Kidney transplantation using expanded criteria deceased donors with terminal acute kidney injury: a single center experience in Korea

PURPOSE: We investigated the clinical outcomes of deceased donor kidney transplantation (KT) using kidneys with terminal acute kidney injury (AKI). METHODS: Between February 2000 and December 2013, we performed 202 deceased donor renal transplants from 159 brain dead donors. According to the expanded criteria donor (ECD) and AKI network criteria, we divided 202 recipients into 4 groups: Group I: Non-AKI & standard criteria donor (SCD) (n = 97); group II: Non-AKI & ECD (n = 15); group III: AKI & SCD (n = 52); and group IV: AKI & ECD (n = 38). RESULTS: The incidence of delayed graft function (DFG) was significantly higher in patients with AKI than it was in the non-AKI group (P = 0.008). There were no significant differences among the 4 groups in graft survival (P = 0.074) or patient survival (P = 0.090). However, the long-term allograft survival rate was significantly lower in group IV than it was in other groups (P = 0.024). CONCLUSION: Allografts from deceased donors with terminal AKI had a higher incidence of DGF than did those from donors without AKI. However, there is no significant difference in graft and patient survival rates among the groups. So, the utilization of renal grafts from ECDs with terminal AKI is a feasible approach to address the critical organ shortage.

Comparison of Minimal Skin Incision Technique in Living Kidney Transplantation and Conventional Kidney Transplantation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recently, the most common incision for kidney transplantation (KT) is an inverted J-shaped incision known as the "hockey-stick." However, demands for minimally invasive surgery in KT are increasing as in other various fields of surgery. Hence, we evaluated whether there is difference between minimal skin incision technique in kidney transplantation (MIKT) and conventional KT (CKT) .</p><p><b>METHODS</b>Between June 2006 and March 2013, a total of 452 living kidney transplant patients were enrolled. The MIKT group included 17 young unmarried women whose body mass index was <25 kg/m2 and had no anatomic variation. The CKT group included 435 patients. The MIKT operation technique restricted to the 10 cm-sized skin incision in the lower right abdomen from laterally below the anterior superior iliac spine to the midline just above the pubis was performed. We compared the baseline clinical characteristics and postoperative results between two groups. For proper comparison, propensity score matching was implemented.</p><p><b>RESULTS</b>There was no difference in graft function, survival, and postoperative complication rate between MIKT and CKT groups (all P > 0.05). The 5-year graft survival was 92.3% and 85.7% in MIKT and CKT groups, respectively (P = 0.786).</p><p><b>CONCLUSIONS</b>Our results indicated that MIKT showed more favorable cosmetic results, and there were no statistical differences in various postoperative factors including graft function, survival, and complications compared with CKT. Hence, we suggested that MIKT is an appropriate method for selected patients in living KT.</p>

Balloon-assisted maturation for arteriovenous fistula maturation failure: an early period experience

PURPOSE: Balloon-assisted maturation (BAM) is emerging as a salvage management for arteriovenous fistula maturation failure (AVF MF). However, BAM is a relatively new, yet controversial technique for AVF maturation. Therefore, we evaluated the effectiveness of BAM for AVF MF. METHODS: Between January 2012 and December 2014, 249 AVFs were created. The total MF rate was 24.8%. But, only 110 AVFs were enrolled, including 74 brachiocephalic (BC) AVFs and 36 radiocephalic (RC) AVFs. The follow-up period was 12 months. Among those, there were 42 MFs (22 BC AVFs and 20 RC AVFs) and 68 maturation successes (MS) (52 BC AVFs and 16 RC AVFs). BAM was involved in MF group. We compared the clinical characteristics, AVF flows, and AVF flow ratios of MF and MS groups. Also, we evaluated the etiology, management, and result of MF. RESULTS: There was no difference in clinical characteristics between MF and MS groups. In MF group, 39 balloon angioplasties (BAs) for 42 AVF MFs were performed. Number of BA was 1.45 ± 0.57 and duration of BA was 21.30 ± 21.24 weeks. BAM rate was 46.2%. For 1 year after AVF creation, AVF flows of MS group were significantly larger than those of MF group (P 0.05). CONCLUSION: BA for AVF MF is a relatively applicable and effective modality. Although a large volume study is necessary, we suggest BAM is an effective salvage management for AVF MF.

