Clinical Experience with a Hybrid Procedure Using the Adherent Clot Catheter for Salvage of Thrombosed Hemodialysis Access: A Comparison with the Standard Fogarty Balloon Catheter

PURPOSE: This study aimed to compare the efficacy of two different catheters in hybrid surgery for salvage of thrombosed hemodialysis accesses. MATERIALS AND METHODS: The hybrid salvage procedure (surgical thrombectomy followed by endovascular angioplasty) of the thrombosed hemodialysis access, was performed using adherent clot (AC) catheter in 140 cases and Fogarty balloon catheter in 68 cases. Procedure-related outcomes such as the clot removal status, clinical success, complications, and primary patency rates were analyzed retrospectively. RESULTS: The proportion of cases with good clot removal scores in the AC catheter and Fogarty balloon catheter groups was 77.9% and 91.2%, respectively (P=0.018). Clinical success was achieved in 90.7% of the cases in the AC catheter group and in 98.5% of the cases in the balloon catheter group (P=0.035). The mean patency rates of the two groups were 50.7% and 63.2% at 3 months, 40.7% and 47.1% at 6 months, and 17.9% and 19.1% at 12 months. The complication rates (12.1% and 5.9%) and primary patency rates between the two catheters were not statistically different (P=0.328). On the analysis of the patency rate on access type of autologous (P=0.169) and prothetic graft (P=0.423), there was no significant difference between the two catheter groups. CONCLUSION: In terms of clot removal and clinical success, the AC catheter did not demonstrate better outcomes than the Fogarty balloon catheter. However, primary patency was not related to the type of catheter. Adherent clot catheter can be a useful alternative to Fogarty balloon catheter for thrombosed hemodialysis access.

The Comparative Analysis between Surgical Thrombectomy and Hybrid Treatment in Salvage Operation / 대한혈관외과학회지

PURPOSE: Salvage operation is performed to improve the functional deficit of vascular access. This study is planned to evaluate the utility of the hybrid surgery through a comparative analysis between the results of surgical thrombectomy and those of hybrid surgery, combining surgical methods and endovascular treatments. METHODS: From January 2007 to December 2008, surgical thrombectomy had been done to 55 patients, whereas hybrid surgery had been done to 111 patients from January 2009 to December 2011. We have done a comparative analysis on the patency rate after the salvage operation for each group, retrospectively. Medical records were reviewed for patient information and radiographic data was used for checking the stenosis site in the hybrid surgery group. RESULTS: There were no statistically significant differences between the two groups, including age, gender, diabetes status, hypertension, and vascular access site or type. The primary patency rate was significantly higher in arteriovenous fistulas (65%) compared with arteriovenous grafts group (55%), at 12 months (P<0.01). At one year after the salvage operation, the secondary patency rate was higher in the hybrid surgery group compared to the surgical thrombectomy group (43.8% vs. 23.7%, P<0.01). CONCLUSION: This study shows that hybrid surgery combining surgical methods and endovascular treatments can be more useful for the salvaging of thrombosed vascular access than performing only surgical thrombectomy.

Spontaneous Hemomediastinum and Hemothorax Caused by a Ruptured Bronchial Artery Aneurysm

A bronchial artery aneurysm (BAA) is uncommon and usually associated with chronic inflammatory lung disease or a systemic vascular condition, which is rarely the etiology of mediastinal hemorrhage. A middle-aged person presented with spontaneous hemothorax and hemomediastinum. A diagnostic evaluation identified a bronchial artery aneurysm as the source. To prevent further rupture, we performed a bronchial artery embolization. In the absence of trauma or other causes for hemothorax and mediastinal hemorrhage, the possibility of a BAA should be considered. A bronchial artery aneurysm can be managed by interventional techniques as well as surgery.

Spontaneous Hemomediastinum and Hemothorax Caused by a Ruptured Bronchial Artery Aneurysm

A bronchial artery aneurysm (BAA) is uncommon and usually associated with chronic inflammatory lung disease or a systemic vascular condition, which is rarely the etiology of mediastinal hemorrhage. A middle-aged person presented with spontaneous hemothorax and hemomediastinum. A diagnostic evaluation identified a bronchial artery aneurysm as the source. To prevent further rupture, we performed a bronchial artery embolization. In the absence of trauma or other causes for hemothorax and mediastinal hemorrhage, the possibility of a BAA should be considered. A bronchial artery aneurysm can be managed by interventional techniques as well as surgery.

