• Journal of Chest Surgery
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• 제13권4호
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• pp.385-393
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• 1980

From 1959 to 1980, for about 21 yrs, the authors have experienced of 69 cases of arterial diseases, and analyzed the diseases. They are Aneurysm 16 Iatrogenic thrombosis after angio & cardiac Cath. 20 Coarctation 3 Primary arteritis 9 Traumatic injury 9 Occlusive disease 12 But PDA (107 cases) & Buerger's disease are excluded in this study.

• Journal of Chest Surgery
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• 제25권12호
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• pp.1570-1577
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• 1992

The vascular surgery is the field that has developed in early 20 century and is progressing nowadays. Recent advance in surgical technique accompanying with excellent medical diagnosis and treatment, prompt angiographic usage, development of variable prosthetic material, and concomitant use of anti-coagulant have made remarkable results of vascular surgery. 83 cases of vascular surgery have been performed at Thoracic and Cardiovascular Surgery Department of Pusan National Unversity Hosaital since 1971 till 1990, for 20 years and their results are followed. Patient ductus arteriosus and Buerger`s disease were omited in this study. 1. The age distribution shows that the fifth and sixth decades are most frequently affected and mean age was 56.1 years old. Male to female ratio is 1: 2.32. 2. Among the 83 cases of all, number of occlusive vascular disease is 46 and that of aneurysmal disease is 33. 3. In clinical manifestation, most common symptom of occlusive disease is pulselessness and pain was next. Mass sensation is most commonly complained by patients of aneurysmal disease. 4. CT scan was more important in diagnosis of aneurysmal diseases and angiogram was more commonly used in occlusive diseases. 5. The common site of arterial occlusion was common iliac artery, femoral artery, aortic bifurcation, and external iliac artery, as its frequency rate. The most commonly affecting portion of aortic aneurysm was abdminal aorta, and descending thoracic aorta and femoral artery were next 6. Preoperative associated diseases were atherosclerosis[41 cases], hypertension[21 cases], valvular heart disease[11 cases], and diabetes mellitus[9 cases], etc, 7. Operative methods in ocllusive diseases were thrombectomy[36.9%], endarterectomy [10.9%], and bypass graft insertion[52.7%]. Among the bypass graft, Y-graft was used in 7 case, straight graft was used in 17 cases, and saphenous venous graft was used in 2 cases. 8. Postoperative complications were developed in 17 cases, and morbidity rate was 36. 9. Eleven patient were died within 1 month after operation, so operative mortality rate was 13.3%. 10. Duration of patency was beteween 7 and 58 months[average 27.5 months] in occlusive diseases and their 5-year patency rate was 56.3%. Duration of patency of aneurysmal disease was 20 months in aveage and their 5-year patency rate was 51.3%. 11. Patients of eleven cases of occlusive disease and two cases of aneurysmal disease required reoperation for variable reason. 12. 35 cases of patient have used anticoagulants: coumadin, ticlid, and persanthin-ASA combination.

• Journal of Chest Surgery
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• 제19권1호
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• pp.58-67
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• 1986

Aggressive revascularization of the ischemic lower extremities in atherosclerotic, occlusive diseases or acute embolic arterial occlusion due to cardiac valvular disease by thromboembolectomy or an arterial bypass operation has been advocated by some authors. We have performed 68 first time vascular operations, including thromboembolectomies on RR patients with ischemic lower extremities, within an 11-year-and-6-month period, from January 1974 to June 1984. We have reviewed and analyzed our vascular operative procedures and post operative results. The patients upon whom thromboembolectomies were performed were 42 males and 13 females ranging from 5 to 72 years of age. The major arterial occlusive sites were common iliac artery in 20 cases, femoral artery in 21 cases, popliteal artery in 8 cases, common iliac artery and femoral artery in 4 cases, and femoral artery and popliteal artery in 3 cases. The underlying causes of arterial occlusive disease were atherosclerosis obliterans in 34 cases; Buerger`s disease in 3 cases; emboli due to cardiac valvular disease in 13 cases; and vascular trauma in 4 cases, including cardiac catheterization in I of those cases. Arterial bypass operations with autogenous or artificial vascular prosthesis were done in 31 cases. Amputations were done on 2 patients carrying out any more vascular operative procedures would have been of no benefit to them. Our bypass operations for ischemic lower extremities were classified as follows: those done between the abdominal aorta and the femoral artery in 17 cases, including those done between the aorta and the bifemoral arteries with a Y graft in four of those cases and long ones done from the axillary to the femoral artery in 4 cases. Five patients died in the hospital following vascular surgery for ischemic lower extremities, the causes of death were not directly related to the vascular reconstructive operative procedures. The leading causes of death were respiratory failure due to metastatic lung carcinoma: renal failure due to complications from atherosclerosis obliterans; sepsis from open, contaminated fractures of the tibia and fibula; and myocardial failures due to open heart surgery in one case and reconstructive surgery of the ascending aorta in another.

