Publications by authors named "Jang-Yong Kim"

44 Publications

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

In Vivo Animal Study of a Highly Viscous N-butyl Cyanoacrylate Medical Adhesive for Intravenous Embolization.

Materials (Basel) 2021 Jun 24;14(13). Epub 2021 Jun 24.

ENGAIN Co. Ltd., 700, Daewangpangyo-ro, Bundang-gu, Seongnam 13488, Gyeonggi-do, Korea.

N-butyl cyanoacrylate (NBCA) is a liquid monomer that undergoes an exothermic polymerization reaction to form a solid upon initiation with hydroxyl anions. Recently, EGpresto, a highly viscous NBCA-based adhesive, has been developed for vascular-occlusion purposes. In this study, we investigated the heat of polymerization of EGpresto and compared the results with those of a low-viscosity NBCA glue. Results show that EGpresto exhibited a lower heat of polymerization (64 ± 7 °C vs. 34 ± 1 °C). This was due to its high viscosity, which resulted in a delayed polymerization time. To investigate the efficacy and safety of EGpresto for intravenous embolization, a 14 d in vivo animal test was conducted using three pigs. Five cc of EGpresto was injected into the epigastric vein of each animal. Complete postoperative vein occlusion was confirmed at 7 and 14 d by ultrasonographic visualization. After the animals were sacrificed, the operated and unoperated veins were exposed, and the injected adhesive was found without migration. During the histology, the injected adhesive was not found in the inner or outer vein walls, and the immune reactions seemed to be the only foreign-body reaction, showing that EGpresto is a non-toxic and safe intravascular embolic agent.
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http://dx.doi.org/10.3390/ma14133527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269526PMC
June 2021

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

Rivaroxaban after Thrombolysis in Acute Iliofemoral Venous Thrombosis: A Randomized, Open-labeled, Multicenter Trial.

Sci Rep 2019 12 30;9(1):20356. Epub 2019 Dec 30.

Seoul National University Hospital, Seoul, South Korea.

Recently non-Vitamin K antagonist oral anticoagulants (NOAC) is replacing warfarin for the treatment of deep vein thrombosis (DVT). However, the role of NOAC after thrombolysis of acute iliofeomral DVT (IFDVT) is not yet defined. This randomized clinical trial aimed to compare the safety and efficacy of rivaroxaban versus warfarin after catheter directed thrombolysis of an IFDVT. Patients with acute DVT of both the iliac and the femoral vein (n = 72) were recruited and randomized to either standard anticoagulation (enoxaparin and warfarin, n = 35) or rivaroxaban (n = 37) after successful thrombolysis or mechanical thrombectomy. Primary efficacy outcome was a recurrence of any venous thromboembolism (VTE) within 6 months. Secondary safety outcomes included major bleeding, clinically relevant non-major bleeding (CRNMB), other adverse event, and all-cause mortality. Rate of recurrent VTE were similar in both groups (11.4% versus 12.5%; p = 0.94). Major bleeding or CRNMB was less in rivaroxaban group without significance (2.9% versus 9.4%, HR, 0.31; 95% CI, 0.03-2.96; p = 0.31). Recurrence-free survival and major bleeding-free survival at 6 months were not different in both groups. After thrombolysis of acute IFDVT, rivaroxaban was as safe and effective as warfarin in preventing DVT recurrence.
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http://dx.doi.org/10.1038/s41598-019-56887-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937283PMC
December 2019

Venous Thromboembolism Following Abdominal Cancer Surgery in the Korean Population: Incidence and Validation of a Risk Assessment Model.

Ann Surg Oncol 2019 Nov 5;26(12):4037-4044. Epub 2019 Sep 5.

Division of Vascular and Transplant Surgery, Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Gyeonggi-do, Korea.

Background: A cancer patient slated for abdominal surgery is considered to be at moderate to high risk for developing venous thromboembolism (VTE), but the incidence is quite low in Korean patients. Most risk assessment models and recommendations for VTE management are from Western reports, however they possibly overestimate the risk of VTE in the Korean population.

Methods: We retrospectively reviewed the medical records of 1966 patients who were diagnosed with abdominal organ cancer and required surgical treatment.

