Surgical Experience of Carotid Pseudoaneurysm

An extracranial carotid artery pseudoaneurysm is a rare condition that is caused by various types of arteritis, trauma and infectious causes. Generally, a pseudoaneurysm may be difficult to treat surgically when dissecting the paraaeurysmal fibrotic dense inflammatory tissues. The surgical management of a peudoaneurysm of the carotid artery involves a risk of nerve and arterial injury. This paper reports the repair of a carotid artery pseudoaneurysm after the proximal and distal control of the internal carotid artery using a Pruitt-Inahara shunt (P-I shunt) and the distal control of the external carotid artery using a small sized occlusion balloon catheter.

Clinical and Functional Assessment after Anticoagulant Therapy of Acute Deep Vein Thrombosis Involving the Lower Limb

We assessed the clinical status after anticoagulant therapy in acute deep vein thrombosis (DVT) involving the lower limbs. Between 1994 and 2001, 139 patients suffering from acute DVT were treated with heparin therapy followed by oral anticoagulant therapy. The coagulation factor assay was done prior to any anticoagulation therapy. The duplex scan was checked serially. The mean follow-up periods was 32 ± 19 months. There were 32 (23.0%) cases of protein C deficiency, 12 (8.6%) cases of protein S deficiency, 13 (9.4%) cases of AT-III deficiency and 11 (7.9%) cases of abnormal plasminogen level. Fourteen cases had coagulation factor abnormalities within the family. The initial lung scan showed 29 (20.9%) cases with high, 13 (9.4%) cases with intermediate and 70 (50.4%) cases with a low probability of pulmonary embolism (PE) developing. During the follow-up periods, there were 3 cases of non-fatal PE documented with chest CT scan. The patients were divided according to the extent of the thrombus; Group I (38 cases) was limited to the infrainguinal deep vein, Group II (70 cases) extended to the iliac vein and Group III (9 cases) extended to the vena cava. Partial lysis occurred in 20/35/3 (52.6/50.0/33.3%) cases and no change in 10/24/6 (26.3/ 34.3/ 66.7%) cases in Groups I/ II/ III, respectively. Deep vein valvular reflux occurred in 15/25/5 (39.5/35.7/55.6%) cases in Groups I/ II/ III, respectively. With anticoagulation therapy, most of the thrombi remained in unresolved states and there was a high rate of deep vein valvular reflux. However, there was no serious complications which affected the patients' quality of life.

Measurement of Smooth Muscle Cell Migration on the Micromachined Groove Topology

PURPOSE: The spreading, orientation, and chemotaxis with the gradient of a chemoattractant of smooth muscle cells (SMCs) were studied on the micro-grooved substrata by the light, fluorescence and scanning electron microscopy. METHOD: Vertical-walled grooves were produced in silicon wafers by the micromachining technique. All grooves were 4~20micrometer deep and 10~80 micrometer wide. SMCs were cultured on each microgroove and examined under stereo-microscope. RESULT: Cell clusters were markedly oriented by all the grooved substrata examined. Time-lapse images acquired from CCD (Charge Coupled Device) showed that the grooves directed the migration of SMCs. There was no prominent difference in the migration speed of SMCs according to the grooves. All the cytoskeletal fibers were reorganized in the same direction with grooves. Especially the alignments of microtubule and intermediate filaments were distinguished in the SMCs on the micro grooves. CONCLUSION: These results could be applied to the analysis of vascular restenosis and the development of artificial blood vessels.

Development of Autologous Endothelial Cell Seeded Prosthetic Vascular Graft

PURPOSE: Small calibered prosthetic vascular grafts are prone to low patency rates after bypass surgery due to its high thrombogenicity and neointimal hyperplasia. Endothelial cells are known to inhibit thrombus formation, platelet aggregation and smooth muscle cells proliferation. The purpose of this study was to examine the development of autologous endothelial cell seeded prosthetic vascular graft. METHOD: The autologous endothelial cells (ECs) were harvested from canine external jugular veins. Approximately 5 104 ECs were obtained through passage 5 to 6 under the static condition. The cultured ECs were seeded into the polytetrafluoroethylene (PTFE) graft and cultured for 3 days before implanting into the canine carotid artery. The PTFE graft was harvested at 6 weeks after implantation. RESULT: The primary cultured ECs were treated with Factor VIII/vWF, CD31/PECAM-1 antibody and confirmed with fluorescence micrograph. The graft patency rates were 2/6 (33%) in the control graft and 5/6 (83%) in the ECs seeded graft at 6 weeks after implantation. The entire luminal surface of the EC seeded graft was covered with ECs. Only the vicinity of the anastomosis site was covered with ECs in the control graft. CONCLUSION: This is a pilot study for the development of autologous endothelial cell seeded prosthetic vascular graft. The results of our study demonstrate that the endothelialized PTFE are better than nonendothelialized PTFE.

Rhabdomyolysis in Aortic Surgery: case report

Rhabdomyolysis is an uncommon complication in a vascular surgery. Recently we experienced two cases of rhabdomyolysis after aortic surgery. The first one underwent an elective surgery for AAA but the 2nd case performed an emergency surgery because of ruptured AAA. Both patients recovered from rhabdomyolysis by conservative medical treatment without any major complications such as acute renal failure.

