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Surgical Management of Arterial Restenosis.

Journal of the Korean Society for Vascular Surgery.1999;15(2):361-364.

The number of procedures performed annually for occlusive vascular disease continues to increase. Currently, approximately 500,000 patients undergo reconstructive vascular surgery each year; half of these procedures are coronary bypass procedures and the remainder include various operations on the peripheral vascular tree. These peripheral interventions encompass a wide assortment of procedures including autogenous and prosthetic bypass grafts, endarterectomies, and a variety of new endovascular procedures. Most established vascular procedures, as well as the new technologies and applications, have proven both technically feasible and safe. The value of any surgical procedure must be measured not only by the success by which it can be initially performed but also in terms of the durability of the results. Although in-hospital success rates are excellent, the long-term durability of most of these procedures has been disappointing. Furthermore, the common culprit accounting for much of the poor long-term success rate of these procedures is intimal hyperplasia. Clearly this process is a significant cause of morbidity in patients undergoing procedures on the vascular system, and investgations into methods to prevent or reverse this process are of great importance. Author evaluates incidence, cause and treatment procedures to correct restenosis and analyzes the results of these procedures in the fields of restenosis after peripheral bypass, carotid endarterectomy and endovascular surgery.
Endarterectomy ; Endarterectomy, Carotid ; Endovascular Procedures ; Humans ; Hyperplasia ; Incidence ; Transplants ; Vascular Diseases

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Surveillance of Arterial Restenosis.

Ho Chul PARK

Journal of the Korean Society for Vascular Surgery.1999;15(2):358-360.

No abstract aailable.

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Pathogenesis of Arterial Restenosis.

Byung Joon SO

Journal of the Korean Society for Vascular Surgery.1999;15(2):349-357.

No abstract aailable.

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Portal Vein Thrombosis in Liver Cirrhosis: A case report.

Dong Hwan KIM ; Woo Hyung KWUN ; Hong Jin KIM ; Bo Yang SUH ; Koing Bo KWUN

Journal of the Korean Society for Vascular Surgery.1999;15(2):343-348.

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*

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Posterior Approach to the Posterior Tibial Artery in Popliteal Arterial Aneurysm Repair: A case report.

Hong Gi LEE ; Chan Jong YOO ; Hee Chang AHN ; Young Soo NAM

Journal of the Korean Society for Vascular Surgery.1999;15(2):338-342.

Surgical approach to the popliteal arterial aneurysm involves medial and posterior approaches. Posterior approach does not need division of hamstring muscle tendons and gastrocnemius head, which is necessary in medial approach for exposure of the entire popliteal artery (PA). Further, it has the advantage of harvesting the lesser saphenous vein without the need of additional incision. Posterior approach to vessels below PA was reported to be effective for bypass from PA to crural vessels in patients with limb ischemia. We report a case of popliteal aneurysm approached posteriorly. A 49-year-old male patient presented with a left popliteal mass and calf claudication for 2 years. Preoperative ultrasonography, MRI and angiography showed a thrombosed popliteal aneurysm. With the patient in left lateral position, the popliteal arterial aneurysm was exposed posteriorly, the lesser saphenous vein was harvested, the crural vessels were exposed by division of gastrocnemius and soleus muscles, and exclusion of the aneurysm and bypass from proximal PA to posterior tibial artery was done. Postoperatively, the patient experienced mild leg edema which soon disappeared, and he was discharged on the 23rd postoperative day. We found the posterior approach to the popliteal and proximal tibial artery to be simple and effective.
Aneurysm* ; Angiography ; Edema ; Extremities ; Head ; Humans ; Ischemia ; Leg ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscles ; Popliteal Artery ; Saphenous Vein ; Tendons ; Tibial Arteries* ; Ultrasonography

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The Occlusions of both Femoral Artery Bifucations by Myxomas: A case report.

Ho Jin JUN ; Jong Kwon PARK ; Jin Woo RYU ; Min CHUNG ; Dong Kook PARK ; Jung Taik KIM

Journal of the Korean Society for Vascular Surgery.1999;15(2):332-337.

