Simultaneous Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm Combined with Saccular Thoracic Aortic Aneurysm

With the recent increase in imaging tests, coexisting abdominal aortic aneurysms (AAAs) and thoracic aortic aneurysms (TAAs) are being discovered accidentally.We report two cases of simultaneous endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) for AAA and TAA. Both 74-year-old and 79-year-old male with infrarenal AAA and saccular TAA were treated simultaneously with EVAR and TEVAR. Saccular TAAs were identified in the upper thoracic aorta during the evaluation of AAA. During endograft placement, carotid-subclavian bypass and cerebrospinal fluid (CSF) drainage were performed. Both patients were successfully discharged without spinal cord ischemia. Simultaneous EVAR and TEVAR can be considered for patients with AAA and saccular TAA in the upper thoracic aorta. Moreover, CSF drainage may be necessary to protect the spinal cord.

Intraoperative tumor localization using a titanium ring strip in totally laparoscopic distal gastrectomy for middle-third gastric cancer / 고신대학교의과대학학술지

Background@#This study presents a novel technical tip for intraoperative tumor localization and determination of the proximal resection line using a titanium ring strip for totally laparoscopic distal gastrectomy in patients with middle-third gastric cancer and describes the short-term results of its application. @*Methods@#In total, 42 patients with middle-third gastric cancer who underwent intraoperative tumor localization using a titanium ring strip and determination of the proximal resection line through intraoperative radiography between January 2020 and December 2021 were enrolled in this study. We retrospectively analyzed patients’ prospectively collected clinical, pathological, and surgical data. @*Results@#Twenty-six men and 16 women with a mean age of 58.3±12.5 years were enrolled. The mean operation time and estimated blood loss were 212.6±43.0 minutes and 122.4±77.6 mL, respectively. The lengths of the proximal and distal resection margin were 2.0±0.4 cm (range, 0.8–3.7 cm) and 10.5±4.1 cm (range, 0.4–20.4 cm), respectively. Roux-en-Y anastomosis was performed in 30 patients, while Billroth II with Braun anastomosis was performed in 12 patients. There were no procedure-related complications, and the mean postoperative hospital stay was 7.2±1.9 days. For all patients, the negative proximal resection margin was confirmed by postoperative pathological examinations. @*Conclusions@#Intraoperative tumor localization and determination of the proximal resection line using a titanium ring strip is a useful alternative method that can be easily and safely performed. This method is especially useful for patients with middle-third gastric cancer requiring an appropriate proximal resection margin.

Hospital mortality and prognostic factors in critically ill patients with acute kidney injury and cancer undergoing continuous renal replacement therapy

Whether continuous renal replacement therapy (CRRT) should be applied to critically ill patients with both acute kidney injury (AKI) and cancer remains controversial because of poor expected outcomes. The present study determined prognostic factors for all-cause in-hospital mortality in patients with AKI and cancer undergoing CRRT. Methods: We included 471 patients with AKI and cancer who underwent CRRT at the intensive care unit of a Korean tertiary hospital from 2013 to 2020, and classified them by malignancy type. The primary outcomes were 28-day all-cause mortality rate and prognostic factors for in-hospital mortality. The secondary outcome was renal replacement therapy (RRT) dependency at hospital discharge. Results: The 28-day mortality rates were 58.8% and 82% in the solid and hematologic malignancy groups, respectively. Body mass index (BMI), presence of oliguria, Sequential Organ Failure Assessment (SOFA) score, and albumin level were common predictors of 28-day mortality in the solid and hematologic malignancy groups. A high heart rate and the presence of severe acidosis were prognostic factors only in the solid malignancy group. Among the survivors, the proportion with RRT dependency was 25.0% and 33.3% in the solid and hematologic malignancy groups, respectively. Conclusion: The 28-day mortality rate of cancer patients with AKI undergoing CRRT was high in both the solid and hematologic malignancy groups. BMI, presence of oliguria, SOFA score, and albumin level were common predictors of 28-day mortality in the solid and hematologic malignancy groups, but a high heart rate and severe acidosis were prognostic factors only in the solid malignancy group.

