• Journal of Chest Surgery
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• 제53권1호
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• pp.28-33
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• 2020

Background: When an arteriovenous fistula (AVF) is created using the basilic or deep cephalic vein, it is additionally necessary to transfer the vessels to a position where needling is easy; however, many patients develop wound-related postsurgical complications due to the long surgical wounds resulting from conventional superficialization of a deep AVF or basilic vein transposition. Thus, to address this problem, we performed videoscopic surgery with small surgical incisions. Methods: Data from 16 patients who underwent additional videoscopic radiocephalic superficialization, brachiocephalic superficialization, and brachiobasilic transposition after AVF formation at our institution in 2018 were retrospectively reviewed. Results: Needling was successful in all patients. No wound-related complications occurred. The mean vessel size and blood flow of the AVF just before the first needling were 0.73±0.16 mm and 1,516.25±791.26 mL/min, respectively. The mean vessel depth after surgery was 0.26±0.10 cm. Percutaneous angioplasty was additionally performed in 25% of the patients. Primary patency was observed in 100% of patients during the follow-up period (262.44±73.49 days). Conclusion: Videoscopic surgery for AVF dramatically reduced the incidence of postoperative complications without interrupting patency; moreover, such procedures may increase the use of native vessels for vascular access. In addition, dissection using a videoscope compared to blind dissection using only a skip incision dramatically increased the success rate of displacement by reducing damage to the dissected vessels.

• Journal of Chest Surgery
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• 제53권2호
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• pp.73-78
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• 2020

Background: As the population of patients with end-stage renal disease has grown older, the proportion of patients with poorly preserved vasculature has concomitantly increased. Thus, arteriovenous grafts (AVG) have been used more frequently to access blood vessels for hemodialysis. Despite this increasing demand, studies of AVG are limited. In this study, we examined the surgical outcomes of upper-limb AVG creation. Methods: Among the arteriovenous fistula formation procedures performed between January 2014 and March 2019 at Dankook University Hospital, 42 cases involved AVG creation. We compared patients in whom the axillary vein was used (group A; brachioaxillary AVG [B-Ax AVG]; n=20) with those in whom upper limb veins were used (group B; brachiobasilic AVG or brachioantecubital AVG; n=22). Results: The 1-year primary patency rate was higher in group A than in group B (57.9% vs. 41.7%; p=0.262). The incidence of postoperative complications was not significantly different between groups. Conclusion: AVG using the axillary vein showed no major differences in safety or functionality compared to AVG using other veins. Therefore, accounting for age, underlying disease, and expected patient lifespan, B-Ax AVG can be considered an acceptable surgical method.

• 대한두개안면성형외과학회지
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• 제11권2호
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• pp.116-119
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• 2010

Purpose: Arteriovenous fistulas that involve the cavernous sinus often produce ophthalmologic symptoms and signs. Transvenous endovascular access is the method of choice for a carotid-cavernous sinus fistula. The superior ophthalmic vein is a safe and reasonable alternative route for the transvenous embolization of carotid-cavernous sinus fistula. We report a case of the embolization of a carotid-cavernous sinus fistula using the superior ophthalmic vein approach. Methods: A 58 year old female had conjunctival congestion, periocular pain and diplopia with a 2 month duration. Diagnostic orbital CT, brain MRI and cerebral angiography revealed a carotid-cavernous sinus fistula. The fistula occlusion was treated by coil embolization using the superior ophthalmic vein approach. Results: The initial presenting symptoms, conjunctival congestion, periocular pain and diplopia, decreased after surgery. Coil embolization via the superior ophthalmic vein approach was difficult because of the venous tortuosity and friability. During the follow up period, the patient was in a good condition without complications. Conclusion: Surgical exposure of the superior ophthalmic vein provides direct venous access to the cavernous sinus as well as an effective and safe treatment approach. The cooperation of the plastic surgeon and interventionist is a factor in successful treatment.

• Journal of Chest Surgery
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• 제54권1호
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• pp.31-35
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• 2021

