• Archives of Plastic Surgery
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• v.32 no.5
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• pp.619-624
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• 2005

Patency of the radial artery plays an important role in the survival of radial forearm fasciocutaneous free flap and artery conduit of coronary artery bypass graft procedure. Even though Allens' test has been used for evaluating the patency of radial artery, the studies on the correlations between risk factors for atherosclerosis and histopathologic findings of radial arteries are rare, until now. Therefore, the authors investigated the correlations between these two factors, and tried to estimate the feasibility of the radial artery in high-risk groups for artherosclerosis. The risk factors for atherosclerosis and lipid profiles were investigated in 38 patients by history taking, physical examinations and blood analysis. And 38 cases of segments of vessel were harvested during the elevation of the flap. The degrees of vessel medial sclerosis were estimated by R values(by Kobayashi and colleagues) that is the median value between the thickness of the intima and that of the media. The measured mean R value was $0.210{\pm}0.05$. Thirty one cases belonged to Grade I(R<0.25), 7 cases belong to Grade II(0.25

• Journal of Chest Surgery
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• v.57 no.3
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• pp.231-239
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• 2024

Background: Although the modified Blalock-Taussig shunt remains the mainstay method of palliation for augmenting pulmonary blood flow in various congenital heart diseases, the shunt must be carefully designed to achieve the best outcomes. This study investigated the effect of shunt configuration on pulmonary artery growth and growth discrepancy. Methods: Twenty patients with successful modified Blalock-Taussig shunt takedown were analyzed. Pulmonary artery and shunt characteristics were obtained using computed tomography scans. Differences in the baseline and follow-up diameter ratios and growth in the ipsilateral and contralateral arteries were calculated. The angle between the shunt and pulmonary artery, as well as the distance from the main pulmonary artery bifurcation, were measured. Correlations between pulmonary arteries and shunt configurations were analyzed. Results: The median interval time between shunt placement and takedown was 154.5 days (interquartile range, 113.25-276.25 days). Follow-up values of the ipsilateral-to-contralateral pulmonary artery diameter ratio showed no significant correlation with the shunt angle (ρ=0.429, p=0.126) or distance (ρ=0.110, p=0.645). The shunt angle and distance from the main pulmonary bifurcation showed no significant correlation (ρ=-0.373, p=0.189). Pulmonary artery growth was negatively correlated with shunt angle (ipsilateral, ρ=-0.565 and p=0.035; contralateral, ρ=-0.578 and p=0.030), but not with distance (ipsilateral, ρ=-0.065 and p=0.786; contralateral, ρ=-0.130 and p=0.586). Conclusion: Shunt configuration had no significant effect on growth imbalance. The angle and distance of the shunt showed no significant correlation with each other. A more vertical shunt was associated with significant pulmonary artery growth. We suggest a more vertical graft design for improved pulmonary artery growth.

• Journal of Korean Neurosurgical Society
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• v.42 no.6
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• pp.446-449
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• 2007

Objective : Persistent trigeminal artery variant (PTAV) is an anastomosis between the internal carotid artery (ICA) and the cerebellar artery without any interposing basilar artery segment. We discuss its probable embryological origin and emphasize clinical implications. Methods : Retrospectively 1250 conventional cerebral angiograms and 2947 cranial magnetic resonance angiographies (MRAs) were evaluated for the patients with PTAV. Results : Five patients (four men and one woman, 23 to 76 years of age, median age 65 years) had a PTAV. Three patients who underwent MRA had a PTAV (3/2947=0.1%). Four of the patients who underwent cerebral angiography had a PTAV (4/1250=0.32%). Two of 143 patients who underwent both conventional angiography and cranial MRA showed PTAV. The PTAV was an incidental finding in all five patients. The PTAV originated from the cavernous segment of the left ICA in four patients and from the cavernous segment of the right ICA in one patient. The terminal branch of the PTAV was the anterior inferior cerebellar artery (AICA) and superior cerebellar artery (SCA) in two patients and the AICA only in the other three patients. Conclusion : Neurosurgeons should be aware of possible presence of PTAV. Manipulation of this vessel during a surgical approach to the parasellar region and percutaneous gasserian ganglion procedure may result in hemorrhage or ischemia.

