Publications by authors named "Hyangkyoung Kim"

27 Publications

  • Page 1 of 1

The Prevalence of Concomitant Abdominal Aortic Aneurysm and Cancer.

J Clin Med 2021 Aug 27;10(17). Epub 2021 Aug 27.

Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul 08826, Korea.

Cancers and abdominal aortic aneurysms (AAA) cause substantial morbidity and mortality and commonly develop in old age. It has been previously reported that AAA patients have a high prevalence of cancers, which has raised the question of whether this is a simple collision, association or causation. Clinical trials or observational studies with sufficient power to prove this association between them were limited because of the relatively low frequency and slow disease process of both diseases. We aimed to determine whether there is a significant association between AAA and cancers using nationwide data. The patients aged > 50 years and diagnosed with AAA between 2002 and 2015, patients with heart failure (HF) and controls without an AAA or HF matched by age, sex and cardiovascular risk factors were enrolled from the national sample cohort from the National Health Insurance claims database of South Korea. The primary outcome was the prevalence rate of cancers in the participants with and without an AAA. The secondary outcome was cancer-related survival and cancer risk. Overall, 823 AAA patients (mean (standard deviation) age, 71.8 (9.4) years; 552 (67.1%) men) and matching 823 HF patients and 823 controls were identified. The prevalence of cancers was 45.2% (372/823), 41.7% (343/823) and 35.7% (294/823) in the AAA, HF and control groups, respectively; it was significantly higher in the AAA group than in the control group ( < 0.001). The risk of developing cancer was higher in the AAA patients than in the controls (adjusted odds ratio (OR), 1.52 (95% confidence interval [CI], 1.24-1.86), < 0.001) and in the HF patients (adjusted OR, 1.37 (1.24-1.86), = 0.006). The cancer-related death rate was 2.64 times higher (95% CI, 2.22-3.13; < 0.001) for the AAA patients and 1.63 times higher (95% CI, 1.37-1.92; < 0.001) for the HF patients than for the controls. The most common causes of death in the AAA patients were cancer and cardiovascular disease. There was a significantly increased risk of cancer in the AAA than in the HF and control groups. Therefore, appropriate screening algorithms might be necessary for earlier detection of both diseases to improve long-term survival.
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http://dx.doi.org/10.3390/jcm10173847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432173PMC
August 2021

A multicenter randomized controlled trial of cyanoacrylate closure and surgical stripping for incompetent great saphenous veins.

J Vasc Surg Venous Lymphat Disord 2021 Aug 23. Epub 2021 Aug 23.

Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Korea. Electronic address:

Objective: Treatment of varicose veins has been shifted from conventional surgical stripping (SS) to minimally invasive endovenous modalities. Cyanoacrylate closure (CAC) with the Venaseal system has gained popularity owing to its non-thermal and non-tumescent technique. The purpose of this study was to compare the clinical outcomes of CAC with SS for the treatment of incompetent great saphenous veins.

Methods: An open-label, multicenter, prospective, randomized controlled trial was conducted. Subjects were randomized to either the CAC or the SS procedure. The primary endpoint of the study was to evaluate the complete closure of the target vein at 3 months. Target vein occlusion was assessed on the third day and 1, 3, 6, and 12 months postoperatively, using duplex ultrasound. Pain and ecchymosis grades were also assessed. Additionally, clinical outcomes, such as the Venous Clinical Severity Score (VCSS) and Aberdeen Varicose Vein Questionnaire (AVVQ) score, were assessed.

Results: Of 126 enrolled and randomized subjects, a 3-month follow-up was obtained for all subjects (63 with CAC and 63 with SS). At 3 months, complete target vein closure was observed in both groups. The postoperative pain score was significantly better in the CAC group than in the SS group (0.3 ± 0.6 in the CAC group and 1.1 ± 1.5 in the SS group, p<0.001). In addition, the mean ecchymosis grade was 0.3 ± 0.5 in CAC group and 1.1 ± 1.1 in the SS group (p<0.001). VCSS and quality of life improved equally in both groups. Adverse events after both procedures were mostly minor complications (9 events in CAC group and 20 events in SS group). Major complications occurred in one patient who underwent the SS procedure.

Conclusion: Both CAC and SS procedures were associated with complete occlusion of the target vein at 3 months. Postoperative pain and ecchymosis grades were significantly lower in the CAC group. Other differences between the two groups were the frequency and nature of the complications. CAC has high success with few complications.
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http://dx.doi.org/10.1016/j.jvsv.2021.08.012DOI Listing
August 2021

Tailored approach to the choice of long-term vascular access in breast cancer patients.

PLoS One 2021 22;16(7):e0255004. Epub 2021 Jul 22.

Division of Vascular and Transplantation Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

This study compared the possible options for vascular access in breast cancer patients by analyzing the complications of each method. We retrospectively evaluated the vascular access procedures for intravenous chemotherapy in breast cancer patients from 2016 to 2018. A total of 300 consecutive patients were included, 100 each who received peripherally inserted central catheters (PICCs), arm ports, and chest ports. When selecting a catheter, a PICC was considered when four cycles of chemotherapy were expected. Otherwise, patient preference was considered. All but one patient with an arm port were women, with mean age of 51.7 ± 9.1 years. The total mean complication-free catheter indwelling time was 1357.6 days for chest ports, 997.8 days for arm ports, and 366.8 days for PICCs (p = 0.004). There were 11 catheter-related complications (3.7%), one in a chest port patient, five in arm port patients, and eight in PICC patients. There was no patient with catheter related blood stream infection or deep vein thrombosis. All three types of catheters could be used in breast cancer patients without causing serious complications. The selection of catheter considering the clinical situation was effective for providing a safe and secure chemotherapy delivery route.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255004PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297812PMC
July 2021

Characteristics, clinical presentation, and treatment outcomes of venous malformation in the extremities.

