• IMMUNE NETWORK
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• 제11권6호
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• pp.368-375
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• 2011

Background: Recent clinical observation reported that there was a significant correlation between change in circulating vascular endothelial growth factor (VEGF) levels and the occurrence of severe acute graft-versus-host disease (GVHD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT), but the action mechanisms of VEGF in GVHD have not been demonstrated. Methods: This study investigated whether or not blockade of VEGF has an effect on acute GVHD in a lethally irradiated murine allo-HSCT model of $B6\;(H-2^b)\;{\rightarrow}B6D2F1\;(H-2^{b/d})$. Syngeneic or allogeneic recipient mice were injected subcutaneously with anti-VEGF peptides, dRK6 ($50{\mu}g/dose$) or control diluent every other day for 2 weeks (total 7 doses). Results: Administration of the dRK6 peptide after allo-HSCT significantly reduced survival with greaterclinical GVHD scores and body weight loss. Allogeneic recipients injected with the dRK6 peptide exhibited significantly increased circulating levels of VEGF and expansion of donor $CD3^+$ T cells on day +7 compared to control treated animals. The donor $CD4^+$ and $CD8^+$ T-cell subsets have differential expansion caused by the dRK6 injection. The circulating VEGF levels were reduced on day +14 regardless of blockade of VEGF. Conclusion: Together these findings demonstrate that the allo-reactive responses after allo-HSCT are exaggerated by the blockade of VEGF. VEGF seems to be consumed during the progression of acute GVHD in this murine allo-HSCT model.

• 대한영상의학회지
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• 제82권1호
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• pp.244-249
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• 2021

52세 여자 환자가 호흡곤란을 주소로 내원하였다. 환자는 2개월 전에 침습성 흉선종으로 광범위 흉선절제술을 받았다. 전산화단층촬영에서는 양측 폐에 수많은 소결절들이 발견되었다. 급성 호흡곤란 증후군이 악화되어 혈관외과의는 정맥-정맥 체외막산소공급(extracorporeal membrane oxygenation; 이하 ECMO)을 계획하였다. 왼쪽 대퇴동맥을 통해 경피적 삽관술을 시행하는 도중에 혈관외과의는 혈관 손상을 의심하였고 환자의 활력 징후가 불안정해졌다. 8일 전에 촬영한 복부 컴퓨터단층촬영에서 May-Thurner 증후군이 있었고, 이후 시행한 혈관조영술에서 좌측 총장골정맥의 파열이 발견되어 stent-graft를 삽입하여 출혈을 멈추었다. 8일 전 시행된 복부 전산화단층촬영을 확인해 보니 May-Thurner 증후군이 있었다. 이에 May-Thurner 증후군 환자에서 ECMO 삽관으로 인한 혈관 손상이 발생하여 스텐트 삽입술을 시행하였던 드문 증례를 보고하고자 한다.

• Journal of Chest Surgery
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• 제20권2호
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• pp.261-269
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• 1987

From 1976 through 1986, authors have experienced 127 cases of peripheral vascular surgery which had been done in this department. There were 29 cases of atherosclerosis obliterances including 7 Leriche syndrome, 32 Buerger`s diseases, 25 arterial thromboembolisms, 21 vascular injuries, 2 peripheral arterial aneurysms, 2 renovascular hypertensions, 1 congenital A-V malformation, 13 varicose vein of lower extremities, and 2 Jugular venous ectasia. Cases with vena caval disease and aortic disease were excluded. The mean age of ASO and Buerger`s disease was 56.1 yrs, 33.8 yrs respectively. The male to female ratio showed marked male preponderance [27:2, and 30:2], and almost every male patient was smoker. The indication of operation was similar in both disease entities. The method of operation for ASO were bypass procedure [17], thromboendarterectomy [6], and lumbar sympathectomy [5], and for Buerger`s disease were mainly sympathectomy and few bypass procedures and amputations. Seventeen patients with ASO were followed from 3 to 75 month and overall patency rate for bypass or endarterectomy in one and two months and 2 1/2 yr were 93%, 87%, and 31% respectively. Post operatively patient`s symptoms was relieved or alleviated in almost ASO patients, and about 60% of Buerger`s disease. We concluded that in patient with ischemic limb, we must revascularized aggressively for symptomatic relief. And choice of graft for bypass procedure was to be evaluated further.

