• Archives of Plastic Surgery
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• v.32 no.1
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• pp.124-130
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• 2005

In the microsurgical era, replantation with microvascular anastomosis is considered as the most superior method in aspects of texture, color, shape in case of nose amputation. There are some reported cases of replantation in nose amputation historically, but most of them are composite graft cases rather than microvascular anastomosis. Only a few cases of successful nasal replantation with microvascular anastomosis have been reported due to the reason that the size of vessels is usually very small and identifying suitable vessels for anastomosis is difficult. Microanastomosis of artery and microanastomosis of vein are ideal in replantation, but identifying suitable veins is often difficult. Without venous anastomosis, resolving the venous congestion remains to be a problem. We can carry out arteriovenous shunt if we can find two arteries in amputee. However, the smaller the size of amputee is, the more difficult it is to find two arteries. Instead of arteriovenous shunt, we can try external venous drainage(frequently swab, pin-prick, stab incision, IV or local heparin injection, dropping, apply of heparin-soaked gauze, use of medical leech). Here, we present three cases of replantation with microscopical arterial anastomosis (one angular artery, two dorsal nasal arteries) and external venous drainage (stab incision, application of medical leech and heparin-soaked gauze) even though the size of amputee may be as small as $1.5{\times}1.0cm$. In all cases, surgical outcomes were excellent in cosmetic and functional aspects. This report describes successful replantation by microvasular anastomosis in case that suitable veins are not found.

• Journal of Trauma and Injury
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• v.37 no.3
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• pp.182-191
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• 2024

Purpose: Vascular injuries require immediate surgical treatment with standard vascular techniques. We aimed to identify pitfalls in vascular surgery for trauma team optimization and to suggest recommendations for trauma and vascular surgeons. Methods: We reviewed 28 victims and analyzed the patterns of injuries, methods of repair, and outcomes. Results: Ten patients had torso injuries, among whom three thoracic aorta injuries were repaired with thoracic endovascular aortic repair, one left hepatic artery pseudoaneurysm with embolization, and two inferior vena cava with venorrhaphy, three iliac arteries with patch angioplasty or embolization, and three common femoral arteries with bypass surgery or arterioplasty. Four patients had upper extremity injuries, among whom one brachial artery and vein was repaired with bypass surgery after temporary intravascular shunt perfusion, two radial arteries were repaired with anastomoses, and one ulnar artery was repaired with ligation. One radial artery under tension was occluded. Fourteen patients had lower extremity injuries, among whom one superficial femoral artery and vein was repaired with bypass and concomitant ligation of the deep femoral artery and vein, three superficial femoral arteries were repaired with bypass (two concomitant femoral veins with bypass or anastomosis), one deep femoral artery with embolization, two popliteal arteries with bypass or anastomosis, four infrapopliteal transected arteries, one arteriovenous fistula with ligation, and one pseudoaneurysm with bypass. However, one superficial femoral artery and all femoral veins were occluded. One leg replantation failed. Conclusions: There are potential complications of vascular access during resuscitative endovascular balloon occlusion of the aorta procedures. Vascular repair should be performed without tension or spasm. Preservation of the harvested vein in papaverine solution and blood while using a temporary intravascular shunt is a method of eliminating spasms.

• Journal of Chest Surgery
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• v.31 no.7
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• pp.650-659
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• 1998

Between August 1996 and August 1997, 22 patients underwent extracardiac Fontan operations. The basic diagnoses included univentricular heart of the right ventricular type (n=12); univentricular heart of the left ventricular type (n=4); tricuspid atresia (n=4); left isomerism, transposition of great arteries, ventricular septal defect and pulmonary stenosis (n=1); and criss-cross heart with uneven ventricle (n=1). The median age of the 14 men and 8 women was 29 months (range from 21 months to 26 years). Previous procedures included bidirectional cavopulmonary shunt (n=15, interval=15.6$\pm$3.4 months), Kawashima operation (n=4, interval=37.5$\pm$20 months), and classic Glenn shunt (n=1, interval=14 years). In 2 patients, extracardiac Fontan operations were done without any previous procedures. A 16- to 22-mm flexible Gore-Tex tube graft (n=18), Hemashield graft (n=3), or, alternatively, a nonvalved aortic allograft (n=1) was cut and anastomosed end-to-end between inferior vena cava and undersurface of pulmonary artery using Gore-Tex or Prolene suture in a running fashion. In risk Fontan patients (n=12), a communication between the extracardiac conduit and the right atrium was constructed. In the most 13 recent patients, the procedures were done without cross-clamping of the aorta and with a beating heart. Operative mortality was 9.1% (n=2). Complications included persistent chest tube drainage for more than 7 days (n=5), chorea (n=2), and low cardiac output (n=1). There were no late deaths. Follow-up echocardiogram (mean: 6 months) demonstrated satisfactory hemodynamic results in the surviving 20 patients. Potential advantages of this technique consist of minimization of surgical manipulation of atrial tissue, reduction or elimination of myocardial ischemia, creationof a uniform and stable inferior vena cava-to-pulmonary artery conduit, and increased flexibility and safety in certain high-risk patients such as those with increased pulmonary vascular resistance, pulmonary hypertension, and impaired ventricular function. Further investigations during a longer follow-up are needed to confirm the intermediate and long-term results, especially the reduction of late atrial arrhythmias.

