• Journal of Chest Surgery
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• 제26권2호
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• pp.80-85
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• 1993

Synthetic and biosynthetic vascular grafts of small diameter have long been considered to be prone to thrombosis, ultimately leading to the complete graft occlusion. Endothelial cell seeding onto synthetic blood-contacting surfaces has been suggested to be an ideal means to solve this problem. This study described a culture method of bovine endothelial cells and evaluated blood-compatibility and seeding efficiency of cultured endothelial cells. Bovine pulmonary artery endothelial cells were harvested enzymatically and grown to confluence on polystyrene culture flask surfaces using established techniques. The identification of endothelial cells was made through the demonstration of expression of factor VIII R:Ag by immunofluorescent technique. To quantitate the effect of improvement in blood-compatibility of viable endothelial cells, endothelial monolayers were exposed to blood containing $\^$111/In-oxine labeled platelets. Viable endothelial monolayers retained less labeled platelets than control surfaces. The Indium-labeled endothelial cells were seeded onto three different blood-contacting surfaces of Dacron vascular graft immobilized in specially equipped wells and incubated for specific time intervals (t=15, 30, 60, 120 minutes). Longer incubation times showed improved cell adherence in collagen-coated and fibrin-coated Dacron vascular graft groups. However in untreated Dacron grafts, no direct relationship was observed between incubation time and endothelial cell seeding efficiency. This may be due to leakage of endothelial cells through porosity of Dacron grafts in this in-vitro experimental condition.

• Journal of Chest Surgery
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• 제48권1호
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• pp.46-51
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• 2015

Background: Maintenance of adequate vascular access for hemodialysis is important in patients with end-stage renal disease. Once arteriovenous fistula (AVF) occlusion occurs, the patient should be treated with rescue therapy. This study was performed to evaluate the results of a rescue therapy for AVF occlusion. Methods: From January 2008 to December 2012, 47 patients who underwent surgical rescue therapy for AVF occlusion after graft AVF formation, were enrolled in this study. The patients were divided into two groups, namely the graft repair group (group A, n=19) and the thrombectomy group (group B, n=28). Postoperative results of both groups were analyzed retrospectively. Results: There were no statistically significant differences in the clinical characteristics between the two groups. In terms of the duration of AVF patency after the first rescue therapy, group A showed a longer AVF patency duration than group B ($24.5{\pm}21.9$ months versus $17.7{\pm}13.6$ months), but there was no statistically significant difference (p=0.310). In terms of the annual frequency of AVF occlusion after the rescue therapy of group A was lower than that of group B (0.59 versus 0.71), but there was no statistically significant difference (p=0.540). The AVF patency rates at 1, 2, 3, and 5 years after the first rescue therapy in group A were 52.6%, 31.5%, 21.0%, and 15.7%, respectively, and those in group B, they were 32.1%, 25.0%, 17.8%, and 7.14%, respectively. There was no statistically significant difference (p=0.402). Conclusion: Graft repair revealed comparable results. Although there was no statistically significant difference, the patent duration and annual frequency of AVF occlusion of group A were better than those of group B. Therefore, graft repair is considered as a safe and useful procedure for maintaining graft AVF.

• 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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• 제41권2호
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• pp.160-169
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• 2008