• 대한의용생체공학회:의공학회지
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• 제17권2호
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• pp.255-262
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• 1996

Antithrombogenic surFace is one of the most important things to the artificial vascular prostheses. This problem will be solved if the surface of prosthesis is covered with endothelial cells. The attachment and the growth of endothelial cells onto vascular prosthesis are very difficult. So many studies have been concentrated on the attachement of endothelial cell. But no good performance of the in uiwo experiments has been shown until now. In this study, we used the whole extracellular matrix (ECM) excreted from fibroblasts as an underlying matrix, and the endothelial cells were seeded to obtain the long term patency of vascular graft(i.e., for the patent 8 week implanted wafts in the animal model of rat). In order to study the antithrombogenic functions of cultured endothelial cells, prostaglandin(PGF 1 a) synthesis and platelet adhesion were assayed. The concentration of PGF a of stimulated group was sisnificantly higher than that of control group(21.97 $\pm$ 3.45 vs 4.93 $\pm$0.71 pg/1000 cells). The platelet adhesion of the polyurethane sheet covered with endothelial cells was lower than that of polyurethane sheet or sheet covered with ECM(1.04$\pm$0.28, 2.87$\pm$0.77, 2.89$\pm$0.70, % radioactivities, respectively). Endothelial cells grew well on polyurethane coated with ECM, synthesized the prostacyclin and functioned well as antithrombogenic. Therefore the endothelialization onto the ECM excreted from fibroblasts may be a good method for the vfudig prosthesis.

• Journal of Chest Surgery
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• 제11권4호
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• pp.378-384
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• 1978

Injuries to the major vessels in the thoracic inlet require early recognition and expedient operative approach. Delayed diagnosis difficulties encountered in the operative exposure of the region are the major factors limiting successful management. This report is a review of 13 patients with vascular injuries to the neck base who were managed at Busan National University Hospital from March 1975 to September 1978 about 3 years and 6 months. The important clinical problems are delineated with emphasis on the technical aspects of operative management. 1] Among 13 cases, 8 cases were male 5 cases were female. 2] Of 28 vascular injuries, subclavian axillary vascular injuries were 22 [78%]. Stab wound was the cause in 70% of these patients. 3] Without extension 7 cases[53.8%] were managed successfully with supraclavicular, and axillary incision. Posterolateral thoracotomy one of extending 4 cases, 2 cases were used right musculoskeletal flap for management of proximal part of the subclavian artery and innominate vessel, 2 cases were used left supraclavicular incision with anterolateral thoracotomy for management of left proximal subclavian artery. One Expired. 4] Repair of vascular injury was accomplished by lateral suture of debridement and end-to end anastomosis in 17[74%]. Autogenous vein was used one for interposition graft. Ligation was required 2 arterial, 6 venous injuries. Of 8 cases which were pulseless preoperatively, 5 cases were able to palpable distal pulse. 5] Post operative complications occurred 50%. Complication of vasular repair was rare. The majority was neurologic deficit (33.3%).

• Journal of Chest Surgery
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• 제48권1호
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• pp.46-51
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• 2015

Background: Maintenance of adequate vascular access for hemodialysis is important in patients with end-stage renal disease. Once arteriovenous fistula (AVF) occlusion occurs, the patient should be treated with rescue therapy. This study was performed to evaluate the results of a rescue therapy for AVF occlusion. Methods: From January 2008 to December 2012, 47 patients who underwent surgical rescue therapy for AVF occlusion after graft AVF formation, were enrolled in this study. The patients were divided into two groups, namely the graft repair group (group A, n=19) and the thrombectomy group (group B, n=28). Postoperative results of both groups were analyzed retrospectively. Results: There were no statistically significant differences in the clinical characteristics between the two groups. In terms of the duration of AVF patency after the first rescue therapy, group A showed a longer AVF patency duration than group B ($24.5{\pm}21.9$ months versus $17.7{\pm}13.6$ months), but there was no statistically significant difference (p=0.310). In terms of the annual frequency of AVF occlusion after the rescue therapy of group A was lower than that of group B (0.59 versus 0.71), but there was no statistically significant difference (p=0.540). The AVF patency rates at 1, 2, 3, and 5 years after the first rescue therapy in group A were 52.6%, 31.5%, 21.0%, and 15.7%, respectively, and those in group B, they were 32.1%, 25.0%, 17.8%, and 7.14%, respectively. There was no statistically significant difference (p=0.402). Conclusion: Graft repair revealed comparable results. Although there was no statistically significant difference, the patent duration and annual frequency of AVF occlusion of group A were better than those of group B. Therefore, graft repair is considered as a safe and useful procedure for maintaining graft AVF.