J Vasc Surg Venous Lymphat Disord 2021 Jun 4. Epub 2021 Jun 4.

Division of Vascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY. Electronic address:

Objective: The clinical presentation of venous malformations (VMs) is variable and not well documented. The present study was designed to determine the clinical characteristics and outcomes in association with the type and extent of VM in the extremities.

Methods: Patients with a diagnosis of a VM using ultrasound, computed tomography, or magnetic resonance imaging were included in the present study. The VM extent and tissue involvement, signs, and symptoms were retrospectively collected. Those with arteriovenous malformations, Klippel-Trenaunay syndrome, lymphedema, and symptoms from other unrelated diseases were excluded. The VMs were classified as extensive or localized according to whether different tissues or the entire compartment was involved. The clinical outcomes and imaging studies were obtained for both the treated patients and those who had chosen to not undergo any intervention.

Results: A total of 72 patients, of whom 26 were men, were included in the present study, with a median age of 30 years. The VM had extended into the subfascial space in 40 patients (55.6%). Patients with VM distributed on their leg had mostly experienced pain, which was more evident during physical activity (n = 40; 80.0%), with swelling worsening with prolonged standing (n = 35; 70.0%). For those with VMs in the upper extremities, the most prominent complaints were venous enlargement (n = 10; 45.5%), pain (n = 9; 40.9%), and swelling (n = 11; 50.0%). The symptoms were related to the extent of the lesion (odds ratio, 7.664; 95% confidence interval, 2.006-29.291; P = .003). Treatment was decided by the extent and depth of the lesions. Excision was performed in 15 patients (20.8%), sclerotherapy in 12 (16.7%), sclerotherapy with phlebectomy or coil embolization in 8 (11.1%), and stripping in 2 (2.8%). An excellent result was achieved with the treatment of localized VMs. For those with extensive VMs, the symptom intensity was reduced or controlled after multiple treatments.

Conclusions: VMs of the extremities affect patients' quality of life significantly owing their appearance and the resulting pain. The VM extent was associated with symptom severity. The clinical outcomes have been excellent for localized VMs; however, extensive VMs will require multiple treatments to reduce the symptom intensity.
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http://dx.doi.org/10.1016/j.jvsv.2021.05.011DOI Listing
June 2021

Association between Laterality and Location of Deep Vein Thrombosis of Lower Extremity and Pulmonary Embolism.

Vasc Specialist Int 2021 May 25;37:12. Epub 2021 May 25.

Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Purpose: The aim of this study was to investigate the relationship between the anatomical location of thrombi in the lower extremities and the development of pulmonary embolism (PE).

Materials And Methods: We collected and analyzed the data of patients diagnosed with deep vein thrombosis (DVT) of the lower extremities between 2006 and 2015, and included those whose computed tomography (CT) data were available for PE identification. We evaluated the relationship between the laterality and the proximal/distal location of the thrombi in lower extremites and the location of PE.

Results: CT images were available for 388/452 patients with DVT. After excluding 32 cases with bilateral involvement, 356 cases were included for analysis in this study. The ratio of DVT in the left:right leg was 232:124. PEs developed in 121 (52.2%) patients with left-sided DVT and in 78 (62.9%) with right-sided DVT (P=0.052). PEs in the main pulmonary arteries developed in 36 (15.5%) patients with left leg DVT and in 30 (24.2%) with right leg DVT (P=0.045). The most frequent site of thrombosis associated with the development of PE was the left iliac vein (59/199, 29.6%). According to the anatomical segment of the leg affected by DVT, patients with DVT in the right femoral vein (50/71, 70.4%; P=0.016) had the highest rate of occurrence of PE.

Conclusion: PE develops more frequently in patients with right-sided DVT than in those with left-sided DVT. Therefore, careful observation for the possible development of PE is recommended in cases with right-sided DVT of the lower extremity.
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http://dx.doi.org/10.5758/vsi.200075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186311PMC
May 2021

Duplex ultrasound findings and clinical outcomes of carotid restenosis after carotid endarterectomy.

PLoS One 2020 29;15(12):e0244544. Epub 2020 Dec 29.

Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

This study aimed to describe the duplex ultrasound (DUS) findings associated with carotid restenosis after carotid endarterectomy (CEA) and to determine whether carotid restenosis is associated with the clinical outcomes of CEA. Between January 2007 and December 2016, a total of 660 consecutive patients who underwent 717 CEAs were followed up at our hospital with DUS surveillance for at least 3 years after CEA. These patients were analyzed retrospectively for this study. Following CEA, restenosis was defined as the development of ≥50% stenosis, diagnosed on the basis of DUS findings of the luminal narrowing and velocity criteria. The study outcomes were defined as restenosis of the ipsilateral carotid artery after CEA and late (>30days) fatal or nonfatal stroke ipsilateral to the carotid restenosis. During the median follow-up period of 74 months, the restenosis incidence was 2.8% (20/717), and there were 2 strokes (2/20, 10%) ipsilateral to the restenosis after CEA; reintervention was performed for 11 patients with carotid restenosis (55%). Within 2 years after CEA, restenosis was identified in 9 cases (45%, 9/20), and 8 reinterventions (72.7%, 8/11) were performed. According to DUS findings, the morphologic characteristics of carotid restenosis were different from the preoperative plaque morphology. Among the 20 carotid restenosis cases, we observed the following DUS patterns: homogenous isoechoic restenosis (n = 14, 70%), homogenous hypoechoic (n = 2, 10%), isoechoic with hypoechoic surface (n = 3, 15%), and hypoechoic with isoechoic surface (n = 1, 5%). Although 9 carotid restenosis patients received prophylactic reintervention to mitigate the progression of restenosis, the 2 symptomatic restenosis patients had isoechoic lesions with hypoechoic surfaces on DUS. On Kaplan-Meier survival analyses, in terms of stroke-free survival rates, there was a higher risk of stroke among patients with carotid restenosis compared with patients without restenosis, with a non-significant trend (P = 0.051). In conclusion, most carotid restenoses were identified within 2 years after CEA, and there was a non-significant trend toward a higher risk of stroke among patients with carotid restenosis.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244544PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771870PMC
March 2021

