• Journal of Chest Surgery
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• v.21 no.2
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• pp.373-378
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• 1988

Since the introduction of percutaneous; transluminal coronary angioplasty[PTCA] by Grunt-zig in 1977, this is widely used in some patients with coronary artery disease and is an effective alternative to surgery for many patients. Indications for emergency coronary artery bypass graft[CABG] after PTCA are prolonged chest pain, worsening of coronary artery obstruction, "current of injury" by electrocardiogram, cardiogenic shock, and in a lesser incidence, ventricular fibrillation, coronary artery dissection[without obstruction], heart block, and intractable cardiac arrest. Recently, we have experienced one case of emergency CABG following unsuccessful PTCA. The patient was 54 year-old male and admitted with complaint of angina pectoris. The routine electrocardiogram revealed within normal limit. The treadmill test revealed severe chest pain after 2 min. exercise. Coronary cineangiogram revealed 95% segmental stenosis of the proximal right coronary artery. Our cardiologist was planned PTCA. During PTCA, severe chest pain and ischemic pattern on electrocardiogram were developed. But they were not relieved even by morphine and nitroglycerin till 90 min. So we performed emergency single coronary artery bypass graft from aorta to proximal right coronary artery with great saphenous vein. The patient had an excellent postoperative recovery and was free from anginal attack. He has shown striking improvement in general status[NYHA functional class 1] during 6 months after operation.operation.

• Archives of Plastic Surgery
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• v.37 no.2
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• pp.148-152
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• 2010

Purpose: In treating diabetic foot ulcers, satisfactory vascularity is an essential prerequisite. To improve vascularity, a bypass graft has long been carried out. Recently, however, percutaneous transluminal angioplasty (PTA) has also been tried since the PTA is less invasive than the bypass graft. However, publication demonstrating the improvement of vascularity after the PTA are lacking. Therefore, this study was designed to show usefulness of the PTA in treating vasculopathy of diabetic foot. Materials: and Methods This study included 30 feet of 24 ischemic diabetic foot patients. Inclusion criteria were diabetes (duration > 5 years) and a significant lower extremity ischemia, as determined by a transcutaneous oxygen pressure ($TcpO_2$) < 30 mmHg. The PTA was carried out in 61 arteries. PTA procedure was considered successful, when residual stenosis was less than 30%. The procedure was considered failed when residual stenosis was more than 50%. Residual stenosis between 30% and 50% was considered acceptable. For evaluation of PTA effect, foot $TcpO_2$ and infrared thermography were measured before and 7th day after PTA. Results: Immediately after PTA performed in 61 arteries, 58 and 3 arteries were evaluated as being successful and acceptable, respectively. Before PTA, average foot $TcpO_2$ was $12.6{\pm}8.8$ mmHg and its value was increased to $44.2{\pm}23.9$ on 7th day after PTA (p<0.01). Average skin temperature was $31.8{\pm}1.2^{\circ}C$ before PTA and it was increased to $33.5{\pm}1.1^{\circ}C$ on 7th day after PTA (p<0.01). Conclusion: PTA procedure increases tissue oxygenation of ischemic diabetic feet which do not have wound healing potential due to low tissue oxygenation, to the level of possible wound healing. In addition, PTA increases skin temperature of ischemic diabetic feet which can imply an improvement of peripheral circulation.

• Journal of Korean Foot and Ankle Society
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• v.22 no.1
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• pp.32-37
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• 2018

