• Journal of Pharmaceutical Investigation
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• v.22 no.3
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• pp.219-227
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• 1992

The influence of phenobarbital (PB) pretreatment (75 mg/kg/day, i.p. for 4 days) on the pharmacokinetics of diltiazem (DTZ) and its metabolite, desacetyldiltiazem (DAD), was investigated in rats. DTZ was injected via femoral (3 mg/kg) or portal (10 mg/kg) vein to the control and PB-pretreated rats. DAD was also injected separately via femoral (3 mg/kg) vein to both groups of rats. The intrinsic hepatic plasma clearance of DTZ was found to be significantly increased (6.8-fold) by the PB pretreatment. However, the fraction of an intravenous DTZ dose converted to DAD $(F_mi)$ was only slightly (6%) increased and calculated metabolic rate constant of DTZ to DAD was not affected by the pretreatment. On the other hand, plasma free fraction of DTZ was increased (1.8-fold) from $4.24{\pm}0.25%$ to $7.45{\pm}0.54%$ by the pretreatment. However, the l.8-fold increase in the free fraction of DTZ would not explain the 6.8-fold increase in the hepatic intrinsic clearance of DTZ. Therefore, the increase in either the hepatic blood flow or the metabolism other than to DAD was expected as the probable mechanism(s) of the increased hepatic clearance of DTZ. Sequential metabolism of DAD to further metabolites, however, would be a more potential cause of the apparently unchanged metabolism of DTZ to DAD by the PB-pretreatment.

• Archives of Plastic Surgery
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• v.34 no.3
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• pp.279-284
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• 2007

Purpose: The vein graft was considered as a useful conduit for nerve defect. But the problem is that it might be collapsed in long vein graft state. A new experimental model using vein graft filled with hyaluronic acid was considered. Methods: Thirty rats were used for the experimental animal. In group I, one side of the femoral nerve was exposed and a segment was removed about 15mm. The neural gap was connected with nerve graft. In group II, the nerve gap was connected with vein graft only. In group III, the nerve gap was connected with vein graft filled with hyaluronic acid. A walking track analysis was made periodically for 2 months and NCV(nerve conduction velocity) was executed at the end of the experiment. And morphologic studies were also done for all groups Results: In a walking track analysis, the toe-spread was widen and the foot-length was lengthened. The recovery of the toe-spread and foot length was checked 2 weeks interval, periodically for two months. The SFI (sciatic function index) was $-52.5{\pm}8.2$ in group I, $-68.1{\pm}4$ in group II, $-55.3{\pm}7.9$ in group III. In electrophysiological study, NCV(nerve conduction velocity) was $26.71{\pm}3.11m/s$ in group I, $17.94{\pm}4.35m/s$ in group II, $25.69{\pm}2.81m/s$ in group III. The functional recovery in group I and III was superior to that the group II statistically(p < 0.05) Under electromicroscopic study, the number of the myelinated axons were $1419.1{\pm}240$ in group I, $921.7{\pm}176.8$ in group II, $1322.2{\pm}318$ in group III. The number of the myelinated axons were much more in group I and III than group II statistically (p<0.05). Conclusion: This study suggested that the vein graft filled with hyaluronic acid is more effective than vein graft only for the conduit of the nerve gap. It was thought that the technique could be used in clinical cases with nerve defects as an alternative method to classical nerve grafts.

• Archives of Reconstructive Microsurgery
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• v.14 no.1
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• pp.57-62
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• 2005

