Spontaneous Celiac Artery Dissection with Splenic Infarction: A Report of Two Cases

Spontaneous isolated celiac artery dissection (SICAD) is a rare condition that is characterized by sudden onset abdominal pain, typically occurring in middle-aged men. Although its clinical course is mostly benign, it may progress to true lumen occlusion. No established therapeutic guidelines are available for SICAD associated with splenic infarction. This report describes two patients who presented with sudden onset abdominal pain and were diagnosed with SICAD with splenic infarction based on computed tomography (CT) findings. Patients were treated with bowel rest and anticoagulants. After a week of medical therapy, the abdominal pain resolved. Follow-up CT revealed no progression of the dissection flap. The patients received oral anticoagulants for 3 months and did not experience any symptom recurrence. Medical therapy with anticoagulants may be considered for patients with SICAD and splenic infarction. Associated splenic infarction itself is not an indication for endovascular or surgical intervention for SICAD.

Myths and truths about varicose veins

Varicose veins are a common chronic venous disorder that leads to a significantly reduced quality of life and high healthcare resource burden. There is a large amount of research-based data and opinions regarding varicose veins. There are also some common myths and misconceptions about the treatment options.Current Concepts: Management options include compression therapy, open venous surgery, and endovenous therapy. An appropriate treatment option must be selected on a case-by-case basis based on the symptoms, severity, and duplex ultrasonography findings. Venous intervention should be considered if the condition is symptomatic and often, there is no need for urgent surgery or endovenous therapy because the symptoms usually progress slowly and severe cardiac problems are rare. According to previous studies, there is no difference between the endovenous therapy modalities and the traditional surgical method (i.e., high ligation and stripping) in terms of recurrence rates. Therefore, case-specific factors, such as anatomy and economic factors, should be considered. When compression therapy is considered, graduated compression stocking with suitable pressure should be prescribed. Venoactive drugs can be suggested in addition to compression therapy for symptomatic varicose veins or venous ulcers.Discussion and Conclusion:. Correct information regarding treatment for varicose veins based on the best available evidence must be provided to patients. The treatment options for varicose veins should be selected on a case-by-case basis considering the patient`s symptoms, anatomy and economic factors.

Flat Pattern Peaks of Tacrolimus Absorption and Associated Pharmacogenomic Variants in Kidney Transplantation Recipients

Background@#Tacrolimus is the most commonly used immunosuppressive drug in solid organ transplantation. After administering a conventional twice-daily dose of tacrolimus, peak levels were achieved within the first 1.5 to 2 hours. A group of patients showed different early absorption phase of tacrolimus after kidney transplantation. @*Methods@#Trough(C0 ) and 1.5-hour blood levels (C1.5 ) of tacrolimus were measured in 95 kidney transplantation recipients. Patients with a C1.5 /C0 1.5 were defined as those having flat pattern peaks and as controls, respectively. Transplantation outcomes were compared between the groups. Whole exome sequencing was performed to investigate the genetic susceptibility to flat pattern peaks. @*Results@#Twenty-eight patients showed flat pattern peaks. The mean C1.5 /C0 values were 1.13 ± 0.22 and 3.78 ± 1.25 in the flat pattern peak and control groups, respectively. In multivariate analysis, flat pattern peak was an independent risk factor for biopsy-proven acute rejection (BPAR) and/or borderline change (P = 0.014). Patients having flat pattern peaks showed significantly lower post-transplant 36-month estimated glomerular filtration rate (P = 0.001). Two single nucleotide variants in ABCB1 genes, rs1922242 and rs2235035, were associated with flat pattern peaks (P = 0.019 and P = 0.027, respectively). @*Conclusion@#Both of C1.5 and C0should be measured to distinguish the patients showing unique initial absorption. A C1.5 /C0 ratio lower than 1.5 was associated with an increased risk of BPAR and/or borderline change. Single nucleotide variants s in ABCB1 gene might influence the flat pattern peaks of tacrolimus absorption.

