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Endovascular Treatment of Isolated Bilateral Common Iliac Artery Aneurysms Using Iliac Branched Stent Graft.

Joung Taek KIM ; Yong Sun JEON ; Hyun Kyung LIM ; Young Sam KIM ; Yong Han YOON ; Wan Ki BAEK

Vascular Specialist International.2014;30(3):87-90. doi:10.5758/vsi.2014.30.3.87

Endovascular treatment of isolated bilateral common iliac artery aneurysm (CIAA) requires salvage of at least one internal iliac artery to prevent complications such as ischemic buttock claudication. We treated a case of bilateral CIAAs using an internal iliac branched stent graft. We report a case of a 58-year-old man who presented with bilateral CIAAs. The left internal iliac artery was occluded with coil embolization. The right internal iliac artery was saved by using a branched stent graft. The aneurysms were excluded with conventional endovascular aneurysm repair. Completion angiography showed technical success. Follow up computed tomography angiogram at three months showed complete exclusion of bilateral CIAAs, no endoleaks, and patent right internal iliac artery. There was no pelvic ischemic complication. We treated successfully a case of isolated bilateral CIAAs using an iliac branched stent graft.
Aneurysm* ; Angiography ; Blood Vessel Prosthesis* ; Buttocks ; Embolization, Therapeutic ; Endoleak ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Iliac Artery* ; Middle Aged

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Results of Open Surgical Repair of Chronic Juxtarenal Aortic Occlusion.

Shin Seok YANG ; Young Wook KIM ; Yang Jin PARK ; Dong Ik KIM ; Shin Young WOO ; Seung HUH ; Hyung Kee KIM

Vascular Specialist International.2014;30(3):81-86. doi:10.5758/vsi.2014.30.3.81

PURPOSE: The aim of study was to review the results of open surgical repair (OSR) of chronic juxtarenal aortic occlusion (JRAO). MATERIALS AND METHODS: We retrospectively reviewed the results of OSR performed in 47 patients (male, 92%; mean age, 59.9+/-9.3 years [range, 44-79]) with chronic JRAO during the past 21 years. In order to reduce intraoperative renal ischemic time (RIT), we excised a portion of the occluded segment of the infrarenal aorta without proximal aortic clamping. We then performed suprarenal aortic clamping with both renal arteries clamped, removed the proximal aortic thrombus cap, confirmed both renal artery orifices, and moved the suprarenal aortic clamp to the infrarenal aorta to allow renal perfusion and standard aortoiliac reconstruction. We investigated early (<30 days) postoperative surgical morbidity (particularly renal function), operative mortality, and longterm patient survival. We conducted risk factor analysis for postoperative renal insufficiency. RESULTS: The mean intraoperative RIT was 10.7+/-5.5 minutes (range, 3-25), including 6 patients who underwent concomitant pararenal aortic thromboendarterectomy. Postoperatively, five (11%) patients had transient renal insufficiency, one had pneumonia, and one patient had an acute myocardial infarction. However, there was no operative mortality or newly developed dialysis-dependent renal failure. Postoperative follow up was available in 36 (77%) patients for a mean period of 6.3 years (range, 1 month-17 years). Kaplan Meier calculations of patient survival at 5 and 10 years after surgery were 91.2% and 83.6%, respectively. CONCLUSION: We have experienced short RIT, acceptable early postoperative results and long-term survival after OSR of chronic JRAO.
Aorta ; Constriction ; Endarterectomy ; Follow-Up Studies ; Humans ; Mortality ; Myocardial Infarction ; Perfusion ; Pneumonia ; Renal Artery ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Thrombosis

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Analysis of Intermediate Term Results of Short Vein Bypass Graft in the Patient with Critical Limb Ischemia.

Hyo Sin KIM ; Hong Joo SEO ; Jeong Hwan CHANG

Vascular Specialist International.2014;30(1):26-32.

