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Objective Limb salvage is an important concern following complete oncologic resection for extremity soft tissue sarcoma (STS). Vascular reconstruction is essential for limb salvage. The purpose of this study was to evaluate the outcomes of vascular reconstruction in patients with extremity STS. Methods This is a retrospective, multi-center, case series of consecutive patients who underwent vascular reconstruction during extremity STS resection at 2 major centers in Korea. Demographics, reconstruction methods, type of conduit, surgical complications, graft patency, limb salvage rate, and patient survival were reviewed. Results From March 2005 to December 2020, 43 patients underwent vascular reconstructions during STS resection. Among the patients, 22 (51.2%) received arterial only, and 21 (48.8%) received simultaneous arterial and venous reconstructions. For the types of conduits, autologous saphenous veins (56.2%), artificial grafts (26.3%), and cryopreserved allografts (15.8%) were used. During a median follow-up of 23.8 months (interquartile range; 7.7-54.5), the overall primary patency of the reconstructed vessels was significantly higher in arteries than in veins (82.5% vs 56.3% at 12 months, P < .001). According to the type of conduit, the primary patency rate of autogenous vein seemed higher in venous reconstruction, however, there was no statistical significance in both arterial and venous reconstruction. There was no significant difference in primary arterial patency rate ( P = .132) or incidence of surgical complications including postoperative edema or wound problem whether or not simultaneous venous reconstruction was performed with arterial reconstruction. The overall limb salvage rate and patient survival were 97.4%, 95.1%, and 89.4% and 91.9%, 81.7%, and 65.4% at 12, 24, and 36 months, respectively. Conclusions Patency rates were poorer in venous reconstruction than in arterial reconstruction. In terms of arterial patency and postoperative complication, the role of simultaneous arterial and venous reconstruction seems not essential, however, it needs to be evaluated in future studies.

The present study was designed to investigate the hypothesis that the outer wall at the carotid bifurcation is the most common area of atherosclerotic plaque deposition due to the low shear stress.We hypothesized that the most common site of arteriosclerosis in carotid arteries is different in the early and late stages.This is an observational study of patients with50% stenosis of the common and internal carotid arteries (ICAs) identified by Duplex ultrasound in our health promotion center. Plaque location was categorized as a quarter of the cross-section in the distal common carotid artery (CCA) and proximal ICA. Carotid plaque score (CPS) was calculated by the addition of one point for each detected section. The sum of CPSs was calculated for each section.Among 3996 Duplex scans of carotid arteries in 999 patients between June 2020 and October 2020, a total of 569 patients (73.6% male; mean age, 68.4± 9.1 years; 652 CCAs and 567 ICAs) were included. Total CPS was high in the anterior and posterior sections. The distribution in the ICA was: 308 (31.0%) anterior, 90 (9.0%) medial, 373 (37.5%) posterior, and 224 (22.5%) lateral section. The distribution in the CCA was 385 (32.6%) anterior, 103 (8.7%) medial, 528 (44.7%) posterior, and 165 (14.0%) lateral section. The axial distribution of posterior and lateral sections was significantly different according to the directional flow (p .001).Anterior and posterior sections of the CCA and ICA were atherosclerotic plaque-prone sites. This result is different from the tendency of atherogenesis to affect the lateral section having low shear stress at the carotid bifurcation.

Background: Varicose veins are a common chronic venous disorder that leads to a significantly reduced quality of life and high healthcare resource burden. There is a large amount of research-based data and opinions regarding varicose veins. There are also some common myths and misconceptions about the treatment options.Current Concepts: Management options include compression therapy, open venous surgery, and endovenous therapy. An appropriate treatment option must be selected on a case-by-case basis based on the symptoms, severity, and duplex ultrasonography findings. Venous intervention should be considered if the condition is symptomatic and often, there is no need for urgent surgery or endovenous therapy because the symptoms usually progress slowly and severe cardiac problems are rare. According to previous studies, there is no difference between the endovenous therapy modalities and the traditional surgical method (i.e., high ligation and stripping) in terms of recurrence rates. Therefore, case-specific factors, such as anatomy and economic factors, should be considered. When compression therapy is considered, graduated compression stocking with suitable pressure should be prescribed. Venoactive drugs can be suggested in addition to compression therapy for symptomatic varicose veins or venous ulcers.Discussion and Conclusion:. Correct information regarding treatment for varicose veins based on the best available evidence must be provided to patients. The treatment options for varicose veins should be selected on a case-by-case basis considering the patient`s symptoms, anatomy and economic factors.

