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Use of Reversed Iliac Leg Stent-Graft for the Treatment of Isolated Aneurysm of Internal Iliac Artery.

Kyung Sup SONG ; Hyunsil LEE ; Deok Ho NAM ; Ki Hyuk PARK ; Sang Seob YUN ; Bae Young LEE ; Kang Hoon LEE

Vascular Specialist International.2014;30(1):38-42.

This is to report the technique of reversed iliac leg stent-graft in endovascular treatment for isolated internal iliac artery (IIA) aneurysm, which had significant size discrepancy between the common iliac artery (CIA) and external iliac artery (EIA) in 3 patients from different hospitals. Three patients were a 85- and two 82-year-old men. Treated were right IIA aneurysms, sized 6.5x6.2 cm, 5.0x4.0 cm, and 4.1 cm in longest diameter, respectively. The diameters of the right CIA and right EIA measured 21 mm/11 mm, 15 mm/11 mm, and 20 mm/10 mm, respectively. In all cases, reversed iliac leg stent-grafts were prepared on-site; unsheathed and mounted upside-down manually, and deployed in each right CIA. Post-stent-graft angiograms showed complete exclusion of the aneurysms, except for minimal type 1 endoleak in one case. This technique is a useful treatment option in patients with isolated IIA aneurysm.
Aged, 80 and over ; Aneurysm* ; Endoleak ; Endovascular Procedures ; Humans ; Iliac Aneurysm ; Iliac Artery* ; Leg* ; Male

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Successful Access Rate and Risk Factor of Vascular Access Surgery in Arm for Dialysis.

Dae Woo YOO ; Myunghee YOON ; Hee Jae JUN

Vascular Specialist International.2014;30(1):33-37.

PURPOSE: Preservation of adequate vascular access is of vital importance for patients undergoing chronic dialysis in renal failure. The aim of this study is to evaluate the successful access rate and risk factors of arteriovenous fistula (AVF) in the arm for dialysis at a single center. MATERIALS AND METHODS: Patients undergoing vascular access operation between January 2006 and December 2011 were retrospectively identified. RESULTS: A total of 362 vascular access operations were performed. There were 338 autologous AVFs (93.4%) and 24 prosthetic grafts (6.6%). Men comprised 58.3% of all subjects. Mean age was 59.5+/-14.7 years. There were 187 diabetes mellitus patients (51.7%). There was a mean duration of 70.3+/-21.1 days between access creation to first cannulation. Overall successful access rate for dialysis was 95.9%. Of 338 autologous AVFs, 326 patients had patent AVFs for dialysis (96.4% surgical success rate), while 21 of 24 prosthetic grafts were patent (87.5% surgical success rate). A total of 141 patients (38.9%) came to surgery with preoperative central venous catheters (CVC) of which 130 (35.9%) AVFs had a patent fistula in the arm. The only risk factor related to successful access rate of AVF was preoperative CVC placement (P=0.012). CONCLUSION: Successful vascular access rate was 95.9%. The only risk factor related to patent access of AVF was preoperative CVC placement. At least 6 months prior to expected dialysis, AVF surgery is recommended, which may overcome the challenge of co-morbid conditions from having a preoperative CVC.
Arm* ; Arteriovenous Fistula ; Catheterization ; Central Venous Catheters ; Diabetes Mellitus ; Dialysis* ; Fistula ; Humans ; Male ; Renal Insufficiency ; Retrospective Studies ; Risk Factors* ; Transplants

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Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Findings of Post Traumatic Lymphangioma in a Young Adult Male.

