• Journal of Trauma and Injury
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• v.27 no.4
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• pp.196-200
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• 2014

Budd-Chiari syndrome is an uncommon condition characterized by hepatic outflow obstruction. Direct suture of the injured Inferior vena cava in a patient with blunt hepatic trauma also may cause an equivalent condition. However, early diagnosis is possible with common symptoms and radiologic evaluation. Moreover, a transluminal approach with balloon angioplasty could prevent long-term complications of Budd-Chiari syndrome without repeated abdominal surgery.

• 대한핵의학회:학술대회논문집
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• 1999.05a
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• pp.205-208
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• 1999

Percutaneous Transluminal Coronary Angioplasty (PTCA) remains limited by restenosis that occurs in 30 to 50% of patients with coronary artery disease. During the last decade, numerous agents have been used to prevent restenosis. Despite positive results in animal models, no pharmacological therapy has been found to significantly decrease the risk of restenosis in humans. These discrepancies between animal models and clinical situation were probably related to an incomplete understanding of the mechanism of restenosis. Neointimal thickening occurs in response to experimental arterial injury with a balloon catheter. Neointimal formation involves different steps: smooth muscle cell activation, proliferation and migration, and the production of extracellular matrix. The factors that control neointimal hyperplasia include growth factors, humoral factors and mechanical factors. Arterial remodeling also plays a major role in the restenosis process. Studies performed in animal and human subjects have established the potentials for "constrictive remodeling" to reduce the post-angioplasty vessel area, thereby indirectly narrowing the vessel lumen and thus contributing to restenosis. The reduction of restenosis rate in patients with intracoronary stent implantation has been attributed to the preventive effect of stent itself for this negative remodeling. In addition to these mochanisms for restenosis, intraluminal or intra-plaque thrombus formation, reendothelialization and apoptosis theories have been introduced and confirmed at least in part.

• Archives of Plastic Surgery
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• v.37 no.2
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• pp.148-152
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• 2010

Purpose: In treating diabetic foot ulcers, satisfactory vascularity is an essential prerequisite. To improve vascularity, a bypass graft has long been carried out. Recently, however, percutaneous transluminal angioplasty (PTA) has also been tried since the PTA is less invasive than the bypass graft. However, publication demonstrating the improvement of vascularity after the PTA are lacking. Therefore, this study was designed to show usefulness of the PTA in treating vasculopathy of diabetic foot. Materials: and Methods This study included 30 feet of 24 ischemic diabetic foot patients. Inclusion criteria were diabetes (duration > 5 years) and a significant lower extremity ischemia, as determined by a transcutaneous oxygen pressure ($TcpO_2$) < 30 mmHg. The PTA was carried out in 61 arteries. PTA procedure was considered successful, when residual stenosis was less than 30%. The procedure was considered failed when residual stenosis was more than 50%. Residual stenosis between 30% and 50% was considered acceptable. For evaluation of PTA effect, foot $TcpO_2$ and infrared thermography were measured before and 7th day after PTA. Results: Immediately after PTA performed in 61 arteries, 58 and 3 arteries were evaluated as being successful and acceptable, respectively. Before PTA, average foot $TcpO_2$ was $12.6{\pm}8.8$ mmHg and its value was increased to $44.2{\pm}23.9$ on 7th day after PTA (p<0.01). Average skin temperature was $31.8{\pm}1.2^{\circ}C$ before PTA and it was increased to $33.5{\pm}1.1^{\circ}C$ on 7th day after PTA (p<0.01). Conclusion: PTA procedure increases tissue oxygenation of ischemic diabetic feet which do not have wound healing potential due to low tissue oxygenation, to the level of possible wound healing. In addition, PTA increases skin temperature of ischemic diabetic feet which can imply an improvement of peripheral circulation.