배경: 혈관질환의 수술에 사용되는 인공 도관의 막힘과 문합부위의 좁아짐 등을 개선하기 위한 방법으로 조직공학적인 방법과 자가 세포를 이용한 인공혈관의 제작이 대안으로 대두되고 있다. 저자들은, 생흡수성이 있는 고분자 폴리머 지지체와 자가 골수세포를 이용한 인공혈관으로 생체실험을 시행하였다. 대상 및 방법: 생분해성 고분자 재료인 poly (lactide-co-${\varepsilon}$-caprolactone) (PLCL)과 poly(glycolic acid) (PGA) fiber로 혈관용 지지체를 제작한 후, 피실험 동물의 골수를 채취하여 혈관 내피 세포와 평활근 세포로 분열시켜 배양한 후 혈관 지지체위에 이식하였다. 만들어진 인공 혈관을 잡견의 복부대동맥에 이식한 후 3주 후에 혈관 조영술을 시행하고, 안락사 후에 혈관을 제거하여 조직학적 검사를 시행하였다. 결과: 6마리의 잡견 중 2마리에서 수술 후 10일에 혈관 지지체의 균열에 의한 대량 출혈로 사망하였다. 나머지 4마리의 잡견은 수술 후 3주까지 생존하였으며, 혈관 조영술상 혈관의 막힘이나 좁아짐은 발견되지 않았다. 인공 혈관의 내면은 작은 혈전들이 붙어 있었으며, 조직학 검사에서 정상 혈관과 유사한 3층의 구조를 나타내었다. 또한 면역화학 검사에서 혈관 내피세포와 혈관 평활근 세포가 재생된 것을 확인하였다. 결론: 고분자 폴리머와 자가 골수세포를 이용한 인공혈관은 생체 내에서 정상혈관과 유사한 모양으로 재생이 가능함을 보여주었다. 그러나, 동맥압력에 견디기 위해 혈관 지지체의 물성에 대한 개량과 충분한 양의 혈관 세포를 얻기 위한 연구가 더 필요할 것으로 생각된다.

• International Journal of Vascular Biomedical Engineering
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• 제1권2호
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• pp.20-29
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• 2003

A new treatment for coronary artery occlusive disease is being developed in which a shunt or conduit is placed directly connecting the left ventricle with the diseased artery at a point distal to the obstruction. To aid in assessing and optimizing its benefit, a computational model of the cardiovascular system was developed and used to explore various design conditions. Simulation results indicate that in complete LAD occlusion, flow can be returned to approximately 65% of normal if the conduit resistance is equal for forward and reverse flow, increasing to 80% in the limit in which backflow resistance is infinite. Increases in flow rate produced by asymmetric flow resistance are considerably enhanced in the case of a partial LAD obstruction since the primary effect of resistance asymmetry is to prevent leakage back into the ventricle("steal") during diastole. Increased arterial compliance has little effect on net flow with a symmetric shunt, but leads to considerable augmentation when the resistance is asymmetric. These results suggest that an LV-LAD conduit will be beneficial when stenosis resistance(Rst) > 27 PRU if resistance is symmetric.

• Physical Therapy Rehabilitation Science
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• 제1권1호
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• pp.6-12
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• 2012

Objective: Coenzyme (CoQ10) is an enzymatic co factor used in normal cellular metabolism. Recent evidence shows that in people with heart disease it can reverse endothelial cell damage in the blood vessels. It is also a potent antioxidant. Design: One group pretest-posttest design. Methods: In the present study, endothelial function was evaluated using the response to occlusion and heat before and 2 weeks after administration of CoQ10, 300 mg/day. Thirty Eight subjects, who are physical therapy students, participated in a series of experiments to see if taking 300 mg of CoQ10 daily for 2 weeks would impact resting blood flow in the forearm skin and the blood flow response to 4 minutes of vascular occlusion and the response to local heat ($42^{\circ}C$) for 6 minutes. Results: The results showed that, for this population, there was no difference in the response to heat. However, the response to occlusion was improved after administration of CoQ10. Conclusions: It would appear that in a young population CoQ10 has no effect on the nitric oxide vasodilator pathway in skin but does influence other vasodilator pathways.

• Journal of Chest Surgery
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• 제38권10호
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• pp.710-713
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• 2005

급성복부대동맥 폐쇄는 드물지만, 응급을 요하며 높은 사망률과 이환율을 보이는 혈관질환이다. 늦은 진단은 예후에 심각한 영향을 미치게 된다. 승모판 협착, 심방세동, 관상동맥협착, 삼첨판 역류 및 심방중격결손으로 인한 개심슬을 받은 60세 여자가 술 후 13일에 하지의 감각이상, 마비, 심한 통증을 호소하였다. 배꼽 아래부터 발끝에 이르는 피부가 얼룩덜룩하였으며 하지의 맥박이 촉지되지 않았다. 저자들은 다중 검출 컴퓨터 단층 촬영을 이용하여 급성 복부 대동맥 폐쇄를 진단하고, 응급 혈색전 제거 및 대동맥-양측 대퇴동맥 우회로술로 성공적으로 치료하였다.