Results: Each patient was rated using the Caprini risk scoring model. The mean score was 7.5 ± 0.7 points; 98.4% of patients were classified as high risk for VTE. Symptomatic VTE occurred in eight patients, and the overall incidence was 0.4%. The mean Caprini score for VTE patients was 8.8 ± 1.9 points. In the group with scores between 5 and 9 points, the incidence was 0.3-0.5%, while in patients with scores > 10 points, the incidence of VTE was found to be 1.12%.

Conclusions: The risk stratification system in the Caprini scoring model needs to be modified based on the actual incidence in the Korean population.
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http://dx.doi.org/10.1245/s10434-019-07633-zDOI Listing
November 2019

Vein conduit for end-to-side anastomosis of a calcified vessel in lower extremity free flap reconstruction.

J Plast Reconstr Aesthet Surg 2019 Jul 8;72(7):1100-1109. Epub 2019 Mar 8.

Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, Seoul, Korea.

Background: As the microsurgical and interventional revascularization techniques are evolving, traditionally amputated limbs are now challenged to salvage. However, a calcified recipient vessel is a common but challenging problem encountered in lower extremity reconstruction.

Methods: An end-to-side anastomosis of a vein graft (1.5-3.5 cm in length) was performed to the recipient vessel when it was difficult to clamp the recipient vessel near the defect because of the inelastic and hard vessel wall. The vascular clamp was applied to the vein graft, and the flap's pedicle was anastomosed to the vein graft.

Results: A total of 18 free flaps (10 ALT cases, 4 TDAP cases, 2 PAP cases, and 2 SCIP cases) were anastomosed with a bridge vein graft to the heavily calcified recipient vessels (7 ATA cases, 3 PTA cases, 7 DPA cases, and 1 MPA case). Overall flap survival rate was 83.3%. Limb salvage rate was 93.7%, and anastomosis patency rate was 94.4% CONCLUSION: Vein conduit in an end-to-side anastomosis of severely calcified recipient vessels shows a reasonable limb salvage rate. It acts as a buffer, which makes microscopic vessel manipulation easier. If vessel calcification is the only drawback for a free flap reconstruction, then a vein graft needs to be prepared instead of an amputation. This method may extend the surgical option to more high-risk patients in lower extremity microsurgical reconstruction and increase the limb salvage rate.
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http://dx.doi.org/10.1016/j.bjps.2019.02.021DOI Listing
July 2019

Treatment options for isolated iliac artery aneurysms and their impact on aortic diameter after treatment.

Ann Surg Treat Res 2019 Mar 26;96(3):146-151. Epub 2018 Feb 26.

Divison of Vascular Surgery, Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

Purpose: Isolated iliac artery aneurysm (IIAA) is uncommon. It is frequently treated by endovascular aneurysm repair (EVAR). This study was to evaluate treatment results of IIAA and survey aortic diameter after EVAR.

Methods: Patients treated for IIAA in Seoul St. Mary's Hospital and Bundang Seoul National University from 2005 to April 2016 were retrospectively enrolled. The inclusion criteria of IIAA was >30 mm of iliac artery aneurysm without abdominal aortic aneurysm, which was treated by open surgical repair (OSR) or EVAR. Patients' clinical characteristics, treatment results, and mortality were obtained from electronic medical records. Diameters of aorta and iliac arteries were measured periodically with scheduled interval based on CT scans.

Results: Forty-nine patients (40 males; mean age, 71.9 ± 11.1 years) were enrolled. Five ruptured IIAAs were treated with EVAR (n = 1) or hybrid methods (n = 4). The diameter of ruptured IIAAs was 65 ± 31.4 mm, which was not significantly different from that of elective (44.3 ± 17.0 mm). Forty-four elective IIAA underwent 9 OSR, 31 EVARs, and 3 hybrid treatments (15 bifurcated and 12 straight stent-grafts). Treatment success rate was 93.8% without hospital mortality. There were 4 type I endoleak, 1 type II endoleak, and 1 type III endoleak without aneurysm-related mortality during follow-up. However, the aortic diameter was increased over time though there was no change or decrease in common iliac artery's diameter.

Conclusion: Treatment of IIAA included various endovascular modalities as well as open surgery. Regular surveillance is still needed due to aortic dilatation after its treatment.
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http://dx.doi.org/10.4174/astr.2019.96.3.146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393409PMC
March 2019

Early experiences of endovascular aneurysm repair for ruptured abdominal aortic aneurysms.

