• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.7
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• pp.4651-4655
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• 2015

The subclavian artery pseudoaneurysm in blunt trauma is uncommon and rarely occurs secondary to penetrating injury. Subclavian artery injuries represent an uncommon complication of blunt chest trauma, this structure being protected by subclavius muscle, the clavicle, the first rib, and the deep cervical fascia as well as the costo-coracoid ligament, a clavi-coraco-axillary fascia portion. Subclavian artery injury appears early after trauma, and arterial rupture may cause life-threatening hemorrhages, pseudoaneurysm formation and compression of brachial plexus. Most injuries were related to clavicle fracture, gunshot, other penetrating trauma, and complication of central line insertion. The presence of large hematomas and pulsatile palpable mass in supraclavicular region should raise the suspicion of serious vascular injury and these clinical evidences must be carefully worked out by physical examination of the upper limb. Since the first reports of endovascular treatment for traumatic vascular injuries in the 1993, an increasing number of vascular lesions have been treated this way. We report a case of subclavian artery pseudoaneurysm 10 days after blunt chest trauma due to traffic accident, treated by endovascular stent grafting.

• Journal of Chest Surgery
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• v.47 no.5
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• pp.468-472
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• 2014

Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management.

• Journal of Physiology & Pathology in Korean Medicine
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• v.23 no.5
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• pp.974-979
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• 2009

Proliferation of vascular smooth muscle cell(VSMC) is one of the key features in onset of atherosclerosis and restenosis after vascular surgery such as stent implant. Atherosclerotic plaques are usually composed of collagen, elatsin and smooth muscle cells. Release of matrix metalloproteinases(MMPs) is considered to have correlation with development of atherosclerotic plaques. Based on the hypothesis that MMP inhibition would be helpful in the treatment of atherosclerosis, we investigated inhibition of MMP activity and migration of TNF-$\alpha$-induced human aortic smooth muscle cell(HASMC) by Cinnamomi Ramulus(CC). The result from gelatin zymography showed that CC inhibited MMP-9 activity in a dose-dependent manner. In addition, CC considerably inhibited the migration of HASMC induced by TNF-$\alpha$, while it showed little cytotoxic effect on HASMC. These results suggest that CC can be a potential anti-atherosclerotic agent through inhibition of MMP-9 activity and SMC migration.

• Proceedings of the KSME Conference
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• 2003.04a
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• pp.1915-1918
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• 2003

Atherosclerosis, which is a degenerate disease, is believed to occur in the vascular system due to deposition of cholesterol and low density lipoprotein(LDL) or thrombosis on the blood vessel. Atherosclerosis narrows arterial lumen, which is known as stenosis phenomenon of blood vessel. Pathogenesis of atherosclerosis is thought to occur mainly by aging. Restenosis phenomenon is observed in the same site of insertion of a stent and balloon angioplasty after treatment of interventional theraphy. Several hypothetical theories related to the generation of atherosclerosis have been reported: high shear stress theory, low shear stress theory, high shear stress gradient theory, flow separation and turbulence theory and high pressure theory. However, no one theory clearly explains the causes of atherosclerosis. In the present study the generation of atherosclerosis in the left coronary artery is investigated. The hypotheses are verified by using the computer simulation.

• Journal of Chest Surgery
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• v.44 no.3
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• pp.266-268
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• 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
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• v.33 no.3
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• pp.431-437
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• 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
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• v.44 no.2
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• pp.148-153
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• 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.

• Korean Journal of Radiology
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• v.22 no.4
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• pp.513-524
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• 2021

Objective: To assess the noncontrast two-dimensional single-shot balanced turbo-field-echo magnetic resonance angiography (b-TFE MRA) features of the abdominal aortic aneurysm (AAA) status following endovascular aneurysm repair (EVAR) and evaluate to detect endoleaks (ELs). Materials and Methods: We examined four aortic stent-grafts in a phantom study to assess the degree of metallic artifacts. We enrolled 46 EVAR-treated patients with AAA and/or common iliac artery aneurysm who underwent both computed tomography angiography (CTA) and b-TFE MRA after EVAR. Vascular measurements on CTA and b-TFE MRA were compared, and signal intensity ratios (SIRs) of the aneurysmal sac were correlated with the size changes in the AAA after EVAR (AAA prognoses). Furthermore, we examined six feasible b-TFE MRA features for the assessment of ELs. Results: There were robust intermodality (r = 0.92-0.99) correlations and interobserver (intraclass correlation coefficient = 0.97-0.99) agreement. No significant differences were noted between SIRs and aneurysm prognoses. Moreover, "mottled high-intensity" and "creeping high-intensity with the low-band rim" were recognized as significant imaging findings suspicious for the presence of ELs (p < 0.001), whereas "no signal black spot" and "layered high-intensity area" were determined as significant for the absence of ELs (p < 0.03). Based on the two positive features, sensitivity, specificity, and accuracy for the detection of ELs were 77.3%, 91.7%, and 84.8%, respectively. Furthermore, the k values (0.40-0.88) displayed moderate-to-almost perfect agreement. Conclusion: Noncontrast MRA could be a promising imaging modality for ascertaining patient follow-up after EVAR.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.753-757
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• 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 Chest Surgery
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• v.34 no.9
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• pp.698-703
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• 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.