Initial experience with laparoscopic posterior retroperitoneal adrenalectomy in single tertiary center

Purpose@#Laparoscopic posterior retroperitoneal adrenalectomy (LPRA) is a surgical method that accesses the adrenal gland through the back. The aim of this study was to report initial experience of LPRA and evaluate possibilities for surgical application. @*Methods@#From March 2018 to December 2019, a total of 30 consecutive patients diagnosed with adrenal tumor underwent surgical treatment at Pusan National University Hospital were enrolled. Clinicopathologic features and various peri- and postoperative parameters were analyzed by retrospective medical record review. The mean age of the patients was 48.20 ± 13.66 years. @*Results@#The mean body mass index (BMI) was 25.50 ± 4.30 kg/m2 . Primary hyperaldosteronism was the most frequently preoperative diagnosed disease (n = 13, 43.4%), followed by adrenal incidentaloma (n = 8, 26.6%), Cushing syndrome (n = 5, 16.6%) and pheochromocytoma (n = 4, 13.3%). The mean size of postoperative adrenal tumor was 2.72 ± 1.76 cm. The mean operating time was 162 ± 58.14 minutes. Among the 30 patients, 28 patients underwent total adrenalectomy (93.3%) and two patients underwent cortical sparing adrenalectomy (6.7%). When LPRA was performed for patients with BMI > 23.16 kg/m2 , the operating time was longer than the average (P = 0.016). @*Conclusion@#LPRA was suitable and safe for patients with benign adrenal tumors. BMI, retroperitoneal fat density and postoperative adrenal weight may be related to the operating time, so they should be considered when deciding on a surgical method for adrenalectomy.

Development of a Diabetic Foot Ulceration Prediction Model and Nomogram

Purpose@#This study aimed to identify the risk factors for diabetic foot ulceration (DFU) to develop and evaluate the performance of a DFU prediction model and nomogram among people with diabetes mellitus (DM). @*Methods@#This unmatched case-control study was conducted with 379 adult patients (118 patients with DM and 261 controls) from four general hospitals in South Korea. Data were collected through a structured questionnaire, foot examination, and review of patients’ electronic health records. Multiple logistic regression analysis was performed to build the DFU prediction model and nomogram. Further, their performance was analyzed using the Lemeshow–Hosmer test, concordance statistic (C-statistic), and sensitivity/specificity analyses in training and test samples. @*Results@#The prediction model was based on risk factors including previous foot ulcer or amputation, peripheral vascular disease, peripheral neuropathy, current smoking, and chronic kidney disease. The calibration of the DFU nomogram was appropriate (χ2 = 5.85, p = .321). The C-statistic of the DFU nomogram was .95 (95% confidence interval .93~.97) for both the training and test samples. For clinical usefulness, the sensitivity and specificity obtained were 88.5% and 85.7%, respectively at 110 points in the training sample. The performance of the nomogram was better in male patients or those having DM for more than 10 years. @*Conclusion@#The nomogram of the DFU prediction model shows good performance, and is thereby recommended for monitoring the risk of DFU and preventing the occurrence of DFU in people with DM.

Multiple drug-coated balloons can be used effectively for peripheral arterial disease including long femoropopliteal lesions

