Adventitial cystic disease (ACD) of venous system is an extremely rare condition. Very few reports of ACD in venous system have been described. In this report we discuss two cases of common femoral vein ACD that presented with a swollen leg by the obstruction of the vein. Ultrasound imaging showed the typical hypoechoic fluid filled cyst with a posterior acoustic window. Computed tomography scan and ascending venogram showed a stenosis to flow in the common femoral vein caused by an extrinsic mass. Trans-adventitial evacuation of cyst with removal of vein wall was performed for both cases. During operation we found the gelatinous material in the cysts arising in the wall of the common femoral vein and compressing the lumen. The patients were released after short hospitalization and have remained symptom free with no recurrence.
Acoustics ; Adventitia ; Constriction, Pathologic ; Femoral Vein ; Gelatin ; Hospitalization ; Humans ; Leg ; Recurrence ; Veins

PURPOSE & METHOD: To evaluate clinical pattern and operative outcome of the ischemic lower extremity, 142 patients who were admitted to Yeungnam University Hospital between January 1996 to December 1998 were analyzed. RESULTS: The patients were 125 males and 17 females ranging from 21 to 88 years of age. The mean age was 59, with the highest incidence among people in their 60s, followed by those in their 70s and then in their 50s. The causes of arterial occlusive disease were artherosclerotic obliterans (ASO) in 87 cases (61.2%), thromboangitis obliterans (TAO) in 44 cases (30.9%), thromboembolism in 10 cases and superficial femoral aneurysm in 1 case. Associated diseases in ASO were hypertension in 37 cases (42.5%), diabetes mellitus in 17 cases (30.9%), cardiac disease in 24 cases (27.5%) and cerebrovascular disease in 7 cases (8.0%). History of smoking was noted in 77.4% of the cases. The major arterial occlusive site of ASO were femoral artery in 36 cases (41.3%), aortoiliac artery in 26 cases (29.8%), iliofemoral artery in 9 cases (10.3%), popliteal artery in 5 cases (5.7%), tibial artery in 6 cases (6.8%) and multi-level occlusion in 5 cases (5.7%). The major arterial occlusive site of TAO were tibial artery in 35 cases (79.5%), pedal artery in 8 cases (18.1%) and popliteal artery in 1 case. According to the Fontaine classification of clinical symptoms, the distribution was as follows: Grade 0 0 case, Grade I 48 cases (33.8%), Grade II 46 cases (32.3%) and Grade III 48 cases (33.8%). The operative procedures of arterial occlusive disease were bypass graft operation in 72 cases, thromboembolectomy in 12 cases, endarterectomy in 2 cases and percutaneous transluminal angioplasty (PTA) was performed in 9 cases. Arterial bypass operation with autogenous or artificial prosthesis were done in 72 cases, which included aortobifemoral or aortobipopliteal bypass in 12 cases, iliofemoral bypass in 5 cases, femoropopliteal bypass in 26 cases, femorotibial bypass in 5 cases, popliteotibial bypass in 8 cases. axillobifemoral bypass in 4 cases and femorofemoral bypass in 12 cases. In over 90% of the operative cases, the early outcome was good with 3+ to 2+ rating according to Rutherford criteria. Mortality for 114 cases was 2.6% (3 cases), including 2 resulting from associated cardiac condition and 1 resulting from ARDS. CONCLUSION: Strategies for successful revascularization and long term patency may be made by consideration of the extent of diseases, associated diseases, clinical symptoms and status of distal perfusion.
Aneurysm ; Angioplasty ; Arterial Occlusive Diseases ; Arteries ; Classification ; Diabetes Mellitus ; Endarterectomy ; Female ; Femoral Artery ; Heart Diseases ; Humans ; Hypertension ; Incidence ; Ischemia* ; Lower Extremity* ; Male ; Mortality ; Perfusion ; Popliteal Artery ; Prostheses and Implants ; Smoke ; Smoking ; Surgical Procedures, Operative ; Thromboangiitis Obliterans ; Thromboembolism ; Tibial Arteries ; Transplants ; Troleandomycin

