PURPOSE: This study evaluates the roles and the clinical effects of BNP (B-type natriuretic peptides) in patients with AMI (acute myocardial infarction). METHODS: We prospectively analyzed the cases of 20 patients with AMI who visited the Emergency Department, Sanggye Paik Hospital, during the 3 months from Dec.1 to Feb. 28,2003. We measured the BNP and the cardiac enzyme (CK-MB) at admission and at 1 day, 3 days, and 5 days after admission. The patients were divided according to LV (left ventricular) systolic function, site of infarction, infarct-related artery, 6-hour vascular patency, and pattern of BNP change. We compared the values for the BNP for parameters such as sex, age, risk factors, onset time, cardiac enzymes, ejection fraction, hospital days, and etc. RESULTS : BNP at each time was higher in cases with LVSD (LV systolic dysfunction) than it was in cases without LVSD, but no statistically significant difference etistied among the subgroup. BNP is correlated with the onset time, the hospital days, the ejection fraction, and the presence of LVSD, but not with cardiac enzyme (CK-MB) or with necrotic severity. CONCLUSION: the BNP level of a patient with AMI is a predictive marker of LVSD at any measurement time and reflects the hospital course. Thus, we can use BNP as a prognostic factor of LVSD and stratify the risk of heart failure.
Arteries ; Emergency Service, Hospital ; Heart Failure ; Humans ; Infarction ; Myocardial Infarction* ; Prospective Studies ; Risk Factors ; Vascular Patency

Stent fracture is one of the major factors compromising implanted stent patency due to its consequences including in-stent restenosis, thrombosis, perforation, and migration. Stent fracture can occur from stress (extrinsic or intrinsic) and biomechanical forces at different implantation sites. We report on 2 cases of stent fractures and pertinent literature. One patient, a 75-year-old male, presented with recurrence of claudication 14 months after superficial femoral artery stenting; a femoral artery occlusion with stent fracture was found, and he underwent femoropopliteal bypass. The other patient, a 72-year-old male presented with recurrence of claudication; a stent fracture was found without femoral artery occlusion, and he was treated with additional femoral artery stenting to secure the fracture site.
Aged ; Early Intervention (Education) ; Femoral Artery ; Humans ; Male ; Recurrence ; Stents ; Thrombosis ; Vascular Patency

Nowadays, more aggressive local control of primary cancer site is believed to be the most effective among the oncologists. However, this aggressive local control of cancer leaves a large defect of tissue which needs the reconstruction by a plastic surgeon.Post-oncologic reconstruction usually needs to use free flap coverage rather than local flap because of extensive tissue defect and post-radiation fibrosis. End-to-side microvascular anastomosis rather than end-to-end microvascular anastomosis is necessary especially for limb salvage in case of malignant cancer of the limb or for saving the important recipient vessel. The effect of radiation of end-to-end microvascular anastomosis was revealed to be minimal in the previous studies, but the effect of radiation on end-to-side microvascular anastomosis has not been researched up to present. The authors designed this experimental study model to clarify the effect of radiation on the patency of end-to-side microvascular anastomosis. For control group, total 20 rats were used. In one control group which consists of 10 rats, end-to-side microvascular anastomoses were carried out on their carotid arteries. In the other control group of 10 rats, end-to-end microvascular anastomoses were done. In radiation groups, 2000 rad X-radiation(peak 250 kV, 30 mA) was given on the neck areas of 40 rats. In two radiation groups, each of which consists of 10 rats, end-to-end and end-to-side microvascular anastomoses were carried out respectively on their carotid arteries 3 weeks after radiation. In another two radiation groups, each of 10 rats, the same procedures were done respectively 6 weeks after radiation. On the fourth week after anastomsis, the vascular patency and histological examinations were done. This study revealed that no effect of radiation on the vascular patency was found depending on both types of microanastomoses although some histologic changes were evident.
Animals ; Carotid Arteries ; Extremities ; Fibrosis ; Free Tissue Flaps ; Limb Salvage ; Neck ; Rats ; Vascular Patency

