• Archives of Plastic Surgery
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• 제43권6호
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• pp.544-550
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• 2016

Background Although the use of temporary shunts in proximal extremity amputations has been reported, no study has described the use of temporary shunts in distal extremity amputations that require vein grafting. Moreover, the total volume of blood loss when temporary shunts are used has not been reported. The aim of this study was to investigate the applicability of a temporary shunt for distal extremity amputations requiring repair by vessel grafting with an ischemia time of >6 hours. This study also aimed to determine the total volume of blood loss when temporary shunts were used. Methods Patients who underwent distal major extremity replantation and/or revascularization with a vessel graft and who experienced ischemia for 6-8 hours between 2013 and 2014 were included in the study. A 6-Fr suction catheter was cut to 5 cm in length after the infusion of heparin, and secured with a 5-0 silk suture between the distal and the proximal ends of the artery. While bleeding continued, the bones were shortened and fixed. After the complete restoration of circulation, the arterial shunt created using the catheter was also repaired with a vein graft. Results Six patients were included in this study. The mean duration of ischemia was 7.25 hours. The mean duration of suction catheter use during limb revascularization was 7 minutes. The mean transfusion volume was 7.5 units. No losses of the extremity were observed. Conclusions This procedure should be considered in distal extremity amputations requiring repair by vessel grafting during critical ischemia.

• Journal of Chest Surgery
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• 제7권1호
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• pp.109-116
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• 1974

Eleven cases of peripheral arterial injuries treated at Korea University Woo Sok Hospital during these 3 years and 3 months from Feb. 1971Eleven cases of peripheral arterial injuries treated at Korea University Woo Sok Hospital during these 3 years and 3 months from Feb. 1971 to May 1974 were reviewed. Common causes of injuries were stab wound, automobile accidents and iatrogenic injuries during operation. Of the 11 arterial injuries 3 were femoral artery which` was the commonest in frequency and the next was 2 cases of brachial artery. The most frequent type of injury was transection. Laceration, contusion and spasm was also recognized. The need to operate immediately following an injury was emphasized. Operative procedures were end to end anastomosis and saphenous vein graft in 5 and 2 cases, respectively. Other cases were undergone multiple suture ligature due to staphyllococcal infection, insertion of polyethylene catheter, and lateral suture after thromboendarterectomy. Fractures and extensive soft tissue damage associated with arterial injuries with widespread destruction of the collateral circulation aggravated the situation and complicated the amputation of lower extremity in 4 cases. The factors influencing the amputation were time lag, presence of associated injuries and complications.[KTCS 1974;1:109-116] Common causes of injuries were stab wound, automobile accidents and iatrogenic injuries during operation. Of the 11 arterial injuries 3 were femoral artery which` was the commonest in frequency and the next was 2 cases of brachial artery. The most frequent type of injury was transection. Laceration, contusion and spasm was also recognized. The need to operate immediately following an injury was emphasized. Operative procedures were end to end anastomosis and saphenous vein graft in 5 and 2 cases, respectively. Other cases were undergone multiple suture ligature due to staphyllococcal infection, insertion of polyethylene catheter, and lateral suture after thromboendarterectomy. Fractures and extensive soft tissue damage associated with arterial injuries with widespread destruction of the collateral circulation aggravated the situation and complicated the amputation of lower extremity in 4 cases. The factors influencing the amputation were time lag, presence of associated injuries and complications.

• Journal of Chest Surgery
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• 제33권3호
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• pp.207-211
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• 2000

Backgroud: Conventional cardiac transplantation with each atrial anastomosis designed by Shumway and associates has been used widely in cardiac transplantation because of its simplicity and efficiency. There have been many reports about the postoperative atrioventricular value regurgitation resulting from the alteration in atrial geometry after cardiac transplantation by Shumway's technique. New surgical technique of direct anastomosis of superior vena cava, inferior vena cava, right pulmonary vein and left pulmonary vein was introduced to overcome the those problems. We performed this study to test the feasibility of this new surgical technique prior to application to clinical practice. Material and Method: Conventional cardiac transplantation was performed on 12 mongrel dogs(Group I) and cardiac transplantation with new surgical mthod of direct anastomosis of SVC, IVC, left and right pulmonary veins was performed on 11 mongrel dogs(Group II). After weaning from cardiopulmonary bypass, we compared the postoperative rhythm, hemodynamic data, and echocardiographic findings between two groups. Result : The cardiopulmonary bypass time and graft ischemic time were 119.0$\pm$4.4 minutes, 162.0$\pm$4.5 minutes respectively in group I, and 140.0$\pm$7.1 minutes, 180.5$\pm$5.4 minutes respectively in group II. The cardiopulmonary time and graft ischemic time in group II were longer than those of group I (p<0.05). There were 3 cases of failure to weaning from cardipulmonary bypass onein group I and two in group II, and this difference was not significant statistically. Sinus rhythm was regained postoperatively in 58% (group I) and 82%(group II), without statistical significant between 2 groups. Postoperative echolcardiography showed 2 cases of tricuspid value regurgitation and 1 case of mitral regurgitation in group I, and no regurgitation of atrioventricular value in group II. Conclusion: Although these was no statistically significant difference between 2 groups, there was tendency of less arrhythmia and less atrioventricular valvular regurgitation in group II. We suggested that the new surgical technique could be a useful strategy in heart transplantation, especially in the case of size mismatching between donor and recipient.