Risk factors and long-term outcomes of delayed graft function in deceased donor renal transplantation

PURPOSE: The purpose of this study was to analyze the risk factors for delayed graft function (DGF) and determine its impact on the outcomes of deceased donor (DD) kidney transplantation (KT). METHODS: Between January 2000 and December 2011, we performed 195 DD renal transplants. After the exclusion of primary nonfunctional grafts (n = 4), the study recipients were divided into two groups-group I, DGF (n = 31, 16.2%); group II, non-DGF (n = 160, 83.8%). The following variables were compared: donor and recipient characteristics, patient and graft survival, postoperative renal function, acute rejection (AR) episodes, and the rates of surgical and infectious complications. RESULTS: Donor-related variables that showed significant differences included hypertension (P = 0.042), diabetes (P = 0.025), and prerecovery serum creatinine levels (P 20%, P = 0.008). On multivariate analysis, only the prerecovery serum creatinine level (P < 0.001; hazard ratio [HR], 1.814) was an independent risk factor for the development of DGF. A Cox multivariate analysis of risk factors for graft survival identified these independent risk factors for graft survival: nephron mass (donor kidney weight to recipient body weight ratio) index (P = 0.026; HR, 2.328), CMV infection (P = 0.038; HR, 0.114), and AR episode (P = 0.038; HR, 0.166). CONCLUSION: In DD KT, an independent risk factor for DGF was the prerecovery serum creatinine level. Although there was a significant difference in graft survival between the DGF and non-DGF groups, DGF was not an independent risk factor for graft failure in this study.

Relationship between bronchial anthracofibrosis and endobronchial tuberculosis

BACKGROUND/AIMS: Various pulmonary diseases may be associated with bronchial anthracofibrosis (BAF). Our aim was to identify a relationship between BAF and endobronchial tuberculosis (EBTB). METHODS: In total, 156 patients, diagnosed with EBTB using bronchoscopy, between June 1999 and May 2008, were included. Clinical and bronchoscopic findings between patients with BAF (n = 72, BAF group) and without BAF (n = 84, non-BAF) were analyzed retrospectively. RESULTS: The crude odds ratio (OR) of BAF for EBTB was 8.88 (95% confidence interval, 6.37 to 12.37). On multivariate analysis, adjusting for age, history of biomass smoke exposure, and comorbidities, the most significant independent factor for EBTB was a history of biomass smoke exposure (adjusted OR, 17.471; adjusted p < 0.001). EBTB was more frequent in the right lung, particularly the right middle lobar bronchus, in the BAF group. Actively caseating, edematous-hyperemic, and ulcerative were the major types, with 77 (49%), 33 (21%), and 31 cases (20%), respectively. The BAF group had more ulcerative type, while the non-BAF group had more actively caseating type. The duration of EBTB treatment was similar between the groups. No significant difference was observed in the development of complications during treatment and posttreatment bronchostenosis between the groups. CONCLUSIONS: These findings suggest that BAF may be a risk factor for EBTB and affect the location and morphological type at the time of EBTB development.

Synchronous, Orthotopic Occurrence of Early Gastric Cancer with Gastrointestinal Stromal Tumor that Mimicked Advanced Gastric Cancer

In recent years, the synchronous occurrence of two adjacent but histologically distinct tumors arising in the same organ has been reported. The simultaneous development of gastric adenocarcinoma and gastrointestinal stromal tumor (GIST) is very uncommon. The question raised was whether such a coexistence is a simple incidental finding or whether the two neighboring tumors are caused by a same unknown carcinogenic agent. Many doctors may have an interest in this rare condition and we expect further studies will be done in order to determine if there is any association between the two different tumors. We report a unique case of a synchronous, orthotopic occurrence of an early gastric cancer with GIST in the same location that mimicked advanced gastric cancer.

