• Journal of Chest Surgery
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• 제26권11호
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• pp.881-885
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• 1993

In the last few years there has been a resurgenceof interest in in-situ saphenous vein arterial bypass for lower extremity revascularization because of improved patency rates. we performed 1 in situ bypass oreration using the intraluminal valve-disruption tecnique. A 65-year-old female who had ztherosclerotic obstruction in the superficial and popliteal arteries underwent in situ saphenous vein arterial bypass. After harvesting of saphenous vein, we used LeMaitre retrograde valvulotome for valve-disruption technique. Completion of the arterrigraphy was performed to evaluate bothh the anastomoses. The two side brances were all ligated. In situ saphenous vein arterial bypass has become the procedure of choice for distal reconstruction in severely ischemic lower extremities because of improved long-term patency compared with reversed-saphenous vein bypass procedure.

• Journal of Chest Surgery
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• 제28권7호
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• pp.678-683
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• 1995

Arterial bypass for the chronic ischemia of the lower extremities underlying atherosclerotic obliterans has been performed with a number of alternative conduits from 1941 by Kunlin. It is indicated for the limb salvage of patients with threatened limb loss despite of several controversies in surgical treatment of atherosclerotic obliterans. From March 1991 to January 1995, 26 arterial bypasses were performed in 23 patients with the chronic ischemia of the lower extremities in our hospital. Their mean follow up period is 18.9 months ranging from 4 months to 44 months. Mean age is 60.9 years ranging 47 years to 76 years and the most prevalent incidence is the 6th decade. 21 patients are male and 2 patients are female. 19 of 23 patients are smokers. Clinical classifications by Fontaine are class II[21.7% , class III[34.8% and class IV[43.5% .Diabetes mellitus[47.8% , hypertension[43.5% , hyperlipid-emia[26% , tuberculosis[21.7% , cerebrovascular accident[13.0% and cardiac diseases[8.7% are associated. Aorto-single femoral bypass in 4 cases, aorto-bifemoral bypass in 5 cases, aortofemoral & femoropopliteal bypass in 2 cases, femoropopliteal bypass in 10 cases, popliteotibial bypass in 3 cases, femoropedal bypass[composite graft bypass in 2 cases were surgically approached. There are complicated early thrombosis in 4 cases those are required immediately reoperation, wound infection in 3 cases, hematoma in 3 cases, and so on. Postoperative complication rate is 53.8%.Postoperative patency rates are 84.6% at 6 months, 75.0% at 1 year, 70.0% at 2 years and 66.7% at 3 years. We usually used 6 mm & 8 mm graft for bypass, and the rate of thrombosis formation is 28.6%[2/7 in 6 mm graft and 12.5%[2/16 in 8 mm separately. In according to the graft materials, the rate of thrombosis formation is higher in the group using artificial graft than in that using autologous saphenous vein[16.6% vs 12.5% . Limb salvage rate is 76.9%. Postoperative mortality rate is zero %.

• Journal of Chest Surgery
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• 제17권4호
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• pp.691-697
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• 1984

After the real birth of vascular surgery occurred with the introduction of the first practical arterial prosthesis about 50 years ago, a variety of potential vascular graft had been tested and rejected. Polytetrafluoroethylene [Teflon, PTFE] was first used as a vascular prosthesis in 1957. Thereafter this pros-thesis was first used clinically in 1972 and has subsequently been widely applied as a small and medium sized vessel replacement because it is easy to use and readily available. There are numerous reports of good results about Polytetrafluoroethylene graft. We experienced the three cases of arterial bypass graft using polytetrafluoroethylene vascular pros-thesis. First, 21 years old female patient had suffered from Takayasus disease which affected the left subclavian artery and right subclavian-left axillary extra anatomical bypass graft as done. Second, 64 years old male patient had suffered from Leriche syndrome for 12 years and the left axillofemoral and femorofemoral extra anatomical bypass graft was done. Third, 34 years old male patient had suffered from recurrent Buergers disease which affected the left popliteal artery and the isolated popliteal artery segment bypass graft was done. Relatively satisfactory result was obtained in early post-operative period in all three cases.

