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Delayed Presentation of Endovenous Heat-Induced Thrombosis Treated by Thrombolysis and Subsequent Open Thrombectomy.

Jung Hak KWAK ; Sang Il MIN ; Song Yi KIM ; Ahram HAN ; Chanjoong CHOI ; Sanghyun AHN ; Jongwon HA ; Seung Kee MIN

Vascular Specialist International.2016;32(2):72-76. doi:10.5758/vsi.2016.32.2.72

Although endovenous heat-induced thrombosis (EHIT) is frequently reported after endovenous laser ablation (EVLA), the incidence and timing of occurrence of EHIT are not fully understood. We present a case of EHIT successfully treated with a combination of surgical and endovascular treatments. A 57-year-old woman, two months post bilateral EVLA, presented with a swollen leg. Deep vein thrombosis was diagnosed by Doppler ultrasonography and computerized tomographic venography. We treated the patient with catheter-directed thrombolysis with urokinase after insertion of an inferior vena cava filter. After thrombolytic treatment, we performed surgical venous thrombectomy, due to the presence of a large thrombus in the femoral vein. During the operation, we found organized old thrombus at the great saphenous vein which connected to the deep femoral vein. From these findings, we confirmed the presence of EHIT despite a long time having passed after EVLA. The patient was placed on anticoagulation therapy with oral rivaroxaban for three months.
Catheter Ablation ; Female ; Femoral Vein ; Humans ; Incidence ; Laser Therapy ; Leg ; Middle Aged ; Phlebography ; Rivaroxaban ; Saphenous Vein ; Thrombectomy* ; Thrombosis* ; Ultrasonography, Doppler ; Urokinase-Type Plasminogen Activator ; Vena Cava Filters ; Venous Thrombosis

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Recurrent Arterial Thrombosis as a Presenting Feature of a Variant M3-Acute Promyelocytic Leukemia.

Pranit N CHOTAI ; Kalenda KASANGANA ; Abhinav B CHANDRA ; Atul S RAO

Vascular Specialist International.2016;32(2):65-71. doi:10.5758/vsi.2016.32.2.65

Acute limb ischemia (ALI) is a common vascular emergency. Hematologic malignancies are commonly associated with derangement of normal hemostasis and thrombo-hemorrhagic symptoms during the course of the disease are common. However, ALI as an initial presenting feature of acute leukemia is rare. Due to the rarity of this presentation, there is a scarcity of prospective randomized data to optimally guide the management of these patients. Current knowledge is mainly based on isolated cases. We report our experience managing a patient who presented with ALI and was found to have occult leukemia. A review of all cases with ALI as a presenting feature of acute leukemia is also presented.
Emergencies ; Extremities ; Hematologic Neoplasms ; Hemostasis ; Humans ; Ischemia ; Leukemia* ; Leukemia, Promyelocytic, Acute ; Prospective Studies ; Thrombosis*

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Left Subclavian Artery Occlusion: Femoro-Axillary Artery Retrograde Bypass.

Masaya NAKASHIMA ; Hideaki KOBAYASHI ; Masayoshi KOBAYASHI

Vascular Specialist International.2016;32(2):62-64. doi:10.5758/vsi.2016.32.2.62

The treatment tactics for subclavian artery occlusion include the more commonly used endovascular therapy rather than surgical intervention. We present a case of a 61-year-old woman with dialysis-dependent chronic renal failure who experienced left finger necrosis in the left upper extremity. To salvage the limb, we performed femoro-axillary (fem-ax) artery bypass using an autologous saphenous vein graft. However, 10 months later, she experienced coldness in the left forearm. Angiography revealed chronic total occlusion of the venous bypass. Despite emergent thrombectomy, redo fem-ax artery bypass operation was performed using a prosthetic graft. Upper limb salvage can be achieved by fem-ax artery retrograde bypass.
Angiography ; Arteries* ; Extremities ; Female ; Fingers ; Forearm ; Humans ; Kidney Failure, Chronic ; Middle Aged ; Necrosis ; Saphenous Vein ; Subclavian Artery* ; Thrombectomy ; Transplants ; Upper Extremity

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Aortobifemoral Reconstruction with Right Extra-Anatomic Obturator Foramen Bypass due to a Septic Groin.