Predictors of Postoperative Mortality of Ruptured Abdominal Aortic Aneurysm: A Retrospective Clinical Study

PURPOSE: Despite significant improvements in surgery, anesthesia, and postoperative critical care, the postoperative mortality rate of ruptured abdominal aortic aneurysm (RAAA) has remained at 40% to 50% for several decades. Therefore, we evaluated factors associated with the postoperative mortality of RAAA. MATERIALS AND METHODS: From January 1999 to December 2008, a retrospective study was performed with 34 patients who underwent open repair of RAAA. The preoperative factors included age, sex, smoking, comorbidities, serum creatinine, hemoglobin, shock, pulse rate, and time from emergency room to operation room. The intraoperative factors included blood loss, transfusion, aortic clamping site and time, aneurysmal characteristics, rupture type, graft type, hourly urine output (HUO), and operative time. The postoperative factors included inotropic support, renal replacement therapy (RRT), reoperation, bowel ischemia, multiple organ failure (MOF), and intensive care unit stay. The 2-day and the 30-day mortality rates were analyzed separately. RESULTS: The 2-day and the 30-day mortality rates were 14.7% and 41.2%, respectively. On univariate analysis, shock, transfusion, HUO, inotropic support and MOF for the 2-day mortality and serum creatinine, transfusion, aortic clamping site, HUO, inotropic support, RRT and MOF for the 30-day mortality were statistically significant. On multivariate analysis, shock, inotropic support and MOF for the 2-day mortality and aortic clamping site, RRT and MOF for the 30-day mortality were statistically significant. CONCLUSION: To decrease the postoperative mortality rate of RAAA, prevention of massive hemorrhage and acute renal failure with infrarenal aortic clamping, as well as prompt operative control of bleeding and maintenance of systemic perfusion are important.

Multivessel Thromboembolism Associated with Dysfunction of Protein S

Protein S is a vitamin K-dependent coagulation factor that acts as an anticoagulant. Deficiency of protein S increases the risk of thromboembolic events. We report a case of isolated protein S deficiency in a 39-year-old woman suffering arterial occlusion in both lower legs. She underwent a surgical procedure using thrombectomy and balloon angioplasty of her left lower extremity. Later, she had right trans-tibial amputation because of the reperfusion injury. Throughout the evaluation of thromboembolic events, we diagnosed a large thrombus in the right atrium and an asymptomatic pulmonary thromboembolism. The patient was successfully treated with right atrial thrombectomy and systemic anticoagulation. Careful evaluation for protein S levels may be necessary in patients with arterial thromboembolic events, especially young adults.

Multivessel Thromboembolism Associated with Dysfunction of Protein S

Protein S is a vitamin K-dependent coagulation factor that acts as an anticoagulant. Deficiency of protein S increases the risk of thromboembolic events. We report a case of isolated protein S deficiency in a 39-year-old woman suffering arterial occlusion in both lower legs. She underwent a surgical procedure using thrombectomy and balloon angioplasty of her left lower extremity. Later, she had right trans-tibial amputation because of the reperfusion injury. Throughout the evaluation of thromboembolic events, we diagnosed a large thrombus in the right atrium and an asymptomatic pulmonary thromboembolism. The patient was successfully treated with right atrial thrombectomy and systemic anticoagulation. Careful evaluation for protein S levels may be necessary in patients with arterial thromboembolic events, especially young adults.