• Journal of Chest Surgery
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• 제33권10호
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• pp.792-797
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• 2000

Background : Even though there were developments in various treatment techniques for acute arterial occlusion this disease still has high rate of mortalities and limb amputations. We investigated the combined diseases symptoms location of occlusion type of treatment complication and prognosis in our patients. Meterial and methods: This study recruited 48 patients(42 men, 6 women, mean age 57.7 years) who received the operation from January 1995 toDecember 1998. We investigated the post-operation course via medical record review or telephone interview with patients or their family members. Result: The most common combined diseases were atherosclerosis in 30 patients. other diseases were 17 diabetes mellitus 16 hypertension and 12 atrial firillation. Pain and clod sensation were noticed in all patients paresthesia in 5 patients fibrillation. Pain and cold sensation were noticed in all patients paresthesia in 5 patients and lower extremity paralysis in 11 patients. In 29 patients the time interval from the onset of symptom to admission was over 72 hours and 15 patients were admitted within 24 hours. The distribution of arterial occlusion location was at 28 femoral arteries 14 popliteal arteries and 6 iliac arteries. All the patients were received embolectomy and 5 patients were received additional bypass grafting. Postoperative complications were 12 reocclusions. 6 compartment syndromes 6 skin necrosis and 2 acute renal failure. The mortality rate was 16.7%(8/48) and the amputation rate was 25% Conclusion : This study revealed 25% reocclusion 25% limb amputation and 16.7% mortaliyt. To improve the prognosis of acute lower extrements arterial occlusion early diagnosis and understand the underlying diseases prompt treatment and operation additional operation including interventional radiologic examination and thorough postoperative care would be appreciated.

• Journal of Chest Surgery
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• 제29권8호
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• pp.889-896
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• 1996

하지 동맥 혈관의 폐쇄로 인한 급,만성적인 하지 허혈은 혈관우회술이나 혈전제거술등의 적극적인 수술을 시행함으로 점차 좋은 경과를 얻고있다. 동아대학교 병원 흉부외과학 교실에서는 하지 허혈의 임상적 양상과 수술 결과를 살펴보고자 1990년 3월부터 1995년 8월까지 5년 5개월동안 101명의 환자를 대상으로 수술을 하여 이를 분석하였다. 연령 및 성별 분포는 25세에서 87세이고 남자가 92례, 여자가 9례로써 약 101로 남자에서 많았다. 이들 환자의 동맥폐쇄질환에 관계있는 병인에는 동맥경화성 협착이 54례, 혈전색전증이 21례. 버거씨병이 20례, 외상에 의한 동맥 폐쇄가 3례, 가성동맥류가 3례였다. 동맥경화성 협착에서 주 폐쇄부위는 대퇴동맥 폐쇄가 30례, 장골동맥 폐쇄 23례, 슬와 동맥 폐쇄 10례, 대동맥 분지부 6례. 경골동맥 폐쇄였고, 버거씨 병에서는 후경골동맥 폐쇄 14례, 전 경골동맥 폐쇄 8례. 슬와동맥 폐쇄 5례. 대퇴동맥과 비골동맥이 각각 2례 였다. 혈관 폐쇄로 인한 하지 혈행장애의 수술은 동맥경화성 협착에서 혈관우회술이 61례. 혈전 제거술 24 례, 교감 신경절제술 20례였다. 동맥경화성 협착 환자에서 혈관우회술을 시행한 苛\ulcorner61례로써 이중 대퇴동맥과 슬와 동맥간의 우회술이 21례, 대퇴동맥과 반대편 대퇴동맥간의 우회술이 15례. 맥와 동맥과 양측 대퇴동맥간의 우회술이 7례, 하복부 대동맥과 양측 대퇴동맥간에 Y graft를 이용한 우회술이 3례였 4술후 이식혈관에 대한 개존율은 전체적으로 술 후 1년에 83.6%. 2년에 77.1%. 3년에 75.5%의 결과를 보였고 하지 보존율은 86.8 %였다. 하지혈행장애의 모든 환자에서 수술후 사망은 6명이었는데 사망 원인은 급성 신부전증, 다장긴 기능 부전, 그리고 패혈중이었다.

• Journal of Chest Surgery
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• 제48권2호
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• pp.134-138
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• 2015

Thoracoabdominal aortic aneurysm accompanied by Leriche syndrome is an extremely rare combination of aortic diseases, the surgical management of which has not been described to date. We report the successful treatment of one such case through open surgical repair of the thoracoabdominal aorta.

• Journal of Chest Surgery
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• 제12권4호
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• pp.371-378
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• 1979

The authors have performed operations on vascular system of 108 cases from 1972 through 1979, and analyzed the diseases, surgical procedures and results. They were 1. Arterial system; 45 cases P.D.A. : 20 Occlusive diseases : 13 Coarctation of aorta : 4 Aneurysm : 4 A-V fistula : 2 Trauma : 2 2. Venous system; 6 cases Esophageal varix : 4 S.V.C. syndrome : 1 Varicose vein : 1 3. Arteriovenous shunt for hemodialysis; 57 cases Of the arterial diseases, the worst results came from Burger`s disease. For the bleeding esophageal varices, we have performed ligations of varices or collateral circulations rather than emergency splenorenal shunt with good results. External A-V shunt for hemodialysis had much more complications than the A-V fistula.