Objectives To validate the accuracy of high-risk criteria for carotid endarterectomy (CEA) and analyze the correlation between age and outcome of CEA and carotid artery stenting (CAS) in risk groups. Methods We reviewed a prospectively managed vascular surgery database in a single tertiary referral center, and 2482 internal carotid arteries (ICAs) had undergone carotid revascularization from November 1994 to December 2021. To validate high-risk criteria for CEA, patients were classified as high risk (Hr) and normal risk (Nr). Subgroup analysis was performed with patients older or younger than 75 years to investigate the relationship between age and outcome in each group. Primary endpoints were 30-day outcomes including stroke, death, stroke/death, myocardial infraction (MI), and major adverse cardiovascular events (MACEs). Results A total of 2345 ICAs in 2256 patients were enrolled. The number of patients in the Hr group was 543 (24%) and the number in the Nr group was 1713 (76%). CEA and CAS were performed on 1384 (61%) and 872 (39%) patients, respectively. The 30-day stroke/death rate was higher with CAS than CEA in both the Hr (1.1% vs. 3.9%, p = 0.032) and Nr (1.2% vs. 6.9%, p < 0.001) groups. In unmatched logistic regression analysis of the Nr group ( n = 1778), the rate of 30-day stroke/death (OR, 5.575; 95% CI, 2.922–10.636; p < 0.001) was higher for CAS than CEA. In propensity score matching of the Nr group, the rate of 30-day stroke/death (OR, 5.165; 95% CI, 2.391–11.155; p < 0.001) was also higher for CAS than CEA. In the age Conclusions In patients older than 75 years in the Hr group, there were relatively poor 30-day treatment outcomes in both CEA and CAS. Alternative treatment is needed that can expect better outcomes in older high-risk patients. In the Nr group, CEA has a significant benefit compared with CAS, and CEA should be recommended more to these patients.

This study aimed to review the pathophysiology of varicose veins and chronic venous insufficiency and the recent surgical treatment trend. Varicose veins are tortuous, twisted, or lengthened veins in the lower extremities. It is part of the spectrum of chronic venous disease. Primary pathogenesis is increased chronic venous hypertension caused by valvular insufficiency, venous outflow obstruction, and calf muscle pump failure. Some patients complain of no symptoms, except report cosmetic concerns. If the varicose vein progresses to chronic venous insufficiency, it may cause edema of the lower limb. The skin lesion can present as hyperpigmentation of the median part of the ankle, congestive dermatitis, and even a skin ulcer. The varicose vein can be diagnosed easily by visual inspection after identifying the skin lesions. For non-surgical treatment, elastic stocking, Unna boots, and pneumatic compression devices are recommended to reduce venous pressure. High ligation with stripping has been the standard treatment for varicose veins to achieve symptom relief and improve cosmetic effects. Endovenous laser ablation, radiofrequency ablation, mechanochemical ablation, and the VenaSeal closure system have been introduced as surgical treatment methods. Recently, endovenous thermal/non-thermal ablations are recommended for treatment because both are less invasive techniques. The appropriate therapy should be selected after considering the patients’ symptoms and signs, anatomical structure, and economic burden of the treatment.

The treatment of varicose veins has shifted from conventional surgical stripping (SS) to minimally invasive endovenous modalities. Cyanoacrylate closure (CAC) with the VenaSeal system (Medtronic, Dublin, Ireland) has increased in popularity owing to its nonthermal and nontumescent technique. The purpose of the present study was to compare the clinical outcomes of CAC and SS for the treatment of incompetent great saphenous veins.An open-label, multicenter, prospective, randomized controlled trial was conducted. The subjects were randomized to either the CAC or SS procedure. The primary endpoint of the present study was to evaluate complete closure of the target vein at 3 months. Target vein occlusion was assessed on the third day and 1, 3, 6, and 12 months postoperatively using duplex ultrasound. The pain and ecchymosis grades were also assessed. Additionally, the clinical outcomes, such as the venous clinical severity score and Aberdeen Varicose Vein Questionnaire score, were assessed.Three-month follow-up data were obtained for all 126 enrolled and randomized subjects (63 with CAC and 63 with SS). At 3 months, complete target vein closure was observed in both groups. The postoperative pain score was significantly better in the CAC group than in the SS group (0.3 ± 0.6 in the CAC group and 1.1 ± 1.5 in the SS group; P .001). In addition, the mean ecchymosis grade was 0.3 ± 0.5 in the CAC group and 1.1 ± 1.1 in the SS group (P .001). The venous clinical severity score and quality of life had improved equally in both groups. The adverse events after both procedures were mostly minor complications (9 events in CAC group and 20 events in SS group). Major complications occurred in one patient who had undergone the SS procedure.The CAC and SS procedures were both associated with complete occlusion of the target vein at 3 months. The postoperative pain and ecchymosis grades were significantly lower in the CAC group. Other differences between the two groups included the frequency and nature of the complications. The results showed that CAC has high success with few complications.