A Clinical Consideration of Abdominal Aortic Aneurysm Rupture / 대한혈관외과학회지

PURPOSE: With current advances in surgical technique, the prognosis for elective open repair of abdominal aortic aneurysm (AAA) has improved, but the mortality rate for ruptured AAA remains high. The aim of this study was to define the risk factors of AAA rupture. METHODS: We performed a retrospective analysis of 169 AAA patients who underwent open surgical repair between March 2000 and October 2010. According to the rupture, the patients were divided into 2 groups: 'ruptured' (n=41), 'non-ruptured' (n=128). To define the risk factor of ruptured AAA, we compared following variables between the 2 groups: clinical co-morbidities (hypertension, diabetes mellitus, ischemic heart disease, malignancies), diameter (maximal diameter of AAA), location of rupture, gender, and previous abdominal surgery history. RESULTS: Mean patient-age was 68.4+/-4.4 years (range: 32 to 86 years); the majority of patients were males, 135 (79.8%). Mean diameter of AAA was 6.67+/-2.0 cm (range: 4 to 15 cm); 'non-ruptured': 6.3+/-1.6 cm, 'ruptured': 7.8+/-2.6 cm. The risk of AAA rupture was statistically significantly increased with increased diameter of the AAA (P=0.007). On multivariateanalysis, the only statistically significant risk factor for AAA rupture was diameter of AAA (P=0.004). CONCLUSION: The only significant risk factor for AAA rupture found in this study is the diameter of AAA. To minimize the rupture rate of the AAA patients, we will have to closely monitor the size of AAA diameter.

Abdominal Compartment Syndrome Due to Spontaneous Retroperitoneal Hemorrhage in a Patient Undergoing Anticoagulation

Spontaneous retroperitoneal hemorrhage is one of the most serious and often lethal complications of anticoagulation therapy. The clinical symptoms vary from femoral neuropathy to abdominal compartment syndrome or fatal hypovolemic shock. Of these symptoms, abdominal compartment syndrome is the most serious of all, because it leads to anuria, worsening of renal failure, a decrease in cardiac output, respiratory failure, and intestinal ischemia. We report a case of a spontaneous retroperitoneal hemorrhage in a 48-year-old female who had been receiving warfarin and aspirin for her artificial aortic valve. She presented with a sudden onset of lower abdominal pain, dizziness and a palpable abdominal mass after prolonged straining to defecate. Computed tomography demonstrated a huge retroperitoneal hematoma and active bleeding from the right internal iliac artery. After achieving successful bleeding control with transcatheter arterial embolization, surgical decompression of the hematoma was performed for management of the femoral neuropathy and the abdominal compartment syndrome. She recovered without any complications. We suggest that initial hemostasis by transcatheter arterial embolization followed by surgical decompression of hematoma is a safe, effective treatment method for a spontaneous retroperitoneal hemorrhage complicated with intractable pain, femoral neuropathy, or abdominal compartment syndrome.

Free Floating Thrombus of the Aorta: An Unusual Cause of Peripheral Embolization

PURPOSE: Free-floating thrombus (FFT) of the aorta is very rare but has a high risk of distal embolization. While the necessity of treating such a condition is evident, the diagnostic and therapeutic modalities remain controversial. Thus, we reviewed seven cases of FFT of the aorta. METHODS: A retrospective study was performed usings even patients diagnosed with FFT of the aorta at the Catholic University of Korea between January 1999 and December 2008. We excluded those patients who had thrombi with concomitant atherosclerotic or aneurysmal aorta. RESULTS: The mean patient age was 59.6+/-13.6 years old. The male-to-female ratio was 3:4. Embolization to arteries of the extremities occurred in two patients and to visceral arteries in four patients. Of these seven patients, four were initially treated with anticoagulation, and two were initially treated with thrombectomy; one patient refused any kind of treatment. Of the four patients treated with anticoagulation, three experienced complete dissolution of the thrombi while anticoagulation proved ineffective in the remaining patient who subsequently underwent thrombectomy. In all of the three patients who had received thrombectomy, postoperative anticoagulation was employed. There was no recurrence of FFT of the aorta during the follow-up period. CONCLUSION: Were commend systemic anticoagulation with low molecular weight heparin (LMWH) as the first line of treatment for FFT of the aorta. If the thrombus persists or recurrent embolism occurs during anticoagulation therapy, surgery should be undertaken.

