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1.
Ann Vasc Surg ; 2020 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-32209414

RESUMO

BACKGROUND: Brachio-basilic/brachial transposition arteriovenous fistula has emerged as one of the autologous arteriovenous fistula options. However, there have not been many reports on the outcomes of basilic or brachial elevation of arteriovenous fistula compared to those of conventional transposition. We evaluated the efficacy of modified brachio-basilic and brachio-brachial arteriovenous fistula creation with short-segment elevation preserving the axillary area. METHODS: From March 2016 to August 2018, medical records of the patients who underwent short-segment elevation of brachio-basilic or brachio-brachial arteriovenous fistula in the upper arm (sBAE or sBRE) were reviewed retrospectively. RESULTS: Of the 51 patients, 37 underwent sBAE and 14 underwent sBRE. Maturation failure occurred in two patients (3.92%), who underwent sBAE. Stenosis was the most common complication, which developed in 13 patients (25.5%), and there was no significant difference between the sBAE and the sBRE. In the 51 patients, Cumulative primary patency rates at 6 and 12 months were 88.3% and 69.1%, respectively. Assisted-primary patency rates at 6 and 12 months were 97.8% and 90.7%, respectively. Secondary patency rates at 6 and 12 months were both 100%. There were no significant differences between the sBAE and the sBRE in 1-year primary patency (79.1% vs. 46.7%; P = 0.20), assisted-primary patency (91.6% vs. 88.1%; P = 0.36), and secondary patency rates (100% vs. 100%). CONCLUSIONS: Brachio-basilic/brachial arteriovenous fistula with short segment elevation preserving the axilla showed excellent 1-year patency rate, easier cannulation, and other future advantages, and therefore, is a logical modification of conventional transposition of arteriovenous fistula.

2.
World J Surg ; 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32144470

RESUMO

BACKGROUND: Central venous catheters should be positioned at the cavoatrial junction or the right atrium. If catheters are inserted to a depth derived by adding the length between the needle insertion point and the clavicular notch and the length between the clavicular notch and the carina, the catheter tip can be placed near the carina. Based on this, we aim to make a formula to place a catheter tip near the cavoatrial junction. METHODS: This prospective nonrandomized interventional study included patients who needed a central venous catheter from June 2017 to July 2018. The location of the cavoatrial junction was identified using a fluoroscopic technique. The following variables were measured: L1, the length between the needle insertion point and the clavicular notch; L2, the length between the clavicular notch and the carina; and α, the length between the carina and the cavoatrial junction. RESULTS: A total of 70 patients were enrolled. The mean age was 65.5 ± 11.6 years, and 62.9% were male. The mean L1 and L2 were 7.6 ± 1.4 and 7.0 ± 1.4 cm, respectively. The mean α was 4.4 ± 1.5 cm (95% CI 4.1-4.8), and it was not affected by demographic factors, such as sex, age, height or weight. CONCLUSIONS: Central venous catheters in adult patients can be placed near the cavoatrial junction using a simple formula: the distance between the insertion point and the clavicular notch + the distance between the clavicular notch to the carina + 4.4 cm.

