• Journal of Chest Surgery
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• 제16권3호
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• pp.362-367
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• 1983

Pulmonary arteriovenous fistula is a congenital malformation resulting from errant capillary development, with incomplete formation or disintegration of the vascular septa that normally divide the primitive connections between the venous and arterial plexuses. It generally occurs as part of the disorder known as hereditary hemorrhagic telangiectasia [Rendu-Osler-Weber disease]. The hereditary lesion is transmitted as a simple non-sex-linked dominant trait. It may be single or multiple, too small to see on plain chest films or large and easily recognized. One third of the lesions are multiple on plain chest film. The pathogenesis of its symptoms is that unoxygenated, desaturated arterial blood enters into the pulmonary venous system, directly. Recently we have experienced a case of the pulmonary arteriovenous fistula in 26 years old male soldier, which was confirmed by pulmonary angiography preoperatively. 2 thumb-tip sized, well circumscribed cystic masses filled with bright red colored blood were seen in subpleural and anterolateral portion of the right upper lobe. Right upper Iobectomy was performed due to close approximation of the fistula with pulmonary vein. Microscopically, it shows angiomatous dilatation of the abnormal vessels embedding in the parenchyma. Postoperative physiologic studies show nearly normal arterial oxygen saturation, hemoglobin and RBC count. There was good, uneventful postoperative course.

• Journal of Chest Surgery
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• 제19권3호
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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.

• Journal of Chest Surgery
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• 제54권1호
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• pp.31-35
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• 2021

Background: Arteriovenous fistula (AVF) for hemodialysis is essential for patients with end-stage renal disease. However, it is difficult to maintain AVF reliably. It is vitally important to select proper blood vessels for AVF formation. In a previous study, a minimum diameter of 3 mm for the autologous vein was proposed. However, patients who did not meet the minimum vascular diameter before anesthesia, but fulfilled other criteria, showed satisfactory venous dilatation after brachial plexus block (BPB). This study investigated the extent of vein expansion by BPB and the surgical outcomes of dilated veins after BPB. Methods: Sixty-one patients who underwent AVF formation using an autologous vein between August 2018 and December 2019 were included in the study. The clinical characteristics of the patient groups, hemodynamic parameters including the diameter of blood vessels before and after BPB, and complications were investigated. Based on the venous diameter measured by sonography before anesthesia, patients were divided into group A (26 patients) and group B (35 patients), with venous diameters <3 mm and ≥3 mm, respectively. Results: The venous diameter expanded after anesthesia by 41% overall, by 62% in group A, and by 25% in group B. This difference between groups A and B was statistically significant (p=0.001). No other variables showed statistically significant differences. Conclusion: Sufficient venous dilatation was observed after BPB. Therefore, if the vein is sufficiently dilated after BPB, even in patients with a pre-anesthesia venous diameter <3 mm, surgery may still be performed with an expected desirable outcome.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제26권1호
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• pp.85-96
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• 2024

Objective: Congenital intracranial pial arteriovenous fistula (PAVF) is a rare cerebral vascular pathology characterized by a direct shunt between one or more pial feeding arteries and a cortical draining vein. Transarterial endovascular embolization (TAE) is widely considered first line therapy. Curative TAE may not be achievable in the multi-hole variant due to the potential to harbor innumerable small feeding arteries. Transvenous embolization (TVE) may be considered to target the final common outlet of the lesion. Here, we present a series of four patients with complex multi-hole congenital PAVF treated with staged TAE followed by TVE. Methods: A retrospective review was conducted on patients who underwent treatment for congenital, multi-hole PAVFs treated by a combined TAE/TVE approach at our institution since 2013. Results: We identified four patients with multi-hole PAVF treated by a combined TAE/TVE. Median age was 5.2 (0-14.7) years. Median follow-up of 8 (1-15) months by catheter angiography and 38 (23-53) months by MRI/MRA was obtained. TVE achieved complete occlusion in three patients that proved durable on radiographic follow-up and demonstrated excellent clinical outcomes with a modified Rankin Score (mRS) of 0 or 1. Complete occlusion of the draining vein was not achieved by TVE in one case. This patient is graded as pediatric mRS=5 three years post-procedure. Conclusions: With thorough technical considerations, our series indicates that TVE of multi-hole PAVF that are refractory to TAE is feasible and effective in arresting the consequences of chronic, high-flow AV shunting produced by this pathology.