This study aimed to evaluate peripherally inserted central catheters (PICCs) and totally implanted venous access devices (TIVADs) as chemotherapy delivery routes. From May 2016 to April 2019, patients with malignancies who had PICCs or TIVADs inserted for chemotherapy were enrolled. We reviewed the patients’ medical records for information concerning demographics, comorbidities, catheter-related complications, and catheter -service days. All patients included in both groups were also assessed for complication-free catheter survival and completion rates of chemotherapy. A total of 467 catheter insertions (185 PICCs and 282 TIVADs) were included in this study. The PICCs were associated with a higher rate of complication-related catheter removal than TIVADs (hazard ratio, 6.5954; 95% confidence interval, 2.394–18.168; p

Objective This study aimed to investigate the incidence of inferior vena cava (IVC) filter strut penetration and risk factors of organ involvement. Methods From June 2003 to August 2015, there were 138 patients with deep venous thrombosis who received an IVC filter. Among 104 patients who did not have the IVC filter retrieved, 66 had follow-up computed tomography and were included in this study. The IVC filters used were 21 Gunther Tulip (Cook Medical, Bloomington, Ind), 26 Celect (Cook Medical), and 19 OptEase (Cordis Corp, Bridgewater, NJ) filters. Filter strut penetration was categorized by a previously published scale of grade 0 to grade 3, and organ involvement was specifically assessed. Multivariate analysis was used to identify risk factors for organ-involving strut penetration (grade 3). Results The median age of the patients was 66 years (27-84 years), and 46% were male. Median computed tomography follow-up duration was 14 months (1-137 months). IVC strut penetration was detected in all patients. Grade 1, grade 2, and grade 3 were 29%, 36%, and 35%, respectively. The risk factor of grade 3 penetration was indwelling time ≥30 months on binary logistic regression analysis (odds ratio, 4.395; 95% confidence interval, 1.179-16.385; P = .027). Conclusions Regardless of type of IVC filter, the incidence of strut penetration was high. The risk of adjacent organ involvement increases over time. Retrievable IVC filters need close follow-up and retrieval as soon as they are no longer needed.

Purpose: This study examined the safety of an ultrasound-guided peripherally insertion central catheter (PICC) for patients undergoing chemotherapy. Methods: The medical records of consecutive patients who received ultrasound-guided PICC for chemotherapy between Sep. 2016 and Dec. 2017 were reviewed. The diameters of the basilic and brachial veins were measured in all patients. The procedures were performed when the diameter was more than 2.5 mm in the basilic vein first. The procedure was performed on the brachial vein when the diameter of the basilic vein was less than 2.5 mm. The technical success rate, catheter-related complications, duration of catheter service day by veins (basilic vs. brachial) were examined. Results: A total of 113 procedures were analyzed. The mean age was 61.9 ± 10.5 years (range 35–83 years). The technical success rate was 100%. The mean diameters of the basilic and brachial veins were 3.8 ± 0.8 mm and 3.9 ± 1.0 mm, respectively. The mean duration of the catheter service day was 95.8 ± 77.8. No difference in the diameter of the vessels according to age was noted. The incidence of complication-related catheter removals was similar in the two groups (26 in the basilic group and 27 in the brachial group; infection, 15.6% vs 22.4%, P > 0.05 ; thrombosis, 6.3% vs. 6.1%, P > 0.05; occlusion, 4.7% vs 6.1%, P > 0.05). Conclusion: The ultrasound-guided PICC procedure ensures a successful probability in cancer patients. The incidence of complications was similar in the two groups (brachial vs. basilic).

A 63-year-old man presented with an asymptomatic infrarenal abdominal aortic aneurysm. He had scoliosis and atrophic right leg change as sequelae of poliomyelitis. The patient was not a candidate for endovascular aneurysm repair because of anatomic unsuitability. An open surgical repair was performed by the retroperitoneal approach because of severe scoliosis and left lateral aneurysm deviation. To minimize contralateral exposure, the Viabahn stent graft (W. L. Gore & Associates, Flagstaff, Ariz) was inserted in the right external iliac artery and anastomosed with the right expanded polytetrafluoroethylene graft limb. I report the successful hybrid repair of infrarenal abdominal aortic aneurysm using the modified Viabahn open revascularization technique.

