Outcomes of Bypass Surgery Versus Endovascular Therapy for TASC II C and D Femoro-Popliteal Lesions in Patients with Chronic Limb Ischemia

PURPOSE: We wanted to define the appropriate treatment modalities for Trans-Atlantic Inter-Society Consensus (TASC) II C and D femoro-popliteal lesions. So we compared the primary patency rate and several clinical factors between percutaneous balloon angioplasty with or without stenting (PTA/S) and bypass surgery (BP). METHODS: We reviewed the medical records of patients who underwent BP or PTA/S for TASC II C (BP-C, PTA/S-C) and D (BP-D, PTA/S-D) femoro-popliteal lesions from March 2001 to May 2009. We analyzed the primary and secondary patency rates, and the major limb salvage rates. RESULTS: Eighty two limbs in 74 patients (mean age: 68.7+/-10.2 years, males: 82.9%) were treated (PTA/S-C: 18, PTA/S-D 19: BP-C 12, BP-D 33). The mean follow-up duration was 30.0+/-19.0 months. The twenty four month primary patency rates was 82.4% for PTA/S-C and 73.3% for BP-C (P=0.876), and 45.3% for PTA/S-D and 66.6% for BP-D (P=0.034). The twenty four month secondary patency rates were 88.2% for PTA/S-C and 73.3% for BP-C (P=0.669), and 54.7% for PTA/S-D and 73.3% for BP-D (P=0.077). The twenty four month major limb salvage rates were 100.0% for PTA/S-C and 75.0% for BP-C (P=0.030) but there were no statistical differences between the TASC II D groups (P=0.377). CONCLUSION: Bypass surgery is a preferred initial therapeutic option for TASC II D femoro-popliteal lesions. However, several clinical factors must be carefully considered when selecting the primary treatment modality for TASC II C lesions.

A Case of Paragonimiasis in the Abdominal Subcutaneous Tissue with Pleural Effusion / 결핵

A paragonimiasis infestation is caused by the paragonimus species. It is commonly found in the lung but has also been found to exist extrapulmonary infestations including cerebral, spinal, subcutaneous, hepatic, splenic, abdominal, urinary, and gynecologic infestation. On the other hand, a cutaneous infestation is extremely rare. Human infestation is caused by ingesting raw or undercooked intermediate hosts. Because paragonimus westermani larva mature to an adult worm in the lung, the possibility of identifying the adult worm of paragonimus westermani at extrapulmonary region is very rare. CASE: After ingesting a fresh-water crab 1 month prior to the hospital visit, a 45-year old female patient was suffering from right pleuritic chest pain during that 1 month. The patient also complained of a palpable mass that was movable and migrating, and it was localized at the right upper quadrant of the abdomen. The eosinophil fraction of the white blood cell of peripheral blood and pleural fluid was elevated to 55.1% and 90%, respectively. Parasite eggs were not found in her sputum and stool examination. By using the enzyme-linked immunosorbent assay (ELISA), the paragonimus-specific IgG antibody titer was elevated to 0.28. During incisional biopsy, we were able to find the young adult worm of paragonimus westermani. We experienced the rare case of ectopic paragonimiasis with pleural effusion that was confirmed by identifying the adult worm of paragonimus westermani within the abdominal subcutaneous tissue. We report a case with brief literature reviews.