Ann Surg Treat Res 2019 Mar 26;96(3):138-145. Epub 2018 Feb 26.

Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Purpose: The use of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysms (r-AAA) is steadily increasing. We report early experiences of EVAR for r-AAA performed in two tertiary referral centers in Korea.

Methods: We retrospectively reviewed r-AAA patients treated by EVAR from May 2013 to December 2017. An EVAR-first strategy for r-AAA was adopted whenever feasible. The demographic information, anatomic characteristics, operative details, postoperative complications with special attention to abdominal compartment syndrome (ACS), and 30-day mortality were collected and analyzed.

Results: We identified 13 patients who underwent EVAR for r-AAA. Mean age was 74.2 years and mean AAA size was 74.2 mm. Two patients underwent cardiopulmonary resuscitation at initial presentation. Bifurcated stent grafts were used in 12 out of 13 cases and physician-modified endografts with fenestrated/chimney techniques were performed in 2 cases with short neck. Successful stent graft deployment was achieved in all cases. Three patients were suspected of having ACS and 2 of them underwent laparotomy for decompression. The 30-day mortality was 7.7% (1 of 13), the only mortality being a patient that refused decompressive laparotomy for suspected ACS.

Conclusion: Despite the small numbers, the outcomes of EVAR for treatment of r-AAA were very promising, even in selected cases with unfavorable anatomy. These outcomes were achieved by a dedicated and well-trained team approach, and by use of high-end angiographic technology. Finally, ACS after EVAR is not uncommon, and requires a high index of suspicion as well as liberal use of decompressive surgery.
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http://dx.doi.org/10.4174/astr.2019.96.3.138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393412PMC
March 2019

Efficacy of volumetric analysis of aorta as surveillance tool after EVAR.

Asian J Surg 2019 Jul 23;42(7):746-754. Epub 2019 Jan 23.

Division of Vascular and Transplant Surgery, Department of Surgery, The Catholic University of Korea, South Korea. Electronic address:

Objective: Compared to the diameter measurement, volume measurement of the aneurysm can be an alternative option for accurate evaluation. This study was undertaken to analyze the relationship between the diameter and the volume measurement of the aorta after EVAR.

Methods: From January 2012 to December 2016, 82 patients underwent EVAR in our institution. The infrarenal aorta after EVAR was evaluated with regard to maximal aortic diameter (DMAX) and aortic volume. The relationship between the DMAX and the aortic volume measurement after EVAR were analyzed.

Results: The rate of enlargement of aortic volume with endoleak over time was 0.02 cm/month. The rate of enlargement of DMAX with endoleak over time was 0.007 mm/month. The mean rate of enlargement of aortic volume was significantly different from the mean enlargement rate of DMAX (p = 0.02). A ≥12% of increase rate of aortic volume was equivalent to an increase of ≥5 mm in the DMAX after EVAR. Significantly more endoleak occurred in the DMAX-enlargement group than no-enlargement group (100% vs. 26.76%, p < 0.001). Significantly more patients need secondary intervention and treatment of endoleak in the DMAX-enlargement group (p = 0.02 and p < 0.001, respectively). Significantly more endoleak occurred in the aortic volume-enlargement group than no-enlargement group (90.91% vs. 16.67%, p < 0.001). Significantly more patients needed secondary intervention and treatment for endoleak in the aortic volume-enlargement group (p = 0.02 and p < 0.001, respectively).

Conclusion: Volumetric analysis can predict successful EVAR more accurate than diameter measurement. A ≥12% increase in aortic volume was equivalent to a ≥5 mm increase in aortic diameter.
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http://dx.doi.org/10.1016/j.asjsur.2018.12.006DOI Listing
July 2019

Genetic characteristics of Y-chromosome short tandem repeat haplotypes from cigarette butt samples presumed to be smoked by North Korean men.

Genes Genomics 2018 08 25;40(8):819-824. Epub 2018 Apr 25.

Forensic DNA Division, National Forensic Service, Wonju, South Korea.