PURPOSE: Since the introduction of short vein bypass (SVB), many have reported its feasibility when long vein bypass (LVB) cannot be performed due to limited vein conduit. However, the presence of inflow-vessel disease may affect graft patency and thus require endovascular treatment prior to surgery. Our study aims to analyze the results between SVB and LVB. MATERIALS AND METHODS: From 2009 to 2013, 27 bypass procedures were reviewed retrospectively. Outcomes such as patency rate, postoperative ankle brachial index (ABI) and limb salvage rate between SVB and LVB were compared. Wound healing time and primary patency rate were analyzed and the former was also analyzed according to the respective angiosome and revascularization type. RESULTS: There were 11 males and 16 females and the mean age was 66.6+/-12.3 years. Twenty four patients had TransAtlantic Inter-Society Consensus (TASC) D and 3 patients had TASC C lesions below knee. The 1-year cumulative patency rate between SVB and LVB were 63% and 66%, P=0.627. The limb salvage rate (100% vs. 73%; P=0.280) and postoperative ABI (0.592 vs. 0.508; P=0.620) were higher in the SVB group than in the LVB group, although the differences were not significant. There was no difference in wound healing time by angiosomal revascularization type. In situ vein graft showed higher patency rate than reversed greater saphenous vein (75% vs. 61%; P=0.00) CONCLUSION: The results of SVB were similar to those of LVB. SVB is feasible in the setting of limited conduit availability, in combination with endovascular treatment in the presence of proximal lesions.
Ankle Brachial Index ; Consensus ; Extremities* ; Female ; Humans ; Ischemia* ; Knee ; Limb Salvage ; Male ; Retrospective Studies ; Saphenous Vein ; Transplants* ; Veins* ; Wound Healing

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Experiences of Surgical Treatment for Juxtarenal Aortic Occlusion.

Hee Jae JUN

Vascular Specialist International.2014;30(1):19-25.

PURPOSE: To evaluate the outcomes of juxtarenal aortic occlusion (JRAO), a review of 15 patients who underwent aortic bypass replacement following aortorenal thrombectomy, especially focusing on the safety of suprarenal aortic clamping or transient aortic compression, was undertaken. MATERIALS AND METHODS: During the period of June 2001 to November 2012, 15 patients with JRAO (chronic 10, acute 5) were analyzed retrospectively. JRAO with combined stenosis of the renal artery was found in 2 patients, renal artery thrombus in 8 patients, and normal in 5 patients. RESULTS: All patients were males. Mean age was 61.7+/-11.2 years. There were 14 aortobifemoral bypass grafting and 1 aortobiiliac bypass grafting. Six Dacron and 9 PTFE artificial Y-grafts were implanted to the aorta with end-to-end anastomosis in the proximal aorta. Suprarenal aortic clamping was performed in 7 patients, supraceliac clamping in 2 patients, and transient aortic compression in 6 patients. There were 13 cases with aortic clamping time <10 minutes and 2 cases with >10 minutes. Thrombectomy of the aorta and renal artery was performed in 10 (66.7%) patients. There were no operative mortality cases. The perioperative morbidity rate was 26.7% (4/15). Preoperative renal function was impaired in four patients. The renal functions of these cases were recovered postoperatively. CONCLUSION: Aortic bypass replacement following aortorenal thrombectomy with suprarenal aortic clamping or transient aortic compression for JRAO is the optimal treatment. It is important to focus on short renal ischemic time during suprarenal aortic clamping for prevention of renal damage. It provides unmatched perioperative and long-term results.
Aorta ; Constriction ; Constriction, Pathologic ; Humans ; Male ; Mortality ; Polyethylene Terephthalates ; Polytetrafluoroethylene ; Renal Artery ; Retrospective Studies ; Thrombectomy ; Thrombosis ; Transplants

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Tracking the Fate of Muscle-derived Stem Cells: an Insight into the Distribution and Mode of Action.

Hyung Sub PARK ; Geum Hee CHOI ; Soli HAHN ; Young Sun YOO ; In Mok JUNG ; Taeseung LEE

Vascular Specialist International.2014;30(1):11-18.

