• The Korean Journal of Physiology and Pharmacology
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• v.20 no.6
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• pp.657-667
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• 2016

Critical limb ischemia (CLI) is one of the most severe forms of peripheral artery diseases, but current treatment strategies do not guarantee complete recovery of vascular blood flow or reduce the risk of mortality. Recently, human bone marrow derived mesenchymal stem cells (MSCs) have been reported to have a paracrine influence on angiogenesis in several ischemic diseases. However, little evidence is available regarding optimal cell doses and injection frequencies. Thus, the authors undertook this study to investigate the effects of cell dose and injection frequency on cell survival and paracrine effects. MSCs were injected at $10^6$ or $10^5$ per injection (high and low doses) either once (single injection) or once in two consecutive weeks (double injection) into ischemic legs. Mice were sacrificed 4 weeks after first injection. Angiogenic effects were confirmed in vitro and in vivo, and M2 macrophage infiltration into ischemic tissues and rates of limb salvage were documented. MSCs were found to induce angiogenesis through a paracrine effect in vitro, and were found to survive in ischemic muscle for up to 4 weeks dependent on cell dose and injection frequency. In addition, double high dose and low dose of MSC injections increased vessel formation, and decreased fibrosis volumes and apoptotic cell numbers, whereas a single high dose did not. Our results showed MSCs protect against ischemic injury in a paracrine manner, and suggest that increasing injection frequency is more important than MSC dosage for the treatment CLI.

• Journal of the Korean Society of Radiology
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• v.82 no.3
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• pp.500-511
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• 2021

The prevalence of lower extremity disease is increasing with age. With recent technological advancements, endovascular treatment is being performed more frequently. The treatment goal of intermittent claudication is to improve walking and reduce claudication. To achieve these goals, anatomical durability and patency are important. In patients with critical limb ischemia, the lesions are diffuse and particularly severe in below-the-knee arteries. The treatment goal of critical limb ischemia is to promote wound healing and to prevent major amputation, which is evaluated by the limb salvage rate. Primary stenting using covered or bare metal stents is a widely accepted endovascular treatment. While drug-eluting technologies with or without atherectomy are widely used in the treatment of femoropopliteal disease, balloon angioplasty is the mainstay treatment for below-the-knee intervention. CT angiography provides a road map for planning endovascular treatment in patients without absolute contraindications.

• Journal of the Korean Society of Radiology
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• v.82 no.3
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• pp.541-550
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• 2021

The below-the-knee arterial tree is the thinnest of all the leg vessels and is an important path for blood flow to the foot. Hence, lesions including stenosis, especially obstruction, may lead to critical limb ischemia which represents the most severe clinical manifestation of peripheral arterial disease. It is characterized by the presence of ischemic rest pain, ischemic lesions, or gangrene attributable to the objectively proven arterial occlusive disease. Typically, the atherosclerotic disease process involving the below-the-knee arterial tree is diffuse in the majority of patients. The cornerstone of therapy is vascular reconstruction and limb salvage. Revascularization should be attempted whenever technically possible, without delay, in patients presenting critical limb ischemia and when the clinical status is not hopelessly non-ambulatory. Therefore, endovascular treatment can become the gold standard for the full range of patients including below-the-knee, limiting the clinical role of the classically trained surgeons.

• Archives of Plastic Surgery
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• v.43 no.6
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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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• v.48 no.2
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• pp.146-150
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• 2015

Arterial thoracic outlet syndrome (TOS) causes ischemic symptoms; it is the rarest type, occurring in 5% of all TOS cases. This paper is a case report of a 38-year-old male patient diagnosed with arterial TOS, displaying symptoms of acute critical limb ischemia caused by thromboembolism. Brachial artery of the patient has been diffusely damaged by repeated occurrence of thromboembolism. It was thought to be not enough only decompression of subclavian artery to relieve the symptoms of hand ischemia; therefore, bypass surgery using reversed great saphenous vein was performed.

