Purpose: Gastric cancer (GC) is among the most prevalent and fatal cancers worldwide.National cancer screening programs in countries with high incidences of this disease provide medical aid beneficiaries with free-of-charge screening involving upper endoscopy to detect early-stage GC. However, the coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions to routine healthcare access. Thus, this study aimed to assess the impact of COVID-19 on the diagnosis, overall incidence, and stage distribution of GC. Materials and Methods: We identified patients in our hospital cancer registry who were diagnosed with GC between January 2018 and December 2021 and compared the cancer stage at diagnosis before and during the COVID-19 pandemic. Subgroup analyses were conducted according to age and sex. The years 2018 and 2019 were defined as the “before COVID” period, and the years 2020 and 2021 as the “during COVID” period. Results: Overall, 10,875 patients were evaluated; 6,535 and 4,340 patients were diagnosed before and during the COVID-19 period, respectively. The number of diagnoses was lower during the COVID-19 pandemic (189 patients/month vs. 264 patients/month) than before it.Notably, the proportion of patients with stages 3 or 4 GC in 2021 was higher among men and patients aged ≥40 years. Conclusions During the COVID-19 pandemic, the overall number of GC diagnoses decreased significantly in a single institute. Moreover, GCs were in more advanced stages at the time of diagnosis. Further studies are required to elucidate the relationship between the COVID-19 pandemic and the delay in the detection of GC worldwide.

PURPOSE: We aimed to compare clinical outcomes after carotid endarterectomy (CEA) between Korean patients with and without severe contralateral extracranial carotid stenosis or occlusion (SCSO). METHODS: Between January 2004 and December 2014, a total of 661 patients who underwent 731 CEAs were stratified by SCSO (non-SCSO and SCSO groups) and analyzed retrospectively. The study outcomes included the occurrence of major adverse cardiovascular events (MACE), defined as stroke or myocardial infarction, and all-cause mortality during the perioperative period and within 4 years after CEA. RESULTS: There were no significant differences in the incidence of MACE or any individual MACE manifestations between the 2 groups during the perioperative period or within 4 years after CEA. On multivariate analysis to identify clinical variables associated with long-term study outcomes, older age (hazard ratios [HRs], 1.06; 95% confidence intervals [CIs], 1.03–1.09; P < 0.001) and diabetes mellitus (HR, 1.71; 95% CI, 1.14–2.57; P = 0.010) were significantly associated with an increased risk of MACE occurrence, while preexisting SCSO was not associated with long-term incidence of MACE and individual MACE components. Kaplan-Meier survival analysis showed similar MACE-free (P = 0.509), overall (P = 0.642), and stroke-free (P = 0.650) survival rates in the 2 groups. CONCLUSION: There were no significant differences in MACE incidence after CEA between the non-SCSO and SCSO groups, and preexisting SCSO was not associated with an increased risk of perioperative or long-term MACE occurrence.
Carotid Stenosis ; Diabetes Mellitus ; Endarterectomy, Carotid ; Humans ; Incidence ; Mortality ; Multivariate Analysis ; Myocardial Infarction ; Perioperative Period ; Retrospective Studies ; Stroke ; Survival Rate

PURPOSE: The aim of this study was to determine the possible predictors of primary arteriovenous fistula (AVF) failure and examine the impact of a preoperative evaluation on AVF outcomes. METHODS: A total of 539 patients who underwent assessment for a suitable site for AVF creation by physical examination alone or additional duplex ultrasound were included in this study. Demographics, patient characteristics, and AVF outcomes were analyzed retrospectively. RESULTS: AVF creation was proposed in 469 patients (87.0%) according to physical examination alone (351 patients) or additional duplex ultrasound (118 patients); a prosthetic arteriovenous graft was initially placed in the remaining 70 patients (13.0%). Although the primary failure rate was significantly higher in patients assessed by duplex ultrasound (P = 0.001), ultrasound information changed the clinical plan, increasing AVF use for dialysis, in 92 of the 188 patients (48.9%) with an insufficient physical examination. Female sex and diabetes mellitus were risk factors significantly associated with primary AVF failure. Because of different inclusion criteria and a lack of adjustment for baseline differences, Kaplan-Meier survival analysis showed better AVF outcomes in patients assessed by physical examination alone; an insufficient physical examination was the only risk factor significantly associated with AVF outcomes. CONCLUSION: Routine use of duplex ultrasound is not necessary in chronic kidney disease patients with a satisfactory physical examination. Given that female gender and diabetes mellitus are significantly associated with primary AVF failure, duplex ultrasound could be of particular benefit in these subtypes of patients without a sufficient physical examination.
Arteriovenous Fistula* ; Demography ; Diabetes Mellitus ; Dialysis ; Female ; Humans ; Kidney Failure, Chronic ; Physical Examination ; Renal Dialysis ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors ; Transplants ; Treatment Outcome ; Ultrasonography

