• Journal of Chest Surgery
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• 제43권6호
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• pp.642-647
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• 2010

배경: 팔 오금에서 시행되는 위팔동맥과 자쪽 피부정맥이나 노쪽 피부정맥을 이용한 동정맥루 조성술 외에 관동정맥을 이용한 동정맥루 조성술을 시행하여 개통률 및 영향을 미치는 인자들을 조사, 분석하고자 한다. 대상 및 방법: 2006년 5월부터 2009년 12월까지 본원 흉부외과에서 팔오금에 동정맥루 조성술을 시행받은 192명 205예의 수술을 대상으로 후향적 조사를 실시하여 개통률 및 개통과의 연관성을 분석하였다. 결과: 관동정맥을 이용한 수술의 6개월, 1년, 2년 개통률은 75.91%, 60.79%, 37.80%으로 다른 혈관을 이용한 수술의 결과와 통계적으로 차이는 보이지 않았다. 여러 인자 중 연령에 따라 개통률에 차이를 보였다(p <0.001). 결론: 팔 오금에서 동정맥루 조성술이 필요한 환자에서는 관통정맥을 이용함으로써 노쪽 피부정맥과 자쪽 피부정맥을 사용할 수 있어 혈관의 접근 방법이 다양해지고 관통정맥의 해부학적 위치에 따라 술식의 어려움이 없어 수술 접근에 대한 추가적 대안이 될 수 있을 것이다.

• Journal of Chest Surgery
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• 제37권4호
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• pp.342-348
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• 2004

말기 신부전 환자의 생명 유지를 위한 혈액투석 치료에 있어서 지속적으로 개존상태가 유지되고 충분한 혈액이 관류되는 투석 경로의 확보는 매우 중요하다. 동정맥루 조성술 시행 후 조기 폐쇄로 인해 투석을 시행하지 못하는 경우, 환자는 경정맥 또는 대퇴정맥 등의 중심 정맥 삽관을 반복적으로 시행 받아 혈액투석을 유지해야 하며 경제적, 시간적 손실을 감수해야 하는 어려움을 겪게 된다. 대상 및 방법: 자가 혈관을 이용한 동정맥루 조성술에 있어 조기개존율에 영향을 미치는 요인을 파악하고, 이를 향상시키기 위해서 2002년 6월부터 2003년 5월까지 1년 간 말기 신부전 환자에게 시행한 총 85예의 동정맥루 수술 중 두부정맥(cephalic vein)과 요골동맥(radial artery)의 단측문합(end-to-side anastomisis)을 시행한 49예를 대상으로 임상분석을 하였다. 걸과: 연구대상 49예에서 조기개존율은 79.6%였다. 환자의 나이나 성별, 고혈압과 당뇨병 유무에 따른 개존율의 차이는 없었으며 환자의 체질량지수 및 고혈압과 당뇨의 유병기간, 술 전 듀플렉스 검사로 측정한 요골동맥의 직경에 따른 조기개존율의 차이는 통계적으로 유의하지 않았다. 수술 전 듀플렉스 검사로 측정한 두부정맥의 직경과 수술 시 측정한 동정맥루의 혈류량이 조기개존율과 유의한 양의 상관관계를 나타내었고, 특히 혈관직경 2.7mm가 초과되는 군에서는 조기 폐쇄 없이 개존율이 100%로 유지되었으며 동정맥루의 혈류량이 100mL/min 이하인 군에서는 조기개존율 33.3%로 100 mL/min초과인 군의 82.2%와 비교할때 유의하게 조기개존율이 낮았다. 결론: 동정맥루에 사용되는 정맥의 직경은 개존율과 밀접한 관련이 있어 가능한 한 직경이 큰 정맥을 선택해야 하며 연구에 따라 다양한 기준이 보고되어 왔으나 보다 정확한 예후 판단을 위해서는 정맥의 직경뿐 아니라 혈관 유출로의 혈류와 협착상태 등에 대한 파악이 필요할 것으로 생각된다. 본 연구에서 측정한 수술 시 동정맥루의 혈류량을 기준으로 판단할때, 100 mL/min 이하의 혈류량을 나타내는 radiocephalic fistula에서는 혈류량 감소의 원인을 찾아 교정술을 시행하고 그 이후에도 혈류량이 증가하지 않을 경우 다른 부위의 혈관 또는 인조혈관의 사용을 고려하여야만 할 것이다.

