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.

Transcatheter Embolization of Giant Pulmonary Arteriovenous Malformation with an Amplatzer Vascular Plug II

Pulmonary arteriovenous malformation (PAVM) is a rare anomalous direct communication between the pulmonary artery and vein with a considerable risk of serious complications such as cerebral thromboembolism or abscess and pulmonary hemorrhage. Although the past, surgical resection such as lobectomy was mostly used to treat PAVM, the recent development of endovascular treatment has made it a primary consideration to perform transcatheter embolization using coils or detachable balloons. We report a case of successful transcatheter embolization of giant PAVM with the second generation Amplatzer vascular plug II as a new self-expanding device.

Bypass Using Autologous Pericardium in the Inflammatory Pseudotumor of the Superior Vena Cava

Among the causes of superior vena cava (SVC) syndrome, intraluminal tumor, especially the inflammatory pseudotumor is very rare. We report a 33-year old male patient who had been suffering from facial edema and flushing for 3 weeks before admission. On physical examination, facial edema and venous engorgement on upper extremities and upper chest wall were showed. The chest computed tomography (CT) scan showed a long intraluminal mass lesion resulting in a near total obstruction of the SVC. Surgery was performed through median sternotomy. After complete resection of the tumor, we make bypass of SVC with autologous pericardium. The follow up chest CT scan revealed no abnormality 3 months after the operation.

Endovascular Repair of Acute Type B Aortic Dissection: The Early Results and Aortic Wall Changes / 대한흉부외과학회지

BACKGROUND: This study assessed the early results of endovascular repair of acute type B aortic dissection and the aortic wall changes following endovascular repair. MATERIAL AND METHOD: From July 2008 to May 2009, the preoperative and follow-up computed tomography (CT) scans of 5 patients with acute type B aortic dissection were evaluated, and these patients had underwent stent graft implantation within 13 days of the onset of dissection (mean: 7 days; range: 3~13). The whole lumen (WL), true lumen (TL) and false lumen (FL) diameters were measured at the proximal (p), middle (m) and distal (d) third of the descending thoracic aorta. RESULT: The study included four men and one woman with an average age of 59.4+/-20.1 years (age range: 37~79 years). The follow-up CT was performed and evaluated at 7 days and 6 months. The primary tear was completely sealed in all the patients. No paraplegia, paresis or peripheral ischemia occurred and none of the patients died. No endoleaks developed in any of the patients during follow-up. The TL diameters increased from 20.4 to 33.5 mm in the proximal third (p/3), from 19.5 to 29.8 mm in the middle third (m/3) and from 15.2 to 23.5 mm in the distal third (d/3). The FL diameters decreased from 18.7 to 0 mm in the p/3, from 15.4 to 0 mm in the m/3 and from 21.4 to 8.7 mm in the d/3. The changes in the TL diameter were statistically significant in the middle and distal aorta, and those changes in the FL diameter were not statistically significant. There was a decrease in the WL after repair, but this was not statistically significant. In three patients, the false lumen disappeared completely on follow-up CT at 6 months. Two patients had patent false lumens and no thrombosis. CONCLUSION: The early results showed that endovascular repair was effective in treating acute type B aortic dissection, and endovascular repair promoted positive aortic wall changes.

Xanthoma of the Rib without Hyperlipoproteinemia: A case report / 대한흉부외과학회지

Primary xanthoma of the bone is a rare benign neoplasm, and it is extremely rare to find this in the ribs. It is most commonly reported in soft tissue and it associated with hyperlipoproteinemia. A 54-years-old male who complained of left chest pain had an X-ray taken. It revealed a left 3rd rib tumor. The blood examinations for lipid and protein were normal. A resection was done for tissue examination. The mass was histolopathologically diagnosed as a xanthoma.

Nuss Procedures using a Transilluminated Introducer / 대한흉부외과학회지

The Nuss procedure has good cosmetic effects, but it could be cause of bleeding and organ injury during dissection of the anterior mediastinum. We have made an effort to overcome the defects of the traditional method through the anterior mediastinum, thus we developed a transilluminated introducer that made it safer and simpler to operate within a 1 cm incision only. A total of 67 patients underwent the Nuss procedure using the transilluminated introducer. Thirty-six patients underwent the procedure with the transilluminated introducer only (age or =14 years). There were no major complications, such as massive bleeding or organ injury in the thoracic cavity during or after the Nuss procedure. Our findings demonstrated that the anterior mediastium could be dissected simply and safely by the use of a transilluminated introducer during the Nuss procedure without fatal major complications, such as bleeding and organ injury.

Video-assisted Talc Poudrage for the Treatment of Malignant Pleural Effusion: Analysis of Effects and Benefits / 대한흉부외과학회지

BACKGROUND: Malignant pleural effusion is a common condition in neoplastic patients and palliative therapy is the usual treatment. Talc has been generally accepted to be the most effective sclerosant for chemical pleurodesis, but the optimal route of administration remains controversy. We compared the results of video-assisted thoracoscopic talc poudrage (VTP) with administering a bedside talc slurry through a chest tube (BTS) for the treatment of malignant pleural effusion. MATERIAL AND METHOD: From December 2004 to May 2006, 20 patients with malignant pleural effusion underwent chemical pleurodesis via VTP (group A, n=10), and BTS (group B, n=10). RESULT:The durations of chest tube placement after the procedure were 7.0+/-4.0 days (group A) and 6.7+/-3.6 days (group B). The hospital stays were 24.3+/-9.4 days (group A) and 30.7+/-21.5 days (group B), respectively. The symptoms of dyspnea were much more improved in group A (p-value=0.014) after discharge (mean f/u group A=8.5+/-2.2 months, group B 8.0+/-7.4 months). The collapsed portions of lung were better expanded in group A than in group B (p-value= 0.011). CONCLUSION: We recommend VTP for the selected patients with malignant pleural effusion because of the advantages of dissecting the fibrous peel to relieve the atelectasis and dyspnea, and excising the pleura for diagnosis with direct viewing of the lesion.