No abstract available.
Atrial Fibrillation* ; Mitral Valve*

A 76-years old man with a ruptured abdominal aortic aneurysm underwent an emergency abdominal aortic replacement with artificial graft. The patient developed abdominal compartment syndrome at the day of the operation and he received secondary decompression operation the next day. At 45 hours after the second operation the patient was returned to operation room to close the abdominal fascia, and sigmoid colon necrosis was found so we performed sigmoid colectomy with colostomy. After 22 days from the last operation, the abdominal wound was closed completely and the patient was discharged at the 42nd postoperative day with a colostomy state. We report here on this complex case together with a review of the recent articles.
Aged ; Aortic Aneurysm, Abdominal* ; Colectomy ; Colon* ; Colon, Sigmoid ; Colostomy ; Compartment Syndromes ; Decompression ; Emergencies ; Fascia ; Humans ; Intra-Abdominal Hypertension* ; Ischemia* ; Necrosis ; Transplants ; Wounds and Injuries

No abstract available.
Myasthenia Gravis* ; Thymectomy*

Infection is one of the most feared complications in vascular surgery, especially when it involves the aortoiliac segment. There are many controversies in the treatment of aortoiliac graft infection with varying results reported. The author treated 2 cases of graft infection after an aortobiiliac bypass. These patients had an abdominal aortic aneurysm with aortoenteric fistula before or after the bypass surgery. Both developed graft infection within about 1 year after the first operation. One was treated with an extra-anatomic bypass after complete removal of the infected graft; and the other was treated with a re-aortobifemoral bypass with bilateral femoral vein graft. Both patients showed no recurrence of infection nor limb loss.
Aortic Aneurysm, Abdominal* ; Extremities ; Femoral Vein ; Fistula ; Humans ; Recurrence ; Transplants*

Varicose vein is one of the ancient diseases, which has its evidence in Greek sculpture. Nowadays varicose vein has become a popular disease because of the media, so that many people want to treat their varicose vein and many medical doctors from a variety of fields seek a varicose clinic, accordingly. Since the introduction of the great saphenous vein stripping, the treatment of varicose vein has not been changed very much for about 100 years. Recently, however, many doctors in the outpatient varicose clinic prefer less invasive treatment and some innovative techniques that have become available recently. Endovascular treatment or transilluminated powered phlebectomy is one of them. Some dermatologists try to treat all kinds of varicose vein with sclerotherapy. But the long-term results of the treatment reveal that the gold standard of the treatment of typical varicose vein is a groin-to-knee inversion stripping of the great saphenous vein with stab avulsion of the varicose cluster. The application of the color Doppler duplex ultrasonogram to the leg vein has made it possible to evaluate the reflux of axial veins and perforator veins more thoroughly and less invasively. Therefore ultrasonography is the method of choice for the diagnosis of varicose vein preoperatively and postoperative follow-up studies for recurrent cases. The recurrence of varicose vein after treatment is mostly from the remnant reflux in the saphenofemoral junction and its tributary. Thus more meticulous treatment of the tributaries of saphenofemoral junction is needed.
Diagnosis ; Follow-Up Studies ; Humans ; Leg* ; Outpatients ; Recurrence ; Saphenous Vein ; Sclerotherapy ; Sculpture ; Ultrasonography ; Varicose Veins* ; Veins

PURPOSE: The removal of varicose vein using a minimally invasive, transilluminated vein-extracting device (TriVex system) with cutaneous transillumination and tumescent anesthesia technique was newly developed and became popular in USA. This study was performed to evaluate its efficacy and safety. METHOD: The author performed TIPP (Transilluminated powered phlebectomy) procedure in 90 patients 118 legs from Feb 2001 to March 2002. The patients were 26 men and 64 women and their age ranged in from 19 to 65 (46.3 +/- 10.7) years. The preoperative evaluation was performed with Dupplex Doppler ulatrasound scan. All patients were admitted before the day of the surgery and discharged on the day or the next day of the surgery. The operation was performed under spinal or general anesthesia. The greater saphenous vein was ligated and in the saphenofemoral junction and stripped out to the knee with stripper under inguinal incision and then the varicose vein was removed with TriVex system. After the operation the patients were discharged at the day of the surgery and followed up at OPD for an average of 43 16 days. RESULT: The mean operative time was 61.6 +/- 25.7 min, the average numbers of small incision per leg were 3.4 +/- 1.3, and the average admission period was 1.6 +/- 0.8 days. These data were far different from those of conventional varicosectomy in previous periods. There were 2 cases of subcutaneous infection at medial calf and one case of remnant varicsoe vein which need reoperation with the TIPP. There was no permanent complication like paresthesia or skin changes. The pain and cosmetic outcome were so excellent that all patient had no limitation in daily life in a week after the procedures. CONCLUSION: The transilluminated powered phlebectomy in varicose vein is safe, efficacious and cosmetically satisfactory.
Anesthesia ; Anesthesia, General ; Female ; Humans ; Knee ; Leg ; Male ; Operative Time ; Paresthesia ; Reoperation ; Saphenous Vein ; Skin ; Transillumination ; Varicose Veins* ; Veins

