Study on Accessory Renal Artery.

Background: Knowledge of the variations of renal vascular anatomy has importance in exploration and treatment of renal trauma, renal transplantation, renovascular hypertension, renal artery embolization, angioplasty. The anomalies of accessory renal artery may be important from the clinical point of view. The importance of being familiar with the renal artery and segmental artery variability, which has become indispensable to urological surgery, has increased as a result of the large number of renal transplants and vascular reconstructions. Materials and Methods: 100 kidneys (Fifty pairs) intact with abdominal aorta were collected from department of Forensic department, JSS Medical College and Mysore Medical College. For study of segmental variation Corrosion cast technique method was used. The variations of posterior division were observed and recorded. Results: Accessory renal arteries were found in two specimens originating directly from aorta out of 100 specimens, it is recorded as 2%. Conclusion: In present study we observed 2% of cases as accessory renal artery. The recent days the increasing demand for kidney transplantation, grafts from living donor is major source for that, with this concept the knowledge of accessory renal artery very essential for kidney transplantation.

Suppression of Neointimal Hyperplasia by External Application of Cilostazol-Eluting Film at Anastomotic Sites in a Canine Model / 日本心臓血管外科学会雑誌

Neointimal hyperplasia is the principal mechanism of graft failure in coronary artery bypass surgery. Systemic administration of cilostazol has been reported to suppress neointimal hyperplasia in some vascular injury models. We sought to deliver cilostazol locally in an attempt to augment its beneficial effect to inhibit neointimal hyperplasia at an anastomotic site. We examined whether the external application of a novel cilostazol-eluting film can inhibit neointimal hyperplasia in a vascular anastomosis model. Canine femoral artery graft interposition was performed in 20 beagle dogs, assigned to 4 groups of 5 dogs each : a graft interposition without copolymer of L-lactide and ε-caprolactone (P (LA/CL) ) film (control group) and groups with P (LA/CL) film containing cilostazol of either 10 mg, 40 mg, or 80 mg doses. All the cilostazol-eluting film with 10 mg, 40 mg, and 80 mg dose groups had a reduced intima/media ratio compared to the control group (0.15±0.03, 0.11±0.03, and 0.12±0.03, vs. 0.31±0.03, <i>p</i><0.05). Immunohistochemical analyses for proliferating cell nuclear antigens revealed reduced cellular proliferating activity associated with decreased α-actin positive cells in the cilostazol-eluting film groups compared to the control group. External application of cilostazol-eluting film can inhibit neointimal hyperplasia, at least in part, by inhibiting smooth muscle cell proliferation in the intima.

Morphologic Follow-Up of the Anastomotic Sites Using One-year and Five-year Angiography after Coronary Artery Bypass Grafting / 대한흉부외과학회지

BACKGROUND: We analysed the characteristics of anastomotic sites after coronary artery bypass grafting (CABG) using coronary angiographies (CAGs) performed at one and five years postoperatively in the same patient population. MATERIAL AND METHOD: Among the 219 patients who underwent isolated CABGs between January 1995 and December 1997, follow-up coronary angiograms were performed in 149 (75.3%) patients at one year and in 115 (58.1%) patients at five years postoperatively. FitzGibbon grading system was used to evaluate the anastomotic sites. RESULT: The patency rates of arterial grafts at one- and five-year were 96.5% (192/199) and 93.1% (134/144), which were higher than those of saphenous vein grafts (SVGs) (82.9% (224/270) and 77.5% (141/182), respectively) (p=0.01). Although there were significant decreases in the patency rates between one- and five-year CAGs of both arterial and venous grafts, the proportion of FitzGibbon grade B among the SVGs was increased from 5.2% (one-year) to 8.2% (five-year), suggesting the progression of vein graft disease (p<0.01). CONCLUSION: The patency rate of the arterial graft was higher than that of SVG in both one- and five-year CAGs. The attrition rate of saphenous vein graft was higher than arterial grafts.

Off-Pump Coronary Artery Bypass Grafting

Coronary artery revascularization with arterial graft is believed to have superiority to that with vein graft with a long-term survival rate with its superb of patency rate. Furthermore, the bilateral internal thoracic artery grafting is an independent predictor of lower rates of angina recurrence, late myocardial infarction, and late cardiac events including reoperation or reintervention. Off-pump coronary artery bypass grafting (OPCAB), which means surgery under the beating heart without use of cardiopulmonary bypass (CPB), is a new attractive surgical strategy for coronary artery disease, because of its benefits for the patients with porcelain ascending aorta to prevent of cerebral emboli and comorbidities such as renal failure, cerebral event, right ventricle dysfunction, and pulmonary disease. The minimally invasive coronary bypass grafting, which means lesser incision, surgery without CPB, and early recovery, can be the surgical method of choice for single vessel disease or limited double vessel disease, with its advantages of early return to work and cosmetics. The OPCAB has been increasing steadily in Korea since 1996, comprising almost 900 cases among the 2,600 cases of bypass surgery performed in the whole country in 2001. The overall mortality rate of bypass surgery in Korea was near 2.3%, comparable to that in western countries. Conclusively, the surgical revascularization for coronary artery disease has the advantages of reducing the cost and lowering the cardiac event, such as reoperation or reintervention.

Uso das artérias torácicas internas esquerda e direita na revascularização da artéria coronária esquerda / The Left and Right Internal Thoracic Arteries Grafts for Revascularization of the Left Coronary Artery

PURPOSE: To analyze the late results of patients who underwent left coronary myocardial revascularization with both internal thoracic arteries, with the right internal thoracic through the transverse sinus. METHODS: From July/83 to September/96, 233 patients underwent myocardial revascularization, with ages ranging from 35 to 76 (average of 52.8) years. One hundred and eighty five were male and 48 female. Internal thoracic arteries (466), saphenous veins (192) and epigastric arteries (11) were employed. RESULTS: The hospital mortality was 3and the late mortality was 6.1. The immediate postoperative bleeding was 0.8, mediastinitis 1.7and myocardial infarction 2.1. The immediate and late coronariography showed the rates of patency, respectively: left internal thoracic artery 98and 96, right internal thoracic artery 96and 92, and saphenous vein grafts 80and 67.5. CONCLUSION: The main advantage in using both internal thoracic arteries in the revascularization of the left coronary branches was the better quality of life, the low rates of cardiac events and the absence of reoperation due to occlusion of the grafts.