• Journal of Chest Surgery
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• 제20권1호
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• pp.187-190
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• 1987

The Saphenous vein is still the graft of choice for bypass of small calibered peripheral arteries, and many recent studies revealed that the "In Situ" technique had higher rate of long term patency than the conventional "reversed" one. A 71-year-old male who had atherosclerotic obstruction in the superficial femoral and popliteal trifurcation underwent In Situ saphenous vein arterial bypass. The saphenous vein is exposed by a long medial skin incision over the course of the vein. All branches of vein are ligated. A olive-tipped metal needle is introduced into the vein from above and everts the valves. The patient has been followed for 2 months after operation. The graft remained pulsatile and the gangrenous areas on the toe proceeded to heal. We think In situ vein bypass offers an excellent and safe method of revascularization of the arterial occlusion below the knee although it is technically demanding and the time consuming. time consuming.

• Journal of Chest Surgery
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• 제22권4호
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• pp.661-666
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• 1989

Congenital coronary arterial fistulae are the most prevalent hemodynamically significant congenital coronary artery malformations. Definition of congenital coronary arterial fistula is a direct communication between a coronary artery and the lumen of one of the four cardiac chambers or coronary sinus or SVC, pulmonary artery or pulmonary vein close to the heart. It is often associated with additional congenital or acquired heart disease. A 49 year old male patient was admitted with the chief complaints of anginal pain and exertional dyspnea for 9 months. He was diagnosed as the right coronary arterial fistula combined with right coronary arteriosclerotic stenosis and old inferior myocardial infarction by cardiac evaluation. The right coronary arterial fistula was communicated between the just distal portion of acute marginal branch and coronary sinus. The operative procedure was as followings; after suture ligation of fistula opening in the coronary sinus under beating heart, coronary arterial bypass grafting with saphenous vein was performed at the just proximal portion of the posterior descending branch under cardiopulmonary bypass. The postoperative course was uneventful and he was discharged without anginal pain at the 8th postoperative day.

• Journal of Chest Surgery
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• 제36권5호
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• pp.367-370
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• 2003

양측 하지의 냉감과 우측 족지의 피부변색을 주소로 내원한 62세 남자환자가 혈관조영상 우측 외장골동맥과 좌측 총장골동맥의 폐쇄소견을 보였다. 환자는 전반적인 전신상태가 좋지 않아 확장성 해부학적외 동맥재건슬을 시행하였다. 우측 쇄골하동맥에서 우측 슬와동맥까지는 8 mm PTFE와 6 mm PTFE를 이용하여 문합하였다. 우측 서혜부의 8 mm PTFE와 좌측 총대퇴동맥을 골반 위에 다른 8 mm PTFE를 거치하여 교차문합하였다. 이후 환자는 별다른 합병증 없이 퇴원하여 현재 외래 추적 중으로 우측 하지의 족지에 피부변색은 없어져 완전히 정상화되었으며 통증 또한 사라졌다. 쇄골하동맥-슬개동맥-교차-대퇴동맥-PTFE-우회술이라는 확장성 해부외 동맥 재건술을 치험하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제25권12호
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• pp.1399-1403
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• 1992

The evaluation of the effectivess of ongoing cardiopulmonary resucitation efforts is dependent on the commonly used methods, such as the presence of femoral or carotid artery pulsations, arterial blood gas determinations, peripheral arterial pressure and intracardiac pressure monitoring. But recent studies suggest that end-tidal carbon dioxide tension serves as a non-invasive measurement of pulmonary blood flow and therefore cardiac output under constant ventilation. A prospective clinical study was done to determine whether end-tidal carbon dioxide monitoring in open heart surgery under cardiopulmonary bypass could be used as a prognostic indicator of bypass weaning. We monitored end-tidal PCO2 values continuously during cardiopulmonary bypass in 30 patients. "Ohmeda 5210 CO-2 monitor" under infrared absorption method were incorperated into the ventilator circuit by means of a side point adaptor between endotracheal tube and ventilator tubing. 18 patients[Group I ] were res-ucitated from partial bypass followed by aorta cross clamp off and 12 patients[Group II ] from aorta cross clamp off followed by partial bypass. But there was no difference between two groups[p>0.05]. The value of end-tidal carbon dioxide tension during ventricular fibrillation or nearly arrest state was 6.6$\pm$2.9 mmHg, and at the time of spontaneous beating was 19.3$\pm$5.6 mmHg[Mean$\pm$Standard deviation], In conclusion end-tidal carbon dioxide tension monitoring provides clinically useful, continous, noninvasive and supplementary prognostic indicator during cardiopulmonary bypass weaning procedures.rocedures.