Phlegmasia cerulea dolens (PCD) is a medical emergency that can lead to venous gangrene of the lower extremity. Early diagnosis and prompt treatment is crucial for limb salvage. There are two treatment options (endovascular or surgical). In the endovascular era, catheter-directed thrombolysis is the treatment of choice to achieve venous outflow. However, surgical thrombectomy is indicated in certain cases. The authors report successful surgical thrombectomy in a 75-year-old man with PCD and review the treatment of PCD.

Purpose: To investigate the changes in the infrarenal aortic length and tortuosity in elderly patients. Materials and Methods : : We retrospectively reviewed the medical records and computed tomography (CT) scans of 857 patients who underwent surgery for colorectal cancer between August 2009 and July 2012. Among these patients, 48 patients who were aged ≥60 years, underwent follow-up CT at least 5 years after surgery, did not have aortic disease, and did not receive radiation therapy were enrolled. The aortic tortuosity index (ATI) was defined by dividing the distance along the central lumen line from the lowest renal artery to the aortic bifurcation (L1) by the straight-line distance from the lowest renal artery to the aortic bifurcation (L2). Aortic diameters were measured at the lowest renal artery level (D1) and 20 mm below (D2). A paired t-test and Wilcoxon signed-rank test were used to compare lengths and diameters between the initial and final CT scan. Spearman’s correlation analysis was performed to determine the correlations between time and the changes in L1 and ATI. Results : : The average follow-up period was 68 months. The mean changes in L1 and L2 were 0.69 mm and –0.59 mm, respectively, while the mean changes in D1 and D2 were 0.77 mm and 0.58 mm, respectively. The mean increase in ATI was 0.015. All findings were statistically significant. On Spearman’s correlation analysis, ΔL1 and ΔATI showed no correlation with follow-up duration. Conclusion : : The infrarenal aortic length and tortuosity of elderly patients increases at a slow rate over time.

Background The objective of the study was to evaluate the safety, technical feasibility, and complications of totally implanted venous access ports (TIVAPs) in the upper arm, for comparison with transjugular chest ports in patients with breast cancer. Methods In total, 223 consecutive female breast cancer patients who received a TIVAP in the upper arm or chest between July 2014 and February 2016 were included. All procedures were performed via a sonographic and fluoroscopic-guided approach using the Seldinger technique under local anesthesia. We reviewed the medical records to determine technical success, pain scale, and early (≤30 days) and late (>30 days) complications. Results In total, 231 devices were implanted in the upper arms (n = 176, 76%) and chests (n = 55, 24%) of the patients. The mean age was 51.6 ± 10.7 years (range 23–78 years; upper arm, 52.1 ± 11.0 years; chest, 50.1 ± 9.7 years, P > 0.05). The mean implantation time for TIVAPs was 181.7 ± 109.2 days (range, 9–460 days; upper arm 175.2 ± 102.7 days; chest, 202.4 ± 126.6 days, P > 0.05), with 41,974 catheter days. The technical success rate was 100%. Fourteen complications (6.1%) occurred in 14 patients (0.33/1,000 catheter days). There was no significant difference in complication-free survival for patients with upper arm TIVAPs and those with transjugular chest TIVAPs. The mean amount of 2% lidocaine, used as local anesthesia, was 3.3 ± 1.7 mL and 14.5 ± 4.1 mL for upper arm and chest TIVAPs, respectively. (P Conclusions Implantation of TIVAPs in the upper arm is a safe procedure with a low rate of complications. Upper arm TIVAPs can be implanted with less pain compared with transjugular chest TIVAPs.

