Management of Vascular Injuries to the Extremities after Trauma / 대한흉부외과학회지

BACKGROUND: Vascular injuries to the extremities are potentially devastating and they can lead to limb loss and mortality if they are not appropriately managed. The vascular trauma caused by traffic and industrial accidents has recently increased according to the developing industry and transport system in Korea. Early recognition and treatment of these injuries are mandatory to achieve satisfactory outcomes. MATERIAL AND METHOD: We retrospective reviewed 43 patients with vascular injuries that were due to blunt and penetrating trauma and they underwent emergency operations from January of 1998 to December of 2006. RESULT: There were 38 men and 5 women patients with a mean age of 42.0+/-16.8 years (range: 17~77). The cause of vascular injuries were 28 traffic accidents (65%), 6 industrial accidents (14%), 6 glass injuries (14%) and 3 knife injuries (7%). The average time from admission to the operating room was 319.0+/-482.2 minutes (range: 27~2,400 minutes). The average time from admission to discharge was 53.1+/-56.0 days (range: 2~265 days). The anatomic injuries included the femoral artery in 16 cases (37%), the popliteal artery in 8 cases (19%), the brachial artery in 8 cases (19%), and the subclavian and axillary arteries in 7 cases (16%). The associated injuries were 23 bone fractures (53%), 18 muscle injuries (42%) 5 nerve injuries (12%) and 11 vein injuries (26%). The operation methods were 20 end to end anastomoses (46%), 16 interposition grafts (36%), 2 repairs with using patches (5%) and 5 others (12%). The number of amputations and cases of mortality were 3 cases (7%) and 4 cases (9%), respectively. CONCLUSION: Minimizing ischemia is an important factor for maximizing salvage of extremities. Prompt diagnosis and treatment can reduce the amputation and mortality rates.

Transplantation of bone-marrow stem cell on chronic lower extremity ischemia / 国际外科学杂志

Atheroselerosis and thrombangiitis obliterans are the chief factors of chronic lower extremity ischemia. Usually we utilize intervcntional treatment which includs balloon dilatation and stent implantation or surgical revascularization for the patients who have good target vessels, but those methods are not suitable for the patients who have small target vessels. The transplantation of bone marrow stem cells is the new tech-nology for chronic lower extremity isehemia, which utilize the capacity of stem cells that have multiple differ-entiation activity and high self renewal potentiality. It can direetionally differentiated into endothelial cells. It has a good perspective in chronic lower extremity isehemia.

Primary implantation of self-expanding nitinol stents for atherosclerotic occlusive disease of the superficial femoral artery: Intermediateterm results / 中国微创外科杂志

0.15) was 81%(17/21) and the clinical improvement of symptoms was achieved in 95%(20/21) of cases.The 17 cases were followed up for a mean of 15.7 months(range,12～35 months).One patient died of cerebral infarction at 6 months postoperatively.One patient with stent occlusion at 3 months after operation was given an embolectomy(the artery has remained patent for 13 months).Stent occlusion also happened in 2 patients(at 3 and 4 months after operation,respectively),on whom a subsequent infragenicular femoropopliteal bypass was operated,and in 2 other patients(at 8 and 12 months after operation,respectively),on whom a below-knee amputation was operated.At one year postoperatively,the patency rate was 75%(15/20) after primary operation and 80%(16/20) after re-operation.The rate of clinical improvement of symptoms was 75%(15/20).The limb salvage rate in patients with critical limb ischemia was 88%(14/16).Conclusions Primary angioplasty with self-expending nitinol stent implantation is a safe, minimally invasive,and effective method,which can be used as the first choice for femoral arterial occlusive diseases,especially in senile patients who cannot tolerate bypass procedures.

Early and Mid-term Results of Operation for Acute Limb Ischemia / 대한흉부외과학회지

Background: Even though there were developments in various treatment techniques for acute limb ischemia, this disease is both life threatening and limb threatening. We investigated early and mid-term results of operation for acute limb ischemia with symptoms, the combined diseases, location of occlusion, complication in our patients. Meterial and Method: A retrospective review was conducted in 54 patients (43 men, 11 women, mean age 67.2 years) presenting with acute limb ischemia due to arterial thrombosis or embolism between Jan. 1996 and Dec. 2003, initially underwent thromboembolectomy. Result: In 33 patients (61.1%) the timeinterval from the onset of symptom to admission was within 24 hours. Causes of acute limb ischemia were embolic occlusion (27.8%), native arterial thrombosis (66.7%), and bypass graft thrombosis (5.6%). The distribution of arterial occlusion location was at 8 aortoiliac (14.8%) and 43 distal to femoral (79.6%) and brachial (5.6%). Clinical categories were grade I in 64.8%, IIa in 24.1%, IIb in 7.4%, and III in 3.7%. All the patients were received embolectomy. Underlying diseases were heart disease (72.2%), hypertension (33.3%), cerebrovascular accident (16.7%) and diabetes (18.5%). History of smoking was noted in 96.3% of the cases. Mortality rate was 5.6% and overall amputation rate was 9.3% (5/54). The 1-year limb salvage rate was 93.62%. Postoperative complications were 1 wound infection, 1 GI bleeding, 3 acute renal failure, and 1 compartment syndromes. The functional outcomes of the salvaged limb according to the recommended scale for gauging changes in clinical status, revised version in 1997 were +3 in 68.5%, +2 in 9.3%, +1 in 7.4%, -1 in 5.6%, -2 in 3.7%, and -3 in 5.6%. Conclusion: This study revealed 5.6% mortality and the amputation rate was 9.3%. We have retrospectively shown good results from early diagnosis & early operation. To improve outcome, early diagnosis and understand the underlying diseases, prompt treatment and operation would be appreciated.

Vascular Interventional Procedures Often Encountered by Primary Physicians

Among various vascular interventional procedures, there are some procedures of vascular recanalization often encountered by primary physicians in clinical practice. These are percutaneous transluminal angioplasty (PTA) and stent application in the lower extremity ishemia, catheter-directed thrombolysis with PTA, stenting for iliofemoral deep vein thrombosis, and interventional management of arteriovenous fistula and graft for hemodialysis access. PTA and stent are safe and effective treatment for iliac arterial stenosis and occlusion with a good long-term patency rate. Long-term effectiveness of femoropopliteal stent is yet to be determined. Catheter-directed thrombolysis is a new emerging vascular intervention for acute iliofemoral deep vein thrombosis. May-Thurner syndrome can be effectively treated with thrombolysis in the iliofemoral vein followed by PTA ad stenting for the left iliac vein stenosis or occlusion. For the failing arteriovenous fistula or grafts in patients with hemodialysis, interventional radiologists can play an important role for the maintenance of the patency by percutaneous thrombolysis and balloon dilatation. It will be very helpful for the primary physicians to understand the role of the interventional radiologists and the indications, techniques, and results of those vascular interventional procedures often encountered in daily practice.