Background: Arteriovenous fistula (AVF) for hemodialysis is essential for patients with end-stage renal disease. However, it is difficult to maintain AVF reliably. It is vitally important to select proper blood vessels for AVF formation. In a previous study, a minimum diameter of 3 mm for the autologous vein was proposed. However, patients who did not meet the minimum vascular diameter before anesthesia, but fulfilled other criteria, showed satisfactory venous dilatation after brachial plexus block (BPB). This study investigated the extent of vein expansion by BPB and the surgical outcomes of dilated veins after BPB. Methods: Sixty-one patients who underwent AVF formation using an autologous vein between August 2018 and December 2019 were included in the study. The clinical characteristics of the patient groups, hemodynamic parameters including the diameter of blood vessels before and after BPB, and complications were investigated. Based on the venous diameter measured by sonography before anesthesia, patients were divided into group A (26 patients) and group B (35 patients), with venous diameters <3 mm and ≥3 mm, respectively. Results: The venous diameter expanded after anesthesia by 41% overall, by 62% in group A, and by 25% in group B. This difference between groups A and B was statistically significant (p=0.001). No other variables showed statistically significant differences. Conclusion: Sufficient venous dilatation was observed after BPB. Therefore, if the vein is sufficiently dilated after BPB, even in patients with a pre-anesthesia venous diameter <3 mm, surgery may still be performed with an expected desirable outcome.

• Journal of Chest Surgery
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• 제35권5호
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• pp.369-374
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• 2002

배경: 혈액 투석을 위한 투석로의 확보는 신부전증 환자의 치료에 필수적인 요소이지만, 여러 요소에 의해 투석로의 확보가 점점 어려워지고 있어서 인조 혈관의 사용 빈도가 증가하고 있는 추세이다. 저자들은 동정맥루 조성술을 시행받은 환자를 대상으로 자가 혈관 및 인조 혈관의 개통률의 차이와 인조 혈관의 종류에 따른 개통률의 차이, 동반 질환이 동정맥루 개존에 미치는 영향 및 이와 연관하여 재수술이 필요했던 경우 등을 분석하고자 하였다. 대상 및 방법: 1996년 1월부터 2000년 12월가지 고려대학교 구로병원 흥부외과에서 혈액투석을 위해 동정맥루 조성술을 시행한 186명의 환자를 대상으로 후향적으로 분석하였다. 대상 환자의 남녀 비는 99 : 87로 남자가 다소 많았고, 평균 연령은 54.37$\pm$12.89세이었으며, 대상 환자에서 시행한 전체 수술은 292건, 이 중 자가 혈관과 인조 혈관을 이용한 동정맥루 조성술이 각각 156과 116건이었다. 결과: 동정맥루의 1년 및 5년 개통률은 자가 혈관의 경우 각각 92.78$\pm$2.35%, 39.03$\pm$9.08%이었고, 인조 혈관의 경우는 각각 96.09$\pm$2.22%, 16.45$\pm$10.15%이었으나 두 군 사이의 통계적 유의성은 없었다. 신부전증과 동반된 질환 중 가장 많은 빈도를 보인 고혈압과 당뇨, 그리고 두 가지를 모두 가지고 있던 환자의 동정맥루 평균 개통 기간은 각각 52.99$\pm$2.05개월, 52.70$\pm$4.24개월, 53.49$\pm$2.33개월로 이러한 질환을 가지지 않는 환자의 평균개통 기간인 48.12$\pm$2.05개월과 비교해 각 군 사이의 통계적 유의성은 없었고, 수술에 사용된 여러 종류의 인조 혈관들의 1년 및 3년 개통률 사이의 비교에서도 서로 간의 통계적 유의성은 없었다. 수술 후 합병증 및 재수술이 필요했던 이유는 주로 혈전이나 혈류 감소, 동맥류 형성 및 인조 혈관 감염 등이었고, 재수술이나 3차 수술 후의 개통률도 첫수술과 비교하여 통계적 유의성은 없었다. 절론 자가 혈관에 비해 인조 혈관을 이용한 동정맥루의 개통률도 우수하였으나, 사용된 인조 철관의 종류에 따른 개통률의 차이를 비교하기 위해서는 인조 혈관에 따른 더 많은 증례가 축적되어야 할 것이다. 한편 동반 질환은 동정맥루 개통률에 영향을 미치지 않았다.

• Korean Journal of Radiology
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• 제20권8호
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• pp.1285-1292
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• 2019

Objective: To evaluate the safety and efficacy of the coil-protected technique for liquid embolization in neurovascular malformations. Materials and Methods: Twenty-two patients who underwent coil-protected liquid embolization for symptomatic cranial (n = 13) and spinal (n = 9) arteriovenous fistula (AVF) or arteriovenous malformations (AVMs) were identified. A total of 36 target feeder vessels were embolized with N-butyl cyanoacrylate and/or Onyx (Medtronic). This technique was used to promote delivery of a sufficient amount of liquid embolic agent into the target shunt or nidus in cases where tortuous feeding arteries preclude a microcatheter wedging techniqu and/or to prevent reflux of the liquid embolic agent in cases with a short safety margin. The procedure was considered technically successful if the target lesion was sufficiently filled with liquid embolic agent without unintentional reflux. Angiographic and clinical outcomes were retrospectively evaluated. Results: Technical success was achieved for all 36 target feeders. Post-embolization angiographies revealed complete occlusion in 16 patients and near-complete and partial occlusion in three patients each. There were no treatment-related complications. Of the six patients who showed near-complete or partial occlusion, five received additional treatments: two received stereotactic radiosurgery for cerebral AVM, two underwent surgical removal of cerebral AVM, and one underwent additional embolization by direct puncture for a mandibular AVM. Finally, all patients showed complete (n = 19) or near-complete (n = 3) occlusion of the target AVF or AVM on follow-up angiographies. The presenting neurological symptoms improved completely in 15 patients (68.2%) and partially in seven patients (31.8%). Conclusion: The coil-protected technique is a safe and effective method for liquid embolization, especially in patients with various neurovascular shunts or malformations who could not be successfully treated with conventional techniques.

