Predicting the Effect of Complex Physical Therapy: Utility of Manual Lymph Drainage Performed on Lymphoscintigraphy

OBJECTIVE: To evaluate the utility of manual lymph drainage (MLD) during lymphoscintigraphy (LS) in predicting the effect of complex physical therapy (CPT). METHOD: Forty seven patients were included in this study. MLD was done for 30 minutes after one hour LS image was obtained. 24 patients were followed up for 3~6 months. According to one hour LS image, patients were assigned to visible lymph node or lymphatic vessel group (Either group) and invisible lymph node and lymphatic vessel group (Neither group), and also according to LS changes after MLD, good and poor response group. The limb volume was checked before, and immediately after CPT, and at 1 month and 3~6 months after CPT. The treatment response was evaluated by percent volume reduction (PVR). RESULTS: There were no significant differences in volume reduction between Either group and Neither group. Otherwise, good response group showed significantly greater volume reduction after CPT than poor response group. Mean PVR in the good response group was 37.02% immediately after CPT, 41.2% at 1 month after CPT, and 47.4% at 3~6 months after CPT. Mean PVR in the poor response group was 19.22% immediately after CPT, 13.0% at 1 month after CPT, and 5.21% at 3~6 months after CPT. CONCLUSION: LS changes after MLD reflected the effects of CPT more accurately than one hour LS image.

Critical Role of Multidisciplinary Team Approach in the New Field of Vascular Surgery - Endovascular Surgery

No abstract available.

Vascular Manifestations in Behcet's Disease

PURPOSE: Behcet's disease, distinguished by the triad of chronic oral aphthae, recurrent genital ulcers and uveitis, is a chronic, relapsing systemic disease. Vascular complications occur in 7~29% of Behcet's patients and are the most common causes of death. Consequently, vascular surgeons should be familiar with the vascular manifestations in Behcet's disease. METHOD: Between October 1994 and July 2002, we retrospectively reviewed 779 patients diagnosed with Behcet's disease in Samsung Medical Center. RESULT: Thirty cases of the 779 patients had vascular manifestations. Male to Female ratio was 25 (83.3%) to 5 (16.7%). In age distribution, males were most frequent in their 30s, while females were equally distributed. Arterial involvement occured in 10 cases (33.3%), venous involvement in 16 (53.3%) and combined arterial and venous involvement in 4 (13.3%). As for arterial manifestations, arterial occlusion occured in 7 cases, aneurysm in 5 and pseudoaneurysm in 4. Venous manifestations were all deep vein thrombosis (DVT). Iliofemoral vein DVT occured in 14 cases, IVC thrombosis in 5, and renal vein thrombosis in 1. Surgical treatment was performed in 5 cases; one primary repair and one arterial ligation were done in 2 cases of pseudoaneurysm, two combined aneurysmal resection and bypass in 2 cases of aneurysm, and one bypass in 1 case of arterial occlusion. Radiologic intervention was done in 5 cases. Stent graft insertion was performed in 2 cases, combined thrombolysis and percutaneous transluminal angioplasty in 1 case, occluder balloon in 1 case, and inf. vena cava filter insertion in 1 case. CONCLUSION: Behcet's disease is a chronic and systemic disease that may involve multiple organs. Because of vascular involvements, in particular the high fatality of arterial complications in Behcet's disease, we must always perform early diagnosis, proper clinical intervention and continuous follow up.

Ethanol Embolization of Arteriovenous Malformations: Results and Complications of 33 Cases

PURPOSE: To assess the effectiveness of ethanol embolization for the treatment of arteriovenous malformation (AVM), and the complications, if any, arising. MATERIALS AND METHODS: Thirty-three patients with AVMs underwent 145 staged sessions of ethanol embolization. AVMs were located in an upper extremity (n=14), a lower extremity (n=10), the pelvis (n=7), the thorax (n=1), or the abdomen (n=1). Eighty-five transcatheter embolizations and 60 direct percutaneous puncture embolizations were performed, and seven patients underwent additional coil embolization of the dilated outflow vein. The therapeutic effectiveness of embolization was evaluated in terms of the extent to which an AVM was obliterated between baseline and the final angiogram. Complications were classified as minor or major. RESULTS: In 13 patients (39%), AVMs were totally obliterated. In eitht patients (24%), more than 75% were obliterated; in three (9%), the proportion was 50-75%; and in four (12%), less than 50%. Five patients (15%), were not treated. The reasons for failure were the difficulty of approaching the nidus due to previous surgical ligation or coil embolization of the feeding artery, the subcutaneous location of an AVM, post-procedural infection, and massive bleeding during the follow-up period. Twenty-one minor complications such as focal skin necrosis or transient nerve palsy developed during 145 sessions of (an incidence of 14%), but these were relieved by conservative treatment. The five major complications arising (3%) were cerebral infarction, urinary tract infection, acute renal failure due to rhabdomyolysis, permanent median nerve palsy, and infection. CONCLUSION: Ethanol embolization by direct percutaneous puncture or using a transcatheter technique is an effective approach to the treatment of an AVM. However, to overcome the considerable number of complications arising, further investigation is required.