3.
PLoS One ; 14(11): e0224595, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31689320

RESUMO

BACKGROUND: Nonadherence to immunosuppressive therapy after renal transplantation is associated with poor graft outcomes. We aimed to evaluate whether the use of the Adhere4U mobile medication manager application could improve adherence among renal transplant recipients ≥1 year posttransplantation. Adhere4U can provide medication reminders, monitor medication use, and provide information on immunosuppressants. METHODS: We conducted a prospective randomized controlled study to compare the rate of nonadherence to index immunosuppressant (tacrolimus or cyclosporine) in a group using the Adhere4U app (mobile group) and in another group receiving conventional care (control group). The primary outcome was the nonadherence rate, which was evaluated using an electronic medication event monitoring system during the 6-month intervention period. Our secondary outcome included self-reported adherence using the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS) and the visual analog scale (VAS) based on a 4-week recall on days 28, 90, and 180. Longitudinal data of repeated measures of self-rated adherence were analyzed using generalized estimating equations (GEE) to compare the between-group difference in adherence change over time. RESULTS: Between November 2013 and May 2015, 138 renal transplant recipients were randomly allocated to the control (n = 67) or the mobile group (n = 71). The overall nonadherence rate over the 6-month study period by electronic monitoring was 63.6%, with no between-group difference [mobile group, 65.0% (n = 39/60); control group, 62.1% (n = 36/58); odds ratio 1.14; 95% confidence interval 0.53-2.40; p = 0.89]. Self-rated nonadherence assessed using the BAASIS and VAS at baseline was 53.7% and 51.5%, respectively. Although the self-rated nonadherence by BAASIS of the mobile group was lower than the control group throughout the study period, there was no between-group difference in the change of nonadherence over time (χ2 = 2.82, df = 3, p = 0.42 by logistic GEE). There also was no significant between-group difference in the nonadherence by VAS (χ2 = 1.71, df = 3, p = 0.63 by logistic GEE) over time. The main limitation of this study was the low rate of patient engagement with the app among the mobile group. The rate of app use was 47.6% (31/65) at 28 days, 33.9% (19/56) at 90 days, and 11.5% (6/52) at 180 days. CONCLUSIONS: The Adhere4U application did not improve adherence to immunosuppressive therapy. Our evidence is limited by the high rate of attrition. Further studies on strategies to facilitate patient engagement with mobile interventions are warranted.

4.
Vasc Specialist Int ; 35(3): 119-120, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31620397
5.
Vasc Specialist Int ; 35(3): 165-169, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31620403

RESUMO

A 58-year-old male patient with severe claudication due to thrombosis of the left ilio-femoro-popliteal artery aneurysm. He also had a venous stasis ulcer with a history of multiple embolotherapy of arteriovenous malformation. Duplex sonography revealed reflux and varicose veins of the left great saphenous vein (GSV). A sequential bypass surgery was performed that consisted of excision of the left external iliac and common femoral artery aneurysm, external iliac to deep femoral interposition with an expanded polytetrafluoroethylene graft, and femoro-posterior tibial artery bypass with the reversed left GSV. Symptoms of claudication were alleviated and the chronic ulcer was healed in time. To our knowledge, this is the first report of successful bypass in a patient with arterial aneurysm, arteriovenous malformation, and venous insufficiency that can be diagnosed as an atypical case of Parkes Weber syndrome. Long-term follow-up is needed to define the fate of aneurysms and varicose vein graft.

6.
Vasc Specialist Int ; 35(2): 60-69, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31297355

RESUMO

For the modern practice of cancer surgery, the concept of oncovascular surgery (OVS), defined as cancer resection with concurrent ligation or reconstruction of a major vascular structure, can be very important. OVS for advanced cancers requires specialized procedures performed by a specialized multidisciplinary team. Roles of oncovascular surgeons are summarized as: a primary surgeon in vesselorigin tumors, a rescue surgeon treating complications during cancer surgery, and a consultant surgeon as a multidisciplinary team for cancer surgery. Vascular surgeons must show leadership in cancer surgery in cases of complex advanced diseases, such as angiosarcoma, leiomyosarcoma, intravenous leiomyomatosis, retroperitoneal soft tissue sarcoma, iatrogenic injury of the major vessels during cancer surgery, pancreatic cancer with vascular invasion, extremity soft tissue sarcoma, melanoma and others.

7.
Transplant Direct ; 5(6): e455, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31321291

RESUMO

Background: High intrapatient variability (IPV) of tacrolimus (Tac) is increasingly recognized as a risk factor for poor graft outcomes in kidney transplantation. The timing of onset of its impact on kidney histologic lesions has not been investigated. Methods: We analyzed the adverse effect of Tac IPV using the coefficient of variability from 6 to 12 months posttransplantation on long-term outcomes in a cohort of 671 kidney recipients and on the evolution of chronic histologic lesions in a cohort of 212 recipients for whom paired protocol biopsies at 10 days and 1 year were available. Results: High IPV of Tac (cutoff value of coefficient of variability = median of 20.5%) was associated with an increased risk of graft loss (hazard ratio, 3.28; 95% confidence interval, 1.090-9.849; P = 0.035) in the entire cohort. At 1 year, the high Tac IPV group showed a significantly deteriorated chronicity score (F = 5.912, P = 0.016) compared with the low Tac IPV group in the Histology cohort after controlling for the 10-day scores. In a multivariate analysis, a high IPV of Tac was predictive of the chronicity score (odds ratio, 1.91; 95% confidence interval, 0.215-1.075; P = 0.003) at 1 year posttransplant. Conclusions: These data indicate that high IPV of Tac is associated with early deterioration of chronic histologic lesions as well as poorer long-term outcomes. Large prospective studies of Tac IPV usage as a clinical monitoring tool are needed in the future.