Klotho as a potential predictor of deceased donor kidney transplantation outcomes

Purpose@#Klotho is an antiaging factor mainly produced by renal tubular cells. Klotho is reportedly decreased in an animal model of acute kidney injury and patients with chronic kidney disease. However, information on Klotho expression after kidney transplantation is limited. We analyzed the correlation between donor Klotho expression and clinical outcomes of kidney transplantation. @*Methods@#Sixty patients who underwent deceased donor kidney transplantation between March 2015 and October 2017 were enrolled. Serum and tissue Klotho expression levels were measured by enzyme-linked immunosorbent assay and immunohistochemistry, respectively. Graft function was assessed by estimated glomerular filtration rate (eGFR). @*Results@#Patients were divided into 2 groups according to donor Klotho expression in renal tissues. A greater improvement in eGFR was observed at 1 week after transplantation in patients receiving kidneys with higher Klotho expression (47.5 ± 21.9 mL/min/1.73 m2 vs. 63.9 ± 28.2 mL/min/1.73 m2, P = 0.030). Patients were also classified into 2 groups according to donor serum Klotho level. There was a tendency for a higher eGFR at 12 months after transplantation in patients receiving kidneys from donors with a higher Klotho level (51.0 ± 18.0 mL/min/1.73 m2 vs. 61.2 ± 16.5 mL/min/1.73 m2, P = 0.059). When subgrouped into patients with or without biopsy-proven acute rejection, 12-month eGFR remained higher in patients receiving kidneys from donors with higher serum Klotho. @*Conclusion@#Our data demonstrated that donor tissue expression of Klotho correlated with early recovery of eGFR after kidney transplantation. Donor serum Klotho level tended to be associated with posttransplant 12-month eGFR. Donor Klotho expression might be a new predictor for deceased donor kidney transplantation outcome.

Klotho as a potential predictor of deceased donor kidney transplantation outcomes

Purpose@#Klotho is an antiaging factor mainly produced by renal tubular cells. Klotho is reportedly decreased in an animal model of acute kidney injury and patients with chronic kidney disease. However, information on Klotho expression after kidney transplantation is limited. We analyzed the correlation between donor Klotho expression and clinical outcomes of kidney transplantation. @*Methods@#Sixty patients who underwent deceased donor kidney transplantation between March 2015 and October 2017 were enrolled. Serum and tissue Klotho expression levels were measured by enzyme-linked immunosorbent assay and immunohistochemistry, respectively. Graft function was assessed by estimated glomerular filtration rate (eGFR). @*Results@#Patients were divided into 2 groups according to donor Klotho expression in renal tissues. A greater improvement in eGFR was observed at 1 week after transplantation in patients receiving kidneys with higher Klotho expression (47.5 ± 21.9 mL/min/1.73 m2 vs. 63.9 ± 28.2 mL/min/1.73 m2, P = 0.030). Patients were also classified into 2 groups according to donor serum Klotho level. There was a tendency for a higher eGFR at 12 months after transplantation in patients receiving kidneys from donors with a higher Klotho level (51.0 ± 18.0 mL/min/1.73 m2 vs. 61.2 ± 16.5 mL/min/1.73 m2, P = 0.059). When subgrouped into patients with or without biopsy-proven acute rejection, 12-month eGFR remained higher in patients receiving kidneys from donors with higher serum Klotho. @*Conclusion@#Our data demonstrated that donor tissue expression of Klotho correlated with early recovery of eGFR after kidney transplantation. Donor serum Klotho level tended to be associated with posttransplant 12-month eGFR. Donor Klotho expression might be a new predictor for deceased donor kidney transplantation outcome.

Outcome of ClosureFAST radiofrequency ablation for large-diameter incompetent great saphenous vein

PURPOSE: There is limited data on the outcomes of radiofrequency ablation (RFA) for large diameter saphenous veins. This study aimed to determine whether the large-diameter great saphenous vein (GSV) affected closure rate, complications, and clinical and quality of life (QoL) improvement. METHODS: From January 2012 to September 2016, a total of 722 limbs were treated with ClosureFAST RFA in a single center. Patients were divided into 2 groups according to the vein diameter measured 3 cm below the saphenofemoral junction (group A ≤ 12 mm, group B > 12 mm). Vein closure was evaluated with duplex scan at 3–5 days, 1, 3, 6, and 12 months postoperatively. The incidence of complications, improvements in symptoms (measured by the Venous Clinical Severity Score [VCSS]) and QoL (measured by the Aberdeen Varicose Vein Symptom Severity Score [AVSS]) were evaluated. RESULTS: Groups consisted of 663 GSVs in group A (mean diameter, 6.00 ± 1.74 mm) and 59 in group B (mean diameter, 13.17 ± 1.28 mm). Vein closure rates at 12 months were 98.9% in group A and 100% in group B (P = 0.428). There was no significant difference in the incidence of complications. Both groups showed marked improvements in the VCSS and the AVSS with no significant differences. CONCLUSION: For large-diameter veins, RFA showed comparable outcomes in terms of closure rate, complications, clinical and QoL improvements.