Clinical and Functional Assessment after Anticoagulant Therapy of Acute Deep Vein Thrombosis Involving the Lower Limb

We assessed the clinical status after anticoagulant therapy in acute deep vein thrombosis (DVT) involving the lower limbs. Between 1994 and 2001, 139 patients suffering from acute DVT were treated with heparin therapy followed by oral anticoagulant therapy. The coagulation factor assay was done prior to any anticoagulation therapy. The duplex scan was checked serially. The mean follow-up periods was 32 ± 19 months. There were 32 (23.0%) cases of protein C deficiency, 12 (8.6%) cases of protein S deficiency, 13 (9.4%) cases of AT-III deficiency and 11 (7.9%) cases of abnormal plasminogen level. Fourteen cases had coagulation factor abnormalities within the family. The initial lung scan showed 29 (20.9%) cases with high, 13 (9.4%) cases with intermediate and 70 (50.4%) cases with a low probability of pulmonary embolism (PE) developing. During the follow-up periods, there were 3 cases of non-fatal PE documented with chest CT scan. The patients were divided according to the extent of the thrombus; Group I (38 cases) was limited to the infrainguinal deep vein, Group II (70 cases) extended to the iliac vein and Group III (9 cases) extended to the vena cava. Partial lysis occurred in 20/35/3 (52.6/50.0/33.3%) cases and no change in 10/24/6 (26.3/ 34.3/ 66.7%) cases in Groups I/ II/ III, respectively. Deep vein valvular reflux occurred in 15/25/5 (39.5/35.7/55.6%) cases in Groups I/ II/ III, respectively. With anticoagulation therapy, most of the thrombi remained in unresolved states and there was a high rate of deep vein valvular reflux. However, there was no serious complications which affected the patients' quality of life.

Clinical Experiences of Lower Limb Amputation in Ischemic Arterial Disease

PURPOSE: Despite the decrease in the number of lower limb amputation in ischemic limb patients as a result of advances in vascular reconstruction surgery, amputation still plays an important role in the management of end-stage peripheral vascular disease. Owing to the importance of the amputation level in postoperative rehabilitation and prevention of reamputation, there have been many reports defining theses level. Clinical characteristics were determined by retrospectively reviewing medical records of patients who underwent lower limb amputation for peripheral vascular disease. METHOD: Between June 1997 and September 2002, lower limb amputation was performed in 73 patients with peripheral vascular disease. RESULT: Mean follow-up period was 15 months; male to female ratio was 7.1 to 1; and mean age was 62.6 years. Associated diseases included DM (39 patients), hypertension (15 patients), ischemic heart disease (13 patients), and cerebrovascular disease (6 patients). Etiologies were atherosclerosis in 47.9%, Buerger's disease in 15.1%, DM foot in 13.7%, acute arterial embolization in 2.7%, ruptured abdominal aortic aneurysm in 1.4%, and combined atherosclerosis with DM foot in 19.2%. Bypass surgery was performed in 24 cases and only 4 cases underwent radiologic vascular intervention. The frequency of amputation was one surgery in 50 cases and more than two surgeries in 23 cases. Amputation level was digit amputation in 49 cases (67.1%), transmetatarsal in 10 cases (13.7%), below-knee in 11 cases (15.1%) and above-knee in 3 cases (4.1%). In 73 cases, reamputation was performed in 19 cases (26%) for poor stump wound healing. The cause of reamputation was atherosclerosis in 17.1%, Buerger's disease in 27.3%, DM foot in 60.0% and combined atherosclerosis with DM foot in 28.6%; the reamputation rate was the highest in DM foot patients. Bypass surgery for improved blood flow in the stump was performed in 24 cases, among these cases, reamputation was performed in 2 cases (8.3%). CONCLUSION: Amputation in ischemic limb patients was most commonly performed in artherosclerosis patients and the most common amputation level was digit. The reamputation rate was the highest in DM foot patients; a more careful selection of the amputation level in DM foot patients may be needed.