PURPOSE: To examine the fate of muscle-derived stem cells (MDSC) after injection into different host conditions and provide an insight for their mechanism of action. MATERIALS AND METHODS: MDSCs differentiated in vitro towards the endothelial lineage and transfected with lentivirus tagged with green fluorescent protein (GFP) were injected into two animal models mimicking vascular diseases: hindlimb ischemia and carotid injury models. Injected cells were tracked at the site of injection and in remote organs by harvesting the respective tissues at different time intervals and performing immunofluorescent histological analyses. Stem cell survival was quantified at the site of injection for up to 4 weeks. RESULTS: MDSCs were successfully tagged with fluorescent material GFP and showed successful implantation into the respective injection sites. These cells showed a higher affinity to implant in blood vessel walls as shown by double fluorescent co-stain with CD31. Quantification of stem cell survival showed a time-dependent decrease from day 3 to 4 weeks (survival rate normalized against day 3 was 72.0% at 1 week, 26.8% at 2 weeks and 2.4% at 4 weeks). Stem cells were also fo und in distant organs, especially the kidneys and liver, which survived up to 4 weeks. CONCLUSION: MDSCs were successfully tracked in different vascular disease models, and their fate was assessed in terms of cell survival and distribution. Better understanding of the donor cell properties, including their interaction with the host conditions and their mechanism of action, are needed to enhance cell survival and achieve improved outcomes.
Adult Stem Cells ; Animals ; Blood Vessels ; Cell Survival ; Hindlimb ; Humans ; Ischemia ; Kidney ; Lentivirus ; Liver ; Models, Animal ; Stem Cell Niche ; Stem Cells* ; Tissue Donors ; Vascular Diseases

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Different Responses of Neointimal Cells to Imatinib Mesylate and Rapamycin Compared with Normal Vascular Smooth Muscle Cells.

Yang Jin PARK ; Sang Il MIN ; In Mok JUNG ; Taeseung LEE ; Jongwon HA ; Jung Kee CHUNG ; Sang Joon KIM ; Seung Kee MIN

Vascular Specialist International.2014;30(1):5-10.

PURPOSE: This study was designed to investigate whether vascular smooth muscle cells (VSMC) from the neointima showed any different response to antiproliferative agents, such as rapamycin or imatinib mesylate, compared to VSMCs from normal artery. MATERIALS AND METHODS: Intimal hyperplasia was made by carotid balloon in jury in male rats. Neointimal cells at 4 weeks after injury and normal VSMCs were extracted by enzymatic isolation method and cultured. Cell viability and proliferation were tested in VSMCs from injured left carotid artery and uninjured right carotid artery. Tests were repeated with rapamycin, imatinib mesylate or both in various concentrations. RESULTS: Rapamycin decreased cell viability only at a high concentration of 10(-5) M in uninjured VSMCs. Combined drugs decreased cell viability at a lower concentration of 10(-7) M in uninjured VSMCs, and at a higher concentration of 10(-5) M in neointimal cells. Overall, rapamycin showed cytocidal effects at a high concentration of 10(-5) M, whereas imatinib did not. Cell proliferation of neointima was significantly decreased along with the drug concentration. Cell proliferation of uninjured VSMCs was significantly decreased at higher drug concentrations. Combined drug therapy showed synergistic effects. Overall, neointimal cells are more susceptible to the antiproliferative effects of the drugs. CONCLUSION: Neointimal cells from the injured carotid artery are more susceptible to the antiproliferative effect of imatinib and rapamycin. Both drugs can be a used for the prevention of intimal hyperplasia, which could be investigated through further in vivo studies.
Animals ; Arteries ; Carotid Arteries ; Carotid Artery Injuries ; Cell Proliferation ; Cell Survival ; Drug Therapy ; Humans ; Hyperplasia ; Male ; Mesylates* ; Muscle, Smooth, Vascular* ; Neointima ; Rats ; Sirolimus* ; Imatinib Mesylate

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Ruptured Abdominal Aortic Aneurysm with Antecedent Endovascular Repair of Abdominal Aortic Aneurysm.

Jae S CHO

Vascular Specialist International.2014;30(1):1-4.

Late aortic rupture following successful endovascular repair of abdominal aortic aneurysm still does occur. It represents the ultimate failure of endovascular aortic repair of abdominal aortic aneurysm (EVAR) and subjects patients to equivalent risk of death as de novo rupture. Unfortunately, it is difficult to identify patients at risk for post-EVAR rupture as many present with aortic rupture in the absence of any endograft-related complications. Continued surveillance and timely intervention are of paramount importance to assure rupture-free survival, the ultimate goal of any aneurysm treatment modality. The vascular surgeon needs to be prepared to provide the optimal therapy, whether open or endovascular, for this challenging cohort of patients.
Aneurysm ; Aortic Aneurysm, Abdominal* ; Aortic Rupture ; Blood Vessel Prosthesis Implantation ; Cohort Studies ; Humans ; Rupture

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Chronic Cerebrospinal Venous Insufficiency.