Purpose@#Drug-coated balloons have shown successful results in treating peripheral arterial occlusive disease. However, using multiple balloons for long femoropopliteal lesions (>15 cm) remains challenging; their safety and efficacy need to be explored. Therefore, we aimed to evaluate the outcomes of multiple drug-coated balloons for long femoropopliteal lesions in terms of the primary patency, freedom from clinically-driven target lesion revascularization, and mortality. @*Methods@#Between April 2015 and September 2018, 96 patients (117 limbs) who underwent balloon angioplasty using at least 2 drug-coated balloons for femoropopliteal lesions were retrospectively reviewed. Lesions were classified as TransAtlantic Inter-Society Consensus (TASC) classification C or D. The outcomes were analyzed using Kaplan-Meyer analysis. @*Results@#The mean age of 96 enrolled patients was 70.8 ± 9.8 years, and 83 patients were males (86.5%). Critical limbthreatening ischemia was found in 29 cases (24.8%). The mean lesion and drug-coated balloon lengths per limb were 292.3 ± 77.8 mm and 325.0 ± 70.2 mm, respectively. The technical success rate was 99.2%. A total of 82.1% were followedup for more than 6 months. The primary patency rates at 12 and 24 months were 71.4% and 41.7%, respectively; freedom from clinically-driven target lesion revascularization rates were 96.4% and 71.0% at 12 and 24 months, respectively. The Kaplan-Meier estimate of the 2-year overall cumulative mortality rate was 20.8%. All identified mortalities appeared to be less associated with paclitaxel. @*Conclusion@#Drug-coated balloons can be effectively used without drug-related mortality, even for long lesions, such as TASC classification C or D femoropopliteal lesions.

Development of a Diabetic Foot Ulceration Prediction Model and Nomogram

Purpose@#This study aimed to identify the risk factors for diabetic foot ulceration (DFU) to develop and evaluate the performance of a DFU prediction model and nomogram among people with diabetes mellitus (DM). @*Methods@#This unmatched case-control study was conducted with 379 adult patients (118 patients with DM and 261 controls) from four general hospitals in South Korea. Data were collected through a structured questionnaire, foot examination, and review of patients’ electronic health records. Multiple logistic regression analysis was performed to build the DFU prediction model and nomogram. Further, their performance was analyzed using the Lemeshow–Hosmer test, concordance statistic (C-statistic), and sensitivity/specificity analyses in training and test samples. @*Results@#The prediction model was based on risk factors including previous foot ulcer or amputation, peripheral vascular disease, peripheral neuropathy, current smoking, and chronic kidney disease. The calibration of the DFU nomogram was appropriate (χ2 = 5.85, p = .321). The C-statistic of the DFU nomogram was .95 (95% confidence interval .93~.97) for both the training and test samples. For clinical usefulness, the sensitivity and specificity obtained were 88.5% and 85.7%, respectively at 110 points in the training sample. The performance of the nomogram was better in male patients or those having DM for more than 10 years. @*Conclusion@#The nomogram of the DFU prediction model shows good performance, and is thereby recommended for monitoring the risk of DFU and preventing the occurrence of DFU in people with DM.

Multiple drug-coated balloons can be used effectively for peripheral arterial disease including long femoropopliteal lesions

Purpose@#Drug-coated balloons have shown successful results in treating peripheral arterial occlusive disease. However, using multiple balloons for long femoropopliteal lesions (>15 cm) remains challenging; their safety and efficacy need to be explored. Therefore, we aimed to evaluate the outcomes of multiple drug-coated balloons for long femoropopliteal lesions in terms of the primary patency, freedom from clinically-driven target lesion revascularization, and mortality. @*Methods@#Between April 2015 and September 2018, 96 patients (117 limbs) who underwent balloon angioplasty using at least 2 drug-coated balloons for femoropopliteal lesions were retrospectively reviewed. Lesions were classified as TransAtlantic Inter-Society Consensus (TASC) classification C or D. The outcomes were analyzed using Kaplan-Meyer analysis. @*Results@#The mean age of 96 enrolled patients was 70.8 ± 9.8 years, and 83 patients were males (86.5%). Critical limbthreatening ischemia was found in 29 cases (24.8%). The mean lesion and drug-coated balloon lengths per limb were 292.3 ± 77.8 mm and 325.0 ± 70.2 mm, respectively. The technical success rate was 99.2%. A total of 82.1% were followedup for more than 6 months. The primary patency rates at 12 and 24 months were 71.4% and 41.7%, respectively; freedom from clinically-driven target lesion revascularization rates were 96.4% and 71.0% at 12 and 24 months, respectively. The Kaplan-Meier estimate of the 2-year overall cumulative mortality rate was 20.8%. All identified mortalities appeared to be less associated with paclitaxel. @*Conclusion@#Drug-coated balloons can be effectively used without drug-related mortality, even for long lesions, such as TASC classification C or D femoropopliteal lesions.