PURPOSE: Deep vein thrombosis and pulmonary embolism are common and potentially fatal complication among hospitalized patients. The first clinical manifestation of venous thromboembolism may be fatal pulmonary embolism. Therefore, some form of prophylaxis is warranted for patients at risk. Prolonged major surgery is well known as high risk factor in development of venous thromboembolism and venous thromboembolism following surgery remains a significant health care problem. But little data are available concerning the changes of venous hemodynamic during prolonged surgery. METHOD: To access the relationship of the lower leg venous congestion that occurred during prolonged and position-fixed surgery to the development of postoperative deep vein thrombosis, the venous pressure of lower leg were measured continuously. A flexible indwelling angiocatheter was inserted into the greater saphenous vein near ankle area and venous pressure was measured by pressure monitor. The data of patients (experimental group:n=10) who performed spinal operation in Jack-Knife position over 180 minutes, healthy volunteers (n=10) and patients (venous hypertension group) who diagnosed as lower leg deep vein thrombosis (n=7), chronic venous insufficiency (n=3) were collected and analyzed. RESULT: The mean age was 34 years old in experimental group and the patients were 7 males and 3 females. The mean lower leg venous pressures of healthy volunteer in Jack-Knife position were 42.89+/-3.52 mmHg at 30 minutes. In acute deep vein thrombosis and chronic venous insufficiency patients, the mean venous pressures were 73.14+/-4.78, 57.33+/-2.52 mmHg at 30 minutes and these data were statistically significant compared with control group (P<0.05). In experimental group, the changes of the mean venous pressures at 30, 60, 90, 120 and 180 minutes were 48.78+/-2.38, 45.89+/-2.09, 45.33+/-2.24, 45.11+/-2.03 and 46.33+/-2.18 mmHg and these data were not statistically significant compared with control group. There was no postoperative development of deep vein thrombosis. CONCLUSION: The surgical factors (prolonged operation time, fixed position) and anesthetic factor may not play a major role in development of postoperative deep vein thrombosis and other postoperative factors will intervene the development of deep vein thrombosis.
Adult ; Ankle ; Delivery of Health Care ; Female ; Healthy Volunteers ; Hemodynamics ; Humans ; Hyperemia ; Hypertension ; Leg* ; Male ; Pulmonary Embolism ; Risk Factors ; Saphenous Vein ; Venous Insufficiency ; Venous Pressure* ; Venous Thromboembolism ; Venous Thrombosis

Chronic Aorto-Iliac Occlusive Disease (CAIOD) commonly occurs in conjunction with obstruction in the femoral and popliteal arteries, resulting in ischemia of the lower extremities. To analyze the characteristics of CAIOD among Koreans, we relied on 110 cases of aorto-iliac occlusive disease in-patients who underwent operative treatment at Yeungnam university hospital during the last 15 years. Among the 110 total cases, the mean age was 61, with the highest incidence among people in their 60s, followed by those in their 50 s and then in their 70 s. 88.2% of the cases occurred in males with the remaining 11.8% occurring among females. Co-existing diseases included hypertension 46 cases (41.8% of the cases), coronary arterial diseases 17 cases (15.4%), diabetes mellitus 22 cases (20%), chronic pulmonary diseases 14 cases (12.7%) and cerebrovascular diseases 10 cases (9.1%). 80% of the cases involved patients with a history of smoking. The level of serum total cholesterol was higher than normal in 32.7% of cases. Advanced arteriosclerotic manifestation was found in over two-thirds of the cases, with the anatomical distribution as follows: Type I 5 cases (4.5%), Type II 30 cases (27.3%) and Type III 75 cases (68.2%). According to the Fontaine classification of clinical symptoms, the distribution was as follows: Grade I (0 case), Grade II 52 cases (47.3%), Grade III 36 cases (32.7%) and Grade IV 22 cases (20.0%). Among the 110 cases, 75 received only inflow procedures, 19 received both inflow and outflow procedures at the same time, and 16 received only outflow procedures. Among the 94 cases of inflow procedures, PTA accounted for 11 cases, PTA with stent accounted for 5, endarterectomy for 3, and bypass operations for 75. The breakdown for the 75 cases of bypass operations was as follows: aortofemoral or aortoiliac (21 cases): iliofemoral (12 cases): extraanatomic bypass including axillobifemoral bypass (15 cases): and fem-fem bypass (27 cases). Thirty-five outflow procedures included femoropopliteal and femorotibial bypass (22 cases), thromboembolectomy (6 cases), endarterectomy (5 cases) and profundoplasty (2 cases). 19 out of these 35 outflow procedures were performed in conjunction with inflow procedures at the time of the initial operation, but 16 were used without inflow procedure, mainly for Type III cases with relatively mild aortoiliac pathology. In over 90% of the 110 operative cases, the early outcome was good with 3 to 2 rating according to Rutherford criteria. The early outcome seemed to be related to the extent of disease and preoperative clinical symptoms but not with the surgical procedures used. Among the 110 total cases, 26 (23.6%) required second procedures. Among the 94 cases of inflow procedures, 24 (25.5%) required the second procedures, while among the 16 cases of outflow procedures, 2 (12.5%) required the second procedures. Among the 94 cases of inflow procedures, the need for second operations was higher in cases undergoing both inflow and outflow procedure at the same time (36.8%, 7 out of 19 cases) compared to the cases that underwent inflow procedure only (22.6%, 17 out of 75 cases). Among the inflow procedures, axillofemoral (46.7%) and iliofemoral (41.7%) bypass required the 2nd procedures much more frequently than aorto-fem (23.8%), fem-fem (14.8%) bypass and PTA (18.8%). An overall 5-year cumulative patency rate demonstrated significant statistical differences between procedures (p=0.001 Log Rank test): aortofemoral or aortoiliac: 0.81, fem-fem: 0.77, PTA: 0.74, iliofemoral: 0.56, and axillofemoral: 0.50. A 5-year cumulative patency rate also showed a significant correlation with the extent of disease (p=0.01), preoperative ischemic symptoms (p=0.05) and Ankle Brachial pressure Index (ABI.). Operative mortality for the 110 cases was 3.6% (4 cases), including 3 resulting from associated cardiac conditions and 1 resulting from aortoduodenal fistula.
Ankle ; Cholesterol ; Classification ; Diabetes Mellitus ; Endarterectomy ; Female ; Fistula ; Humans ; Hypertension ; Incidence ; Ischemia ; Lower Extremity ; Lung Diseases ; Male ; Mortality ; Pathology ; Popliteal Artery ; Smoke ; Smoking ; Stents

