Total Laparoscopic Abdominal Aortic Aneurysm Repair: A Case Report / 대한혈관외과학회지

Open surgical repair has long been considered a mainstream treatment for abdominal aortic aneurysm (AAA). Although endovascular aneurysm repair is minimally invasive and yields satisfying short-term results, there has been concerns about it's the long-term durability. Recent studies showed that laparoscopic AAA repair is a feasible technique and that the benefits of laparoscopy can be consistent with open repair. In particular, total laparoscopic AAA repair has the advantage of reducing postoperative problems in abdominal wall and intestine, and increasing the patient's respiratory recovery and general comfort. In this paper, we report a successful case of total laparoscopic AAA repair. To our knowledge, this is the first report of total laparoscopic AAA repair in Korea.

Feasibility of Superficial Femoral Artery Intervention Using Mobile C-arms Compared to Fixed C-arms / 대한혈관외과학회지

PURPOSE: Endovascular therapy (ET) for peripheral arterial occlusive disease has increased dramatically in the past decade. ET is currently being performed by different specialists with available resources, with some of these resources being far superior to others, yet there have been no studies comparing the interventional outcomes according to the varying resources. The aim of this study was to analyze the outcomes of ET for superficial femoral artery (SFA) atherosclerosis using a mobile C-arm, in comparison to a historical control group. METHODS: Between March 2009 and December 2010, ET for SFA atherosclerosis was performed in 54 limbs from 47 patients using a mobile C-arm in the operation theater (mobile group). In contrast, a historical group for comparison consisted of 60 patients, for whom ET for SFA atherosclerosis was performed in 76 limbs using a fixed C-arm in the angiographic suite, between July 2003 and May 2008 (fixed group). The outcomes of ET for both groups were retrospectively analyzed by a medical chart review. RESULTS: There was no statistically significant difference in gender, age, risk factors, Trans-Atlantic Inter-Society Consensus (TASC) classification, intervention type, and postoperative blood creatinine levels between the two groups. However, procedural time was statistically higher in the mobile group. Patency rates at 1 year were 68.3% and 68.1% in the fixed and mobile group, respectively, which was not statistically significant. Subgroup analysis of 1 year patency rates for TASC A, B lesions and TASC C, D lesions were also similar. CONCLUSION: ET using the mobile C-arm in the operating theater is as effective as using the fixed C-arm, in the treatment of SFA atherosclerosis in terms of the technical success, patency, and early postoperative outcomes.

An Experimental Study for Mouse Lymphedema Model / 대한혈관외과학회지

PURPOSE: Lymphedema is a disease with a poorly understood pathogenesis and without definite ways of treatment, yet it can lead to serious complications. The purpose of this study was to establish a new lymphedema mouse model and to evaluate its usefulness for future studies. METHODS: A lymphedema model was created by interrupting flow from the superficial lymphatic system (skin and subcutaneous tissue removal, electrocautery) and the deep lymphatic system (hindlimb muscle resection, dye injection, and inguinal lymph node dissection). The lymphedema group (n=10) was compared to a control group (n=10) by assessing the differences in hindlimb edema, through the use of a water displacement volumetry method. In addition, lymphoscintigraphy, immunohistochemistry, and reverse transcription- polymerase chain reaction (RT-PCR) were performed and compared between the 2 groups. RESULTS: Volumetric analysis showed that the lymphedema group had a 2-fold increase in swelling compared to the control group at study day 3; this gradually decreased to normal levels after 8 weeks. Staining showed an increase in fibrosis in the lymphedema group, as well as an increase in vascular endothelial growth factor receptor-3, a receptor specific for lymphatic cells. RT-PCR showed that there was increased expression of the lymphatic cell specific markers, Prox-1 and podoplanin, in the distal portion of the hindlimb. Lymphoscintigraphy showed retention of lymphatic flow after 30 minutes, however, eventually all of the radioactive substance drained out from the hindlimb. CONCLUSION: Our method for creation of lymphedema in mice was effective in creating acute lymphedema. However it failed to retain its edematous properties for long periods of time. Further studies are needed to create a novel method of chronic lymphedema.