We describe a patient with an unusual cause of the occlusions of both femoral arteries by myxomas. A 41-year-old man presented with sudden onset of both leg pain and paresthesia. His hematological and cardiological status was normal. Lower peripheral angiography was performed and demonstrated thrombotic occlusion, both common femoral artery and superficial femoral and proximal portion of deep femoral artery. He was successfully treated with surgical and forgaty catheter extraction. Histologic finding was myxoma probably from cardiac origin. Cardiac investigations to determine the source of the myxoma, including 2-D echocardiography and Transesophageal echocardiogram (TEE) of the heart, failed to demonstrate residual myxoma in heart. No residual tumor or potential source of the tumor was found. The cause of both leg pain was the occlusions of the both common femoral arteries by myxomas. An entire cardiac tumor might have embolized with no detectable residual tumor in the heart; alternatively a myxoma might have originated as a primary tumor in the femoral artery.
Adult ; Angiography ; Catheters ; Echocardiography ; Femoral Artery* ; Heart ; Heart Neoplasms ; Humans ; Leg ; Myxoma* ; Neoplasm, Residual ; Paresthesia

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Multiple Arterial Aneurysms in Cerebral Palsy Patient.

Won Hyun CHO ; Hyoung Tae KIM ; Wan Hee SONG ; Hyoung Soo KIM ; Dae Kwang KIM ; Hong KIM ; Young Woo KANG

Journal of the Korean Society for Vascular Surgery.1999;15(2):327-331.

A 36-year-old man presented abrupt onset of epigastric pain with high fever for one week after pork meal. Extensive diagnostic studies including blood, urine and stool cultures and other inflammatory factors were done but only leukocytosis, 1:160 for H Ag of widal test, and increased FDP were positive findings. Abdominal CT showed multifocal hepatic and splenic arterial aneurysms which grew very rapidly during these 10 days. Emergency exploration and ligation at either side of common hepatic artery and the proximal segment of right hepatic artery were done because of impending rupture. The histologic findings of the excised aneurysmal wall were diffuse infiltration of inflammatory cells and medial necrosis. Several other arterial aneurysms at right brachial, left carotid and branch of superior mesenteric artery were identified on the follow up angiogram. Also noted right brachial artery thrombosis in aneurysmal dilatation site and this was treated by continuous intraarterial infusion of urokinase. Even though the patient had no endocarditis and no growth of blood culture, we consider this multiple artery aneurysms as an infected aneurysm by unknown bacteremia due to pork meal.
Adult ; Aneurysm* ; Aneurysm, Infected ; Arteries ; Bacteremia ; Brachial Artery ; Cerebral Palsy* ; Dilatation ; Emergencies ; Endocarditis ; Fever ; Follow-Up Studies ; Hepatic Artery ; Humans ; Infusions, Intra-Arterial ; Leukocytosis ; Ligation ; Meals ; Mesenteric Artery, Superior ; Necrosis ; Rupture ; Thrombosis ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator

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Arterial Thoracic Outlet Syndrome (TOS) with Multiple Distal Embolization: A case report.

Jeong Eon LEE ; Seung Kee MIN ; Moon Sang AHN ; Seung HUH ; In Mok JUNG ; Jong Won HA ; Jung Kee CHUNG ; Sook Whan SUNG ; Sang Joon KIM

Journal of the Korean Society for Vascular Surgery.1999;15(2):322-326.

Thoracic outlet syndrome (TOS) is an uncommon condition which is caused by compression of subclavian artery, vein or brachial plexus in the region of thoracic outlet area, which is composed by the first rib, clavicle, anterior and middle scalene muscles and other connective tissue. In arterial TOS, chronic arterial compression causes arterial stenosis, poststenotic dilatation, aneurysm formation, intramural thrombus and peripheral arterial embolism. We present herein a case of arterial TOS patient with multiple distal embolization. The patient was 43-year old male with crutch ambulation because of sequelae of polioviral infection in his youth. His chief complaint was discoloration and gangrenous change of five right digits for 1 month. A rudimentary first right rib was found in simple chest X-ray. Angiographic findings were stenosis and poststenotic dilatation of right subclavian artery, multiple peripheral arterial embolic obstructions and numerous collateral vessel formation. Right thoracoscopic sympathectomy (T2), resection of the abnormal first rib and the abnormal axillary arterial segment was performed through the supraclavicular and transaxillary incision, then interpositional graft with saphenous vein was done for arterial reconstruction. A minor lymphatic fluid collection around the area of operation occurred, but it was easily controlled by percutaneous drainage. The gangrenous wounds of digits were improved after restoration of blood circulation.
Adolescent ; Adult ; Aneurysm ; Blood Circulation ; Brachial Plexus ; Clavicle ; Connective Tissue ; Constriction, Pathologic ; Dilatation ; Drainage ; Embolism ; Humans ; Male ; Muscles ; Ribs ; Saphenous Vein ; Subclavian Artery ; Sympathectomy ; Thoracic Outlet Syndrome* ; Thorax ; Thrombosis ; Transplants ; Veins ; Walking ; Wounds and Injuries

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Tourniquet Occlusion Technique for Infrapopliteal Artery Revascularization.