• Clinical and Experimental Reproductive Medicine
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• 제25권2호
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• pp.189-198
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• 1998

Since the male sterilization (vasectomy) has been performed on a large scale as an accepted family planning in Korea on 1980s and this, in turn, has been followed by an increase in the number of patients requesting vasovasostomy. We studies 1000 consecutive cases of vasovasostomy performed from January 1975 to July 1995 in Pusan National University Hospital. In this report, we are going to present serial studies of vasovasostomy through which we attempted to find out what factors are of impotence in influencing the successful outcome of vasovasostomy operation. We inquired the operative results data through the questionnaire and telephone interview with survey of medical records. A total of 259 cases was excluded due to the loss of follow-up. The overall patency and pregnancy rates of 741 cases were 86.9% and 51.1%, respectively. The age of man at the time of anastomosis ranged from 23 to 57 years old with an average of 34.9. The most frequent reason for requesting vasovasostomy was the desire to have more children (43.4%). The average obstructive interval was 60.6 months with range from 1 to 264 months. If the obstructive interval had been less than 5 years patency rate was 92.4% and pregnancy rate 64.8%, but 6 years or more 84.1% and 48.5% (p<0.01, p<0.01). Patency and pegnancy rates according to intraoperative vas fluid were 93.1% and 62.8% for presence and 83.7% and 53.1% for absence (p<0.01, p<0.05). Patency and pregnancy rates according to histologically proven sperm granuloma at vasectomy site were 87.7% and 49.2% for presence and 86.9% and 50.6% for absence (p>0.05, p<0.05). Patency and pregnancy rates were not significantly different between microscopic standard vasovasostomy (88.4%, 64.3%) and modified vasovasostomy (89.5%, 56.3%)(p>0.05, p>0.05). Both patency and pregnancy rates according to level of anastomosis were 89.8% and 59.8% in cases of straight vas and 91.5%, 60.1% in cases of convoluted vas (p>0.05, p>0.05). Patency and pregnancy rates according to the kind of suture materials were 91.5% and 56.2% for absorbable, 91.0% and 64.2% for non-absorbable and 93.3% and 53.3% for absorbable plus non-absorbable, respectively (p>0.05, p<0.05). Thus it is suggested that the important factor influencing the success rate of vasovasostomy is the interval of obstruction and vasal ooze with surgical skills.

• Journal of Chest Surgery
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• 제27권9호
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• pp.764-769
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• 1994

From november, 1985 to May, 1993, 222 arteriovenous fistulae were made in 201 patients with chronic renal failure. Among them, a total of 183 arteriovenous fistulae in 173 patients were reviewed to evaluate the factors influencing patency rate of the vascular access. The results were revealed as follows: There were 102 men and 71 women,aged 10 to 76 years [mean = 45.7 years]. Sixteen patients of them had previous shunts. The procedures included establishment of 214 radiocephalic or brachioocephalic fistulae, 203 side to end, 9 side to side, 2 end to end, 2 autologous saphenous vein grafts, 6 Gore-Tex grafts. There were 28 early shunt failures[12%] due to use of 23 inadequate veins and 5 thrombosis.There were 32 late complications[14%]; 19 thrombosis, 4 aneurysm, 4 venous hypertension, 3 steal syndrome, 2 infections. There were 32 diabetic patients [17 %]. No significant differences in graft patency were noted between diabetic and nondiabetic individuals. There were no significant difference in graft patency between male and female. Overall shunt patency in 183 cases with chronic renal failure was 96% at I month, 95% at 3 months, 93% at I year, 91% at 2 years, 84% at 3 years, 56% at 5years.This Study showed that early postoperative thrombosis and diabetic vasculopathy were most causes of the vascular access failure and suggested that prevention of thrombi and well control of diabetes mellitus were most important to enhance patency rates of the vascular access.

• Journal of Chest Surgery
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• 제53권2호
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• pp.64-72
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• 2020