Alessandro RASMAN

Vascular Specialist International.2015;31(3):106-107. doi:10.5758/vsi.2015.31.3.106

No abstract available.
Venous Insufficiency*

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Popliteal-to-Dorsalis Pedis In-Situ Small Saphenous Vein Bypass under Planning with Mapping Using Computed Tomography Volume Rendering Technique.

Seung Jae BYUN

Vascular Specialist International.2015;31(3):102-105. doi:10.5758/vsi.2015.31.3.102

The small saphenous vein (SSV) is an important graft in limb salvage surgery. It is frequently translocated for bypass surgery. Sometimes, the use of the SSV as an in-situ graft for posterior tibial artery or peroneal artery reconstruction offers the advantages of reduced vein graft injury and improved patency. Recently, saphenous vein mapping through computed tomography (CT) volume rendering technique offers a great quality view to the surgeon. We experienced a patient in whom a CT image with volume rendering technique revealed an aberrant SSV connected with the great saphenous vein at the medial malleolus level. This case indicates that an aberrant SSV may be successfully used as an in-situ conduit for bypass to the dorsalis pedis artery. Here, we present the case of a popliteal-to-dorsalis pedis in-situ vein bypass using a LeMaitre valvulotome (LeMaitre Vascular Inc., USA) under mapping of the aberrant SSV by CT volume rendering technique.
Arteries ; Humans ; Limb Salvage ; Saphenous Vein* ; Tibial Arteries ; Transplants ; Veins

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Anatomical Popliteal Artery Entrapment Syndrome Caused by an Aberrant Plantaris Muscle.

Yong Jae KWON ; Tae Won KWON ; Eun Hae UM ; Sung SHIN ; Yong Pil CHO ; Jong Min KIM ; Sang Hoon LEE ; Seung Joon HWANG

Vascular Specialist International.2015;31(3):95-101. doi:10.5758/vsi.2015.31.3.95

PURPOSE: We report on cases of anatomical popliteal artery entrapment syndrome (PAES) caused by an aberrant plantaris muscle and highlight the involvement of this muscle in PAES. MATERIALS AND METHODS: Seven symptomatic PAES legs in six patients treated at The Division of Vascular Surgery, Asan Medical Center, Seoul, Korea, between 1995 and 2011 were included in this study. We retrospectively analyzed patient records, magnetic resonance imaging (MRI) and/or computed tomography (CT) scans of the knee joint, Doppler pressure studies, CT angiographies, and conventional femoral arteriographies. RESULTS: Five males and one female patient with a median age of 32 (18-53) years old were enrolled in the study. All patients complained of intermittent claudication of the affected leg. All aberrant plantaris muscles were higher and more medially located than normal plantaris muscles, causing occlusion of the popliteal artery upon forced plantar flexion of the ankle. For arterial lesions, five occlusions of the popliteal artery and two patent popliteal arteries with positive provocation were noted. As for treatment, myotomy of the aberrant plantaris muscle was done for two non-occlusive PAES legs. For occlusive PAES legs, one thrombectomy, one saphenous vein graft interposition of the popliteal artery followed by myotomy, and two below-knee femoro-popliteal bypasses were performed. The median follow-up period was 88 (7-148) months. CONCLUSION: An aberrant plantaris muscle can cause anatomical PAES. Classification or diagnosis of PAES should be based on axial studies using CT scans or MRI using various reconstruction methods. Treatment, including myotomy of the plantaris muscle, should be individualized.
Angiography ; Ankle ; Chungcheongnam-do ; Classification ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Intermittent Claudication ; Knee Joint ; Korea ; Leg ; Magnetic Resonance Imaging ; Male ; Muscle, Skeletal* ; Muscles ; Popliteal Artery* ; Retrospective Studies ; Saphenous Vein ; Seoul ; Thrombectomy ; Tomography, X-Ray Computed ; Transplants

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