Relationship of Serum Ferritin, Cholesterol, and Intimal Hyperplasia after Mechanical Injury to Carotid Artery in a Rat Model

PURPOSE: Iron plays an important role in the process of oxidizing Low Density Lipoprotein (LDL) in the arterial wall during the development of atherosclerosis, but the role of iron during the development of intimal hyperplasia has not been confirmed. Therefore, we evaluated the relationship of serum ferritin, serum cholesterol and intimal hyperplasia. METHODS: Forty rats were divided into four groups according to diet. Group I was the normocholesterol and normoferritin group, group II was the hypercholesterol and normoferritin group, group III was the hypercholesterol and hypoferritin group, and group IV was the hypercholesterol and hyperferritin group. At the sixth week, we induced clamping injury at the left common carotid artery of each rat. At the end of the eighth week, we obtained tissue of the left common carotid artery from each rat, and we performed staining. After that, we evaluated differences of the intima to media ratio (IMR) of arterial walls according to groups. RESULTS: The IMR of group II was higher than that of group I (P<0.001). Among hypercholesterol groups (group II~IV), the IMR of group III was lower than that of group II (P<0.001), and the IMR of group IV was higher than that of group II (P=0.007). CONCLUSION: We suggest the possibility that serum ferritin and serum cholesterol are proportionally related with intimal hyperplasia. But we think that large-volume experiments in animal models and prospective studies in humans are needed to confirm and expand on our results.

Symptomatic Lower Extremity Deep Vein Thrombosis after Kidney Transplantation: a 40-Year Single Center Experience in Korea / 대한이식학회지

BACKGROUND: It is well known that kidney transplant recipients in Western countries are at high risk for development of lower extremity (LE) deep vein thrombosis (DVT). The aim of this study was to establish the frequency of symptomatic LE DVT, the time until their occurrence, and to define risk factors for them following kidney transplantation (KT) in Korea. METHODS: We performed a retrospective analysis of LE DVT among 1695 patients who were kidney transplant recipients between 1969 and 2009. All patients were symptomatic with objective diagnostic modalities. Results were compared with those for a cohort of kidney transplant recipients from the same center without DVT. RESULTS: During follow-up, 21 symptomatic LE DVTs (1.2%) occurred in 18 patients (1.1%). The mean interval between transplantation and a first episode of DVT was 77.1+/-76.6 months. No DVT episode developed within one month after KT. There were no significant differences in body mass index, graft function, donor age and sex, recipient sex, type of preoperative renal replacement therapy, immunosuppressive agents, and malignancy between the two groups. Patients who developed LE DVT had a significantly different recipient age, presence of diabetes mellitus, presence of acute rejection episodes, and type of donor (P<0.05). CONCLUSIONS: Our retrospective study showed that the incidence of LE symptomatic DVT after KT is lower than after other surgeries performed in Korean hospitals and after KT performed in Western countries. There were no cases of symptomatic DVT within 1 month after KT. Our findings suggest that aggressive DVT prevention is not necessary for KT recipients in Korea.

