Femoropopliteal (FP) artery-in stent restenosis (ISR) is a daunting management problem that we continue to face. FP artery-ISR rates after primary stent implantation are relatively high. Although repeat FP artery-ISR and the need for additional interventions remain all too common, little consensus exists regarding the best treatment algorithm. In this article, we review the limitations of the currently used devices for the endovascular treatment of FP artery-ISR and discuss which strategies are the most effective and safe.

A 68-year-old male patient with a history of femoro-femoral bypass following unsuccessful intervention for chronic total iliac occlusion was found to have a saccular pseudoaneurysm of the right common iliac artery (CIA) due to interventional device-related injuries associated with the past endovascular intervention. An iatrogenic pseudoaneurysm in the CIA is generally asymptomatic, but it has a high risk of rupture, regardless of its size or symptoms. Endovascular therapy may be the best treatment option; however, ineffective sealing with a stent graft may lead to a type I endoleak. Under such conditions, use of the liquid embolic agent, Onyx, as a bailout solution for the type 1 endoleak is promising.
Aged ; Aneurysm ; Aneurysm, False ; Blood Vessel Prosthesis ; Endoleak ; Humans ; Iliac Artery ; Male ; Rupture ; Stents

Femoropopliteal (FP) artery-in stent restenosis (ISR) is a daunting management problem that we continue to face. FP artery-ISR rates after primary stent implantation are relatively high. Although repeat FP artery-ISR and the need for additional interventions remain all too common, little consensus exists regarding the best treatment algorithm. In this article, we review the limitations of the currently used devices for the endovascular treatment of FP artery-ISR and discuss which strategies are the most effective and safe.
Arteries ; Consensus ; Peripheral Arterial Disease ; Stents

A 78-year-old man presented at Eulji University Hospital due to an abdominal aortic aneurysm with maximum diameter of 52 mm, which had been increased from 45 mm over 6 months. He underwent embolization of the left internal iliac artery with vascular plug, prior to endovascular abdominal aortic repair with a bifurcated stent graft system. Unfortunately, the inserted vascular plug was maldeployed and protruded into left external iliac artery, and caused acute limb ischemia. Because revascularization of the occluded segment was failed, emergent hybrid approach with aorto-uni-iliac stent grafting and femoro-femoral bypass was done, successfully.
Aged ; Aortic Aneurysm* ; Aortic Aneurysm, Abdominal ; Blood Vessel Prosthesis* ; Extremities ; Humans ; Iliac Artery ; Ischemia ; Stents*

Coronary stenting for long complex lesion is effective but associated with complication. We compared the results of stenting between with multiple conventional stenting group (group A) and with single long stenting group (group B). Fifty patients were prospectively and randomly enrolled: 25 patients for each group. Each group showed no significant differences of clinical characteristics. One patient died of heart failure in each group, not associated with the procedure itself. One patients had cerebrovascular accident in each group. Five patients had major bleeding (2, group A; 3, group B). Angiographic success rate was 100% in each group and procedural success rate was 96% and 100% in group A and B, respectively. Angiographic and clinical restenosis rate at 6 months follow-up were 60%, 36% in group A and 65%, 44% in group B, respectively (p=S). Multivariate analysis showed that several factors affected the angiographic restenosis rate as follows; a) male gender (M:F=76.9%:25.0%, P<0.001), b) AMI (AMI:stable angina pectoris=72.7%:66.7%, P<0.001), c) lesion length d) residual stenosis. In conclusion, there were no statistical differences of restenosis and complication rate between the two groups. Our data support single long stenting is acceptable and economically more favorable for long diffuse lesion, compared to multiple conventional stenting.
Constriction, Pathologic ; Coronary Stenosis* ; Coronary Vessels* ; Follow-Up Studies ; Heart Failure ; Hemorrhage ; Humans ; Male ; Multivariate Analysis ; Prospective Studies ; Stents* ; Stroke

PURPOSE: Histological evidence of intraprostatic inflammation is a common finding of transrectal ultrasonography (TRUS)-guided needle biopsy of the prostate in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). The aim of this study was to evaluate the relationship between intraprostatic inflammation and lower urinary tract symptoms depending on the severity of intraprostatic inflammation. MATERIALS AND METHODS: Between January 2002 and December 2006, 141 BPH patients with prostate-specific antigen (PSA) of 4.0-10.0 ng/ml underwent TRUS-guided biopsy of the prostate. The extent and aggressiveness of intraprostatic inflammation were classified into 4 grades. The relationship between the grades of extent and aggressiveness of inflammation and the International Prostate Symptom Score (IPSS) was evaluated. The IPSS was evaluated according to voiding and storage symptom scores. RESULTS: Mean storage symptom scores were increased by grade of the extent of intraprostatic inflammation (grade 0, 6.3; grade 1, 10.1; grade 2, 11.0; and grade 3, 11.3) (p<0.001). The aggressiveness of intraprostatic inflammation also showed increasing storage symptom scores with grade (grade 0, 6.3; grade 1, 10.2; grade 2, 10.9; and grade 3, 11.6) (p<0.001). Voiding symptom scores had no relationship with extent or aggressiveness of intraprostatic inflammation (p=0.942 and p=0.449, respectively). CONCLUSIONS: BPH patients with intraprostatic inflammation complained of more severe storage symptoms than did patients without inflammation. Therefore, if storage symptoms are severe, we might consider medical treatment for intraprostatic inflammation in BPH patients.
Biopsy ; Biopsy, Needle ; Humans ; Inflammation ; Lower Urinary Tract Symptoms ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia

Primary aortoenteric fistula (PAEF) is a rare but catastrophic cause of massive gastrointestinal bleeding. Diagnosis of PAEF is difficult to make and is frequently delayed without strong clinical suspicion. Timely surgical intervention is essential for patient's survival. We report on a case of an 86-year-old woman with no history of abdominal surgery, who presented with abdominal pain. Initially, computed tomography scan showed an intra-abdominal abscess, located anterior to the aortic bifurcation. However, she was discharged without treatment because of spontaneous improvement on a follow-up computed tomography scan, which showed a newly developed right common iliac artery aneurysm. One week later, she was readmitted due to recurrent abdominal pain. On the second day of admission, sudden onset of gastrointestinal bleeding occurred for the first time. After several endoscopic examinations, an aortoenteric fistula bleeding site was found in the sigmoid colon, and aortography showed progression of a right common iliac artery aneurysm. We finally concluded that intra-abdominal abscess induced an infected aortic aneurysm and enteric fistula to the sigmoid colon. This case demonstrated an extremely rare type of PAEF to the sigmoid colon caused by an infected abdominal aortic aneurysm, which has rarely been reported.
Abdominal Abscess/*diagnosis/microbiology ; Aged, 80 and over ; Aorta, Abdominal/radiography ; Aortic Aneurysm, Abdominal/*diagnosis/etiology ; Bacteroides/isolation & purification ; Bacteroides fragilis/isolation & purification ; Colon, Sigmoid/radiography ; Colonoscopy ; Enterococcus/isolation & purification ; Female ; Fistula/*diagnosis ; Humans ; Tomography, X-Ray Computed

Background: Recent studies have successfully implemented next-generation sequencing (NGS) in HLA typing. We performed HLA NGS in a Korean population to estimate HLA-A, -B, -C, and -DRB1 allele and haplotype frequencies up to an 8-digit resolution, which might be useful for an extended application of HLA results. Methods: A total of 128 samples collected from healthy unrelated Korean adults, previously subjected to Sanger sequencing for 6-digit HLA analysis, were used. NGS was performed for HLA-A, -B, -C, and -DRB1 using the AllType NGS kit (One Lambda, West Hills, CA, USA), Ion Torrent S5 platform (Thermo Fisher Scientific, Waltham, MA, USA), and Type Steam Visual NGS analysis software (One Lambda). Results: Eight HLA alleles showed frequencies of ≥ 10% in the Korean population, namely, A*24:02:01:01 (19.5%), A*33:03:01 (15.6%), A*02:01:01:01 (14.5%), A*11:01:01:01 (13.3%), B*15:01:01:01 (10.2%), C*01:02:01 (19.9%), C*03:04:01:02 (11.3%), and DRB1*09:01:02 (10.2%). Nine previous 6-digit HLA alleles were further identified as two or more 8-digit HLA alleles. Of these, eight alleles (A*24:02:01, B*35:01:01, B*40:01:02, B*55:02:01, B*58:01:01, C*03:02:02, C*07:02:01, and DRB1*07:01:01) were identified as two 8-digit HLA alleles, and one allele (B*51:01:01) was identified as three 8-digit HLA alleles. The most frequent four-loci haplotype was HLA-A*33:03:01-B*44:03:01:01-C*14:03-DRB1*13:02:01. Conclusions We identified 8-digit HLA-A, -B, -C, and -DRB1 allele and haplotype frequencies in a healthy Korean population using NGS. These new data can be used as a representative Korean data for further disease-related HLA type analysis.

Raynaud's phenomenon (RP) is a reversible vasospasm that is aggravated by cold or emotional stress. Before confirming RP, it is essential to consider other possible causes including compressive neuropathy, sensori-neuropathy, thyroid disease, hematologic conditions and offending drugs. RP is typically characterized by the three-step color change that turns pallor (white), cyanosis (blue), and then erythema (red) of reperfusion. Once RP is diagnosed, it is important to determine whether it is primary or secondary RP. To distinguish primary from the secondary RP, the specialized tests performing in clinical practice are antinuclear antibody (ANA) and nailfold capillary microscopy (NFC). The combination of ANA and NFC is most helpful for discriminating secondary RP due to autoimmune rheumatic disease. Thereby, normal findings of NFC in primary RP distinguished from secondary RP should be understood. Patients with primary RP usually improves with symptomatic treatment focused on lifestyle modification and patient education, but those with secondary RP should be treated together with associated disease or causes.
Antibodies, Antinuclear ; Capillaries ; Cyanosis ; Erythema ; Humans ; Life Style ; Microscopic Angioscopy ; Microscopy ; Pallor ; Patient Education as Topic ; Reperfusion ; Rheumatic Diseases ; Stress, Psychological ; Thyroid Diseases

Purpose: In Korea, since the Act on Hospice and Palliative Care and Decisions on LifeSustaining Treatment for Patients at the End of Life was implemented in February 2018, advance directives (ADs) have become legally effective and should be documented after sufficient explanation by a registered counselor. However, little is known regarding the adequacy of current AD counseling. This qualitative study aimed to explore the barriers to AD counseling based on counselors’ experiences. Methods: We conducted focus group interviews using purposive sampling. Seven counselors working at hospitals, community health institutions, and non-profit organizations participated in this study. They were asked about the challenges and problems they encountered during AD counseling. Results: Three themes emerged from this study; 1) issues regarding consistency in AD counseling, 2) issues regarding AD counselors’ competency and work environment, and 3) issues regarding the adequacy of the service system. The interviewees stated that the lack of a manual for standardized service made AD counseling inconsistent. The limited competency and poor work environment of counselors were pointed out as major barriers. The interviewees also stated that a proper service system considering individual circumstances is absent. Conclusion The goals of AD counseling should be clarified and guidance should be implemented for providing standardized services. Further efforts to enhance the competency of AD counselors and to improve their working conditions are needed. Establishing an integrated framework for an adequate service system is also essential to overcome systematic barriers to AD counseling.