CASS (CyanoAcrylate closure versus Surgical Stripping for incompetent saphenous veins) study: a randomized controlled trial comparing clinical outcomes after cyanoacrylate closure and surgical stripping for the treatment of incompetent saphenous veins.

Trials 2020 Jun 3;21(1):460. Epub 2020 Jun 3.

Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 07061 20 Boramae-ro, Dongjak-gu, Seoul, South Korea.

Background: Several modalities are used for the treatment of varicose veins. Open surgical treatment with ligation and stripping of the saphenous vein has been the standard of care for many years. Endovenous thermal ablation has been shown to be a safe and effective alternative with high, long-term, target-vein closure rates. Despite this, there is the possibility of thermal injury to surrounding structures. The recently introduced cyanoacrylate closure is also considered to be a good alternative and the risk of injury to surrounding structures is minimal. The purpose of this study is to demonstrate the non-inferiority of cyanoacrylate closure with the VenaSeal™ closure system compared to surgical stripping in terms of clinical outcomes for the treatment of incompetent great saphenous veins.

Methods/design: This is an open-label, multicenter, prospective, randomized controlled trial evaluating the non-inferior clinical outcomes of cyanoacrylate closure compared to surgical stripping for the treatment of incompetent saphenous veins. After baseline measurements, participants will be randomly allocated into either the cyanoacrylate closure group or the surgical-stripping group. The primary endpoint of the study is the complete closure rate of the target vein in the cyanoacrylate closure group, and the absence of venous reflux or residual venous tissue after surgical stripping in the surgical-stripping group. These endpoints will be measured by Doppler ultrasound performed by qualified vascular technologists or investigators at 3 months after treatment. Secondary outcomes include perioperative pain, postoperative ecchymosis, clinical assessment (including general and disease-specific quality of life evaluations), complete closure rate, and absence of venous reflux or residual venous tissue at the 12- and 24-month follow-ups, as well as all adverse event rates during the 24-month follow-up period.

Discussion: This multicenter randomized controlled trial is designed to show non-inferiority in terms of complete closure rate of cyanoacrylate compared to surgical stripping for the treatment of incompetent saphenous veins.

Trial Registration: Clinical Research Information Service (CRIS), ID: KCT0003203. Registered on 20 September 2018.
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http://dx.doi.org/10.1186/s13063-020-04393-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268719PMC
June 2020

Outcomes of bedside peripherally inserted central catheter placement: a retrospective study at a single institution.

Acute Crit Care 2020 Feb 11;35(1):31-37. Epub 2020 Feb 11.

Division of Vascular and Transplant Surgery, Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Background: Bedside insertion of peripherally inserted central catheters (PICCs) has higher rates of malposition than fluoroscopic-guided PICC placement. This study evaluated the success rate of bedside PICC placement, variations in tip location, and risk factors for malposition.

Methods: This retrospective study included patients who underwent bedside PICC placement from January 2013 to September 2014 in a single institution. The procedure was conducted under ultrasound guidance or by a blind method. After PICC placement, tip location was determined by chest X-ray.

Results: The overall venous access success rate with bedside PICC placement was 98.1% (1,302/ 1,327). There was no significant difference in the venous access success rate between ultrasound-guided placement (868/880, 98.6%) and a blind approach placement (434/447, 97.1%). Optimal tip position was achieved on the first attempt in 1,192 cases (91.6%). Repositioning was attempted in 65 patients; 60 PICCs were repositioned at the bedside, two PICCs were repositioned under fluoroscopic guidance, and three PICCs moved to the desired position without intervention. Final optimal tip position after repositioning was achieved in 1,229 (94.4%). In logistic regression analysis, five factors associated with tip malposition included female sex (Exp(B), 1.687; 95% confidence interval [CI], 1.180 to 2.412; P=0.004), older age (Exp(B), 1.026; 95% CI, 1.012 to 1.039; P<0.001), cancer (Exp(B), 0.650; 95% CI, 0.455 to 0.929; P=0.018), lung disease (Exp(B), 2.416; 95% CI, 1.592 to 3.666; P<0.001), and previous catheter insertions (Exp(B), 1.262; 95% CI, 1.126 to 1.414; P<0.001).

Conclusions: Bedside PICC placement without fluoroscopy is effective and safe in central venous catheters. Potential risk factors associated with catheter tip malposition include older age, female sex, cancer, pulmonary disease, and previous central vein catheterizations.
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http://dx.doi.org/10.4266/acc.2019.00731DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7056959PMC
February 2020

The role of aortomesenteric angle in occurrence of spontaneous isolated superior mesenteric artery dissection.

Int Angiol 2020 Apr 12;39(2):125-130. Epub 2020 Feb 12.

Department of Surgery, Stony Brook University Medical Center, New York, NY, USA -

Background: This study investigated whether anatomical factors affect the occurrence of SISMAD by measuring the aortomesenteric angle (AMA).