Development of Autologous Endothelial Cell Seeded Prosthetic Vascular Graft

PURPOSE: Small calibered prosthetic vascular grafts are prone to low patency rates after bypass surgery due to its high thrombogenicity and neointimal hyperplasia. Endothelial cells are known to inhibit thrombus formation, platelet aggregation and smooth muscle cells proliferation. The purpose of this study was to examine the development of autologous endothelial cell seeded prosthetic vascular graft. METHOD: The autologous endothelial cells (ECs) were harvested from canine external jugular veins. Approximately 5 104 ECs were obtained through passage 5 to 6 under the static condition. The cultured ECs were seeded into the polytetrafluoroethylene (PTFE) graft and cultured for 3 days before implanting into the canine carotid artery. The PTFE graft was harvested at 6 weeks after implantation. RESULT: The primary cultured ECs were treated with Factor VIII/vWF, CD31/PECAM-1 antibody and confirmed with fluorescence micrograph. The graft patency rates were 2/6 (33%) in the control graft and 5/6 (83%) in the ECs seeded graft at 6 weeks after implantation. The entire luminal surface of the EC seeded graft was covered with ECs. Only the vicinity of the anastomosis site was covered with ECs in the control graft. CONCLUSION: This is a pilot study for the development of autologous endothelial cell seeded prosthetic vascular graft. The results of our study demonstrate that the endothelialized PTFE are better than nonendothelialized PTFE.

Development of the Unsteady Capillary Tube Viscometer and Viscosity Measurement of Blood Analogue Fluid

The purpose of the present study is to measure the viscosity of liquid in the capillary tube viscometer using the unsteady flow concept. The capillary tube viscometer is consisted of a small cylindrical reservoir, capillary tubes, and the mass flow rate measuring system interfaced with computer. Two capillary tubes with 1.152 and 3.002 mm (inner diameter) are used to determine the diameter effects on the viscosity measurements. The instantaneous shear rate and gravitational driving force in the capillary tube are determined by measuring the mass flow rate through the capillary tube instantaneously. The measured viscosities of water and aqueous Separan solution as the blood analogue fluid are in good agreement with the reported experimental data.

Measurement of Smooth Muscle Cell Migration on the Micromachined Groove Topology

PURPOSE: The spreading, orientation, and chemotaxis with the gradient of a chemoattractant of smooth muscle cells (SMCs) were studied on the micro-grooved substrata by the light, fluorescence and scanning electron microscopy. METHOD: Vertical-walled grooves were produced in silicon wafers by the micromachining technique. All grooves were 4~20micrometer deep and 10~80 micrometer wide. SMCs were cultured on each microgroove and examined under stereo-microscope. RESULT: Cell clusters were markedly oriented by all the grooved substrata examined. Time-lapse images acquired from CCD (Charge Coupled Device) showed that the grooves directed the migration of SMCs. There was no prominent difference in the migration speed of SMCs according to the grooves. All the cytoskeletal fibers were reorganized in the same direction with grooves. Especially the alignments of microtubule and intermediate filaments were distinguished in the SMCs on the micro grooves. CONCLUSION: These results could be applied to the analysis of vascular restenosis and the development of artificial blood vessels.

Clinical Analysis of the Extremity of Lymphedema

PURPOSE: Given the increased frequency of operative therapy and radiation therapy on breast cancers and uterine cancers, there is very little information on lymphedema associated with these treatments in Korea. Thus, the authors conducted this study to describe and analyze the data which they had obtained from the patients. METHOD: A retrospective study was undertaken on 840 patients who registered to the Lymphedema Clinic of Samsung Seoul Hospital throughout the period of February 1995 to August 2001. RESULT: Out of 840 patients, 205 patients (24%) were confirmed as having primary lymphedema, while 635 patients (76%) had secondary lymphedema. The ratio of male to female for primary lymphedema was 1:1.8 (Male:Female), while secondary lymphedema demonstrated to be 1:21 (Male:Female), demonstrating a female preponderance. Secondary lymphedema mostly developed after undergoing treatment for uterine cancer (341 patients, 53.7%) and Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. breast cancer (226 patients, 35.5%). The lesions of occurrence for both primary and secondary lymphedema were mainly in the lower extremities than the upper extremities. In regards to the degree of clinical edema, a large number of the patients, that is 633 patients (76%) had progressed to Stage II-III. Among the patients who developed edema after undergoing treatment for cancers, only 43 patients (7%) were provided information on the possibility of developing lymphedema, while the majority of the patients had no knowledge about this possibility. When the patients' subjective experiences were investigated on the degree of the edema, there was no significant increase in pain despite an increase in the degree of the edema (P0.05). CONCLUSION: As a general rule, complete recovery from chronic lymphedema is not expected. However, early detection of lymphedema and timely appropriate treatment as well as aggressive patient education on lymphedema and its related complications can prevent its progression.