8.
Ann Vasc Surg ; 60: 415-423.e4, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31075482

RESUMO

BACKGROUND: Conservative treatment is feasible in most patients with spontaneous isolated dissection of the superior mesenteric artery (SID-SMA). However, the role of antiplatelet agents and anticoagulants is not well defined in either symptomatic or asymptomatic SID-SMA. This study aimed to conduct a meta-analysis, including a single-arm study, comparing the resolution rate of conservative management with versus without antithrombotics for symptomatic and asymptomatic SID-SMA. METHODS: A systematic search of electronic databases, including PubMed, EMBASE, and Cochrane Library, on August 22nd, 2018, was performed to identify studies concerning SID-SMA. Meta-analyses were conducted to determine the primary resolution rate, long-term aneurysmal change for symptomatic SID-SMA, and any event for asymptomatic SID-SMA. We calculated pooled risk ratios and 95% confidence intervals (CIs) using random-effects model in studies with two arms and in studies with two arms or a single arm. RESULTS: We included data from 35 articles involving 727 patients with SID-SMA (symptomatic 693, asymptomatic 134). No significant differences were observed in the successful resolution rate between conservative management with and without antithrombotics (random-effects model, risk ratio [RR] 0.96; 95% CI, 0.87-1.05]). The pooled resolution rate from combining single-arm studies was 91% (95% CI, 85-95) and 95% (95% CI, 88-100) in conservative management with and without antithrombotic, respectively, which was not statistically significant (RR, 0.97; 95% CI, 0.91-1.02). The pooled morphologic progression rate from combining single-arm studies was 3% (95% CI, 0-8) and 11% (95% CI, 2-26) in conservative management with and without antithrombotics, respectively, which was not statistically significant (RR, 0.44; 95% CI, 0.12-1.64). The adverse event was 0% for both groups for asymptomatic SID-SMA. CONCLUSIONS: Additional antithrombotic therapy for both symptomatic and asymptomatic SID-SMA did not benefit the outcomes. We do not recommend the use of antithrombotics for SID-SMA, unless further evidence shows any beneficial effect.


Assuntos
Aneurisma Dissecante/tratamento farmacológico , Tratamento Conservador/métodos , Fibrinolíticos/uso terapêutico , Artéria Mesentérica Superior/efeitos dos fármacos , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Tratamento Conservador/efeitos adversos , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
10.
J Vasc Access ; 20(6): 659-665, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30958094

RESUMO

INTRODUCTION: Current guidelines recommend the placement of vascular access 6 months before the anticipated start of hemodialysis therapy; however, many patients start hemodialysis using a central venous catheter. We investigated the timing of referral for vascular access, the vascular access type at hemodialysis initiation, and the barriers to a timely referral. METHODS: The study involved a retrospective review of 237 patients for whom the first vascular access for hemodialysis was created between January and November 2017. RESULTS: Among the 237 patients, 58.2% were referred before hemodialysis initiation, while 41.8% were referred after hemodialysis initiation. Among the 138 patients, 55, 59, and 24 patients were referred more than 6 months, between 2 and 6 months, and within 2 months before hemodialysis initiation, respectively. Within these subgroups, 3.6%, 10.2%, and 75.0% patients underwent hemodialysis initiation with a central venous catheter, respectively. Among the 99 patients referred after hemodialysis initiation, the reasons for late referral were as follows: unexpected rapid progression of kidney disease (n = 23), noncompliance (n = 21), late visit to the nephrologist (initial visit within 2 months of hemodialysis initiation; n = 14), change of treatment strategy from peritoneal dialysis or transplants (n = 9), and unknown reasons (n = 32). CONCLUSION: Only 23% of patients were referred for vascular access 6 months before the anticipated hemodialysis therapy. In addition, 53% of patients initiated hemodialysis with a central venous catheter. Avoidance of catheter insertion was mostly successful in patients referred 2 months before hemodialysis initiation. The most common modifiable barrier to the timely referral was noncompliance.