Background: It is generally agreed that using a bilateral internal thoracic artery (BITA) composite graft improves long-term survival after coronary artery bypass grafting (CABG). Although the left internal thoracic artery (LITA)-based Y-composite graft is widely adopted, technical or anatomical difficulties necessitate complex configurations. We aimed to investigate whether BITA configuration impacts survival or patency in patients undergoing coronary revascularization. Methods: Between January 2006 and June 2017, 1,161 patients underwent CABG at Seoul National University Bundang Hospital, where the standard technique is a LITA-based Y-composite graft with the right internal thoracic artery (RITA) sequentially anastomosed to non-left anterior descending (LAD) targets. Total of 160 patients underwent CABG using BITA with modifications. Their medical records and imaging data were reviewed retrospectively to investigate technical details, clinical outcomes, and graft patency. Results: Modifications of the typical Y-graft (group 1, n=90), LITA-based I-graft (group 2, n=39), and RITA-based composite graft (group 3, n=31) were used due to insufficient RITA length (47%), problems using LITA (28%), and target vessel anatomy (25%). The overall 30-day mortality rate was 1.9%. Among 116 patients who underwent computed tomography or conventional angiography at a mean interval of 29.9±33.1 months postoperatively, the graft patency rates were 98.7%, 95.3%, and 83.6% for the LAD, left circumflex artery, and right coronary artery territories, respectively. Patency rates for the inflow, secondary, and tertiary grafts were 98.2%, 90.5%, and 80.4%, respectively. The RITA-based graft (group 3) had the lowest patency rate of the various configurations (p<0.011). Conclusion: LITA-based Y composite graft, showed satisfactory clinical outcomes and patency whereas modifications of RITA- based composite graft had the lowest patency and 5-year survival rates. Therefore, when using RITA-based composite graft, other options should be considered before proceeding atypical configurations.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권2호
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• pp.132-140
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• 2007

This study compared the histological patency rates of anastomoses of the femoral artery. Twelve rabbits weighing about 2 kg were studied. Both the right and left femoral arteries were cut. The control group had no damage to the vessel, saline irrigation, and micro-anastomosis. Experimental group I had a crush injury to the vessel, saline irrigation, and micro-anastomosis. Experimental group II had a crush injury, saline irrigation, 100 U/ml heparin irrigation, and micro-anastomosis. Experimental group III had the same treatment as experimental group II plus the systemic application of 100 U/kg heparin iv. The histological patency rates were compared. The patency rates of the control group 30 min and 3 days after the anastomosis were 100 and 83%, respectively. The respective rates for experimental groups I and II 30 min and 3 days after the anastomosis were 100% in all cases. The respective rates in experimental group III were 100 and 83%. In this study, no significant correlation was observed between the patency rate and the effects of local irrigation or the systemic application of heparin on the microvascular anastomosis of the rabbit femoral artery. However, the patency rate tended to decrease concomitantly with an increase in surgery time. Increased bleeding was observed after the systemic application of heparin. Obvious damage to the crush-injured vascular endothelium was detected on histologic examination of the micro-anastomosed area. In addition, some vessels subjected to crush injury contained thrombi attached to the vascular endothelium. No preventive effect of heparin on thrombus formation was observed.

• Journal of Chest Surgery
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• 제54권2호
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• pp.117-126
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• 2021

Background: Several factors, such as the degree of target vessel stenosis, are known to be associated with radial artery (RA) graft patency in coronary artery bypass grafting (CABG). There is a lack of data regarding the effect of the RA proximal configuration (aortic anastomosis versus T-anastomosis). This study evaluated the effects of the RA proximal configuration on the patency rate and clinical outcomes after CABG. Methods: We conducted a retrospective study, analyzing 328 patients who had undergone CABG with an RA graft. We divided the patients into 2 groups. The primary endpoint was RA patency and the secondary endpoints were overall mortality and major adverse cardiac and cerebrovascular events (MACCE). We performed a propensity score-matched comparison. Results: Aorta-RA anastomosis was performed in 275 patients, whereas the rest of the 53 patients received T-RA anastomosis. The mean age was 67.3±8.7 years in the T-RA anastomosis group and 63.8±9.5 years in the aorta-RA anastomosis group (p=0.02). The mean follow-up duration was 5.13±3.07 years. Target vessel stenosis ≥70% (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.20-0.91; p=0.03) and T-RA anastomosis configuration (HR, 2.34; 95% CI, 1.01-5.19; p=0.04) were significantly associated with RA occlusion in the multivariable analysis. However, T-RA anastomosis was not associated with higher risks of overall mortality and MACCE following CABG (p=0.30 and p=0.07 in the matched group, respectively). Conclusion: Aorta-RA anastomosis showed a superior patency rate compared to T-RA anastomosis. However, the RA proximal anastomosis configuration was not associated with mortality or MACCE.