• Journal of the Korean Society of Radiology
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• v.85 no.4
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• pp.746-753
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• 2024

Purpose This study aims to evaluate the incidence and management of venous ruptures after percutaneous transluminal angioplasty (PTA) for dysfunctional arteriovenous (AV) access. Materials and Methods From January 1998 to December 2015, 13506 PTA, mechanical thrombectomy, and thrombolysis procedures were performed in 6732 patients. The venous rupture rate following PTA was obtained, and access circuit primary patency (ACPP) was compared according to the etiology (PTA, thrombotic occlusion, and treatment type) of the venous rupture present. Results Venous rupture developed in 604 of the 13506 procedures. Venous ruptures were more frequent in female, AV graft cases, and in cases accompanied by thrombosis. Balloon tamponade was performed in 604 rupture cases, and stents were deployed in 119 cases where contrast extravasation and flow stasis persisted. ACPP was significantly better in the non-ruptured AV access circuits than in the ruptured group. However, AV access type and thrombosis was not associated with primary patency. In ruptured cases, ACPP is 8.4 months for prolonged balloon tamponade and 11.2 months for bare-metal stent insertion, showing statistically significant difference. Conclusion Balloon tamponade and bare-metal stent placement are effective treatment for PTA-induced venous ruptures. In particular, stent placement showed a similar ACPP to that of non-ruptured AV access circuits.

• Journal of Chest Surgery
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• v.32 no.12
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• pp.1123-1126
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• 1999

Coronary artery bypass grafting (CABG) technique has been much developed but CABG under cardiopulmonary bypass has the unavoidable deficits such as generalized inflammatory reaction from cardiopulmonary bypass and myocardial ischemia from aortic-cross clamp. There has been remarkable advancement of CABG without cadiopulmonary bypass. We performed CABG successfully without cardiopulmonary bypass. We performed CABG successfully without cardiopulmonary bypass in two patients with multivessel coronary disease who were failed to intervene with percutaneous transluminal coronary angioplasty. We herein report the two cases.

• Journal of Yeungnam Medical Science
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• v.11 no.2
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• pp.230-239
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• 1994

In Order to evaluate determinants of successful percutaneous transluminal coronary angioplasty (PTCA), PTCA was performed for 172 coronary arterial lesions in 120 patients (89 male, 31 female) at Yeungnam university hospital from Sep. 1992 to Aug. 1993. The corinary artery luminal diameter at the site of the original stenosis was eveluated from end-diastolic frames of identical projections of the preangioplasty and immediate post angioplasty. The coronary luminal and balloon diameters were measured with using of computer measuring system. Overall success rate of 172 attempted lesions was 87.2%. Success rate of female patients was 93.5% and higher than those of male patients. According to the clinical diagnosis, success rate in stable angina was 93.7% and higher than those of post myocardial infarction angina, unstable angina and acute myocardial infarcrion. Success rate of American Heart Association type C lesion was 65.5% and lower those of type A (95.7%), type B (89.5%). There was signfifcantly difference in preangioplasty luminal stenosis, elastic recoil and length of lesion between successful PTCA group and failed PTCA group. Success rate of lesion location at a bend > $45^{\circ}$ and presence of intracoronary thrombus were lower than than those of other angiographic findings. In coclusion, primary angioplasty success was affected by specific angiographic factors. Stenosis severity, thrombus, lesion location at a bend > $45^{\circ}$, elastic recoil, and length of lesion were the principle of determinants of coronary angioplasty success rate.

• Journal of Chest Surgery
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• v.30 no.1
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• pp.34-39
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• 1997

Between May, 1994 and December, 1995, 122 adult cardiac surgical procedures requiring cardiopulmonary bypa s were performed at Kang Dong Sacred Heart Hospital, including 18 cases(14.8%) that were associated with preoperative(n:9), intraoperative(n=7), postoperative(n:2) use of an IABP (intra-aortic balloon pump). The reasons for IABP were low cardiac output and PTCA(percutaneous transluminal coronary angioplasty) failure in preoperative period, CPB(cardiopulmonary bypass) weaning difficulty in intraoperative period, and intractable arrhythmia in postoperative period. The mean age of the IABP patients was 61.8 $\pm$ 6.9 years(range, 39 to 75years). The overall hospital mortalities in patients with preoperative and intraoperative IABP insertion were 3 and 42.9% respectively. Two patients with postoperative IABP insertion are alive. The rate of IABP weaning is 66.7% for preoperative group, 85.7% for intraoperative group and 100% for postoperative group . In conclusion, if there were no irreversible myocardial damages, IABP could be used safely and emergently at any perioperative period for hemo ynamic stability, CPB weaning, and to overcome low cardiac output syndrome.