Carlos A HINOJOSA ; Javier E ANAYA-AYALA ; Hugo LAPARRA-ESCARENO ; Rene LIZOLA ; Adriana TORRES-MACHORRO

Vascular Specialist International.2016;32(2):57-61. doi:10.5758/vsi.2016.32.2.57

The aortic bifurcation and iliac vessels are common sites of atherosclerotic occlusive disease causing the clinical expression known as "Leriche's syndrome". An aortobifemoral bypass grafting in the setting of a septic groin remains a significant challenge to vascular surgeons. We present a 65-year-old male with complete occlusion of the distal aorta and iliac arteries; he had undergone a left axillo-femoral and femoral-femoral artery bypass 2 years prior to our evaluation. Owing to a complex graft infection in the right groin and worsening lower extremity ischemia, we performed an aortobifemoral reconstruction through the right obturator membrane. This report highlights the safety and efficacy of the obturator bypass for avoiding infected groins while preserving vascular continuity and durability with 78 months of secondary patency rate.
Aged ; Aorta ; Arteries ; Groin* ; Humans ; Iliac Artery ; Ischemia ; Lower Extremity ; Male ; Membranes ; Surgeons ; Transplants

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Upper Arm Basilic Vein Transposition for Hemodialysis: A Single Center Study for 300 Cases.

Yunhee LEE ; Dan SONG ; Myung Jin KIM ; Sang Chul YUN

Vascular Specialist International.2016;32(2):51-56. doi:10.5758/vsi.2016.32.2.51

PURPOSE: The population of end-stage renal failure patients dependent on hemodialysis continues to expand with an increasing number of patients having an unsuitable cephalic vein or failed radio- and brachio-cephalic fistula. In these patients, the transposed basilic vein to brachial artery arteriovenous fistula (BaVT) provides autologous choice for hemodialysis. The results of basilic vein transposition arteriovenous fistula were assessed. MATERIALS AND METHODS: Three hundred cases of BaVT performed at a single center during the period of January 2005 to December 2011 were reviewed retrospectively. Data including demographics and postoperative complications were collected. Primary and secondary patency rates were determined by using Kaplan-Meier methods. RESULTS: The median age of patients was 57.4±13.1 years, and 154 patients were male. Renal failure was associated with hypertension in 88.7%, and with diabetes in 34.0%. The mean follow-up was 27.4±20.0 (12 to 72) months. There was no operation-related death. Eighteen patients required prosthetic graft interposition because of short vein. Thirty-five postoperative complications developed in 41 patients (148 cases), including thrombosis, stenosis, hematoma, seroma, arm swelling, steal syndrome, infection and aneurysm formation. Primary patency of BaVT was 69%, 60%, 53%, 52%, 44%, and 22% at 1, 2, 3, 4, 5, and 6 years, respectively. Secondary patency was 99%, 97%, 97%, 97%, 95%, and 95%, respectively. CONCLUSION: Chronic renal failure patients with hemodialysis may benefit from BaVT, because of high patency, less radiologic procedure, and less infection rate. The BaVT fistula should be used in preference to polytetrafluoroethylene grafts for secondary access.
Aneurysm ; Arm* ; Arteriovenous Fistula ; Brachial Artery ; Constriction, Pathologic ; Demography ; Fistula ; Follow-Up Studies ; Hematoma ; Humans ; Hypertension ; Kidney Failure, Chronic ; Male ; Ocimum basilicum* ; Polytetrafluoroethylene ; Postoperative Complications ; Renal Dialysis* ; Renal Insufficiency ; Retrospective Studies ; Seroma ; Thrombosis ; Transplants ; Veins*

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Risk Factor Analysis for Buttock Claudication after Internal Iliac Artery Embolization with Endovascular Aortic Aneurysm Repair.

