• Journal of Chest Surgery
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• v.37 no.11
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• pp.897-902
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• 2004

Background: Although great concerns have been raised regarding the suitability of the use of the radial artery as a bypass conduit after transradial catheterization, there has been no studies that examined this issue in Korea. The purpose of this study was to compare clinical and angiographic results of radial artery grafting between patients with and without previous transradial catheterization. Material and Method: From January 2000 to February 2004, a total of 93 patients underwent coronary artery bypass grafting using the radial artery: 49 patients received preoperative transradial catheterization for coronary angiography (group I) and 44 patients did not (group II). These patients were retrospectively reviewed. Result: There was no significant difference in sex ratio, age, clinical diagnosis, risk factors, ejection fraction and early clinical outcomes between two groups. The graft patency rates in groups I and II were both 100% in the internal thoracic artery and in the radial artery, and 85% and 86% in the saphenous vein. respectively. The stenosis-free graft patency in groups I and II were 93% and 81% in the radial artery respectively but no statistical significance was shown. Conclusion: There was no significant difference in graft patency at postoperative coronary angiography between two groups. Radial artery graft after transradial catherization seems to be suitable for bypass conduit in short-term analysis.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.182-187
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• 2002

Background: There have been many reports of coronary angiographic findings after coronary bypass grafting, most of which are focused on the graft patency rate of the bypass conduits. However, postoperative angiography can provide numerous informations other than patency rates that are useful for establishing operative strategy. Material and Method: We studied 73 patients in whom coronary angiography was done after more than 1 month of CABG. Mean interval from the operation to coronary angiography was 10.6 months and the reasons for coronary angiography follow up were residual or recurrent angina in 54 patients, abnormalities on myocardial perfusion scan or echocardiography in 13 patients, and for simple follow up in 6 patients. Result: Overall graft patency rate was 80.9% (internal thoracic artery 100%, saphenous vein 75.0%) in patients of simple follow up and 61.6%(internal thoracic artery 81.1%, saphenous vein 55.3%) in patients with ischemia. Progression of native coronary arterial disease proximal to the grafting site was found in 50 patients(68.5%). Among 201 coronary arterial branches that had not been completely occluded preoperatively, ninty five branches(47.3%) revealed progression of diameter stenosis by more than 20% on the follow up study. Among them, 64 branches(31.8%) progressed to total occlusion. The incidence of disease progression was highter in the coronary arteries with patent grafts(57.5%) than in those with occluded grafts(36.3%)(p<0.05), Comparing internal thoracic artery graft with saphenous vein graft, internal thoracic artery was superior to saphenous vein, not only in terms of patency(83.3% vs 56.6%), but also in terms of result of later percutaneous intervention success rate(100% vs 62%, p<0.05). Conclusion: Due to the considerable incidence of progression of native coronary artery stenosis in the early postoperative periods, bypass grafting of a vessel with borderline stenosis, especially with vein graft, must be done prudently. And it was confirmed again that revascularization of left anterior descending artery is most important and that internal thoracic artery was superior to saphenous vein.

• Journal of Chest Surgery
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• v.39 no.4 s.261
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• pp.261-268
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• 2006

