Role of surgical treatment for peripheral arterial disease in endovascular era / 대한외과학회지

PURPOSE: The purpose of this study is to review the roll changes of surgical treatment for peripheral artery disease in endovascular era. METHODS: One hundred and twelve surgically treated cases of peripheral artery disease at a single institution during the period from 2006 to 2011 were studied retrospectively. The cases were divided into two groups of different time periods, one before 2009 (surgical period group) and the other from 2009 onward (endovascular period group). We analyzed the type and location of surgery as well as clinical characteristics of patients and treatment results. RESULTS: Fifty-three cases were for the surgical period group and 59 cases for the endovascular group. No difference in the demographic characteristics and the distribution of major atherosclerosis risk factors was found between the two groups. Additionally, the technical and functional success rate was similar in both groups. However, it is found that there were more acute cases in the endovascular period group than in the surgical period group. The number of cases in need of suprainguinal or below knee exposure was similar in both groups. In hybrid cases, suprainguinal or below knee exposures were more frequently needed during the former period than the latter period. CONCLUSION: The role of surgical treatment is currently in the process of changing. Surgical treatment seems to be a complementary alternative to endovascular treatment for chronic limb ischemia. However, it still seems to play a major role for acute limb ischemia.

Successful Reuse of a Kidney Allograft from a Brain-Dead Donor into a Second Recipient: A Case Report / 대한이식학회지

The limited donor organ supply is a main problem for transplant surgeons in Korea, and forces them to use organs from extended sources. In one such case, we reused a transplanted kidney allograft in August 2012. This was the first successful case involving the reuse of a transplanted kidney allograft in Korea. The kidney donor was a 44-year-old man brain-dead due to spontaneous subdural hemorrhage. He received a kidney transplant from his sister in 2006. The second recipient was a 59-year-old man who had been receiving hemodialysis for 11 years. There were full human leukocyte antigen (HLA) matches between the first donor and the first recipient, and two HLA mismatches between the first donor and the second recipient. Fortunately, we were able to perform a crossmatch test between the first donor and the second recipient as well as the first recipient and the second recipient (with the first donor's agreement). We used the left iliac artery for perfusion instead of the aorta during organ procurement. The cold ischemic time was 4 hours and the initial kidney function was excellent. The patient has been doing well, without any significant complications or rejections, for 3 weeks. His last serum creatinine level was 0.91 mg/dL. Our case shows that the reuse of kidney allografts could be a possible solution for the shortage of donor kidneys. However, this method requires careful consideration and an agreement among participants before its performance.

Extrinsic compression of left iliac vein does not predict the development of post thrombotic syndrome in left side deep venous thrombosis / 대한외과학회지

PURPOSE: Left side deep venous thrombosis (DVT) is associated with May-Thurner's anatomical variation and is often instigated by invasive treatment. The aim of this study is to analyze the influence of left iliac vein narrowness on incidence of post thrombotic syndrome (PTS) that developed after left side DVT. METHODS: Forty-one left side DVT cases that were followed up for more than 1 year were enrolled. The iliac vein narrowness was measured by the shortest distance from the right iliac artery to the 5th lumbar vertebra overlying left iliac vein in computed tomography (CT) scan. The incidence of PTS was measured by phone-call history taking for specific symptoms of PTS. The means of the shortest distance were compared by independent t-test. RESULTS: The number of PTS cases was eleven (26.8%). The level of thrombus, demographic data and other risk factors were similar in both PTS and non-PTS groups except the mean risk factor score. The mean of the shortest distance of PTS group and non-PTS group were 5.56 mm and 5.89 mm, respectively. CONCLUSION: The degree of left iliac vein narrowness measured by the shortest distance from the right iliac artery and the 5th lumbar vertebral body was not a predictive factor for PTS.

Closely Sequential Carotid Endarterectomies in Patients with Bilateral Internal Carotid Artery Stenosis / 대한혈관외과학회지

PURPOSE: The purpose of this study was to evaluate the efficacy and safety of closely sequential carotid endarterectomies (CEAs) for bilateral internal carotid artery stenosis. METHODS: From September 1995 to December 2011, 953 CEAs were performed for internal carotid artery occlusive disease in Asan Medical Center. Seven hundreds eighty-five patients received unilateral CEA, and 84 patients received bilateral CEAs. Of the 84 patients with bilateral CEAs, 15 who underwent closely sequential CEAs with an intersurgical period of 7 days were included in this study. Retrospectively, surgical outcomes were evaluated and compared, regarding CEA-related parameters, and early and late mortality and morbidity rates between patients with closely sequential bilateral CEAs and unilateral CEA. RESULTS: With this strategy, initial CEA was performed for the symptomatic side in symptomatic patients, or for the higher-grade carotid stenosis in asymptomatic patients. All 15 patients received contralateral CEA 7 days after initial CEA, and sufficient revascularization was obtained in all procedures. With a mean follow-up of 11.7 months, there were no perioperative neurological complications or strokes. During the follow-up period, early and late complications, except for transient cranial nerve injury, occurred without statistically significant difference between unilateral CEA and closely sequential bilateral CEAs. CONCLUSION: Closely sequential bilateral CEAs showed excellent early and late clinical outcomes. Although the number of patients included in the study was few, our results demonstrated that closely sequential bilateral CEAs were safe and effective strategies for bilateral internal carotid artery stenosis. In addition, future clinical studies will be needed, with a greater number of patients.

Impact of Distance from the Right Iliac Artery to the Lumbar Vertebra in Left Side Deep Venous Thrombosis / 대한혈관외과학회지

PURPOSE: The aim of this study is to evaluate how much influence iliac vein compression exerts on the clinical feature of deep venous thrombosis (DVT). METHODS: One hundred five cases of lower extremity DVT were enrolled. The cases were grouped by location of the thrombus, left/right and inferior vena cava, iliac vein (IV), femoral vein (FV), popliteal vein, and calf vein. The estimated frequency was calculated by means of that the numbers of each goup were divided by the group's mean of DVT risk score. The minor distance from the right iliac artery to the fifth lumbar vertebral body overlying the left iliac vein was measured in computed tomography. Correlation of the severity and the minor distance was evaluated. RESULTS: Left, right, and bilateral DVT were represented in 66, 26, and 13 cases, respectively. Estimated frequencies were 2, 6.47, 5.47, 2.08, and 0.96 in the left side and 2, 1.44, 2.5, 1.33, and 1 in the right, respectively. Statistics significance was seen at the IV and FV levels. The means of minor distances in millimeters were 4.88, 3.98, 6.13, 6.20, and 4.20 in the left and 2.50, 7.00, 5.20, 7.33, and 6.50 in the right, respectively. Significance was seen only at the IV level. DVT severity and the minor distance could not be correlated with statistical significance. CONCLUSION: We consider that May-Thurner's anatomical changes impacts the DVT prevalence only at the proximal vein. We also suggest that the compression of the left iliac vein might be a contributing factor for developing DVT but not for severity of the DVT.