Report of Nation-wide Questionnaire Survey for Abdominal Aortic Aneurysm Treatment in Korea

While endovascular aneurysm repair (EVAR) is prevailing for the treatment of abdominal aortic aneurysm (AAA) in modern vascular practice, PURPOSE: we conducted nationwide questionnaire survey to investigate the current status of AAA treatment and their results in Korea. METHOD: We reviewed the replies from 28 hospitals (33 departments) to the questionnaire inquiring annual number, clinical features, mode of treatment and results of AAA patients during the period from Jan. 2000 to Jul. 2004. Results: 980 AAA patients were reported including 292 ruptured AAA (29.8%) and 688 non-ruptured AAA (70.2%). For treatment of AAA, 834 (85.1%) surgical repairs (SRs) and 111 (11.3%) endovascualr aneurysm repairs (EVARs) were performed while 35 patients (3.6%) died of AAA rupture before operation. The locations of AAA were infrarenal in 889 (90.7%), juxtarenal in 62 (6.3%), and suprarenal in 29 patients (3.0%). Among 834 patients undergoing SR, 577 patients (69.2%) had non-ruptured AAAs and 257 patients (30.8%) had ruptured AAAs. Mean operative mortality rate was 4.1% after elective SRs, 30.7% after SR for ruptured AAAs, and 2.3% after EVARs. The reported brand name of stent graft devices were various including domestic custom-made in 56 (50.5%), imported brand in 18 (16.2%) while 37 (33.3%) stent grafts were not reported their brand name. The frequencies of type I and III endoleaks after EVAR were reported 5.8% and 5.8% respectively in 86 patients with an available data. CONCLUSION: SR has been used as a major treatment option in Korea for the treatment of AAA patients while EVAR is increasing. The mortality rate of SR of AAA was comparable to western multi-center trial reports but mortality or morbidity rates of EVAR were unable to know in this questionnaire survey.

Outpatient Trans-Illuminated Powered Phlebectomy under the Local Anesthesia might be a Feasible Procedure for Varicose Veins

PURPOSE: A Trans-Illuminated Powered Phlebectomy (TIPP) is accepted as a useful surgical procedure for varicose vein, but requires hospitalization and general or spinal anesthesia. To show the feasibility of outpatient TIPP under local anesthesia, we established an outpatient fast track protocol of TIPP, and showed the results. METHOD: We performed outpatient department-based TIPP, under local anesthesia with a 2% lidocaine subcutaneous injection and the tumescent method. Using the visual analogue pain scale and a questionnaire, the compliance of the patient were examined. RESULT: Between August 2001 and January 2005, 252 limbs of 238 patients underwent operations using our protocol. Mean age of the patients was 59 years, with a male:female of 185:53. The mean operation time and number of incisions were 30.6 minutes and 4.6, respectively. There were 7 wound problems (2.78%) and 5 redo TIPP (1.98%) due to a recurrence. 58 questionnaires were completed and collected from the patients. The mean visual analogue pain scale score was 5.7. Of the 58 patients that completed the questionnaires, 6 (10%) replied that the procedure was intolerable and that they would not have again. Whereas, the other 52 patients (90%) said the procedure was tolerable, and would have again, if necessary. CONCLUSION: Outpatient TIPP, under local anesthesia, might be a relatively safe and feasible method to establish a fast track protocol for varicose veins.