• Journal of Chest Surgery
• /
• v.50 no.5
• /
• pp.371-377
• /
• 2017

Background: Lesions in distal target arteries hinder surgical bypass procedures in patients with peripheral arterial occlusive disease. Methods: Between April 2012 and October 2015, 16 patients (18 limbs) with lifestyle-limiting claudication (n=12) or chronic critical limb ischemia (n=6) underwent femoral-above-knee (AK) polytetrafluoroethylene (PTFE) bypass grafts with a bridging stent graft placement between the distal target popliteal artery and the PTFE graft. Ring-supported PTFE grafts were used in all patients with no available vein for graft material. Follow-up evaluations assessed clinical symptoms, the ankle-brachial index, ultrasonographic imaging and/or computed tomography angiography, the primary patency rate, and complications. Results: All procedures were successful. The mean follow-up was 12.6 months (range, 11 to 14 months), and there were no major complications. The median baseline ankle-brachial index of 0.4 (range, 0.2 to 0.55) significantly increased to 0.8 (range, 0.5 to 1.0) at 12 months (p<0.01). The primary patency rate at 12 months was 83.3%. The presenting symptoms resolved within 2 weeks. Conclusion: In AK bypasses with a diffusely diseased distal target popliteal artery or when below-knee (BK) bypass surgery is impossible, this procedure could be clinically effective and safe when used as an alternative to femoral-BK bypass surgery.

• Journal of Korean Neurosurgical Society
• /
• v.50 no.3
• /
• pp.185-190
• /
• 2011

Objective : To investigate the efficacy of extracranial-intracranial (EC-IC) bypass surgery using a radial artery interposition graft (RAIG) for surgical management of cerebrovascular diseases. Methods : The study involved a retrospective analysis of 13 patients who underwent EC-IC bypass surgery using RAIG at a single neurosurgical institute between 2003 and 2009. The diseases comprised intracranial aneurysm (n=10), carotid artery occlusive disease (n=2), and delayed stenosis in the donor superficial temporal artery (STA) following previous STA-middle cerebral artery bypass surgery (n=1). Patients were followed clinically and radiographically. Results : Bypass surgery was successful in all patients. At a mean follow-up of 53.4 months, the short-term patency rate was 100%, and the long-term rate was 92.3%. Twelve patients had an excellent clinical outcome of Glasgow Outcome Scale (GOS) 5, and one case had GOS 3. Procedure-related complications were a temporary dysthesia on the graft harvest hand (n=1) and a hematoma at the graft harvest site (n=1), and these were treated successfully with no permanent sequelae. In one case, spasm occurred which was relieved with the introduction of mechanical dilators. Conclusion : EC-IC bypass using a RAIG appears to be an effective treatment for a variety of cerebrovascular diseases requiring proximal occlusion or trapping of the parent artery.

• Journal of Chest Surgery
• /
• v.44 no.2
• /
• pp.89-98
• /
• 2011

Background: Although considerable efforts have been made to improve the graft patency in coronary artery bypass surgery, the role of biomechanical factors remains underrecognized. The aim of this study is to investigate the influences of geometric configurations of the bypass graft on hemodynamic characteristics in relation to anastomosis. Materials and Methods: The Numerical analysis focuses on understanding the flow patterns for different values of inlet and distal diameters and graft angles. The Blood flow field is treated as a two-dimensional incompressible laminar flow. A finite volume method is adopted for discretization of the governing equations. The Carreau model is employed as a constitutive equation for blood. In an attempt to obtain the optimal aorto-coronary bypass conditions, the blood flow characteristics are analyzed using in vitro models of the end-to-side anastomotic angles of $45^{\circ}$, $60^{\circ}$ and $90^{\circ}$. To find the optimal graft configurations, the mass flow rates at the outlets of the four models are compared quantitatively. Results: This study finds that Model 3, whose bypass diameter is the same as the inlet diameter of the stenosed coronary artery, delivers the largest amount of blood and the least pressure drop along the arteries. Conclusion: Biomechanical factors are speculated to contribute to the graft patency in coronary artery bypass grafting.

• Proceedings of the KOSOMBE Conference
• /
• v.1996 no.11
• /
• pp.254-257
• /
• 1996

An aorto-coronary bypass graft is frequently adopted for the interventional therapy of the diseased atherosclerotic coronary artery grafting. The bypass artery is often occluded due to restenosis and/or anastomotic neointimal fibrous hyperplasia after bypass graft. The optimal aorto-coronary bypass procedure must be studied in order to improve patency rate for the arterial bypass techniques. The objective of this study is to investigate the influences of geometric dimensions of bypass on the hemodynamics around the anastomosis in the stenosed coronary artery with aorto-coronary bypass.

• Journal of Korean Clinical Nursing Research
• /
• v.14 no.1
• /
• pp.25-32
• /
• 2008

Purpose: The purpose of this study was to examine quality of life with patients in 12 months after coronary artery bypass graft surgery, compared with general population. Method: A cross-sectional comparative study was designed. Study participants were 90 adults who had undergone CABG surgery (n=45) in experimental group and general population (n=45) in control group. The subjects were asked the questionnaire (SF-36, Short Form-36) regarding the quality of life. The data were analyzed by the SPSS 13.0 program including frequency, percentage, $x^2$ test, t-test and One-Way ANOVA. Results: There were no significant differences in the quality of life between two groups including physical functioning (t=-.938, p=.351), role-physical limitation (t=-.322, p=.748), bodily pain (t=-.938, p=.351), general health (t=-.1418, p=.888), vitality (t=-.816, p=.417), social functioning (t=.720, p=.474), role-emotional limitation (t=-.710, p=.479), mental health (t=-.431, p=.667). Conclusion: Even though patients in experimental group had operation experience, the quality of life examined on the time of 1 year after bypass surgery is similar in that of general population. We suggest the study change the design as examination of quality of life before and after coronary artery bypass graft surgery.