Purpose: The aim of study was to review the results of open surgical repair (OSR) of chronic juxtarenal aortic occlusion (JRAO). Materials and Methods: We retrospectively reviewed the results of OSR performed in 47 patients (male, 92%; mean age, 59.9±9.3 years [range, 44–79]) with chronic JRAO during the past 21 years. In order to reduce intraoperative renal ischemic time (RIT), we excised a portion of the occluded segment of the infrarenal aorta without proximal aortic clamping. We then performed suprarenal aortic clamping with both renal arteries clamped, removed the proximal aortic thrombus cap, confirmed both renal artery orifices, and moved the suprarenal aortic clamp to the infrarenal aorta to allow renal perfusion and standard aortoiliac reconstruction. We investigated early (

Half of patients with critical limb ischemia (CLI) are ineligible for revascularization at diagnosis. The aim of this study was to assess the safety and feasibility of intramuscular human umbilical cord blood-derived mesenchymal stem cell (hUCB-MSC) therapy in patients with CLI due to atherosclerosis obliterans (ASO) or thromboangiitis obliterans (TAO).A total of eight patients (all male, median age 52 years, range 31∼77) with CLI were enrolled in this phase I trial. All patients were considered ineligible for further revascularization to improve CLI. We injected 1×10(7) hUCB-MSCs per single dose intramuscularly into the affected limb. The primary end points of safety were occurrence of adverse events (procedure-related complication, allergic reaction to hUCB-MSCs, graft-versus-host disease, cardiovascular and cerebrovascular events) and improvement of symptoms/clinical parameters (healing of foot ulcer, ankle-brachial index, and pain-free walking distance). Angiogenesis was measured with conventional angiography and scored by an independent reviewer. There were four adverse events in three patients. One patient, developed whole body urticaria after injection on treatment day, which disappeared after one day of antihistamine treatment. The other adverse events included diarrhea, oral ulceration, and elevation of serum creatinine level; all conditions improved without treatment. Abnormal results of laboratory parameters were not detected in any patients. Three of four ulcerations (75%) healed completely. Angiographic scores increased in three of eight patients.This phase I study demonstrates that intramuscular hUCB-MSC injection is a safe and well tolerated treatment for patients with end-stage CLI due to ASO and TAO.

The purposes of this study are to review the results of endovascular and surgical interventions and to evaluate clinical appearances of recurrent arterial involvement in patients with peripheral arterial Behcet disease (BD). A total of 28 patients with peripheral arterial BD were identified. There were 24 males (85.7 %), with mean age of 40.0 ± 9.0 years (range 21–59). Arterial involvements were confirmed with computed tomography angiography, magnetic resonance image angiography, or ultrasound. Immunosuppressive agents were administrated to all patients. Indications of intervention were acute symptoms due to arterial occlusion and aneurysmal changes with or without rupture. Among 28 patients with peripheral arterial BD, 10 endovascular and 24 surgical interventions were performed in 21 patients. All 21 patients who underwent endovascular and surgical intervention were followed up for a mean duration of 78.7 ± 52.5 months (range 0–182 months). There was one mortality due to the rupture of pseudoaneurysm in patient who underwent stent-graft insertion for abdominal aortic aneurysm. New arterial involvements of BD occurred in 10 patients. All patients were male, and median age was 33.5 years (range 29–59 years). Mean time of onset of the new arterial lesion was 32.7 ± 32.1 months. In conclusion, the result of endovascular and surgical interventions is satisfactory in patients with acute peripheral arterial BD. Accurate diagnosis with immunosuppressive therapy is mandatory to prevent recurrence and activation of peripheral arterial BD.

We assessed the utility of a 3-grade classification of photoplethysmography (PPG) with cold water provocation test in Raynaud phenomenon (RP). A total of 35 patients with RP and 38 healthy volunteers were recruited. In healthy volunteers, PPG was measured twice at intervals of 30 minutes for evaluating reproducibility of test. Percentage variation of the PPG amplitude in post- versus precold provocation was expressed on a 3-grade scale at 1, 3, and 5 minutes (reflection index: RI) in patients with RP. The improvement pattern of the PPG (IPPPG) was evaluated by summing the score differences from RI1 min to RI3 min and RI5 min. After a therapeutic period of 8 weeks with nifedipine, the decreases in posttherapeutic RI3 min and RI5 min were statistically significant ( P < .05). Subgroup analysis of IPPPG showed statistical significance in patients with negative fluorescent antinuclear antibody ( P < .05). The analysis of cold-provoked PPG waves demonstrated and quantified improvements in peripheral arterial circulation in RP.

