• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.2
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• pp.132-140
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• 2007

This study compared the histological patency rates of anastomoses of the femoral artery. Twelve rabbits weighing about 2 kg were studied. Both the right and left femoral arteries were cut. The control group had no damage to the vessel, saline irrigation, and micro-anastomosis. Experimental group I had a crush injury to the vessel, saline irrigation, and micro-anastomosis. Experimental group II had a crush injury, saline irrigation, 100 U/ml heparin irrigation, and micro-anastomosis. Experimental group III had the same treatment as experimental group II plus the systemic application of 100 U/kg heparin iv. The histological patency rates were compared. The patency rates of the control group 30 min and 3 days after the anastomosis were 100 and 83%, respectively. The respective rates for experimental groups I and II 30 min and 3 days after the anastomosis were 100% in all cases. The respective rates in experimental group III were 100 and 83%. In this study, no significant correlation was observed between the patency rate and the effects of local irrigation or the systemic application of heparin on the microvascular anastomosis of the rabbit femoral artery. However, the patency rate tended to decrease concomitantly with an increase in surgery time. Increased bleeding was observed after the systemic application of heparin. Obvious damage to the crush-injured vascular endothelium was detected on histologic examination of the micro-anastomosed area. In addition, some vessels subjected to crush injury contained thrombi attached to the vascular endothelium. No preventive effect of heparin on thrombus formation was observed.

• Journal of Chest Surgery
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• v.53 no.3
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• pp.121-126
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• 2020

Background: The aim of this study was to analyze the clinical outcomes of autogenous brachiocephalic arteriovenous fistulas and to investigate the factors associated with 1-year patency after initiation of hemodialysis. Methods: We retrospectively reviewed the medical records of 41 patients who underwent surgery to create an autogenous brachiocephalic arteriovenous fistula between January 2015 and December 2017, received hemodialysis at the same hospital for longer than 1 year, and were monitored for their vascular access status. Intraoperative flow was measured using transit-time ultrasonography. Results: The 1-year primary and secondary patency rates were 61% (n=25) and 87.8% (n=36), respectively. The functional group (subjects who required no intervention to maintain patency within the first year after hemodialysis initiation) displayed a significantly higher median intraoperative flow rate (450 mL/min) than the non-functional group (subjects who required intervention at least once regardless of 1-year patency) (275 mL/min) (p=0.038). Based on a receiver operating characteristic curve analysis, all patients were additionally subdivided into a high-flow group (>240 mL/min) and a low-flow group (≤240 mL/min). The high-flow group included a significantly greater number of functional brachiocephalic arteriovenous fistulas than the low-flow group (74.2% vs. 20%, respectively; p=0.007). Conclusion: Transit-time flow, as measured with intraoperative transit-time ultrasonography, was associated with patency without the need for intervention at 1 year after initiation of hemodialysis.

• Archives of Plastic Surgery
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• v.36 no.2
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• pp.183-187
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• 2009

Purpose: Because of the volume of elective sterilizations performed in the world during the past decade, the vasectomy was a popular method for male sterilization in Korea and this, in turn, had been followed by an increase in the number of patient requiring vasectomy reversal with the high rate of subsequent divorce and remarriage. Recently, many authors have reported high success rates of vasovasostomy using microsurgical techniques and we performed modified two layer vasovasostomy with intravasal silicone tube to increase postoperative patency and pregnacy rate. Methods: Microscopic vasovasostomy was performed in 9 patients and their average age was $35.78{\pm}1.36years$(from 28 years to 44 years) from June 2006 to June 2008 at our department using modified two layer vasovasostomy with silicone tube insertion. Standard Guibor silicone tube, consisting of two 17.7 cm, 0.064 cm diameter, malleable, stainless steel probes connected by 29 cm of silicone tubing wedged onto disposable probes, were used in all cases. Results: Success rates were 88.8 % for patency and pregnancy 44.4 % for pregnancy in modified two layer vasovasostomy with silicone tube insertion. The patency rates were higher in cases of long postoperative day and in cases of short duration of vasectomy and vasovasostomy. Conclusion: We used a modified method to correspond the patency and pregnancy rate in microscopical modified two layer vasovasostomy using the intravasal silicone tube permanently. This method brings normal patency in microsurgical vasovasostomy because the silicone tube prevent obstruction of anastomosed site of the vas permanently.