• 한국간담췌외과학회지
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• 제27권3호
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• pp.313-316
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• 2023

Attenuated portal vein (PV) flow is challenging in pediatric liver transplantation (LT) because it is unsuitable for classic end-to-end jump graft reconstruction from a small superior mesenteric vein (SMV). We thus introduce a novel technique of an end-to-side jump graft from SMV during pediatric LT using an adult partial liver graft. We successfully performed two cases of end-to-side retropancreatic jump graft using an iliac vein graft for PV reconstruction. One patient was a 2-year-old boy with hepatoblastoma and a Yerdel grade 3 PV thrombosis who underwent split LT. Another patient was an 8-month-old girl who had biliary atresia and PV hypoplasia with stenosis on the confluence level of the SMV; she underwent retransplantation because of graft failure related to PV thrombosis. After native PV was resected at the SMV confluence level, an end-to-side reconstruction was done from the proximal SMV to an interposition iliac vein. The interposition vein graft through posterior to the pancreas was obliquely anastomosed to the graft PV. There was no PV related complication during the follow-up period. Using a jump vascular graft in an end-to-side manner to connect the small native SMV and the large graft PV is a feasible treatment option in pediatric recipients with inadequate portal flow due to thrombosis or hypoplasia of the PV.

• Journal of Chest Surgery
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• 제19권1호
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• pp.58-67
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• 1986

Aggressive revascularization of the ischemic lower extremities in atherosclerotic, occlusive diseases or acute embolic arterial occlusion due to cardiac valvular disease by thromboembolectomy or an arterial bypass operation has been advocated by some authors. We have performed 68 first time vascular operations, including thromboembolectomies on RR patients with ischemic lower extremities, within an 11-year-and-6-month period, from January 1974 to June 1984. We have reviewed and analyzed our vascular operative procedures and post operative results. The patients upon whom thromboembolectomies were performed were 42 males and 13 females ranging from 5 to 72 years of age. The major arterial occlusive sites were common iliac artery in 20 cases, femoral artery in 21 cases, popliteal artery in 8 cases, common iliac artery and femoral artery in 4 cases, and femoral artery and popliteal artery in 3 cases. The underlying causes of arterial occlusive disease were atherosclerosis obliterans in 34 cases; Buerger`s disease in 3 cases; emboli due to cardiac valvular disease in 13 cases; and vascular trauma in 4 cases, including cardiac catheterization in I of those cases. Arterial bypass operations with autogenous or artificial vascular prosthesis were done in 31 cases. Amputations were done on 2 patients carrying out any more vascular operative procedures would have been of no benefit to them. Our bypass operations for ischemic lower extremities were classified as follows: those done between the abdominal aorta and the femoral artery in 17 cases, including those done between the aorta and the bifemoral arteries with a Y graft in four of those cases and long ones done from the axillary to the femoral artery in 4 cases. Five patients died in the hospital following vascular surgery for ischemic lower extremities, the causes of death were not directly related to the vascular reconstructive operative procedures. The leading causes of death were respiratory failure due to metastatic lung carcinoma: renal failure due to complications from atherosclerosis obliterans; sepsis from open, contaminated fractures of the tibia and fibula; and myocardial failures due to open heart surgery in one case and reconstructive surgery of the ascending aorta in another.

