Rare Vascular Anomalies in the Femoral Triangle During Varicose Vein Surgery

BACKGROUND: We observed several cases of rare vascular anomalies within the femoral triangle during varicose vein operations. METHODS: From among 2,093 patients who underwent stripping operations of the great saphenous vein between January 2002 and June 2016, 14 cases of rare vascular anomalies were enrolled in this study. RESULTS: Twelve cases of femoral artery and vein transposition (0.57%), 1 case of separate entrance of the great saphenous vein trunk and its tributaries (0.05%), and 1 case of separate entrance with femoral artery and vein transposition (0.05%) were observed. The preoperative diagnosis rate was 71% (10 of 14) using duplex ultrasound. In all cases of femoral artery and vein transposition, the saphenofemoral junction was located at the lateral or posterolateral side of the superficial femoral artery, corresponding to complete or incomplete transposition, respectively. Among the 12 cases of femoral artery and vein transposition, 5 cases were complete transposition and 7 cases were incomplete transposition. In 2 cases of separate entrance of the great saphenous vein trunk and its tributaries, the separated tributaries formed a common trunk before connecting to the femoral vein. CONCLUSION: The anatomy of the saphenofemoral junction may infrequently be altered in some individuals. Detailed preoperative sonographic examinations and meticulous groin dissection during the operation are necessary to prepare for unexpected anatomical variations.

Distal Femoral Arteriovenous Fistula with Iliac Vein Thrombosis after Blunt Trauma

A 39-year-old woman arrived at our emergency department, complaining of severe pain and swelling of her left leg. She had slipped down stairs and injured on her left leg about 3 months ago. Computed tomography angiography showed left distal superficial femoral artery’s pseudoaneurysm with arteriovenous fistula and thrombotic occlusion of left common iliac vein. We decided to do endovascular intervention due to severe venous hypertension and chronic inflammation around the fistula. The femoral arteriovenous fistula was closed via stent-graft (7 mm×5, 9 mm×5 cm) deployment. The occluded left iliac vein was reopened by nitinol metal stenting (12 mm×4 cm, 14 mm×4 cm). The authors report a very rare case of femoral arteriovenous fistula combined with iliac vein thrombosis developed after a blunt trauma.

Two-Stage Endovascular Repair for Concurrent Penetrating Atherosclerotic Ulcers of the Thoracic and Abdominal Aorta

We report a case of concurrent saccular aneurysms caused by a penetrating atherosclerotic ulcer of the thoracic and abdominal aorta that were successfully treated by staged endovascular repair. Even though surgical open repair or endovascular repair is the treatment option, use of endovascular repair is now accepted as an alternative treatment to surgery in selected patients. To prevent contrast medium-induced nephropathy and spinal cord ischemia caused by a simultaneous endovascular procedure, a saccular aneurysm of the descending thoracic aorta was excluded by stent graft, followed by the placement of a bifurcated stent graft in the infrarenal abdominal aorta one month later.

Clinical Analysis of Hemodialysis Vascular Access: Comparision of Autogenous Arterioveonus Fistula & Arteriovenous Prosthetic Graft

BACKGROUND: Mature autogenous arteriovenous fistulas have better long term patency and require fewer secondary interventions compared to arteriovenous prosthetic graft. Our Study evaluated vascular patency rates and incidence of interventions in autogenous arteriovenous fistulas and grafts. MATERIAL AND METHODS: A total of 166 vascular access operations were performed in 153 patients between December 2002 and November 2009. Thirty seven caeses were excluded due to primary access failure and loss of follow-up. One group of 92 autogenous arterioveous fistulas and the other group of 37 arteriovenous prosthetic grafts were evaluated retrospectively. Primary and secondary patency rates were estimated using the Kaplan-Meier method. RESULTS: The primary patency rate (84%, 67%, 51% vs. 51%, 22%, 9% at 1, 3, 5 year; p=0.0000) and secondary patency rate (96%, 88%, 68% vs. 88%, 65%, 16% at 1. 3, 5 year; p=0.0009) were better in autogenous fistula group than prosthetic graft group. Interventions to maintain secondary patency were required in 23% of the autogenous fistula group (average 0.06 procedures/patient/year) and 65% of prosthetic graft group (average 0.21 procedures/patient/year). So the autogenous fistula group had fewer intervention rate than prosthetic graft group (p=0.01) The risk factor of primary patency was diabetus combined with ischemic heart disease and the secondary patency's risk factor was age. CONCLUSION: Autogenous arteriovenous fistulas showed better performance compared to prosthetic grafts in terms of primary & secondary patency and incidence of interventions.

