a pivotal role in mitophagy (selective removal of damaged mitochondria), contributing to the prevention of CVD progression. PINK1-mediated mitophagy also affects the maintenance of cardiomyocyte homeostasis in ischemic heart disease, thus mitigating mitochondrial dysfunction and oxidative stress, as well as regulates endothelial health in atherosclerosis through influencing ROS levels and inflammatory response.We also investigated the role of PINK1 in vascular smooth muscle cells, emphasizing on its role in apoptosis and atherosclerosis. Dysfunctional mitophagy in these cells accelerates cellular senescence and contributes to adverse effects including plaque rupture and inflammation. Mitophagy has also been explored as a potential therapeutic target for vascular calcification, a representative lesion in atherosclerosis, with a focus on lactate-induced mechanisms. Finally, we highlight the current research and clinical trials targeting mitophagy as a therapeutic avenue for CVD.

PURPOSE: The aim of this study was to confirm the factors that affect the mortality associated with the open surgical repair of ruptured abdominal aortic aneurysm (rAAA) and to analyze the long-term survival rates. METHODS: A retrospective review was performed on a prospectively collected database that included 455 consecutive patients who underwent open surgical repair for AAA between January 2001 and December 2012. We divided our analysis into in-hospital and postdischarge periods and analyzed the risk factors that affected the long-term survival of rAAA patients. RESULTS: Of the 455 patients who were initially screened, 103 were rAAA patients, and 352 were non-rAAA (nAAA) patients. In the rAAA group, 25 patients (24.2%) died in the hospital and 78 were discharged. Long-term survival was significantly better in the nAAA group (P = 0.001). The 2-, 5-, and 10-year survival rates of the rAAA patients were 87%, 73.4%, and 54.1%, respectively. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.02–.08; P < 0.001) and aneurysm rupture (HR, 1.96; 95% CI, 1.12–.44; P = 0.01) significantly affected long-term survival. CONCLUSION: Preoperative circulatory failure is the most common cause of death for in-hospital mortality of rAAA patients. After excluding patients who have died during the perioperative period, age is the only factor that affects the survival of rAAA patients.
Aneurysm ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Aortic Rupture ; Cause of Death ; Hospital Mortality* ; Humans ; Mortality ; Perioperative Period ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Rupture ; Shock ; Survival Rate

Percutaneous vertebroplasty (PVP) is a minimally invasive surgical treatment for patients with osteoporotic vertebral compression fracture (OVCF) and can rapidly alleviate pain, improve mobility, and stabilize the vertebrae. However, it has the potential to cause complications such as cement embolism. A 55-year-old female presented with pain in the lumbar region as a chief complaint. PVP was performed after diagnosis of acute OVCFs at L4 and L5. No abnormal symptoms were reported after surgery, but a large cement embolism was observed in her right atrium and ventricle. After discussion in a multi-disciplinary team, the large cement embolism was successfully removed by a combination of endovascular procedure and an inferior vena cava exploration. Surgeons must consider the possibility of intra-cardiac cement embolism after PVP. A hybrid approach of an endovascular procedure and a vascular surgery may be a reasonable treatment option to minimize the surgical procedure in cases of a large intra-cardiac cement embolism.
Diagnosis ; Embolism* ; Endovascular Procedures* ; Female ; Fractures, Compression ; Heart Atria ; Humans ; Lumbosacral Region ; Middle Aged ; Spine ; Surgeons ; Vena Cava, Inferior* ; Vertebroplasty*