Influence of Infrapopliteal Runoff Vessels on Primary Patency after Superficial Femoral Artery Angioplasty with Stenting in Patients with Claudication

Purpose@#The number of infrapopliteal runoff vessels seems to be one of the factors influencing arterial patency in patients who had undergone superficial femoral artery (SFA) angioplasty with stenting. However, the effectiveness of infrapopliteal runoff vessels in predicting patency during SFA angioplasty remains unclear. This study aimed to determine whether the number and quality of infrapopliteal runoff vessels affect the primary patency after SFA angioplasty with stenting in patients with claudication. @*Materials and Methods@#This study reviewed a retrospective database of patients with claudication who underwent SFA angioplasty with stenting between March 2011 and December 2016. The preoperative computed tomography findings of all patients were reviewed to assess infrapopliteal runoff vessels. The Trans-Atlantic Inter-Society (TASC) II classification and modified Society for Vascular Surgery (SVS) runoff score were used for subsequent analysis. Kaplan–Meier survival curves were constructed, and Fisher’s exact and chi-square tests were used for data analysis. @*Results@#A total of 153 limbs of 122 patients (88.2% male, mean age: 69.1 years) underwent SFA angioplasty with stenting. The overall primary patency rates of TASC II A/B and C/D cases were 77.1% and 31.2%, respectively, at 36 months (P<0.001). The primary patency rates at 36 months using the modified SVS runoff scoring system were 64.6% and 49.8% for the good-to-compromised (≤9 points) and poor (≥10 points) runoff groups, respectively (P=0.011). @*Conclusion@#The modified SVS runoff scoring system is effective in predicting primary patency after SFA angioplasty with stenting in patients treated for claudication.

What predicts better prognosis in elderly breast cancer patients?

Purpose@#As we enter an aging society, the number of elderly patients with breast cancer is increasing. We assessed the prognostic factors for breast cancer recurrence or metastasis in patients over the age of 65 years by analyzing tumor characteristics and long-term clinical outcomes. @*Methods@#In this retrospective study, the data of 286 breast cancer patients aged 65 years and older, who underwent treatment at the Pusan National University Hospital and Pusan National University Yangsan Hospital from 2008 to 2014, were analyzed. The patients were divided into two groups: those with recurrence or metastasis and those without. Cox-regression model was used to analyze the risk factors for recurrence or metastasis. Kaplan-Meier method was used to analyze survival rates by the log-rank test. @*Results@#Among the 286 patients with invasive breast cancer, 43 patients (15.0%) had recurrence or distant metastasis during a median follow-up period of 61 months. Advanced stages of breast cancer and patients who are not adapted to endocrine therapy were associated with poor prognosis. @*Conclusion@#In this study, advanced stages of breast cancer and endocrine therapy were the prognostic factors for breast cancer recurrences or metastases. Early detection of elderly breast cancer generally increases the possibility of diagnosis at an earlier stage, which can lead to a better prognosis. Moreover, endocrine therapy should be administered to elderly patients who manifest favorable intrinsic subtypes of breast cancer.

Influence of Infrapopliteal Runoff Vessels on Primary Patency after Superficial Femoral Artery Angioplasty with Stenting in Patients with Claudication