Methods: The study population is comprised of 3 distinct population; Korean SISMAD patients, two control groups from a medical checkup database of 4997 Korean and 317 Caucasian patients from 2011 to 2016. The patient group (PG) included 26 symptomatic patients and 19 Korean diagnosed with SISMAD during medical checkup. The control group was selected based on propensity score similarities calculated by using the following covariates: sex, age, body mass index, drinking, smoking, hypertension, diabetes, and cancer. We compared PG with equal numbers of two control groups comprised of Koreans (KG) and Caucasians (FG), respectively.

Results: The mean (SD) AMA was 74.9o (17.5) (range, 45.9-110.9o) in the PG, 56.8o (19.5 (range, 10.2o -91.9o) in the FG, and 62.4o (19.1) (range, 25.4-110.8o) in the KG. A significant difference was observed between PG and the two control groups (P<0.001). The AMA in the FG was significantly more acute than the AMA in Korean patients including those in the PG and KG (P=0.001).

Conclusions: Large AMA is considered to be an important etiologic factor in SISMAD.
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http://dx.doi.org/10.23736/S0392-9590.20.04314-XDOI Listing
April 2020

Outcomes of Spontaneous Isolated Superior Mesenteric Artery Dissection Without Antithrombotic Use.

Eur J Vasc Endovasc Surg 2018 Jan 8;55(1):132-137. Epub 2017 Dec 8.

Department of Surgery, Ulsan University Hospital and University of Ulsan College of Medicine, Republic of Korea.

Objectives: This study aimed to show the intention to treat results of treatment for spontaneous isolated superior mesenteric artery dissection (SISMAD) without anticoagulation or antiplatelet agents and the follow-up results of SISMAD according to the configuration on computed tomography (CT) scans.

Design: Retrospective, observational single centre study METHODS: All cases of SISMAD were enrolled consecutively from 2006 onwards. There were 25 symptomatic and four asymptomatic patients in whom SISMAD was found incidentally. The SISMAD patients were treated using a consistent therapeutic strategy without antithrombotics. SISMAD was categorized into four types based on the configuration on CT scans by Yun's classification. Follow-up CT was performed at 3 months, 6 months, and yearly thereafter.

Results: The median follow-up duration was 57 months (13-129 months). Improvement or complete resolution on CT scans, with no symptom recurrence, was seen in 27 patients. The non-invasive approach failed in three cases and two patients underwent further intervention. No patient died during the follow-up.

Conclusions: Weighing the risks versus benefits of antithrombotics and considering the benign nature of SISMAD, conservative treatment without antithrombotics might be sufficient in patients without evidence of bowel ischaemia or infarction on initial CT scan.
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http://dx.doi.org/10.1016/j.ejvs.2017.11.002DOI Listing
January 2018

Usefulness of Doppler waveform analysis before performing a complex procedure using femoral venous access.

J Clin Ultrasound 2018 Feb 21;46(2):157-159. Epub 2017 Nov 21.

Department of Cardiology, College of Medicine, Chung-Ang University, Seoul, Korea.

Ultrasonography is a well-defined and widely accepted technique in the settings of interventional procedures requiring peripheral venous access, either for the confirmation of the vein patency (with the compression test) or for guiding needle insertion. This report describes a case of unsuccessful guidewire passage through the right iliac vein in spite of successful ultrasonography-guided puncture of the femoral vein. On repeat duplex ultrasonography, the Doppler waveform showed a continuous pattern without respiratory phasicity, which was consistent with proximal venous occlusion. Venous Doppler signal waveform analysis can be helpful for ensuring downstream patency when planning long-distance catheterization via femoral venous access.
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http://dx.doi.org/10.1002/jcu.22564DOI Listing
February 2018

Effect of systemic immunosuppressive drugs on the patency of hemodialysis accesses
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Clin Nephrol 2018 Jan;89 (2018)(1):27-33

Aim: Intimal hyperplasia remains the leading cause of late hemodialysis access stenosis or occlusion. This study assessed the influence of conventional immunosuppressive drugs on the patency of hemodialysis accesses in patients with a history of organ transplantation.

Materials And Methods: Between January 2002 and December 2007, 1,654 patients underwent an operation for hemodialysis access. 135 patients received immunosuppressive therapy (IT); of these, 115 underwent an operation for hemodialysis access after transplanted graft failure and 20 patients after liver transplantation. The 5-year primary patency rates of hemodialysis access were compared twice between the entire study population and the matched cohorts using a 1 : 4 propensity score.

Results: A total of 82.2% of the nontransplanted (NT) patients and 71.9% of the IT patients had arteriovenous fistulas (AVFs). The 5-year primary patency rate was 74.0% for the NT group and 51.5% for the IT group (p < 0.001). The characteristics of the matched cohorts (135 IT patients and 536 NT patients) were well balanced; the 5-year primary patency rates were 70.0% and 54.9% for the NT and IT groups, respectively (p = 0.030). A significant impact of IT on primary patency was not observed in the matched cohort (hazard ratio, 0.930; 95% confidence interval, 0.706 - 0.226; p = 0.608).

Conclusion: Systemic administration of immunosuppressive drugs did not significantly affect the patency of AVF or arteriovenous graft (AVG) access in the present study.
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http://dx.doi.org/10.5414/CN108956DOI Listing
January 2018

Effects of upper-extremity vascular access creation on cardiac events in patients undergoing coronary artery bypass grafting.

PLoS One 2017 5;12(9):e0184168. Epub 2017 Sep 5.

