• Journal of Chest Surgery
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• 제57권1호
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• pp.99-102
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• 2024

This article presents a straightforward hybrid arch technique for treating residual type B aortic dissecting aneurysms following type A repair (replacement of the ascending aorta) that employs a frozen elephant trunk (FET) straight vascular prosthesis. The debranch-first method involves only cutting and sewing the previous ascending graft, inserting the FET from zone 0, and debranching the arch vessels using a trifurcated graft. This technique is less invasive as it eliminates the need to manipulate the dissected distal arch aneurysm. We successfully applied this technique to 3 patients, with no instances of in-hospital death, stroke, or paraplegia. The debranch-first technique, combined with zone-0 FET insertion, simplifies the redo repair of residual type B aortic dissection.

• Journal of Korean Neurosurgical Society
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• 제30권1호
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• pp.33-40
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• 2001

Objective : Aneurysms of vertebral artery and its branches make up approximately 3% of all intracranial aneurysms. As the aneurysm have an intimate relationship with lower cranial nerves and medulla, surgical management of the aneurysms are one of the challenging neurosurgical problems. The authors analyzed the management outcomes for aneurysms arising from vertebral artery and its branches. Methods : At the authors' institution between May 1989 and Jan. 2000, 42 patients were treated with transcranial and endovascular surgery for aneurysms of vertebral artery and its branches. The medical records and neuroimaging studies of the patients were reviewed retrospectively. Results : Forty two patients were comprised of 28 female and 14 male patients aged from 26-80 year old(mean : 51.8). Of the 42 patients, 37 patients(88%) had subarachnoid hemorrhage. Of the 37 patients with subarachnoid hemorrahge, 35 patients(95%) were in good neurological status(Hunt Hess grade I-III), 2 patients(5%) in poor grade(H-H grade IV-V) before operation. Location of the aneurysm were 16 in vertebral artery, 12 in vertebro-PICA junction, and 14 in the peripheral PICA. Twenty nine patients were treated with transcranial surgery and 13 patients with endovascular surgery. The management outcome of the transcranial surgery was : Glasgow outcome scale(GOS) I and II ; 24, GOS III ; 2, GOS IV ; 1 and GOS V(death) ; 2. The causes of mortality related to transcranial surgery were rebleeding after failure in clipping in one and suspected brainstem infarct in one. Morbidity was attributed to vasospasm(3), lower CN palsy(7, including temporary dysfunction) and pseudomeningocele(1). The management outcome of the endovascular surgery was : Glasgow outcome scale(GOS) I-II ; 9, GOS III ; 1, GOS IV ; 1, and GOS V(death) ; 2. The causes of mortality related to endovascular surgery were sepsis from pneumonia(1) and vasospasm(1). There were one cerebellar infarct and one lateral medullary syndrome. Conclusion : Excellent and good surgical results can be expected in 80% of the patients with aneurysms of vertebral arery and its branches. The outcomes of endovascular surgery in treating vertebral artery aneurysm were satisfactory and endovascular surgery may offer a therapeutic alternative especially in vertebral dissecting aneurysm.

• Journal of Trauma and Injury
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• 제18권1호
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• pp.70-79
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• 2005

Background: Abdominal compartment syndrome has multiple etiologies that are not only related to trauma but also any problem condition in the absence of abdominal injury. To determine whether prevention of the abdominal compartment syndrome after celiotomy for trauma victims justifies the use of temporary abdominal coverage with monofilament knitted polypropylene mesh (Malex mesh) in severely injured patients. Method: Medical records at the Ajou University Medical Center were reviewed for a 32-month period from May 1st, 2002 to December 31st, 2004. Twenty-nine consecutive patients requiring celiotomy who were survived until at the end of celiotomy received temporary abdominal coverage and staged abdominal repairs with Malex mesh. One of them was dissecting aortic aneurysm patient and the others were all trauma victims. Malex mesh prosthesis coverage was used in cases of abdominal compartment syndrome due to excessive fascial tension, severe bowel edema and retroperitoneal hemorrhage or edema followed by staged abdominal repairs. Result: Eighteen of twenty-nine patients were survived. Demographic characteristics, injury severity number of abdominal-pelvic bone injuries, mortality rate, complications, number of operations for permanent closure, required time for permanent closure showed no difference between man and women or child and adult. Except one dissecting aortic aneurysm patient, trauma cases showed $3.24{\pm}0.98$ injury sites. All cases that received temporary abdominal coverage and staged abdominal repairs did not show abdominal compartment syndrome. $10.08{\pm}5.85$ days and $2.27{\pm}0.82$ times of operation required making permanent abdominal closure after temporary abdominal coverage followed by staged abdominal repairs. Most of surviving patients have shown antibiotic-resistant organism and fungus infection. Patients who received permanent closure recovered from infectious problem completely. Conclusion: The use of Malex mesh for temporary abdominal coverage in severely injured patients undergoing celiotomy was effective treatment method.