Clinical Experience of Mesenteric Vascular Diseases and Management

PURPOSE: Mesenteric vascular disease is a rare group of diseases including dissection, embolism, atherosclerosis, and venous thrombosis. Technical advances have led to increased diagnostic rates and new treatments with improved outcomes. The purpose of this study was to analyze the characteristics, methods of diagnosis, treatments, and outcomes of patients with mesenteric vascular diseases at our institution. METHODS: Between November 2003 and April 2010, 30 patients with mesenteric vascular disease diagnosed and treated at Seoul National University Bundang Hospital were reviewed retrospectively. Demographic data, etiology, treatment modality, and outcomes, including complications and mortalities, were analyzed. RESULTS: The mean age of the patients was 63.2 years (range, 43~91 years) and there was a male predominance (21 males vs. 9 females). The etiologies were superior mesenteric artery (SMA) dissection (n=13), SMA embolism (n=8), SMA atherosclerosis (n=5), and superior mesenteric vein thrombosis (n=4). Eleven patients underwent surgical treatment, while 11 patients underwent endovascular intervention and ten patients underwent conservative therapy with or without medication. No recurrence of symptoms or thrombosis was observed, except for one case of surgical thrombectomy, which underwent an endovascular aspiration thrombectomy with thrombolysis 9 days after the surgery. Two cases of technical endovascular treatment failure occurred, and one case of mortality after an endovascular stent insertion was observed. CONCLUSION: The incidence of mesenteric vascular diseases is increasing, and clinical manifestations and prognosis may vary from minor to life-threatening conditions. Early diagnosis is very important and the appropriate choice between endovascular intervention and a surgical approach may lead to good treatment results.

EVAR with Hypogastric Artery Bypass in Patient with Abdominal Aorto-Iliac Aneurysm

Endovascular aneurysm repair (EVAR) of combined abdominal and iliac aneurysm requires exclusion of the hypogastric artery for prevention of endoleak. However, exclusion of the hypogastric artery is often associated with significant ischemic complications such as hip or buttock claudication, gluteal necrosis and bowel ischemia. Several techniques have been introduced to preserve the flow of the hypogastric artery. We report a successful case of external iliac artery-to-hypogastric artery bypass with artificial graft combined with EVAR.

A Case of Early Bile Duct Cancer Arising from Villous Adenoma in Choledochal Cyst / 대한소화기학회지

Choledochal cyst is an uncommon premalignant anomaly. The morphology and pathogenesis of the premalignant lesion of cholangiocarcinoma arising from the choledochal cyst has not been well described. Herein, we report a rare case of bile duct adenoma arising from choledochal cyst with anomalous union of pancreaticobiliary duct (AUPBD). 50-year-old woman was admitted to our hospital with the complaint of epigastric pain. She had received common bile duct (CBD) exploration and choledocholithotomy and cholecystectomy 3 months earlier under the diagnosis of multiple CBD stones. Intraoperalive cholangiogram was not remarkable except CBD dilatation at that time. Endoscopic retrograde cholangiopancreatography revealed choledochal cyst with AUPBD and round filling defect which disappeared easily on the balloon cholaniogram. On magnetic resonance cholangiopancreatography, the filling defect was confirmed as 2 cm polypoid mass attached to the distal bile duct wall. At laparotomy, a soft whitish mass was palpable on the lower CBD. On histological examination, adenoma with focal carcinoma change arising from choledochal cyst was diagnosed.