Korea has been divided into South Korea and North Korea for over 70 years. DNA profiles of the North Korean population have never been reported in the Y-chromosome STR Haplotype Reference Database (YHRD; https://yhrd.org ). To investigate genetic features of Y-chromosome STR haplotypes of the North Korean population for the first time. Genomic DNA was isolated from 838 cigarette butts assumed to have been smoked by North Korean men and amplified with PowerPlex Y23 (PPY23) kit. Statistical parameters were calculated using Nei's formula and analysis of molecular variance (AMOVA). Multidimensional scaling (MDS) plot was constructed by the AMOVA tool and neighbor-joining (NJ) tree was constructed by MEGA 6.06. A total of 121 haplotypes were analyzed for PPY23 loci from a sample population. Haplotype diversity and discrimination capacity were 0.9992 and 0.9837, respectively. Genetic diversities ranged from 0.2981 to 0.9716. For the 16 Y-filer loci and eight minimal loci, respectively 90.9 and 82.6% of the matched haplotypes were estimated to belong to haplogroup O, representing the Southeast and East Asian type. The MDS plot and NJ tree indicated that the samples are most closely related to South Korean. In addition, p-value in the pairwise comparison to the South Korean was slightly above statistical significance (p = 0.0534). The Y-STR haplotypes of the samples were unique and highly genetically polymorphic. Despite the separation between North and South Korea for 70 years, they can still be considered a single genetic population, based on Y-STR haplotypes.
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http://dx.doi.org/10.1007/s13258-018-0701-5DOI Listing
August 2018

Open Surgical Repair Using the Femoral Vein for a Mycotic Superior Mesenteric Artery Aneurysm.

Korean J Thorac Cardiovasc Surg 2018 Jun 5;51(3):209-212. Epub 2018 Jun 5.

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

Superior mesenteric artery (SMA) aneurysms are rare and often fatal. A 72-year-old man had previously been admitted to the emergency room with epigastric pain and heart murmur. The echocardiographic diagnosis was vegetation on the aortic and mitral valves, with moderate regurgitation from both valves due to infective endocarditis. No aneurysm was detected on abdominal computed tomography, and emergency double-valve replacement was performed. On postoperative day 25, the patient experienced abrupt abdominal pain, and computed tomography revealed a mycotic SMA aneurysm. Open surgical repair of the SMA aneurysm was performed using the femoral vein, and the patient's postoperative course was uneventful.
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http://dx.doi.org/10.5090/kjtcs.2018.51.3.209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5973219PMC
June 2018

Hybrid treatment of multilevel revascularization in patients with peripheral arterial disease - a multi-centre study in Korea.

Vasa 2018 Apr 27;47(3):235-241. Epub 2018 Feb 27.

10 Research Institute for Convergence of Biomedical Science and Technology, Division of Vascular and EndoVascular Surgery, Department of Surgery, Pusan National University School of Medicine, Yangsan, Republic of Korea.

Background: Endovascular treatment is an alternative first-line management for peripheral artery disease (PAD). Hybrid treatment (HT) is defined as a combined treatment for patients with PAD using endovascular and open surgery, simultaneously performed in an operating room. The results of HT are reportedly good for multilevel revascularization (MR) in patients with chronic limb ischaemia, and even in older high-risk patients. The goal of this study was to examine the clinical and haemodynamic outcomes of HT in patients who need MR.

Patients And Methods: Nine university hospitals in Korea participated in this multicentre study. A total of 134 patients with multilevel PAD underwent HT and MR. Patients were enrolled from July 2014 to June 2015 and were followed for 18 months.

Results: The mean age of the patients was 68.8 ± 9.93 years and 88.1 % were men. Patients with Rutherford category 2 to 3 and 4 to 6 comprised 59.0 % and 42.0 % of the group, respectively. The technical success rate was 100 %. The primary patency rates at 12 and 18 months were 77.6 % and 63.9 %, respectively. The primary-assisted patency rates at 12 and 18 months were both 90.0 %. The pre-operative mean ankle brachial index (0.43 ± 0.23) increased to 0.87 ± 0.23 at six months post-operatively (t-test, p < 0.05). The amputation free survival rate was 97.1 %.

Conclusions: Although outcomes of multilevel PAD are reportedly poor when endovascular treatment alone is used, we have shown that HT is a feasible alternative modality for patients with multilevel PAD, with satisfactory amputation-free survival and freedom from re-intervention rates.
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http://dx.doi.org/10.1024/0301-1526/a000694DOI Listing
April 2018

Comparative Analysis of the Suspected Heparin-Induced Thrombocytopenia Level in Korea.