Outcomes of Arteriovenous Fistula for Hemodialysis in Pediatric and Adolescent Patients

PURPOSE: This retrospective review aimed to report the outcomes of arteriovenous fistula (AVF) and to evaluate the suitability of AVF as a permanent vascular access in pediatric populations. MATERIALS AND METHODS: Data were collected for all patients aged 0 to 19 years who underwent AVF creation for hemodialysis between January 200 and June 2014. RESULTS: Fifty-two AVFs were created in 47 patients. Mean age was 15.7±3.2 years and mean body weight was 46.7±15.4 kg. Of the 52 AVFs, 43 were radiocephalic AVFs, 7 were brachiocephalic AVFs and 2 were basilic vein transpositions. With a mean follow-up of 49.7±39.2 months, primary patency was 60.5%, 51.4%, and 47.7% at 1, 3, and 5 years, respectively and secondary patency was 82.7%, 79.2% and 79.2% at 1, 3, and 5 years, respectively. Age, body weight, AVF type, the presence of a central venous catheter, use of anticoagulation therapy, and history of vascular access failure were not significantly associated with patency rates. There were 9 cases (17.3%) of primary failure; low body weight was an independent predictor. Excluding cases of primary failure, the mean duration of maturation was 10.0±3.7 weeks. During follow-up, 20 patients (42.6%) underwent kidney transplantation, with a median interval to transplantation of 36 months. CONCLUSION: AVF creation in children and adolescents is associated with acceptable long-term durability, primary failure rate and maturation time. Considering the waiting time and limited kidney graft survival, placement of AVFs should be considered primarily even in patients expected to receive transplantation.

Surgical Treatment of Infected Aortoiliac Aneurysm

PURPOSE: Infected aneurysms of the abdominal aorta or iliac artery (IAAA) are rare but fatal and difficult to treat. The purpose of this study was to review the clinical presentations and outcomes of IAAA and to establish a treatment strategy for optimal treatment of IAAA. MATERIALS AND METHODS: Electronic medical records of 13 patients treated for IAAA at Seoul National University Hospital between March 2004 and December 2012 were retrospectively reviewed. RESULTS: Mean age was 64.2 (median 70, range 20-79) years. Aneurysms were located in the infrarenal aorta (n=7), iliac arteries (n=5), and suprarenal aorta (n=1). Seven patients underwent excision and in situ interposition graft, 3 underwent extra-anatomical bypass, and 1 underwent endovascular repair. One patient with endovascular repair in an outside hospital refused resection, and only debridement was done, which revealed tuberculosis infection. One staphylococcal infection was caused by iliac stenting. Mycobacterium was the most common pathogen, followed by Klebsiella, Salmonella, and Staphylococcus. There were 3 in-hospital mortalities and the causes were sepsis in 2 and aneurysm rupture in 1. The 3 extra-anatomic bypasses were all patent after 5-year follow-up. CONCLUSION: IAAA develops from various causes and various organisms. IAAA cases with gross pus were treated with extra-anatomic bypass, which was durable. In situ reconstruction is favorable for long term-safety and efficacy, but extensive debridement is essential.

Open Surgical Repair of Abdominal Aortic Aneurysm Coexisting with Horseshoe Kidney

Horseshoe kidney (HSK) is the most common congenital abnormality of the urologic system encountered during abdominal aortic aneurysm (AAA) surgery. Here, the authors report a case of AAA coexisting with HSK that was successfully treated by open surgery. Two accessory renal arteries of 2.5 mm and 3.1 mm were reimplanted. One of the implanted arteries later occluded and infarct of the isthmus developed, but there was no impairment of renal function. The authors discuss the complexity of the surgical treatment of AAA coexisting with HSK, and place focus on which accessory renal arteries should be reconstructed.