Purpose The aim of this study was to determine whether stratification of deceased donors by the United Network for Organ Sharing (UNOS) criteria negatively impacts graft survival. Materials and Methods We retrospectively reviewed deceased donor and recipient pretransplant variables of kidney transplantations that occurred between February 1995 and December 2009. We compared clinical outcomes between standard criteria donors (SCDs) and expanded criteria donors (ECDs). Results The deceased donors consisted of 369 patients. A total of 494 transplant recipients were enrolled in this study. Mean age was 41.7±11.4 year (range 18–69) and 273 patients (55.4%) were male. Mean duration of follow-up was 8.8±4.9 years. The recipients from ECD kidneys were 63 patients (12.8%). The overall mean cold ischemia time was 5.7±3.2 hours. Estimated glomerular filtration rate at 1, 2, and 3 years after transplantation were significantly lower in ECD transplants (1 year, 62.2±17.6 vs. 51.0±16.4, p0.05), although patient survival was lower in ECDs than SCDs (Log rank test, p=0.011). Conclusion Our data demonstrate that stratification by the UNOS criteria does not predict graft survival. In order to expand the donor pool, new criteria for standard/expanded donors need to be modified by regional differences.

ObjectiveThis study compared treatment outcomes of patients with supra-aortic arterial (SAA) occlusive disease due to Takayasu arteritis (TA) treated with bypass surgery or endovascular treatment.MethodsAll patients diagnosed with TA from September 1994 to November 2010 were identified using the hospital database. This retrospective study included 21 TA patients who underwent endovascular or surgical intervention due to SAA lesions and four patients who were referred from other hospitals after endovascular treatment of SAA lesions. Fifteen arterial lesions in 10 patients were treated with an endovascular technique, and 24 arteries in 15 patients were reconstructed using bypass surgery. We performed endovascular intervention for short (50%) or occlusion of the reconstructed arteries was observed in eight of 15 arteries (53.3%) in the endovascular treatment group vs three of 24 (12.5%) in the bypass surgery group (P = .01; Fisher exact test). More serious complications, such as intracerebral hemorrhage (n = 2) due to cerebral hyperperfusion syndrome or cardiac tamponade developed in the surgical bypass group. No operative deaths occurred in either group.ConclusionsSurgical or endovascular interventions were required in one of 10 TA patients with SAA occlusive lesions. Arteries reconstructed after surgical bypass had superior patency to those reconstructed by endovascular treatment. However, bypass surgery was more likely than endovascular treatment to be accompanied by serious early postoperative complications.

Pulmonary tumor embolism can be a cause of respiratory failure in patients with cancer even though it occurs rarely. We describe a 56-year-old man who underwent a pulmonary tumor embolectomy using cardiopulmonary bypass on beating heart combined with inferior vena cava embolectomy and right radical nephrectomy. Aggressive surgical treatment in this severe case is necessary not only to reduce the fatal outcome of pulmonary embolism in the short run, but also to improve the oncological prognosis in the long term.

Compartment syndrome is a clinical condition associated with decreased blood circulation that can lead to swelling of tissue in limited space. Several factors including lithotomy position, prolonged surgery, intermittent pneumatic compressor, and reperfusion after treatment of arterial thrombosis may contribute to compartment syndrome. However, compartment syndrome rarely occurs after gynecologic surgery. In this case, the patient was diagnosed as compartment syndrome due to reperfusion injury after treatment of arterial thrombosis, which occurred after laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer. Despite its rarity, prevention and identifying the risk factors of complication should be performed perioperatively; furthermore, gynecologist should be aware of the possibility of complications.

ObjectiveTo determine the impact of contralateral carotid occlusion (CCO) and/or vertebral artery occlusion (VAO) on the development of early postoperative neurologic complications after carotid endarterectomy (CEA) or carotid artery stenting (CAS).MethodsA retrospective analysis was conducted using a database of patients who underwent CEA (n = 698) or CAS (n = 455) at a single institution. Excluded were 44 CEAs synchronously performed with coronary artery bypass grafting and 76 CASs performed without an embolic protective device (n = 69) or that resulted in technical failures (n = 7). All CEAs were the conventional type and performed under general anesthesia, and carotid shunts were routinely used. Patients were categorized into three groups according to patency of the contralateral carotid and vertebral arteries: Group I (no CCO or VAO); Group II (CCO with or without VAO); Group III (with VAO but no CCO). CCO or VAO were diagnosed with two or more carotid imaging studies including duplex ultrasonography, computed tomography angiography, magnetic resonance angiography, or conventional carotid angiography. Patient groups were compared with demographics, preoperative symptomatic status, and frequencies of early (

