STUDY DESIGN: Case report. OBJECTIVES: To report a rare case in which a tack was used to control bleeding due to a torn iliac vein during revisional anterior spine surgery. SUMMARY OF LITERATURE REVIEW: During anterior lumbar surgery, bleeding following a vascular injury is possible to control and reparable in most cases. During revisional anterior lumbar surgery, however, there are irreparable cases of bleeding as well. In some cases, it can threaten the patient's life. MATERIALS AND METHODS: A 56-year-old man suffered from potentially fatal bleeding following iliac vein rupture during revisional anterior lumbar surgery. Primary vascular closure was impossible due to severe adhesion. We attempted to stop the venous bleeding with a tack, as an alternative treatment. The potentially fatal bleeding was controlled and the patient's vital signs stabilized after hemostasis by the tack. RESULTS: Hemostasis using the tack saved the patient's life without any rebleeding. CONCLUSIONS: During revisional anterior lumbar surgery, bleeding following an iliac vein rupture can be controlled by a tack in cases that are irreparable due to severe adhesion.
Hemorrhage ; Hemostasis ; Humans ; Iliac Vein* ; Middle Aged ; Rupture* ; Spine ; Vascular System Injuries ; Vital Signs

PURPOSE: To identify the risk factors of major adverse cardiac event (MACE) in patients with chronic atherosclerotic lower extremity ischemia (CALEI) undergoing revascularization without noninvasive stress testing (NIST). METHODS: From January 2007 to January 2012, patients with CALEI who underwent revascularization were retrospectively reviewed. Emergent operations, revision procedures for previous surgery, or patients with active cardiac conditions were excluded. NIST was not performed for patients without active cardiac conditions. Cardiac risk was categorized into low, intermediate and high risk, according to the Lee's revised cardiac risk index. MACE was defined as acute myocardial infarction or any cardiac death within 30 days after surgery. RESULTS: A total of 459 patients underwent elective lower extremity revascularization procedures (240 open surgeries, 128 endovascular procedures, and 91 hybrid surgeries). The treated lesions comprised of 18% aorto-iliac, 58% infrainguinal, and 24% combined lesions. With regard to cardiac risk, low-, intermediate- and high risks were 67%, 32% and 2%, respectively. MACE was developed in 7 patients (2%). High or intermediate risk group by the Lee's index was related to postoperative MACE. Subgroup analysis for open surgery or hybrid surgery group identified female gender as an independent risk factor of MACE (P = 0.049; odds ratio, 5.168; confidence interval, 1.011 to 26.423). CONCLUSION: The Lee's index was a useful predictor of MACE. MACE is more common in female patients than male patients after open or hybrid surgery. Routine preoperative NIST is not suggested for all patients undergoing revascularization for CALEI, especially for those in the low risk group.
Chimera ; Death ; Endovascular Procedures ; Exercise Test ; Female ; Humans ; Ischemia ; Lower Extremity ; Male ; Myocardial Infarction ; Odds Ratio ; Peripheral Arterial Disease ; Postoperative Complications ; Retrospective Studies ; Risk Factors

PURPOSE: The aim of the present study was to identify the radiation hazards to vascular surgeons and scrub nurses working in mobile fluoroscopy equipped hybrid vascular operation rooms; additionally, to estimate cumulative cancer risk due to certain exposure dosages. METHODS: The study was conducted prospectively in 71 patients (53 men and 18 women) who had undergone vascular intervention at our hybrid vascular theater for 6 months. OEC 9900 fluoroscopy was used as mobile C-arm. Exposure dose (ED) was measured by attaching optically stimulated luminescence at in and outside of the radiation protectors. To measure X-ray scatter with the anthropomorphic phantom model, the dose was measured at 3 distances (20, 50, 100 cm) and 3 angles (horizontal, upward 45°, downward 45°) using a personal gamma radiation dosimeter, Ecotest CARD DKG-21, for 1, 3, 5, 10 minutes. RESULTS: Lifetime attributable risk of cancer was estimated using the approach of the Biological Effects of Ionizing Radiation report VII. The 6-month ED of vascular surgeons and scrub nurses were 3.85, 1.31 mSv, respectively. The attenuation rate of lead apron, neck protector and goggle were 74.6%, 60.6%, and 70.1%, respectively. All cancer incidences among surgeons and scrub nurses correspond to 2,355 and 795 per 100,000 persons. The 10-minute dose at 100-cm distance was 0.004 mSv at horizontal, 0.009 mSv at downward 45°, 0.003 mSv at upward 45°. CONCLUSION: Although yearly radiation hazards for vascular surgeons and scrub nurses are still within safety guidelines, protection principles can never be too stringent when aiming to minimize the cumulative harmful effects.
Fluoroscopy* ; Gamma Rays ; Humans ; Incidence ; Luminescence ; Male ; Neck ; Prospective Studies ; Radiation, Ionizing ; Surgeons