PURPOSE: Critical limb ischemia (CLI) is equated with a need for limb salvage. We studied whether measurement of skin perfusion pressure (SPP) can be used to accurately identify the ampuation level of those patients with CLI who require major amputation and predict the patients whose foot ischemic ulcer would heal or not after vasodilator treatment for over 4 weeks. METHODS: Fifty-one patients with a nonhealing foot ulcer were studied prospectively at Yeungnam university hospital. Age range was 46 to 78 years old with average 68 years old and male to female ratio was 3.3:1. Patients were included in the study if informed consent for medication of vasodilators was obtained, and patients were excluded if there was uncontrolled sepsis or if they required imminent amputation. We used PGE1 (Opalmon(R), 6 tablets/day #3 for 6 weeks, 100 mg/tablet) in 20 cases, PGI2 (Beraprost(R), 6 tablets/day, #3 for 6 weeks, 20 mg/tablet) in 16 cases and Argatroban (antithrombin: Novastan(R) 2 amples/day #2 IV for 4 weeks, 10 mg/ample) in 15 cases. The ankle pressure was checked for each limb. Measurements of SPP were made with photoplethysmography (Life Sciences MVL Modulab(R)) at the metatarsal level which were mostly located at the proximal site of ulcer in viable tissue. The SPP measuements were compaired with the clnical results of therapy (group I: stop medication and major amputation in 7 cases, group II: failed to heal in 18 cases, group III: ulcer healed in 26 cases) in group II & III. We calculated overall acuracy of SPP measurement for prediction of limb ischemic ulcer healing. RESULTS: The ankle pressure or Ankle Brachial Index (ABI) was not predictive of the need for the outcome of drugs therapy. Average SPPs were 12+/-6 mmHg in group I,27+/8 mmHg in group II and 45+/-7 mmHg in group III. The overall predictive accuracy of SPP over 40 mmHg for ulcer healing was 80%. CONCLUSIONS: SPP measurement with PPG is an objective, easy and effective noninvasive method that can be used to predict ischemic ulcer healing.
Aged ; Alprostadil ; Amputation ; Ankle ; Ankle Brachial Index ; Epoprostenol ; Extremities ; Female ; Foot ; Foot Ulcer ; Humans ; Informed Consent ; Ischemia ; Limb Salvage ; Male ; Metatarsal Bones ; Perfusion ; Photoplethysmography ; Prospective Studies ; Sepsis ; Skin ; Ulcer ; Vasodilator Agents