Seven Cases of Epiploic Appendagitis: Retrograde Analysis of Clinical Characteristics

Epiploic appendagitis is a relatively rare cause of acute abdominal pain. Usually, epiploic appendagitis is a benign and self-limited condition, but it can be clinically misdiagnosed as acute appendicitis or diverticulitis, so an inaccurate diagnosis may lead to unnecessary treatment. We recently managed 7 cases of epiploic appendagitis during 1 year and review these cases with an emphasis on the clinical diagnostic features. The main pathophysiologic mechanism underlying epiploic appendagitis is thought to be triggered by appendageal torsion and caused by a subsequent blood flow disturbance. This medical condition must be kept in mind when a patient with acute abdominal pain has well-localized pain which is characteristically sharp in nature and a mild systemic inflammatory response compared to the severity of the pain.

The Impact of Peripheral Arterial Disease on the Treatment and Amputation of Diabetic Foot Ulcer

PURPOSE: Diabetic foot ulcers are one of the most important complications of patients with diabetes for their quality of life. Yet the data on factors that affect the treatment outcome and the guidelines for a multidisciplinary approach are limited. The purpose of this study was to assess the clinical characteristics that affect healing of diabetic foot ulcers, and especially when this is associated with peripheral arterial disease (PAD). METHOD: We retrospectively reviewed the clinicopathologic data of 112 patients who were admitted for the treatment of diabetic foot ulcers from May 2004 to December 2007 at Bundang Seoul National University Hospital. The patient's demography and co-morbidities, the laboratory and radiological details, the surgical data and the treatment outcomes were evaluated and analyzed according to the presence of PAD. RESULT: The mean age of the patients was 66 years old and the male to female ratio was 2.3:1. Except for simple dressing of the ulcers, skin graft, amputation or revascularization were performed for 77 patients. Ulcers healed in 74 patients (66.1%) and recurrence was observed in 42 patients (37.5%). Major amputation was performed on 11 patients (9.8%). The non-healing group had a higher incidence of male gender (P=0.049), end stage renal disease (P=0.038), coronary arterial disease (P=0.018), the presence of PAD (P=0.034) and a higher level of cholesterol (P=0.011) and triglyceride (P=0.039). Patients with PAD had a lower ankle-brachial index (P<0.001) and a higher rate of undergoing revascularization (P<0.001), overall amputation (P=0.003), non-healing (P=0.034) and recurrence (P<0.001). After revascularization, the rate of major amputation was not reduced (P=0.915). CONCLUSION: The risk of non-healing, overall amputation and recurrence is increased in the presence of PAD. Evaluating the PAD status and multidisciplinary treatment strategies are needed to treat these patients with diabetic foot ulcer.

A Case of Anti-LKM 1 Positive Autoimmune Hepatitis Accompanied by Systemic Lupus Erythematosus / 대한소화기학회지

Overlap of autoimmune hepatitis and systemic lupus erythematosus (SLE) is a comparatively rare condition. Although both autoimmune hepatitis and SLE can share common autoimmune features such as polyarthralgia, hypergammaglobulinemia and positive ANA, it has been considered as two different entities. We report a case of anti-LKM1 positive autoimmune hepatitis who developed SLE two years later. The presence of interface hepatitis with lymphoplasma cell infiltrates and rosette formation points to the autoimmune hepatitis rather than SLE hepatitis. Autoimmune hepatitis is infrequently accompanied by SLE, therefore, it could be recommended to investigate for SLE in patients with autoimmune hepatitis.