Purpose@#The number of infrapopliteal runoff vessels seems to be one of the factors influencing arterial patency in patients who had undergone superficial femoral artery (SFA) angioplasty with stenting. However, the effectiveness of infrapopliteal runoff vessels in predicting patency during SFA angioplasty remains unclear. This study aimed to determine whether the number and quality of infrapopliteal runoff vessels affect the primary patency after SFA angioplasty with stenting in patients with claudication. @*Materials and Methods@#This study reviewed a retrospective database of patients with claudication who underwent SFA angioplasty with stenting between March 2011 and December 2016. The preoperative computed tomography findings of all patients were reviewed to assess infrapopliteal runoff vessels. The Trans-Atlantic Inter-Society (TASC) II classification and modified Society for Vascular Surgery (SVS) runoff score were used for subsequent analysis. Kaplan–Meier survival curves were constructed, and Fisher’s exact and chi-square tests were used for data analysis. @*Results@#A total of 153 limbs of 122 patients (88.2% male, mean age: 69.1 years) underwent SFA angioplasty with stenting. The overall primary patency rates of TASC II A/B and C/D cases were 77.1% and 31.2%, respectively, at 36 months (P<0.001). The primary patency rates at 36 months using the modified SVS runoff scoring system were 64.6% and 49.8% for the good-to-compromised (≤9 points) and poor (≥10 points) runoff groups, respectively (P=0.011). @*Conclusion@#The modified SVS runoff scoring system is effective in predicting primary patency after SFA angioplasty with stenting in patients treated for claudication.

Symptomatic Isolated Celiac Artery Dissection following Blunt Trauma

An isolated splanchnic artery injury due to blunt trauma occurs rarely because abdominal vascular injuries are typically associated with injuries to the surrounding abdominal structures, including solid organs or hollow viscus. Of the major abdominal vessels, the celiac artery is the least commonly injured by penetrating or blunt abdominal trauma. Furthermore, a celiac artery dissection due to blunt trauma is rarely reported and there is no clearly defined treatment method, even though endovascular and conservative treatments are accepted widely. On the other hand, endovascular treatment can be challenging if the celiac artery dissection involves its main branch, including the proper hepatic artery, left gastric artery, and splenic artery. This case study presents the treatment experience of a celiac artery dissection involving its main branch following dorsal blunt trauma. Furthermore, conservative treatment is proposed as a treatment option for this rare injury.

Colonic hypoperfusion following ligation of the inferior mesenteric artery in rectosigmoid colon cancer patients

PURPOSE: Colon perfusion status is one of the most important factors for the determination of postoperative anastomotic complications. Colonic hypoperfusion can be induced by inferior mesenteric artery (IMA) ligation in some patients. This study aimed to evaluate atherosclerotic risk assessment and vascular parameters of CT angiography as predictors of colonic hypoperfusion. METHODS: This prospective study was conducted at a tertiary referral hospital and included 46 rectosigmoid colon cancer patients undergoing laparoscopic anterior resection between August 2013 to July 2014. Atherosclerotic risk scores were assessed using the Framingham cardiovascular risk score system. The IMA length, branching pattern, atherosclerotic calcification, and intermesenteric artery and mesenteric vascular diameters were evaluated using CT angiography. Mesenteric marginal artery pressures were measured before and after IMA clamping. The mean arterial pressure (MAP) index was calculated by dividing the mesenteric marginal MAP into the systemic MAP to determine the mesenteric hypoperfusion status after IMA clamping. A critically low MAP index was defined as <0.4. RESULTS: Critically low MAP index (<0.4) was observed in 6 cases (13.0%) after IMA clamping. Atherosclerotic calcification of the IMA and superior mesenteric artery occurred in 11 (23.9%) and 5 patients (10.9%), respectively. Low MAP index was associated with high atherosclerotic risk score and short IMA length, rather than atherosclerotic calcification and other vascular parameters of the major mesenteric arteries. Multivariate analysis indicated that high atherosclerotic risk and short IMA length were independent predictors of critically low MAP index. CONCLUSION: Atherosclerotic risk assessment and IMA length were useful predictors of the mesenteric hypoperfusion status following IMA ligation during laparoscopic rectosigmoid colon surgery.

