• Journal of Chest Surgery
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• v.54 no.3
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• pp.221-223
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• 2021

Giant coronary artery aneurysms are rare and challenging to treat because of variation in the presenting symptoms and the lack of established management guidelines. We report the case of a patient with a 6-cm-wide giant coronary artery aneurysm that was resected, followed by reconstruction using a saphenous vein graft and 18 years of follow-up.

• Journal of Chest Surgery
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• v.12 no.3
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• pp.297-305
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• 1979

Occlusive coronary artery disease presents a potential threat to a significant population in the United States. According to many case reports, the increasing incidence of coronary artery disease due to atherosclerosis is noted in Korean, recently. Operative vascular procedures have increased steadily in number over the past 20 years in the United States. There have been many isolated case reports about coronary artery surgery, but these had little clinical impact. Nowadays, major three coronary bypass surgery has developed principally at three cardiac centers in the United States since 1967. Among three coronary bypass operation, the aorta-coronary artery saphenous vein bypass graft was first demonstrated by Favolaro and Effler at the Cleveland Clinic in 1967. We experienced one case of coronary artery disease, which was treated successfully by aorta-coronary saphenous vein graft with mild hypothermia under extracorporeal circulation in May, 1977. Saphenous vein was removed from above the knee and was 2.5 mm in diameter. The left ventricle was not vented for the left ventricle was not overdistended. Temporary artificial pace-maker-Medtronic-was implanted for the prevention and treatment of post-operative arrhythmia and heart block in post-operative first day. He is a 57 year old male businessman who had been suffered from hypertension [200 mmHg in systolic pressure] since 4 years ago, who had intermittent conservative treatment at local clinic. He had been afflicted with severe chest pain with choking sensation for 50 days. This symptom was aggravated exposing cold weather, or cold water, but was respond to rest. Pre-operative ECG revealed no any other ischemic sign except sinus bradycardia. Significant S-T segment depression was noted at lead II, AVF after double 5 minutes exercise, indicating positive Master`s test. Serum cholesterol was slight elevated to 253 mg/dl. Final pre-operative diagnosis was made by coronary arteriogram, which showed about 1.0-cm segmental 90 % occlusive atherosclerotic lesion in the proximal part of right coronary artery above the origin of acute marginal artery. Left coronary artery revealed good patency and there was no collateral circulation between right and left coronary artery .Hospital course was not eventful. He was discharged with good result on the post-operative day. He has been free from chest pain for longer than 2 years. And also the arterial flow in the coronary bypass graft is auscultated with the pocket-sized ultrasonic velocity detector, which shows the patency of the coronary bypass graft good.

• Journal of Chest Surgery
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• v.30 no.12
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• pp.1190-1196
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• 1997

Between July 1994 and August 1995, 78 patients underwent coronary artery bypass graft at Seoul National University Hospital. Coronary angiogram was performed one year after coronary artery bypass graft in 49 patients(62.8%) for evaluation of the graft patency and analysis of the risk factors for graft occlusion. The patency rates of both the internal mammary artery and the radial artery grafts were 100% , although three internal mammary artery grafts(5.0%) were narrowed(string sign). And that of the saphenous vein grafts were 85.2%. Multivariate analysis for the preoperative, operative, and postoperative factors was done between the widely patent and the narrowed internal mammary artery graft groups, and between the patent and the occluded saphenous vein graft groups by the general linear models procedure. Patient's age($\geq$60 years), postoperative intraaortic balloon pump insertion, bleeding, and acute renal failure were found to be the significant risk factors for internal mammary artery graft narrowing, and coronary artery size(< 1.5 mm) was the significant risk factor for the saphenous vein graft occlusion (p<0.05) . This study confirms that the arterial graft is superior to the vein graft at one-year patency rate, and suggests the risk factors for graft occlusion during the first postoperative year. Knowledge of this study may provide a basis for estimating the risk factors for graft occlusion, and thereby modifying surgical strategy and postoperative surveillance.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.344-347
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• 1997

A 49-year-old female patient who had obstruction of superior vents cave(SVC) with SVC syndrome was successfully managed by bypass operation of superior vents cava with spiral vein graft. A composite spiral vein graft was placed between the right innominate vein and the right atrium to bypass the occluded SVC. The graft was constructed from the patient's own saphenous vein, which was split longitudinally and wrapped around a stent in spiral fashion and the edges of the vein were sutured together to form a large autogenous conduit. The patient was relieved o SVC obstructive symtoms and signs and discharged 21 days postoperatively without any complication.