Clinical Feature of Iatrogenic Vascular Injury

PURPOSE: As the care of surgical patients becomes increasingly complex and catheter-based techniques are more frequently applied, the pattern of iatrogenic vascular injuries may be increasing. Major vascular injuries can jeopardize a patient's life or limb survival. The purpose of this study was to examine the current etiology and prognosis for iatrogenic vascular injuries. METHODS: We reviewed medical records of 29 cases of iatrogenic vascular injury that were treated Seoul National University Bundang Hospital between October 2003 and October 2008. We studied clinical variables including demographics, cause of injury, clinical presentations, management and prognosis. RESULTS: The mean age was 60.8 years (range: 25-86), and the male to female ratio was 1.9 : 1. The causes of injuries were operation related complication in 18 cases (62.1%), endovascular intervention and diagnostic angiography in 11 cases (37.9%). The types of vascular injury were partial severance in 14 cases, pseudoaneurysm in 8, arteriovenous fistula (AVF) in 3, thrombosis in 2, complete severance in 2. Especially, device related complication including percutaneous closing device were occurred in 9 and the others came from inadvertent physician's procedure. Primary repair were done in 12 cases, end-to-end anastomosis in 5, interposition graft in 4, ligation in 2, patch angioplasty in 1, peudoaneurysm excision and arteriorrhaphy in 1, hematoma evacuation in 1, and endovascular repair in 3. There were 2 cases of mortality, one of them due to hemorrhagic shock and the other due to septic shock. CONCLUSION: Proper selection of treatment modalities should be important to have better outcome according to the type of injury as well as anatomical location. Each physician should be familiar to new device as well as patient's topographical feature. Immediate referral to vascular specialist is also essential to reduce morbidity.

A Retrospective Review of Endovascular Aneurysm Repair (EVAR) for Abdominal Aortic Aneurysm (AAA) with Home-made Devices

PURPOSE: This study was performed to assess the safety and efficacy of Endovascular Aneurysm Repair (EVAR) with a home-made stent graft. METHOD: The medical records of 17 patients who underwent EVAR at Seoul National University Hospital between January 1995 and December 2003 were analyzed retrospectively. The outcomes were measured with respect to efficacy (deployment success rate, technical success rate, conversion rate, and reintervention rates) and safety (30-day mortality rate, complication rate, endoleaks, graft thrombosis, stenosis, and migration). RESULT: The median follow-up of the patients was 42.8 months (range, 2.7~72.67 months). The male to female ratio was 7.5 (15:2). The deployment success rate was 100% and the technical success rate was 70.6% at discharge. Early complications were present in five patients (29%). Late complications occurred in 47% of the cases. Secondary intervention to treat complications was required in 29% of patients. Open repairs were performed in two patients (12%), one with an immediate type Ia endoleak and the other for migrations. The cumulative patient survival rate was 94.1%, 76.0% and 57.0% at 1, 3 and 5 years follow up. The overall clinical success rate during follow-up was 38.5%. CONCLUSION: Although EVAR with a home-made device in high-risk patients showed good early technical outcomes, there were complications. Continued device innovation, good compliance and close surveillance are required for these patients.

Long-term Outcomes of Post-transplant Diabetes Mellitus in Renal Transplant Recipients / 대한이식학회지

PURPOSE: Post-transplant diabetes mellitus (PTDM) is believed to cause serious complications. PTDM might be one of the important risk factors of cardiovascular death after renal transplantation. Because the consequence of PTDM is expected to take long time, long-term follow-up is necessary. We performed this study not only to define the prevalence and risk factors of PTDM but also to define the long-term clinical impact of PTDM. METHODS: Among 508 patients who had received renal transplantation at Seoul National University Hospital between July 1969 and December 1995, 431 patients were included. Patients were grouped into PTDM and non-DM groups. The clinical characteristics were compared between two groups. RESULTS: Mean follow-up duration was 121.9 months (2~346 months). PTDM was developed in 68 (15.8%) patients. Recipient age at transplantation (P=0.004), family history of DM (P=0.000) and obesity (P= 0.000) were significant risk factors in multivariate analysis. Complications of PTDM such as cerebrovascular disease (CVD, P=0.040), ischemic heart disease (IHD, P=0.040), and infection (p=0.044) were significantly more frequent in PTDM group. The frequency of chronic allograft nephropathy (CAN) was not different between two groups. Although graft survival rate was not affected by PTDM, patient survival rate was significantly lower in PTDM group (P=0.002). CONCLUSION: PTDM increased complication rates such as CVD, IHD and infection. PTDM seemed not to affect graft survival, but to worsen the patient survival rate.