Seung HUH ; Moon Sang AHN ; Seung Kee MIN ; Jung Kee CHUNG ; Sang Joon KIM

Journal of the Korean Society for Vascular Surgery.1999;15(2):317-321.

Refinements in surgical technique have resulted in significant improvement in the patency rates of infrapopliteal artery revascularizations, but the cumulative patency rate were still low. Possibly the principle cause for the late graft failure was the constricting scar formation around the distal anastomosis following surgical injury. Thus we adopted a nondissection method, using pneumatic tourniquet occlusion technique, to simplify the procedure of distal anastomosis and to lessen the surgical injury. Six patients underwent infrapopliteal artery revascularizations with this method. Three of them were diagnosed with arteriosclerosis obliterans and the others with thromboangiitis obliterans. Tourniquet pressures of 350 mmHg were applied from 32 to 60 minutes. All patients were given systemic anticoagulants. The distal anastomoses were performed to peroneal artery in three cases, posterior tibial artery in two, and anterior tibial artery in one. Hemostasis was adequate in all cases and no alternative occlusive devices were required. There were no complications attributable to the use of the pneumatic tourniquet. Therefore we suggest that tourniquet occlusion technique may simplify the infrapopliteal artery revascularization and minimize surgical injury at the distal anastomosis contributed to the long-term patency of the distal bypass.
Anticoagulants ; Arteries* ; Arteriosclerosis Obliterans ; Cicatrix ; Hemostasis ; Humans ; Intraoperative Complications ; Thromboangiitis Obliterans ; Tibial Arteries ; Tourniquets* ; Transplants

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Dissecting Aneurysm Originating in the Abdominal Aorta: A case report.

Woo Jin CHUNG ; Kyoung Keun LEE ; Jung Kyun LEE ; Kwon Mook CHAE ; Byung Jun SO

Journal of the Korean Society for Vascular Surgery.1999;15(2):312-316.

Although almost all cases of spontaneous aortic dissection originate in the thoracic aorta, dissections limited to the abdominal aorta occur very rarely. According to the previous literatures, localized abdominal aortic dissections account for 1~4% of all aortic dissections. The predisposing factors of spontaneous abdominal aortic dissection are similar to those of thoracic aortic dissection. Many patients have a history of hypertension and the incidence appears to be greater in patients with congenital heart diseases, pregnancy or Marfan's syndrome. And it occurs 3 times more frequently in men than in women. Histologically, atherosclerosis is the most common finding. In many cases, presenting symptoms and signs are not specific, so that this disease entity can be overlooked at bedsides. In our case, the patient was a 76-year-old man who had a vague periumbilical pain occurred one day before. He had no trauma history nor other illness. Abdomino-pelvic CT showed 4x7 cm sized dilatation of abdominal aorta from below the renal arteries to just above the aortic bifurcation site and compatible with aortic dissecting aneurysm. We performed aneurysmectomy and restored arterial continuity with an aorto-bifemoral bypass using dacron. The patient's postoperative course was relatively uneventful and he remains well one year after operation. In conclusion, because of its rarity and nonspecific symptoms and signs, spontaneous aortic dissection confined to the abdominal aorta may be misdiagnosed by physicians. And usually, untreated aortic dissections have a lethal course. So, more accurate diagnostic approaches and optimal managements are needed for good outcome.
Aged ; Aneurysm, Dissecting* ; Aorta, Abdominal* ; Aorta, Thoracic ; Atherosclerosis ; Causality ; Dilatation ; Female ; Heart Diseases ; Humans ; Hypertension ; Incidence ; Male ; Marfan Syndrome ; Polyethylene Terephthalates ; Pregnancy ; Renal Artery

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