Basic Clin Pharmacol Toxicol 2017 Oct 9;121(4):360-367. Epub 2017 Aug 9.

Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.

The primary objective of our study was to evaluate the frequency of suspected heparin-induced thrombocytopenia (HIT) among patients treated with different formulations of heparin and investigate the factors that affect the incidence of HIT. This study is an electronic medical record (EMR)-based large-scale retrospective cohort study conducted from 2009 to 2014 in Korea. After hospitalization, patient platelet count was determined before heparin was prescribed, and all platelet count values obtained during hospitalization were extracted. Suspected HIT was estimated by three 4Ts scores (acute thrombocytopenia, timing onset and other possible causes), which when combined yielded a high probability of HIT. Among 6046 patients enrolled in this study, HIT was suspected in 641 cases (10.6%) and a statistically significant increase in HIT incidence rate was observed for three heparins used (p < 0.001). Dalteparin (HR = 0.55, p = 0.036) and enoxaparin (HR = 0.40, p < 0.001) showed a relatively low HIT incidence rate, compared to unfractionated heparin. Majority of suspected HIT cases (76.9 and 66.7%) occurred in days 8-10 and 5-7 of dalteparin and enoxaparin treatments, respectively. Most of the patients medicated with dalteparin were cancer patients; however, no statistically significant relationship was observed between HIT occurrence and cancer. HIT can cause serious complications, making early diagnosis crucial. Clinical practitioners first prescribing heparin should focus on preventing and detecting complications early by conducting frequent, regular platelet counts before and after heparin administration.
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http://dx.doi.org/10.1111/bcpt.12791DOI Listing
October 2017

Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines.

Vasc Specialist Int 2016 Sep 30;32(3):77-104. Epub 2016 Sep 30.

Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Korea.

Lower extremity deep vein thrombosis is a serious medical condition that can result in death or major disability due to pulmonary embolism or post-thrombotic syndrome. Appropriate diagnosis and treatment are required to improve symptoms and salvage the affected limb. Early thrombus clearance rapidly resolves symptoms related to venous obstruction, restores valve function and reduces the incidence of post-thrombotic syndrome. Recently, endovascular treatment has been established as a standard method for early thrombus removal. However, there are a variety of views regarding the indications and procedures among medical institutions and operators. Therefore, we intend to provide evidence-based guidelines for diagnosis and treatment of lower extremity deep vein thrombosis by multidisciplinary consensus. These guidelines are the result of a close collaboration between interventional radiologists and vascular surgeons. The goals of these guidelines are to improve treatment, to serve as a guide to the clinician, and consequently to contribute to public health care.
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http://dx.doi.org/10.5758/vsi.2016.32.3.77DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045251PMC
September 2016

Radiofrequency ablation of varicose veins improves venous clinical severity score despite failure of complete closure of the saphenous vein after 1 year.

Asian J Surg 2017 Jan 1;40(1):48-54. Epub 2016 Jul 1.

Department of Surgery, Division of Vascular and Transplant Surgery, The Catholic University of Korea College of Medicine, Suwon, South Korea.

Background And Objectives: Endovenous treatment is increasingly supplanting open surgery for the treatment of varicose veins. Among emerging endovenous techniques, radiofrequency ablation (RFA) with a ClosureFast catheter is popular in Korea. The objective of this study was to evaluate and compare the efficacy and patient-reported outcomes of RFA of varicose veins.

Methods: This is a retrospective study of a prospectively registered database of patients who underwent RFA for varicose veins from 2012 to 2013 in St. Mary's Hospital in Seoul. Korea. Efficient ClosureFast RFA catheters (Medtronic, San Jose, CA, USA) were used. The techniques used for RFA of varicose veins were performed according to the manufacturer's recommendations. Duplex scans and venous clinical severity scores (VCSSs) were used to document treatment outcome and patient symptoms before and after the procedures. Treatment outcomes were estimated before the procedure and 3 months, 6 months, and 12 months after the procedure. Outcomes were analyzed by paired t test, chi-square test, or Fisher's exact test as well as by logistical regression.

