• Journal of Chest Surgery
• /
• v.44 no.3
• /
• pp.266-268
• /
• 2011

Cystic adventitial disease is rare, but it is one of the well-recognized causes of non-atherosclerotic arterial stenosis or obstruction. Despite one of its most common symptoms being chronic intermittent claudication, it may be misdiagnosed as arterial embolism when presented with acute ischemic symptoms. Surgical resection is recommended because of recurrence or a low success rate with aspiration or endovascular stent. We performed resection and repair with autologous vein patch for cystic adventitial disease of the popliteal artery of a 57-year-old man presenting with pain, pallor, and paresthesia, without any postoperative complications or recurrence.

• Kosin Medical Journal
• /
• v.33 no.3
• /
• pp.431-437
• /
• 2018

Spontaneous and isolated dissection of the limb arteries without involvement of the aorta is extremely rare, and has been reported previously in pregnant patients in association with collagen vascular disease, and in cases of high-energy trauma or intensive activity in athletes. There is no consensus yet on indications for medical or surgical therapeutic modality. Due to the rarity of spontaneous dissection of external iliac artery, its natural history has been poorly described. A healthy 50-year-old male with normotension was admitted with an acute onset of left flank pain. Left external iliac artery dissection was diagnosed by abdominal computed tomography.

• Journal of Chest Surgery
• /
• v.44 no.2
• /
• pp.148-153
• /
• 2011

Background: The number of cases employing thoracic endovascular aortic repair (TEVAR) has been increasing due to lower morbidity and mortality compared to open repair technique. The aim of this study is to evaluate the outcome of TEVAR for thoracic aortic diseases. Materials and Methods: Sixteen patients underwent TEVAR from October 2003 to April 2010. Mean age at operation was 59 years (20~78 years), and 11 were male. Indications for TEVAR were large aortic diameter (>5.5 cm) upon presentation in 6 patients, increasing aortic diameter during the follow-up period in 4, traumatic aortic rupture in 3, persistent chest pain in 2, and ruptured aortic aneurysm in one. The mean diameter, length and the number of the stents were 33 mm (26~40 mm), 12 cm (9.5~16.0 cm), and 1.25 (1~2), respectively. Aortography employing Multi-detector computerized tomography (MDCT) technique was performed at one week, and patients were followed up in the out-patient department at one month, 6 months, and one year postoperatively. Results: Primary technical success showing complete exclusion of the aneurysm was achieved in 15 patients. One patient showed a small endo-leak (type 1). Four patients developed perioperative stroke: Three recovered without sequelae, and one showed mild right-side weakness. There was no operative mortality. Diameter of the thoracic aorta covered by stent graft changed within 10% range in 12 patients, decreased by more than 10% in 3, and increased by more than 10% in one during mean follow-up duration of 18 months (1~73 months). There was no recurrence-related death during this period. Conclusion: Intermediate-term outcome after TEVAR was encouraging. Indications for TEVAR could be extended for other thoracic aortic diseases.

• Journal of Chest Surgery
• /
• v.34 no.9
• /
• pp.698-703
• /
• 2001

Background: Endovascular stent-graft insertion in aortic diseases is now generally accepted as an attractive alternative treatment modality. We reviewed our clinical experiences of endovascular stent-graft insertion in thoracic aorta. Material and Method: Since 1995, we performed 8 cases of endovasclar stent-graft insertion. Preoperative diagnoses were aortic aneurysms in 4, traumatic aortic ruptures in 3, and ruptured aortic pseudoaneurysm in 1. All procedures were performed in angiography room with the guidance of fluoroscopy. The stent-graft device is a custom-made 0.35mm thickness Z-shaped stainless steel wires, intertwined with each other using polypropylene suture ligation. It is covered with expanded Dacron vascular graft. Result: All procedures were performed successfully. Follow-up studies revealed 2 minimal perigraft leakages. There was no significant leakage or graft migration. 2 patients expired due to multiple organ failure and fungal sepsis. Other survivors(6) are doing well. Conclusion: Endovascular stent-graft insertion is relatively saft and effective treatment modality in the managment of various types of aortic diseases. In may be an effective alternative in aortic diseases of great surgical risk.

• Journal of Chest Surgery
• /
• v.43 no.6
• /
• pp.753-757
• /
• 2010

We report hereon a case of double bypass of the esophagus and descending thoracic aorta for the treatment of esophagopleural fistula and aortopleural fistula due to an infected aortic aneurysm after esophageal rupture. A 48 year old man was diagnosed as having esophageal rupture after an accidental explosion. Although he had been treated by esophageal repair and drainage at another hospital, the esophageal leakage could not be controlled and subsequent empyema developed in the left pleura. Further, bleeding from the descending thoracic aorta had developed and he was managed with endovascular stent insertion to the descending thoracic aorta. He was transferred to our hospital for corrective surgery. We performed esophago - gastrostomy via the substernal route, without exploring posterior mediastinum and we let the empyema resolve spontaneously. While he was being managed postoperatively Without any signs and symptoms of infection, sudden bleeding developed from the left pleural cavity. After evaluation for the bleeding focus, we discovered an Infected aortic aneurysm and an aortospleural fistula at the stent insertion site. We performed a second bypass procedure for the infected descending thoracic aorta from the ascending aorta to the descending abdominal aorta via the right pleural cavity. We found leakage at the distalligation site during the immediate postoperative period, and we occluded the leakage using a vascular plug. He discharged without complications and he is currently doing well without any more bleeding or other complications.