Sang Don KWON ; Kyung Ah CHUN ; Eun Jung KONG ; Ihn Ho CHO

Vascular Specialist International.2016;32(3):137-139. doi:10.5758/vsi.2016.32.3.137

The authors report the case of a 34-year-old male, who underwent a fluorine-18 fluoro deoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) scan 7 years after trauma for the evaluation of multifocal masses in the right iliac and right inguinal areas. CT findings showed multifocal low density masses and ¹⁸F-FDG PET revealed slightly increased uptake (maximum standardized uptake value [SUVmax] 3.1). These findings did not exclude the possibility of a benign or malignant lesion. To achieve differential diagnosis, partial surgical excision was performed and a pathologic examination subsequently revealed lymphangioma. Here, the authors describe the ¹⁸F-FDG PET/CT findings of a rare case of lymphangioma resulting from trauma.
Adult ; Deoxyglucose ; Diagnosis, Differential ; Electrons* ; Fluorodeoxyglucose F18 ; Humans ; Lymphangioma* ; Male* ; Positron-Emission Tomography and Computed Tomography ; Young Adult*

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Bovine Aortic Arch and Bilateral Retroesophageal Course of Common Carotid Arteries in a Symptomatic Patient.

Daniele BISSACCO ; Maurizio DOMANIN ; Giuseppina SCHINCO ; Livio GABRIELLI

Vascular Specialist International.2016;32(3):133-136. doi:10.5758/vsi.2016.32.3.133

Anatomical variations of carotid arteries may be related to their development (agenesis, aplasia, hypoplasia) or course (coiling, kinking, tortuosity). Partial or total aberrancies in carotid vessel anatomy rarely occur. We describe the case of a 95-year-old woman presented with sudden onset of confusion and disorientation together with upper limb clonus. Computed tomography (CT)-scan revealed a left frontal brain injury with a not conclusive carotid doppler ultrasound. CT angiography reported a bovine aortic arch with bilateral retroesophageal course of both common carotid arteries and left severe (>70%) internal carotid artery stenosis. The knowledge of anatomical variations of the course of carotid arteries is relevant for possible surgical or endovascular repair or in case of otolaryngology or intubation procedures.
Angiography ; Aorta, Thoracic* ; Brain Injuries ; Cardiovascular Abnormalities ; Carotid Arteries ; Carotid Artery, Common* ; Carotid Stenosis ; Female ; Humans ; Intubation ; Otolaryngology ; Ultrasonography ; Upper Extremity

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Intensive Long Distance Running as a Possible Cause of Multiple Splanchnic Arterial Aneurysms: A Case Report.

Lee Chan JANG ; Sung Su PARK

Vascular Specialist International.2016;32(3):129-132. doi:10.5758/vsi.2016.32.3.129

This is a case report that suggests the possible association between multiple splanchnic arterial aneurysms and long-distance running. The clinical features of one patient admitted at Chungbuk National University Hospital for treatment of multiple splanchnic arterial aneurysms were reviewed. A 54-year-old man had a recurrent, intermittent and epigastric pain for 2 months. There was no abnormality in gastroscopy and colonoscopy. An abdominal computed tomography angiography documented calcified superior mesenteric artery (SMA) and splenic artery aneurysms. The patient had a history of recreational long-distance running for over 10 years. His average running time per week was more than 10 hours. There was no evidence of systemic arteritis, connective tissue disorder or infectious process that may have caused the aneurysms. He did not take any drugs. The SMA aneurysm was opened, and the aneurysmal segment of SMA was replaced with a vein graft. The splenic aneurysm was observed. The patient recovered without any sequelae.
Aneurysm* ; Angiography ; Arteritis ; Chungcheongbuk-do ; Colonoscopy ; Connective Tissue ; Gastroscopy ; Humans ; Mesenteric Arteries ; Mesenteric Artery, Superior ; Middle Aged ; Running* ; Splenic Artery ; Transplants ; Veins

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Cystic Disease of the Groin Presenting as Compression of a Femoral Vessel.