• Journal of Chest Surgery
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• v.54 no.2
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• pp.117-126
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• 2021

Background: Several factors, such as the degree of target vessel stenosis, are known to be associated with radial artery (RA) graft patency in coronary artery bypass grafting (CABG). There is a lack of data regarding the effect of the RA proximal configuration (aortic anastomosis versus T-anastomosis). This study evaluated the effects of the RA proximal configuration on the patency rate and clinical outcomes after CABG. Methods: We conducted a retrospective study, analyzing 328 patients who had undergone CABG with an RA graft. We divided the patients into 2 groups. The primary endpoint was RA patency and the secondary endpoints were overall mortality and major adverse cardiac and cerebrovascular events (MACCE). We performed a propensity score-matched comparison. Results: Aorta-RA anastomosis was performed in 275 patients, whereas the rest of the 53 patients received T-RA anastomosis. The mean age was 67.3±8.7 years in the T-RA anastomosis group and 63.8±9.5 years in the aorta-RA anastomosis group (p=0.02). The mean follow-up duration was 5.13±3.07 years. Target vessel stenosis ≥70% (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.20-0.91; p=0.03) and T-RA anastomosis configuration (HR, 2.34; 95% CI, 1.01-5.19; p=0.04) were significantly associated with RA occlusion in the multivariable analysis. However, T-RA anastomosis was not associated with higher risks of overall mortality and MACCE following CABG (p=0.30 and p=0.07 in the matched group, respectively). Conclusion: Aorta-RA anastomosis showed a superior patency rate compared to T-RA anastomosis. However, the RA proximal anastomosis configuration was not associated with mortality or MACCE.

• Journal of Chest Surgery
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• v.56 no.5
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• pp.313-321
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• 2023

Background: This study evaluated the early, 1-year, and 3-year graft patency rates and mid-term clinical outcomes after no-touch saphenous veins (NT-SVs) were used as aortocoronary grafts in coronary artery bypass grafting (CABG). Methods: In total, 101 patients who underwent CABG using NT-SVs as aortocoronary grafts were included. The 2 most common indications for performing aortocoronary grafting with NT-SVs were unavailability of the left internal thoracic artery (n=36) and moderate lesions where flow competition was expected (n=27). Early (median, 1 day; interquartile range [IQR], 1-2 days), 1-year (median, 13 months; IQR, 11-16 months), and 3-year (median, 34 months; IQR, 27-41 months) graft angiography was performed in 98 (97.0%), 84 (83.2%), and 40 patients (39.6%), respectively. The median follow-up duration was 43 months (IQR, 13-76 months). Overall survival rates and the cumulative incidence of major adverse cardiac events were evaluated. Results: The operative mortality rate was 2% (2 of 101 patients). Early postoperative patency rates for overall and aortocoronary NT-SV grafts were 98.2% (223 of 227 distal anastomoses) and 98.2% (164 of 167), respectively. The 1- and 3-year patency rates for aortocoronary SV grafts were 94.9% (131 of 138) and 90.6% (58 of 64), respectively. The overall survival rates at 5 and 10 years were 81.7% and 59%, respectively. The cumulative incidence of major adverse cardiac events at 5 and 10 postoperative years was 20.7% and 39%, respectively. Conclusion: The feasibility of using NT-SVs as aortocoronary grafts in CABG was shown in this study, based on the graft patency rates up to 3 years and the mid-term clinical outcomes.

• Journal of Chest Surgery
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• v.57 no.2
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• pp.178-183
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• 2024

Background: The superficial veins are commonly used in conventional autogenous arteriovenous fistulas and the placement of prosthetic grafts. When they are unsuitable, however, the use of the deep veins (venae comitantes) is generally considered to be a reasonable alternative. This study conducted a comparative analysis of clinical outcomes for arteriovenous grafts between 2 groups based on the type of venous outflow: superficial veins or venae comitantes. Methods: In total, 151 patients who underwent arteriovenous grafts from November 2005 to March 2022 were retrospectively analyzed. The patients were divided into 2 groups: group A (superficial veins, n=89) and group B (venae comitantes, n=62). The primary, secondary patency, and complication rates were analyzed in each group. A propensity score-matched analysis was performed. Results: In total, 55 well-balanced pairs were matched. Kaplan-Meier analysis revealed no significant differences in the primary patency rate between the 2 groups at 1-year, 3-year and 5-year intervals (group A, 54.7%, 35.9%, 25.4% vs. group B, 47.9%, 16.8%, 12.6%; p=0.14), but there was a difference in the secondary patency rate (group A, 98.2%, 95.3%, 86.5% vs. group B, 87.3%, 76.8%, 67.6%; p=0.0095). The rates of complications, simple percutaneous transluminal angioplasty, and stent insertion were comparable between the groups. Conclusion: Although this study demonstrated not particularly favorable secondary patency rates in the venae comitantes group, the venae comitantes may still be a viable option for patients with unsuitable superficial veins because there were no significant differences in the primary patency and complication rates between the 2 groups.