• Journal of Korean Neurosurgical Society
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• v.58 no.6
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• pp.499-503
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• 2015

Objective : The transradial catheterization (TRC) is becoming widespread, primarily for neurointerventions. Therefore, the evaluation of radial artery puncture in clinical practice and a better understanding of the anatomy are important to improve the safety of neuroendovascular surgery. Methods : Ten formalin-fixed adult Korean cadavers were dissected to expose radial artery (RA), brachial artery (BrA) and subclvian artery (ScA), bilaterally. Vessel lengths and diameters were meaured using a caliper and distance between the specific point of vessels and the anatomical landmarks including the radial styloid process, the medial epicondyle of the humerus, the sternoclavicular joint, and the vertebral artery orifice were also measured. Results : The average length between the radial (RAPS) and the BrA puncture sites (BrAPS) and between the vertebral artery orifice (VAO) and the BrA bifurcation (BrAB) did not differ between sides (p>0.05). The average length between the radial styloid process (RSP) and the RAPS was $13.41{\pm}2.19mm$, and the RSP was $26.85{\pm}2.47mm$ from the median nerve (MN). The mean length between the medial epicondyle (ME) and the BrAPS as $44.23{\pm}5.47mm$, whereas the distance between the ME and the MN was $42.23{\pm}4.77mm$. The average VAO-ScA angle was $70.94{\pm}6.12^{\circ}$, and the length between the ScA junction (SCJ) and the VAO was $60.30{\pm}8.48mm$. Conclusion : This study provides basic anatomical information about the radial artery and the brachial route and can help improving new techniques, selection of size and shape of catheters for TRC. This can help neurointerventionists who adopt a transradial neuroendovascular approach and offers comprehensive and safe care to their patients.

• Journal of Chest Surgery
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• v.30 no.10
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• pp.1036-1039
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• 1997

Primary pulmonary artery sarcoma is a rare tumor and commonly misdiagnosed as pulmonary embolism. The prognosis of these tumors is very poor. The Median length of survival without surgical resection is approximately 1.5 months, but surgical resection has lengthened survival time to approximately 1 year. We encountered a case of primary pulmonary artery sarcoma, with a 55 year-old woman whose symptoms were exertional dysp ea, right chest pain, and hemoptysis. A preoperative chest CT scan revealed mass lesion mimicking pulmonary embolism. Pulmonary angioplasty and right Pneumonectomy were Performed on partial cardiopulmonary bypass. Postoperatively the mass was confirmed as undifferenciated sarcoma histopathologically. The symptoms were somewhat improved, but the patient died of unknown causes about 3 months after surgery.

• Journal of Chest Surgery
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• v.40 no.12
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• pp.871-873
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• 2007

A rupture of an innominate artery caused by blunt trauma is relatively rare because this artery is short and protected by the chest bony cage. This report describes a 25-year-old man who suffered a traffic accident, that resulted in an innominate artery rupture, which was detected by a chest computed tomogram and angiogram. This patient underwent urgent surgery through a right clavicular incision and median sternotomy without a cardiopulmonary bypass due to multiple injuries. An approximately 3 cm sized injury was found from the innominate artery to the proximal right subclavian artery and the origin of the common carotid artery. The injured lesion was repaired with a saphenous vein patch. After surgery, he was discharged from hospital without complications.

• Journal of Chest Surgery
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• v.47 no.3
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• pp.220-224
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• 2014

Background: For the surgical management of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), there have been various techniques that reduce the tension and kinking of the coronary artery during reimplantation to the aorta. The aim of this study is to describe the results of our modified technique of coronary reimplantation for the treatment of ALCAPA. Methods: Between October 2003 and February 2011, seven patients underwent coronary reimplantation with the modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta). The median follow-up duration was 52 months (range, 4 to 72 months). Clinical outcomes and serial echocardiographic data were reviewed. Results: There was no mortality. One patient had a small amount of cerebral hemorrhage postoperatively and improved without any sequelae. Another patient had left diaphragm palsy and underwent diaphragm plication. Follow-up echocardiogram showed that all patients had normal ventricular function without chamber enlargement. Conclusion: Our modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta) demonstrated successful clinical outcomes. We conclude that this surgical technique can be a potential alternative for the treatment of ALCAPA.

