• Journal of Chest Surgery
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• 제48권1호
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• pp.46-51
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• 2015

Background: Maintenance of adequate vascular access for hemodialysis is important in patients with end-stage renal disease. Once arteriovenous fistula (AVF) occlusion occurs, the patient should be treated with rescue therapy. This study was performed to evaluate the results of a rescue therapy for AVF occlusion. Methods: From January 2008 to December 2012, 47 patients who underwent surgical rescue therapy for AVF occlusion after graft AVF formation, were enrolled in this study. The patients were divided into two groups, namely the graft repair group (group A, n=19) and the thrombectomy group (group B, n=28). Postoperative results of both groups were analyzed retrospectively. Results: There were no statistically significant differences in the clinical characteristics between the two groups. In terms of the duration of AVF patency after the first rescue therapy, group A showed a longer AVF patency duration than group B ($24.5{\pm}21.9$ months versus $17.7{\pm}13.6$ months), but there was no statistically significant difference (p=0.310). In terms of the annual frequency of AVF occlusion after the rescue therapy of group A was lower than that of group B (0.59 versus 0.71), but there was no statistically significant difference (p=0.540). The AVF patency rates at 1, 2, 3, and 5 years after the first rescue therapy in group A were 52.6%, 31.5%, 21.0%, and 15.7%, respectively, and those in group B, they were 32.1%, 25.0%, 17.8%, and 7.14%, respectively. There was no statistically significant difference (p=0.402). Conclusion: Graft repair revealed comparable results. Although there was no statistically significant difference, the patent duration and annual frequency of AVF occlusion of group A were better than those of group B. Therefore, graft repair is considered as a safe and useful procedure for maintaining graft AVF.

• Journal of Chest Surgery
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• 제54권6호
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• pp.500-508
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• 2021

Background: The major limitation of arteriovenous graft access is the high incidence of thrombotic occlusion. This study investigated the outcomes of our salvage strategy for thrombosed hemodialysis arteriovenous grafts (including surgical thrombectomy with balloon angioplasty) and evaluated the efficacy of intragraft curettage. Methods: Salvage operations were performed for 290 thrombotic occluded arteriovenous grafts with clinical stenotic lesions from 2010 to 2018. Of these, 117 grafts received surgical thrombectomy and balloon angioplasty from 2010 to 2012 (group A), and 173 grafts received surgical thrombectomy and balloon angioplasty, with an additional salvage procedure using a curette and a graft thrombectomy catheter, from 2013 to 2018 (group B). Outcomes were described in terms of post-intervention primary patency and secondary patency rates. Results: The post-intervention primary patency rates in groups A and B were 44.2% and 66.1% at 6 months and 23.0% and 38.3% at 12 months, respectively (p=0.003). The post-intervention secondary patency rates were 87.6% and 92.6% at 6 months and 79.7% and 85.0% at 12 months, respectively (p=0.623). Multivariate Cox regression analysis demonstrated that intragraft curettage was a positive predictor of post-intervention primary patency (hazard ratio, 0.700; 95% confidence interval, 0.519-0.943; p=0.019). Conclusion: Surgical thrombectomy and balloon angioplasty showed acceptable outcomes concerning post-intervention primary and secondary patency rates. Additionally, intragraft curettage may offer better patency to salvage thrombotic occluded arteriovenous grafts with intragraft stenosis.

• Journal of Chest Surgery
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• 제28권1호
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• pp.73-77
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• 1995

We are reporting one case of right subclavian vein thrombotic occlusion as a result of previous hemodialysis catheter placement in a patient with a functioning right brachio-cephalic arteriovenous fistula. Its complication was painful right arm swelling, limitation of motion and cellulitis. Diagnosis was confirmed by right subclavian venography and the complication was successfully managed by right subclavian vein-superior vena cava bypass with a GoreTex vascular graft. The arteriovenous fistula had remained to protect patency of the bypass at first, but two months later after the operation, the arteriovenous fistula had to be occluded because of the heart failure resulting from shunt over flow. After ligation of arteriovenous fistula, heart failure improved, and uncomfortable arm swelling did not develop again.

• Vascular Specialist International
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• 제34권4호
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• pp.88-93
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• 2018

Purpose: This study aimed to compare surgical revisions and balloon angioplasty after surgical thrombectomy on thrombosed dialysis access as a first event. Materials and Methods: Records of patients undergoing creation of arteriovenous grafts (AVGs) at the Gachon University Gil Medical Center between March 2008 and February 2016 were reviewed. Among them, patients who underwent treatment on first-time thrombotic occlusion after AVG creation were identified. Outcomes were primary, primary-assisted, and secondary patency. The patency was generated using the Kaplan-Meier method, and patency rates were compared by log-rank test. Results: A total of 59 de novo interventions (n=26, hybrid interventions; n=33, surgical revisions) for occlusive AVGs were identified. The estimated 1-year primary patency rates were 47% and 30% in the surgery and hybrid groups, respectively. The estimated primary patency rates were not different between the two groups (log-rank test, P=0.73). The Kaplan-Meier estimates of 6 and 12 months for primary-assisted patency rates were 68% and 57% in the surgery group and 56% and 56% in the hybrid group. The Kaplan-Meier estimates of 12 and 24 months secondary patency rates were 90% and 71% in the surgery group and 79% and 62% in the hybrid group. There were no differences in the estimated primary-assisted and secondary patency rates between the two groups. Conclusion: Our results showed no significant difference between the two groups in terms of primary patency (P=0.73), primary-assisted patency (P=0.85), and secondary patency (P=0.78). However, percutaneous transluminal angioplasty can give more therapeutic options for both surgeons and patients.