Assuntos
Derivação Arteriovenosa Cirúrgica , Cateterismo Venoso Central , Encaminhamento e Consulta , Diálise Renal , Tempo para o Tratamento , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Recusa do Paciente ao Tratamento
11.
J Vasc Access ; 20(6): 646-651, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30919734

RESUMO

BACKGROUND: Preoperative mapping with duplex ultrasonography is crucial for successful vascular access creation for hemodialysis. The aims of this study are to assess the baseline characteristics of arm vessels by preoperative duplex ultrasonography in Korean patients, to find out a preoperative duplex ultrasonography parameter precluding distal arteriovenous fistula creation, to assess the maturation failure rate of arteriovenous fistulas, and to identify associated risk factors. METHODS: Preoperative duplex ultrasonography mapping for vascular access creation was done in all patients with end-stage renal diseases during the year 2015. The baseline data of duplex ultrasonography were retrospectively analyzed with follow-up clinical data. RESULTS: A total of 299 end-stage renal disease patients (mean age = 62 years, 62% male) were included. On preoperative duplex ultrasonography, mean diameters of radial artery and cephalic vein at wrist were 2.03 and 2.40 mm in the non-dominant arm and 2.10 and 2.26 mm in the dominant arm, respectively. The most common reason for precluding radial-cephalic arteriovenous fistula at wrist was small-sized cephalic vein. Multivariate logistic regression analysis revealed that the risk factors for inadequate vessels were warfarin treatment, old age (⩾75 years), and peripheral arterial occlusive disease. The rate of arteriovenous fistula maturation failure was 21% and vein diameter <2.5 mm was the only risk factor for arteriovenous fistula maturation failure by multivariate logistic regression analysis. CONCLUSION: Preoperative duplex ultrasonography evaluation is important to find out inadequate vessels for native arteriovenous fistula and to determine the location of vascular access.


Assuntos
Derivação Arteriovenosa Cirúrgica , Falência Renal Crônica/terapia , Artéria Radial/diagnóstico por imagem , Diálise Renal , Ultrassonografia Doppler , Extremidade Superior/irrigação sanguínea , Veias/diagnóstico por imagem , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Feminino , Humanos , Falência Renal Crônica/diagnóstico por imagem , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Artéria Radial/fisiopatologia , Artéria Radial/cirurgia , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Fatores de Risco , Seul , Falha de Tratamento , Grau de Desobstrução Vascular , Veias/fisiopatologia , Veias/cirurgia
12.
J Vasc Interv Radiol ; 30(2): 195-202.e1, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30717950

RESUMO

PURPOSE: To compare the efficacy of lymph node (LN) embolization using N-butyl cyanoacrylate versus ethanol sclerotherapy in the management of symptomatic postoperative pelvic lymphorrhea. MATERIALS AND METHODS: Thirty-three patients with 40 instances of symptomatic postoperative lymphorrhea were treated with either LN embolization or sclerotherapy at Seoul National University Hospital from January 2009 to July 2017 and were retrospectively included (LN embolization group: 24 lymphoceles of 19 patients, mean age of 59.29 years; sclerotherapy group: 16 lymphoceles of 14 patients, mean age of 60.95 years). The types of operations were hysterectomy and bilateral oophorectomy with pelvic lymph node dissection (n = 9), radical prostatectomy (n = 3), and renal transplantation (n = 2) for the sclerotherapy group and radical prostatectomy (n = 10) and hysterectomy and bilateral oophorectomy with pelvic lymph node dissection (n = 9) for the LN embolization group. The 3 most common indications of treatment were lower extremity edema (n = 11), pain (n = 11), and fever (n = 8). The amount of leak before treatment (initial daily drainage) and clinical outcomes, including the clinical success rate in 3 weeks, treatment period, and complication rate were compared between both groups. RESULTS: LN embolization showed a higher 3-week clinical success rate than sclerotherapy in a univariate analysis (83.3% and 43.8%, P = .026). There was no statistically significant difference in the treatment period and the complication rate (7.1 days and 12.3 days, P = .098; 8.3% and 25.0%, P = .184). CONCLUSIONS: LN embolization is more effective for treating postoperative pelvic lymphorrhea than sclerotherapy with similar safety.