BACKGROUND: Aortic diseases tend to involve the entire aorta. Hence, there is the constant possibility of the need for a secondary operation at the remnant aorta. This study analyzed our cases of secondary aortic surgery in order to determine its characteristics and problems. MATERIAL AND METHOD: Between April 2003 and June 2007, 12 patients (6 male and 6 female) underwent thoracoabdominal aortic replacement as a secondary aortic operation. Their clinical courses were analyzed. Four of the patients underwent lower thoracobadominal aortic replacement under the normothermic femorofemoral bypass, and the others underwent an entire thoracobdominal aortic replacement under deep hypothermic circulatory arrest. RESULT: There was no death or paraplegia. As local complications, there were 3 cases of wound infection and 2 cases of an immediate reoperation caused by bleeding and one case of delayed wound revision for a contaminated perigraft hematoma. As a systemic complication, there was one case of renal insufficiency, which required hemodialysis and one case of respiratory insufficiency that needed prolonged ventilator care. The mean admission period was 30+/-21 days. All the patients were followed up for 626+/-542 days without reoperation or other problems. CONCLUSION: Using properly selected patients and a careful approach, thoracoabdominal aortic replacement can be performed safely as a secondary aortic surgery.
Aorta ; Aortic Diseases ; Circulatory Arrest, Deep Hypothermia Induced ; Hematoma ; Hemorrhage ; Humans ; Male ; Paraplegia ; Renal Dialysis ; Renal Insufficiency ; Reoperation ; Respiratory Insufficiency ; Ventilators, Mechanical ; Wound Infection

BACKGROUND: Thoracoabdominal aortic replacement is an extensive operation that opens both the pleural cavity and abdominal cavity, which has high mortality and morbidity rate. The authors have reported 9 cases of the thoracoabdominal aortic replacement in 2001. Since 2003 we have applied the deep hypothermic circulatory arrest to the Crawford type I and II thoracoabdominal aortic replacement. Therefore, we analysed the effect of the changes in operative techniques. MATERIAL AND METHOD: Between 1996 and 2005, we have performed 20 cases of thoracoabdominal aortic replacement. The underlying diseases were 8 cases of atherosclerotic aneurysm with 4 cases of ruptured aneurysm and 12 cases of aortic dissection with 10 cases of a previous operations. According to Crawford classification, there were 2 cases of type I, 7 cases of type II, 1 case of type III, 7 cases of type IV, and 3 cases of type V. We compaired the results of the patients who underwent thoracoabdmoninal replacement before 2001 which already has been reported and after then. RESULT: Before 2001 we have performed 9 cases of thoracoabdominal replacement and 5 patients were died of the operation. All three patients with type I and II were died. There was no case of thoracoabdominal replacement between 2001 and 2002, but after 2003 we have performed 11 cases of thoracoabdominal replacement which involved 1 case of type I, 5 cases of type II, 1 case of type III, 2 cases of type IV and 2 cases of type V. There was no mortality and no fetal complications. CONCLUSION: The deep hypothermic circulatory arrest is a safe method of extended thoracoabdominal aortic replacement.
Abdominal Cavity ; Aneurysm ; Aneurysm, Ruptured ; Circulatory Arrest, Deep Hypothermia Induced* ; Classification ; Humans ; Mortality ; Pleural Cavity

Since the operative mortality rate of the Acute aortic dissection has been reducing, a more extensive primary repair of the dissected aorta is preferred for acute aortic dissection to reduce the needs of secondary procedures. We performed a total aortic arch replacement with distal stent-grafting in acute type A aortic dissection. The patient was a 50-years old man. He recovered from the operation and was followed up for 7 months. The pseudolumen in the descending aorta was obliterated with the stent.
Mortality

BACKGROUND: The thoracic and thoracoabdominal aortic surgery is a complicated procedure that has various method of approach and protection. The authors have performed several methods to treat these diseases. Therefore, we attempt to analyze their results and risks. MATERIAL AND METHOD: From June of 1992 to August of 2001, we performed 26 cases of thoracic aortic surgery and 10 cases of thoracoabdominal aortic surgery. There were 17 aortic dissections, 17 aortic aneurysms, one coarctation of aorta and one traumatic aortic aneurysm. The thoracic aortic replacement was performed under a femorofemoral bypass, an LA to femoral bypass, or a deep hypothermic circulatory arrest. The thoracoabdominal aortic replacement was performed under a femorofemoral bypass or a pump assisted rapid infusion. RESULT: There were 7 renal failures, 11 hepatopathies, 7 cerebral vascular accidents, 2 heart failures, 5 respiratory insufficiencies, and 2 sepsis in postoperative period. There were 9 hospital mortalities which were from 2 bleedings, 2 heart failures, 2 renal failures, a sepsis, a respiratory failure, and a cerebral infarction. There were 3 late deaths which were from ruptured distal anastomosis, cerebral infarction, and pneumonia. CONCLUSION: Deep hypothermic circulatory arrest was not good supportive methods for thoracic aortic replacement. Total thoracoabdominal aortic replacement was a high risk operation.
Aorta, Thoracic ; Aortic Aneurysm ; Aortic Aneurysm, Thoracic ; Aortic Coarctation ; Cerebral Infarction ; Circulatory Arrest, Deep Hypothermia Induced ; Heart ; Hospital Mortality ; Pneumonia ; Postoperative Period ; Renal Insufficiency ; Respiratory Insufficiency ; Sepsis