• Journal of Korean Neurosurgical Society
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• v.51 no.2
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• pp.75-80
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• 2012

Objective : To optimize the recanalization of acute cerebral stroke that were not effectively resolved by conventional intraarterial thrombolysis (IAT), we designed a double device technique to allow for rapid and effective reopening. In this article, we describe the feasibility and efficacy of this technique. Methods : From January 2008 to September 2009, twenty patients with acute cerebral arterial occlusion (middle cerebral artery : n=12; internal carotid artery terminus : n=5; basilar artery : n=3) were treated by the double device technique. This technique was applied when conventional thrombolytic methods using drug, microwires, microcatheters and balloons did not result in recanalization. In the double device technique, two devices are simultaneously placed at the lesion (for example, one microcatheter and one balloon or two microcatheters). Chemicomechanical or mechanicomechanical thrombolysis was performed simultaneously using various combinations of two devices. Recanalization rates, procedural time, complications, and clinical outcomes were analyzed. Results : The initial median National Institute of Health Stroke Scale (NIHSS) was 16 (range 5-26). The double device technique was applied after conventional IAT methods failed. Recanalization was achieved in 18 patients (90%). Among them, 55% (11 cases) were complete (thrombolysis in cerebral infarction 2B, 3). The median thrombolytic procedural time including the conventional technique was $135{\pm}83.7$ minutes (range 75-427). Major symptomatic hemorrhages (neurological deterioration ${\geq}4$ points in NIHSS) developed in two patients (10%). Good long term outcomes (modified Rankin Scale ${\leq}2$ at 90 days) occurred in 25% (n=5) of the cases. Mortality within 90 days developed in two cases (10%). Conclusion : The double device technique is a feasible and effective technical option for large vessel occlusion refractory to conventional thrombolysis.

• Journal of Korean Neurosurgical Society
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• v.50 no.4
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• pp.377-380
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• 2011

Objective : The purpose of this study was to determine the anatomic relationships between neurovascular structures and the transverse carpal ligament so as to avoid complications during endoscopic carpal tunnel surgery. Methods : Twenty-eight patients (age range, 35-69 years) with carpal tunnel syndrome were entered into the study. We examined through wrist magnetic resonance imaging in three different positions (neutral, radial flexion, and ulnar flexion) and determined several anatomic landmark (distance from the hamate hook to the median nerve, ulnar nerve, and ulnar vessel) based on the lateral margin of the hook of the hamate. The median nerve and ulnar neurovascular structure were studied with the wrist in the neutral, ulnar, and radial flexion positions. Results : The ulnar neurovascular structures usually passed just over or ulnar to the hook of the hamate. However, in 12 hands, a looped ulnar artery coursed 0.6-3.3 mm radial to the hook of the hamate and continued to the superficial palmar arch. The looped ulnar artery migrates on the ulnar side of Guyon's canal (-5.2-1.8 mm radial to the hook of the hamate) with the wrist in radial flexion. During ulnar flexion of the wrist, the ulnar artery shifts more radially beyond the hook of the hamate (-2.5-5.7 mm). Conclusion : It is appropriate to transect the ligament greater than 4 mm apart from the lateral margin of the hook of the hamate without placing the edge of the scalpel toward the ulnar side. We would also recommend not transecting the transverse carpal ligament in the ulnar flexed wrist position to protect the ulnar neurovascular structure.

• Journal of Chest Surgery
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• v.52 no.2
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• pp.70-77
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• 2019

Background: Extracorporeal life support (ECLS) is used as a bridge to revascularization in high-risk patients with ischemic heart disease. We reviewed our experiences of coronary artery bypass grafting (CABG) after ECLS in patients with cardiac arrest or refractory cardiogenic shock. Methods: We retrospectively reviewed 4,616 patients who underwent CABG at our institution between May 2006 and February 2017. We identified patients who underwent CABG following ECLS for cardiogenic shock or cardiac arrest. Twenty-three patients (0.5% of all CABG cases) were enrolled in the analysis. Their median age was 65 years (Q1-Q3, 58-77 years). Nine patients (39.1%) were diagnosed with ST-elevation myocardial infarction. Mechanical complications after acute myocardial infarction, including acute mitral regurgitation, left ventricular rupture, and ventricular septal defect, occurred in 9 patients (39.1%). Results: The median time from cardiopulmonary resuscitation to ECLS initiation was 25 minutes (Q1-Q3, 18.5-28.5 minutes). Conventional CABG was performed in 10 patients (43.5%) who underwent concomitant intracardiac procedures. Postoperative ECLS was required in 16 patients (69.5%). The rate of successful ECLS weaning was 91.3% (n=21). There were 6 early mortalities (26.1%). Conclusion: CABG after ECLS was very rare in real-world circumstances. Although the early mortality rate was high, the risk of mortality may be acceptable under such devastating circumstances.