Perioperative ischemic stroke is an uncommon event associated with significant morbidity and mortality. The complexity of the surgical procedure and surgery induced hypercoagulable status also influence the incidence of stroke. The management of stroke involves a decision regarding the quickest suitable revascularization method. Endovascular mechanical thrombectomy, such as intra-arterial mechanical thrombectomy (IAMT), can restore vascular patency of the vessels, providing an alternative or synergistic method to restore blood flow. Although, there are no recommended treatment guidelines, IAMT is eligible to be a treatment of choice for perioperative ischemic stroke. We experienced a case of a patient who demonstrated hemiplegia and aphasia, the early symptom of acute ischemic stroke, in the post-anesthesia care unit and performed IAMT successfully. Thus we report the case with a review of the relevant literature.
Aphasia ; Cerebral Infarction* ; Hemiplegia ; Humans ; Incidence ; Mechanical Thrombolysis ; Mortality ; Perioperative Care ; Stroke ; Thrombectomy* ; Vascular Patency

PURPOSE: As the proportion of patients with diabetes and old age increases, the use of arteriovenous graft (AVG) is increasing. However, there are few data about the comparison of the patency rate of native arteriovenous fistula (AVF) to that of AVG in Korea. We compared the outcome of native AVF to that of AVG with analysis of the factors affecting the patency of the permanent vascular access in use. METHODS: A retrospective database of all vascular access related procedures performed from January 1, 2003 to December 31, 2003 was established. We evaluated the primary unassisted and cumulative access patency rate with analysis of patency-related factors. We also evaluated the primary failure rate of AVF and AVG. RESULTS: 196 new vascular access surgeries were performed during the period. 14 cases were excluded due to loss of follow-up. 142 native arteriovenous fistulas (78%) and 40 grafts (22%) were constructed. The primary failure rate was similar between AVF and AVG group. The primary unassisted (78%, 72%, 68% vs. 62%, 41%, 22% at 1, 2, 3 year; p<0.001) and cumulative patency rate (93%, 88%, 85% vs. 84%, 74%, 73% at 1, 2, 3 year; p=0.087) were better in AVF group than in AVG group. The factors affecting the patency of vascular access were the type of vascular access and planned construction of permanent vascular access. CONCLUSION: Patency of native AVF as the permanent vascular access was better than that of AVG. Planned construction of permanent vascular access improved the patency of the access.
Arteriovenous Fistula ; Follow-Up Studies ; Humans ; Korea ; Renal Dialysis ; Retrospective Studies ; Transplants ; Vascular Patency

BACKGROUND: CT angiography is now available to evaluate the early graft patency after coronary bypass surgery. We investigated whether patency or occlusion of the bypass grafts can be visualized by CT angiography and what factors effect the visuality. MATERIAL AND METHOD: Fifty patients underwent scanning with a 4-slice computed tomographic scanner (Somatom Volume ZoomTM; Siemens, Germany) before being discharged after coronary artery bypass grafting. To evaluate graft patency and relationship between the quality of graft image and the characteristics of the diseased coronary vessels, 50 internal thoracic artery grafts, 18 radial artery grafts, and 56 vein grafts were included in this study. RESULT: All vein grafts (24 grafts; 32 anastomoses) to left coronary artery system were well visualized, but 3 grafts (4.7%) of 30 vein grafts (35 anastomoses) to right coronary artery system were not visualized. The latter was also occluded in invasive coronary angiographic study. Thirty-nine (78%) internal thoracic artery grafts were well visualized, 8 (16%) faintly visualized, and 3 (6%) not visualized, but all the internal artery grafts were well patent in invasive coronary angiographic study. CONCLUSION: Unvisualized vein grafts in CT angiography means occlusion of the grafts, but unvisualized arterial grafts in CT angiography may not mean occlusion of the graft but result from competitive flow between the graft and coronary artery. To confirm patency of the unvisualized arterial grafts, invasive coronary angiography is needed.
Angiography* ; Arteries ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Vessels* ; Humans ; Mammary Arteries ; Radial Artery ; Transplants* ; Vascular Patency ; Veins