Hye Ryeon CHOI ; Ki Hyuk PARK ; Jae Hoon LEE

Vascular Specialist International.2016;32(2):44-50. doi:10.5758/vsi.2016.32.2.44

PURPOSE: Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) involving the common iliac artery requires extension of the stent-graft limb into the external iliac artery. For this procedure, internal iliac artery (IIA) embolization is performed to prevent type II endoleak. In this study, we investigated the frequency and risk factor of buttock claudication (BC) in patients having interventional embolization of the IIA. MATERIALS AND METHODS: From January 2010 to December 2013, a total of 110 patients with AAA were treated with EVAR in our institution. This study included 27 patients (24.5%) who had undergone unilateral IIA coil embolization with EVAR. We examined hospital charts retrospectively and interviewed by telephone for the occurrence of BC. RESULTS: Mean age of total patients was 71.9±7.0 years and 88.9% were males. During a mean follow-up of 8.65±9.04 months, the incidence of BC was 40.7% (11 of 27 patients). In 8 patients with claudication, the symptoms had resolved within 1 month of IIA embolization, but the symptoms persisted for more than 6 months in the remaining 3 patients. In univariate and multivariate analysis, risk factors such as age, sex, comorbidity, patency of collateral arteries, and anatomical characteristics of AAA were not significantly related with BC. CONCLUSION: In this study, BC was a frequent complication of IIA embolization during EVAR and there was no associated risk factor. Certain principles such as checking preoperative angiogram, proximal and unilateral IIA embolization may have contributed to reducing the incidence of BC.
Aneurysm ; Aortic Aneurysm* ; Aortic Aneurysm, Abdominal ; Arteries ; Buttocks* ; Comorbidity ; Embolization, Therapeutic ; Endoleak ; Extremities ; Follow-Up Studies ; Humans ; Iliac Artery* ; Incidence ; Intermittent Claudication ; Male ; Multivariate Analysis ; Retrospective Studies ; Risk Factors* ; Telephone

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Current Understandings of Spontaneous Isolated Superior Mesenteric Artery Dissection.

Young Wook KIM

Vascular Specialist International.2016;32(2):37-43. doi:10.5758/vsi.2016.32.2.37

Spontaneous isolated superior mesenteric artery dissection (SISMAD) has been known as a rare vascular disease. However it is increasingly reported in these days with the development of advanced imaging technology. Underlying etiology, natural course or an optimal management strategy of SISMAD is not exactly known at the moment. During the past 10 years, we have had an interest in this rare vascular disease and collected clinical and image data in 100 or more patients with SISMAD. In this review article, I would like to describe my current understanding of SISMAD on the base of our recent publications in the major vascular surgery journals.
Humans ; Mesenteric Artery, Superior* ; Vascular Diseases

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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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Tangential Resection of a Popliteal Vein Aneurysm in a Patient Complaining of Localized Popliteal Pain.

Sun HAN ; Jae Wook RYU

Vascular Specialist International.2016;32(1):33-36. doi:10.5758/vsi.2016.32.1.33

A 48-year old man presented with left popliteal pain. A 2.2×1.6 cm sized saccular aneurysm at the level of the left popliteal fossa was diagnosed by ultrasonography. Tangential aneurysmectomy and popliteal vein repair was performed uneventfully. The patient fared well for a year without symptoms. Popliteal vein aneurysms are rare and typically found in patients with fatal thromboembolic features without warning symptoms. Fortunately, our patient had localized pain which was helpful in its early diagnosis and treatment.
Aneurysm* ; Early Diagnosis ; Humans ; Popliteal Vein* ; Ultrasonography

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