This single center cohort study aimed to test the hypothesis that use of a cryopreserved arterial allograft could avoid the maturation or healing process of a new vascular access and to evaluate the patency of this technique compared with that of vascular access using a prosthetic graft. Between April 2012 and March 2013, 20 patients underwent an upper arm vascular access using a cryopreserved arterial allograft for failed or failing vascular accesses and 53 using a prosthetic graft were included in this study. The mean duration of catheter dependence, calculated as the time interval from upper arm access placement to removal of the tunneled central catheter after successful cannulation of the access, was significantly longer for accesses using a prosthetic graft than a cryopreserved arterial allograft (34.4 ± 11.39 days vs. 4.9 ± 8.5 days, P < 0.001). In the allograft group, use of vascular access started within 7 days in 16 patients (80%), as soon as from the day of surgery in 10 patients. Primary (unassisted; P = 0.314) and cumulative (assisted; P = 0.673) access survivals were similar in the two groups. There were no postoperative complications related to the use of a cryopreserved iliac arterial allograft except for one patient who experienced wound hematoma. In conclusion, upper arm vascular access using a cryopreserved arterial allograft may permit immediate hemodialysis without the maturation or healing process, resulting in access survival comparable to that of an access using a prosthetic graft.
Adult ; Arteries/*transplantation ; Blood Vessel Prosthesis ; Cohort Studies ; *Cryopreservation ; Female ; Hematoma/diagnosis ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Renal Dialysis ; Transplantation, Homologous ; Vascular Access Devices ; Veins/pathology

This single center cohort study aimed to test the hypothesis that use of a cryopreserved arterial allograft could avoid the maturation or healing process of a new vascular access and to evaluate the patency of this technique compared with that of vascular access using a prosthetic graft. Between April 2012 and March 2013, 20 patients underwent an upper arm vascular access using a cryopreserved arterial allograft for failed or failing vascular accesses and 53 using a prosthetic graft were included in this study. The mean duration of catheter dependence, calculated as the time interval from upper arm access placement to removal of the tunneled central catheter after successful cannulation of the access, was significantly longer for accesses using a prosthetic graft than a cryopreserved arterial allograft (34.4 ± 11.39 days vs. 4.9 ± 8.5 days, P < 0.001). In the allograft group, use of vascular access started within 7 days in 16 patients (80%), as soon as from the day of surgery in 10 patients. Primary (unassisted; P = 0.314) and cumulative (assisted; P = 0.673) access survivals were similar in the two groups. There were no postoperative complications related to the use of a cryopreserved iliac arterial allograft except for one patient who experienced wound hematoma. In conclusion, upper arm vascular access using a cryopreserved arterial allograft may permit immediate hemodialysis without the maturation or healing process, resulting in access survival comparable to that of an access using a prosthetic graft.
Adult ; Arteries/*transplantation ; Blood Vessel Prosthesis ; Cohort Studies ; *Cryopreservation ; Female ; Hematoma/diagnosis ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Renal Dialysis ; Transplantation, Homologous ; Vascular Access Devices ; Veins/pathology

PURPOSE: This retrospective cohort study aimed to determine the clinical outcomes of staged bilateral carotid endarterectomy (CEA) for bilateral internal carotid artery (ICA) stenosis performed with a short interval between the primary and secondary CEA procedures. METHODS: In our institution, 574 consecutive patients underwent CEA between September 2007 and August 2014. Bilateral significant ICA stenosis was identified in 43 patients (7.5%) who underwent staged bilateral CEA within 30 days or less. Patients with unilateral CEA and staged bilateral CEA were compared in terms of CEA outcomes. The primary endpoint was the composite of any stroke, myocardial infarction, or death during the periprocedural period or ipsilateral stroke within 3 years after the CEA. RESULTS: Staged bilateral CEA was not associated with ipsilateral stroke (P = 0.178) during postoperative follow-up. The two groups did not differ in terms of estimated 3-year primary endpoint rates (2.8% vs. 4.7%, P = 0.456) or ipsilateral stroke-free (P = 0.225), any stroke-free (P = 0.326), or overall (P = 0.739) survival rates. CONCLUSION: Patients with bilateral significant ICA stenosis can undergo staged bilateral CEA within 30 days or less with outcomes that compare favorably with those of patients undergoing unilateral CEA.
Carotid Arteries* ; Carotid Artery, Internal ; Carotid Stenosis* ; Cohort Studies ; Constriction, Pathologic ; Endarterectomy, Carotid* ; Follow-Up Studies ; Humans ; Myocardial Infarction ; Retrospective Studies ; Stroke ; Survival Rate ; Treatment Outcome