Purpose: Diabetic foot gangrene has a high morbidity rate and a great influence on the quality of life. Amputation is an appropriate treatment if conservative treatment is impossible according to the severity of gangrene and infection. The purpose of this study was to evaluate the usefulness of preoperative percutaneous transluminal angioplasty for the postoperative outcome. Materials and Methods: From February 2013 to April 2016, among 55 patients with diabetic foot gangrene, who require surgical treatment, percutaneous transluminal angioplasty was performed on patients with an ankle brachial index (0.9 and stenosis) 50% on angiographic computed tomography. The study subjects were 49 patients, comprised of 37 males (75.5%) and 12 females (24.5%). The mean age of the patients was $70.0{\pm}9.6years$. The treatment results were followed up according to the position and length of the lesion and the changes during the follow-up period. Results: As a result of angiography, there were 13 cases of atherosclerotic lesions in the proximal part, 11 cases in the distal part and 25 cases in both the proximal and distal parts. As a result of the follow-up after angiography, in 13 patients, the operation was not performed and only follow-up and dressing were performed around the wound. Sixteen patients underwent debridement for severe gangrene lesions and 20 patients, in whom the gangrene could not be treated, underwent amputation (ray amputation or metatarsal amputation, below knee amputation). Conclusion: Preoperative percutaneous angioplasty in diabetic foot gangrene patients with peripheral vascular occlusive disease is simple, and 59.2% of the patients with diabetic foot gangrene could be treated by conservative treatment or debridement.

• Journal of Preventive Medicine and Public Health
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• v.34 no.1
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• pp.9-20
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• 2001

Objectives : To explore the relationship between Percutaneous Transluminal Coronary Angioplasty(PTCA) volume and the associated immediate outcome. Methods : A total of 1,379 PTCAs were peformed in 25 hospitals in Korea between October 8 and December 31 in 1997. Data from 1,317 PTCAs (95.5%) were collected through medical record abstraction. Inter-observer reliability of the data was examined using the Kappa statistic on a subsample of 110 PTCA procedures from five hospitals. Intra-observer reliability of the data was also examined. PTCA success and immediate adverse outcomes were selected as the outcome variables. A successful PTCA was defined as a case that shows less than 50% diameter stenosis and more than 20% reduction of diameter stenosis. Immediate adverse outcomes included deaths during the same hospitalization, emergency coronary artery bypass graft (CABG) within 24 hours after PTCA, and acute myocardial infarction within 24 hours after PTCA. The numbers of PTCAs performed in 1997 per hospital were used as the volume variables. Results : Without adjusting for patient risk factors that may affect outcomes, procedures at high volume hospitals ($\geq200$ cases per year) had a greater success rate (P=0.001) than low volume hospitals. There was a marginally significant difference (P=0.070) in major adverse outcome rates between high and low volume hospitals. After adjusting for risk factors, there were significant differences in procedural failure and major adverse outcome rates between high and low volume hospitals. Conclusions : After adjusting for patient clinical risk factors, the hospital volume of PTCA was associated with immediate outcomes. It is recommended that a PTCA volume per year be established in order to improve the immediate outcome of this procedure in Korea.

• Journal of Chest Surgery
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• v.25 no.1
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• pp.73-78
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• 1992

From Octorber 1984 through September 1991, 480 patients underwent percutaneous tra-nsluminal coronary angioplasty and 7 of these[1.4%] required coronary artery bypass surgeries in the emergency base. The principal indications for surgery were coronary dis-sections[n=2], acute coronary occlusions[n=3], and ventricular arrhythmias[n=2]. There were two early deaths and one late death. No patient who developed cardiac arrest and had not been resuscitated before surgery survived the operation. The outcome of surgery was related to the preoperative clinical status of patients.

• Journal of Chest Surgery
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• v.32 no.12
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• pp.1123-1126
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• 1999

Coronary artery bypass grafting (CABG) technique has been much developed but CABG under cardiopulmonary bypass has the unavoidable deficits such as generalized inflammatory reaction from cardiopulmonary bypass and myocardial ischemia from aortic-cross clamp. There has been remarkable advancement of CABG without cadiopulmonary bypass. We performed CABG successfully without cardiopulmonary bypass. We performed CABG successfully without cardiopulmonary bypass in two patients with multivessel coronary disease who were failed to intervene with percutaneous transluminal coronary angioplasty. We herein report the two cases.

