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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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Spontaneous Iliac Vein Rupture.

Dae Hwan KIM ; Hyung Sub PARK ; Taeseung LEE

Vascular Specialist International.2015;31(2):62-65. doi:10.5758/vsi.2015.31.2.62

Spontaneous iliac vein rupture (SIVR) is a rare entity, which usually occurs without a precipitating factor, but can be a life-threatening emergency often requiring an emergency operation. This is a case report of SIVR in a 62-year-old female who presented to the emergency room with left leg swelling. Workup with contrast-enhanced computed tomography revealed a left leg deep vein thrombosis with May-Thurner syndrome and a hematoma in the pelvic cavity without definite evidence of arterial bleeding. She was managed conservatively without surgical intervention, and also underwent inferior vena cava filter insertion and subsequent anticoagulation therapy for pulmonary thromboembolism. This case shows that SIVR can be successfully managed with close monitoring and conservative management, and anticoagulation may be safely applied despite the patient presenting with venous bleeding.
Emergencies ; Emergency Service, Hospital ; Female ; Hematoma ; Hemoperitoneum ; Hemorrhage ; Humans ; Iliac Vein* ; Leg ; May-Thurner Syndrome ; Middle Aged ; Precipitating Factors ; Pulmonary Embolism ; Rupture* ; Rupture, Spontaneous ; Vena Cava Filters ; Venous Thrombosis

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Successful Endovascular Stent-Graft Repair for Complicated Type B Aortic Dissection Developed in a Patient with Polycystic Kidney Disease.

Chan Sung JUNG ; Byoung Won PARK ; Duk Won BANG ; Won Ho JANG ; Hyo Shik KIM ; Ji Hyun OH

Vascular Specialist International.2015;31(2):58-61. doi:10.5758/vsi.2015.31.2.58

Polycystic kidney disease (PCKD) is rarely associated with aortic dissection (AD), which is a life-threatening disease. Although endovascular stent-graft repair tends to show better outcomes than conventional therapies in complicated type B AD (TBAD), successful endovascular intervention of TBAD with malperfusion in a patient with PCKD has not been reported. This case shows a 37-year-old male who had sudden onset of sharply stabbing epigastric pain with severe hypertension, who was diagnosed with TBAD and PCKD by a computed tomography and initially underwent medical treatment. Four days after discharge, he was rehospitalized with left leg pain and paresthesia due to left lower leg malperfusion. Thoracic endovascular stent-graft repair covering the primary tear site of dissection was performed successfully, leading to a decrease in false lumen and improvement of symptoms. We report the case of complicated TBAD in a patient with PCKD treated with endovascular stent-graft repair.
Adult ; Aortic Diseases ; Endovascular Procedures ; Humans ; Hypertension ; Leg ; Male ; Paresthesia ; Polycystic Kidney Diseases*

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Open Surgical Repair of Abdominal Aortic Aneurysm Coexisting with Horseshoe Kidney.

Ahram HAN ; Suh Min KIM ; Chanjoong CHOI ; Sang Il MIN ; Jongwon HA ; Seung Kee MIN

Vascular Specialist International.2015;31(2):54-57. doi:10.5758/vsi.2015.31.2.54

Horseshoe kidney (HSK) is the most common congenital abnormality of the urologic system encountered during abdominal aortic aneurysm (AAA) surgery. Here, the authors report a case of AAA coexisting with HSK that was successfully treated by open surgery. Two accessory renal arteries of 2.5 mm and 3.1 mm were reimplanted. One of the implanted arteries later occluded and infarct of the isthmus developed, but there was no impairment of renal function. The authors discuss the complexity of the surgical treatment of AAA coexisting with HSK, and place focus on which accessory renal arteries should be reconstructed.
Aortic Aneurysm, Abdominal* ; Arteries ; Congenital Abnormalities ; Kidney* ; Renal Artery

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Long-Term Results of Catheter-Directed Thrombolysis Combined with Iliac Vein Stenting for Iliofemoral Deep Vein Thrombosis.