• 대한골관절종양학회지
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• 제3권1호
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• pp.39-46
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• 1997

The pasteurization of bone tumor shows necrosis of tumor tissue and it is used widely as one of the options of limb salvage operation. However malignant tumors of the extremities commonly involve major neurovascular structures and pasteurization of this structure will make limb salvage operation much easier and safer than autogenous vein graft or artificial vessel graft. So the purpose of this study is to evaluate that the pasteurization can be applied in the limb salvage surgery of malignant tumor involving major vessels by means of studying the patency of pasteurized femoral vessels of the dogs. The right femoral arteries of 5 to 7 mm in diameters and veins of 7 to 10 mm in diameters of five dogs were pasteurized with sterile $60^{\circ}C$ saline for 30 minutes. Contralateral femoral vessels were evaluated for the control study. After one month, the changes in the pasteurized femoral vessels were evaluated by physical examinations, femoral angiography, gross findings, and pathologic findings on the each side. One month after pasteurization, the pulse of the femoral and popliteal arteries was palpated with normal tone on the each side of the all five experimental animals, and there was no gross swelling or necrotic changes in the legs. Femoral angiography showed a good patency of femoral and popliteal arteries. On the gross examinations at time of sampling of the specimen for the pathologic examinations, there was a good patency of femoral artery and vein, and mild fibrous adhesion was noted around the pasteurized femoral vessels. On the pathologic examinations, the more fibrotic adhesion and neocapillarization were noted in the outer layer of adventitia of the pasteurized femoral arteries and veins than the control sides. The vascular lumina were also patent in all cases. With these results, we suggest that the malignant tumor of the extremity involving major vessels is possibly treated by the limb salvage operation using the pasteurization of the involved vessels.

• Archives of Plastic Surgery
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• 제39권1호
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• pp.71-75
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• 2012

Recurrent laryngeal nerve paralysis is the most common and serious complication after thyroid cancer surgery. The objective of this study was to report the advantages of the vein wrapping technique for nerve reconstruction in patients with thyroid cancer invading the recurrent laryngeal nerve and its effects on postoperative phonatory function. The subjects were three patients who underwent resection of the recurrent laryngeal nerve during surgical extirpation of papillary thyroid cancer. Free ansa cervicalis nerve graft or direct neurorrhaphy with a vein wrapping technique was used to facilitate nerve regeneration, protect the anastomosed nerve site mechanically, and prevent neuroma formation. One-year postoperative laryngoscopic examination revealed good vocal cord mobility. Maximum phonation time ($19.5{\pm}0.3$ sec) was longer than a previously-reported value in conventional reconstruction patients ($18.8{\pm}6.6$ sec). The present phonation efficiency index ($7.88{\pm}0.78$) was higher than that previously calculated in conventional reconstruction ($7.59{\pm}2.82$). The mean value of the Voice Handicap Index-10 was 6, which was within the normal range. This study demonstrates improvement in phonation indices measured 1 year after recurrent laryngeal nerve reconstruction. Our results confirm that the vein wrapping technique has theoretical advantages and could be favored over conventional reconstruction techniques for invenerate nerve injuries.

• Journal of Chest Surgery
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• 제53권2호
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• pp.73-78
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• 2020

Background: As the population of patients with end-stage renal disease has grown older, the proportion of patients with poorly preserved vasculature has concomitantly increased. Thus, arteriovenous grafts (AVG) have been used more frequently to access blood vessels for hemodialysis. Despite this increasing demand, studies of AVG are limited. In this study, we examined the surgical outcomes of upper-limb AVG creation. Methods: Among the arteriovenous fistula formation procedures performed between January 2014 and March 2019 at Dankook University Hospital, 42 cases involved AVG creation. We compared patients in whom the axillary vein was used (group A; brachioaxillary AVG [B-Ax AVG]; n=20) with those in whom upper limb veins were used (group B; brachiobasilic AVG or brachioantecubital AVG; n=22). Results: The 1-year primary patency rate was higher in group A than in group B (57.9% vs. 41.7%; p=0.262). The incidence of postoperative complications was not significantly different between groups. Conclusion: AVG using the axillary vein showed no major differences in safety or functionality compared to AVG using other veins. Therefore, accounting for age, underlying disease, and expected patient lifespan, B-Ax AVG can be considered an acceptable surgical method.