Simultaneous pancreas-kidney transplantation: lessons learned from the initial experience of a single center in Korea

PURPOSE: The purpose of this study is to report the results of simultaneous pancreas-kidney (SPK) transplantations and describe the lessons learned from the early experiences of a single center. METHODS: Between January 2002 and June 2013, a total of 8 patients underwent SPK transplantation. Clinical and radiologic data were reviewed retrospectively. RESULTS: Seven patients were diagnosed with type I diabetes mellitus and one patient became insulin-dependent after undergoing a total pancreatectomy because of trauma. Pancreas exocrine drainage was performed by enteric drainage in 4 patients and bladder drainage in 4 patients. Three patients required conversion from initial bladder drainage to enteric drainage due to urinary symptoms and duodenal leakage. Four patients required a relaparotomy due to hemorrhage, ureteral stricture, duodenal leakage, and venous thrombosis. There was no kidney graft loss, and 2 patients had pancreas graft loss because of venous thrombosis and new onset of type II diabetes mellitus. With a median follow-up of 76 months (range, 2-147 months), the death-censored graft survival rates for the pancreas were 85.7% at 1, 3, and 5 years and 42.9% at 10 years. The patient survival rate was 87.5% at 1, 3, 5, and 10 years. CONCLUSION: The long-term grafts and patient survival in the current series are comparable to previous studies. A successful pancreas transplant program can be established in a single small-volume institute. A meticulous surgical technique and early anticoagulation therapy are required for further improvement in the outcomes.

Clinical significance of type I endoleak on completion angiography

PURPOSE: Type I endoleak is known to be associated with sac enlargement and occasional rupture, therefore, the treatment of type I endoleak is recommended at the time of diagnosis. The aim of this study was to identify the significance of early type I endoleak found on completion angiography. METHODS: Between January 2000 and December 2012, a total of 86 patients underwent endovascular abdominal aortic aneurysm repair (EVAR) and 10 patients (11.6%) were diagnosed with type Ia endoleak on completion angiography. Clinical and radiologic data were reviewed retrospectively. RESULTS: Of the 10 patients, two underwent EVAR with custom-made stent-grafts in the initial stage and both of them needed immediate treatment: one case involved open repair while the other involved insertion of an additional stent-graft. In 8 patients, the amount of leakage decreased after repeated balloon molding. They were managed conservatively and followed up with computed tomography angiography within 2 weeks after EVAR. In 7 of the 8 cases, type Ia endoleaks disappeared. In one patient with a persistent endoleak and a folded posterior wall of the stent-graft, coil embolization was performed 1 week after EVAR. With a median follow-up of 12 months (range, 1-61 months), no patients showed recurrence of type I endoleak or sac expansion. CONCLUSION: Type I endoleaks diagnosed on completion angiography sealed spontaneously in 7 of 10 patients (70.0%). In cases of decreased amounts of leakage after balloon molding, simple observation may be an alternative to repetitive procedures. The long-term follow-up of patients with self-sealed type I endoleaks is mandatory.

Clinical Outcome of Basilic Vein Transposition Arteriovenous Fistula Compared to the Forearm Loop Arteriovenous Graft / 대한혈관외과학회지

PURPOSE: The purposes of this study were to evaluate upper arm basilic vein transposition (BVT) arteriovenous fistula in terms of graft patency and surgical complications and to compare BVT with the forearm loop arteriovenous graft (AVG). METHODS: Between March 2003 and December 2008, 23 patients underwent BVT and 30 patients underwent AVG. The patency rates and complications were analyzed. RESULTS: Patients who underwent BVT had more previous history of operations for arteriovenous access (2.5+/-1.2 in BVT vs. 1.8+/-1.4 in AVG; P=0.038). A total of 10 cases of complications occurred in patients with BVT and 22 cases in patients with AVG (P=0.047). One-year and 2-year primary patency rates were 55.2%, and 36.3%, respectively, for BVT and 31.3% and 17.9%, respectively, for AVG (P=0.031). One-year and 2-year primary assisted patency rates were 85.2% and 66.7% for BVT, respectively and 67.2% and 43.8 for AVG, respectively (P=0.112). During follow-ups, less rescue procedures were performed in BVT than in AVG patients (P=0.055). One case of thrombolysis, 4 balloon angioplasty, and 1 stent insertion were performed in BVT, whereas 5 cases of thrombectomy, 3 thrombolysis, 4 balloon angioplasty, and 2 interposition grafting were performed in AVG. CONCLUSION: BVT had higher 1-year and 2-year patency rates and fewer complications compared to AVG. Lower numbers of intervention were required to maintain patency in BVT compared to AVG. BVT is a feasible procedure and can be considered before planning forearm loop AVG, particularly in a rescue vascular access.