A Program for Management of Vascular Disease

As medical technology progresses rapidly, there is a rise in the average age along with the Korean dietary lifestyle becoming more westernized, which leads to an increase in the number of vascular disease patients in Korea. Thus, we need to manage the medical information of a disease systematically in order to diagnose and treat constructively. However, since there has been no standardized method of management to date, a great deal of information could not be properly utilized nor studied. Therefore, the departments of Cardiology, Radiology and Neurology of Samsung Seoul Hospital recently got together to develop an information management system called the Vascular Data System. This program was developed to be run on win98 O/S, upper Pentium III, and upper 128 MB Memory, and its source code is Dephi 4.0. It was configured for the user to set the configurations as well as do a variety of search and analysis. If this program were to be updated continuously, it may be used extensively as well as in various parts of clinical research activities.

Rhabdomyolysis in Aortic Surgery: case report

Rhabdomyolysis is an uncommon complication in a vascular surgery. Recently we experienced two cases of rhabdomyolysis after aortic surgery. The first one underwent an elective surgery for AAA but the 2nd case performed an emergency surgery because of ruptured AAA. Both patients recovered from rhabdomyolysis by conservative medical treatment without any major complications such as acute renal failure.

Tissue Engineering of Vascular Prosthetic Grafts Using Autogenous Vein Cells

PURPOSE: To investigate bioartificial vessels capable of being used for vascular grafts, we studied cell-polymer constructs from venous smooth muscle cells (SMCs) and biodegradable scaffolds using the canine model. METHODS: Scaffolds constructed from 50/50 poly (D,L-Lactide-co-glycolide) (PLGA) were created with pores containing gelatin particles. Disk type scaffolds were used as templates of cell attachment and vascular tissue regeneration. SMCs were isolated from canine external jugular veins and primary SMCs cultures were produced with the explant-derived method. SMCs were seeded into the scaffolds and cultured statically for 4 weeks. The cell-polymer constructs were examined histochemically and using scanning electron microscopy. RESULTS: The SMCs obtained by the explant-derived method were confirmed with immunohistochemical staining using an anti-smooth muscle actin antibody. Four weeks after the SMCs were seeded into the scaffold, histological examination showed SMCs infiltration into the scaffold wall and scanning electron microscopy revealed the SMCs mass which resembled tissue on the scaffold surface. CONCLUSION: This is a pilot study for the constructing artificial vessels using tissue engineering. The construction of the ideal scaffold for vessel and the improvement of culture methods in vitro are the most important parts in this field.

Prophylaxis against Hepatitis B Recurrence Following Liver Transplantation in HBsAg( ) Patients: Hepatitis B Immune Globulin vs Lamivudine

PURPOSE: Thanks to hepatitis B immune globulin (HBIG) and antiviral agents such as Lamivudine , HBV cirrhosis is no longer a contraindication of liver transplantation. Actually it is frequent indication for liver transplantation in Korea. However, to date, the most effective HBV prophylaxis regimen has not been determined. The purpose of this study was to evaluate whether the regimen consisting of lamivudine and one-week HBIG for the hepatitis B virus (HBV) prophylaxis following liver transplantation is as effective as a long-term therapy of high dose HBIG. METHODS: From May 1996 to December 1999, 58 patients among a total of 80 cases of liver transplantation were hepatitis B surface antigen positive preoperatively. They were grouped into two protocol regimens, the HBIG group and the Lamivudine combination group, at random. 43 patients (19 patients in the HBIG group, twenty four patients in the Lamivudine combination group) who survived more than 90 days were included in this study. The recurrence was defined as the conversion of HBs-Ag from negative to positive. RESULTS: There was no statistical significance between the two groups in regards to age, sex or the preoperative positive rate of HBeAg. The mean follow-up duration was 27 months (range from 6-55). Of the 43 patients, 5 patients were converted to HBs-Ag positive in serum; two were in theHBIG group and three in the Lamivudine combination group. There was no statistical significance in HBV recurrence rate between the two groups (p=0.97). CONCLUSION: The combined therapy of lamivudine and one week HBIG has an effect equivalent to a long term therapy of high dose HBIG in HBV prophylaxis following liver transplantation.

