Clinical outcomes in surgical and non-surgical management of hepatic portal venous gas

BACKGROUNDS/AIMS: Hepatic portal venous gas (HPVG) is a rare condition, with poor prognosis and a mortality rate of up to 75%. Indications for surgical and non-surgical management of HPVG including associated complications and mortality remain to be clarified. METHODS: From January 2008 to December 2014, 18 patients with HPVG diagnosed through abdominal computed tomography (CT) imaging were retrospectively identified. Clinical symptoms, laboratory data, underlying diseases, treatment, and mortality rate were analyzed. Patients were classified into 2 groups: surgical management recommended (SR, n=10) and conservative management (CM, n=8). The SR group was further subdivided into patients who underwent surgical management (SM-SR, n=5) and those who were managed conservatively (NS-SR, n=5). RESULTS: Conditions underlying HPVG included mesenteric ischemia (38.9%), intestinal obstruction (22.2%), enteritis (22.2%), duodenal ulcer perforation (5.6%), necrotizing pancreatitis (5.6%), and diverticulitis (5.6%). In terms of mortality, 2 patients (40%) died in the SM-SR group, 1 (12.5%) in the CM group, and 100% in the NS-SR group. Higher scores from Acute Physiology and Chronic Health Evaluation (APACHE) II predicted the mortality rates of the NS-SR and CM groups. CONCLUSIONS: Identification of HPVG requires careful consideration for surgical management. If surgical management is indicated, prompt laparotomy should be performed. However, even in the non-surgical management condition, aggressive laparotomy can improve survival rates for patients with high APACHE II scores.

Endovascular Therapy to Salvage Hemodialysis Access / 대한혈관외과학회지

PURPOSE: Maintaining function of dialysis access is very important to end stage renal disease patients, and it is critical for these patients' overall well-bing. This study was performed to evaluate the success rate of endovascular interventions, risk factors and patencies of interventions. METHODS: From January 2008 to June 2010, 315 interventions were performed on 189 patients with malfunctioning hemodialysis access. Angioplastic intervention (n=147), and percutaneous mechanical thrombectomies (n=168) were done to restore flow of vascular access. RESULTS: Most common cause of malfunctioning hemodialysis accesses was stenosis (71%) in autogenous fistula group (AFG) and thrombosis (73%) in prosthetic graft group (PGG). Common stenotic site was juxta-anastomotic area (48%) in AFG, and venous anastomotic area (42%) in PGG, primary patencies of interventions at 6, 12, and 18 months were 67%, 45%, and 37% and secondary patencies were 83%, 66%, and 49%, respectively. Finally, thrombotic events (P=0.005) and numbers of procedure (P=0.000) were independent predictive factors of shorter access patency after endovascular treatment. CONCLUSION: Endovascular treatment in malfunctioning hemodialysis access is highly successful procedure with acceptable primary and secondary patency results. Especially, in the cases of stenotic lesion without thrombosis, percutaneous transluminal angioplasty was successfully done in AFG and PGG.

Abdominal Aortic Aneurysm Repair in Patient with a Renal Allograft: A Case Report

Renal transplant recipients requiring aortic reconstruction due to abdominal aortic aneurysm (AAA) pose a unique clinical problem. The concern during surgery is causing ischemic injury to the renal allograft. A variety of strategies for protection of the renal allograft during AAA intervention have been described including a temporary shunt, cold renal perfusion, extracorporeal bypass, general hypothermia, and endovascular stent-grafting. In addition, some investigators have reported no remarkable complications of the renal allograft without any specific measures. We treated a case of AAA in a patient with a renal allograft using a temporary aortofemoral shunt with good result. Since this technique is safe and effective, it should be considered in similar patients with AAA and previously placed renal allografts.