Hyung Kee KIM ; Deokbi HWANG ; Sujin PARK ; Won Ju JEONG ; An Na SEO ; Seung HUH

Vascular Specialist International.2016;32(3):124-128. doi:10.5758/vsi.2016.32.3.124

In this study, we describe our diagnosis and treatment of two patients who presented with femoral vessel compression caused by a cystic lesion in the groin. One case was diagnosed as adventitial cystic disease (ACD) of the common femoral artery resulting in leg claudication and the other was diagnosed as a ganglion cyst (GC) causing femoral vein compression and unilateral leg swelling. The operative findings differed between these two cases with respect to the dissection of the cyst and femoral vessel, but the postoperative histological examination results were similar. The pathogenesis of ACD and GC is not fully understood, and further investigation is needed to delineate the exact pathology of these uncommon conditions.
Adventitia ; Diagnosis ; Femoral Artery ; Femoral Vein ; Ganglion Cysts ; Groin* ; Hip ; Humans ; Leg ; Pathology

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Bilateral Type IIIa Endoleak and Disconnection of Both Limbs after Evar with an Endurant II Endograft.

Sotirios GIANNAKAKIS ; George GALYFOS ; Georgios GEROPAPAS ; Stavros KERASIDIS ; Gerasimos PAPACHARALAMPOUS ; Georgios KASTRISIOS ; Chrisostomos MALTEZOS

Vascular Specialist International.2016;32(3):119-123. doi:10.5758/vsi.2016.32.3.119

A 75-year-old patient with severe comorbidities was treated with an Endurant® (Medtronic, USA) II endograft due to a ruptured abdominal aortic aneurysm (AAA). After four years of unremarkable follow-up, bilateral limb separation was detected. The patient underwent endovascular bridging without any complication. Although rarely detected in newer grafts, late bilateral type IIIa endoleaks can present and should be promptly repaired. Complex or ruptured AAAs treated with off-label use of endografts should be under closer surveillance using imaging tools for potential endoleaks or aneurysm sac growth.
Aged ; Aneurysm ; Aortic Aneurysm, Abdominal ; Comorbidity ; Endoleak* ; Endovascular Procedures ; Extremities* ; Follow-Up Studies ; Humans ; Off-Label Use ; Retreatment ; Transplants

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Outcomes of Arteriovenous Fistula for Hemodialysis in Pediatric and Adolescent Patients.

Suh Min KIM ; Seung Kee MIN ; Sanghyun AHN ; Sang Il MIN ; Jongwon HA

Vascular Specialist International.2016;32(3):113-118. doi:10.5758/vsi.2016.32.3.113

PURPOSE: This retrospective review aimed to report the outcomes of arteriovenous fistula (AVF) and to evaluate the suitability of AVF as a permanent vascular access in pediatric populations. MATERIALS AND METHODS: Data were collected for all patients aged 0 to 19 years who underwent AVF creation for hemodialysis between January 200 and June 2014. RESULTS: Fifty-two AVFs were created in 47 patients. Mean age was 15.7±3.2 years and mean body weight was 46.7±15.4 kg. Of the 52 AVFs, 43 were radiocephalic AVFs, 7 were brachiocephalic AVFs and 2 were basilic vein transpositions. With a mean follow-up of 49.7±39.2 months, primary patency was 60.5%, 51.4%, and 47.7% at 1, 3, and 5 years, respectively and secondary patency was 82.7%, 79.2% and 79.2% at 1, 3, and 5 years, respectively. Age, body weight, AVF type, the presence of a central venous catheter, use of anticoagulation therapy, and history of vascular access failure were not significantly associated with patency rates. There were 9 cases (17.3%) of primary failure; low body weight was an independent predictor. Excluding cases of primary failure, the mean duration of maturation was 10.0±3.7 weeks. During follow-up, 20 patients (42.6%) underwent kidney transplantation, with a median interval to transplantation of 36 months. CONCLUSION: AVF creation in children and adolescents is associated with acceptable long-term durability, primary failure rate and maturation time. Considering the waiting time and limited kidney graft survival, placement of AVFs should be considered primarily even in patients expected to receive transplantation.
Adolescent* ; Arteriovenous Fistula* ; Body Weight ; Central Venous Catheters ; Child ; Follow-Up Studies ; Graft Survival ; Humans ; Kidney ; Kidney Transplantation ; Ocimum basilicum ; Pediatrics ; Renal Dialysis* ; Retrospective Studies ; Veins

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Association of Nitric Oxide Levels and Endothelial Nitric Oxide Synthase G894T Polymorphism with Coronary Artery Disease in the Iranian Population.

