Clinical Analysis for the Patients of Arterio-venous Fistula

PURPOSE: Many studies show the important factors for better patency rate of the arteriovenous patients. accoding the former articles, age, the site of artery, the presence of diabete or hypertension and the BUN and creatinine level are most important factors. In this article is willing to identify factors that may influence the patency rate of arteriovenous fistulae. METHOD: 125 consecutive patients who underwent internal arteriovenous fistula formation in chonnam national university during 18 months from 1997 to 1998 were reviewed and analyzed. The analyzing factors were age, sex, presence of DM, and hypertension, the level of BUN, Creatinine. RESULT: Overall patency rates of upper arm arteriovenous fistular were 73.3% at one year and 71.5% at the end of two year. BUN level at the time of the fistula formation was another significant factor, and one year patency rates of the groups with BUN less than 50 mg/dL, BUN between 50 and 99 mg/dL, and BUN over 100 mg/dL were, 50.4%, 64.8% and 87.5% respectively, and these differences continued at least for 30 months after the fistular creation (P=0.046). Serum creatinine level also had close relationship with patency and one year patency rate of group with serum creatinine levels less than 5 mg%, 5-9.9 mg%, over the 10 mg% were, 48.5%, 67.5% and 84.5% respectively (P=0.014) Differences in patency rates were also noted according the presence of diabete mellitus (P=0.0397) and the hypertension (P=0.0424) Age is also meaningful factor and significant in this study. CONCLUSION: Among the suspected factors that may influence the patency of fistula, BUN, serum creatinine, and the presence of DM or hypertension were statistically significant on multivariant analysis.

Clinical Study of Acute Arterial Occlusion of Lower Extremities

PURPOSE: The major source of acute peripheral arterial occlusion has been embolization from the heart. However overall improvement in medical care have increased life spans, resulting in significant increase in the incidence of systemic atherosclerosis and thrombotic occlusion of peripheral vessels. Recently, occlusion from in situ thrombosis has surpassed occlusion from embolization as the major cause of acute arterial occlusion. The introduction of the balloon catheter technique in 1963 dramatically simplified the technical aspect of surgical therapy for acute arterial occlusion and it became the main modality of the therapy. Recently, numerous reports have documented increased identification of intraluminal defects after arterial surgery using angioscopy as compared with those using intraoperative arteriography, and for this reason, the use of intraluminal angioscopy has grown in popularity. METHODS: We analyzed clinical characteristics and treatment results in patients with acute arterial occlusion. The variables studied include location, etiology, time interval from occurrence of occlusion to performance of thromboembolectomy. RESULTS: There were 41 men and 4 women and most prevalent age group was in 7th decades. The causes of acute arterial occlusion were embolism in 21 cases (46.7%), thrombosis in 24 cases (53.3%). The primary source of embolism was heart in 20 cases as a result of ischemic heart disease (n=11, 52.4%) and atrial fibrillation (n=9, 42.9%). Two patients in embolic group died of cardiogenic shock and were in shorter duration group (<24 hours). Iliac arterial occlusion group was associated with highest amputation rate (23.1%). Amputation rates were 12.5% for thromboembolectomy performed within 24 hours of onset of symptoms, and 17.4% when performed after 48 hours. We used angioscopic technique in limited cases of 5 patients to detect residual thrombus, intimal flap and other intraluminal defects. CONCLUSION: To improve outcome, early diagnosis and early treatment are essential. Direct visualization of the arterial lumen with angioscopy during thromboembolectomy procedure would provide a more reliable method of assessing luminal morphologic characteristics than angiography alone.

Abdominal Aortic Reconstruction Using PTFE(Polytetrafluoroethylene)

Fifty cases of abdominal aortic reconstruction using PTFE were performed between january 1991 and february 1998 at the Department of Surgery, Chonnam University Hospital. The thirty-five of 50 cases were abdominal aortic aneurysm and the other 15 cases were aortoiliac occlusive disease. Patients were analysed on the basis of sex, age, associated disease, size of aneurysm, operative method, mortality, and cause of death. There were 43 men and 7 women and the mean age was 64.9 years. Hypertension in 24 cases is the most common associated disease, following by ischemic heart disease in 5 cases, COPD in 5 cases. Aorto-bifemoral bypass graft using PTFE was done in 17 cases and aorto-biiliac bypass in 33 cases. The most common complication following surgery was graft occlusion in 6 cases, and other complications were prosthetic infection, postoperative bleeding and ischemic colitis. The cases of death were hypovolemic shock (2), acute renal failure (1), and sepsis (1). There was no evidence of PTFE oriented prosthetic graft complications.