할 수 있다는 장점이 있다(11). Purpose: To compare the usefulness of Doppler ultrasonography and renal scintigraphy in the assessment of shortand long-term function of transplanted kidneys. Materials and Methods: We retrospectively reviewed the cases of 79 patients who underwent Doppler ultrasonography and technetium-99m diethylene triamine pentaacetic acid renal scintigraphy on the same day, within 4 days of renal transplantation. Image parameters were evaluated for statistical differences. Results: There was a strong positive correlation between the glomerular filtration rate (GFR) as measured by renal scintigraphy and the estimated GFR (eGFR) based on serum creatinine levels (correlation coefficient = 0.71). Scan grade according to the time-activity curve, resistive index, and end diastolic velocity showed moderate correlations with the eGFR (correlation coefficients = -0.557, -0.329, and 0.370, respectively) in the early post-transplantation period. The mean survival time was longer in patients with lower resistive indices (≤ 0.68, 54.9 months vs. > 0.68, 29.5 months) and lower pulsatility indices (≤ 1.32, 53.8 months vs. > 1.32, 28.7 months); however, there were no statistically significant differences in the long-term follow-up period (p = 0.121 for resistive index and p = 0.074 for pulsatility index). Conclusion: Renal scintigraphy is a more sensitive method than Doppler ultrasonography for assessing transplanted kidney function in the early post-transplantation period. Doppler ultrasonography might reflect the long-term survival time. However, it is difficult to predict long-term renal function using either method. Index terms Ultrasonography, Doppler Radionuclide Imaging Kidney Transplantation Glomerular Filtration Rate

The success of endovascular aortic aneurysm repair (EVAR) is highly dependent on the anatomical features of the aneurysm. In order to prevent type II endoleaks from the internal iliac artery (IIA), embolization of one or both IIAs may be required.We performed a retrospective study of a prospectively gathered database of 100 patients who underwent EVAR at our institution. The case notes were examined, and patients were interviewed by telephone and specifically asked about symptoms of pelvic ischemia that they had experienced since undergoing EVAR.We identified 42 (42 %) patients who had undergone coil embolization of one or both IIAs in preparation for EVAR. The mean time from surgery to the follow-up telephone interview was 21.5 months. Buttock claudication occurred in 10 (26 %) of 38 patients. Sexual dysfunction occurred in 13 of 36 male patients (36 %). Age was associated with buttock claudication and sexual dysfunction.Based on our experience, IIA embolization prior to EVAR is not a benign procedure. It can lead to numerous effects associated with pelvic ischemia, such as buttock claudication and sexual dysfunction. It is necessary to preserve both internal iliac arteries if possible, especially in young patients.

Purpose: The aim of this study was to assess renal or abdominal visceral complications after open aortic surgery (OAS) requiring supra-renal aortic cross clamping (SRACC). Methods: We retrospectively reviewed the medical records of 66 patients who underwent SRACC. Among them, 17 followed supra-celiac aortic cross clamping (SCACC) procedure, 42 supra-renal, and 7 inter-renal aorta. Postoperative renal, hepatic or pancreatic complications were investigated by reviewing levels of serum creatinine and hepatic and pancreatic enzymes. Preoperative clinical and operative variables were analyzed to determine risk factors for postoperative renal insufficiency (PORI). Results: Indications for SRACC were 25 juxta-renal aortic occlusion and 41 aortic aneurysms (24 juxta-renal, 12 supra-renal and 5 type IV thoraco-abdominal). The mean duration of renal ischemic time (RIT) was 30.1 ± 22.2 minutes (range, 3 to 120 minutes). PORI developed in 21% of patients, including four patients requiring hemodialysis (HD). However, chronic HD was required for only one patient (1.5%) who had preoperative renal insufficiency. RIT ≥ 25 minutes and SCACC were significant risk factors for PORI development by univariate analysis, but not by multivariate analysis. Serum pancreatic and hepatic enzyme was elevated in 41% and 53% of the 17 patients who underwent SCACC, respectively. Conclusion: Though postoperative renal or abdominal visceral complications developed often after SRACC, we found that most of those complications resolved spontaneously unless there was preexisting renal disease or the aortic clamping time was exceptionally long.

Introduction Adventitial cystic disease (ACD) affecting veins is a very rare condition. Report We report two cases of ACD affecting veins in female patients aged 50 and 32 years who underwent surgical excision. Discussion Venous ACD presents with deep venous thrombosis (DVT)-mimic symptoms resulting from venous compression by the cystic mass. Optimal treatment of venous ACD is complete surgical removal of the cystic wall and its contents; however, recurrent symptoms are often reported because of recurrence of the cystic mass.