• Journal of Chest Surgery
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• 제37권4호
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• pp.342-348
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• 2004

말기 신부전 환자의 생명 유지를 위한 혈액투석 치료에 있어서 지속적으로 개존상태가 유지되고 충분한 혈액이 관류되는 투석 경로의 확보는 매우 중요하다. 동정맥루 조성술 시행 후 조기 폐쇄로 인해 투석을 시행하지 못하는 경우, 환자는 경정맥 또는 대퇴정맥 등의 중심 정맥 삽관을 반복적으로 시행 받아 혈액투석을 유지해야 하며 경제적, 시간적 손실을 감수해야 하는 어려움을 겪게 된다. 대상 및 방법: 자가 혈관을 이용한 동정맥루 조성술에 있어 조기개존율에 영향을 미치는 요인을 파악하고, 이를 향상시키기 위해서 2002년 6월부터 2003년 5월까지 1년 간 말기 신부전 환자에게 시행한 총 85예의 동정맥루 수술 중 두부정맥(cephalic vein)과 요골동맥(radial artery)의 단측문합(end-to-side anastomisis)을 시행한 49예를 대상으로 임상분석을 하였다. 걸과: 연구대상 49예에서 조기개존율은 79.6%였다. 환자의 나이나 성별, 고혈압과 당뇨병 유무에 따른 개존율의 차이는 없었으며 환자의 체질량지수 및 고혈압과 당뇨의 유병기간, 술 전 듀플렉스 검사로 측정한 요골동맥의 직경에 따른 조기개존율의 차이는 통계적으로 유의하지 않았다. 수술 전 듀플렉스 검사로 측정한 두부정맥의 직경과 수술 시 측정한 동정맥루의 혈류량이 조기개존율과 유의한 양의 상관관계를 나타내었고, 특히 혈관직경 2.7mm가 초과되는 군에서는 조기 폐쇄 없이 개존율이 100%로 유지되었으며 동정맥루의 혈류량이 100mL/min 이하인 군에서는 조기개존율 33.3%로 100 mL/min초과인 군의 82.2%와 비교할때 유의하게 조기개존율이 낮았다. 결론: 동정맥루에 사용되는 정맥의 직경은 개존율과 밀접한 관련이 있어 가능한 한 직경이 큰 정맥을 선택해야 하며 연구에 따라 다양한 기준이 보고되어 왔으나 보다 정확한 예후 판단을 위해서는 정맥의 직경뿐 아니라 혈관 유출로의 혈류와 협착상태 등에 대한 파악이 필요할 것으로 생각된다. 본 연구에서 측정한 수술 시 동정맥루의 혈류량을 기준으로 판단할때, 100 mL/min 이하의 혈류량을 나타내는 radiocephalic fistula에서는 혈류량 감소의 원인을 찾아 교정술을 시행하고 그 이후에도 혈류량이 증가하지 않을 경우 다른 부위의 혈관 또는 인조혈관의 사용을 고려하여야만 할 것이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.46.1-46.7
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• 2016

Background: Osteoradionecrosis is the most dreadful complication after head and neck irradiation. Orocutaneous fistula makes patients difficult to eat food. Fibular free flap is the choice of the flap for mandibular reconstruction. Osteocutaneous flap can reconstruct both hard and soft tissues simultaneously. This study was to investigate the success rate and results of the free fibular flap for osteoradionecrosis of the mandible and which side of the flap should be harvested for better reconstruction. Methods: A total of eight consecutive patients who underwent fibula reconstruction due to jaw necrosis from March 2008 to December 2015 were included in this study. Patients were classified according to stages, primary sites, radiation dose, survival, and quality of life. Results: Five male and three female patients underwent operation. The mean age of the patients was 60.1 years old. Two male patients died of recurred disease of oral squamous cell carcinoma. The mean dose of radiation was 70.5 Gy. All fibular free flaps were survived. Five patients could eat normal diet after operation; however, three patients could eat only soft diet due to loss of teeth. Five patients reported no change of speech after operation, two reported worse speech ability, and one patient reported improved speech after operation. The ipsilateral side of the fibular flap was used when intraoral soft tissue defect with proximal side of the vascular pedicle is required. The contralateral side of the fibular flap was used when extraoral skin defect with proximal side of the vascular pedicle is required. Conclusions: Osteonecrosis of the jaw is hard to treat because of poor healing process and lack of vascularity. Free fibular flap is the choice of the surgery for jaw bone reconstruction and soft tissue fistula repair. The design and selection of the right or left fibular is dependent on the available vascular pedicle and soft tissue defect sites.