A Case Report of a Successful Bypass Operation for Peripheral Venous Hypertension with Digital Pigmentation and Ulcer with Crust in Hemodialysis Patient / 대한혈관외과학회지

Peripheral venous hypertension is a rare complication in end-stage renal disease patients undergoing maintenance hemodialysis. Primarily, it is secondary to frequent venous accesses, thrombosis, and to other causes. Venous hypertension may cause pain and edema of the ipsilateral arm; increased venous pressure can prevent acceptable flow rates during dialysis. In this case report, we describe our experience using a Gore-Tex tube graft to treat a venous bypass complicated by peripheral venous hypertension with digital pigmentation and an ulcer with crust. Based on our experience, this technique is as an effective and low-risk surgical option to treat this condition.

Subcutaneous Emphysema and Pneumomediastinum After Mandibular Third Molar Extraction: a Case Report

Recurrence Analysis after Video-assisted Thoracic Surgery for the Treatment of Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: Video-assisted thoracic surgery (VATS) became common in the treatment of spontaneous pneumothorax (SP). Therefor we've reviewed the recurrence rate after VATS and analysed the factors affecting recurrent pneumothorax after VATS on this study. MATERIAL AND METHOD: This retrospective analysis was performed on 321 patients of SP who had undergone VATS from Jan. 2001 to Dec. 2008. The two goups were divided as follow: group A, non-recurrent group (298 patients: 93%); and group B, recurrent group (26 patients: 7%); the two groups were analysed retrospectively. RESULT: The average age of the study groups were 20.9+/-.3 years old in recurrent group vs. 25.9+/-1.7 years old in non-recurrent group with statistical significance (p<0.05). There were no statistical significance in male to female ratio, height/weight ratio, location of pneumothorax, smoking history, operative time, duration of drain, hospital stay, indication of opertion and incidence rate. Average length of duration in recurrence was 12.9 months. There was 22 (95.7%) recurrent patients after VATS within 4 year period among recurrent group. Treatment methods in 23 of recurrent patients were, 8 (VATS), 2 (Axillary thoracotomy) with 15% or more in amount of pneumothorax and 7 (7 Fr. chest tube), 6 (nasal O2) with 15% or less in amount of pneumothorax. Among 10 cases of reoperation, there were 3 cases of over looking type and 7 cases of new growing type. There was no additional recurrence after these procedures were given. CONCLUSION: There was higher recurrence rate in younger age after VATS thus for those under 20 yrs old, detailed and possible preoperative warning for recurrence is warranted. Most recurrence occured within 4 year period, thus for this reason, regular interval based follow up with chest x-ray study is suggested during this period.

The Use of Rapid Ventricular Pacing to Facilitate Stent Graft Deployment in the Distal Aortic Arch / 대한흉부외과학회지

Systemic hypotension has been traditionally used to facilitate deployment of thoracic stent grafts. Decreasing blood pressure with vasodilating agents further increases cardiac output and, consequently, the cardiac output-mediated windsock effect during deployment. Use of rapid ventricular pacing reduces the windsock effect during stent graft deployment and allows the graft to appose to the aortic wall under zero cardiac output, thus minimizing aortic wall shear stress. In this case we report the use of transvenous rapid ventricular pacing, a safe and reproducible technique to allow precise deployment of a Valiant Captivia stent graft in the distal thoracic arch for a saccular thoracic aneurysm.

The Outback(R) LTDtrade mark Catheter: The Novel Re-Entry Technique in Recanalization of Chronic Inflow Occlusion of the Superficial Femoral Arteries in 3 Cases / 대한흉부외과학회지

The acute technical failure of endovascular treatment of chronic total occlusions is most often due to the inability to re-enter the true lumen after occlusion is crossed in a subintimal plane. True lumen re-entry catheters are very effective at gaining wire passage back to the true lumen and facilitating successful endovascular treatment of chronic total occlusions that would otherwise require open bypass. These case reports describe our initial experiences with a new catheter system (the Outback(R) LTDtrade mark catheter) that is designed to allow fluoroscopically controlled re-entry of the true arterial lumen after subintimal guidewire passage during recanalization procedures of arterial occlusions.