Assuntos
Embolização Terapêutica/métodos , Embucrilato/administração & dosagem , Etanol/administração & dosagem , Linfonodos , Linfocele/terapia , Pelve/cirurgia , Escleroterapia/métodos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Angiografia por Tomografia Computadorizada , Embolização Terapêutica/efeitos adversos , Embucrilato/efeitos adversos , Etanol/efeitos adversos , Hospitais Universitários , Humanos , Linfocele/diagnóstico por imagem , Linfocele/etiologia , Linfografia , Pessoa de Meia-Idade , Flebografia/métodos , Estudos Retrospectivos , Fatores de Risco , Escleroterapia/efeitos adversos , Seul , Fatores de Tempo , Resultado do Tratamento
13.
Sci Rep ; 9(1): 20356, 2019 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-31889152

RESUMO

Recently non-Vitamin K antagonist oral anticoagulants (NOAC) is replacing warfarin for the treatment of deep vein thrombosis (DVT). However, the role of NOAC after thrombolysis of acute iliofeomral DVT (IFDVT) is not yet defined. This randomized clinical trial aimed to compare the safety and efficacy of rivaroxaban versus warfarin after catheter directed thrombolysis of an IFDVT. Patients with acute DVT of both the iliac and the femoral vein (n = 72) were recruited and randomized to either standard anticoagulation (enoxaparin and warfarin, n = 35) or rivaroxaban (n = 37) after successful thrombolysis or mechanical thrombectomy. Primary efficacy outcome was a recurrence of any venous thromboembolism (VTE) within 6 months. Secondary safety outcomes included major bleeding, clinically relevant non-major bleeding (CRNMB), other adverse event, and all-cause mortality. Rate of recurrent VTE were similar in both groups (11.4% versus 12.5%; p = 0.94). Major bleeding or CRNMB was less in rivaroxaban group without significance (2.9% versus 9.4%, HR, 0.31; 95% CI, 0.03-2.96; p = 0.31). Recurrence-free survival and major bleeding-free survival at 6 months were not different in both groups. After thrombolysis of acute IFDVT, rivaroxaban was as safe and effective as warfarin in preventing DVT recurrence.

14.
BMC Nephrol ; 19(1): 306, 2018 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-30400882

RESUMO

BACKGROUND: The number of elderly patients with end-stage renal disease is increasing rapidly. The higher prevalence of comorbidities and shorter life expectancy in these patients make it difficult to decide on the type of vascular access (VA). We explored the optimal choice for VA in elderly hemodialysis patients. METHODS: We included elderly patients (> 65 years) visiting our VA clinic and divided them into three groups as follows: radiocephalic arteriovenous fistula (AVF), brachiocephalic AVF, and prosthetic arteriovenous graft (AVG). The primary outcomes were VA abandonment and all-cause mortality. The secondary outcome was maturation failure (MF). RESULTS: Of 529 patients, 61.2% were men. The mean age was 73.6 ± 6.0 years. The VA types were as follows: 49.9% radiocephalic AVF, 31.8% brachiocephalic AVF, and 18.3% AVG. Patients with an AVG tended to be older, female, and have a lower body mass index. More than half of patients (n = 302, 57.1%) started dialysis with central catheters, but the proportion of predialysis central catheter placement was not different among the VA types. Radiocephalic AVF was significantly superior to AVG in terms of VA abandonment (P = 0.005) and all-cause mortality (P < 0.001) in spite of a higher probability of MF. Brachiocephalic AVF was associated with a shorter time to the first needling and fewer interventions before maturation than radiocephalic AVF. CONCLUSIONS: Autologous AVF was suggested as the preferred VA choice in terms of long-term outcomes in elderly patients.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Derivação Arteriovenosa Cirúrgica/tendências , Falência Renal Crônica/terapia , Diálise Renal/métodos , Diálise Renal/tendências , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular/fisiologia
15.
J Korean Med Sci ; 33(40): e265, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30275808