Purpose: The platelet function analyzer (PFA)-100/200 is widely used to assess platelet function. However, its role in predicting the perioperative risk of bleeding in patients undergoing liver resection remains controversial. Therefore, we aimed to ascertain whether the platelet function test could be useful in predicting bleeding risk in patients undergoing hepatic surgery. Methods: The study participants were patients who underwent hepatectomy for hepatocellular carcinoma at our hospital over a period of 10 years from January 1, 2010 to May 31, 2020. PFA-200 values of these patients were divided into 2 groups; normal (n = 333) and prolonged (n = 39). Results: There were no significant differences regarding the volumes of calculated blood loss during surgery between the normal and prolonged PFA groups (879.55 ± 1,046.50 mL vs. 819.74 ± 912.64 mL, respectively; P = 0.733); intraoperative RBC transfusion (0.52 ± 2.02 units vs. 0.26 ± 1.02 units, P = 0.419) and postoperative RBC transfusion (0.24 ± 1.17 units vs. 0.46 ± 1.97 units, P = 0.306) were similar between the 2 groups, respectively. Multivariate analysis revealed no association between PFA closure time and calculated blood loss (hazard ratio, 1.06; P = 0.881). Moreover, there was no association between PFA closure time and preoperative laboratory results or assessment of tool-related liver function in multivariate analysis. Conclusion There was no correlation between the amount of blood loss and platelet function in patients who underwent liver resection. In patients undergoing liver resection who are not managed on antiplatelet agents or do not have chronic kidney disease, the use of routine PFA is not recommended.

PURPOSE: The aim of this study was to analyze anatomical popliteal artery entrapment syndrome (PAES) and to individualize the treatment of this condition according to the anatomical status of the artery and the adjacent structure. METHODS: A total of 35 anatomical PAES legs in 23 consecutive patients treated within the Asan Medical Center, Seoul, Korea between 1995 and 2011 were analyzed retrospectively. Anatomical PAES was diagnosed by MRI and/or CT scans of the knee joint, and CT or conventional transfemoral arteriography of the lower extremities. RESULTS: We noted a type II gastrocnemius medial head (GNM) anomaly, a type III GNM anomaly, or an aberrant plantaris muscle in 51.4%, 20%, and 28.6% of PAES legs, respectively. In assessments of the arterial lesions, popliteal or tibial artery occlusion was noted in 19 of 26 symptomatic PAES legs. For cases without popliteal artery lesions, myotomy of the anatomically deranged muscle was performed in 5 of 7 symptomatic and 4 of 9 asymptomatic PAES legs. For occluded popliteal arteries, we performed ten direct repairs of the pathological popliteal artery and 4 femoro-below the knee popliteal bypass surgeries. As a result of the arterial Surgery, 9 direct procedures with myotomy yielded a patent artery, while 3 graft failures were noted in the bypass group. The median follow-up period was 84 months (range, 12–206 months). CONCLUSION: We recommend that treatment of PAES should be individualized based on pathology, symptoms, and various imaging studies.
Angiography ; Arteries ; Chungcheongnam-do ; Follow-Up Studies ; Head ; Humans ; Knee ; Knee Joint ; Korea ; Leg ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle, Skeletal ; Pathology ; Popliteal Artery* ; Retrospective Studies ; Seoul ; Tibial Arteries ; Tomography, X-Ray Computed ; Transplants

We describe two patients, with no previous history of vascular problems but poor lung function, who experienced septic shock due to bowel ischemia. Both were fed an enteral formula rich in fiber using a feeding tube and experienced septic shock with regular enteral feeding. Surgical finding showed hemorrhagic ischemia in the bowel. The pathologic finding suggests these changes may have been due to inspissations of bowel contents, which may put direct pressure on the mucosa of the bowel wall, leading to local impairment of mucosal and submucosal blood flow with subsequent bowel necrosis. Bowel ischemia may have been precipitated by an increased mesenteric blood flow requirement in combination with a metabolically stressed bowel. Patients in the intensive care unit fed a fiber-rich enteral formula may have inspissated bowel contents, leading to bowel ischemia, suggesting that the use of fiber-rich formula should be limited in patients at high-risk of bowel ischemia.
Enteral Nutrition ; Humans ; Intensive Care Units ; Ischemia ; Lung ; Mucous Membrane ; Necrosis ; Sepsis ; Shock, Septic ; Vascular Diseases