Management of Asymptomatic Small Abdominal Aortic Aneurysm

PURPOSE: There have been controversies about the management of small abdominal aortic aneurysm (AAA). This prospective study was performed to analyze the annual expansion rates and the clinical courses of small AAAs, and to we wanted to suggest some guidelines for the proper management of small AAAs in Koreans. METHOD: From 1991 to 2003, thirty-five patients who had an initial diagnosis of small AAA were enrolled into the study group. All the patients were assigned to undergo regular imaging studies with either ultrasonography or CT angiography every 6 months. At the end of the study, the twenty four patients who were followed up with at least three successive visits were included in the statistical analysis. The clinical symptoms and the size of their aneurysms were documented on each visit. Symptomatic aneurysms and aneurysms with a size greater than 5.5 cm were considered as candidates for surgical repair. The annual expansion rate, rupture rate and the requirements for aneurysm repair were analyzed. The overall aneurysm expansion rate was 0.33+/-0.22 cm/year. RESULT: The expansion rate of the aneurysms smaller than 4.0 cm (12 cases) was 0.32+/-0.26 cm/year and that of aneurysms between 4.0 cm and 5.0 cm in size (12 cases) were 0.34+/-0.19 cm/year (P=0.55). Only the presence of iliac artery involvement was significantly related with a higher aneurysm expansion rate (0.47+/-0.2 cm/year vs. 0.19+/-0.13 cm/year, respectively, P=0.001). There was no rupture of aneurysm during the study. 10 cases undergone aneurysm repair and there was no morbidity or mortality after the aneurysm repair. CONCLUSION: Small AAAs in Koreans can be safely managed with regular follow-up. Closer follow-up is recommended as the aneurysm size increases and for small aneurysms that involve the iliac artery.

Laparoscopic Partial Splenectomy for Splenic Pseudocyst

Splenic preservation and conservative management are now accepted norms when dealing with splenic pathologic conditions. Recently, we managed one case of splenic pseudocyst by successfully performing partial splenectomy via a laparoscopic approach. This case report possibly the first case report of its kind in Korea, describes laparoscopic partial splenectomy for an undiagnosed and suspected benign splenic lesion. A thorough understanding of splenic anatomy permits laparoscopic partial splenectomy with the resultant benefits, including a decreased risk of postsplenectomy sepsis by preserving splenic function, short hospital stay, smooth convalescence, superior cosmesis, and non-recurrence. The success and relative ease of performing this procedure will pave the way for its future use in other selective cases involving splenic pathology.

Diagnosis and Management of Arterial Thoracic Outlet Syndrome (TOS)

PURPOSE: Arterial TOS is a rare condition caused by compression of the subclavian artery at the thoracic outlet area, which is composed of the anterior and middle scalene muscles, the first rib and the clavicle. We have experienced four cases of arterial TOS and we reviewed them to determine the appropriate management of arterial TOS. METHOD: We reviewed the medical records of 26 patients who were diagnosed and managed for TOS at Seoul National University Hospital from 1985 to 2004. We reviewed the clinical manifestations, diagnostic tools, mode of management and the outcomes. RESULT: The four patients with arterial TOS, 3 males and 1 female, had an average age of 41.3 years (range: 30~53 years). They complained of a tingling sense, coldness, weakness, and cyanosis of affected limb, and a gangrenous finger. They were diagnosed with CT angiography, conventional angiography and Doppler US. The findings were stenotic artery segments, post- stenotic dilatation and luminal thrombi of the subclavian artery. Two of them showed multiple peripheral arterial embolic obstructions and numerous collateral vessels. Three patients with arterial TOS underwent surgery. The operation consisted of the excision of the bony abnormality and the scalene muscle, segmental resection of subclavian artery including the aneurismal dilatation, interposition of a saphenous vein graft, and thromboembolectomy. Their symptoms improved after restoration of blood circulation, but the gangrenous finger required amputation. CONCLUSION: Arterial TOS has the definite risk of limb loss. If there is a high clinical suspicion of this lesion, early diagnosis and confirmation by angiogram may be critical to prevent limb loss. Surgical revascularization provides satisfactory results for limb salvage with low operative morbidity.