RESUMO

Background: Limb salvage surgery with vascular reconstruction is currently considered as the standard treatment for extremity soft tissue sarcoma (STS), showing equivalent oncologic outcome compared with amputation. In this retrospective study, the surgical and functional outcomes after arterial or venous reconstruction in limb salvage surgery for STS were analyzed. Methods: Consecutive patients who underwent vascular resection and reconstruction as part of limb salvage surgery for extremity STS from July 2009 to June 2015 were included in this study. Incidence of surgical complication, graft patency, and patients' functional outcome were reviewed. Results: During the study period, 14 arteries and 13 veins were reconstructed in 17 patients (artery only in 4, vein only in 3, artery and vein in 10). Autologous great saphenous vein (GSV) was the most commonly used vascular conduit in both arterial and venous reconstruction (78.6% and 77.0%). The patency of synthetic graft was significantly lower than that of the autologous vein conduit (log rank test, P = 0.001). Among 15 patients with tumors in lower extremity, 13 were ambulatory after limb salvage surgery. During median follow up of 23.3 months (interquartile range 39.9 months), 2 patients (11.7%) needed amputation of the initially salvaged limb due to local recurrence. Conclusion: Limb salvage surgery of soft tissue tumor combined with vascular reconstruction showed favorable functional outcome with good local control. Autologous vein conduit is preferred over synthetic graft both in arterial and venous reconstruction.


Assuntos
Salvamento de Membro , Humanos , Extremidade Inferior , Recidiva Local de Neoplasia , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Sarcoma , Seul , Resultado do Tratamento
16.
Vasc Specialist Int ; 34(2): 35-38, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29984216

RESUMO

A 57-year-old woman presented to vascular surgery clinic with visceral artery aneurysms that were incidentally detected during regular check-up. Imaging studies revealed occlusion of the celiac axis and severe stenosis of the superior mesenteric artery and 3 aneurysms along the posterior and inferior pancreaticoduodenal arteries, as well as the right gastroepiploic artery. Endovascular embolization of all aneurysms was rejected because of the risk of hepatic ischemia. These complicated lesion caused by polyarteritis nodosa were successfully treated using a hybrid operation with coil embolization, aneurysm resection, and antegrade aorto-celiac-superior mesentery artery bypass.

17.
Vasc Specialist Int ; 34(2): 44-47, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29984218

RESUMO

To present a world-first case of a successful endovascular treatment of a celiomesenteric trunk (CMT) aneurysm. A 45-year-old man had an asymptomatic saccular aneurysm in a rare anomaly of CMT. Endovascular multiple micro-coil embolization of the common hepatic artery, splenic artery and the aneurysm was done, followed by a stent-graft deployment in the superior mesenteric artery covering the orifice to the aneurysm. Postoperative course was uneventful. Only 21 cases have been previously reported in the literature, and all were treated by open surgeries. Endovascular therapy can be safely done in selected cases of a CMT aneurysm with sufficient collaterals to the liver and spleen.

18.
Congenit Heart Dis ; 13(4): 608-616, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30033572

RESUMO

OBJECTIVE: Pheochromocytoma and paraganglioma (extra-adrenal pheochromocytoma) are rare neuroendocrine tumors that arise from the neuroendocrine cells. Chronic hypoxia is known as a possible cause, and a strong link between cyanotic congenital heart disease and these tumors has been reported. However, reports of phechromocytoma/paraganglioma in Fontan patients were scarce. We herein report seven cases of phechromocytoma/paraganglioma after Fontan operation at a single tertiary center. METHODS: We retrospectively reviewed medical records and imaging studies who diagnosed as phechromocytoma/paraganglioma after Fontan operation in Seoul National University Children's Hospital. RESULTS: Seven patients were identified during follow-up after Fontan operation, and the prevalence was 2.5% among Fontan patients greater than 10 years old on active follow-up. Three patients were diagnosed as phechromocytoma and 4 patients as paraganglioma. Median time interval between Fontan operation and diagnosis of pheochromocytoma/paraganglioma was 21.4 years (range, 10.4-29.7 years). Resting percutaneous oxygen saturation varied from 77% to 94%. All patients underwent complete tumor resection. Phechromocytoma recurred in two patients, of whom one patient died at the age of 18 years due to the tumor progression with multiple metastasis and aggravation of heart failure with profound cyanosis. Pheochromocytoma/paraganglioma developed after hepatocellular carcinoma in two patients. CONCLUSION: Phechromocytoma/paraganglioma could occur in Fontan patients more than expected. Because it is curable by tumor resection during its early phase, early diagnosis and treatment of pheochromocytoma are crucial in Fontan patients not to make hemodynamic deterioration and aggravation of heart failure.