Department of and Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea.

The present study was conducted to investigate whether upper-extremity vascular access (VA) creation increases the risk for major adverse cardiac events (MACE) and death in patients undergoing coronary artery bypass grafting (CABG) with an in situ left internal thoracic artery (ITA) graft. A total of 111 patients with CABG with a left ITA graft who underwent upper-extremity VA creation were analyzed retrospectively; 93 patients received left VA creation (83.8%, ipsilateral group) and 18 patients received right VA creation (16.2%, contralateral group). The primary outcome was the occurrence of MACE, and the secondary outcome was the composite of MACE or late death. There were no significant differences in the incidence of primary (P = 0.30) or secondary (P = 0.09) outcomes between the two groups. Multivariate regression analysis indicated that prior cerebrovascular accidents (hazard ratio [HR] 3.30; 95% confidence interval [CI] 1.37-7.97; P = 0.01) and type of VA (HR 3.44; 95% CI 1.34-8.82; P = 0.01) were independently associated with MACE; prior peripheral arterial occlusive disease (HR 4.22; 95% CI 1.62-10.98; P<0.01) and type of VA (arteriovenous fistula vs. prosthetic arteriovenous grafting) (HR 3.06; 95% CI, 1.42-6.61; P<0.01) were associated with the composite of MACE or death. The side and location of VA were not associated with MACE or death. Our study showed no definite evidence that ipsilateral VA creation affects the subsequent occurrence of MACE or late death from any cause. The type of VA (a prosthetic arteriovenous grafting) is a significant predictor of the subsequent occurrence of MACE or late death.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0184168PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584927PMC
October 2017

Impact of diabetes duration and degree of carotid artery stenosis on major adverse cardiovascular events: a single-center, retrospective, observational cohort study.

Cardiovasc Diabetol 2017 06 6;16(1):74. Epub 2017 Jun 6.

Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 05505, South Korea.

Background: We aimed to investigate the impact of diabetes duration and carotid artery stenosis (CAS) on the occurrence of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) without clinical cardiovascular disease.

Methods: A total of 2006 patients with T2DM, without clinical cardiovascular disease, aged >50 years, and who underwent baseline carotid Doppler ultrasound screening with regular follow-ups at the outpatient clinic of our diabetes center, were stratified into four subgroups according to diabetes duration and CAS degree. The primary outcomes included the occurrence of MACE, defined as fatal or nonfatal stroke and myocardial infarction, and all-cause mortality.

Results: The difference in the MACE incidence was significantly greater in patients with a longer diabetes duration (≥10 years) and significant CAS (50-69% luminal narrowing) (p < 0.001). Analysis of individual MACE components indicated a trend towards an increased incidence of stroke (p < 0.001), parallel to a longer diabetes duration and significant CAS. In contrast, the risk of myocardial infarction was significantly higher in patients with a diabetes duration <10 years and significant CAS (p = 0.039). Multivariate regression analysis showed that patients with both a longer diabetes duration and significant CAS demonstrated additive and very high risks of MACE (hazard ratio [HR], 2.07; 95% confidence interval [CI] 1.17-3.66; p = 0.012) and stroke (HR, 3.38; 95% CI 1.54-7.44; p = 0.002).

Conclusions: The risk of MACE is significantly greater in patients with T2DM, without clinical cardiovascular disease, who have both a longer diabetes duration and significant CAS, compared with those who have a shorter duration and/or nonsignificant CAS.
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http://dx.doi.org/10.1186/s12933-017-0556-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461631PMC
June 2017

Alcohol Consumption, High-Density Lipoprotein Cholesterol, Antithrombin III, and Body Mass Index Are Associated with Great Saphenous Vein Reflux in the Thigh.

Ann Vasc Surg 2017 Oct 10;44:307-316. Epub 2017 May 10.

Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea. Electronic address:

Background: Venous valvular reflux is the main cause of chronic venous dysfunction. However, the etiology of valvular reflux is not completely understood. We conducted this study to investigate new risk factors for venous reflux of the great saphenous vein (GSV) in the thigh.

Methods: We studied 139 consecutive patients (278 legs) who underwent Doppler ultrasonography at our hospital between March 2015 and February 2016 for leg discomfort with visible varicosities, edema, skin changes, or venous ulcer in the legs. Continuous variables included age, body mass index (BMI), hematological and blood chemistry parameters, smoking (pack-years), and alcohol consumption (days). Nominal variables included sex, comorbidities, smoking status, alcohol drinking status, and specific antibodies. The relationship of GSV reflux with pregnancy and number of children was investigated in 184 legs of 92 patients among 96 female patients.

Results: On logistic regression analysis, independent factors determining GSV reflux were BMI (B = 0.126, P = 0.012), high-density lipoprotein (HDL) cholesterol level (B = 0.029, P = 0.025), duration of alcohol consumption (B = 1.237 E, P = 0.016), and antithrombin III level (B = -0.036, P = 0.011).

Conclusions: In this study, the factors determining GSV reflux were higher HDL cholesterol level, longer duration of alcohol consumption, lower antithrombin III level, and higher BMI.
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http://dx.doi.org/10.1016/j.avsg.2017.05.004DOI Listing
October 2017

Multifocal Myoclonus as a Manifestation of Acute Cerebral Infarction Recovered by Carotid Arterial Stenting.

J Mov Disord 2017 Jan 18;10(1):64-66. Epub 2017 Jan 18.

Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.

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http://dx.doi.org/10.14802/jmd.16040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5288662PMC
January 2017

Clinical Outcomes of Anticoagulation Therapy in Patients With Symptomatic Spontaneous Isolated Dissection of the Superior Mesenteric Artery.