Major peripheral arterial graft infection is a potentially devastating complication of vascular surgery, associated with significant mortality and high amputation rates. Autologous saphenous veins are considered optimal arterial conduits for lower extremity revascularization in infected fields, but they are often unavailable or unsuitable in these patients. This study describes two patients with major peripheral graft infection, but without available autologous veins, who underwent graft excision and cryopreserved cadaveric arterial allograft reconstruction. Although long-term graft durability is unclear because of gradual deterioration and degeneration, these findings suggest that cadaveric allografts may be good options for patients with major peripheral graft infection.
Allografts* ; Amputation ; Blood Vessel Prosthesis ; Cadaver* ; Humans ; Lower Extremity ; Mortality ; Saphenous Vein ; Tissue Preservation ; Transplants* ; Veins

Although the standard treatment of abdominal aortic aneurysm has shifted from open surgery to endovascular repair, open surgery has remained the standard of care for complex aneurysms involving the visceral arteries and in patients unsuitable for endovascular aneurysm repair. Postoperative renal insufficiency may occur after open surgical repair of suprarenal abdominal aortic aneurysm. Methods of minimizing renal ischemic injury include aortic cross-clamping and renal reconstruction techniques. This report describes the use of renal autotransplantation for renal reconstruction during open surgical repair of a suprarenal abdominal aortic aneurysm. This technique was successful, suggesting its feasibility for open suprarenal abdominal aortic aneurysm repair, minimizing renal ischemic injury and optimizing postoperative renal function.
Aneurysm ; Aorta ; Aortic Aneurysm, Abdominal* ; Arteries ; Autografts* ; Humans ; Kidney ; Renal Insufficiency ; Standard of Care ; Transplantation

Aortic complications of giant cell arteritis are a rare cause of abdominal aortic aneurysm. Here, we describe a case of a ruptured aortic aneurysm in a patient with giant call arteritis (GCA) who was preoperatively suspected of having an infectious aortic aneurysm. Intraoperative inspection revealed infectious granulation tissue on the anterior wall of the abdominal aorta. GCA was finally confirmed by pathological diagnosis. Our findings suggest that the surgical and postoperative treatment of nonatheromatous aortic aneurysm should be based on accurate diagnosis.
Aorta, Abdominal ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Aortic Rupture ; Aortitis ; Arteritis ; Diagnosis ; Giant Cell Arteritis* ; Giant Cells* ; Granulation Tissue ; Humans

PURPOSE: The present study aimed to evaluate the risk factors and the role of graft material in the development of an acute phase systemic inflammatory response, and the clinical outcome in patients who undergo endovascular aneurysm repair (EVAR) or open surgical repair (OSR) of an abdominal aortic aneurysm (AAA). METHODS: We retrospectively evaluated the risk factors and the role of graft material in an increased risk of developing systemic inflammatory response syndrome (SIRS), and the clinical outcome in patients who underwent EVAR or OSR of an AAA. RESULTS: A total of 308 consecutive patients who underwent AAA repair were included; 178 received EVAR and 130 received OSR. There was no significant difference in the incidence of SIRS between EVAR patients and OSR patients. Regardless of treatment modality, SIRS was observed more frequently in patients treated with woven polyester grafts. Postoperative hospitalization was significantly prolonged in patients that experienced SIRS. In multivariate analyses, the initial white blood cell count (P = 0.001) and the use of woven polyester grafts (P = 0.005) were significantly associated with an increased risk of developing SIRS in patients who underwent EVAR. By contrast, the use of woven polyester grafts was the only factor associated with an increased risk of developing SIRS in patients who underwent OSR, although this was not statistically significant (P = 0.052). CONCLUSION: The current study shows that the graft composition plays a primordial role in the development of SIRS, and it leads to prolonged hospitalization in both EVAR and OSR patients.
Aneurysm ; Aorta ; Aortic Aneurysm, Abdominal* ; Hospitalization ; Humans ; Incidence ; Leukocyte Count ; Multivariate Analysis ; Polyesters ; Retrospective Studies ; Risk Factors ; Systemic Inflammatory Response Syndrome ; Transplants*