Therapeutic strategy for pseudoaneurysms: a report of 21 cases / 介入放射学杂志

Objective To study the locations, types and causes of different pseudoaneurysms in order to find out the optimal individualized treatment for different pseudoaneurysms. Methods Different methods were applied in treating 21 patients with pseudoaneurysm, which were located at limb (n = 11 ), spleen (n =3), kidney (n = 2) , common lilac artery (n = 1), internal iliac artery (n = 1), gallbladder (n = 1) and penis (n = 1 ). Different managements were employed in treating these pseudoaneurysms. Temporary obstruction of blood circulation with balloon together with arterial anastomosis or direct incision neoplasty was performed in 9 cases with pseudoaneurysms at limb arteries close to the larger joints. Endovascular stent graft was used to isolate the trunk type of pseudoaneurysm in 4 cases, in 2 of them branch arterial embolism and stent graft endovascular exclusion were applied as they had common iliae artery trunk type of pseudoaneurysm at the opening of internal iliac artery. Gelfoam together with metallic coils embolization was employed in 6 cases with terminal type of pseudoaneurysms. Results After different treatments, tumor cavities disappeared in the 21 cases with pseudoaneurysms. Distal arterial pulse returned to normal and no nerve damage occurred in 11 cases with limb pseudoaneurysms. No internal hemorrhage was observed and distal blood circulation returned to normal after graft endovascular exclusion in 2 eases with pseudoaneurysms at spleen artery trunk and in 2 cases with pseudoaneurysms at iliac artery trunk. In 6 cases with terminal type of pseudoaneurysms,the tumor cavity disappeared, hemorrhage stopped and no ischemic necrosis of organ occurred. But one of them with multiple traumatic pseudoaneurysms located at the second grade branch died one week after embolism due to a serious pelvic trauma accompanied with serious infection. Conclusion Based on the locations, types and causes of pseudoaneurysms, different individualized treatment should be adopted in order to obtain optimal results with least damages.

Single Arterial Anastomosis in Case of the Presence of Multiple Hepatic Arteries and the Presence of Pulsatile Back Flow is Safe in Living Donor Liver Transplantation / 대한이식학회지

PURPOSE: The aim of this study is to analyze the outcome of a single hepatic artery anastomosis among multiple graft arteries in living donor liver transplantation. METHODS: A total of 153 LDLTs were performed at Seoul National University Hospital between January 1999 and December 2002. Thirty four cases (22.2%) of grafts were fed by multiple hepatic arteries. Twenty cases which were fed by left hepatic artery and middle hepatic artery, one intraoperative expired case and one case which was performed two hepatic arteries anastomosis were excluded in our study. Eight cases with two left hepatic arteries and 4 cases with two right hepatic arteries were reviewed. Hepatic artery anastomosis was carried out under operating microscope using interrupted Carrel's technique. In case of the presence of pulsatile back- flow after single hepatic artery anastomosis, the other hepatic artery was ligated. The median period of follow-up was 35 (26~58) months. RESULTS: There was no mortality due to complications associated with hepatic artery. In 11 cases, the adequate blood flow was verified daily for seven days after transplantation by means of Doppler ultrasonography. In 7 cases, intrahepatic arteries of donors seen on the preoperative CT aniography were confirmed at the same site on the postoperative CT angiography of recipients. Reoperation was performed for a one-year old child due to hepatic artery obstruction at the 11th postoperative day and she experienced acute rejection twice and steroid pulse therapy was performed. But she expired at the 107th postoperative day due to graft failure despite intact hepatic arterial flow on liver doppler sonography. CONCLUSION: Single hepatic artery anastomosis among multiple graft arteries had no complication. Thus single hepatic artery anastomosis among multiple graft arteries when pulsatile back flow existed, is safe and convenient method.

2 cases of aortic - coronary arterial anastomosis by antilogous vein

Two patients have undergone to myocardial revasculairisation with venous segments, removed from the lower leg. In one patients, two anastomosis has been performed (left anterio-descending artery and first diagonal branch). In the another, the anastomosis has been completed by continuous over and over suture on the left anterior descending artery, obtuse marginal artery and left postero-lateral branch. There are no morbidity and operative mortality.

Hepatic Venous Return in Atrial Isomerism Evaluated by MR / 대한흉부외과학회지

We performed this study to evaluate hepatic venous drainage in atrial isomerism by MR and the clinical significance of anomalous hepatic venous return in total cavopulmonary shunt operation. Numbers and locations of hepatic veins in twenty-two patients with isomerism(thirteen with right isomerism and nine with left isomerism) were evaluated by MR. Operative procedure of hepatic veins and postoperative arterial oxygen saturation were compared with hepatic vein connection in six patients after total cavopulmonary shunt operation. Among nine patients with left isomerism, hepatic venous return was totally anomalous via a single opening in eight, and via two separate openings in one. Among thirteen patients with right isomerism, partial anomalous hepatic venous connection directly to the atrium was seen in four. One showed total anomalous hepatic venous connection to atrium through one opening. Total cavopulmonary shunt operation was performed in 6 patients. Hepatic veins were connected to pulmonary arteries in four patients who had one atrial opening of hepatic vein and/or IVC, or two ipsilateral atrial opening of hepatic veins and IVC. In conclusion, hepatic vein drainage to atrium is variable in atrial isomerism. MR is useful for evaluation of hepatic vein drainage in atrial isomerism and surgical planning.

CO2 Laser and Bipolar Electrocautery Effects on Vessel Coagulation and Arterial Repair

Hemostatic effect is achieved most efficiently by bipolar electrocoagulation in the neurosurgical operation. As far as function is concerned, the laser surgical unit closely resembles the electrosurgical unit. It has been possible to unite arterial vessel ends in a very fast procedure by means of heat application with the laser or bipolar electrocautery. The authors studied the difference between the CO2 Laser and Bipolar Electrocautery Effects on coagulation and anastomosis of vessels experimentally. 46 rats weighing 200gm to 250gm, were used in this study. We divided the experimental animals into 4 groups : 1) arterial coagulation with the CO2 laser, 2) vessel coagulation with the bipolar electrocautery, 3) arterial anastomosis with the CO2 laser, 4) arterial anastomosis with the bipolar electrocautery. The CO2 laser was operated at 10 watts(W) to 50W for vessel coagulation, and 2W for arterial anastomosis. The output of bipolar generation(Malis type) varied from 10 to 80 dial setting (DS) for vessel coagulation or arterial anastomosis. The results obtained were as follows : 1) The lower limit of proper arterial coagulation by the CO2 laser was 20W, 3 seconds(sec) of exposure time with defocused beam. 2) The arteries were properly coagulated with the bipolar coagulator under the DS 30~40, coagulation time 2~4 sec. Over DS 50, the artery perforated to active bleeding. 3) The veins were coagulated satisfactorily under DS 20~30 with 1~5sec. of coagulation time. 4) Both temporary cease of blood flow and using blunt bipolar forceps reduced the coagulation time, and the arteries were not performed over DS 50. 5) Arterial anastomosis was accomplished with 2W, 0.05sec of exposure with 0.2mm of focused CO2 laser beam. With the bipolar coagulator, the arteries could be anastomosed under DS 5~10, 2~3sec. of coagulation time. 6) The patency rate after arterial anastomosis was 71% with the CO2 laser and was 22% with the bipolar coagulator. 7) In the histological examination of coagulated arteries, the entire layers of laser irradiated side revealed destruction and constriction of adventitia and media sparing intima on all around the vessel wall. Anastomosed site revealed coaptation of adventitia and media.