Chan PARK ; Byung Jun SO

Vascular Specialist International.2015;31(2):47-53. doi:10.5758/vsi.2015.31.2.47

PURPOSE: We were going to access the effect of catheter-directed thrombolytic therapy (CDT) on post-thrombotic syndrome (PTS) and the long term effects of iliac vein stenting in acute iliofemoral deep vein thrombosis (IFDVT). MATERIALS AND METHODS: Fifty-six limbs in fifty-one patients (46 unilateral, 5 bilateral) were included from November 2001 through December 2007. Patients were classified based on the method of treatment: with stent implantation (n=37) and without stent implantation (n=19). The Villalta scale was chosen to assess for severity of PTS. The validated outcome measures were compared between the treatment groups. Statistical analysis was estimated according to the Kaplan-Meier test and Pearson chi-square test. RESULTS: Mean age was 57+/-13 years (range, 27-76 years). Mean follow up duration was 56+/-12 months (range, 24-144 months). Overall 5-year primary patency rate was 66.1% (77.8% in the stenting group and 42.1% in the non-stenting group) and showed statistically significant difference between the two groups (P=0.02). The recurrence rate of deep vein thrombosis was 10/37 (27.1%) in the stenting group and 11/19 (57.9%) in the non-stenting group, respectively, which showed statistically significant difference between the two groups (P=0.024). Overall incidence of mild PTS was 8/30 (26.7%): 4/13 (30.8%) in the stenting group and 4/17 (23.5%) in the non-stenting group. None of the other factors showed statistically significant difference between the groups. CONCLUSION: Long term results of CDT in IFDVT were acceptable, and stent implantation to the iliac segment seems to have a good effect on the long term results. Therefore CDT with simultaneous stenting is recommended to improve long term results of IFDVT, if indicated.
Extremities ; Follow-Up Studies ; Humans ; Iliac Vein* ; Incidence ; Kaplan-Meier Estimate ; Outcome Assessment (Health Care) ; Recurrence ; Stents* ; Thrombolytic Therapy ; Venous Thrombosis*

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Surgical Treatment of Infected Aortoiliac Aneurysm.

Joong Kee YOUN ; Suh Min KIM ; Ahram HAN ; Chanjoong CHOI ; Sang Il MIN ; Jongwon HA ; Sang Joon KIM ; Seung Kee MIN

Vascular Specialist International.2015;31(2):41-46. doi:10.5758/vsi.2015.31.2.41

PURPOSE: Infected aneurysms of the abdominal aorta or iliac artery (IAAA) are rare but fatal and difficult to treat. The purpose of this study was to review the clinical presentations and outcomes of IAAA and to establish a treatment strategy for optimal treatment of IAAA. MATERIALS AND METHODS: Electronic medical records of 13 patients treated for IAAA at Seoul National University Hospital between March 2004 and December 2012 were retrospectively reviewed. RESULTS: Mean age was 64.2 (median 70, range 20-79) years. Aneurysms were located in the infrarenal aorta (n=7), iliac arteries (n=5), and suprarenal aorta (n=1). Seven patients underwent excision and in situ interposition graft, 3 underwent extra-anatomical bypass, and 1 underwent endovascular repair. One patient with endovascular repair in an outside hospital refused resection, and only debridement was done, which revealed tuberculosis infection. One staphylococcal infection was caused by iliac stenting. Mycobacterium was the most common pathogen, followed by Klebsiella, Salmonella, and Staphylococcus. There were 3 in-hospital mortalities and the causes were sepsis in 2 and aneurysm rupture in 1. The 3 extra-anatomic bypasses were all patent after 5-year follow-up. CONCLUSION: IAAA develops from various causes and various organisms. IAAA cases with gross pus were treated with extra-anatomic bypass, which was durable. In situ reconstruction is favorable for long term-safety and efficacy, but extensive debridement is essential.
Aneurysm* ; Aneurysm, Infected ; Aorta ; Aorta, Abdominal ; Debridement ; Electronic Health Records ; Endovascular Procedures ; Follow-Up Studies ; Hospital Mortality ; Humans ; Iliac Artery ; Klebsiella ; Mycobacterium ; Retrospective Studies ; Rupture ; Salmonella ; Seoul ; Sepsis ; Staphylococcal Infections ; Staphylococcus ; Stents ; Suppuration ; Transplants ; Tuberculosis

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Different Effects of Orbital Shear Stress on Vascular Endothelial Cells: Comparison with the Results of In Vivo Study with Rats.