Clinical Analysis of the Pseudoaneurysm of Chronic Pancreatitis

Arterial pseudoaneurysm is an infrequent but potentially catatrophic complication of pancreatitis. A pseudoaneurysm is encountered in 6~9.5% of patient with chronic pancreatitis and as many as 17% of all patients operated on for chronic pancreatitis. A ruptured pseudoaneurysm is the most fatal complication with reported mortality rate as low as 12.5% in treated patients, greater than 90% in patients not receiving treatment. Therefore bleeding pseudoanurysms are required early diagnosis and radical treatment. We reviewed 8 patients who were admitted to Department of Surgery of Chonnam University Hospital for treatment of pseudoaneurysm complicating chronic pancreatits from January, 1993 to December, 1997. The results were as follows. 1) The patiens were all male, and the age range was 30 to 65 years(mean 47 years). 2) The most prevalent symtom and sign were anemia and abdominal pain(100%). 3) Angiography and abdiminal CT were performed in all patients. 4) Pseudoaneurysms were located in gastroduodenal artery(4 cases), branch of superior mesenteric artery(2 cases), superior mesenteric artery(1 case) and pancreaticoduodenal artery(1 case). 5) Transarterial embolization was performed in 6 cases and reembolization was done in 1 case and 1 rebleeding case was expired. 6) Operative management(aneurysmorrhaphy) was performed without complication in 2 cases. We consider that complete resection of pseudoaneurysm complicating chronic pancreatitis is the treatment of choice but transarterial embolization using coil may be considered as the first method of treatment.

Clinical Study of Deep Vein Thrombosis of Lower Extremity

Medical managements and prevention of deep vein thrombosis(DVT) continue to be a difficult problem and DVT often result in serious complications, in spite of improvements in early diagnosis of DVT. Various attemps to treat effectivly and to prevent DVT have been tried. We reviewed 82 patients who were admitted to Department of Surgery of Chonnam University Hospital for treatment of DVT from January, 1991 to May, 1997. The results were as follows. 1) There was a wide age distribution from teenage to 8th decade, and peak age distribution was 7th decade(28.0%). Sex distribution of DVT, male to female ratio, was 1 : 1.1. 2) Main chief complaint in patients with DVT was swelling of lower extremities(97.5%), and followed by pain(51.2%). The left side of lower extremities was more frequently affected than that of right side, left to right ratio was 2.2 : 1. 3) Occupations of patients with DVT were variable, fourty patients(48.8%) had no specific occupations. 4) Most frequent predisposing factor of DVT was trauma(12.2%) and followed by malignancy (11.0%) and operation(7.3%). 5) Diagnosis of DVT was made with plethysmography in all cases, and venography(25 cases), radioiodine(RI) venography with lung scan(7 cases). 6) Treatment was done with heparin and oral anticoagulant in most patients for 3 to 12 months. Fogarty thrombectomy was done in 4 cases, but adequate removal of thrombi was failed in 2 cases because the catheter couldn't be advnaced into the site of thrombi. Anticoagulant therapy was done for 2

Compression Sclerotherapy of Varicose Vein

Varicose vein is one of the most common vascular disorders of the lower extremities, and the two methods of treatment, ablative surgery and compression sclerotherapy are currently employed. Compression sclerotherapy has been controversial, but in recent, if it is performed in case of optimal indication, favorable effect can be expected. We reviewed 80 outpatients treated by compression sclerotherapy of varicose vein at Department of Surgery of Chonnam University Hospital from January, 1988 to December 1995 evaluate indication and usefulness of compression sclerotherapy. Indications for compression sclerotherapy included telangiectasia, reticular varicosities, reticular veins, isolated varicosities, below-the-knee varicosities, etc. Five percent ethanolamine oleate was utilized as a sclerosing agent in cases of absence of gross saphenous reflux, below knee varicosities, under 5.0mm in diameter, and elastic compression was continued for three months postsclerotherapy. The results were as follows ; 1) The distributions of age were 4th decade(38.7%), 5th decade(30.0%), 3rd decade(26.3%), in order. 2) The predisposing factors of varicose vein were profession requiring long periods of standing(51.2%), pregnancy(15%), in order. 3) Varicose veins were located in greater saphenous system(50%), lesser saphenous system (45%), and both (5.0%), in order. 4) The duration of clinical manifestation was 8-10 years(35.0%), 1-5 years(33.8%), in order. 5) The cardinal symptoms and signs were tortuosity of veins(100%), aching(80%), heaviness (50%), walking discomfort(30%), in order. 6) The outcome of treatment was that no further treatment was needed in 68 cases(85.0%), and re-treatment(sclerotherapy) was needed in 12 cases(15.0%). Among them, sclerotherapy was performed 2 times in 6 cases, 3 times in 4 cases, and 4 times in 2 cases. 7) The postsclerosing complications were hematoma(5 cases) and pigmentation(1 case). If compression sclerotherapy of lower extremities varicose vein is performed in selected patients, it may be the method of less expensive, safe and effective treatment.