Atherosclerotic Aneurysm of the Right Proximal Subclavian Artery :A case report / 대한흉부외과학회지

A 75-year-old man presented with worsening dyspnea and intermittent dysphagia of one month's duration. A plain chest X-ray showed severe tracheal indentation by the right superior mediastinal mass. A chest CT established the diagnosis of a saccular aneurysm arising from the right proximal subclavian artery. Resection of the aneurysm and arterial revascularization was done through a median sternotomy with supraclavicular extension. Aneurysm wall and thrombus culture results were negative and pathology showed an atherosclerotic aneurysm. After the operation, dyspnea and dysphagia were reduced, but he died of advanced stomach cancer 8 months later.

Popliteal Artery Entrapment Syndrome : A case report / 대한흉부외과학회지

The entrapment of the popliteal artery is a rare cause of ischemia of the lower extremities among young males. The development of local occlusive or aneurysmal changes of the popliteal artery is caused by abnormal anatomic relationships between vascular and musculo-tendinous structures in the popliteal fossa. An 18-year-old male visited our outpatient clinic with the chief complaint of claudication in his right calf. Three dimensional CT angiography showed an occlusion of the popliteal artery and less opacified arteries of the right leg. Intraoperatively, the popliteal artery was compressed by an accessory muscle band arising from the medial head of the gastrocnemius. After release of the muscle band, thrombectomy with endarterectomy was done. Three years after surgery, he is doing well without any problems.

Neurogenic Tumor of the Brachial Plexus: case report / 대한흉부외과학회지

Neurogenic tumors of brachial plexus are rare lesions. Recently I experienced a case of Schwannoma arising from the brachial plexus. Thirtyfour-year-old man presented with a slow-growing mass on the left supraclavicular area. Magnetic resonance imaging revealed a well demarcated solid mass on posterosuperior aspect of the left subclavian artery. During operation, a well-encapsulated mass was seen beneath the brachial plexus. I performed intracapsular enucleation of the tumor from the nerve in an effort to avoid damaging nerve fibers as much as possible. Post-operative neurological deficit was not found.

Ligation of Thoracic Duct Via Extrapleural Approach for the Treatment of Chylothorax: Report of 1 case / 대한흉부외과학회지

Traditional surgical management of chylothorax refractory to conservative treatment is thoracic duct ligation through a right open thoracotomy. A new surgical procedure of ligation of the thoracic duct via extrapleural approach is presented. Its advantages are less invasive, no need of a new drainage tube, and easier to expose the thoracic duct than the conventional transthoracic approach. We experienced a new surgical method in the treatment of the chylothorax and report it with literatures.

Differential Lung Ventilation Therapy for Reexpansion Pulmonary Edema: Report of 2 cases / 대한흉부외과학회지

Reexpansion pulmonary edema is a rare complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion, or atelectasis. But occasionally, severe morbidity and death may result. Reexpansion pulmonary edema occurs when chronically collapsed lung is rapidly reexpanded by evacuation of large amounts of air or fluid. In the treatment of the chronically collapsed lung, physicians must remember the possible events and prevent the complications. When the difference in airway resistance or lung compliance between the two lungs is exaggerated, conventional mechanical ventilation might lead to preferential ventilation with hyperexpansion of one lung and gradual collapse of the other. Differential ventilation has been advocated to avert this problem. By differential lung ventilation, we successfully treated a severe reexpansion pulmonary edema in two patients. Therefore we suggest that differential lung ventilation is the treatment of choice for severe reexpansion pulmonary edema.

Adult Onset of Langerhans Cell Histiocytosis in the Rib: Report of 2 cases / 대한흉부외과학회지

Langerhans cell histiocytosis (LCH), previously called histiocytosis X, refers to a spectrum of disease characterized by idiopathic proliferation of histiocytes producing focal or systemic manifestations. Causes and pathogenesis remain unclear. The basic histopatholgic findings are identical in the three well-established clinical syndromes (eosinophilic granuloma, Hand-Shuller-Christian disease, Letterer-Siwe disease). The disease has a predilection for children, although it may occur in adults. We experienced two cases of adult onset Langerhans cell histiocytosis in the ribs. One case was associated with diabetes insipidus and the other case had a solitary lesion.