Medicine (Baltimore) 2016 Apr;95(16):e3480

From the Departments of Surgery (YH, Y-PC, HK, T-WK), Radiology (GYK), Internal Medicine (DWS), and Biostatistics Collaboration Unit (MJK), University of Ulsan College of Medicine and Asan Medical Center; and Department of Surgery (HK), Chung-Ang University Hospital, Seoul, Republic of Korea.

The aim of this study was to determine the clinical outcomes of long-term anticoagulation therapy in patients with symptomatic spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) and to evaluate whether conservative treatment with anticoagulation therapy is a safe and effective treatment modality for these patients.In this single center, observational cohort study, data from a prospectively recruiting symptomatic SIDSMA registry, including demographics, risk factors of interest, clinical characteristics and outcomes, and initial and follow-up computed tomography angiography (CTA) findings, were analyzed retrospectively. During an 8-year period, a total of 52 consecutive patients who underwent conservative treatment with the use of long-term anticoagulation were included in this study. Clinical symptoms resolved within 11 days in all except 4 patients (7.7%); 3 received endovascular treatment for persistent symptoms and 1 received surgical repair. The mean duration of anticoagulation therapy was 9 (range: 3-60) months. A follow-up CTA showed complete remodeling in 20 (41.7%) patients, and the mean diameter and the incidence of false lumen thrombosis were also decreased significantly. There was no anticoagulation therapy-related mortality or morbidity except 2 (4.2%) minor bleeding complications, and no symptomatic recurrence or aggravation of the dissection occurred during the mean follow-up period of 47.5 (range: 10-97) months. The present study showed that long-term anticoagulation therapy could result in a high rate of complete remodeling during the natural course of symptomatic SIDSMA. Conservative treatment with long-term anticoagulation therapy could be an optimal treatment strategy for symptomatic SIDSMA.
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http://dx.doi.org/10.1097/MD.0000000000003480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845857PMC
April 2016

Comparison of surgical and endovascular salvage procedures for juxta-anastomotic stenosis in autogenous wrist radiocephalic arteriovenous fistula.

Ann Vasc Surg 2014 Nov 7;28(8):1840-6. Epub 2014 Jul 7.

Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea. Electronic address:

Background: Although dysfunctional radiocephalic arteriovenous fistulas (RCAVFs) are typically treated surgically, the endovascular approach is also considered suitable. The aim of this retrospective study was to compare the cumulative patency rates following surgical and endovascular salvaging of dysfunctional RCAVFs, and to evaluate whether the maturity of vascular access sites at the time of treatment influenced the outcomes.

Methods: A total of 60 patients underwent surgical or endovascular salvage treatment for juxta-anastomotic stenosis of autogenous wrist RCAVFs: 35 patients underwent proximal neo-anastomosis and 25 underwent percutaneous transluminal angioplasty (PTA).

Results: Clinical and anatomical success rates were, respectively, 100% and 97.1% in the surgery group, and 100% and 96.0% in the angioplasty group (P = 0.81). The post-treatment restenosis rate was higher in the angioplasty group (n = 11, 46.0%) than in the surgery group (n = 8, 22.8%), without reaching statistical significance (P = 0.15). In a Kaplan-Meier analysis, the primary and assisted primary patency rates were significantly higher in the surgery group (P = 0.036 and P = 0.026, respectively), but there was no significant difference in secondary patency rates between the groups (P = 0.52). When stratified by RCAVF maturity at the time of treatment, no significant difference was noted in primary patency rates between the treatment groups. After adjusting for other variables, the relative risk of restenosis was significantly higher in the angioplasty group (hazard ratio 2.56; 95% confidence interval 1.02-6.46; P = 0.046).

Conclusions: Post-treatment primary and assisted primary patency rates after proximal neo-anastomosis were significantly higher than after PTA, and RCAVF maturity did not influence the outcomes.
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http://dx.doi.org/10.1016/j.avsg.2014.06.060DOI Listing
November 2014

Frequency and evolution of thin-capped fibroatheromas in left main coronary artery as assessed by serial virtual histology intravascular ultrasound analysis.

J Invasive Cardiol 2014 Apr;26(4):175-9

Heart Research Institute, Chung-Ang University Medical Center, 224-1 Heukseok Dong, Dongjak Gu Seoul, Korea, 156-755.

Background: The objective of the current study was to assess thin-capped fibroatheroma (TCFA) of the left main coronary artery (LMCA) and its changes after statin therapy.

Methods: We assessed the frequency and distribution of virtual histology intravascular ultrasound (VH-IVUS) thin-capped fibroatheroma (VH-TCFA) in the LMCA in 500 patients. Serial VH-IVUS examinations were available in 50 patients at 12-month follow-up.

Results: The incidence of LM-TCFA was 8.8% (44/500). IVUS LMCA length was longer in patients with VH-TCFA vs without VH-TCFA. Reference external elastic membrane (EEM) area was similar, but reference lumen area and minimal lumen area were smaller in LMCA with VH-TCFA vs without VH-TCFA (P<.001). LMCA with VH-TCFA had a higher plaque burden (P<.001), a larger necrotic core area (P<.001), and more dense calcium (P<.001) at the maximum necrotic core (NC) site vs LMCA without VH-TCFA. In patients with an LMCA length greater than the median, 62% were located in the distal half of the LMCA. After 12 months of statin therapy, only 44.4% (4/9) of VH-TCFA had evolved to a non- VH-TCFA phenotype and 3 new VH-TCFA had appeared.