Recently significant neurotoxicity has been reported with the use of carcineurin inhibitors. An 11-year-old-girl had undergone a transplantation of kidney from her mother. On post-operative day 12, hypertension, headache, and left motor weakness (grade I) suddenly occurred. The brain-magnetic resonance imaging and magnetic resonance angiography showed acute cerebral infarction at subcortical white matter of the right hemisphere and multiple stenoses of both anterior cerebral artery and middle cerebral artery. While stopping tacrolimus treatment, we experienced clinical and radiological improvement. So, the neurological complications of this patient seem to have been caused by the use of tacrolimus.
Anterior Cerebral Artery ; Cerebral Infarction ; Constriction, Pathologic ; Headache ; Humans ; Hypertension ; Kidney ; Kidney Transplantation ; Magnetic Resonance Angiography ; Middle Cerebral Artery ; Mothers ; Neurotoxicity Syndromes ; Tacrolimus ; Transplants

PURPOSE AND METHOD: To access the value and results of femoro-femoral bypass for the treatment of unilateral iliac artery occlusion, the clinical data of 53 patients who underwent femoro-femoral bypass graft at Yeungnam University Hospital between January 1994 to December 2000 were analyzed retrospectively. The influence of several variables (such as, age, sex, preoperative symptom, risk factors and associated medical illness, status of distal artery, preoperative ABI) on the long term patency was evaluated by univariate statistical analysis. RESULT: The patients were 47 males and 6 females ranging from 37 to 84 years of age. The mean age was 65, with the highest incidence among people in their 60s, followed by those in their 70s and then in their 50s. Associated diseases were hypertension in 28 cases (52.8%), diabetes mellitus in 10 cases (18.8%), cardiac disease in 19 cases (32.0%) and cerebrovascular disease in 4 cases (7.5%). History of smoking was noted in 77.4% of the cases. Focal stenosis of donor site iliac artery has been found in 2 cases and combined distal outflow occlusion has been found in 21 cases. 2 donor site iliac artery ballon angioplasty was performed preoperatively and 14 adjuvant procedures (9 femoro-popliteal bypass, 2 femoro-tibial bypass, 3 profundoplasty) was performed simultaneously during the operation. Cumulative 1, 3, 5,-year primary and secondary patency rates of all femoro-femoral bypass were 87.0%, 76.6%, 68.1% and 91.7%, 85.7%, 73.5%. There was no operative mortality and major perioperative complications. Univariate analysis showed that the patients without distal arterial occlusion had significantly better 1-, 3- and 5-year primary patency rates (93.0%, 89.0% and 74.2% versus 76.6%, 45.9% and 45.9%, P=0.02) compared with the patients with distal arterial occlusion. No significant effect was exerted by all other variables on long term results. CONCLUSION: These results suggest that femoro-femoral bypass is a safe and durable operation that results in good patency in a good runoff.
Angioplasty ; Arteries ; Constriction, Pathologic ; Diabetes Mellitus ; Female ; Heart Diseases ; Humans ; Hypertension ; Iliac Artery ; Incidence ; Male ; Mortality ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Tissue Donors ; Transplants*

PURPOSE: This study aimed to investigate early and mid-term outcomes of carotid artery stenting (CAS). METHODS: We retrospectively reviewed 111 patients who were treated for carotid stenosis between October 2004 and December 2009 (42 CASs and 69 carotid endarterectomies [CEAs]). RESULTS: CAS group was older than CEA group (70 years vs. 67 years, P = 0.001). Coronary artery disease and high lesion above the 2nd cervical vertebral body were more common in CAS group (29% vs. 13%, P = 0.002; 4% vs. 24%, P = 0.004). The 30-days stroke rate was higher in CAS group (10% vs. 1% in CEA group, P = 0.067, Fisher's exact test). New brain lesions on diffusion-weighted magnetic resonance imaging were more common in CAS group (48% vs. 20% in CEA group, P = 0.002, chi-square test). The 1-, 3-year freedom from stroke were 91%, 84% in CAS group and 99%, 99% in CEA group (P = 0.007, log-rank test). Univariate analysis showed that female gender and age > 70 years were related with postprocedural neurological complications (P = 0.046 and P = 0.007, log-rank test). However, none were independent risk factors on multivariate analysis. CONCLUSION: In our series, the rates of peri-procedural neurological complications in CAS group were significantly high. These results suggest that more experience and restricted patient selection will be needed for CAS.
Brain ; Carotid Arteries ; Carotid Stenosis ; Coronary Artery Disease ; Endarterectomy ; Endarterectomy, Carotid ; Female ; Freedom ; Humans ; Magnetic Resonance Imaging ; Patient Selection ; Penicillanic Acid ; Retrospective Studies ; Risk Factors ; Stents ; Stroke