• Journal of Chest Surgery
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• 제36권5호
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• pp.371-374
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• 2003

동맥혈관 폐쇄 질환의 원인 중 동맥경화증에 의한 경우가 60% 이상을 차지하고 있다. 부위별로는 복부대동맥 및 하지동맥의 폐쇄가 가장 많은 것으로 알려져 있다. 본 2예의 증례는 양측 하지의 간헐적 파행이 지속되어 혈관조영술 시행 후 양측 대동맥-장골동맥 및 대퇴동맥-슬와동맥의 동반 폐색을 진단받고 각각 내과적 치료 및 혈관성형술을 시행하였으나 실효성을 거두지 못하여 본과에서 수술적 방법으로 근치술을 시행한 경우이다. 수술은 Hemashield Y graft를 이용한 복부대동맥-양측 대퇴동맥간 우회술과 자가복재대정맥을 이용한 양측 대퇴동맥-슬와동맥 우회술을 동시에 시행하였다. 수술후 환자의 증상은 소실되었으며 복부창상결손 외에는 특별한 합병증이 없었고 수술 후 시행한 혈관 조영술상 이식혈관의 유통성이 양호하였다. 환자들은 증상의 재발 없이 외래에서 관찰 중이다.

• Journal of Chest Surgery
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• 제38권2호
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• pp.152-156
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• 2005

배경: 동맥 재건술 후에 발생하는 폐쇄성 합병증은 치료가 어렵고 재발 가능성이 높은 것으로 알려져 있다. 저자들은 동맥 재수술에 관하여 임상양상 및 수술방법, 사용된 이식편, 술 후 결과들을 분석하여 이식편 폐쇄에 영향을 미치는 인자를 알아보고 효율적인 치료 방침을 세우는 데 도움을 얻고자 하였다. 대상 및 방법: 1998년 1월부터 2002년 12월까지 부산대학교병원 흉부외과에서 시행된 173명의 동맥재건술 후 재수술을 받은 33명(55예)을 대상으로 조사하여 임상적 특성과 치초 수술의 유형, 재수술시까지의 경과한 시간, 사용한 이식편, 치료의 결과 등을 후향적으로 분석하였다. 결과: 33명 중 32명이 남자였고 재수술 당시의 평균연령은 63.5세였다. 첫 수술에서 재수술까지의 기간은 11.9개월이었고 원인질환은 동맥경화증이 28예, 버거씨병 5예였다. 동반된 질환은 고혈압 19예, 당뇨병 11예, 심부전 6예 등의 순이었다. 한 환자당 평균 1.67회의 재수술이 시행되었고 치초의 수술유형은 대퇴동맥-슬와동맥 우회술이 19예로 가장 많았다. 수술에 사용되었던 이식편은 PTFE가 25예, Dacron이 6예였고 이식편에 따른 재수술률은 차이가 없었다. 재수술은 혈전제거술이 20예, 혈관 성형술 18예, 우회로 재조성술이 13예, 요부 교감신경절제술이 4예에서 시행되었다. 재수술의 결과는 하지의 기능회복이 15명, 하지보존 7명, 슬상부절단 5명, 슬하부 절단 3명, 사망 3명이었다. 걸론· 하지 동맥 재건술 후 발생하는 폐쇄성 합병증은 유입 동맥이나 유출동맥의 폐쇄가 발생하며 생기는 경우가 많았다 치료의 방침은 최초의 수술방법과 사용된 이식편에 따라 다를 수 있고 무엇보다도 이식편의 감시가 중요한데 이차 수술의 시행빈도가 가장 높은 시기인 술 후 1년 이내의 이식편 감시가 중요하다고 생각한다. 또한 재우회로술 뿐만 아니라 방사선학적 중재술 및 교감신경 절제술과 같은 부가적인 치료도 적극적으로 시행하여야 하지 보존율의 향상을 기대할 수 있을 것이다.

• Journal of Chest Surgery
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• 제27권10호
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• pp.846-849
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• 1994

Extra-anatomic bypass is indicated for the limb salvage of patients with threatened limb loss especially those who have high risk of infection and death after general anesthesia. We did extra-anatomic bypass procedure nineteen times over a seven year, two month period on sixteen patients. Their mean follow up period was 41.3 months. Male to female ratio was 7:1. Major complaints were resting pain[36.8%], claudication[31.6%], cyanosis[15.8%] and ulcerative change[15.8%]. Associated diseases were hypertension, tuberculosis, chronic renal failure, atrial fibrillation, complete heart block and laryngeal cancer. Postoperative patency rates were 76.9% at 1 year, 72.7% at 2 years and 70% at 3 years. Limb salvage rate was 78.9%. Postoperative mortality rate was 10.5%.