Conclusion: VH-TCFAs are clustered in the distal half of the LMCA with infrequent positive remodeling. It might persist despite the usual dose of statin therapy. Further study should confirm the changes in large vessels like the LMCA.
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April 2014

Effect of Active Hexose Correlated Compound (AHCC) in alcohol-induced liver enzyme elevation.

J Nutr Sci Vitaminol (Tokyo) 2014 ;60(5):348-56

Department of Surgery, Chung-Ang University Healthcare System, Chung-Ang University College of Medicine.

To investigate the effects of Active Hexose Correlated Compound (AHCC) supplementation and the mechanism action of AHCC in patients with alcohol-induced mildly elevated liver enzyme levels, participants were randomly allocated to the placebo, 1 g AHCC, or 3 g AHCC group and took the supplement for 12 wk. Subjects visited the hospital for clinical and biochemical measurements, for examination of adverse events, to return unused supplements, and to obtain their next supplements. Biochemical tests including liver enzymes, a questionnaire survey, and anthropometric measurements were collected at baseline and every 4 wk thereafter. Adherence and adverse events were evaluated. After 12 wk of supplementation, the percentage change in alanine aminotransferase (ALT) level was significantly different between the placebo (4.02±59.07%) and both AHCC groups (1 g AHCC: 223.89±20.59%, 3 g AHCC: 224.09±30.73%) (p=0.04). Serum levels of tumor necrosis factor-α (p<0.05) and interleukin-1β (p<0.01) were significantly lower, while those of adiponectin were higher in both AHCC groups than in the placebo group (p<0.01). AHCC supplementation for 12 wk may improve the levels of liver enzymes and circulating pro-inflammatory and anti-inflammatory cytokines in patients with alcohol-induced liver enzyme elevation with mildly elevated liver enzyme levels.
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http://dx.doi.org/10.3177/jnsv.60.348DOI Listing
October 2015

Arthroscopic reduction and internal fixation of acetabular fractures.

Knee Surg Sports Traumatol Arthrosc 2014 Apr 5;22(4):867-70. Epub 2013 Dec 5.

Department of Surgery, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, South Korea.

Arthroscopic reduction and screw fixation of acetabular fractures have not been reported. In this case report, arthroscopic treatment for acetabular fracture is reported for two patients. A 49-year-old man diagnosed with acetabular posterior wall fracture was treated by arthroscopic reduction and fixation using two screws. A 20-year-old woman who diagnosed with anterior column fracture was fixed using a screw using the arthroscopic technique prior to open reduction and internal fixation in the iliac bone fracture. Arthroscopic reduction and fixation in some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal.
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http://dx.doi.org/10.1007/s00167-013-2799-yDOI Listing
April 2014

Bilateral ischemic lumbosacral plexopathy from chronic aortoiliac occlusion presenting with progressive paraplegia.

J Vasc Surg 2014 Jan 31;59(1):241-3. Epub 2013 May 31.

Department of Thoracic Cardiovascular Surgery, Chung-Ang University, College of Medicine, Seoul, Korea.

Spinal cord ischemia is rare but causes significant morbidity and mortality. Spinal cord ischemia has been reported after open and endovascular interventions of the thoracic and abdominal aorta, and, rarely, acute occlusion of aorta from in situ thrombosis or acute embolic occlusion. Acute interruption of the critical blood supply to the spinal cord or root contributes to this devastating neurologic deficit. However, gradually worsening lumbosacral plexopathy and consequent paraplegia related to chronic aortic occlusion is extremely rare. We present a case of a 58-year-old man with progressive lower limb paralysis from atherosclerotic aortoiliac occlusion without history of aortic surgery or evidence of thromboembolism.
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http://dx.doi.org/10.1016/j.jvs.2013.04.008DOI Listing
January 2014

Report of a case of ischemic colitis with bilaterally patent internal iliac arteries after endovascular abdominal aneurysm repair.

J Korean Surg Soc 2012 Mar 27;82(3):200-3. Epub 2012 Feb 27.

Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.

During endovascular aneurysm repair (EVAR), interruption of the internal iliac arteries (IIAs) or the inferior mesenteric artery by stents or embolization is thought to cause colon ischemia. To minimize this risk, attempts have been made to preserve the IIAs using iliac branch devices or IIA revascularization. Here we present our experience of colon ischemia after EVAR in a patient with bilaterally patent IIAs without evidence of embolism. A 70-year-old man had abdominal pain and a ruptured abdominal aortic aneurysm was found. We performed EVAR with custom-made tube grafts preserving the bilateral IIAs. On postoperative day 2, the patient complained of abdominal pain, a sigmoidoscopy was performed revealing colon ischemia. On laparotomy, transmural infarction of the sigmoid colon was found and resected. Because IIA preservation cannot guarantee protection against colon ischemia, surgeons should maintain a high level of suspicion and use surveillance liberally after EVAR for early diagnosis of colon ischemia, even if both IIAs are preserved.
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http://dx.doi.org/10.4174/jkss.2012.82.3.200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3294116PMC
March 2012

Ten-year comparative analysis of bovine pericardium and autogenous vein for patch angioplasty in patients undergoing carotid endarterectomy.

Ann Vasc Surg 2012 Apr 8;26(3):353-8. Epub 2012 Feb 8.

Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.

Background: To evaluate early and late clinical outcomes of carotid endarterectomy (CEA) with bovine pericardium patch in comparison with autogenous vein.

Methods: During a 10-year period, 456 CEAs were performed using patch closure of the arteriotomy with bovine pericardium (252 cases) and autogenous vein (204 cases). Retrospectively, surgical outcomes were evaluated and compared regarding CEA-related parameters, early and late mortality and morbidity rates, and the incidence of restenosis and aneurysmal dilatation between patients with bovine pericardium patch closure and those with autogenous vein closure.