• Journal of Trauma and Injury
• /
• v.27 no.4
• /
• pp.215-218
• /
• 2014

Blunt abdominal trauma may often cause multiple vascular injuries. However, common iliac artery injuries without associated bony injury are very rarely seen in trauma patients. In the present case, a 77-year-old male patient who had no medical history was admitted via the emergency room with blunt abdominal trauma caused by a forklift. At admission, the patient was in shock and had abdominal distension. On abdomino-pelvic computed tomography (CT), the patient was seen to have hemoperitoneum, right common iliac artery thrombosis and left common iliac artery rupture. During surgery, an additional injury to inferior vena cava was confirmed, and a primary repair of the inferior vena cava was successfully performed. However, the bleeding from the left common iliac artery could not be controlled, even with multiple sutures, so the left common iliac artery was ligated. Through an inguinal skin incision, the right common iliac artery thrombosis was removed with a Forgaty catheter and a femoral-to-femoral bypass graft was successfully performed. After the post-operative 13th day, on a follow-up CT angiography, the femoral-to-femoral bypass graft was seen to have good patency, but a right common iliac artery dissection was diagnosed. Thus, a right common iliac artery stent was inserted. Finally, the patient was discharged without complications.

• Journal of the Korean Society of Radiology
• /
• v.6 no.1
• /
• pp.11-17
• /
• 2012

The purpose of this study is to measure and evaluate radiation dose on patients in interventional radiological(IVR) procedures classified by each procedure, and aid as data for safety management. Fluroscopy time(F-time), dose area product(DAP) and number of acquired images from each kind of procedure was checked. Non-vascular procedures showed low value, and vascular procedure showed high value in all procedures except in IVC filter. F-time was longest in EVAR, which showed also the highest DAP value of all procedures. DAP-rate showed high value in TACE. By this result, we attempt to establish standard guideline of radiation dose on patients in IVR procedure.

• Polymer(Korea)
• /
• v.33 no.1
• /
• pp.84-90
• /
• 2009

Nitinol alloy (TiNi) has been widely used in vascular stents. To improve the blood compatibility of Nitinol alloy, its surface was chemically modified in this study. Nitinol was first coated with gold, then chemisorbed with L-cysteine (C/N), and followed by grafting of zwitter ionic poly(ethylene glycol) (PEG) (PEG-$N^+-SO_3{^-}$) to produce TiNi-C/N-PEG-N-S. The zwitter ionic PEG grafted on the Nitinol surface was identified by ATR-FTIR, ESCA and SEM. The hydrophilized surface was proven by the decrease of water contact angle. In addition, from the blood compatibility tests such as protein adsorption, platelet adhesion, and blood coagulation time, the surface-modified TiNi alloy exhibited a better blood compatibility as compared to the untreated Nitinol control. These results indicated a feasibility of synergistic effect of hydrophilic PEG and antithrombotic zwitter ion.

• Journal of Chest Surgery
• /
• v.42 no.1
• /
• pp.53-58
• /
• 2009

Background: The goal of this study was to compare the patency and complications of femoropopliteal bypass with superficial femoral artery stenting for patients with atherosclerotic superficial femoral artery occlusive disease. Material and Method: Between July 2005 and July 2008, we reviewed 29 femoropopliteal bypass procedures (24 patients) with prosthetic grafts (the bypass group) and 19 superficial femoral artery stentings (15 patients) with nitinol stent (the stent group). There were 35 male patients (89.7%) and the mean age of the patients was 69.2 years (range: 48~84). The number of patients who had DM, hypertension and a smoking history was 25 patients (64.1%), 17 patients (43.6%) and 30 patients (76.9%), respectively. 23 (59.0%) patients had skin ulceration or tissue gangrene at admission. Result: There were 27 cases (93.0%) of TASC C&D lesion in the bypass group and 16 cases (84.2%) of TASC A&B lesion in the stent group. There were significant differences for the indications for a procedure between the two groups (p<0.01). The primary patency rates at 6 months, 12 months and 24 months were 91.9%, 79.7% and 79.7% for the bypass group and 93.3%, 86.2% and 86.2% for the stent group, respectively. There were no statistical difference between the two groups (p=0.48). Conclusion: There were no significant differences in the outcome between two groups. TASC C&D lesion and failed intervention therapy should be treated with femoropopliteal bypass surgery, and TASC A&B lesion and the high-risk patients should be treated with femoral artery stent insertion.

• Journal of Chest Surgery
• /
• v.50 no.2
• /
• pp.114-118
• /
• 2017

Kimura disease (KD) is an immune-mediated chronic inflammatory disease of unknown etiology. KD has many complications associated with hypereosinophilia, including various forms of allergic reactions and eosinophilic lung disease. Additionally, hypereosinophilia is associated with hypercoagulability, which may lead to thromboembolic events. A 36-year-old man with KD presented with acute limb ischemia and coronary artery occlusion. He underwent thrombectomy, partial endarterectomy of both popliteal arteries, and coronary artery stent insertion. KD is a systemic disease that affects many organs and presents with thromboembolism and vasculitis. In a patient with KD, physicians should evaluate the vascular system, including the coronary arteries.