Khalil MAHMOODI ; Leila NASEHI ; Elham KARAMI ; Mohammad Soleiman SOLTANPOUR

Vascular Specialist International.2016;32(3):105-112. doi:10.5758/vsi.2016.32.3.105

PURPOSE: The endothelial nitric oxide synthase (eNOS) G894T polymorphism has been reported to cause endothelial dysfunction and may have a role in the development of coronary artery disease (CAD). The aim of the present study was to investigate the association of eNOS G894T genetic polymorphism and plasma levels of nitric oxide (NO) with CAD risk in an Iranian population. MATERIALS AND METHODS: We studied 200 patients with angiographically documented CAD and 100 matched controls. Analysis of G894T genetic polymorphism of eNOS was performed by polymerase chain reaction-restriction fragment length polymorphism method. Plasma levels of NO were determined using Griess method. Biochemical analysis was conducted by routine colorimetric methods. RESULTS: Plasma levels of NO were significantly lower in CAD patients than control subjects (41.60±12.70 vs. 55.48±16.57, P=0.001). Also, the mean plasma levels of NO were significantly lower in T allele carriers of eNOS G894T polymorphism than G allele carriers (P<0.001). The genotype distribution and minor T allele frequency of eNOS G894T polymorphism significantly differed between CAD patients and control subjects (P<0.05). However, no significant association was found between the eNOS G894T polymorphism and the severity of CAD (number of diseased vessel) or the lipid profile of CAD patients (P>0.05). CONCLUSION: Reduced plasma level of NO is associated with increased risk of CAD in our population. Moreover, eNOS G894T polymorphism is a significant risk factor for CAD development via reducing the plasma levels of NO. However, eNOS G894T polymorphism is not a contributing factor for the severity of CAD.
Alleles ; Coronary Artery Disease* ; Coronary Vessels* ; Gene Frequency ; Genotype ; Humans ; Methods ; Nitric Oxide Synthase Type III* ; Nitric Oxide* ; Plasma ; Polymorphism, Genetic ; Risk Factors

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Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines.

Seung Kee MIN ; Young Hwan KIM ; Jin Hyun JOH ; Jin Mo KANG ; Ui Jun PARK ; Hyung Kee KIM ; Jeong Hwan CHANG ; Sang Jun PARK ; Jang Yong KIM ; Jae Ik BAE ; Sun Young CHOI ; Chang Won KIM ; Sung Il PARK ; Nam Yeol YIM ; Yong Sun JEON ; Hyun Ki YOON ; Ki Hyuk PARK

Vascular Specialist International.2016;32(3):77-104. doi:10.5758/vsi.2016.32.3.77

Lower extremity deep vein thrombosis is a serious medical condition that can result in death or major disability due to pulmonary embolism or post-thrombotic syndrome. Appropriate diagnosis and treatment are required to improve symptoms and salvage the affected limb. Early thrombus clearance rapidly resolves symptoms related to venous obstruction, restores valve function and reduces the incidence of post-thrombotic syndrome. Recently, endovascular treatment has been established as a standard method for early thrombus removal. However, there are a variety of views regarding the indications and procedures among medical institutions and operators. Therefore, we intend to provide evidence-based guidelines for diagnosis and treatment of lower extremity deep vein thrombosis by multidisciplinary consensus. These guidelines are the result of a close collaboration between interventional radiologists and vascular surgeons. The goals of these guidelines are to improve treatment, to serve as a guide to the clinician, and consequently to contribute to public health care.
Consensus ; Cooperative Behavior ; Diagnosis* ; Extremities ; Incidence ; Lower Extremity* ; Methods ; Public Health ; Pulmonary Embolism ; Surgeons ; Thrombosis ; Venous Thrombosis*

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