The Availability of Computed Tomography for the Patients with Deep Vein Thrombosis

PURPOSE: Computed-tomography (CT) is known as a useful modality to diagnose the occurrence and extent of deep vein thrombosis (DVT) and the existence of pulmonary embolism (PE). This article will focus on the availability of DVT-CT at Kyungpook National University Hospital. METHOD: From 1994 to 2006, 403 DVT patients were documented for the extent of thrombus and the existence of PE. DVT-CTs, according to our protocol, were obtained for 136 patients; there were 112 CT scans taken that were limited to the abdomen and lower extremity, and 47 patients underwent only chest CT to diagnose PE. Other modalities such as duplex scan and venography for DVT and lung scan for PE were also performed for 155 patients. RESULT: The patients in the CT group (248 patients) demonstrated that the extent of the thrombus was in the inferior vena cava (IVC) in 38 (16%), the iliac veins (IVs) in 98 (40%), the femoral veins (FVs) in 73 (29%), the popliteal veins (PVs) in 3 (1%), and the mesenteric veins in 24 (10%). For the group that underwent venography or duplex scanning (155 patients), the extent of thrombus was in the IVC in 4 (3%), the IVs in 47 (30%), the FVs in 73 (47%), and the PVs in 21 (14%). For the 136 patients who underwent DVT-CTs, 38 (28%) cases had PE. The DVT-CT and lung scan were in agreement for all the 12 cases who underwent both two tests. CONCLUSION: In the present study, DVT-CT accurately revealed the extent of DVT and it is a useful tool for making the diagnosis of PE.

The Availability of Computed Tomography for the Patients with Deep Vein Thrombosis

PURPOSE: Computed-tomography (CT) is known as a useful modality to diagnose the occurrence and extent of deep vein thrombosis (DVT) and the existence of pulmonary embolism (PE). This article will focus on the availability of DVT-CT at Kyungpook National University Hospital. METHOD: From 1994 to 2006, 403 DVT patients were documented for the extent of thrombus and the existence of PE. DVT-CTs, according to our protocol, were obtained for 136 patients; there were 112 CT scans taken that were limited to the abdomen and lower extremity, and 47 patients underwent only chest CT to diagnose PE. Other modalities such as duplex scan and venography for DVT and lung scan for PE were also performed for 155 patients. RESULT: The patients in the CT group (248 patients) demonstrated that the extent of the thrombus was in the inferior vena cava (IVC) in 38 (16%), the iliac veins (IVs) in 98 (40%), the femoral veins (FVs) in 73 (29%), the popliteal veins (PVs) in 3 (1%), and the mesenteric veins in 24 (10%). For the group that underwent venography or duplex scanning (155 patients), the extent of thrombus was in the IVC in 4 (3%), the IVs in 47 (30%), the FVs in 73 (47%), and the PVs in 21 (14%). For the 136 patients who underwent DVT-CTs, 38 (28%) cases had PE. The DVT-CT and lung scan were in agreement for all the 12 cases who underwent both two tests. CONCLUSION: In the present study, DVT-CT accurately revealed the extent of DVT and it is a useful tool for making the diagnosis of PE.

Bilateral Obturator Bypasses for Femoral Graft Infection: 1 Case Report

Infection of both native and prosthetic vessels are most frequently seen in the groin. The successful treatment of prosthetic graft infection requires excision of the affected graft, adequate debridement, and restoration of circulation. Restoration of arterial circulation can be accomplished by using in situ reconstruction with femoral vein, cryopreserved allografts, or antibiotic-impregnated synthetic grafts. The obturator and lateral femoral bypasses are the most frequently used extra-anatomic bypasses. We experienced one case of bilateral obturator bypasses for the femoral graft infection.

Bilateral Obturator Bypasses for Femoral Graft Infection: 1 Case Report

Infection of both native and prosthetic vessels are most frequently seen in the groin. The successful treatment of prosthetic graft infection requires excision of the affected graft, adequate debridement, and restoration of circulation. Restoration of arterial circulation can be accomplished by using in situ reconstruction with femoral vein, cryopreserved allografts, or antibiotic-impregnated synthetic grafts. The obturator and lateral femoral bypasses are the most frequently used extra-anatomic bypasses. We experienced one case of bilateral obturator bypasses for the femoral graft infection.