• Journal of Chest Surgery
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• 제39권5호
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• pp.407-410
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• 2006

경동맥과 경정맥 사이의 외상성 동정맥루는 매우 드문 질환이고 경부의 해부학적 복잡성으로 인해 외상 후 진단을 놓치는 경우가 있으므로 혈관 손상이 있는 경우에는 동정맥루의 발견을 위해 적극적인 검사가 필요하다. 44년 전에 경부에 총상을 입은 57세 남자에서 늦게 발견된 경동맥-경정맥간의 동정맥루를 치험하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제37권8호
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• pp.702-706
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• 2004

폐동정맥루는 선천적 혹은 후천적인 원인에 의해 발병할 수 있으며 단락이 존재하는 경우 호흡곤란, 청색증, 폐혈관 잡음 등의 증상이 나타날 수 있다. 진단 방법은 혈액검사, 흉부단순촬영, 흉부전산화 단층촬영, 폐동맥조영술 등이 있으며 그 중 가장 정확한 진단 방법으로는 폐동맥조영술이 있다. 폐동정맥루의 합병증으로는 파열로 인한 혈흉, 뇌농양, 뇌졸중 등이 있으며 이에 대한 치료법으로는 수술적 절제술과 치료적 색전술을 시행할 수 있다. 26세 여자 환자가 내원 30분 전 갑자기 발생된 호흡곤란을 주소로 내원하였다. 흉부전산화단층촬영과 폐동맥조영술상 우하엽 상분절에서 4${\times}$4${\times}$3 cm의 폐동정맥루가 진단되어 우하엽 절제술을 계획한 후 응급수술을 시행하였다. 저자들은 우하엽 상분절에 발병한 혈흉을 동반한 선천성 폐동정맥루를 치험하였기에 문헌고찰과 함께 증례보고하는 바이다.

• Journal of Chest Surgery
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• 제29권1호
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• pp.63-66
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• 1996

폐 절제술후 기관지 늑막루를 갖는 농흥은 흔하지는 않지만 치료가 매우 힘든 치명적인 합병증이다. 본 이화대학교목동병원 흉부외과에서는 1993년 10월 부터 1994년 12월 까지 본원에서 기관지 늑막루를 갖는 농흥을 근성형술을 이용하여 치료하였다. 치료는 술전 농흥강내 세척을 실시하고 수술대에서 염증조직을 완전히 제거한후 신경 혈관속이 보존된 근육으로 농흥강내를 채웠다. 술후 추적관찰 기간은 4개월에서 12개월 이었다. 수술한4명중 3명은 수술이 성공한 것으로 생각되며 1명은실패로 생각된다. 실패의 원인으로 농흥강을 채운 복직근의 혈관손상으로 인한 무혈성 괴사와 농흥강내 잔존한 염증조직이 다른 근육을 감염시켜 같이 괴사 하였다고 생각된다.

• 대한영상의학회지
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• 제81권6호
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• pp.1472-1477
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• 2020

경막 동정맥루는 다양한 증상을 일으킬 수 있는 후천적 혈관 이상이다. Borden I 유형의 S상 정맥동 동정맥 누공이 지주막하 출혈로 나타난 드문 증례를 보고한다. 출혈은 전방 하뇌 소뇌 동맥의 작은 연막 공급 혈관인 측면 연수 교뇌 부분에 있는 측벽 동맥류 파열로 인해 발생하였다. 저자들은 뇌 전산화단층촬영 및 혈관조영술, 자기공명영상 및 혈관조영술 그리고 디지털 감산 혈관조영술을 포함한 영상 소견과 기존의 유사한 증례에 대한 문헌을 검토하고자 한다.