Comparison of Treatment Result Between Anticoagulation Alone and Catheter-Directed Thrombolysis Plus Anticoagulation in Acute Lower Extremity Deep Vein Thrombosis

PURPOSE: Deep vein thrombosis (DVT) is the third most common cause of cardiovascular morbidity and mortality. Anticoagulation has been the primary treatment modality for acute DVT. However, catheter-directed thrombolysis (CDT) has recently become widely accepted as an additional therapy to anticoagulation. We assessed comparative outcomes in patients with acute DVT who underwent anticoagulation therapy alone (ACA) group and those treated with CDT group. MATERIALS AND METHODS: We retrospectively reviewed medical records of 149 patients with DVT from January 2011 to December 2015. We compared patients who received ACA group (n=120) and those who received CDT plus anticoagulation (CDT group, n=29). We analyzed the prevalence of lesions, thrombus removal rate in each lesion, and recurrence-free rate between the two groups. RESULTS: We found thrombus involvement in a total of 281 lesions in the ACA group and 85 lesions in the CDT group. For the distribution of lesions in each group, those in the femoral vein accounted for 34.2% of all lesions and those in the popliteal vein accounted for 31.7%. During follow-up, the overall thrombus removal rate was 91.1% in the ACA group and 87.0% in the CDT group (P=0.273). The recurrence-free rate was higher in the CDT group in a log-rank test; however, there was no statistically significant difference between the two groups (P=0.594). CONCLUSION: According to our results, there was no significant difference in thrombus removal and recurrence-free rates between the CDT and ACA groups. ACA still has an important role in the treatment of DVT.

Comparison of Image Qualities of 80 kVp and 120 kVp CT Venography Using Model-Based Iterative Reconstruction at Same Radiation Dose

PURPOSE@#To compare image qualities of 80 kVp CT venography (CTV) and 120 kVp CTV by model-based iterative reconstruction (MBIR) at the same radiation dose.@*MATERIALS AND METHODS@#Sixty-nine patients that underwent CTV using 80 kVp (36 patients, group 1) or 120 kVp (33 patients, group 2) with MBIR at the same radiation dose were enrolled, and objective and subjective image qualities were assessed independently by two radiologists.@*RESULTS@#Mean vascular enhancement and contrast-to-noise ratio were significantly higher in group 1 than in group 2 for inferior vena cavas, femoral veins, and popliteal veins (p < 0.001), and there was significantly lower objective image noise in group 1 (p < 0.001). Subjective analysis revealed image quality was significantly higher in group 1 and image noise was significantly higher in group 2 (p < 0.001). Mean dose-length products was not significantly lower in group 1 (356.1 ± 153.7 mGy cm) than in group 2 (370.1 ± 77.1 mGy cm) (p = 0.635).@*CONCLUSION@#CTV at 80 kVp with MBIR is a better protocol than CTV at 120 kVp with MBIR at the same radiation dose.

Ruptured Mycotic Aneurysm of the Common Carotid Artery: A Case Report

Mycotic aneurysms of the common carotid artery (CCA) are very rare and warrant surgical treatment to prevent rupture and death. A 89-year-old man who complained of a sore throat and swelling of the right side of neck. He had no history of trauma or neck infection. Physical examination revealed hard and pulsatile mass. Computed tomography showed initially pseudoaneurysm rupture on the right CCA with surrounding inflammation. The emergency operation revealed mycotic aneurysm rupture with CCA necrosis and was successfully done by wide debridement and carotid artery resection with interposition bypass. The resected tissue and blood culture grew growth of Staphylococcus aureus group. We report a rare case of mycotic aneurysm of right CCA that treated by bypass interposition.

Rescue Technique for Malposition Caused by Mislabeled Stent Graft in Thoracic Aneurysm

The aim of this paper is to report a salvage treatment for malpositioned stent graft due to mislabeled product during thoracic endovascular aortic repair (TEVAR) in descending thoracic aneurysm (DTA). A 78-year-old male presented with 6.7×4.1 cm sized saccular DTA and 7.1×7.3 cm sized abdominal aortic aneurysm (AAA). DTA was initially treated by TEVAR and 2 months later AAA was treated by open aortic repair. Unfortunately, although the stent graft was correctly labeled for DTA, the actual size of product wrapped in a box was different contrary to our expectations. On completion angiography, proximal sealing zone showed no endoleak, however, celiac trunk and superior mesenteric artery (SMA) was found to be accidentally occluded. Through an emergent thoracotomy, distal part of stent graft was removed by cutting distal segment of stent graft and pulling out maneuver to restore blood flow. The completion angiography presented no endoleak, and celiac trunk and SMA were secured. Cutting distal segment of stent graft and pulling out maneuver is one of feasible rescue technique to maintain blood flow of occluded celiac trunk during TEVAR.