Extraanatomic Aortic Bypass through a Median Sternotomy in a Patient with Coarctation of Aorta Associated with Annuloaortic Ectasia: A case report / 대한흉부외과학회지

Coarctation of the aorta is frequently associated with intracardiac disease. It is very difficult to decide on the best method for surgically treating adult patients with these combined heart diseases. We performed single-stage repair via a modified Bentall operation and by creating an intrapericardial ascending-descending aortic bypass through a median sternotomy in a patient with coarctation of the aorta and annuloaortic ectasia, and the latter was associated with aortic valve regurgitation.

Initial Experience with an Endovascular Suite (A Hybrid Operating Room)

PURPOSE: Endovascular interventions have seen explosive growth over the last decade. One of the critical factors to perform safe and reliable endovascular procedures is the availability of a well-equipped endovascular suite. The aim of this study is to clarify the necessity and benefits of an endovascular suite through our initial experience. METHODS: We performed an overview of the basic equipment and the adjunctive hardware and software of an endovascular suite for performing open surgical exposures or/and endovascular procedures. We also conducted a review of the endovascular procedures that were performed for 2 months in a newly built endovascular suite. RESULTS: The endovascular suite should offer sterile conditions to provide the endovascular specialist a complete gamut of options to treat patients with complex vascular diseases. The number of vascular and endovascular treatments increased about two fold after the establishment of the endovascular suite. CONCLUSION: The establishment of a modern endovascular suite arranged in an ergonomically devised fashion is helpful to remain on the cutting edge of medical practice. A endovascular suite will undoubtedly enhance the ability of vascular surgeons to provide quality health care to the patients who have a variety of arterial and venous disorders.

Surgical Management of Aortic Valve Injury after Nonpenetrating Trauma / 대한흉부외과학회지

We present 2 cases of patients who underwent surgical repair and replacement of an injured aortic valve that was secondary to nonpenetrating trauma. Primary repair was undertaken on an 18-year old boy, but he had persistent moderate aortic regurgitation for five years after surgery. Another 64-year old man was treated successfully with surgical replacement of the aortic valve via employing a prosthetic mechanical valve. Attempts at valvuloplasty for the treatment of traumatic aortic valve injury have not been uniformly successful, and prosthetic valve replacement is recommended for repair, except for highly selected cases.

Granular Cell Tumor Arising from the Left Main Bronchus : A case report / 대한흉부외과학회지

Granular cell tumors (GCT) are uncommon benign neoplasms. Their location is mostly in the the skin, tongue, and breast; appearance in other parts of the body is rare, but it has been reported. They have also been reported to occur synchronously in multiple organs and metachronously in a single organ. The incidence of GCTs in the tracheobronchial tree is unknown and pulmonary GCTs are uncommon, with approximately 100 reported cases in the literature. We present the case of a 33-year-old man with a granular cell tumor of the left main bronchus. The tumor was found at bronchoscopy performed to exclude suspected endobronchial mass with symptoms of pneumonia. Biopsies revealed the histological pattern of a benign granular cell tumor. He underwent resection of the left main bronchus followed by end to end anastomosis of left main bronchus. He has not had any recurrence of the tumor during the 1 year follow-up.

Twenty-year Experience of Mitral Valve Replacement with the St. Jude Medical Mechanical Valve Prosthesis / 대한흉부외과학회지

BACKGROUND: A retrospective study was conducted to analyze the results of St. Jude Medical mitral valve replacement at the Chonbuk National University Hospital since the initial implant in May 1984. MATERIAL AND METHOD: Between May of 1984 and December of 1996, 95 patients underwent MVR with the St. Jude Medical mechanical valve prosthesis at Department of Medical Science of Chonbuk National University Hospital and follow-up ended in May of 2004. RESULT: Age ranged from 19 to 69 years. Follow-up (mean+/-standard deviation) averaged 10.6+/-4.2 year. Thirty-day operative mortality was 4.2% (4/95). Nine late deaths have occurred and actuarial survival was 90.5+/-3.0%, 87.9+/-3.4% and 83.2+/-4.6% at 5, 10 and 20 years, respectively. Probability of freedom from valve-related death was 95.5+/-2.1%, 94.3+/-2.4% and 91.0+/-3.9% at 5, 10 and 20 years, respectively. Seven patients have sustained thromboembolic events (1.05%/patient-year). Fifteen patients had anticoagulation related hemorrhage (3.56%/patient-year). There was no structural valve deterioration. Probability of freedom from all complications was 82.0+/-3.9%, 71.3+/-4.8% and 42.4+/-10.5% at 5, 10 and 20 years, respectively. CONCLUSION: We confirm the effective and excellent durability of the St. Jude Medical prosthesis in the mitral position with a low event rate at long-term follow-up. It also demonstrates the commonly encountered practical difficulty of adjusting the anticoagulation protocol in patients with prosthetic mitral valves.