PURPOSE: Challenging iliac anatomy remains an important issue during endovascular aneurysm repair (EVAR), and it is known that the length of the common iliac artery (CIA) is shorter in Asians than in Western groups. We analyzed both the iliac anatomy and the incidence of adjunctive maneuvers to overcome iliac artery-related difficulties during EVAR. METHODS: Seventy-four EVARs were performed for abdominal aortic aneurysm between January 2010 and March 2013. Patient demographic data, iliac anatomical characteristics (presence of iliac artery aneurysm, iliac artery diameter and length, and iliac tortuosity), and adjunctive iliac artery maneuvers were reviewed retrospectively. RESULTS: Mean CIA length was 52.8 mm (range, 6.6-98.0 mm) on the right and 56.3 mm (range, 0-94.8 mm) on the left. CIA length was > or =20 mm, except in one patient with bilateral short CIAs. Forty patients (54%) had a CIA aneurysm, and 18 had aneurysms on both sides. Iliac adjunctive procedures were performed in 38 patients (51%) as follows: 23 internal iliac artery (IIA) embolizations or ligations, seven IIA revascularizations, 16 external iliac artery (EIA) balloon angioplasties or stenting, one EIA patch angioplasty, one EIA interposition, two femoral endarterectomies with patch angioplasty, and nine femoro-femoral bypasses after EVAR with an aorto-uni-iliac device. Technical success for the adjunctive iliac procedures was achieved in all patients. CONCLUSION: Short CIA length was uncommon. Although many patients had access-related difficulties, most were overcome by an endovascular or hybrid technique. Liberal use of iliac adjunctive procedures can facilitate EVAR.
Aneurysm ; Angioplasty ; Aortic Aneurysm, Abdominal* ; Arteries ; Asian Continental Ancestry Group ; Endarterectomy ; Endovascular Procedures ; Humans ; Iliac Aneurysm ; Iliac Artery ; Incidence* ; Ligation ; Retrospective Studies ; Stents

PURPOSE: During crossover femoro-femoro-popliteal sequential bypass (CFFPB) surgery in ilio-femoral occlusive disease, proximal anastomosis of the femoro-popliteal bypass is usually performed distal to the distal anastomosis of the crossover femoro-femoral bypass. If not, it is done with a piggyback configuration. Another method is a side-to-side anastomosis. Its benefit is that this is the only anastomosis made. And it is less bulky compared with the piggyback configuration. This study was aimed to investigate the long-term outcome of CFFPB using side-to-side anastomosis. METHODS: From Sep 2006 to Aug 2012, 21 patients who underwent CFFPB using side-to-side anastomosis were enrolled. Externally supported polytetrafluoroethylene graft was used as a conduit in all patients. Patient demographic data and procedure details were investigated. Primary graft patency was calculated using the Kaplan-Meier method. RESULTS: The mean age of patients was 79 years (range, 62-81 years) and males were 17 (81%). Fifteen patients (71%) had critical limb ischemia. Inflow arteries comprised of 16 common femoral artery (CFA), 4 superficial femoral artery (SFA), and 1 deep femoral artery (DFA). Side-to-side anastomosis was performed on the CFA in 11, SFA in 2, and DFA in 8 patients. During the mean follow-up period of 21 months (1-60 months), 8 patients died. The 1-, 3-, and 5-year primary patency rates were 76%, 63%, and 63%. CONCLUSION: Long-term patency of CFFPB using side-to-side anastomosis was acceptable. It can be one of the treatment options for patients with ilio-femoral occlusive disease.
Arteries ; Extremities ; Femoral Artery ; Follow-Up Studies ; Humans ; Ischemia ; Male ; Polytetrafluoroethylene ; Transplants

Objective: This randomized crossover simulation study aimed to compare the effectiveness of chest compressions, performed during 10 minutes of cardiopulmonary resuscitation, in three different compression postures: standing posture (SP), single-leg kneeling posture (SLKP) and both legs kneeling posture (BLKP) on a manikin lying on a bed. Methods: Enrolled participants were doctors, nurses and emergency medical technicians who worked in the emergency department and performed chest compressions (CCs) without ventilation for 5 sessions (10 minutes) in the three compression postures from June to August 2019. The chest compression parameters (CCPs) such as compression depth, compression rate (CR), the accuracy of compression depth (ACD) and accuracy of relaxation (AR) were collected by the Resusci Anne PC skill report system. The statistical differences of CCPs between three postures were analyzed. Results: A total of 32 participants were enrolled in this study. There were no significant differences between SP, SLKP and BLKP on compression depth (52.6 vs. 53.2 vs. 50.9 mm, P>0.05), CR (110.2 vs. 111.8 vs. 111.6 compressions/min, P>0.05), ACD (43.7% vs. 47.0% vs. 46.3%, P>0.05), and AR (99.4% vs. 99.0% vs. 99.3%, P>0.05). There were no significant differences in CCPs according to chest compression time in the three postures. However, there was a significant difference between the SP and BLKP (16.0 vs. 14.0, P=0.023) on the Borg scale of subjective fatigability. Conclusion In our study, when rescuers performed chest compression on a hospital bed, the parameters of CCs for the three compression postures were similar.