Results: The two groups were comparable regarding basic demographics, clinical data, and anatomic data, except the incidence of coronary or peripheral arterial diseases. In patients with bovine pericardium patch closure, the total operating time and carotid clamping duration were statistically significantly shorter than in those with autogenous vein closure (P < 0.01). During the early postoperative period, 10 major (stroke and death) complications (2.2%) occurred without statistically significant difference between the two groups. The incidence of early minor postoperative complications was less with bovine pericardium patch closure (5.6% vs. 10.8%; P < 0.05). With a mean follow-up of 62 months for bovine pericardium patch closure and 67 months for autogenous vein closure, the incidence of restenosis was similar, but aneurysmal dilatation was higher in patients with autogenous vein closure with a statistically significant difference (0% vs. 2.0%; P < 0.05).

Conclusion: CEA with bovine pericardium patch angioplasty showed excellent early and late clinical outcomes. Our results demonstrated bovine pericardium to be a suitable patch material for routine use in CEA.
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http://dx.doi.org/10.1016/j.avsg.2011.10.014DOI Listing
April 2012

Embolic stroke after carotid artery ligation during carotid body tumor resection.

Vascular 2013 Feb 18;21(1):23-6. Epub 2011 Nov 18.

Department of Surgery, Chung-Ang University Seoul, Korea.

This report describes a case of a delayed cerebral embolic infarction, after internal carotid artery (ICA) ligation secondary to carotid body tumor resection. We describe a 34-year-old woman who underwent left ICA ligation during a large carotid body tumor surgery. Immediately after surgery, the patient was neurologically asymptomatic; however, she subsequently developed a cerebral embolic infarction nine hours postoperatively. After beginning antiplatelet therapy, all symptoms ultimately resolved, although over a gradual course. Since the ligation of the ICA can cause thromboembolic infarctions of the cerebrum, we contend that antiplatelet agents be administered to prevent and/or treat embolic strokes.
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http://dx.doi.org/10.1258/vasc.2011.cr0274DOI Listing
February 2013

Risk factors for stroke during surgery for carotid body tumors.

World J Surg 2011 Sep;35(9):2154-8

Division of Vascular Surgery, Department of Surgery, University of Ulsan Medical College and Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul, 138-736, South Korea.

Background: Removing carotid body tumors (CBTs) carry the risk of operative morbidity including stroke. We evaluated the risk factors for stroke related to resection of CBTs.

Methods: We retrospectively reviewed the records of 17 procedures performed on 16 patients with CBT between March 1998 and September 2008.

Results: The study population consisted of 5 men and 11 women, of mean age 41.7 years (range: 23-62 years). At surgery, 8 cases (47%) were localized and classified as Shamblin class I, 4 cases (23.5%) as class II, and 5 cases (29.4%) as class III. Four patients had postoperative stroke (23.5%), with Shamblin classification related to the incidence of stroke (P = 0.041). In contrast, neither tumor size (P = 0.412) nor heparin injection before internal carotid artery (ICA) manipulation (P = 0.538) was associated with stroke. Although preoperative embolization of the tumor feeder did not significantly reduce the stroke rate (P = 0.579), early external carotid artery (ECA) division in patients with class II and III tumors was effective (P = 0.008). Internal carotid artery (ICA) manipulation, including reconstruction, ligation, and repair of injury, significantly increased the incidence of stroke (P = 0.029), as did ICA ligation without reconstruction (P = 0.044).

Conclusions: Internal carotid artery manipulation, including reconstruction, ligation, and repair of injury, significantly increased the incidence of stroke. For uncomplicated CBT resection, careful preoperative planning, especially for patients with class II and III tumors, is mandatory to avoid inadvertent ICA manipulation necessitated by bleeding. Early ECA division during the operation rather than preoperative percutaneous embolization in patients with class II and III tumors was significantly effective in reducing the stroke rate.
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http://dx.doi.org/10.1007/s00268-011-1167-7DOI Listing
September 2011

Surgical treatment of inferior vena cava tumor thrombus in patients with renal cell carcinoma.

J Korean Med Sci 2010 Jan 26;25(1):104-9. Epub 2009 Dec 26.

Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea.

Radical nephrectomy with inferior vena cava (IVC) thrombectomy remains the most effective therapeutic option in patients with renal cell carcinoma and IVC tumor thrombus. Cephalic extension of the thrombus is closely related to perioperative morbidity. We purposed to design a safe and successful surgical strategy through a review of our surgical experience and treatment results in 35 patients (male:female=28:7, mean age=56 yr [32-77]) who underwent IVC thrombectomy with radical nephrectomy between January 1997 and December 2006. The limit of tumor extension was level I in 10 patients (28.6%), level II in 17 (48.6%), and level III and IV in 4 patients each (11.4%). Liver mobilization with hepatic vascular exclusion was performed in 12 patients and cardiopulmonary bypass in 7. Thirty-two primary closures, 2 patch closures, and 1 graft interposition were performed. One patient underwent simultaneous pulmonary embolectomy because of an operative pulmonary embolism. There was no operative mortality, and the overall survival at 5-yr was 50.8%. Complete thrombus removal without tumor fragmentation under long venotomy on fully exposed involved IVC is recommended for successful result in a bloodless operative field. The applicability of liver mobilization, hepatic vascular exclusion, and cardiopulmonary bypass, can be determined by the level of thrombus.
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http://dx.doi.org/10.3346/jkms.2010.25.1.104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800013PMC
January 2010
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