BACKGROUND AND PURPOSE: Carotid endarterectomy (CEA) is performed to prevent cerebral infarction, but a common side effect is cerebral microinfarcts. This study aimed to identify the variables related to the production of microinfarcts during CEA as well as determine their association with delayed postoperative infarction. METHODS: This was a retrospective review of data collected prospectively from 548 patients who underwent CEA. The clinical characteristics of the patients and the incidence rates and causes of microinfarcts were analyzed. Microinfarcts were diagnosed by diffusion-weighted magnetic resonance imaging. The presence of delayed postoperative infarction was compared between microinfarct-positive and microinfarct-negative groups. RESULTS: In total, 76 (13.86%) patients were diagnosed with microinfarcts. Preoperative neurological symptoms were significantly related to the incidence of microinfarcts [odds ratio (OR)=2.93, 95% confidence interval (CI)=1.72–5.00, p<0.001]. Shunt insertion during CEA was the only significant procedure-related risk factor (OR=1.42, 95% CI=1.00–2.19, p=0.05). The presence of microinfarcts did not significantly increase the incidence of delayed postoperative infarction (p=0.204). CONCLUSIONS: In the present study, risk factors for microinfarcts after CEA included preoperative symptoms and intraoperative shunt insertion. Microinfarcts were not associated with delayed postoperative infarction.
Cerebral Infarction* ; Endarterectomy, Carotid* ; Humans ; Incidence ; Infarction ; Magnetic Resonance Imaging ; Prospective Studies ; Retrospective Studies ; Risk Factors*

BACKGROUND: This retrospective study analyzed the causes of failure in the management process from the identification of brain-dead potential organ donors to actual donation in Korea over the past 5 years. METHODS: Data of 8,120 potential brain deaths reported to the Korea Organ Donation Agency were used, including information received at the time of reporting, donation suitability evaluation performed by the coordinator after the report, and data obtained from interviews of hospital medical staff and the donor's family. RESULTS: From January 2012 to December 2016, the total number of brain-dead potential organ donors in Korea was 8,120, of which 2,348 (28.9%) underwent organ procurement surgery with designated recipients. While the number of transplant donors has increased over time, the ratio of transplant donors to medically suitable brain-dead donors has decreased. The common causes of donation failure included donation refusal (27.6%), non-brain death (15.5%), and incompatible donation (11.6%); 104 potential donors (7.8%) were unable to donate their organs because they were not pronounced brain dead. CONCLUSION: The rate of successful organ donation may be increased by analyzing the major causes of failure in the brain-dead organ donation management process and engaging in various efforts to prevent such failures.
Brain Death ; Humans ; Korea* ; Medical Staff, Hospital ; Retrospective Studies ; Statistics as Topic* ; Tissue and Organ Procurement ; Tissue Donors* ; Transplantation

Background: Few studies have investigated the association between Behçet disease (BD) and cardiovascular disease (CVD). The aim of this study was to investigate the risk of various CVDs in patients with BD. Objective: The aim of this study was to investigate the risk of various CVD in patients with BD. Methods: Between 2003 and 2015, we performed a retrospective cohort study involving patients with BD selected from Korea’s National Health Insurance Service-National Sample Cohort database and age- and sex-matched controls. Age- and sex-matched controls were selected randomly from the NHIS-NSC database at a frequency of 1:5. Results: Among the 998 patients with BD and the 4,990 controls studied, patients with BD showed significantly higher risk for angina pectoris (adjusted Hazard Ratio [HR] 1.522, 95% confidence interval [CI] 1.020∼2.273;p=0.04) and peripheral arterial disease (adjusted HR 2.939, 95% CI 1.296∼6.664; p=0.01) than the controls. The cumulative incidence rates of these diseases in patients with BD were also significantly higher than those in the controls. Conclusion Patients with BD showed independent risk for angina pectoris and peripheral arterial disease.