Purpose: Infrainguinalfemoropopliteal bypass (IFPB) is recommended to peripheral arterial disease (PAD) with a long occlusion of the superficial femoral artery (SFA). The aims of our study were to determine the patency of graft materials, and identify the risk factors of graft failure. Methods: From January 1995 to April 2011, we had performed 380 IFPBs in 351 patients, including 302 femoro-above the knee (AK) bypasses and 78 femoro-below the knee (BK) bypasses. We compare age, sex, severity of ischemia between polytetra-uoroethylene (PTFE) graft and saphenous vein (SV) graft, and evaluate patency rate rates of the two groups. Results: The primary patency rates at 5 years for SV (n = 76 limbs) and PTFE grafts (n = 226 limbs) in AK were 85.2% and 64.5% (log rank = 0.03), and the secondary patency rates at 5 years for SV and PTFE grafts in AK were 88.2% and 79.0% (log rank = 0.13). The primary patency rates at 5 years for SV (n = 50 limbs) and PTFE grafts (n = 28 limbs) in BK were 63.2% and 40.0% (log rank = 0.08), and the secondary patency rates at 5 years for SV and PTFE grafts in BK were 71.6% and 55.5% (log rank = 0.18). Conclusion: There was no statistical significant difference in secondary patency rates between SV and PTFE in IFPB. PTFE grafts as SV grafts can be a good alternative bypass material in IFPB instead of SV grafts.

Median arcuate ligament syndrome is a rare cause of abdominal pain which results from compression of the celiac artery (CA) or rarely, the superior mesenteric artery by a ligament formed by the right and left crura of the diaphragm. We report a case of open surgical decompression of the CA by division of the median arcuate ligament for a 37-year-old female patient who had suffered from chronic postprandial epigastric pain and severe weight loss. We described clinical features, characteristic angiographic findings and details of the surgical procedure for the patient with this rare vascular problem.

Purpose: We attempted to determine risk factors for the development of failing vein graft and optimal treatment in patients with infrainguinal vein grafts. Methods: We retrospectively reviewed a database of patients who underwent infrainguinal bypass using autogenous vein grafts due to chronic atherosclerotic arterial occlusive disease of lower extremity (LE) at a single institute between September 2003 and December 2011. After reviewing demographic, clinical, and angiographic features of the patients with failing grafts, we analyzed those variables to determine risk factors for the development of failing grafts. To determine an optimal treatment for the failing vein grafts, we compared results of open surgical repair (OSR), endovascular treatment (EVT) and conservative treatment. Results: Two hundred and fifty-eight LE arterial bypasses using autogenous vein grafts in 242 patients were included in this study. During the follow-up period of 39 ± 25 months (range, 1 to 89 months), we found 166 (64%) patent grafts with no restenosis, 41 (15.9%) failing grafts, 39 (15.1%) graft occlusions, and 12 (4.7%) grafts lost in follow-up. In risk factor analysis for the development of a failing graft, no independent risk factors were identified. After 50 treatments of the 41 failing grafts (24 OSR, 18 EVT, 8 conservative management), graft occlusion was significantly more common in conservative treatment group and severe (＞75%) restenosis was significantly more common following EVT than OSR (P = 0.001). Reintervention-free graft patency was also superior in the OSR group to that of the EVT group (87% vs. 42%, P = 0.015). Conclusion: OSR of failing grafts has better outcomes than EVT or conservative management in treating failing grafts.

Purpose: Most outcome studies of bypass surgery are limited to five years of follow-up. However, as human life expectancy has increased, analyses of more long-term outcomes are needed. The aim of this study is to evaluate 10-year outcomes of anatomical bypasses in aortoiliac occlusive disease. Methods: From 1996 to 2009, 92 patients (82 males and 10 females) underwent aortic anatomical bypasses to treat aortoiliac occlusive disease at Samsung Medical Center. The patients were reviewed retrospectively. Kaplan-Meier survival analyses were performed using PASW ver. 18.0 (IBM Co). Results: A total of 72 patients (78.3%) underwent aorto-femoral bypasses (uni- or bi-femoral), 15 patients (16.3%) underwent aorto-iliac bypasses (uni- or bi-iliac), and 5 patients (5.4%) underwent aorto-iliac and aorto-femoral bypasses. The overall primary patency rates of the 92 patients were 86.2% over 5 years and 77.6% over 10 years. The 10-year limb salvage rate and overall survival rate were 97.7% and 91.7%, respectively. Conclusion: The overall patency rates of bypass graft and limb salvage rates decreased as time passed. The analysis of results after bypass surgery to treat arterial occlusive disease will be needed to extend for 10 years of follow-up.