• Journal of Chest Surgery
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• 제40권11호
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• pp.773-776
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• 2007

47세 남자 환자로 양측 하지의 파행을 주소로 내원하였는데 심한 흡연력, 당뇨와 고혈압을 가지고 있었다. 평소 허혈성 심질환의 증상과 뇌혈류의 역류로 인한 증상은 없었지만 상 하지 혈관조영술과 동시에 시행한 관상동맥조영술 검사에서 좌측쇄골하동맥 폐색을 포함한 말초혈관질환과 관상동맥에 심한 협착이 관찰되었다. 수술은 좌측 늑강을 경유한 상행대동맥-좌액와동맥 혈관우회술을 시행 후 우내흉동맥을 좌전하행지에 문합하고 복재정맥을 사선지와 인조혈관에 문합하였다. 하지 말초혈관의 폐색은 술 후 18일에 혈관우회술로 교정되었고 결과는 양호하였다.

• 한국생물공학회:학술대회논문집
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• 한국생물공학회 2003년도 생물공학의 동향(XII)
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• pp.98-100
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• 2003

합성고분자(PET, ePTFE)로 제작된 기존의 혈관 패치는 혈전생성으로 인한 혈관 막힘 현상과 생체 비적합성으로 인한 석회화 현상 때문에 장기간 혈관 기능을 수행할 수 없다. 본 연구에서는 혈관조직을 형성하는 세포들로 분화가 가능한 중간엽줄기세포와 생체적합성 매트릭스를 이용하여 혈관용 패치를 개발하였다. 이식 후 3주에 관찰하였을 때 조직공학적으로 제조된 혈관 패치는 동물 임상시험에서 혈관막힘 현상 없이 혈관기능을 수행하였고 실제 혈관과 유사한 조직으로 재생되었다. 동물모델에서의 장기간 추가 보완 연구를 거친다면 본 연구에서 개발된 혈관 패치는 기존의 재료를 대체하여 많은 혈관질환 치료에 적용이 가능할 것으로 사료된다.

• 대한약침학회지
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• 제20권1호
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• pp.23-28
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• 2017

Objectives: Exercise with partially restricted blood flow is a low-load, low-intensity resistance training regimen which may have the potential to increase muscle strength in the obese, elderly and frail who are unable to do high-load training. Restricted blood flow exercise has also been shown to affect blood vessel function variably and can, therefore, contribute to blood vessel dysfunction. This pilot study tests the hypothesis that unilateral resistance training of the leg extensors with partially restricted blood flow increases muscle strength and decreases vascular autoregulation. Methods: The subjects were nine normotensive, overweight, young adult African-Americans with low cardiorespiratory fitness who underwent unilateral training of the quadriceps' femoris muscles with partially restricted blood flow at 30% of the 1-repetition maximum (1-RM) load for 3 weeks. The 1-RM load and post-occlusion blood flow to the lower leg (calf) were measured during reactive hyperemia. Results: The 1-RM load increased in the trained legs from $77{\pm}3$ to $84{\pm}4 kg$ (P < 0.05) in the absence of a significant effect on the 1-RM load in the contralateral untrained legs (P > 0.1). Post-occlusion blood flow decreased significantly in the trained legs from $19{\pm}2$ to $13{\pm}2mL{\cdot}min^{-1}{\cdot}dL^{-1}$ (P < 0.05) and marginally in the contralateral untrained legs from $18{\pm}2$ to $16{\pm}1mL{\cdot}min^{-1}{\cdot}dL^{-1}$ (P = 0.09). Changes in post-occlusion blood flow to the skin overlying the trained and the contralateral untrained muscles were not significant. Conclusion: These results demonstrate that restricted blood flow exercise, which results in significant gains in muscle strength, may produce decrements in endothelial dysfunction and vascular autoregulation. Future studies should determine whether pharmacopuncture plays a role in treatments for such blood vessel dysfunction.