• 대한핵의학회:학술대회논문집
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• 1999.05a
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• pp.205-208
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• 1999

Percutaneous Transluminal Coronary Angioplasty (PTCA) remains limited by restenosis that occurs in 30 to 50% of patients with coronary artery disease. During the last decade, numerous agents have been used to prevent restenosis. Despite positive results in animal models, no pharmacological therapy has been found to significantly decrease the risk of restenosis in humans. These discrepancies between animal models and clinical situation were probably related to an incomplete understanding of the mechanism of restenosis. Neointimal thickening occurs in response to experimental arterial injury with a balloon catheter. Neointimal formation involves different steps: smooth muscle cell activation, proliferation and migration, and the production of extracellular matrix. The factors that control neointimal hyperplasia include growth factors, humoral factors and mechanical factors. Arterial remodeling also plays a major role in the restenosis process. Studies performed in animal and human subjects have established the potentials for "constrictive remodeling" to reduce the post-angioplasty vessel area, thereby indirectly narrowing the vessel lumen and thus contributing to restenosis. The reduction of restenosis rate in patients with intracoronary stent implantation has been attributed to the preventive effect of stent itself for this negative remodeling. In addition to these mochanisms for restenosis, intraluminal or intra-plaque thrombus formation, reendothelialization and apoptosis theories have been introduced and confirmed at least in part.

• Journal of Chest Surgery
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• v.30 no.1
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• pp.34-39
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• 1997

Between May, 1994 and December, 1995, 122 adult cardiac surgical procedures requiring cardiopulmonary bypa s were performed at Kang Dong Sacred Heart Hospital, including 18 cases(14.8%) that were associated with preoperative(n:9), intraoperative(n=7), postoperative(n:2) use of an IABP (intra-aortic balloon pump). The reasons for IABP were low cardiac output and PTCA(percutaneous transluminal coronary angioplasty) failure in preoperative period, CPB(cardiopulmonary bypass) weaning difficulty in intraoperative period, and intractable arrhythmia in postoperative period. The mean age of the IABP patients was 61.8 $\pm$ 6.9 years(range, 39 to 75years). The overall hospital mortalities in patients with preoperative and intraoperative IABP insertion were 3 and 42.9% respectively. Two patients with postoperative IABP insertion are alive. The rate of IABP weaning is 66.7% for preoperative group, 85.7% for intraoperative group and 100% for postoperative group . In conclusion, if there were no irreversible myocardial damages, IABP could be used safely and emergently at any perioperative period for hemo ynamic stability, CPB weaning, and to overcome low cardiac output syndrome.

• Journal of Chest Surgery
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• v.21 no.6
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• pp.1030-1039
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• 1988

From 1985 through Oct. 1988, we have experienced 5 cases of Aorto-Coronary Bypass Surgery [ACBS] and 3 cases of Percutaneous Transluminal Coronary Anogioplasty [PTCA]under the diagnosis of unstable angina. There were 6 males and 2 females who ranged from 48 to 70 years old. Almost all patients had a evidence of hypertension & hyperlipidemia. Two patients showed old myocardial infarction and remaining patients showed myocardial ischemia on resting state. The patterns of involvement of coronary artery disease were single vessel disease [4 cases], double vessel disease [3 cases], Triple vessel disease [1 case]. Among 5 cases of ACBS, double bypass graft was in 3 cases and single bypass graft was in 2 cases. Mode of anastomosis were all individual anastomosis, using Saphenous vein graft. Postoperative complications were perioperative myocardial infarction [2 cases], postoperative bleeding [1 case], leg wound disruption [1 case]. Perioperative myocardial infarction cases didn*t survive. In cases of PTCA, there were no complications. Follow up periods were ranged from 1 month to 25 months. All survived cases were asymptomatic except one case, who showed Functional Class II.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.994-1000
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• 1995

Thirty patients with ischemic heart disease underwent coronary artery bypass grafting [CABG from 1985 through 1994. There were 16 males and 14 females whose age ranged from 41 to 72 years old. Preoperative diagnoses were unstable angina in 13 of patients, stable angina in 8, postmyocardial infarction state in 7, and state of failed percutaneous transluminal coronary angioplasty [ PTCA in 2. The patterns of disease were single vessel involvement [ 17cases , double vessel involvement [ 7 cases , triple vessel involvement [ 3 cases , Lt main lesion including Lt. ostial lesion [ 3 cases . Saphenous vein grafts were used in 27/30 patients [ 90% , and internal mammary artery grafts were used in 6/30 patients [ 20% . The hospital mortality was 13.3% and all survivors were asymptomatic and improved over their preoperative status.