Clinical Analysis of the Extremity of Lymphedema

PURPOSE: Given the increased frequency of operative therapy and radiation therapy on breast cancers and uterine cancers, there is very little information on lymphedema associated with these treatments in Korea. Thus, the authors conducted this study to describe and analyze the data which they had obtained from the patients. METHOD: A retrospective study was undertaken on 840 patients who registered to the Lymphedema Clinic of Samsung Seoul Hospital throughout the period of February 1995 to August 2001. RESULT: Out of 840 patients, 205 patients (24%) were confirmed as having primary lymphedema, while 635 patients (76%) had secondary lymphedema. The ratio of male to female for primary lymphedema was 1:1.8 (Male:Female), while secondary lymphedema demonstrated to be 1:21 (Male:Female), demonstrating a female preponderance. Secondary lymphedema mostly developed after undergoing treatment for uterine cancer (341 patients, 53.7%) and Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. breast cancer (226 patients, 35.5%). The lesions of occurrence for both primary and secondary lymphedema were mainly in the lower extremities than the upper extremities. In regards to the degree of clinical edema, a large number of the patients, that is 633 patients (76%) had progressed to Stage II-III. Among the patients who developed edema after undergoing treatment for cancers, only 43 patients (7%) were provided information on the possibility of developing lymphedema, while the majority of the patients had no knowledge about this possibility. When the patients' subjective experiences were investigated on the degree of the edema, there was no significant increase in pain despite an increase in the degree of the edema (P0.05). CONCLUSION: As a general rule, complete recovery from chronic lymphedema is not expected. However, early detection of lymphedema and timely appropriate treatment as well as aggressive patient education on lymphedema and its related complications can prevent its progression.

A Program for Management of Vascular Disease

As medical technology progresses rapidly, there is a rise in the average age along with the Korean dietary lifestyle becoming more westernized, which leads to an increase in the number of vascular disease patients in Korea. Thus, we need to manage the medical information of a disease systematically in order to diagnose and treat constructively. However, since there has been no standardized method of management to date, a great deal of information could not be properly utilized nor studied. Therefore, the departments of Cardiology, Radiology and Neurology of Samsung Seoul Hospital recently got together to develop an information management system called the Vascular Data System. This program was developed to be run on win98 O/S, upper Pentium III, and upper 128 MB Memory, and its source code is Dephi 4.0. It was configured for the user to set the configurations as well as do a variety of search and analysis. If this program were to be updated continuously, it may be used extensively as well as in various parts of clinical research activities.

Tissue Engineering of Vascular Prosthetic Grafts Using Autogenous Vein Cells

PURPOSE: To investigate bioartificial vessels capable of being used for vascular grafts, we studied cell-polymer constructs from venous smooth muscle cells (SMCs) and biodegradable scaffolds using the canine model. METHODS: Scaffolds constructed from 50/50 poly (D,L-Lactide-co-glycolide) (PLGA) were created with pores containing gelatin particles. Disk type scaffolds were used as templates of cell attachment and vascular tissue regeneration. SMCs were isolated from canine external jugular veins and primary SMCs cultures were produced with the explant-derived method. SMCs were seeded into the scaffolds and cultured statically for 4 weeks. The cell-polymer constructs were examined histochemically and using scanning electron microscopy. RESULTS: The SMCs obtained by the explant-derived method were confirmed with immunohistochemical staining using an anti-smooth muscle actin antibody. Four weeks after the SMCs were seeded into the scaffold, histological examination showed SMCs infiltration into the scaffold wall and scanning electron microscopy revealed the SMCs mass which resembled tissue on the scaffold surface. CONCLUSION: This is a pilot study for the constructing artificial vessels using tissue engineering. The construction of the ideal scaffold for vessel and the improvement of culture methods in vitro are the most important parts in this field.

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.

Factors That Affect the Survival Rate of Ruptured Abdominal Aortic Aneurysm

PURPOSE: Ruptured abdominal aortic aneurysm (RAAA) continue to be a significant causes of death. We review 14 patients who underwent repair of RAAA to analyze the factors affecting the mortality rate. METHOD: Fourteen patients who underwent repair of a RAAA at Samsung Medical Center from March 1995 to July 2001 were reviewed retrospectively. The patients were divided two groups as survival and fatal group. Data was analyzed by both univariate and multivariate analysis. RESULT: There were nine patients (64%) in survival group and five patients (36%) in fatal group. The mean age of survival group was 64.67+/-19.59 years and 67.0+/-5.15 years in fatal group. All patients in fatal group were died within 2 days postoperatively. By univariate analysis of various factors associated with the mortality rate, creatinine level, hemoglobin level were statistically significant. Other factors associated with the mortality rate, albumin, initial systolic blood pressure, initial diastolic blood pressure, operation time, prothrombin time and perioperative platelet count were not statistically significant. CONCLUSION: These findings suggest that creatinine level is predictive of death in repair of RAAA. But patients who have RAAA should not be denied therapy on the basis of any specific criteria of preoperative factors.