Microvascular anastomosis with suture technique is a basic skill but there are several problems such as stenosis, thrombosis and long operating time. Recently plastic surgeons have developed non-suturing mechanical coupling devices for microvascular anastomosis. The authors applied non-penetrating vascular clips (VCS clips) in the field of free flap surgery of head and neck area. Between August of 2004 and January of 2005, we performed 9 free flaps (16 vessels) using small-sized VCS clips. Four stay sutures were applied first and then VCS clips were placed between sutures about 1 mm apart. Vascular pedicle of free flap included the descending branch of lateral circumflex femoral vessel, thoracodorsal vessel, deep inferior epigastric vessel and cephalic vein. The recipient vessels were the superior thyroid artery, superficial temporal artery, internal jugular vein, external jugular vein, and superficial temporal vein. We performed 13 end-to-end (4 arteries and 9 veins) and 3 venous end-to-side anastomoses. No flap related complication occurred but we applied additional clips or sutures in two cases due to blood leakage after completion of anastomosis. Primary patency rates seemed to be good and more rapid anastomosis could be done than conventional suture technique. Advantages of VCS technique are high patency rate, low thrombogenecity and rapidity. Although the high cost of VCS instrument may be a problem, this clip could be applied safely in microvascular free tissue transfer.

• Journal of Chest Surgery
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• v.35 no.6
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• pp.483-486
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• 2002

71 years old man was operated on due to abdominal aortic aneurysm associated with complete occlusion of left common iliac artery. The coexisting chronic deep vein thrombosis of the left femoral and iliac vein was not diagnosed preoperatively. Resection of aneurysm and Y-graft interposition was performed. Recurrent edema and pain occured to the left lower extremity immediately postoperatively, which aggrevated with the lapse of time, resulting in fatal extensive venous thrombosis. This report regards the surgical treatment and complication of the aortoiliac occlusive disease associated with chronic deep vein thrombosis.

• Journal of the Korean Society of Radiology
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• v.82 no.1
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• pp.244-249
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• 2021

A 53-year-old woman presented with dyspnea. She had undergone extended thymectomy for an invasive thymoma two months prior. CT revealed numerous small nodules in the lung. After that, she deteriorated owing to acute respiratory distress syndrome (ARDS), and the vascular surgeon planned veno-venous extracorporeal membrane oxygenation (ECMO). During percutaneous cannulation through the left femoral vein, a vascular injury was suspected, and the patient's vital signs became unstable. Diagnostic angiography showed a ruptured left common iliac vein, and the bleeding was stopped by placement of a stent-graft. May-Thurner syndrome was diagnosed on abdominal CT. Here, we report a rare case of ECMO-related vascular injury in a patient with an unrecognized anatomical variant, May-Thurner syndrome.

• Archives of Plastic Surgery
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• v.49 no.4
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• pp.543-548
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• 2022

Microvascular reconstruction frequently requires anastomosis outside of the zone of injury for successful reconstruction. Multiple options exist for pedicle lengthening including vein grafts, arteriovenous loops, and arteriovenous bundle interposition grafts. The authors performed a systematic review of arteriovenous bundle interposition grafts to elucidate indications and outcomes of arteriovenous grafts in microvascular reconstruction. A systematic review of the literature was performed using targeted keywords. Data extraction was performed by two independent authors, and descriptive statistics were used to analyze pooled data. Forty-four patients underwent pedicle lengthening with an arteriovenous graft from the descending branch of the lateral circumflex femoral artery. Most common indications for flap reconstruction were malignancy (n = 12), trauma (n = 7), and diabetic ulceration (n = 4). The most commonly used free flap was the anterolateral thigh flap (n = 18). There were five complications, with one resulting in flap loss. Arteriovenous bundle interposition grafts are a viable option for pedicle lengthening when free flap distant anastomosis is required. The descending branch of the lateral circumflex femoral artery may be used for a variety of defects and can be used in conjunction with fasciocutaneous, osteocutaneous, muscle, and chimeric free flaps.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.2
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• pp.109-129
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• 1995