• Journal of Chest Surgery
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• 제57권2호
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• pp.178-183
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• 2024

Background: The superficial veins are commonly used in conventional autogenous arteriovenous fistulas and the placement of prosthetic grafts. When they are unsuitable, however, the use of the deep veins (venae comitantes) is generally considered to be a reasonable alternative. This study conducted a comparative analysis of clinical outcomes for arteriovenous grafts between 2 groups based on the type of venous outflow: superficial veins or venae comitantes. Methods: In total, 151 patients who underwent arteriovenous grafts from November 2005 to March 2022 were retrospectively analyzed. The patients were divided into 2 groups: group A (superficial veins, n=89) and group B (venae comitantes, n=62). The primary, secondary patency, and complication rates were analyzed in each group. A propensity score-matched analysis was performed. Results: In total, 55 well-balanced pairs were matched. Kaplan-Meier analysis revealed no significant differences in the primary patency rate between the 2 groups at 1-year, 3-year and 5-year intervals (group A, 54.7%, 35.9%, 25.4% vs. group B, 47.9%, 16.8%, 12.6%; p=0.14), but there was a difference in the secondary patency rate (group A, 98.2%, 95.3%, 86.5% vs. group B, 87.3%, 76.8%, 67.6%; p=0.0095). The rates of complications, simple percutaneous transluminal angioplasty, and stent insertion were comparable between the groups. Conclusion: Although this study demonstrated not particularly favorable secondary patency rates in the venae comitantes group, the venae comitantes may still be a viable option for patients with unsuitable superficial veins because there were no significant differences in the primary patency and complication rates between the 2 groups.

• Journal of Chest Surgery
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• 제33권9호
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• pp.716-722
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• 2000

Background: Modified Blalock-Taussig shunt using 3mm or 3.5mm PTFE graft has been performed in patients with small body weight or in candidates for single ventricle palliation. However, there are few reports concerning clinical outcomes in terms of pulmonary artery growth and shunt patency rate after shunt operations using such a small graft. Material and Method: Twenty-five patients rate after shunt operations using 3 or 3.5 mm sized grafts from September 1996 to August 1999. We retrospectively assessed the pulmonary artery growth and the shunt patency rate by reviewing the pre-and post-operative pulmonary angiograms. The risk factors for late death and second shunt operations were also analyzed. To assess the presence of any correlation between body weight and selection of the graft size, regression analysis was done in 81 cases of shunt operations performed during the same period. Result: There were 1(4%) early death and 5(20%) late deaths. The survivors were followed up for an average of 7.34 months. The pulmonary artery index increased significantly from 129$\pm$66$\textrm{mm}^2$/$m^2$ to 213$\pm$114 $\textrm{mm}^2$/$m^2$(p=0.002). The shunt patency rate assessed at postoperative 2, 4, 6 and 8 months were 82.5%, 77%, 73% and 42% respectively with a marked decline between 6 and 8 months. Asplenia was a frequent finding for the patients with late death although the incidence failed to reach statistical significance(p=0.078). Pre-operative diagnosis of PA with VSD was found to be a statistically significant risk factor for a second shunt operation(p=0.01). Body weight(a) at operation and graft size(b) used in the shunt operations revealed strong correlation and could be expressed by the following formula; b=0.128a + 3.233. Conclusion: Adequate growth of pulmonary artery and satisfactory early patency rate could be obtained by modified Blalock-Taussing shunt using 3mm or 3.5mm graft. However, during 6 to 8 months after shunt operations, the patency rate fell sharply, which implicates that close observation and early intervention are mandatory in this period.

• Journal of Chest Surgery
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• 제33권2호
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• pp.167-172
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• 2000

Background: As the internal mammary artery is far superior to the vein in the patency rate recently there has been a tendency to use the arterial graft as much as possible in coronary artery bypass grafts with the expectation of better the short- and long-term patency rate. Material and Method: We sequentially grafted the diagonal and the left anterior descending artery significantly influencing the cardiac function with the internal mammary artery. There were 32 cases of sequential grafts from July 1993 to December 1998: 21 men and 11 women. The age range was from 43 to 69 years with a mean age of 56.64$\pm$6.41 years. There were 22 unstable angina 7 stable angina and 3 acute myocardial infarction. 8 cases of them were accompanied by stenosis of the left main coronary artery. The grafts for coronary artery bypass surgery included the great saphenous vein at 60 the right gastroepiploci artery at 5 and the left internal mammary artery at 64 coronary arteries. Result: One patient died from sepsis and multiorgan failure. Complications included wound infections in two cases and gastrointestinal bleeding in one patient. All patients showed decrease or disappearance of angina after operation. The postoperative coronary angiogram performed in 9 patients showed neither occlusion nor stenosis of the grafts. Conclusion: This study suggests that sequential anastomosis of the internal mammary artery to the diagonal and the left anterior descending artery may result in excellent short-term patency diagonal and the left anterior descending artery may result in excellent short-term patency rate and be useful for the coronary artery bypass graft using only arterial grafts