Background: Current vascular prostheses are still inadequate for reconstruction of small-diameter vessels. Autologous pericardium can be a good alternative for this purpose as it already possesses good blood compatibility and shows a mechanical behavior similar to that of natural arteries. However, the clinical use of autologous pericardial tissue as a small-diameter vascular graft has limitations due to mixed outcomes from uncertain biological behavior and difficulty to gain reliable patency results in animal experiments. To study this issue, we implanted fresh and glutaraldehyde-treated autologous pericardium as small-diameter arterial grafts in dogs, and compared their time-related changes histologically. Material and Method: As a form of 5mm-diameter arterial graft, one pair of autologous pericardial tissue was used for comparison between the glutaraldehyde-treated and the glutaraldehyde-untreated grafts in the bilateral carotid arteries in the same dog. The patency of the grafts were evaluated at regular intervals with Doppler ultrasonography. After the predetermined periods of 3 days, 2 weeks, 1 month, 3 months and 6 months, the grafts in each animal were explanted. The retrieved grafts were processed for light and electron microscopic analyses following gross observation. Result: Of 7 animals, 2 were excluded from the study because one died postoperatively due to bleeding and the other was documented as one side of the grafts being obstructed. All 10 grafts in the remaining 5 dogs were patent. Grossly, a variable degree of thromboses were observed in the luminal surfaces of the grafts at 3 days and 2 weeks, despite good patency. Pseudointimal smooth blood-contacting surfaces were developed in the grafts at f month and later. By light microscopy, mesothelial cell layers of the pericardial tissue were absent in all explanted grafts. Newly formed endothelial cell layers on the blood-contacting surface were observed in both the glutaraldehyde-treated and fresh grafts at 3 months and later. The collagen fibers became degraded by fragmentation in the fresh graft at 1 month and In the glutaraldehyde-treated graft at 3 months. At 6 months, the collagen layers were no longer visible in either the glutaraldehyde-treated or fresh grafts. By electron microscopy, a greater amount of coarse fibrin fibers were observed in the fresh grafts than in the glutaraldehyde-treated grafts and, more compact and well-arrayed layers were observed in the glutaraldehyde-treated grafts than in the fresh grafts. Conclusion: The glutaraldehyde-treated small-diameter pericardial arterial grafts showed a better endothelialization of the blood-contacting surface and a slower fragmentation of the collagen layers than the fresh grafts, although it has yet to be proven whether these differences are so significant as to affect the patency results between the groups.

• Journal of Chest Surgery
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• v.19 no.2
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• pp.288-294
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• 1986

During the period from Mar. 1983 to Feb. 1986, 22 patients with vascular trauma were treated at Capital Armed General Hospital. 1] 11 patients had arterial injury alone, 6 patients had venous injury alone, and 5 patients had both arterial and venous injuries. 2] The mechanism of injury in these 22 patients was 7 penetrating non-gun shot wounds, 5 blast fragments injuries, 4 iatrogenic injuries, 4 blunt injuries, 2 gun shot wounds. 3] The method of 16 arterial repair was 5 autogenous saphenous vein graft, 8 synthetic vascular graft, 1 end to end anastomosis, 2 lateral suture. Midterm patency of 16 repairs was 100% within 1 months. 4] The method of 11 venous repair was 1 autogenous saphenous vein graft, 2 onlay vein patch, 2 ligation, 1 lateral suture. The thrombotic obstructions occurred in 4 repairs [36.4%], but they were resolved somewhat with heparinization. 5] Uncommon cases of false aneurysm of internal carotid artery and laceration of retrohepatic inferior vena cava were summarized.

• Journal of Chest Surgery
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• v.27 no.9
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• pp.798-800
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• 1994

Chyloascities is an extravasation of milky chyle into the peritoneal cavity due to tumor , inflammation or rarely postoperative lymphatic trauma.It is an unusual complication that can lead to significant immunologic and nutritional consequences.We experienced one case of chyloascites after aorto-bifemoral bypass graft in a patient with aorto-iliac occlusive disease.The patient was a 62-year-old male, who suffered from severe progressive claudication for 5 months. A 16$\times$ 8mm gelsealed Dacron-Y shaped graft was used in arterial reconstruction. A bloody-milky fluid was drained through the operative wound from 3days after operation and evaluated biochemically.Diagnosis of chyloascites was made with repeated paracentesis and examination of the fluid.After Total parenteral nutrition[T.P.N] for 3 weeks from 6days after operation, chyloascites was controlled sufficiently and maintained a good graft-patency in abdominal sonogram.