• Archives of Reconstructive Microsurgery
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• v.25 no.2
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• pp.75-78
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• 2016

The method of lower limb reconstruction surgery is selected based on a patient's underlying conditions, general conditions, and wound status, and it usually varies from direct closure to skin graft and flap coverage. Herein, we describe a patient with Duchenne muscular dystrophy who developed critical limb ischemia after femoral cannulation for extracorporeal membrane oxygenation was used during knee disarticulation, which was followed by reconstruction of the defect around the knee using a pedicled anterolateral thigh flap and skin graft.

• Archives of Plastic Surgery
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• v.49 no.5
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• pp.696-700
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• 2022

We performed distal bypass and free flap transfer in a single-stage operation to repair an extensive soft tissue defect in an ischemic foot of an 84-year-old woman. The nutrient artery of the free flap was anastomosed to the bypass graft in an end-to-side manner. Subsequently, the bypass graft became occluded on several occasions. Although intravascular and surgical interventions were performed each time, the bypass graft eventually became completely occluded. However, despite late occlusion of the nutrient artery, the free flap has remained viable and the patient is ambulatory. The time required for a transplanted free flap to become completely viable without a nutrient artery is likely longer for an ischemic foot compared with a healthy foot. However, the exact period of time required is not known. A period of month was required in our patient. We report this case to help clarify the process by which a free flap becomes viable when applied to an ischemic foot.

• Journal of Chest Surgery
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• v.47 no.2
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• pp.174-177
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• 2014

Surgical revascularization for patients with Buerger's disease is possible only in a few cases, due to the diffuse segmental involvement and the lack of distal runoff vessels available for bypass surgery. We encountered a case of resting pain in the right foot, coldness with dysesthesia, and cyanosis on the right 1st toe. The patient was treated with an endovascular intervention after vein patch angioplasty failed due to an inflammatory reaction of Buerger's disease. We suggest that an endovascular procedure can be an effective treatment, even in addition to more conservative and surgical management, in patients with Buerger's disease and critical limb ischemia.

• Journal of Chest Surgery
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• v.28 no.10
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• pp.900-905
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• 1995

Between Jan.1990 and Mar.1994, twenty-three patients[Male:20, Female:3 with aortoilac occlusive disease had underwent reconstruction [bypass garft . Two main causes of occlusion were atherosclerosis [21 patients and chronic thromboembolism[2 patients . Indications for operation were disabling claudication in 20 patients and critical limb ischemia in 12 patients. The procedures of operation included femorofemoral[8 , axillobifemoral[6 , aorto-bifemoral[6 , axillounifemoral[2 , aortoiliac[1 bypass graft. Postoperatively one patient died for sepsis and the operative mortality was 4.3%. Various anticoagulant therapy were maintained for at least six months. The 1year, 2year, 3year and 4year patency rates of bypass graft after operation were 91.3%, 80.8%, 71.4% and 58.4% respectively.

• BMB Reports
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• v.54 no.7
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• pp.356-367
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• 2021

Cell-based therapy is a promising approach in the field of regenerative medicine. As cells are formed into spheroids, their survival, functions, and engraftment in the transplanted site are significantly improved compared to single cell transplantation. To improve the therapeutic effect of cell spheroids even further, various biomaterials (e.g., nano- or microparticles, fibers, and hydrogels) have been developed for spheroid engineering. These biomaterials not only can control the overall spheroid formation (e.g., size, shape, aggregation speed, and degree of compaction), but also can regulate cell-to-cell and cell-to-matrix interactions in spheroids. Therefore, cell spheroids in synergy with biomaterials have recently emerged for cell-based regenerative therapy. Biomaterials-assisted spheroid engineering has been extensively studied for regeneration of bone or/and cartilage defects, critical limb ischemia, and myocardial infarction. Furthermore, it has been expanded to pancreas islets and hair follicle transplantation. This paper comprehensively reviews biomaterials-assisted spheroid engineering for regenerative therapy.