• Archives of Reconstructive Microsurgery
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• v.11 no.1
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• pp.63-66
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• 2002

Microvascular anastomosis is too important to reduce the failure in operating room because of no choice in case of failure and prognosis of the failure would be more worse than any other success ones. Factors for microsurgery trainee influencing patency in microvascular anastomosis at the laboratory are numerous but three basic prerequisites are magnification, instruments and suture material and training. First Author trained microsurgical technique to the second author using femoral artery of the rat and patency of the anastomosis was evaluated by the milking test. Period which microsurgeon successes femoral arterial anastomosis in rat in both of 5 and 30 minutes was 7th week at the laboratory which has done 2 vessels a week under the supervise of the skilled first author.

• Journal of Chest Surgery
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• v.33 no.6
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• pp.512-517
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• 2000

Background: Onlay vein patch coronary angioplasty has been known to be an option for coronary artery stenosis in the selective iesions Material and method: During the period between July 1997 and August 1999, coronary angioplasty using autologous saphenous vein was done on 16 sites in 14 cases for the stenotic lesion at the bifurcation area and significantly stenosis distal to anastomosis. Result: Early patency of the angioplasty site was 85.7% at postoperative day 7. There was no statistically difference in graft patency, operative parameters, and complications compared to conventional anatomosis(p>0.05). Conclusion: Despite the small number of cases, the patency rate of the coronary patch angioplasty was comparable to the conventional CABG. Coronary artery only patch angioplasty could be performed in highly selected coronary arteries.

• Journal of Chest Surgery
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• v.46 no.3
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• pp.165-177
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• 2013

This is the third in a series on coronary artery bypass which reviews three alternative arterial conduits. The radial artery has become the most widely used of the three and accumulating experience demonstrates better patency at 10 years versus saphenous vein. Drawbacks are a long incision on the forearm, the propensity for spasm and persistent sensory disturbance in about 10%. The first is answered by endoscopic harvest which may yield a shorter conduit but reduces sensory nerve injury. Spasm is managed pharmacologically and by less harvest trauma. The gastroepiploic artery is used in situ and free and although the abdominal cavity is entered complications are minimal and patency compares favorably with the radial artery. Use of the inferior epigastric artery remains minimal and its similar length often requires composite use but limited patency data are supportive. Other arteries have had rare use and this is unlikely to change because the three presented here have significant advantages and acceptance.

• Journal of Chest Surgery
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• v.40 no.8
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• pp.546-551
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• 2007

Background: The radial artery is gaining widespread acceptance as complementary arterial conduits for surgical myocardial revascularization, but there have been limited reports about its angiographic patency compared with that of internal thoracic artery or saphenous vein. We tried to evaluate angiographic patency of radial artery graft and to compare that of radial artery and other gratis with retrospective manner. Material and Method: From January 2001 to Jure 2006, totally 132 patients (male 92, female 40) who underwent coronary artery bypass graft using radial artery were re-admitted to our hospital for follow up angiographic examination. Mean age was 58.2+8.87 and mean follow up duration was 32 month ($2{\sim}110$ month). Off pump and on pump bypass surgery were performed 74 and 58 patients respectively. Along with radial artery, left internal thoracic arteries were used in 57 cases, concomitant left internal thoracic artery and saphenous veins were used in 47 cases and bilateral internal thoracic arteries were used in 20 cases. Result: Totally 412 distal anastomosis were performed and 376 anastomosis remained patent (91.2%). Left internal thoracic artery showed the most excellent patency in all of the conduits (98.5%). Radial artery graft patency was 90.8% (169/186). There was no statistical difference of the patency by conduit between on-pump and off-pump group. But radial artery showed more higher patency rate (98/110, 89%) in the severe stenotic lesion that preoperatively revealed more than 90% stenosis than in the lesser severe (<90%) stenotic lesion (60/76, 78%)(p < 0.005). Radial artery conduit represented the worst result when it was grafted in the right coronary system. But when it was positioned in the left heart especially diagonal or obtuse marginal area, patency was comparable with left internal thoracic artery. Conclusion: Radial artery graft showed good midterm patency when it was used in the severe stenotic lesion more than 90% and left coronary system. But great notice should be taken when it is grafted in the right coronary system or less severe stenotic lesion.