Clinical Study of Endovenous Laser Treatment in Short Saphenous Vein Varicosity

PURPOSE: With regard to the selection of varicose treatment, conventional therapy such as stripping and ligation has became unpopular but the selection of endovenous radiofrequency coagulations (RF) or endovenous laser treatment (EVLT) of the greater saphenous varicose vein have increased as they are more convenient for patient. Mipiphlebectomy (MP) and sclerotherapy (SC) have also been welcome due to the advantages of less scaring and a rapid return to work. Therefore, varicose vein of the greater saphenous vein (GSV) and its tributaries are well controlled by new modalities, such as RF, EVLT, MP and SC, but those of the short saphenous vein (SSV) are difficult to control because of the many tributaries and perforating veins. A new modality with a simultaneous EVLT +/-MP combination for the treatment of SSV varicosities has been used. METHOD: 27 cases of SSV varicosities in 24 patients, between Feb 2002 and May 2004, were included in this study. The series of patients were followed up for recurrence of varisose vein, SSV recanalization and complications. RESULT: The patients were grossly examined postoperatively, and doppler were checked, and the varicose recurrence rates at 1, 3 and 6 months were found to be 0, 7.4 (2/27) 25.9% (7/27), espectively, the Doppler SSV recanalization rates at 1, 3 and 6 months were 0, 0 and 11.1% (3/27) and tributaries recurrence rates were 0, 7.4 (2/27) and 14.8% (4/27) with recurrence controlled by MP or SC, or observed for progression only. Most patients (93.6%) were satisfied with our treatment modality, and complications, such as pain, hematoma and swelling were controlled within 1 month, with 3 cases of tingling sensation of calf that subsided spontaneously. CONCLUSION: The control of SSV varicosities wes a little hard due to the many recurrences after surgery or EVLT alone. In our study, the cases of SSV varicosity alone were collected, and combination therapy, such as EVLT with miniphlebectomy, wes effective, as indicated by the relatively few recurrences, and even in these recurrence cases, additional postoperative MP or SC was enough for patient's satisfaction.

The Expression of Peforin, Fas-ligand, and Granzyme B in Peripheral Blood Lymphocytes of Renal Allograft Recipients / 대한신장학회잡지

BACKGROUND: Previous findings demonstrated that the expression of cytotoxic effector molecules is increased in acute rejection of renal allografts. In the present study, we serially examined the gene expression of perforin, granzyme B and Fas ligand(FasL) in peripheral blood lymphocytes(PBLs) of renal allograft recipients to assess the potential of their expression as a marker of acute rejection. METHODS: PBLs were isolated from blood samples taken on days 2, 4, 6, 8, 10 and 12 after transplantation. Competitive PCR was performed to evaluate the abundance of mRNA of perforin, granzyme B and FasL. The mean value of each molecule plus 2 SD for the control group was set as a discriminatory level. RESULTS: When all measured samples were compared, perforin expression was significantly higher in patients with acute rejection than in the control group(1.84+/-3.01 versus 0.71+/-0.48, p=0.01). The percentage of perforin expression exceeding the discriminatory level was also significantly higher in patients with acute rejection(p=0.0003). Five patients in the rejection group(5/7, 71.4%) showed perforin expression exceeding the discriminatory level, while only 1 patient in the control group did so(1/8, 12.5%)(p= 0.02). Perforin expression of days 0 and 1 of rejection crisis was the highest over the study period. No consistent pattern of granzyme B and FasL expression was identified in relation to rejection crisis. CONCLUSION: Gene expression of perforin by PBLs was upregulated in accordance with acute rejection, thus offering the possibility that it may be utilized as a marker of acute rejection.