Successful Endovascular Treatment of Delayed Type Ib Endoleak with Aortic Rupture after Endovascular Repair of Abdominal Aortic Aneurysm / 대한혈관외과학회지

Endovascular aneurysm repair (EVAR) has progressively become the preferred method for abdominal aortic aneurysm repair. Controlled studies have indicated that EVAR is related to decreased perioperative morbidity and mortality compared with open repair. However, long-term complications are more common. The most common complication following EVAR is an endoleak. Few studies on delayed type Ib endoleak with aortic rupture have been found in the literature. We report a case of a 92-year-old man with a delayed type Ib endoleak with aortic rupture that developed 7 years after EVAR. Lifelong surveillance after EVAR is mandatory.

Inhibition of intimal hyperplasia by local perivascular application of rapamycin and imatinib mesilate after carotid balloon injury / 대한외과학회지

PURPOSE: Inhibition of the intimal hyperplasia after vascular surgery is an important issue. The purpose of this study is to define whether perivascular application of rapamycin, imatinib mesylate or cysteamine can reduce intimal hyperplasia in a carotid balloon injury model. METHODS: Each drug was mixed with 40% pluronic gel solution and was topically applied over the injured carotid artery evenly. Two or four weeks after injury, the arteries were harvested and morphometric analysis was done. RESULTS: The medial areas were not significantly different in each group and a thinning of the media as a toxic drug effect was not observed in any treatment group. The intimal area and intima-to-media (I/M) ratio were significantly reduced in rapamycin-treated group and imatinib-treated group (P < 0.05). But cysteamine-treated group showed a trend of decrease in I/M ratio in 2 weeks, but no difference in 4 weeks. CONCLUSION: Perivascular delivery of imatinib or rapamycin with pluronic gel attenuated the development of intimal hyperplasia. But cysteamine did not. Further studies are needed to refine the optimal drug dosages in large animal models.

Reconstruction of portal vein and superior mesenteric vein after extensive resection for pancreatic cancer / 대한외과학회지

PURPOSE: Tumor invasion to the portal vein (PV) or superior mesenteric vein (SMV) can be encountered during the surgery for pancreatic cancer. Venous reconstruction is required, but the optimal surgical methods and conduits remain in controversies. METHODS: From January 2007 to July 2012, 16 venous reconstructions were performed during surgery for pancreatic cancer in 14 patients. We analyzed the methods, conduits, graft patency, and patient survival. RESULTS: The involved veins were 14 SMVs and 2 PVs. The operative methods included resection and end-to-end anastomosis in 7 patients, wedge resection with venoplasty in 2 patients, bovine patch repair in 3 patients, and interposition graft with bovine patch in 1 patient. In one patient with a failed interposition graft with great saphenous vein (GSV), the SMV was reconstructed with a prosthetic interposition graft, which was revised with a spiral graft of GSV. Vascular morbidity occurred in 4 cases; occlusion of an interposition graft with GSV or polytetrafluoroethylene, segmental thrombosis and stenosis of the SMV after end-to-end anastomosis. Patency was maintained in patients with bovine patch angioplasty and spiral vein grafts. With mean follow-up of 9.8 months, the 6- and 12-month death-censored graft survival rates were both 81.3%. CONCLUSION: Many of the involved vein segments were repaired primarily. When tension-free anastomosis is impossible, the spiral grafts with GSV or bovine patch grafts are good options to overcome the size mismatch between autologous vein graft and portomesenteric veins. Further follow-up of these patients is needed to demonstrate long-term patency.

Successful One-Stage Transabdominal Excision of Intravenous Leiomyomatosis with Extension into the Right Atrium / 대한혈관외과학회지

Intravenous leiomyomatosis is a rare benign tumor originating from the uterus that spreads through vessels. In rare cases, intracaval and intracardiac involvement has been described. We report a case of a 64-year-old woman who presented intravenous leiomyomatosis, which originated from the right uterine vein and extended through the inferior vena cava into the right atrium. The tumor was completely removed through a one-stage transabdominal approach with transesophageal echocardiography monitoring. Sparing thoracotomy is important in order to reduce postoperative morbidity and tumor removal by pulling down was technically possible without the risk of embolization.