The Response of Human Umbilical Vein Endothelial Cells Under Complicated Flow Conditions

PURPOSE: Endothelial cells (ECs) are exposed to continuous shear stress from their birth and also respond to the hemodynamic environmental changes which may be localizing factor in vascular diseases, such as atherosclerosis. The hemodynamic shear stress is implicated in the pathogenesis of atherosclerosis, thrombosis, and also restenosis. The objective of this study is to investigate the morphological and molecular biological changes of vein ECs under complicated flow flield which could occur in the anastomosis site of the autogenous vein bypass graft. METHOD: We developed a laminar flow chamber for the normal vessel and a sudden expansion flow chamber to simulate the recirculation or the stagnation zone of vascular graft. RESULT: Normal flow shear stress transformed ECs from random oriented polygonal, cobblestone shape to elongated shape aligned along the flow direction. However the stagnation and flow separation zone could not show the morphologic change of ECs and could be the region of low shear stress prone for intimal hyperplasia and atherosclerosis initiation. CONCLUSION: It also represents that the ECs can sense the magnitude and the direction of the flow shear stress and change their phenotype through the remodeling of the actin microfilaments.

Clinical Analysis of Above-Knee Femoropopliteal Bypass on Chronic Lower Limb Ischemia

PURPOSE: To elucidate overall aspects of femoropopliteal bypass including patency rate, risk factors for patency and complications. METHOD: We analyzed 61 limbs with atherosclerosis in 57 patients underwent above-knee femoropopliteal bypass surgery from September 1994 to April 2000 retrospectively. The mean age of the patients was 65.3 years (31~80 yr.) Operative indications included disabling claudication (54%), resting pain (11.5%), ischemic gangrene (or ulceration) (34.4%). Associated risk factors were cerebrovascular accident (51%), diabetes mellitus (39%), coronary artery disease (32%), hypertension (30%), hyperlipidemia (16%). We used PTFE (polytetrafluoroethylene) synthetic graft in all cases. Adjunctive procedures were performed in 13 cases, which were iliac artery stent insertion in 7 cases, balloon dilatation in 4 cases, neurolysis in 1 case, profundaplasty in 1 case. RESULT: Overall 1, 3, 5-year primary and secondary graft patency rates were 83.8%, 73.0%, 71.3% and 98.0%, 85.0%, 75.0%. 17 postoperative complications occured including 10 cases of leg edema, 3 cases of myocardiac infarction, 3 cases of cerebral infarction, 1 case of pneumonia. In uni- and multivariate analysis, run off score was the only significant factor influencing primary graft patency rate (p=0.013), but risk factors such as DM, smoking, hyperlipidemia had no statistical significancy on the primary and the secondary graft patency rates. CONCLUSION: We consider that run off score is the most important factor for predicting the graft patency as other studies verified.

OK-432 Intralesional Injection Therapy for Lymphangioma in Children

Lymphangioma is a congenital malformation of the lymphatic system, commonly seen in the neck. Operation was the treatment of choice but it is difficult to resect the lymphangiomas completely. The aim of this study is to evaluate the result of intralesional injection of OK-432 as a treatment strategy of lymphangioma in children. Medical records of 51 cases of lymphangioma from March 1996 to February 2001 were reviewed retrospectively. Intralesional injection of 0.1 mg OK-432 in 10ml normal saline was performed after the aspiration of as much fluid as possible. The location of the lesion was the face and neck in 26 patients, the chest wall in 14, the extremities in 9, and the abdominal wall in 2. The cystic type was present in 45 patients and the cavernous type in 6. Four postoperative recurrent cases were included. Fluid aspiration from the lesion was impossible in 5 patients. Development of fever after injection was observed in 27 patients and local inflammatory reaction was in 5 patients. There was no scar formation at injection sites. Complete shrinkage was observed in 20 patients, remarkable shrinkage in 23, slight shrinkage in 3, and no response in 5. Cystic type or aspiration-possible cases showed better outcome than cavernous type or aspiration-impossible cases. All of four recurrent cases after surgical excision showed at least remarkable shrinkage. These results indicate that intralesional injection of OK-432 is a safe and satisfactory treatment modality of lymphangiomas in children and might be considered as a treatment of choice, even in recurrent cases.