Palma-Dale Operation for Chronic Ilio-femoral Vein Thrombosis

PURPOSE: Deep vein thrombosis is usually managed conservatively or with radiologic intervention. Yet deep vein reconstruction is of value as one of the treatments for a small group of patients who present with significant chronic venous insufficiency due to hypoplastic, absent or occluded deep venous outflow such as occurs because of chronic ilio-femoral vein thrombosis. Therefore, we evaluate the improvement of symptoms and graft patency after a Palma-Dale operation as a treatment modality for chronic ilio-femoral vein thrombosis. METHODS: From January 2001 to August 2008, a retrospective study was performed on 15 patients with chronic ilio-femoral vein thrombosis that was treated with a Palma-Dale operation. RESULTS: The mean age of the patients was 51.1+/-15.9 years. The ratio of males to females was 8 to 7. All the patients had lower limb swelling. A Palma-Dale operation was performed on all the patients. Simultaneous thrombectomy was done for 1 patient and arteriovenous fistulas were used to improve graft patency in four patients. The mean follow-up period was 36.3+/-24.0 months. Postoperatively, there was improvement of symptoms in all the patients. However, there was recurrence of symptoms in three patients after two or three months. The rate of graft patency was 84.1% at one year after surgery. CONCLUSION: The Palma-Dale operation has the possibility of recurrence of deep vein thrombosis and postoperative complications. Yet in patients with significant chronic venous insufficiency due to chronic ilio-femoral vein thrombosis, this type of surgery is obviously of value with respect to improvement of symptoms and an acceptable graft patency rate.

Aorta and Peripheral Arterial Diseases in Renal Transplant Patients / 대한이식학회지

BACKGROUND: In the era of surgical advancement of transplantation, renal transplant patients with risks of atherosclerosis have improved its survival rate. And these renal transplant patients with aortic or peripheral arterial diseases required surgical treatment. Herein, we discussed the prevalence and treatment options for the atherosclerotic disease in renal transplant patients. METHODS: We retrospectively reviewed 1,163 patients who underwent renal transplant surgery from Jan. 1990 to May. 2007. Among them, we found 10 patients with atherosclerotic disease of aorta and peripheral arteries. Four patients had abdominal aortic aneurysm (AAA), five patients had atherosclerosis obliterans in the lower extremities, and one had renal artery stenosis in transplanted kidney. RESULTS: Four patients with AAA had aorto-biiliac bypass surgery with bifurcated grafts. Two of them had transplanted kidney protection during surgery, the others did not. Five patients with atherosclerosis obliterans in lower extremities had arterial bypass surgery. One patient with renal artery stenosis had patch angioplasty with great saphenous vein graft. CONCLUSIONS: Renal transplant patients also have possibilities to have severe atherosclerotic disease. Furthermore, transplanted kidney could be damaged during operation. Therefore, we have to do our best to prevent development and aggravation of atherosclerotic condition and try to minimize the ischemic injury of transplanted kidney during vascular operation in renal transplant patients.

The Anatomical Relationship of the Aortic Bifurcation and the Iliocaval Junction to the Lumbar Vertebrae in a Korean Population

PURPOSE: The objective of this study was to determine the anatomic significance and the level of the abdominal aortic bifurcation and the iliocaval junction in relation to the lumbar spine. METHOD: We conducted a retrospective study of 79 patients who underwent prosthetic replacement of an intervertebral disc by the anterior approach. The location of the aortic bifurcation and iliocaval junction and the size of the aorta and IVC were evaluated using CT angiography. The levels of the aortic bifurcation and iliocaval junction were recorded in relation to the upper or lower half of the adjacent vertebral body or intervertebral disc. RESULT: The aorta was bifurcated at the lower half of the L4 vertebral body in 35.4% of the cases. The iliocaval junction was between L4 and L5, and it was most often at the upper half of L5 (43.0%). CONCLUSION: The variability of the aortic bifurcation and iliocaval junction is high and an accurate description may be useful for using the various retroperitoneal approaches for not only aortic and venacaval surgery, but also for the anterior approach for spinal surgery.