• Journal of Chest Surgery
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• 제35권4호
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• pp.283-289
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• 2002

배경: 폐쇄성 혈관 질환을 가진 환자에서 폐쇄된 혈관 자체의 문제를 해부학적으로 해결하기에는 환자의 상태나 병변의 종류, 수술 위험도 등이 문제가 된다. 이때 환자의 연령이나 상태에 따라 선택할 수 있는 고식적인 치료 방법으로 extra-anatomic bypass나 교감신경 절제술 등이 있다. 우리는 이러한 고식적 치료의 장기 성적과 적응증에 관하여 관찰하고자 하였다. 방법: 1996년부터 2000년까지 고식적 치료가 필요했던 폐쇄성 혈관 질환을 가진 38명의 환자를 대상으로 수술의 결과를 후향적으로 고찰하였다. 남자가 32명, 여자가 6명 이었으며 평균 연령은 60.37$\pm$17.65세이다. 이 중 원인 질환으로는 동맥경화증이 32명으로 가장 많았으며, Buerger씨 병이 4명, Raynaud씨 증후군과 상대정맥 증후군이 각각 1명씩이었다. 결과: 수술은 extra-anatomic bypass가 40회, 요추 교감신경 절제술이 17회, 혈전제거술이 7회, 대퇴동맥 혈관 간치술이 1회 등이었고, 혈관 우회술 없이 요추 교감신경 절제술 혹은 혈전 제거술만을 시행한 환자는 7명이었다. 수술 후 6명에서 재수술이 필요하였는데, 이 중 5명은 원위부 혈류 폐쇄 혹은 약화로 발목 관절이나 족지 절단 혹은 요추 교감신경 절제술을 시행한 경우이었고, 1명은 혈관 우회술 1달 후에 인조혈관 원위부의 동맥류가 발생하여 다시 우회술이 필요한 경우였다. 폐쇄성 혈관 질환에 대한 고식적 치료 3년 후의 1차 혈관 개통률은 78.29 $\pm$ 3.81%이었으며, 수술 방법과 혈관 개통률 사이의 통계적 유의성은 없었다. 결론: 여러 논란에도 불구하고 폐쇄성 혈관 질환 환자의 일부에서는 여러 고식적 수술이 이루어지는데, 적절한 환자의 선택과 수술 전후의 적절한 환자 교육, 추적 관찰이 이루어진다면 좋은 결과를 얻을 수 있을 것으로 생각된다.

• Journal of Chest Surgery
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• 제41권2호
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• pp.160-169
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• 2008

배경: 혈관질환의 수술에 사용되는 인공 도관의 막힘과 문합부위의 좁아짐 등을 개선하기 위한 방법으로 조직공학적인 방법과 자가 세포를 이용한 인공혈관의 제작이 대안으로 대두되고 있다. 저자들은, 생흡수성이 있는 고분자 폴리머 지지체와 자가 골수세포를 이용한 인공혈관으로 생체실험을 시행하였다. 대상 및 방법: 생분해성 고분자 재료인 poly (lactide-co-${\varepsilon}$-caprolactone) (PLCL)과 poly(glycolic acid) (PGA) fiber로 혈관용 지지체를 제작한 후, 피실험 동물의 골수를 채취하여 혈관 내피 세포와 평활근 세포로 분열시켜 배양한 후 혈관 지지체위에 이식하였다. 만들어진 인공 혈관을 잡견의 복부대동맥에 이식한 후 3주 후에 혈관 조영술을 시행하고, 안락사 후에 혈관을 제거하여 조직학적 검사를 시행하였다. 결과: 6마리의 잡견 중 2마리에서 수술 후 10일에 혈관 지지체의 균열에 의한 대량 출혈로 사망하였다. 나머지 4마리의 잡견은 수술 후 3주까지 생존하였으며, 혈관 조영술상 혈관의 막힘이나 좁아짐은 발견되지 않았다. 인공 혈관의 내면은 작은 혈전들이 붙어 있었으며, 조직학 검사에서 정상 혈관과 유사한 3층의 구조를 나타내었다. 또한 면역화학 검사에서 혈관 내피세포와 혈관 평활근 세포가 재생된 것을 확인하였다. 결론: 고분자 폴리머와 자가 골수세포를 이용한 인공혈관은 생체 내에서 정상혈관과 유사한 모양으로 재생이 가능함을 보여주었다. 그러나, 동맥압력에 견디기 위해 혈관 지지체의 물성에 대한 개량과 충분한 양의 혈관 세포를 얻기 위한 연구가 더 필요할 것으로 생각된다.