• Journal of Chest Surgery
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• 제43권6호
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• pp.729-733
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• 2010

스텐트 그라프트를 이용한 대동맥류에 대한 혈관내 치료는 급격히 발전하고 있다. 저자들은 대동맥궁 탈분지술 후 스텐트 그라프트를 설치한 hybrid TEVAR (thoracic endovascular aortic repair) 1예에 대해 보고하고자 한다. 환자는 2년 반 전 Type I 급성 대동맥 박리로 상행 대동맥 치환술을 시행하였다. 수술 후 박리 원위부의 동맥류성 변화가 점차 진행하여 이에 대한 치료로 먼저 상행 대동맥으로 부터 무명동맥과 좌경동맥으로 향하는 우회로를 만든 다음 전향적으로 대동맥궁 전체 및 근위부 하행 흉부 대동맥에 걸쳐 스텐트 그라프트를 설치하였다.

• Journal of Chest Surgery
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• 제28권3호
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• pp.332-334
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• 1995

Two hypertensive men with DeBakey type III dissection were admitted due to acute onset of leg ischemia.One patient had ischemia of both legs,The other patient had ischemia of the right leg.Angiograms showed occlusion of aortic bifurcation in one patient and occlusion of right common iliac artery and right renal artery in the other patient.The first patient who had ischemia of both legs was relieved by axillo-bifemoral bypass operation and the second patient with right leg ischemia by femoro-femoral bypass.The dissection of the aorta was successfully managed by conservative measures including hypotensive medication.The bypass grafts was functioning well one year later.The aortic dissection should not be overlooked as an etiology of acute onset of ischemia of the lower extremities.

• Journal of Chest Surgery
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• 제36권3호
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• pp.194-201
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• 2003

급성 대동맥 박리증에는 주요 장기의 관류 부전이 동반될 수 있으며 이는 사망의 중요한 원인이다. 관류 부전은 수술 전뿐 아니라 수술 중 및 수술 후에도 발생할 수 있고 침범하는 대동맥 분지의 위치에 따라 다양한 양상으로 나타난다. 이를 성공적으로 치료하기 위해서는 급성 대동맥 박리증 환자의 진료시 항상 관류 부전 합병 가능성을 염두에 두고 적절한 진단 및 치료 조치를 신속하게 진행하는 것이 가상 중요하다. 저자들은 급성 대동맥 박리증에 뇌, 하지, 신장 및 위장관 등 다양한 장기의 관류 부전이 합병한 환자 4명을 성공적으로 치험하였기에 보고한다.

• Journal of Chest Surgery
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• 제31권2호
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• pp.173-177
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• 1998

28세 여자환자가 임신중 발생한 급성 A 형 대동맥 박리증으로 응급제왕 절개술을 시행하여 아이를 분만하고 곧바로 응급 상행 및 전대동맥궁 치환술을 시행받아 별 문제없이 퇴원하였다가 수술후 1년 6개월 뒤에 만성 대동맥 박리증에 의한 하행 대동맥 및 복부 대동맥류가 재발하여 하행 대동맥으로부터 복부 대동맥을 거쳐 양쪽 총장골동맥까지 치환하는 수술을 시행하여 결국 대동맥 전장을 치환하여 이를 문헌 고찰과 함께 보고한다.

• Journal of Chest Surgery
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• 제31권2호
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• pp.178-181
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• 1998

급성 대동맥 해리 수술후 발생할 수 있는 합병증중 원위 대동맥류의 재발로 인한 인접 폐실질과 누공이 형성되는 것은 매우 드물어서 지금까지 소수의 증례만이 보고되고 있다. 대부분의 경우 조기 진단이 실패하여 사망한 후 부검에서 발견되며 간혹 수술장에서 발견되어 수술적 요법으로 치료되는 경우가 보고되고 있어 조기 진단과 즉각적인 수술이 이러한 합병증으로 인한 사망을 막는 유일한 길이다. 본원에서는 Debakey type I급성 대동맥 해리로 인해 상행 대동맥 대치술을 받은 뒤 5개월 후 원위대동맥과 인접 폐실질사이 누공이 발생한 환자를 조기 진단하여 수술적 치료를 함으로 좋은 결과를 얻었다.