Myocardial Hamartoma Involving the Posterior Left Ventricular Wall: Surgical Experience of One Case / 대한흉부외과학회지

A 16 year-old boy was admitted to our department because of mild chest discomfort and mild dyspnea. A mass involving posterior wall of the left ventricle near posterior mitral annulus was found on echocardiography and cardiac MRI. Total excision of the mass was performed via posterior ventriculotomy under the cardiopulmonary bypass. The pathologic diagnosis revealed mature cardiac myocyte hamartoma. There was no evidence of arrhythmia and tumor recurrence during the 1 year of follow up after the surgery.

Pulmonary Infarction due to Chronic Pulmonary Thromboembolism: Surgical Experience of One Case / 대한흉부외과학회지

Infarction of the lung usually results from pulmonary arterial obstruction. Pulmonary infarcts often become infected from bronchial contamination and may become lung abscesses, empyema, or bronchopleural fistula causing sepsis. Diagnosis is important for intensive therapy, since infection is prone to spread. Resection of the infarcted lung should be considered early in an attempt to control infection. A sixty-seven-year-old man was hospitalized with dyspnea. A computed tomographic scan of the chest showed left lower lobe infiltration and mild pleural effusion with pleural thickening. There was a thrombus in the left pulmonary artery leading from the lower lobe to the upper lobe artery. At operation, the left lower lobe was found to have complete hemorrhagic infarction. The left lower lobectomy was performed. The remaining thrombus was removed after the left main pulmonary arteriotomy. He has been followed up for 15 months and has done well with no recurrence of thrombus and infarction of the lung.

Clinical Results of Pulmonary Resection for Hemoptysis of Inflammatory Lung Disease / 대한흉부외과학회지

BACKGROUND: To assess the outcome of pulmonary resection in the management of hemoptysis caused by benign inflammatory lung disease. MATERIAL AND METHOD: A longitudinal cohort study of 45 consecutive patients who were presented with hemoptysis and were treated with pulmonary resection from January 1995 to May 2004. The predictive preoperative risk factors of morbidity and recurrence of hemoptysis were analyzed. The mean age of the patients was 47.1 years. The mean follow-up was 35+/-34 months. RESULT: The overall hospital mortality rate was 4.4% (2/45). Postoperative complications occurred in 8 patients (18.6%). Complications were more common in patients who received blood transfusion than non-transfused patients (p=0.002). Patients with tuberculous destroyed lung disease had more amount of preoperative hemoptysis (p=0.002), more probability of transfusion (p=0.001), more probability of undergoing pneumonectomy (p=0.039) and more probability of postoperative morbidity. Patients of undergoing pneumonectomy had more probability of reoperation due to postoperative bleeding (p=0.047). Hemoptysis recurred in five patients but three had been subsided and two sustained during follow-up. A latter two patients had been prescribed with antituberculosis medication due to relapse of tuberculosis. CONCLUSION: A tuberculous destroyed lung disease has a higher rate of postoperative morbidity than other inflammatory lung diseases. A pneumonectomy in patients of inflammatory lung disease should be performed with great caution especially because of postoperative bleeding. Future study with longer and larger follow-up might show the reasons of recurrence of hemoptysis.

Concomitant Operation of Pulmonary Resection and Redo Double Valve Replacement: 1 case report / 대한흉부외과학회지

Patients with concomitant surgical diseases of the heart and lungs are a therapeutic challenge to cardiothoracic surgeons. A 59-year-old woman underwent right middle lobectomy for lung cancer and redo double valve replacement with tricuspid annuloplasty simultaneously. Concomitant operation is a safe procedure and might allow prompt correction of both conditions, thereby sparing the patient a second major thoracic procedure with its attendant risks.

Huge Intraabdominal and Thoracic Desmoid Tumor: Surgical experience in one case / 대한흉부외과학회지

Desmoid tumors are benign neoplasms with high rates of recurrence. A case of huge desmoid tumor of the intrathoracic and intraabdominal space is presented. The patient was treated with resection, which involved hepatic left lobectomy and diaphragmatic resection and partial pericardiectomy and wedge resection of left lower lobe of lung. The resulting defect over the pericarium and diaphragm was reconstructed by bovine pericardium and Marlex mesh. Prevention of presumed local recurrence of desmoid tumors requires wide excision margin.

Bronchogenic Squamous Cell Carcinoma in Patient with Swyer-James Syndrome: One Case Report / 대한흉부외과학회지

Swyer-James syndrome is a rare disease with patients presenting with unilateral hyperlucent lungs and hypoperfusion due to hypoplasia of the pulmonary artery and bronchiolitis obliterans. A unilateral hyperlucent lung generally develops after a lower respiratory tract infection during early childhood. In extremely rare cases, an association of bronchogenic carcinoma with Swyer-James syndrome has been reported. We report a case of bronchogenic squamous cell carcinoma associated with Swyer-James syndrome that performed right upper lobectomy and lymph node dissection with a relevant literature review.