• Journal of Chest Surgery
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• v.39 no.9 s.266
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• pp.692-698
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• 2006

Background: Owing to the fact that the average life span has increased and the progress in medical science has been made, the number of patients with chronic renal failure (CRF) who have to take hemodialysis (HD) has been going up gradually. Accordingly, it is considered to be as a significant issue to obtain blood vessels which can be used repetitively and supply enough blood flows. Therefore, there have been various kinds of study on an inosculation rate andfactors influencing it following an arteriovenous fistula (AV fistula) and lots of studies are ongoing for the purpose of escalating the inosculation rate. The authors analyzed the effects of short-term result, age, sex, diabetes and hypertension on arteriovenous inosculations in 134 anatomical snuffbox operated subjects among the patients who have taken an AV fistula at this center. Material and Method: Based on 134 patients who underwent an AV fistula at the department of thoracic surgery of this center from July, 2000 to May, 2004, the difference in arteriovenous inosculation rate was compared and analyzed depending or age (discriminated by 65-year-old), sex and the condition of the presence or absence of diabetes and hypertension. Correlation analyses were conducted for each parameter and statistical tests were performed by using SPSS for windows Release 11.0.1, which were determined to be statistically significant if p value was below 0.05. Result: The total number of operations was 169 including 35 of re-operations. The male/female rate was 70 : 64 (52% : 48%). The average age was $56.3{\pm}12.26$ years and there were 33 (24%) old aged patients above 65-year-old; there were 103 (71%) patients with hypertension and 90 (67%) patients with diabetes. Overall arteriovenous inosculation rate was $93{\pm}2.4%,\;91{\pm}2.7%,\;89{\pm}3.0%$ at 6, 12, 24 months, respectively. The arteriovenous inosculation rate of above 65-year-old patient group was $85{\pm}4.8%,\;80{\pm}5.8%,\;80{\pm}5.8%$ and below 64-year-old patient group's was $85{\pm}4.8%,\;80{\pm}5.8%,\;80{\pm}5.8%$ at given time points, respectively, which showed higher inosculation rate in below 64-year-old patient group with a statistical significance (p=0.0034). However, no statistical significance was found between the patients with hypertension and diabetes and the patients with no complication. In addition, there was no statistical significance in inosculation rate between male and female. Conclusion: The arteriovenous inosculation ratewas higher in the treated patient below 64-year-old than in the treated patient above 65-year-old. Thus it is advantageous for increase in long-term inosculation rate to obtain hemodialysis routes at an early age. The conditions of sex and the presence or absence of diabetes and hyper- tension do not make statistically significant effect on the arteriovenous inosculation rate.

• Journal of Chest Surgery
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• v.37 no.2
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• pp.154-159
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• 2004

The arteriovenous fistula (AVF), which maintains satisfactory blood flow, is necessary to the patients of end-stage renal disease for the long term hemodialysis. We performed the snuffbox fistula as the first operation for hemodialysis vascular access. This study was performed to investigate the patency rates, complications, risk factors for occlusion of the AVF, and the types of reoperations. Material and Method: We performed 146 snuffbox fistulas from Jun. 1994 to Dec. 2001 The records of the patients except six patients who were lost from follow up were analyzed retrospectively, Mean age and male:female ratio were 52$\pm$15 years (range, 17∼79 years) and 80 : 60 respectively. Diabetes mellitus and hypertension were combined in 47 patients and 101 respectively. Preoperative levels of creatinine and potassium were 9.09$\pm$3.68 mg/dL (range, 2.55∼20.09 mg/dL) and 4.7$\pm$0.9 mmol/L (range, 2.3∼8.1 mmol/L). One hundred thirteen cases of the snuffbox fistulas were done at left side hand and the others at right hand. Result: Mean follow up period of the patients was 41.8$\pm$31.0 months (range, 0.2∼108,8 months). During the follow up period, 35 occlusions of AVF occurred and these AVFs were patent for 9.8$\pm$10.1 months (range, 0.1∼40.4 months). The patency rates of f month, and 1, 2, 3, 5 years were known as 92.8, 80.2, 73.8, 71.3, 69.6% respectively. Right sided snuffbox fistulas (p-value=0.045) and old age (p-value=0.048) were revealed as significant risk factors for occlusion of AVF. The postoperative complications consisted of occlusions of AVF caused by intimal hyperplasia of vein in 24, thrombosis in nine, stenosis of anastomosis site in three, and venous hypertensions in two. After the first operation 37 patients underwent 86 reoperations. Conclusion: The snuffbox fistulas showed acceptable patency rates and low complication rates. The snuffbox fistulas as the first operation for AVF formation can be a good option for the patients with end-stage renal disease.

• Journal of Chest Surgery
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• v.42 no.5
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• pp.677-683
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• 2009

May-Thurner syndrome is a deep vein thrombosis of the ilio-femoral vein due to compression of the left common iliac vein by the overlying right common iliac artery. Although, catheter directed thrombectomy (CDT) and thrombolysis with stent insertion has become the standard treatment method for acute or subacute May-Thurner syndrome, because of technical feasibility and lower recurrence rate, however, sometimes this methods make fatal complications. Furthermore, there are few reports on optimal treatment strategies for patients in a chronic state of May-Thurner syndrome. We now present two cases of chronic (> 1 month since onset of symptoms) May-Thurner syndrome treated by surgical thrombectomy and femoral arteriovenous shunt with simultaneous stent insertion after failed endovascular treatment. This technique may provide a significant benefit for patients who are not suitable for conventional endovascular treatment.