Surgical Treatments for Takayasu's Arteritis

PURPOSE: Takayasu's arteritis (TA) is a chronic inflammatory, stenotic or aneurysmal disease of an unknown etiology. TA occurs worldwide, but it disproportionately affects young females of Asian descent. TA is known to affect a variety of vessels, but the subclavian artery, axillary artery, carotid arteries and infraabdominal aorta are most frequently affected. In this article, we evaluated surgical treatment as a modality for the management for TA. METHOD: We retrospectively reviewed 20 patients with TA and who were operated on from January 1994 to December 2007. RESULT: The ages of patients were ranged from 12 to 56 years. The ratio of males to females was 1 to 19. The main affected vessels were the subclavian artery (n=10), the common carotid artery (n=10), the abdominal aorta (n=4) and the renal artery (n=4). 20 patients with TA were operated on. 17 of them underwent arterioarterial bypass, and 5 patients received angioplasty. There were 8 cases of reoperation due to the effect on other arteries, or due the stenosis or occlusion of the previous bypass graft. Angioplasty and stenting can be used in the treatment of shorter stenoses such as those encountered in the renal arteries. CONCLUSION: Symptomatic patients who have Takayasu's arteritis can be operated on. Our surgical experiences have showed low mortality and the surgical procedures relieved the symptoms. Surgical therapy for Takayasu's arteritis was safe and it showed good results.

The Risk Factors for Pulmonary Embolism in Patients with Lower Extremity Deep Vein Thrombosis

PURPOSE: Pulmonary embolism (PE) represents the most important and fatal complication of deep vein thrombosis (DVT), of which a dislodged thrombus is most commonly derived from the deep venous system of the lower extremity. The aim of this study is to define the incidence and risk factors of PE in DVT patients. METHOD: We retrospectively reviewed 248 patients with DVT in a lower extremity at Uijeongbu St. Mary's Hospital between January 2000 and August 2008 and they had received additional examinations for making the diagnosis of PE regardless of its symptoms. RESULT: There were 117 men and 131 women, and their mean age was 59 years old (range: 13~91) at the time of diagnosis. There were 190 DVT-only patients and 58 patients with PE (the incidence rate of PE in the DVT patients: 23.8%). The gender ratio of the DVT only group was 1:1.3 (males: 83, female: 107) and the gender ratio of the DVT with PE group was 1:0.7 (males: 34, females: 24) (P<0.05). The risk factors of PE in the DVT patients were hypercoagulability (34%), cancer (23%), immobilization (17%), trauma/operation (10%), obesity (10%) and a past DVT history (7%). The idiopathic DVT patients had a relatively high cancer diagnosis rate (18.5%) and the majority of the newly detected cancer were from the chest or abdominal cavity. CONCLUSION: The incidence of DVT and PE is increasing and 23.8% of the DVT patients showed PE on their chest CT scan. The most significant risk factor for PE in the DVT patients was the male gender, yet an evaluation for cancer should be carefully done for idiopathic DVT patients because of their high rate of having cancer diagnosed.

Fenestration of the Common Femoral Artery in Patients with Acute Aortic Dissection Combined with Lower Limb Ischemia

Acute aortic dissection is a catastrophic event. Nowadays, the management of aortic dissection can be challenging with performing procedures such as aortic fenestration, stenting and endovascular treatment. While most cases of acute Stanford type A dissection are managed surgically, many cases of acute Stanford type B dissection are treated medically, although open surgery or stent-graft placement is sometimes performed. Patients with Stanford type B dissection may develop vascular complications such as mesenteric or peripheral ischemia, which cannot be managed medically. Fenestration is a procedure for decompressing the hypertensive false lumen by creating a hole in the distal part of the dissection flap and this allows outflow from the false lumen, it relieves branch vessel obstruction, it restores the flow to the ischemic organ and it reduces the risk of extension or rupture of the dissection. Urgent revascularization is required to correct mesenteric and renal ischemia and to restore distal perfusion if there is rest pain and ischemia signs at the lower extremity. We report here on a case of successful surgical fenestration of an acute aortic dissection for relief of lower limb ischemia, and we utilized a transfemoral artery to puncture the obstructed intimal flap.