Nutcracker Syndome: 2 Cases

Compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta has been termed the nutcracker syndrome. The entrapment of the left renal vein is not easily detectable by ordinary diagnostic procedures. We report 2 cases of the nutcracker syndrome with symptoms ( / ) diagnosed by phlebography and pressure measurement. In both cases, no remarkable findings were obtained from medical history and physical examination. Profuse collaterals from a left renal vein in one case with no symptom were observed in venous phase of renal angiography. In the other case, recurrent left flank pain and microscopic hematuria developed. In both cases, the diagnosis of "nutcracker phenomenon" was presumed by renal venography with measurement of pressure gradient between left renal vein and inferior vena cava. Awareness of the pathophysiology of the nutcracker syndrome ensures an early diagnosis. New diagnostic modalities are demanded for atypical cases.

Morphologic change of the internal elastic lamina in Buerger's disease

Morphologic features and pathogenesis of arterial changes occurring in Buerger's disease (thromboangiitis obliterans) are still controversial. This study describes histopathologic features of medium sized arteries from patients with Buerger's disease, particularly of the internal elastic lamina in relation to the immunologic mechanism of the injury. Seventeen segments of occluded arteries (femoral or popliteal arteries) from 17 patients with Buerger's disease were analyzed by histopathological and immunohistochemical methods. The most characteristic features were total luminal obliteration, together with a varying degree of recanalization and deposition of hemosiderin pigments. Detailed analysis, however, showed marked undulation and multiplication of the internal elastic lamina (100%) associated with basophilic degeneration and delicate linear calcification (47%). Lymphocytic infiltration along the internal elastic lamina was seen in 71% and was associated with localized edema. Lymphocytes along the lamina were consistently positive for T cell marker. Mild to moderate fibrosis was present at the media in 24%. Adventitial changes included mild, nonspecific and irregular fibrosis seen in 53%. Immunologic injury to the internal elastic lamina associated with T-lymphocytic infiltration might be the initial morphogenetic mechanism of the thrombotic occlusion and organization of medium-sized arteries in Buerger's disease.

Effects of Postaglandin E1 on the Oxidative Stress Injury Index and the Expression of PCNA in Vein Grafts of Rabbit Carotid Arteries

BACKGROUND: This study investigated the protective mechanism of Prostagladin E1 (PGE1) against intimal hyperplasia after vein interposition grafts in rabbits. It has been demonstrated that active oxygen species contribute to vascular smooth muscle cell growth via early cell cycle gene activation. We attempted to study whether PGE1 had an effect on the inhibition of the oxidative stress injury index (8-OHdG, MDA). METHODS: Forty-eight jugular vein grafts were inserted into the carotid arteries of male hyperlipidemic New Zealand white rabbits, which were divided into 2 groups (saline group and PGE1 group). Saline and Prostaglandin E1 (0.1 microgram/kg/min) were administered as a continuous infusion for 2 hours every day from just before graft interposition to harvest. The vein grafts were harvested at 6 hour, 1 day, 1 week, and 2 week after grafting and rapidly stored in liquid nitrogen ( 70oC). 8-OHdG was measured by using high performance liquid chromatography coupled with electrochemical detection (HPLC-EC), and malondialdehyde (MDA) was measured by using thiobarbituric acid (TBA) assay. PC 10 index and intimal thickness of the grafts were measured with a computer digitalized image analyzer. RESULTS: There was no difference in 8-OHdG levels between the saline and the PGE1 groups. PGE1 had more inhibitory effect on the MDA level as an oxidative stress injury index, but its action was restricted to 1 day. A morphometric analysis and an immunohistochemical study showed that the PGE1 group had more suppressive effects both in intimal thickeness and proliferating cell nuclear antigen (PCNA) expression than the saline group (p<0.05). CONCLUSION: These results suggest that PGE1 is effective in preventing intimal hyperplasia after vein interposition grafts in rabbits and may play a role in inhibiting oxidative stress injury.