Comparison of Costs of Endovascular Repair versus Open Surgical Repair for Abdominal Aortic Aneurysm in Korea

This study was designed to compare the hospital-related costs of elective abdominal aortic aneurysm (AAA) treatment and cost structure between endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in Korean health care system. One hundred five primary elective AAA repairs (79 OSRs and 26 EVARs) performed in the Seoul National University Hospital from 2005 to 2009 were included. Patient characteristics were similar between two groups except for older age (P = 0.004) and more frequent history of malignancy (P = 0.031) in EVAR group. Thirty-day mortality rate was similar between two groups and there was no AAA-related mortality in both groups for 5 yr after repair. The total in-hospital costs for the index admission were significantly higher in EVAR patients (mean, KRW19,857,119) than OSR patients (mean KRW12,395,507) (P < 0.001). The reimbursement was also significantly higher in EVAR patients than OSR patients (mean, KRW14,071,081 vs KRW6,238,895, P < 0.001) while patients payments was comparable between two groups. EVAR patients showed higher follow-up cost up to 2 yr due to more frequent imaging studies and reinterventions for type II endoleaks (15.4%). In the perspective of cost-effectiveness, this study suggests that the determination of which method to be used in AAA treatment be more finely trimmed and be individualized.

Chronic allograft injury by subclinical borderline change: evidence from serial protocol biopsies in kidney transplantation / 대한외과학회지

PURPOSE: This study investigated the impact of subclinical borderline changes on the development of chronic allograft injury in patients using a modern immunosuppression protocol. METHODS: Seventy patients with stable renal allograft function and who underwent protocol biopsies at implantation, 10 days and 1 year after transplantation were included and classified based on biopsy findings at day 10. The no rejection (NR) group included 33 patients with no acute rejection. The treatment (Tx) group included 21 patients with borderline changes following steroid pulse therapy, and the nontreatment (NTx) group included 16 patients with borderline changes nontreated. RESULTS: The Banff Chronicity Score (BChS) and modified BChS (MBChS) were not different among the three groups at implantation (P = 0.48) or on day 10 (P = 0.96). Surprisingly, the NTx group had more prominent chronic scores at the 1-year biopsy, including BChS (3.07 +/- 1.33, P = 0.005) and MBChS (3.14 +/- 1.41, P = 0.008) than those in the Tx and NR group, and deterioration of BChS was more noticeable in the NTx group (P = 0.037), although renal function was stable (P = 0.66). No difference in chronic injury scores was observed between the Tx and NR groups at the 1-year biopsy. CONCLUSION: Subclinical borderline changes can be a risk factor for chronic allograft injury and should be considered for antirejection therapy.

Proximalization of Arterial Inflow for the Treatment of Access-Related Steal Syndrome / 대한혈관외과학회지

Hemodialysis access-related arterial steal syndrome can result in serious complications, such as tissue loss and amputation. Several methods have been used to treat arterial steal syndrome, but controversy persists regarding the optimal technique. Here we present a case of arterial steal syndrome successfully treated with proximalization of arterial inflow (PAI). A 63-year-old man with a brachial-cephalic arteriovenous fistula (AVF) was admitted with complaints of coldness and pain in the left hand and fingers. Duplex sonography and angiography revealed arterial steal and occlusion of the distal radial artery. He was underwent PAI which included transsection of the AVF just distal to the previous anastomosis and attachment of the arterialized vein to a more proximal portion of the brachial artery with a 4-mm expanded polytetrafluoroethylene graft. Digital arterial flow was restored, and his symptoms subsequently were relieved. The AVF was well-functioning without any ischemic symptoms after 3-month follow-up.

Initial Experiences of Endovascular Surgery for Lower Extremity Arterial Occlusive Diseases in the Operation Room / 대한혈관외과학회지

PURPOSE: Endovascular surgery (EVS) has been rapidly increasing within the last two decades, changing the pattern of treatments for arterial disease. The purpose of this study was to report our initial experiences of EVS for lower extremity arterial occlusive diseases in the operation room performed solely by a vascular surgeon. METHODS: Between January 2009 and June 2010, 13 EVS were performed for lower extremity arterial occlusive diseases with a mobile C-arm. Three patients underwent simultaneous bypass surgery with balloon angioplasty. Clinical characteristics, treatments, and outcomes were retrospectively reviewed. RESULTS: Primary patency rates at 1 and 12 months following balloon angioplasty were 92.3% (12/13) and 88.9% (8/9), respectively. Only one patient had a thrombotic occlusion, resulting in an above-knee amputation. No procedure-related deaths occurred. CONCLUSION: We showed an initial acceptable result of EVS for lower extremity arterial occlusive diseases in the operation room. However, the data analyzed was of a small group with a short term follow-up period. More experiences, judicious planning, and efforts to optimize endovascular techniques to resolve complications are needed to be a true vascular and endovascular surgeon.