Primary Pulmonary Angiosarcoma Presenting as Enbodronchial Stenosis: One Case Report / 대한흉부외과학회지

Primary pulmonary angiosarcomas are extremely rare tumors. The diagnosis is often delayed due to nonspecific symptoms, mimicking pulmonary embolism and require careful clinical evaluation to exclude metastasis from the heart, pericardium, and distant extrathoracic sites. Most diagnosis are made postmortem. We report a case of primary pulmonary angiosarcoma histopathologically confirmed postoperatively, which was clinically suspected endobronchial carcinoma with endobronchial obstruction with relavant literature review.

Coronary Artery Fistula Associated with Atrial Septal Defect: Report of one case / 대한흉부외과학회지

We present a case of coronary artery fistula originating from the proximal left anterior descending artery draining into the main pulmonary artery,which was associated with atrial septal defect.The patient was a 56 year old male who was admitted for exertional dyspnea and abdominal distension.Echocardiogram and selective coronary arteriogram revealed a atrial septal defect and fistulous connection.The patient underwent surgery under the cardiopulmonary bypass with fibrillating heart.The pericardial patch closure of atrial septal defect and internal obliteration of the fistula termination site in the main pulmonary artery were performed.Postoperative hospital courses were uneventful without any specific complication and the patient was discharged without problem.

Lipoblastoma of the Neck and Mediastinum: 1 case report / 대한흉부외과학회지

Lipoblastoma are rare benign tumors arising from the fetal-embryonal fat that occur almost exclusively in children. About 70% of them arise in the limbs but several other sites have been reported. We have treated a 3-year-old boy who had a benign lipoblastoma in left posterior mediastinum and left supraclavicular area. CT scanning demonstrated a mass of principally fat attenuation which had a compressive effect on normal intrathoracic structures. The tumor was resected completely without complication from the left posterior mediastinum and left supraclavicular area. The tumor mass was yellowish in color and it was histopathologically confirmed to be a lipoblastoma.

Surgical Resection of the Pulmonary Mucormycosis in the Diabetic Patient: 1 case report / 대한흉부외과학회지

Pumonary mucormycosis is an uncommon but a fatal, opportunistic fungal infection that occurs primarily in patients who are immunocompromised such as hematologic malignancies, renal failure, or diabetes mellitus. The patient was a 32 year-old male with a 3-year history of diabetes(type I) and hyperthyroidism, and has been suffering from coughing, fever and left-sided chest pain for 1 month. The patient was diagnosed by the bronchoscopic examination with transbronchial lung biopsy and underwent a left lower lobectomy. On 21th postoperative day, multiple loculated pleural effusion was detected by follow-up chest X-ray and thus, drained using thoracoscopy. On 23rd day after the thoracoscopic drainage, the patient was discharged without postoperative complication. Previous reports have suggested that aggressvie and early surgical intervention may further enhance survival in operative candidates with mucormycosis confined to one lung.

The Risk Factors of Morbidity and Mortality after Pulmonary Resection / 대한흉부외과학회지

BACKGROUND: Surgical resection offers the potential care in patients with carcinoma of the lung whose tumors are amenable to resection, those with infections destroyed lung discase or congenital lung disease prediction of risk factors to influencing outcome after thoracic operations offers important benefits. Physicians anticipating those patients most prone to complications can provide special attention aimed at reducing morbidity and mortality. MATERIAL AND METHOD: We have retrospectively reviewed hospital records of 153 patients undergoing pulmonary resection for neoplastic and inflammatory destroyed lung disease between 1994 and 1998 to identify predictors of outcome. The mean age was 54.3+/-10.6years. Ninety-six patients(62%) had malignant lung disease and 47 patients(30%) had destroyed lung desease and 10(7%) had congenital or other lung desease. RESULT: Of the 153 resections performed 118 were lobectomies, 29 were pneumonectomies, 6 were segmentectomies, Seven of the 153 patients died during their hospital stay(4.5%). The most significant predietors of in-hospital mortality were presence of concomittent medical disease (P<0.001) and patients age 70 years or over(P<0.003). There were 67 postoperative complication occurring in 57 patients. Operation related complications were in 50 patients (32%), respiration related were in 14(9.1%) and cardiovascular related were in 1(0.6%) and other complications were in 2 patients(1.3%). The most significant predictors of postoperative morbidity was patients age 70 years or over(P<0.004). CONCLUSION: concomitant medical disease and patients age 70 years or over were very predictive value of postoperative mortality, also the patients age 70 years or over was significant preoperative value of postoperative morbidity.