• Journal of Chest Surgery
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• v.49 no.5
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• pp.387-391
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• 2016

The dehiscence of saphenous vein grafts (SVGs) is a rare, often fatal, complication of coronary artery bypass grafting (CABG). We present the case of a 57-year-old man who underwent hemiarch graft interposition and CABG for a Stanford type A aortic dissection. Five months after discharge, the patient developed streptococcal sepsis caused by a hemodialysis catheter. Complete rupture of the proximal anastomoses of the saphenous veins and containment by the obliterated pericardial cavity was observed 25 months after the initial operation. The patient was successfully treated surgically. This report describes a patient who developed potentially fatal dehiscence of SVGs secondary to infection and outlines preventive and management strategies for this complication.

• Journal of Chest Surgery
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• v.46 no.4
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• pp.265-273
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• 2013

Background: The safety and efficacy of arterial composite grafts for total arterial revascularization have been demonstrated. The saphenous vein (SV) is a widely used graft because of its accessibility, sufficient length, and ease of manipulation. Our aim was to compare mid-term outcomes of saphenous vein Y-grafts with radial artery Y-grafts joined by anastomosis to the left internal thoracic artery. Materials and Methods: Records of off-pump coronary artery bypass grafting with composite Y-grafts based on the left internal thoracic artery technique in 552 patients were analyzed retrospectively. After propensity score matching, 79 radial arterial (RA) composite grafts (RA group) and 79 saphenous vein composite grafts (SV group) were compared. The duration of mean follow-up was $24.6{\pm}14.6$ months (range, 1 to 55 months). Results: There were no differences in surgical mortality, all-cause mortality, or morbidity among the groups. Rates of 4-year survival were 91.7% and 96.3% in the RA and SV groups, respectively (p=0.519). The coronary reintervention-free survival rate and freedom from major adverse cardiovascular or cerebrovascular events were similar in the two groups (p=0.685, p=0.564). Conclusion: Construction of composite Y-grafts using the radial artery or saphenous vein showed similar mid-term results. Long-term follow-up and randomized trials will be needed to confirm our present conclusions.

• Archives of Plastic Surgery
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• v.50 no.6
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• pp.568-572
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• 2023

Cutaneous squamous cell carcinoma (CSCC) overlying an arteriovenous fistula (AVF) is rare and presents unique challenges. This case report describes a method of fistula preservation after CSCC excision using a flow-through venous free flap. The saphenous vein of the venous flap was used as flow-through segment for AVF preservation. The flap was inserted along the dorsal aspect of the forearm wound and microvascular anastomosis of the arterial inflow was completed using a vein just proximal to the radiocephalic fistula anastomosis. Venous outflow was established by creating an end-to-end vascular anastomosis between the cephalic vein and the greater saphenous vein. A separate subcutaneous vein was used to provide a low-pressure outflow for the flap to avoid congestion. This case demonstrates an option for AVF preservation that has not been previously described. It also highlights the importance of a multidisciplinary approach for the safe treatment of CSCCs overlying AVFs.

• Journal of Chest Surgery
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• v.43 no.2
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• pp.127-132
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• 2010