PURPOSE: To report result and usefulness of immediate postoperative balloon angioplasty of de novo arteriovenous fistula (AVF) with limited flow just after creation. MATERIALS AND METHODS: From January 1, 2012 to March 31, 2014, 1,270 patients received native AVF creations in a single vascular clinic. In twenty-four patients (1.9% of total AVF creation), immediate postoperative balloon angioplasty was performed because of limited flow on palpation (only pulsation or no thrill) just after AVF creation. Medical records were reviewed retrospectively; technical success (restoration of AVF flow)/clinical success (growing as functional AVF) rate, maturation time, primary patency rate and fistula survival outcome were analyzed during a mean 10.8 months of follow-up. RESULTS: Technical/clinical success rate was 95.8% (23/24 cases); AVF flow was restored after balloon angioplasty, and all the flow-restorated AVFs grew as functional AVFs with mean+/-standard deviation, 4.5+/-1.5 weeks of maturation time. In seven (30.4%) patients, a secondary balloon angioplasty was needed to enhance maturation. The overall primary patency after immediate postoperative balloon angioplasty was 69.6% at 1 and 6 months and 59.0% at 12 months. There was 1 complication (operation site hematoma). CONCLUSION: Immediate postoperative balloon angioplasty for salvage of newly-placed, flow-limiting native AVF is a useful, effective and safe procedure.
Angioplasty ; Angioplasty, Balloon* ; Arteriovenous Fistula* ; Fistula ; Follow-Up Studies ; Humans ; Medical Records ; Palpation ; Retrospective Studies ; Vascular Patency

Interpositionally grafted arteries and veins were expanded with a 20cc tissue expanders in 50 Sprague-Dawley rats. The grafts were done on both hind legs, one side was expanded and the remaining side was used as control. The average gain in length of expanded grafted arteries and veins was over 4 and 6 times that of the controls respectively. The differences in the patency rates between expanded and control grafts were not statistically significant. Histologic examination revealed that there were no changes in the areas of the media and lengths of the inner elastic laminae of the expanded arterial grafts. In both expanded and control vein grafts, marked intimal thickening was noticed, although these changes were not statistically significant. Expansion of grafted vessels can be safely carried out without loss of vessel patency. Tissue expander, grafted vessels
Animal ; Femoral Artery/*anatomy and histology/transplantation ; Male ; Rats ; Rats, Inbred Strains ; *Tissue Expanders ; Vascular Patency ; Veins/*anatomy and histology/transplantation

Interpositionally grafted arteries and veins were expanded with a 20cc tissue expanders in 50 Sprague-Dawley rats. The grafts were done on both hind legs, one side was expanded and the remaining side was used as control. The average gain in length of expanded grafted arteries and veins was over 4 and 6 times that of the controls respectively. The differences in the patency rates between expanded and control grafts were not statistically significant. Histologic examination revealed that there were no changes in the areas of the media and lengths of the inner elastic laminae of the expanded arterial grafts. In both expanded and control vein grafts, marked intimal thickening was noticed, although these changes were not statistically significant. Expansion of grafted vessels can be safely carried out without loss of vessel patency. Tissue expander, grafted vessels
Animal ; Femoral Artery/*anatomy and histology/transplantation ; Male ; Rats ; Rats, Inbred Strains ; *Tissue Expanders ; Vascular Patency ; Veins/*anatomy and histology/transplantation

Biliary-pancreatic cancers are frequently associated with vascular invasion, as well as adjacent organ invasion, due to their biologic and anatomical characteristics. These findings preclude the curative resection of these tumors due to the high mortality and morbidity following a combined vascular resection. The object of this study was to assess the safety and the effect on survival of the combined vascular resection for patients with biliary-pancreatic malignancies through an analysis of our experience. Fifteen biliary-pancreatic cancer patients underwent curative surgery, including major vascular resection, during the period from Mar. 1993 to Oct. 1996. The risk factors such as the operative mortality, the morbidity, operative time, demand for transfusion, postoperative hospital stay, and the pathological characteristics for the 12 patients who underwent pancreaticoduodenectomy(PD) with combined vascular resection were compared with those of 75 cases who underwent a PD without vascular resection from 1993 to 1995. After resections and reconstructions of superior mesenteric and portal veins, vascular patencies were mostly well preserved, and there were no damage to the liver function. Combined vascular resection did not increase the mortality, the morbidity, the hospital stay, or the operative risk. With respect to pathologic characteristics, tumors with vascular invasion did not have more metastases to the lymph node, but did have more frequent perineural invasions and were slightly larger in size. Vascular invasion alone is not a contraindication to curative resection of biliary-pancreatic cancers and combined vascular-superior mesenteric and portal vein-resection should be considered in selected cases in which histologically curative resection is possible.
Humans ; Length of Stay ; Liver ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Operative Time ; Pancreaticoduodenectomy ; Portal Vein ; Risk Factors ; Vascular Patency ; Veins*