Many patients with malignancies of the head and neck undergo radiation therapy, either as the only method of treatment or in combination with surgery. Radiation therapy has great effect in the case of fairly advanced malignancies which can't be operated radically. But the complication of radiation therapy arise because of damage to the peri- and operated area. It is fully known that irradiated tissue shows retarded healing process in the skin, mucosa and especially vascuslar tissue. The purpose of this study was to observe the healing process of irradiated free or island flap after operation. As Experimental Models, Femoral arterial and venous anastomosis (Group 1), Epigastric-island flap (Group 2) and free Epigastric falp(Group 3) with irradiated postoperative 24 hrs were made on 30 rats/group. As Control Model(Group 4), Free Epigastric flap was not irradiated after operation was chosen on 30 rats. The amount of irradiation was single fraction of 20 Gy using as linear megavoltage accelerator. Difference between Experimental and Control group was evaluated by the method of clinical examination, histopatholoical findings, biochemical analysis and DNA activity at postoperative 1, 3, 7, 14 and 28 days. The results were as follows, 1. Skin color and new epithelization in group 2 and 3 was similar to control group clinically. 2. Postoperarive patency of femoral artery and vien showed 5% and 22% of ischemity. 3. The externa, media and intima of irradiated femoral artery and vein were similar to control group histopathlogically. 4. Granulation and collagen tissue accumulation of irradiated groups were more active due to degenerative and fibrotic changes than control group at postoperative 7 days histopathologically. 5. The hydroxyproline content of all experimental groups were reduced till 14 days and the group 2 was most prominent at postoperative 7 and 28 days(p<0.05). 6. DNA activities of all groups were reduced till 3 days, but begun to recover at 7 days and more activities in control group than irradiated group(p<0.05). Based on the above results, the clinical healing process of free flaps with irradiated postoperative 24 hrs little difference from control group without complications.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.4
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• pp.397-418
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• 1994

Microvascular surgery has been widely used in the clinical field of replantation and reconstructive surgery. Since the last 20 years, microsurgical techniques and instruments have been rapidly developed and the success rate is remarkably increased. But thrombotic occlusion of vessels remains the major reason for clinical failure. The change of vessel wall is the most important factor in thrombus formation. If we can reduce the traumatic changes in the vessel walls during surgery, the success rate can be markedly increased. For this study, femoral arteries and veins of 36 Sprague-Dawley rats with average weights of 300gm were used. The author observed the histological changes and healing process in the anastomostic site after 1 hour, 24 hours, 1, 2, 3 and 4 weeks under light microscopy and scanning electron microscopy. The results were as follows : 1. The patency rate was 100% in femoral arteries and 85% in femoral vein. 2. At the early stages after microvascular anastomosis, the loss of endothelial cell in the vessel walls was observed in the wide area including anastomotic site. In scanning electron microscopic finding the anastomotic site was covered with much fibrin, many red blood cells and some platelets. 3. At 1st week, new endothelial cells were formed toward anastomotic site and at 3rd week, the anastomotic site was completely covered by new endothelial cells. At 4th week, the complete endothelialization over the threads was observed. 4. The media extended from the anastomotic site toward the end of the specimen. At later stages, the extent of media necrosis was markedly decreased. But the media necrosis of anastomotic site was not regenerated till 4th week. 5. Intimal hyperplasia appeared at 1st week and increased till 4th week. The layer consisted of endothelialization the most luminal layers and smooth muscle in the deeper layers. But in veins, the response was less pronounced than in arteries. 6. Foreign body granuloma remained during 4 weeks and aneurysm was observed at 3rd week in artery. In aneurismal wall, media necrosis, loss of elastic lamina and intimal hyperplasia were seen.

• Journal of Chest Surgery
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• v.29 no.8
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• pp.927-930
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• 1996

We experienced six cases of pseudoaneurysm of the peripheral artery which occurred after stab wound or after diagnostic and operative procedures. Among 6 cases, 4 cases of pseudoaneurysm were developed in the femoral arteries, and others were the subclavian and the axillary artery. Two of 6 cases were combined with previous arterio enous fistula. Doppler imaging and angiogram were performed for the dignosis and an operation. Operative procedures were resection of the aneurysm, ligation of the involved arteries and reconstruction of the artery with the autogenous saphenous vein or the cephalic vein graft. Each operations were successfully performed without any disability.

• Journal of Chest Surgery
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• v.43 no.4
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• pp.441-446
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• 2010

The ideal graft requires acceptable size, less tissue toxicity, resistance to infection, and long-term durability. Great saphenous veins are gaining popularity as acceptable graft conduits, but they require time to grow in caliber. We report 2 cases of graft bypass and reconstruction using superficial femoral veins to acheive immediate high-flow patency.