Objective: This randomized crossover simulation study aimed to compare the effectiveness of chest compressions, performed during 10 minutes of cardiopulmonary resuscitation, in three different compression postures: standing posture (SP), single-leg kneeling posture (SLKP) and both legs kneeling posture (BLKP) on a manikin lying on a bed. Methods: Enrolled participants were doctors, nurses and emergency medical technicians who worked in the emergency department and performed chest compressions (CCs) without ventilation for 5 sessions (10 minutes) in the three compression postures from June to August 2019. The chest compression parameters (CCPs) such as compression depth, compression rate (CR), the accuracy of compression depth (ACD) and accuracy of relaxation (AR) were collected by the Resusci Anne PC skill report system. The statistical differences of CCPs between three postures were analyzed. Results: A total of 32 participants were enrolled in this study. There were no significant differences between SP, SLKP and BLKP on compression depth (52.6 vs. 53.2 vs. 50.9 mm, P>0.05), CR (110.2 vs. 111.8 vs. 111.6 compressions/min, P>0.05), ACD (43.7% vs. 47.0% vs. 46.3%, P>0.05), and AR (99.4% vs. 99.0% vs. 99.3%, P>0.05). There were no significant differences in CCPs according to chest compression time in the three postures. However, there was a significant difference between the SP and BLKP (16.0 vs. 14.0, P=0.023) on the Borg scale of subjective fatigability. Conclusion In our study, when rescuers performed chest compression on a hospital bed, the parameters of CCs for the three compression postures were similar.

PURPOSE: Elastin is a major arterial structural protein, and elastin-derived peptides are related to arterial change. We previously reported on a novel assay developed using aortic elastin peptides; however, its clinical implications remain unclear. In this study, we assessed whether anti-elastin antibody titers reflect the risk of coronary artery disease (CAD) or its characteristics. MATERIALS AND METHODS: We included 174 CAD patients and 171 age- and sex-matched controls. Anti-elastin antibody titers were quantified by enzyme-linked immunosorbent assay. Parameters of arterial stiffness, including the augmentation index (AI) and heart-to-femoral pulse wave velocity (hfPWV), were measured non-invasively. The clinical and angiographic characteristics of CAD patients were also evaluated. Associations between anti-elastin levels and vascular characteristics were examined by linear regression analysis. RESULTS: The median blood level of anti-elastin was significantly lower in the CAD group than in the controls [197 arbitrary unit (a.u.) vs. 63 a.u., p<0.001]. Levels of anti-elastin were significantly lower in men and in subjects with hypertension, diabetes mellitus, hyperlipidemia, or high hfPWV. Nevertheless, anti-elastin levels were not dependent on atherothrombotic events or the angiographic severity of CAD. In a multivariate analysis, male sex (beta=-0.38, p<0.001), diabetes mellitus (beta=-0.62, p<0.001), hyperlipidemia (beta=-0.29, p<0.001), and AI (beta=-0.006, p=0.02) were ultimately identified as determinants of anti-elastin levels. CONCLUSION: Lower levels of anti-elastin are related to CAD. The association between antibody titers and CAD is linked to arterial stiffness rather than the advancement of atherosclerosis.
Aged ; Angiography ; Antibodies/*blood ; Atherosclerosis/*blood/immunology ; Coronary Artery Disease/blood/*immunology ; Elastin/*blood/immunology ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Hyperlipidemias ; Hypertension/complications ; Male ; Middle Aged ; Pulse Wave Analysis ; Vascular Stiffness/*immunology/physiology

Background: Ultrasonography (US) is a simple and reliable tool that can aid in the diagnosis of benign subcutaneous lesions such as epidermal cysts and lipomas. Objective: This study aimed to determine the efficacy of US for the differential diagnosis of epidermal cysts and lipomas. Methods: A retrospective study of 100 patients with epidermal cysts (n=45) or lipomas (n=55) who underwent US and then received a pathological diagnosis in the dermatology department of Pusan National University Hospital was conducted. Results: US and clinical impressions accurately diagnosed the epidermal cysts in 90.0% and 88.0% of the patients, respectively, and the lipomas in 92.0% and 88.0% of the patients, respectively. US combined with clinical impression significantly increased the diagnostic yield of epidermal cysts (98%) and lipomas (99%). On US, the frequency of posterior acoustic enhancement was higher for the epidermal cysts than for the lipomas (82.2% and 29.1%, respectively; p＜0.001), and striated echoes such as internal linear echogenic reflections and dark clefts were more frequently found in the lipomas than in the epidermal cysts (90.9% and 6.7%, respectively; p＜0.001). Conclusion This study implies that the diagnostic role of US can be greatly enhanced by knowledge of the clinical presentation.