• Journal of Chest Surgery
• /
• v.12 no.3
• /
• pp.297-305
• /
• 1979

Occlusive coronary artery disease presents a potential threat to a significant population in the United States. According to many case reports, the increasing incidence of coronary artery disease due to atherosclerosis is noted in Korean, recently. Operative vascular procedures have increased steadily in number over the past 20 years in the United States. There have been many isolated case reports about coronary artery surgery, but these had little clinical impact. Nowadays, major three coronary bypass surgery has developed principally at three cardiac centers in the United States since 1967. Among three coronary bypass operation, the aorta-coronary artery saphenous vein bypass graft was first demonstrated by Favolaro and Effler at the Cleveland Clinic in 1967. We experienced one case of coronary artery disease, which was treated successfully by aorta-coronary saphenous vein graft with mild hypothermia under extracorporeal circulation in May, 1977. Saphenous vein was removed from above the knee and was 2.5 mm in diameter. The left ventricle was not vented for the left ventricle was not overdistended. Temporary artificial pace-maker-Medtronic-was implanted for the prevention and treatment of post-operative arrhythmia and heart block in post-operative first day. He is a 57 year old male businessman who had been suffered from hypertension [200 mmHg in systolic pressure] since 4 years ago, who had intermittent conservative treatment at local clinic. He had been afflicted with severe chest pain with choking sensation for 50 days. This symptom was aggravated exposing cold weather, or cold water, but was respond to rest. Pre-operative ECG revealed no any other ischemic sign except sinus bradycardia. Significant S-T segment depression was noted at lead II, AVF after double 5 minutes exercise, indicating positive Master`s test. Serum cholesterol was slight elevated to 253 mg/dl. Final pre-operative diagnosis was made by coronary arteriogram, which showed about 1.0-cm segmental 90 % occlusive atherosclerotic lesion in the proximal part of right coronary artery above the origin of acute marginal artery. Left coronary artery revealed good patency and there was no collateral circulation between right and left coronary artery .Hospital course was not eventful. He was discharged with good result on the post-operative day. He has been free from chest pain for longer than 2 years. And also the arterial flow in the coronary bypass graft is auscultated with the pocket-sized ultrasonic velocity detector, which shows the patency of the coronary bypass graft good.

• Journal of Chest Surgery
• /
• v.28 no.3
• /
• pp.320-323
• /
• 1995

We report a case of recurred Takayasu,s arteritis.The patient was 28-year-old female underwent aorto-left common carotid and aorto-left subclavian bypass graft replacement 1 year ago.Unfortunately, she was readmitted because of newly developing angina and both eye claudication severe headache. Aorto-coronary angiogram showed complete obstruction of left common carotid artery ,stenosis of right carotid artery bifurcation and ostial stenosis of right coronary artery.Bilateral carotid arteries bypass graft with great saphenous vein and right coronary artery bypass graft with right internal mammary artery were done at same the time and she discharged after 21 days without any problem.

• Journal of Chest Surgery
• /
• v.27 no.9
• /
• pp.798-800
• /
• 1994

Chyloascities is an extravasation of milky chyle into the peritoneal cavity due to tumor , inflammation or rarely postoperative lymphatic trauma.It is an unusual complication that can lead to significant immunologic and nutritional consequences.We experienced one case of chyloascites after aorto-bifemoral bypass graft in a patient with aorto-iliac occlusive disease.The patient was a 62-year-old male, who suffered from severe progressive claudication for 5 months. A 16$\times$ 8mm gelsealed Dacron-Y shaped graft was used in arterial reconstruction. A bloody-milky fluid was drained through the operative wound from 3days after operation and evaluated biochemically.Diagnosis of chyloascites was made with repeated paracentesis and examination of the fluid.After Total parenteral nutrition[T.P.N] for 3 weeks from 6days after operation, chyloascites was controlled sufficiently and maintained a good graft-patency in abdominal sonogram.

• Journal of Chest Surgery
• /
• v.30 no.3
• /
• pp.344-347
• /
• 1997

A 49-year-old female patient who had obstruction of superior vents cave(SVC) with SVC syndrome was successfully managed by bypass operation of superior vents cava with spiral vein graft. A composite spiral vein graft was placed between the right innominate vein and the right atrium to bypass the occluded SVC. The graft was constructed from the patient's own saphenous vein, which was split longitudinally and wrapped around a stent in spiral fashion and the edges of the vein were sutured together to form a large autogenous conduit. The patient was relieved o SVC obstructive symtoms and signs and discharged 21 days postoperatively without any complication.

• Journal of Chest Surgery
• /
• v.27 no.9
• /
• pp.801-803
• /
• 1994

We report a case of a 45-year-old woman with Budd-Chiari syndrome caused by the obstruction of the inferior vena cava just below the diaphragm. Transatrial dilatation or membranotomy was not possible due to the severe fibrotic obliteration of the inferior vena cava. Instead, cavoatrial bypass with a Dacron graft[20 mm-Vascutek] was performed under the median sternotomy and median abdominal incision.The postoperative course was uneventful and generalized symptoms were much improved. During the following period[6 month] the graft patency was maintained with no recurrence of symptoms.