• Journal of Chest Surgery
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• 제43권6호
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• pp.648-654
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• 2010

배경: 급성 B형 대동맥 박리 환자들에게 시행한 혈관 내 스텐트-그라프트 치료의 초기 성적 및 대동맥 벽의 변화에 대해서 알아보고자 하였다. 대상 및 방법: 2008년 7월부터 2009년 5월까지 본원을 방문한 급성 B형 대동맥 박리 환자들을 대상으로 혈관 내 스텐트-그라프트를 13일 이전에 삽입하였다. 수술전과 수술 후 약 6개월에 혈관조영 컴퓨터 단층촬영을 시행하였고 하행 대동맥을 근위부, 중위부 그리고 원위부로 나눈 뒤 각 부위별로 진성내강과 가성내강 그리고 대동맥 전내강의 내경을 비교 분석하였다. 결과: 남녀 비는 4:1이였으며 평균나이는 $59.4{\pm}20.1$세 (37~79세)였다. 수술 전에 혈관조영 컴퓨터 단층촬영을 시행하였으며 수술 후 7일 후와 6개월에 추적검사를 시행하였다. 5명 모두에게 일차성 내막 파열(primary entry tear)의 폐쇄가 완벽하게 이루어 졌으며 신경학적 후유증이나 말초의 허혈은 관찰되지 않았고 수술로 인한 사망은 없었다. 진성내강의 변화는 근부위에서 수술 전 20.4 mm에서 33.5 mm로 증가하였으며 중위부와 원위부에서도 각각, 19.5 mm에서 29.8 mm, 15.2 mm에서 23.5 mm로 증가하였으며 (p<0.05), 가성내강의 변화는 근위부에서 18.7 mm에서 0 mm로 감소하였고 중위부와 원위부에서도 감소하는 추세로 관찰되었다. 대동맥 전내강의 변화는 수술 전 보다 수술 후 증가하였다(p<0.05). 3명의 환자에서 6개윌 후 가성내강의 완벽한 소실이 관찰되었고 2명의 환자에게서는 복부대동맥 부위에서 가성대동맥이 지속적으로 관찰되었다. 결론: 급성 B형 대동맥 박리 환자들에게 시행한 혈관 내 스텐트-그라프트의 초기 결과는 매우 효과적이였으며 스텐트-그라프트 삽입 후 대동맥 벽의 변화 역시 매우 긍정적이라 할 수 있겠다.

• Journal of Chest Surgery
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• 제43권1호
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• pp.92-95
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• 2010

고위험군의 대동맥 질환 환자에서 고전적인 수술에 대한 대안책으로서 혈관내 스텐트 그라프트를 고려할 수 있다. 본원에서는 유방암에 대한 항암 방사선 치료로 인한 전 흉부 괴사와 그에 따른 상행 대동맥 파열이 발생한 79세 여자 환자에 대해 혈관내 스텐트 그라프트를 이용하여 효과적으로 치료하였기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제52권5호
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• pp.335-341
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• 2019

Background: The endovascular approach to aortic disease treatment has been increasingly utilized in the past 2 decades. This study aimed to determine the long-term results of using the Seal thoracic stent graft. Methods: We retrospectively reviewed the outcomes of patients who underwent thoracic endovascular aortic repair or a hybrid procedure using the Seal thoracic stent graft (S&G Biotech, Seongnam, Korea) from January 2008 to July 2018 at a single institution. We investigated in-hospital mortality and the incidence of postoperative complications. We also investigated the mid-term survival rate and incidence of aorta-related complications. Results: Among 72 patients with stent grafts, 15 patients underwent the hybrid procedure and 21 underwent emergency surgery. The mean follow-up period was $37.86{\pm}30.73$ months (range, 0-124 months). Five patients (6.9%) died within 30 days. Two patients developed cerebrovascular accidents. Spinal cord injury occurred in 2 patients. Postoperative renal failure, postoperative extracorporeal membrane oxygenation support, and pneumonia were reported in 3, 1, and 6 patients, respectively. Stent-related aortic complications were observed in 5 patients (6.8%). The 1- and 5-year survival and freedom from stent-induced aortic event rates were 81.5% and 58.7%, and 97.0% and 89.1%, respectively. Conclusion: The use of the Seal thoracic stent graft yielded good mid-term results. Further studies are needed to examine the long-term outcomes of this device.

• Journal of Trauma and Injury
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• 제28권4호
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• pp.232-240
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• 2015

Purpose: Thoracic aortic injury is a life-threatening injury that has been traditionally treated by using surgical management. Recently, thoracic endovascular aortic repair (TEVAR) has been conducted pervasively as a better alternative treatment method. Therefore, this study will focus on analyzing the outcome of TEVAR in patients suffering from a blunt thoracic aortic injury. Methods: Of the blunt thoracic aortic injury patients admitted to Eulji University Hospital, this research focused on the 11 patients who had received TEVAR during the period from January 2008 to April 2014. Results: Seven of the 11 patients were male. At the time of admission, the mean systolic pressure was $105.64{\pm}24.60mm\;Hg$, and the mean heart rate was $103.64{\pm}20.02per$ minute. The median interval from arrival to repair was 7 (4, 47) hours. The mean stay in the ICU was $21.82{\pm}16.37hours$. In three patients, a chimney graft technique was also performed to save the left subclavian artery. In one patient, a debranching of the aortic arch vessels was performed. In two patients, the left subclavian artery was totally covered. In one patient whose proximal aortic neck length was insufficient, the landing zone was extended by using a prophylactic left subclavian artery to left common carotid artery bypass before TEVAR. There were no operative mortalities, but a patient who was covered of left subclavian artery died from ischemic brain injury. Complications such as migration, endovascular leakage, collapse, infection and thrombus did not occur. Conclusion: Our short-term outcomes of TEVAR for blunt thoracic aorta injury was feasible. Left subclavian artery may be sacrificed if the proximal landing zone is short, but several methods to continue the perfusion should be considered.