• Journal of Chest Surgery
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• 제22권6호
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• pp.1092-1100
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• 1989

Since May 1987 to April 1989, fifteen patients have been subjected to coronary artery bypass graft [CABG] including coronary thromboendarterectomy in 3 patients at Hanyang University Hospital. The correlation between the preoperative coronary angiography, electrocardiography, clinical status, operative finding and postoperative blood flow, complication and degree of clinical improvement were evaluated. 1. Ten patients [67 %] were male and five patients [33 %] were female, Ages ranged from 30 to 68 years. [average 52.2 years] 2. The angina by types of presentation was stable in 3 patients, unstable in 12 patients with resting, postinfarction and progressive angina as the criteria of unstability. 3. The number of involved vessels were single in 6 cases, double in 4 cases, triple in 5 cases including 1 case of left main coronary arterial disease. 4. The distribution of sites of distal anastomosis revealed predilection to left coronary arterial system [83 %], especially left anterior descending arterial system. 5. The author performed 4 cases of single bypass, 4 cases of double bypass, 5 cases of triple bypass and 2 cases of quadruple bypass. Of these 15 patients, 3 patients received coronary thromboendarterectomy, LAD in 2 patients and right coronary artery [RCA] in 1 patient. 6. The distal anastomosis were performed first with using saphenous vein grafts as conduits in all cases except 1 case using Gore-Tex conduit because of deficient in length and narrowed internal mammary artery and sequential bypass methods were employed in last 6 cases. 7. One operative death occurred and therefore, mortality rate was 6.7%. The perioperative myocardial infarction were occurred in 3 cases [20%] and its cause was supposed that they were triple vessel disease and therefore, aortic cross clamping times were relatively long. 8. All survivors were followed for 17.7 months on an average [range 5-28 months] and they have had symptomatic improvement except 1 case having mild degree of angina at 1.5 months after operation.

• Journal of Chest Surgery
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• 제32권10호
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• pp.897-902
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• 1999

Use of the left internal thoracic artery(ITA) to bypass the left anterior descending(LAD) coronary artery has become the standard of care based on its superior graft patency, reduced cardiac events, and enhanced survival. But rarely we encountered with injury to the artery during harvesting which leads to loss of the merits of surgery. We reconstructed inadequate ITAa with other arterial conduits so proximal stump to be a blood source if possible. Maternal and method: Between January 1996 and March 1999, 12 patients received bypass with the reconstructed left internal thoracic artery grafts to left anterior descending artery because of an injury(n=8), short or small(n=4). Right or left ITA was used to LAD as a free graft(n=2). And the other 10 left ITAs were extended with radial artery(n=6), right ITA(n=3), saphenous vein(n=1). Composite "T" graft was made with other arterial conduits in these extended graft(n=5). Result: There was only one morbidity of minor would problem, and no mortality. The patency of extended graft to LAD was complete in 5 patients who received angiography during the period of 2wks to 2 years postoperative, but one of side branch of "T" graft occluded. All of these patients were well. Conclusion: Reconstructive extension with the use of other arterial conduit for the injured proximal ITA is warranted in any patients with acceptable results. acceptable results.

• Journal of Chest Surgery
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• 제35권12호
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• pp.898-901
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• 2002

관상동맥 우회술에서 동맥도관만을 사용하는 방법은 동맥편이 가진 도관개통률의 우수성 때문에 복재정맥을 혼합하여 사용하는 관상동맥 우회술에 비해 좋은 단기 성적은 물론이고, 향상된 장기 성적을 기대할 수 있다. 그러나 때때로 내흉동맥 또는 다른 동맥편들의 사용이 가능하지 않은 경우가 있고, 특히 당뇨환자에서 양측 내흉동맥의 사용은 술 후 종격동염을 비롯한 합병증을 우려하여 사용이 꺼려지기도 한다. 또한 관상동맥 우회술의 재수술의 경우에는 사용가능한 동맥편 수의 제한이 문제가 되는데 이러한 경우 대체동맥편으로서 흉배동맥을 사용할 수 있으며, 저자들은 흉배동맥을 사용하여 시행했던 3례의 관상동맥 우회술을 보고하고자 한다.