Background: Femoropopliteal artery bypss grafting is an effective form of treatment for infrainguinal artery occlusive disease in those patients who have either intermittent claudication or resting critical ischemia. The objective of this analysis was to evaluate the long-term patency of a femoropopliteal bypass graft that is classified as an above-the-knee saphenous vein graft or an above-the-knee PTFE (polytetrafluoroethylene) graft. Material and Method:From January 1998 to February 2005, 103 above-the-knee femoro-popliteal bypasses were performed on 87 patients. There were 74 male and 13 female patients with a mean age of $65.7{\pm}9.69$ (range: 31~82). The surgical indications were intermittent claudication in 65 cases (74.7%), foot ulceration in 2 cases (2.3%), foot necrosis in 10 ases (11.5%) and toe necrosis in 10 cases (11.5%). For the bypass graft, a reversed saphenous vein was used in 31 limbs and a polytetrafluoroethylene (PTFE) prosthesis was used in 72 limbs (6 mm: 27 limbs, 8 mm: 45 limbs). The perioperative risk factors were diabetes mellitus in 33 cases (37.9%), hypertension in 47 cases (54.0%), a history of ischemic heart disease in 13 cases (14.9%) and smoking in 72 cases (82.8%). Result:There were three perioperative deaths (3.4%) and seven late deaths (8.3%). Major leg amputation was necessary in 12 patients (13.8%) during the entire course of the study. The primary patency rate at 5 years for the vein grafts, the 8 mm-PTFE grafts and the 6 mm-PTFE grafts were 84.7%, 77.4% and 74.2%, respectively and the overall primary patency rate was 78.7%, and there were no significant statistical differences among the graft groups. By using multivariate analysis, the number of patent tibial arteries was determined to be a significant factor that influenced the primary graft patency rate (p<0.005), but risk factors such as diabetes mellitus, ischemic heart disease, smoking and age had no statistically significant affect on the primary graft patency rates. Conclusion: The great saphenous vein is considered the most durable conduit for infrainguinal revascularization, but the overall results of this study show that saphenous vein and PTFE grafts have comparable patency rates when used above the knee in patients with claudication or critical ischemia. The use of PTFE above the knee is a reasonable alternative for a femoro-poplitael bypass and it is associated with acceptable long term patency rates.

• Journal of Chest Surgery
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• v.19 no.3
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• pp.412-420
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• 1986

From 1968 through September 1986, the authors have experienced 34 cases of peripheral arterial surgery using various vascular grafts. Almost all patients [32] were men, and age distribution was variable according to the disease entities. There were twenty eight cases of chronic occlusive peripheral vascular disease including ASO [21], Buerger`s disease [6], Aortoenteric fistula complicating infrarenal abdominal aortic aneurysm [1], four cases of vascular trauma, one case of acute arterial embolism [1] and one case of unknown etiology. The indications of operations for chronic vascular disease was intermittent claudication in 48%, rest pain in 45%, ischemic pregangrene or gangrene in 28%, and sensory change in 10% of patients. Types of operation used were arterial bypass in 28 cases [Aortobifemoral in 5, Aortoiliac in 3, Aortofemoral in 4, Aortoiliac with Aortofemoral in 1, Femorofemoral in 1, Femoropopliteal in 8, Femoroperoneal in 2, Axillofemoral in 3 cases of patients], graft interposition in four and patch angioplasty in three cases. Thirty four prosthetic vascular grafts including Dacron, Gore-Tex, Nylon and two autogenous saphenous vein graft and patch were used for vascular reconstruction in thirty four patients. Unfortunately recently performed one vein bypass was failed immediate postoperatively due to severity of disease and poor case selection. The authors experienced five post operative complications: wound infection [1], graft infection [1], bleeding [1], great saphenous neuralgia [1], pseudoaneurysm [1]. Twenty two of thirty four patients were followed up for more than one month and their cumulative patency rate was 81% [17/22] at 1 month and, 31% [7/22] at 5 month.

• Archives of Plastic Surgery
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• v.33 no.5
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• pp.536-540
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• 2006

Purpose: The soft tissue injuries of the patellar area are difficult problems because of insufficient arterial blood supply and lack of muscle layer. There have been many methods for reconstructing the soft tissue injuries of the patellar area such as primary closure, skin graft, local flap and free tissue transfer. However, each method has some limitations in their application. After the first introduction, the fasciocutaneous flaps are widely used to reconstruct the soft tissue injuries. The saphenous nerve, one of the superficial sensory nerves in the lower leg, is supplied by the saphenous artery and its vascular network. We used the saphenous fasciocutaneous island flap to reconstruct the soft tissue injuries of the patellar area. Methods: From March 2002 to May 2005, we used the saphenous fasciocutaneous island flap to reconstruct the soft tissue injuries of the patellar area. The flap was elevated with saphenous nerve, saphenous vein and saphenous artery and its vascular network. The flap donor site was reconstructed with primary closure or split-thickness skin graft. Results: Five cases survived completely but 1 case developed partial necrosis of the skin on the upper margin of the flap. However, the necrosis was localized on skin layer, and we reconstructed with debridement and split-thickness skin graft only. After the operation, there was no contracture or gait disturbance in any patient. Conclusion: In conclusion, the saphenous fasciocutaneous island flap is safe, comfortable and effective method to reconstruct the soft tissue injuries of the patellar area.