• 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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• 제35권3호
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• pp.239-243
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• 2002

본 증례의 39세 남자는 전신부종과 간부전증을 일으키는 Budd-Chiari syndrome과 상대정맥 폐색증을 가지고 입원하였다. 보존적 내과 치료 후 방사선과의 침습적 방법에 의한 확장술에 실패하여 하공정맥-우심방 단락술을 시행하였다. 수술은 정중흉골 절제술 및 직사행 복부 절제술을 통하여 직경 24 mm의 Dacron graft를 사용하여 좌신정맥 하에서 하공정맥-우심방 단락술을 체외순환을 하지 않고 시행하였다 수술후 출혈이나 합병증없이 양호한 결과를 보였으며 수술당일부터 항응고제 치료를 병행하였다. 술후 26일째 시행한 복부 도플러 초음파 상에서 graft의 유통성이 양호함을 확인하였다. 퇴원시 상대정맥 폐색 증상은 남아 있었으나 외래 추적 검사시 상대정맥 폐색 증상도 호전되었음을 확인할 수 있었다

• Journal of Chest Surgery
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• 제56권5호
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• pp.313-321
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• 2023

Background: This study evaluated the early, 1-year, and 3-year graft patency rates and mid-term clinical outcomes after no-touch saphenous veins (NT-SVs) were used as aortocoronary grafts in coronary artery bypass grafting (CABG). Methods: In total, 101 patients who underwent CABG using NT-SVs as aortocoronary grafts were included. The 2 most common indications for performing aortocoronary grafting with NT-SVs were unavailability of the left internal thoracic artery (n=36) and moderate lesions where flow competition was expected (n=27). Early (median, 1 day; interquartile range [IQR], 1-2 days), 1-year (median, 13 months; IQR, 11-16 months), and 3-year (median, 34 months; IQR, 27-41 months) graft angiography was performed in 98 (97.0%), 84 (83.2%), and 40 patients (39.6%), respectively. The median follow-up duration was 43 months (IQR, 13-76 months). Overall survival rates and the cumulative incidence of major adverse cardiac events were evaluated. Results: The operative mortality rate was 2% (2 of 101 patients). Early postoperative patency rates for overall and aortocoronary NT-SV grafts were 98.2% (223 of 227 distal anastomoses) and 98.2% (164 of 167), respectively. The 1- and 3-year patency rates for aortocoronary SV grafts were 94.9% (131 of 138) and 90.6% (58 of 64), respectively. The overall survival rates at 5 and 10 years were 81.7% and 59%, respectively. The cumulative incidence of major adverse cardiac events at 5 and 10 postoperative years was 20.7% and 39%, respectively. Conclusion: The feasibility of using NT-SVs as aortocoronary grafts in CABG was shown in this study, based on the graft patency rates up to 3 years and the mid-term clinical outcomes.

• Journal of Chest Surgery
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• 제30권3호
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• pp.275-281
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• 1997

요골동맥을 이용한 관상동맥 우회 술은 1970년대초 처음 도입되었으나 요골동맥 연축(spasm)에 의한 이식편의 부전으로 사용이 중지되었으나, 1980년대 후반 칼슘 길항제등 새로운 연축 방지제의 개발과 요골동맥 채취방법(harvesting technique)의 개선으로 다시 사용하게 되었다. 저자들은 1994년 10월부터 1995년 7월까지 총 36례에서 요골동맥 자유이식 편을 이용하륵 관상동맥우 회술을 시행하였다. 이들중 34례에서 좌측 내흉동맥을 동시에 사용하였으며 15례(42%)에서는 모든 이 식편을 동맥이식 편으로 사용하였다. 총 123개의 원위부 문합중(환자당 평균 3.4개) 좌측 내흉동맥을 사용한 문합이 36개,복재정맥을 이용한 문합이 23개였으며 나머지 64개의 윈위부 문합은 요골동맥을 사 용하였고(환자당 평균 1.8개), 요골동맥을 이용한 문합이 전체문합수의 52%를 차지하였다. 요골동맥이 식편의 원위부 문합장소는 좌측회선지(circunflex artery)가 38개, 사선지(diagonal artery)가 18개, 우측 관상동맥이 6개, 좌전하행 지(left anterior descending artery)가 2개로 분포하였다. 요골동맥을 하나의 이 식편으로 사용한 경우가 10례, 순차적문합으로 사용 \ulcorner경우가25례 및 두개의 이식 편으로 나누어 사용 한 경우가 1례였다. 관상동맥 우회 술과 동반된 수술로는 관상동맥 내막절제술이 14례, 관상동맥 포편성 형술(patch angioplasy)이 4례, 승모판막 재건술이 1례, 심근경색후 심실중격파열 봉합술이 1례였다. 수 술후 합병증으로는 요골동맥을 채취한 측의 엄지손가락 감각이상이 2례, 술후 출혈이 1례,저심박출증 으로 좌심실보조장치 1례등이 있었으며 이중 좌심실보조장치를 시행한 1례에서 사망하였다. 조기추적 관상동맥 조영술은 생존한 35례중 11례(31%)에서 수술후 79일에서 210일(평균 126일)에 시행하여 좌측 내흉동맥 및 복재정맥은 100%, 요골동맥은 95%의 개방률을 보였다. 생존한 환자 모두에서 협심증의 재 발은 없었다. 결론적으로 본 연구에서는 아직 증례의 부족과 짧은 추적기간으로 요골동맥 이식편의 우 월성은 입증할 수 없으나 단기적으로 만족할만한 것으로 향후 더 많은 경험의 축적과 장기적 인 추적이 요할 것으로 사료된다.