• Journal of Chest Surgery
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• 제51권6호
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• pp.406-409
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• 2018

Aortocaval fistula (ACF) occurs in <1% of all abdominal aortic aneurysms (AAAs), and in 3% to 7% of all ruptured AAAs. The triad of clinical findings of AAA with ACF are abdominal pain, abdominal machinery bruit, and a pulsating abdominal mass. Other findings include pelvic venous hypertension (hematuria, oliguria, scrotal edema), lower-limb edema with or without arterial insufficiency or venous thrombus, shock, congestive heart failure, and cardiac arrest. Surgery is the main treatment modality. We report successful surgical treatment in a patient with a ruptured AAA with ACF who presented with cardiogenic shock.

• Journal of Korean Neurosurgical Society
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• 제38권4호
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• pp.269-272
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• 2005

Objective : The object of this study is to present the treatment experience of the 6cases of scalp arteriovenous malformations[AVMs] focus on treatment strategy. Methods : Six patients with scalp AVM were treated during past 12years. We analysis the clinical characteristics of the lesions, treatment methods and management outcomes. Results : The lesions were located on temporal in 2patients, parietal in 2patients, frontal and occipital area in each one. Four of six patients had a trauma history on scalp. The presenting symptoms were progressive enlarged pulsating mass with or without bruit. Four of the six lesions had the large fistula in the lesion. Two patients were treated with surgical resection alone, three patients with proximal feeding artery balloon[s] occlusion followed by surgical resection, and one patient with coil embolization through trans-venous route alone. We obtained good results in all patients. Conclusion : Most of scalp AVM can be completely cured by Judicious selection and a combination of treatment modalities, i.e., surgery only, or embolization only, or embolization plus surgical therapy. Although embolization became a primary therapy for this sort of scalp AVM recently, the selection of treatment modality should be chose based on the size, angioarchitecture, and clinical presentations of the lesion.

• 대한영상의학회지
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• 제82권6호
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• pp.1628-1633
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• 2021

척수 경막외 동정맥루는 매우 드문 질환으로 진단과 치료가 어렵다. 무증상 환자도 있으나 동정맥단락으로 척수주위정맥으로 역류되고 늘어난 정맥이 인접한 신경근을 압박하면서 증상이 생길 수 있다. 본 증례는 31세 남자 환자로 2년 동안 지속되는 요통, 방사성 허벅지통증, 하지 감각변화로 내원하였다. 컴퓨터단층촬영, 자가공명장치 및 척수혈관조영술에서 요추의 경막외 공간에서 동정맥단락에 의해 늘어난 정맥이 신경근을 압박하고 있는 척수 경막외 동정맥루로 진단하였다. 코일색전술을 시행하여 동정맥단락을 차단하였고 수일 내에 신경근 압박증상이 호전되었다. 이번 증례에서는 척수 경막외 동정맥루에서 외과적 수술의 대안으로 코일 색전술이 효과적인 치료가 될 수 있다는 것을 보여주었다.

• Journal of Chest Surgery
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• 제12권4호
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• pp.371-378
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• 1979

The authors have performed operations on vascular system of 108 cases from 1972 through 1979, and analyzed the diseases, surgical procedures and results. They were 1. Arterial system; 45 cases P.D.A. : 20 Occlusive diseases : 13 Coarctation of aorta : 4 Aneurysm : 4 A-V fistula : 2 Trauma : 2 2. Venous system; 6 cases Esophageal varix : 4 S.V.C. syndrome : 1 Varicose vein : 1 3. Arteriovenous shunt for hemodialysis; 57 cases Of the arterial diseases, the worst results came from Burger`s disease. For the bleeding esophageal varices, we have performed ligations of varices or collateral circulations rather than emergency splenorenal shunt with good results. External A-V shunt for hemodialysis had much more complications than the A-V fistula.