• Journal of Preventive Medicine and Public Health
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• v.34 no.1
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• pp.9-20
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• 2001

Objectives : To explore the relationship between Percutaneous Transluminal Coronary Angioplasty(PTCA) volume and the associated immediate outcome. Methods : A total of 1,379 PTCAs were peformed in 25 hospitals in Korea between October 8 and December 31 in 1997. Data from 1,317 PTCAs (95.5%) were collected through medical record abstraction. Inter-observer reliability of the data was examined using the Kappa statistic on a subsample of 110 PTCA procedures from five hospitals. Intra-observer reliability of the data was also examined. PTCA success and immediate adverse outcomes were selected as the outcome variables. A successful PTCA was defined as a case that shows less than 50% diameter stenosis and more than 20% reduction of diameter stenosis. Immediate adverse outcomes included deaths during the same hospitalization, emergency coronary artery bypass graft (CABG) within 24 hours after PTCA, and acute myocardial infarction within 24 hours after PTCA. The numbers of PTCAs performed in 1997 per hospital were used as the volume variables. Results : Without adjusting for patient risk factors that may affect outcomes, procedures at high volume hospitals ($\geq200$ cases per year) had a greater success rate (P=0.001) than low volume hospitals. There was a marginally significant difference (P=0.070) in major adverse outcome rates between high and low volume hospitals. After adjusting for risk factors, there were significant differences in procedural failure and major adverse outcome rates between high and low volume hospitals. Conclusions : After adjusting for patient clinical risk factors, the hospital volume of PTCA was associated with immediate outcomes. It is recommended that a PTCA volume per year be established in order to improve the immediate outcome of this procedure in Korea.

• Journal of Chest Surgery
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• v.29 no.8
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• pp.861-866
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• 1996

Surgical angioplasty of isolated stenosis of the left main coronary artery(LMCA) restores a more physiologic flow to the myocardium, allows percutdneous transluminal coronary angioplasty (PTCA) of distal coronary stenoses at a later stage, and is a less time consuming and convenient procedure than the conventional coronary artery bypass grafting(CABG) . Between Jul. 1994 and Dec. 1995, 7 surgical angioplasty had been performed. LMCA stenoses involved ostium in 2 patients, middle third in 3, and dis- tal third in 2. In 2 patients, the origin of left anterior descending coronary artery was involved in conjunction with LMCA. T e additional coronary artery stenoses were found in 2 cases. One patient was emergently operated after coronary angiography following his cardiac arrest. LMCA was approached anteriorly in all patients. The pulmonary artery was transected in 3 patients for a better exposure. The onlay patch consisted or autologous or bovine pericardium. There was no postoperative myocardial infarction or mortality. Left ventricular functions were well preserved in all patients. Postoperative coronary angiography revealed widely patent LMCA in 5 cases, and mild narrowing of distal anastomotic sites in 2 cases. Provided that well defined indications are followed correctly, surgical angioplasty can be a safe alternative to conventional CABG.

• Journal of Chest Surgery
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• v.40 no.3 s.272
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• pp.209-214
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• 2007

Background: Failed percutaneous transluminal coronary angioplasty (PTCA) is occasionally required for emergency coronary artery bypass grafting (CABG). The aim of this study was to assess the outcome of patients receiving emergency CABG after failed PTCA. Material and Method: Between May 1988 and May 2005, 5712 patients underwent PTCA, where 84 (1.4%) failed. 27 patients underwent emergency CABG after failed PTCA. The mean age was $63.7{\pm}8.9\;(46{\sim}80)$ years, with 14 male patients (51.9%). Result: All patients underwent emergent surgical revascularization within 6 hours. 22 patients underwent conventional CABG and 5 underwent off-pump CABG. The causes of PTCA failure were coronary obstruction due to new thrombi formation during the procedure (n=4), coronary dissection (n=17), coronary artery rupture (n=3) and 3 due to other causes. The rate of in-hospital operative mortality after emergent operation was 18.5% (5/27). A univariate analysis revealed that patients who died more often had left anterior descending artery disease, a preprocedural shock status, postoperative use of multiple isotropics and postoperative use of intra-aortic balloon pump. The mean follow up duration was $53.6{\pm}63.4$ months. Conclusion: Although PTCA is known to be life saving, there is still a high risk for morbidity and mortality following emergency CABG after failed PTCA, despite the advancement in PTCA techniques. This result will help identify and more effectively treat patients selected for PTCA when emergency CABG is required.