Hyosoo KIM ; Keun Ho YANG ; Hyunjin CHO ; Geumhee GWAK ; Sun Cheol PARK ; Ji Il KIM ; Sang Seob YUN ; In Sung MOON

Vascular Specialist International.2015;31(2):33-40. doi:10.5758/vsi.2015.31.2.33

PURPOSE: An attempt was made to characterize the orbital shear stress by comparing the effects of orbital shear stress on vascular endothelial cells (ECs) with the results of animal experiments. MATERIALS AND METHODS: In the laboratory study, cultured ECs of well were distinguished by center and periphery then exposed to orbital shear stress using an orbital shaker. In the animal study, arteriovenous (AV) fistulas were made at the right femoral arteries of Sprague-Dawley rats to increase the effect of the laminar flow. The condition of the stenosis was given on the left femoral arteries. The protein expression of inducible nitric oxide synthase (iNOS) and Akt phosphorylation were observed and compared. RESULTS: Under orbital shear stress, ECs showed an increase in iNOS protein expression and phosphorylation of Akt but most of the protein expressions derived from the periphery. When compared to the animal study, the increased expression of iNOS protein and phosphorylation of Akt were observed in the sample of AV fistula conditions and the iNOS protein expression was decreased in the stenosis conditions. CONCLUSION: Orbital shear stress did not show the characteristics of a pure turbulent shear force. By comparing the observation with the morphological changes of vascular ECs and site-specific protein expression on the results of animal experiments, uniform directional lamina shear stress forces were expressed at the periphery.
Animal Experimentation ; Animals ; Constriction, Pathologic ; Endothelial Cells* ; Femoral Artery ; Fistula ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type II ; Orbit* ; Phosphorylation ; Rats* ; Rats, Sprague-Dawley

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Clinical Experience with a Hybrid Procedure Using the Adherent Clot Catheter for Salvage of Thrombosed Hemodialysis Access: A Comparison with the Standard Fogarty Balloon Catheter.

Yu Sung YANG ; Kyu Dam HAN ; Eun Hye CHOI ; Young Sam PARK ; Yeon Ho SEO ; Cheol Seung KIM

Vascular Specialist International.2015;31(1):25-31. doi:10.5758/vsi.2015.31.1.25

PURPOSE: This study aimed to compare the efficacy of two different catheters in hybrid surgery for salvage of thrombosed hemodialysis accesses. MATERIALS AND METHODS: The hybrid salvage procedure (surgical thrombectomy followed by endovascular angioplasty) of the thrombosed hemodialysis access, was performed using adherent clot (AC) catheter in 140 cases and Fogarty balloon catheter in 68 cases. Procedure-related outcomes such as the clot removal status, clinical success, complications, and primary patency rates were analyzed retrospectively. RESULTS: The proportion of cases with good clot removal scores in the AC catheter and Fogarty balloon catheter groups was 77.9% and 91.2%, respectively (P=0.018). Clinical success was achieved in 90.7% of the cases in the AC catheter group and in 98.5% of the cases in the balloon catheter group (P=0.035). The mean patency rates of the two groups were 50.7% and 63.2% at 3 months, 40.7% and 47.1% at 6 months, and 17.9% and 19.1% at 12 months. The complication rates (12.1% and 5.9%) and primary patency rates between the two catheters were not statistically different (P=0.328). On the analysis of the patency rate on access type of autologous (P=0.169) and prothetic graft (P=0.423), there was no significant difference between the two catheter groups. CONCLUSION: In terms of clot removal and clinical success, the AC catheter did not demonstrate better outcomes than the Fogarty balloon catheter. However, primary patency was not related to the type of catheter. Adherent clot catheter can be a useful alternative to Fogarty balloon catheter for thrombosed hemodialysis access.
Catheters* ; Renal Dialysis* ; Retrospective Studies ; Thrombectomy ; Thrombosis ; Transplants

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