Expression of Heat Shock Protein 70 in Vein Endothelial Cells Induced by Shear Stress

PURPOSE: Endothelial cells (ECs) are exposed to continuous shear stress due to the blood flow. Heat shock protein (hsp) 70 is a well-known stress-response protein. The objective of this study is to investigate the expression of hsp70 in human umbilical vein endothelial cells induced by shear stress. METHOD: The pattern of hsp70 was investigated by the in vitro laminar flow system and its image was analyzed by PV-WAVE software program. The image of heat shock-induced hsp70 expression was analyzed and compared with that of shear stress-induced hsp70 expression. RESULT: Under the condition of shear stress produced by flow, the ECs change their morphology and lineup along the flow direction. As to expression of flow stress-induced hsp70, it was accumulated in perinuclear region of endothelial cells, which is different from heat shock-induced hsp70 exression. CONCLUSION: ECs alignment along the direction of the flow shear stress and changes their phenotype are due to the remodeling of the actin microfilaments. Perinuclear expression of hsp70 may play an important roles in this shear stress induced remodeling response.

Factors That Affect the Survival Rate of Ruptured Abdominal Aortic Aneurysm

PURPOSE: Ruptured abdominal aortic aneurysm (RAAA) continue to be a significant causes of death. We review 14 patients who underwent repair of RAAA to analyze the factors affecting the mortality rate. METHOD: Fourteen patients who underwent repair of a RAAA at Samsung Medical Center from March 1995 to July 2001 were reviewed retrospectively. The patients were divided two groups as survival and fatal group. Data was analyzed by both univariate and multivariate analysis. RESULT: There were nine patients (64%) in survival group and five patients (36%) in fatal group. The mean age of survival group was 64.67+/-19.59 years and 67.0+/-5.15 years in fatal group. All patients in fatal group were died within 2 days postoperatively. By univariate analysis of various factors associated with the mortality rate, creatinine level, hemoglobin level were statistically significant. Other factors associated with the mortality rate, albumin, initial systolic blood pressure, initial diastolic blood pressure, operation time, prothrombin time and perioperative platelet count were not statistically significant. CONCLUSION: These findings suggest that creatinine level is predictive of death in repair of RAAA. But patients who have RAAA should not be denied therapy on the basis of any specific criteria of preoperative factors.

Analysis of Graft Patency and Risk Factors Influencing Graft Failure in Femorofemoral Crossover Bypass

PURPOSE: Femorofemoral crossover bypass is commonly employed to treat unilateral iliac artery occlusion in chronic limb ischemic patients. We retrospectively analysed the risk factors related to postoperative graft failure and primary patency. METHODS: We reviewed 33 iliac artery occlusion patients who visited Samsung Medical Center between March 1995 and July 2000 and underwent femorofemoral bypass surgery. 33 cases were employed 6 mm or 7 mm PTFE (polytetrafluoroethylene). The average age of the patients was 63.3 year-old, and all of them were male. The indication of surgery were claudication (19 cases, 57.6%), resting pain (9 cases, 27.3%), and lower limb ulceration or gangrene (5 cases, 15.2%) in preoperatively. RESULTS: The average ankle-brachial index (ABI) was 0.34 preoperatively and 0.837 postoperatively. Graft failure after 30 days (late graft failure) was found in 7 cases (21.3%). The primary patency rates were 80.1% for 1 year and 60.1% for 2 years. According to the cross table analysis of the risk factors, smoking, diabetes mellitus, cardiac status, distal run-off score, and cerebrovascular disease related with carotid stenosis showed significantly high rate graft failure. A univariate analysis of risk factors showed that preoperative smoking, diabetes mellitus, hypertension, distal run-off score, cardiac status, and cerebrovascular diseases related with carotid stenosis were significantly related with primary patency. However, according to multivariate analysis, these risk factors did not show any significant relationship with primary patency, with the exception of the distal run-off score (p= 0.0018). CONCLUSION: Continuous and close care of patients through postoperative long-term follow up would improve graft patency in patients with risk factors, such as diabetes mellitus, carotid stenosis, cardiac status, and smoking. Examination of the preopertive distal run off artery will predict the prognosis of the postoperative graft patency.