• Journal of Chest Surgery
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• v.28 no.3
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• pp.274-279
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• 1995

To evaluate clinical pattern and operative outcome of atherosclerotic obstructive disease in the lower extremity, surgical experience in 25 patients between September 1987 and June 1994 was analyzed. There were 24 male patients and 1 female patient. The age of the patients ranged between 36 and 77 years[mean:60.9 years . Disabing intermittent claudication, rest pain, or ischemic gangrene[or ulceration was the operative indication. The patients were classified into three groups according to the level of obstruction: Aortoiliac level[11 cases/44% , femoropopliteal level[6 cases/24% , and whole level[8 cases/32% . Anatomic bypass with prosthetic graft was performed in all cases: aortobifemoral or aortofemoral bypass in 15 procedures, iliofemoral bypass in 5 procedures, femoropopliteal bypass in 13 procedures. The perioperative mortality rate was 12%. Two patients received postoperative major amputation. Twenty two patients were followed-up for 1 to 70 months[mean: 21 months . Late graft obstruction occurred in two patients. The cumulative patency rate at 3 years was 69.5%. The cumulative limb salvage rate at 3 years was 92.0%.

• Journal of Chest Surgery
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• v.36 no.12
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• pp.995-998
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• 2003

During coronary artery bypass surgery, there are several discrete maneuvers that facilitates localization of the invisible left anterior descending coronary artery. In some cases with intramyocardial left anterior descending artery, long-term patency of a bypassed graft may depend on anastomosing the internal mammary artery graft to the more proximal and superficial site of the intramyocardial left anterior descending artery. We describe an easy technique to locate the proximal superficial left anterior descending artery with a distal coronary arteriotomy and retrograde insertion of a coronary probe.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.983-988
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• 1995

From January 1983 to December 1994, 48 cyanotic patients were underwent a subclavian artery-pulmonary artery shunt using polytetrafluoroethylene[PTFE for the purpose of improvement of reduced pulmonary blood flow. The diameters of the PTFE used were 4mm[4 cases , 5mm[36 cases , and 6mm[8 cases sizes. The effectiveness of modified Blalock-Taussig shunts was evaluated clinically and angiographically. There were 5 early deaths and 2 late deaths. There were 3 early shunt failures and 5 late shunt failures. The overall graft patency rate was 83.3%. Postoperative hemoglobin was reduced significantly[p = 0.0011 in comparison of the preoperative and postoperative hemoglobin, SaO2, PaO2, and cardiothoracic ratio.

• Journal of Chest Surgery
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• v.18 no.2
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• pp.314-319
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• 1985

Nineteen patients with various types of cyanotic congenital heart disease underwent systemic-pulmonary artery shunts with a microporous polytetrafluoroethylene [PTFE] graft between September, 1983, and April, 1985. Age ranged from 3 months to 18 years, and seven of them were less than 12 months old. There were seventeen Great Ormond Street type of modified Blalock-Taussig shunts, and two central polytetrafluoroethylene shunt [ascending aorta-right pulmonary artery]. There was one postoperative death [1/19=5.3%] in a 10 Kg child born with pulmonary atresia and ventricular septal defect associated with patent ductus arteriosus. He had another anomaly of imperforated anus. Relief from cyanosis was achieved in other eighteen patients with variable degree. Eighteen survivors have been followed up from 1 month to 19 months. Clinical status, auscultation, oxygen partial pressure of arterial blood, and hemoglobin have been used to establish shunt patency in all survivors. By above criteria, all survivors have good patent shunt.

• Journal of Chest Surgery
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• v.18 no.3
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• pp.529-533
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• 1985

Though esophageal cancer was not a common disease, early metastasis and direct extension to adjacent organ were important on the treatment of disease. Therefore, palliative operation was often useful in advanced esophageal cancer. Between June 1985 through July 1985, we treated three cases of inoperable esophageal cancer with Celestin`s endo-esophageal tube by esophageal intubation. Three operations were done under general anesthesia. Celestin`s tube were inserted via oral cavity and additional traction on stomach were applied. After complete insertion of tube was done, the distal end of Celestin`s tube was modified in length. Also stay suture was applied between tube and stomach wall was applied. Postoperative esophagogram revealed good esophageal patency through Celestin`s tube. Clinically, swallowing difficulty was much improved after operation.