Comparison of Surgical Outcomes between Reversed Vein Graft and Prosthetic Graft in Above-knee Femoropopliteal Bypass

PURPOSE: Though it has been well known that the autologous vein graft is conduit of choice for infragenicular leg artery bypass, it is still less clear for above-knee femoro-popliteal artery bypass. We attempted to evaluate the outcomes of reversed saphenous vein graft in comparison with polytetrafluoroethylene (PTFE) graft in above-knee femoro-popliteal bypasses for the patients with chronic arterial occlusive disease. METHOD: In a period of 7 years and 9 months, 108 above-knee femoro-popliteal bypasses were performed in 96 patients (91 male, 5 female, mean age 67.3 years). The indications for bypass operation were short distance claudication in 54 (50%), rest pain in 36 (33%), and toe, foot ulcer or gangrene in 18 (17%) limbs. As bypass conduit, autologous reversed saphenous vein was used in 67 limbs, and PTFE graft in 41 limbs. We compared early (<30 days) postoperative complications, primary patency rates of grafts, and late outcomes of the limbs with proven graft occlusion between 2 patients groups (vein graft group vs. PTFE graft group). Primary cumulative graft patency rate were determined by Kaplan Meier method and compared them with log-rank test. RESULT: Early postoperative complications were not significantly different between two groups. During the follow-up period, 20 (18.5%) grafts were lost to follow-up and 14 patients were dead. Primary cumulative patency rates at 1, 3, 5 years were 97.44 +/- 2.53%, 91.11 +/- 4.94%, and 75.92 +/- 14.46% for vein grafts and 81.76 +/- 7.49%, 36.15 +/- 13.42, and 36.15 +/- 13.42% for PTFE grafts respectively. CONCLUSION: In the patients underwent autologous vein graft for above-knee femoro-popliteal bypass, we experienced significantly better long-term patency, less serious surgical complication and less severe recurrent ischemic symptom after graft occlusion than in patients with PTFE graft.

Comparison of Surgical Outcomes between Below-knee Femoro-popliteal and Femoro-infrapopliteal Bypasses after Using Autologous Reversed Saphenous Vein Graft

PURPOSE: Femoro-infrapopliteal bypass is usually indicated for the patients with critical leg ischemia and when below- knee femoro-popliteal bypass is not available. Considering the technical difficulties and requirement of longer vein graft, inferior surgical outcomes are anticipated after femoro-infrapopliteal bypass compared to below-knee femoro-popliteal bypass. We attempted to compare the early and late outcomes between the patients who underwent below-knee femoro-popliteal and femoro-infrapopliteal bypasses. METHODS: Among 285 autologous reversed vein grafts implanted for the patients with chronic atherosclerotic leg arterial occlusion, the data base of 119 below-knee femoro-popliteal and 97 femoro-infrapopliteal bypasses (4 tibioperoneal trunk, 52 posterior tibial, 10 anterior tibial, 20 peroneal, and 11 inframalleolar arteries) were retrospectively reviewed to compare the patients characterisitics and surgical outcomes. To compare early postoperative outcome, operative mortality (<30 days), ankle-brachial pressure index, early graft failure, wound complication, and major limb amputation were compared and to compare late outcome, primary cumulative patency rates of vein grafts were compared between 2 groups. Cumulative patency rates were determined by Kaplan-Meier method and compared with log-rank test between 2 groups. RESULTS: Demographic features and frequencies of comorbidities including diabetes, coronary artery disease, chronic obstructive lung disease and cerebrovascular disease were not different between 2 groups except renal insufficiency which is more frequent in femoro-infrapopliteal bypass group. And femoro-infrapopliteal bypasses were more commonly indicated for the patients with ischemic tissue loss and as repeated bypass and requiring spliced vein graft more commonly. There revealed no significant differences in the frequencies of operative mortality (<30 days), early graft failure, wound complication, and major limb amputation and the amount of ABI increase between 2 groups. Primary cumulative patency rates at 1, 3, and 5 years were 88.1 +/-3.5%, 77.3+/-5.1%, and 64.5+/-7.4% after B-K femoro- popliteal bypasses and 87.9+/-4.1%, 72.5+/-6.3%, and 60.4+/-10.1% after femoro-infrapopliteal bypasses, respectively revealing no significant differences between 2 groups. CONCLUSION: In spite of anatomical and technical disadvantages associated with femoro-infrapopliteal bypasses, there revealed no significant difference in early and late outcomes between below-knee femoro-popliteal and femoro- infrapopliteal bypasses with autologous reversed vein graft.

The Effects of Preoperative Chemoradiation Therapy in Pectal Cancer

To evaluate the effects of the preoperative chemoradiation therapy(CRT) for rectal cancer. 31 rectal cancer patients received preoperative CRT. A total 3060cGy of radiation was given in 3 weeks, 180cGy for a fraction. 425mg/m2/day of 5-FU and 20mg/m2/day of leucovorin were continuously infused in the first 5 days of the preoperative radiation therapy. A IV injection of Mitomycin C 10mg/m2 was given on the first day. A digital rectal examination, endoscopy with biopsy, barium enema, chest X-ray, hepatobiliary ultrasonography & IV bolus CT were done before and after CRT. Clinically, 19 patients(61.3%) and pathologically, 16 patients(51.6%) showed reduced tumor size. In 7 patients (22.6%), there was no residual tumor in the pathologic specimen. Digital rectal examination was possible in 23 patients. 16(69.5%) of them had a decrease in height of ulcer margin on digital rectal examination. Seven of the fifteen patients showed decreased perirectal fat tissue infiltration. There was no severe toxicity which might delay the curative surgery. In conclusion, preoperative chemoradiation therapy in rectal cancer was very effective in reducing tumor size and perirectal fat tissue infiltration without considerable toxicity.

A Case of Surgical Treatment of Nesidioblastosis in Infancy

Nesidioblastosis in one of the causes of hyperinsulinemic hypoglysemia in infancy. The most important goal of treatment for persistent hypoglycemia is the prevention of permanent brain damage. The early surgical management is satisfactory to this goal in nesidioblastosis and maintains normal blood sugar level without administration of drugs or supplement of sugar postperatively in many cases. We experienced a female infant of 3 months old who has suffered from persistent hypoglysemia due to hyperinsulinism and was suspected nesidioblastosis for ' its cause clinically. She underwent 95% distal pancreatectomy. The histologic findings of nesidioblastosis was confirmed postoperatively. No postoperative complication was occured and her blood sugar levels were maintained within normal range without medical treatment.