• Journal of Chest Surgery
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• 제42권4호
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• pp.487-491
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• 2009

배경: 인조혈관 동정맥루 폐쇄의 구조요법으로는 수술적 방법과 중재적 혈관내 치료법을 사용할 수 있다. 인조혈관 동정맥루를 재개통 시키는데 이 두가지 방법의 효율성을 후향적으로 분석하였다. 대상 및 방법: 2006년 1월부터 2007년 12월까지 수술적 혈전제거술 및 재건술(그룹 A)또는 경피적 혈전제거술 및 혈관성형술(그룹 B)을 시행받은 41명의 환자를 대상으로 환자의 임상적 특성, 협착부의 위치, 시술 후 일차 개통률을 비교하였다. 결과: 총 41명의 환자 중, 21명의 환자는 수술적 혈전제거술 및 재건술을 받았으며, 20명의 환자는 경피적 혈전제거술 및 혈관성형 술을 받았다. 두 군간에 환자의 임상적 특성은 차이가 없었다. 두 군 모두에서 정맥 문합부 협착이 인조혈관 동정맥루 폐쇄의 가장 흔한 원인이었다. 시술 후 일차 개통률은 6개월 누적 개통률이 그룹 A 90.5%, 그룹 B 55%였으며, 1년 누적 개통률은 그룹 A 38.1%, 그룹 B 20.0%로 그룹 A가 통계적으로 의미 있게 높은 개통률을 보였다(p=0.034). 결론: 본 연구에서는 조기에 적절한 수술적 재건술을 시행함으로써 인조혈관 동정맥루의 구제가 가능하였고 비교적 우수한 개통률을 얻을 수 있었다. 인조혈관 동정맥루의 폐쇄가 발생하였을 경우 일차적인 치료방법으로서 수술적 재건술은 효과적인 방법이라고 생각된다.

• Journal of Chest Surgery
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• 제40권3호
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• pp.228-231
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• 2007

흉부 외상은 단순 부정맥에서 심근 파열 등 심장에 다양한 합병증을 일으킬 수 있다. 그중 관상동맥 손상은 매우 드문 합병증이고 특히 좌측 관상 동맥의 동맥류는 우측에 비해서 발생빈도가 작은 것으로 되어있다. 흉부 둔상 후 관상 동맥 내벽의 동맥류 형성, 박리, 열상, 동정맥루 및 혈전 등이 매우 드물게 생길 수 있으며, 혈관이 막히고 심근 경색이 발생하면 환자에게 치명적인 손상을 일으킨다. 교통사고로 인한 흉부의 둔상 후 발생한 심근경색증을 진단받은 33세 남자에서 관상동맥 우회로술을 통해 좋은 결과를 얻었기에 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제53권6호
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• pp.349-355
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• 2013

Objective : Recently, microscope-integrated near infrared indocyanine green videoangiography (ICG-VA) has been widely used in cerebrovascular surgery because it provides real-time high resolution images. In our study, we evaluate the efficacy of intraoperative ICG-VA during cerebrovascular surgery. Methods : Between August 2011 and April 2012, 188 patients with cerebrovascular disease were surgically treated in our institution. We used ICG-VA in that operations with half of recommended dose (0.2 to 0.3 mg/kg). Postoperative digital subtraction angiography and computed tomography angiography was used to confirm anatomical results. Results : Intraoperative ICG-VA demonstrated fully occluded aneurysm sack, no neck remnant, and without vessel compromise in 119 cases (93.7%) of 127 aneurysms. Eight clipping (6.3%) of 127 operations were identified as an incomplete aneurysm occlusion or compromising vessel after ICG-VA. In 41 (97.6%) of 42 patients after carotid endarterectomy, the results were the same as that of postoperative angiography with good patency. One case (5.9%) of 17 bypass surgeries was identified as a nonfunctioning anastomosis after ICG-VA, which could be revised successfully. In the two patients of arteriovenous malformation, ICG-VA was useful for find the superficial nature of the feeding arteries and draining veins. Conclusion : ICG-VA is simple and provides real-time information of the patency of vessels including very small perforators within the field of the microscope and has a lower rate of adverse reactions. However, ICG-VA is not a perfect method, and so a combination of monitoring tools assures the quality of cerebrovascular surgery.