• Journal of Chest Surgery
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• 제9권1호
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• pp.10-19
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• 1976

One hundred and seventy-four patients were treated in this Department since 1956. One hundred and fifteen patients of them were surgically treated. They were classified on the basis of the disease entity as follows; 48 case of thrombo-angiitis obliterance, 8 cases of Leriche syndrome, 12 cases of arterial embolism, 36 arterial aneurysm, 5 arterio-venous fistula, 15 arterial and venous injuries, 8 pulseless diseases, 2 coarctation of aortas, 15 varicose veins, 12 thrombophlebitis, 9 superior venacaval syndromes, 2 inferior vena caval obstructions and Raynaud's diseases. All the cases of the Burger's diseases were males, and half of them were in the fourth decades, 39 cases underwent undergone unilateral or bilateral sympathectomies. All the Leriche syndromes were males aged over fifty. Three cases out of six were suffering from diabetes mellitus. 2 cases underwent aorto-femoral bypass graft with Y-shaped dacrons. And two embolectomies were performed in 2 cases. Eight cases of arterial embolisms among 12 had mitral valvular diseases with auricular fibrillation The most common site of lodgement of emboli was femoral artery. Nine out of 14 underwent embolectomies with Fogarty catheters. There were 14 peripheral arterial aneurysms, 16 thoracic and/or abdominal aortic aneurysms, and 4 dissecting aneurysms. Most frequent cause of peripheral arterial aneurysms were external trauma. Thoracic and abdominal aortic aneurysms were non-traumatic. And four cases of the dissecting aneurysms had significant hypertension and aged over fifty. Among 5 cases of arteriovenous fistulas, 2 cases hand typical Branham's sign, and they were normalized after operation. Eight cases of pulseless disease were females and aged from three to twenty-five. Three out of them were treated surgically using dacron prosthetic grafts, but the results of the surgery were variable and not satisfactory. A case of coarctation of aorta was treated surgically with an excellent result. Fourteen out of 15 varicose veins underwent ligation of the saphenous vein system, exstirpation of the varicose veins, stripping or some combination of these methods. Two cases of superior vena caval syndromes were operated by bypass graft between the left innominate vein and the right auricle. Two cases of inferior vena caval obstructions were operated upon through right atrial route using extracorporial circulation. All the four cases of vena caval obstructions showed excellent results postoperatively. Two cases out of 12 thrombophlebitis underwent thrombectomies. One of two Raynaud's diseases was surgically treated with an excellent result.

• Journal of Chest Surgery
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• 제30권5호
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• pp.506-511
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• 1997

1980년 10월부터 1995년 5월까지 대동맥근 치환을 받은 53명의 환자를 대상으로 inclusion technique(IT)과 open technique(OT)의 수술성적을 비교하였다 대동맥근 치환술의 원인으로 W군에서는 대동맥륜확장을 동반할 상3n대동맥 동맥류가 20례, 대동맥박리가 8례, 그리고 인공판막심내막염이 1례였다. 07군에서는 대동맥륜 가성동맥류가 1례 있었다. 수술방법으로 Bentall등이 기술한 방 확장이 9례, 대동맥박리가 14례, 상행대동맥 법 또: 약가 변형된 방법을 사용하였다. 수술사망은 W군에서 패혈증과 심실부정 맥으로 각각 1례가 사망하 o3고 07구에서는 출혈로 1례가 사망하였다. 만기합병증은 W군에서 8례 발생하였으며 Of군에서 2례 발생하다. 마기사망은 W군에서 7례,07군에서 1례 발생하였다. 12개월 event free는 W군과 07군에서 각각 87% 와 85%, 24개월 생존률은 각각 87% 와 95%로 W군이 24개월생존률이 약간 높았으나 두 군 간에 통계학적 이 유의성은 없었다. nan으로 대동맥륜확장을 동반한 상행대동맥류나 대동맥박리에서 composite valve를 이용한 대동맥근 치 화술으 마조할 만한 단기 수술결과를 보여주었으나 inclusionfwrap technique과 ope technique간에 통계학적으로 의미있는 차이는 발견할 수 없었다. 그러나 시간이 지남에 따라 prothesis와 관련된 만기 합병증의 빈도가 증가하기 때문에 수술 후 추적관찰에 대한 노력이 장기생존에 중요할 것으로 생각된다.