PURPOSE: Iliac vein compression syndrome (IVCS), first characterized by Cockett and Thomas in 1965, is the development of iliofemoral deep venous thrombosis due to compression of the left common iliac vein against the spine and pelvic brim by the right common iliac artery. Thrombectomy treatment of the underlying compression is essential if significant long-term sequelae are to be avoided. Surgical treatment options include venous reconstruction or venous bypass, but treatment using endovascular techniques have recently been described. This study was conducted to evaluate the usability of endovascular treatment (esp. thrombolysis with stent insertion) in a venous outflow obstruction resulting from IVCS. METHOD: During a 2-year period, 20 patients (17 women, 3 men; mean age, 60 years) presented with clinical and imaging findings consistent with IVCS. All patients presented with leg edema or pain. The mean duration of symptom onset was 6.6+/-4.4 days, ranging from 1 to 15 days. All patients were evaluated using a Duplex scan, computerized tomography and venography. After the ascending venography had been performed, an infusion catheter system was placed, and urokinase infused locally into the thrombus burden. After near complete clot dissolution, the residual left common iliac vein stenosis was treated by means of angioplasty and the placement of a Wallstent. All patients continued to receive oral warfarin. Patients were followed-up by means of clinical visits, and the stent patency was assessed by means of a Duplex scan or computerized tomography. RESULT: The total dose of urokinase used and the duration of infusion were 2.28+/-0.93 million unit, ranging from 1.00 to 5.20 and 46.8+/-14.8 hours, ranging from 14 to 72 hours, respectively. Grade III (complete lysis) thrombolysis was achieved in 17 patients. All 17 patients successfully received a Wallstent. The initial clinical success was 100%, with complete resolution of symptoms in all patients. One patient, with combined ovarian cancer, had a recurrent symptomatic deep vein thrombosis and complete occlusion of the stent due to thrombosis 2 months after treatment. However, no other patients showed evidence of deep vein thrombosis after treatment. The overall patency rate of the stenting at 18 months was 94.1%. There were no deaths, pulmonary embolism, cerebral hemorrhage or major bleeding complications. CONCLUSION: These results suggested that the treatment of iliac vein compression syndrome, using catheter directed thrombolytic therapy and venous stent insertion, was a safe and effective method at the mid term evaluation. These patients will continue to be followed up with screening tests to further define the long-term patency.
Angioplasty ; Catheters ; Cerebral Hemorrhage ; Constriction, Pathologic ; Edema ; Endovascular Procedures ; Female ; Hemorrhage ; Humans ; Iliac Artery ; Iliac Vein* ; Leg ; Male ; Mass Screening ; May-Thurner Syndrome* ; Ovarian Neoplasms ; Phlebography ; Pulmonary Embolism ; Spine ; Stents ; Thrombectomy ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Venous Thrombosis ; Warfarin

Portal vein thrombosis is a rare condition occurring in association with a wide variety of precipitating factors. Among these, liver cirrhosis and neoplasm constitute the major etiology of portal vein thrombosis. In oriental countries, as compared with western countries, liver cirrhosis has been reported to be extremely rare cause of portal vein thrombosis. The authors experienced a case of portal vein thrombosis in a 46-years-old man with liver cirrhosis who admitted to our hospital due to abdominal pain. Abdominal CT, angiography and laparotomy showed involvement of portal vein with thrombus and there were no evidences of neoplastic disease. The screening tests for hypercoagulable states were normal. The patient was treated with portal vein thrombectomy and anticoagulation therapy. We report this case with brief review of literature.
Abdominal Pain ; Angiography ; Humans ; Laparotomy ; Liver Cirrhosis* ; Liver* ; Mass Screening ; Portal Vein* ; Precipitating Factors ; Thrombectomy ; Thrombosis ; Tomography, X-Ray Computed ; Venous Thrombosis*