Operation of Tricuspid Valve Endocarditis with Pulmonary Infarction: Lobectomy with Open Heart Surgery / 대한흉부외과학회지

An eight-year-old boy was referred to our hospital with cough and high fever. His past medical history included a small sized ventricular septal defect (VSD) at birth. Transthoracic echocardiography disclosed a 10x6 mm vegetation on tricuspid valve, a small VSD and the moderate tricuspid valve insufficiency were found. Blood cultures grew methicillin-resistant staphylococcus aureus. Despite proper antibiotic therapy, fever was not controlled and his course was complicated by pulmonary infarction. The patient simultaneously underwent pulmonary resection and open heart surgery. Through the median sternotomy we performed open thrombectomy and lobectomy (right lower lobe) at first, and then vegetectomy, tricuspid valve repair, and direct closure of VSD were done under cardiopulmonary bypass.

The Effect of Improved Operating Room and Intensive Care Unit on the Sternal Infection After Open Heart Surgery / 대한흉부외과학회지

BACKGROUND: Sternal infection after open heart surgery is a serious complication associated with high rate of mortality. We reviewed the effect of improved operating room and intensive care unit on the sternal infection by analyzing the incidence and condition of that around the movement of operating room and intensive care unit in July 1999. MATERIAL AND METHOD: We reviewed a total of 453 patients. Group I contains 237 patients who underwent open heart surgery between January 1997 and December 1998 before we moved the intensive care unit and operating room, and Group II contains 216 patients who underwent open heart surgery between January 2000 and July 2001 after we moved. We only included adult patients over age 15 who underwent cardiopulmonary bypass through median sternotomy and excluded the mortality cases except sternal infections in this study. RESULT: Sternal infection developed in 18 patients(8.0%) in Group I, and in only 1 patient(0.49%) in Group II. Emergency operation, cardiopulmonary bypass time, operation time, transfusion, tracheostomy, and reoperation are significantly associated with sternal infection among the known risk factors. The logistic regression analysis containing those six factors revealed that the movement of intensive care unit and operating room is effective on the decreasing sternal infection(p=0.029, 95% confidence interval 0.011~0.788). CONCLUSION: Although there have been studies on many risk factors associated with the sternal infection after open heart surgery, we think that the improvement of operting room and intensive care unit is a method for decreasing the incidence of sternal infection.

Two Cases of Cervical and Mediastinal Emphysema / 소아알레르기및호흡기학회지

Spontaneous pneumomediastinum is rare in children, mainly affecting male adolescents. It usually occurs secondary to alveloar rupture in the pulmonary interstitium, followed by dissection of gas towards the hilum and mediastinum. Many pathological and physiological events can lead to alveolar rupture, but the most common cause in children is asthma. The most frequent triggers in the pediatric age group are asthma, vomiting of any cause, situations reproducing the Valsalva maneuver (e.g., shouting, coughing), and intense sport activities. We report two cases of pneumomediastinum, occuring in a patient with vigorous coughing and pneumonia and in a patient with dyspnea and pneumonia. We describe the clinical and radiologic findings of two cases. In addition, we have made a comprehensive review of the literature on spontaneous pneumomediastinum in children.

Perioperative ECMO for Postpartum Cardiogemic Shock with Severe Pulmonary Cdema / 대한흉부외과학회지

Temporary and short-term cardiac assists have been used for management of cardiac failure in a wide variety of application. Among these, extra-corporeal membrane oxygenation (ECMO) can be used if conventional therapies have been unsuccessful. Although ECMO has been utilized often in infants, the indications for ECMO in the adult population are not well delineated and the results have been less encouraging. This is a case of a 32 year-old female who has had underlying mitral stenosis. When admitted, she was in shock and presented with severe post-partum pulmonary edema unresponsive to inotropics, pulmonary vasodilator , and diuretics. She was put on ECMO for 14 hours by right femoral venoarterial cannulation and improved immediately after the application of ECMO. Afterwards, double valve replacement was done, and ECMO was continued post-operatively. The total application of ECMO was 62 hours including valve operation, and the weaning of ECMO was accomplished successfully under stable hemodynamics, improved pulmonary edema, and correction of underlying pathophysiology. She was discharged on post-operative day 30 without specific complications.

A Case of Carcinoid-Type Tumorlets of The Lung / 결핵

Carcinoid-type tumorlets of the lung are nodular microscopic proliferation of round and spindle-shaped small cells which originated from bronchial or bronchiolar Kulchitsky-type neuroendocrine cells, which are usually encountered as an incidental finding during microscopic examination of the lungs at autopsy or surgically removed for bronchiectasis or other reasons. We report one case of carcinoid-type tumorlets in the lung which was surgically removed from a patient who had bronchiectasis, and the cells of tumorlets showed immunohistochemical reactivities for markers of epithelial and neuroendocrine differentiation.