Stereotactic vacuum-assisted breast biopsy under lateral decubitus position

PURPOSE: Stereotactic vacuum-assisted breast biopsy (VAB) has been established as a standard method for histological diagnosis of microcalcification or nonpalpable breast lesions on mammography. Generally, the procedure has been done under the prone position or upright sitting position. We herein attempt to evaluate clinical utility of Stereotactic VAB under lateral decubitus position. METHODS: One hundred six women (mean age, 51.2 years) with mammographically detected microcalcification underwent lateral decubitus positioning VAB using the 8G probe. In all cases, we obtained mammography specimens for identification of microcalcification and postprocedure mammography. We reviewed mean procedure time, pieces of specimen, pathology and follow-up mammography. RESULTS: The procedure took approximately 20 minutes (range, 15-24 minutes). Average number of obtained specimens was 8.5 pieces (range, 6-12 pieces). Microcalcifications were confirmed in both specimen mammography and microscopic slides. Of 106 cases, 10 cases were diagnosed as ductal carcinoma in situ. Additional surgical management was performed. Atypical ductal hyperplasias were found in 8 cases, and fibrocystic changes in 88 cases. CONCLUSION: Stereotactic VAB using the 8G probe under lateral decubitus position does not need a dedicated table, and is easier to maintain the position. Also, this procedure is accurate and safe. Thus, stereotactic VAB using the 8G probe under lateral decubitus position will be a useful method for diagnosis of microcalcification or nonpalpable breast lesions on mammography.

Infected Groin (Graft/Patch): Managed with Sartorious Muscle Flap

PURPOSE: The purpose of this study was to review the natural history, clinical outcome and safety in patients undergoing sartorius muscle flap (SMF) for groin infection, including lymphocele. MATERIALS AND METHODS: We retrospectively reviewed the records of patients who underwent SMF in a single center between 2000 and 2009. RESULTS: Thirty patients (17 male, 13 female) underwent SMF for groin infection, which included infections of 22 artificial femoral bypass grafts (including 2 cryoveins) and 5 common femoral patch grafts, and 3 lymphocele infections (2 cardiac catheterizations and 1 penile cancer lymph node dissection). Wound isolates were most commonly Gram-positive organisms (n=22) with Gram-negative isolates and mixed infections accounting for 4 and 3 cases, respectively. In 9 patients there was no growth of organisms. Adjunctive wound vacuum-asssisted wound closure therapy was performed in 18 patients. Follow-up duration ranged from 8 days to 56 months (mean 14.1 months) after SMF. Reoperation was performed in 3 patients due to wound bleeding (n=1) and reinfection (n=1). One patient underwent graft excision with external bypass operation. There was 1 mortality case due to sepsis during the study period. CONCLUSION: We found that muscle flap surgery provides successful single-intervention therapy for groin infections including lymphocele. Graft ligation or aggressive excision with bypass surgery should be reserved for patients requiring rapid control of sepsis for lifesaving.

Hybrid Treatment of Coexisting Renal Artery Aneurysm and Abdominal Aortic Aneurysm in a Gallbladder Cancer Patient

Renal artery aneurysm (RAA) is uncommon, and the coexistence of an abdominal aortic aneurysm (AAA) is an extremely rare condition with potentially high life-threatening mortality in case of rupture. Aneurysms can be treated by endovascular intervention or open surgery. Although most of aneurysms are treated by endovascular intervention, open surgery is often necessary for RAAs associated with the proximal renal bifurcation or the branches in the distal renal arteries. We report a rare case of coexisting RAA with AAA treated by hybrid method, consisting of endovascular aneurysm repair for AAA and open surgery for RAA located adjacent to the distal branches of the renal artery.