Clinical Experiences of the Arterial Bypass in Aortoiliac Occlusive Disease

PURPOSE: To analysis of the clinical aspects of axillofemoral (AXFBG) and aortofemoral bypass (AOFBG) for aortoiliac occlusive disease. METHODS: Between June 1996 and May 2001, 23 patients underwent AXFBG or AOFBG for lower extremity ischemia caused by aortoiliac occlusive disease at Samsung Medical Center. The decision to perform AXFBG or AOFBG was based on an assessment of surgical risk and the patient's preference. We retrospectively analyzed the preoperative clinical status, risk factors and distal runoff scores affecting the patency rate as well as the clinical outcome following surgery. RESULTS: We performed 10 AXFBGs and 13 AOFBGs. The mean age was 67.8 years in AXFBG patients and 57.4 years in AOFBG patients. Limb salvage as an indication for surgery included 8 (80%) cases with AXFBG, as compared to 13(100%) cases with AOFBG. The mean follow-up period was 20.7 months in AXFBG and 21.8 months in AOFBG. The clinical improvement following surgery was statistically higher with AOFBG. The one-year and 2-year primary patency rates in AXFBG were 100% and 82% retrospectively. All of the grafts of AOFBG were patent during this follow-up period. CONCLUSION: The clinical improvement was higher with AOFBG as compared to AXFBG. However AXFBG is a safe practice in high-risk patients.

Complex Physical Therapy for Lymphedema

Complex Physical Therapy (CPT) is one of the variable conservative methods of lymphedema and recently used in many countries with great success. The main concept of CPT is to improve central lymph flow by opening non-functioning lymphatic pathway and by stimulating collateral lymphatic channels to drain the swollen area into adjacent areas where lymph flow is normal. CPT consists of 4 main parts; 1. meticulous skin care, 2. manual lymph drainage, 3. multilayered non-stretching compression bandages and compression garments, 4. special exercise. We tried to assess the immediate and maintenance effects of CPT in patients with lymphedema. CPT was used on 25 patients (male 5, female 20) with 10 upper and 15 lower extremity edemas for 2weeks such as 5 days per week, 1.5 hours per day at out-patient clinic. Immediately, the reduction of edema volume was 25.5+/-13.8% at the upper extremity and 27.5+/-15.5% at lower extremity in 2 weeks after treatment. All these were well maintained following 3 months without any significant variation. In comparison between proximal and distal parts, there was no significant difference except the immediate post-treatment result of the lower extremity. But the maintenance of volume reduction of distal part was better than proximal part through 3 months after treatment. We also found the reduction of skin subcutaneous thickness according to the volume reduction. In conclusion, CPT is a effective treatment method for patients with lymphedema but follow up study will be needed for identifying long term maintenance effect.