• Investigative Magnetic Resonance Imaging
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• 제16권2호
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• pp.159-168
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• 2012

흉부대동맥류는 좌측 쇄골하동맥에 가까이 위치해 있어서 흉부대동맥내치료를 시행할 때 좌측 쇄골하동맥의 폐색이 불가피한 경우가 많다. 좌측 쇄골하동맥 폐색의 안전성과 좌측 쇄골하동맥 재생술의 필요성에 대해 논란이 계속되고 있음에도 불구하고, 좌측 쇄골하동맥의 폐색후 뇌혈류역학적인 변화에 대한 기존의 체계적인 연구는 없었다. 저자들은 좌측 쇄골하동맥폐색을 동반한 흉부대동맥내치료의 대상이 되는 2명의 환자에서 치료 전후의 2차원 위상차 대조 자기공명영상을 시행하였다. 좌측 쇄골하동맥의 폐색 후 좌측 쇄골하도주가 발생하였으며, 이로 인한 뇌혈류의 소실을 양측 경동맥과 주된 부행혈류인 오른쪽 추골동맥이 적절하게 보상하였다. 전체 뇌혈류는 감소하지 않았으며 이는 임상적으로 뇌졸증이나 척수마비의 증상이 나타나지 않은 것과 잘 일치하였다. 2차원 위상차 대조 자기공명영상은 좌측 쇄골하동맥 폐색을 동반한 흉부대동맥내치료의 뇌혈류역학적인 평가와 좌측 쇄골하동맥 재생술이 필요한 환자의 선별에 유용할 것으로 사료된다.

• Journal of Chest Surgery
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• 제48권2호
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• pp.139-141
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• 2015

The aetiology, incidence and management of type II endoleaks in standard infrarenal endovascular aortic aneurysm repair is well described. Far less data is available for thoracic stent grafting. We present a rare and interesting case of a type II endoleak post thoracic aortic stenting and highlight the aberrant anatomy that can cause this phenomenon in such cases.

• Journal of Chest Surgery
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• 제57권5호
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• pp.419-429
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• 2024

The frozen elephant trunk (FET) technique can be applied to extensive aortic pathology, including lesions in the aortic arch and proximal descending thoracic aorta. FET is useful for tear-oriented surgery in dissections, managing malperfusion syndrome, and promoting positive aortic remodeling. Despite these benefits, complications such as distal stent-induced new entry and spinal cord ischemia can pose serious problems with the FET technique. To prevent these complications, careful sizing and planning of the FET are crucial. Additionally, since the FET technique involves total arch replacement, meticulous surgical skills are essential, particularly for young surgeons. In this article, we propose several techniques to simplify surgical procedures, which may lead to better outcomes for patients with extensive aortic pathology. In the era of precision medicine, the next-generation FET device could facilitate the treatment of complex aortic diseases through a patient-tailored approach.

• 대한신경집중치료학회지
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• 제11권2호
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• pp.148-151
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• 2018

• Journal of Chest Surgery
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• 제54권5호
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• pp.425-428
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• 2021

Aortobronchial fistula (ABF) induced by an infected pseudoaneurysm of the thoracic aorta is a life-threatening condition. As surgical treatment is associated with significant mortality and morbidity, thoracic endovascular aneurysm repair (TEVAR) may be an alternative for the treatment of ABF. However, the long-term durability of this intervention is largely unknown and the recurrence of ABF is a potential complication. We experienced a case of recurrent ABF after stent grafting as an early procedure for an infected pseudoaneurysm of the thoracic aorta. Remnant ABF, bronchial and/or aortic wall erosion, vasa vasorum connected with ABF, and recurrent local inflammation of the thin aortic wall around ABF might cause recurrent hemoptysis. As a result, we suggest that TEVAR should be considered as a bridge therapy for the initial treatment of ABF resulting from an infected pseudoaneurysm, and that several options, such as second-stage surgery, should be considered to prevent the recurrence of ABF.

• Journal of Chest Surgery
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• 제50권5호
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• pp.407-410
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• 2017

Traumatic chylothorax after blunt chest trauma alone is considered rare. Our patient was a 27-year-old female who was in a motorcycle accident and sustained blunt thoracic and traumatic thoracic aortic injuries with T1-T2 vertebral subluxation. She underwent thoracic endovascular aortic repair from T4 to T9 without any thoracic or spinal surgery. On postoperative day 7, the drainage from her left chest turned into a milky-white fluid indicative of chyle leakage. The patient was treated conservatively for 2 weeks and then the chest drain was safely removed. The results show that traumatic chylothorax can be successfully managed with conservative treatment.