Assuntos
Neoplasias das Glândulas Suprarrenais/epidemiologia , Técnica de Fontan , Cardiopatias Congênitas/cirurgia , Paraganglioma/epidemiologia , Feocromocitoma/epidemiologia , Adolescente , Adulto , Criança , Comorbidade/tendências , Feminino , Seguimentos , Cardiopatias Congênitas/epidemiologia , Humanos , Masculino , República da Coreia/epidemiologia , Estudos Retrospectivos , Adulto Jovem
19.
PLoS One ; 13(4): e0196115, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29672580

RESUMO

BACKGROUND: We aimed to assess whether patients colonized with certain organisms in the genitourinary tract would have greater urinary tract infection (UTI) risk during the post-transplantation period, and whether information on the perioperatively colonized organisms may help identify the causal organisms during early UTI. METHODS: We retrospectively reviewed the culture results of preoperative urine, preoperative urethral swab, and postoperative urinary catheter tip specimens of 420 renal transplant recipients. The colonization status was compared to the culture results during the first UTI episode within 6 months after transplantation. RESULTS: Twenty six (6.2%) patients developed early UTI, and the presence of common uropathogens in the perioperative genitourinary specimen was positively associated with a higher early UTI risk odds ratio [OR], 3.23; 95% confidence interval [CI], 1.44 to 7.24; P = 0.003). However, the actual causal organism during UTI was observed perioperatively only in 15 patients (40.5%). Neither perioperative colonization nor early UTI was associated with subsequent acute cellular rejection or graft failure. CONCLUSIONS: Renal transplantation patients who were colonized with common uropathogens were more likely to develop early UTI. However, the usefulness of the culture results of perioperative colonizers in predicting the causal organism during early UTI seems limited due to the low concordance rate.


Assuntos
Contagem de Colônia Microbiana , Transplante de Rim/efeitos adversos , Assistência Perioperatória , Infecções Urinárias/diagnóstico , Infecções Urinárias/etiologia , Adulto , Contagem de Colônia Microbiana/métodos , Feminino , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/prevenção & controle , Humanos , Imunossupressores , Incidência , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Prognóstico , Transplantados , Infecções Urinárias/epidemiologia , Adulto Jovem
20.
Transplantation ; 102(4): e180-e184, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29334529

RESUMO

BACKGROUND: Thin basement membrane nephropathy (TBMN) is the most common cause of persistent glomerular hematuria. Most individuals with TBMN show a benign course, although it can be difficult to distinguish it from early stages of progressive renal diseases. However, only limited studies address the prognosis of donors with TBMN and their recipients. METHODS: From 2007 to 2016, 11 recipients received kidney grafts from donors with TBMN, and their clinical data were analyzed retrospectively. Follow-up protocol kidney biopsies were given to the recipients at 10 days and 1 year after transplantation. The donors were also received a follow-up evaluation of their renal function and were interviewed via telephone survey. RESULTS: All donors were living, and their kidney grafts showed TBMN on pretransplantation biopsy. The recipients were followed for 57.4 ± 28.6 months posttransplantation. Seven recipients showed acute rejection by a median of 9.7 months, and all recipients recovered their renal function after treatment. Although 1 kidney failed due to graft arterial occlusion, the functions of the others were preserved during the follow-up period. The donors were followed for 41.0 ± 39.1 months and additionally contacted via telephone survey (in total, 56.8 ± 32.0 months). All the donors maintained their renal function upon clinical follow-up without significant complications and denied any discomfort at the time of the telephone interview. CONCLUSIONS: Kidney transplant donors with TBMN and their recipients maintained their renal function through midterm follow-up without significant complications. Therefore, kidney transplantation from donors with TBMN could be a safe option.


Assuntos
Seleção do Doador , Hematúria , Transplante de Rim , Doadores de Tecidos , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
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