Results: A total of 117 patients were evaluated for 183 consecutive RFA procedures (183 limbs). The initial technical success was 97.3% (178/183). The estimated mean VCSS changed over time from 4.0 ± 1.67 at preprocedure to 0.6 ± 1.05, 0.5 ± 1.02, and 0.6 ± 1.14 at 3 months, 6 months, and 12 months after the procedure, respectively. The improved VCSS was maintained 1 year after the procedure (p < 0.001). Recanalization of the saphenous vein was detected in 20 limbs at the 1-year follow up. The treatment failure group also exhibited a significant decline in the VCSS between preprocedure and 12 months (4.8 ± 1.76 vs. 1.8 ± 2.04, p < 0.001). Specifically, in the treatment failure group, 65% of limbs with episodic recanalization (13/20) were reoccluded or recanalized without venous reflux at the 1-year follow up.

Conclusion: In this study, RFA of varicose veins had an initial success rate of 97.7% and a significantly improved patient VCSS at 1 year. Patients with episodic recanalization of the saphenous vein also exhibited an improved VCSS with favorable duplex findings at 1 year.
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http://dx.doi.org/10.1016/j.asjsur.2016.03.004DOI Listing
January 2017

Current trends of major arterial diseases in Korea: based on data from the Health Insurance Review and Assessment Service.

Ann Surg Treat Res 2016 Apr 30;90(4):218-23. Epub 2016 Mar 30.

Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Purpose: This study aims to figure out the changes of the prevalence and management of carotid arterial occlusive diseases (CAOD), abdominal aortic diseases (AAA), and arterial diseases of the lower extremities (LAOD) in Korea over the past 5 years.

Methods: Data were extracted from the Health Insurance Review and Assessment Service during the period from 2008 to 2012.

Results: The number of patients with CAOD increased by about 30% every year. From the year 2008, the number of open surgeries (OS) and endovascular treatments (ET) increased by more than 20% during each of the first 2 years and by 10% every year for 3 years thereafter for CAOD. ET was preferred to OS and occupied 77%-79% of the total number of procedures. The number of patients with AAA increased by 11%-17% every year. ET for AAA occupied 52% of the total number of procedures in 2008 and gradually increased to 70% in 2012. The number of patients who were diagnosed with LAOD fluctuated over the five years. The total number of procedures to treat LAOD increased each year by 20%-25%. ET for LAOD constantly increased by 18%-24% each year and occupied 80%-95% of the total number of procedures.

Conclusion: It is evident that the incidence of vascular diseases will be increasing as our society ages, not to mention its care costs. The need for long-range plans and guidelines are urgent.
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http://dx.doi.org/10.4174/astr.2016.90.4.218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4826985PMC
April 2016

Ruptured aneurysm of the external iliac vein.

J Vasc Surg Venous Lymphat Disord 2016 Jan;4(1):92-4

Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. Electronic address:

Primary iliac venous aneurysm is an extremely rare vascular abnormality that is associated with the likelihood of rupture, embolism, and thrombosis. In this report, we describe the case of a ruptured aneurysm of the external iliac vein in a 63-year-old woman who was admitted to the emergency department and diagnosed by computed tomography. Computed tomography indicated a 4 × 5-cm ruptured aneurysm in the right external iliac vein that was surrounded by hematoma in the right side of the pelvis. The aneurysm was successfully treated by tangential aneurysmectomy and lateral venorrhaphy.
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http://dx.doi.org/10.1016/j.jvsv.2015.07.005DOI Listing
January 2016

Outcomes of endovascular treatment for TASC C and D aorto-iliac lesions.

Asian J Surg 2017 May 16;40(3):215-220. Epub 2016 Jan 16.

Division of Vascular and Transplant Surgery, Department of Surgery, The Catholic University of Korea, College of Medicine, Seoul, South Korea. Electronic address:

Background/objective: The aim of this study was to evaluate the technical success rates, primary patency, and complications for TASC C and D aorto-iliac lesions treated by endovascular procedures. Additionally, the influence of the access site and the clinical outcomes were analyzed.

Methods: Between 2008 and 2014, data from 39 patients with 45 chronic iliac artery stenosis and/or occlusion who were treated with endovascular treatment were retrospectively reviewed.

Results: The procedure time was longer for TASC D lesions than for TASC C lesions (163 ± 82 min vs. 105 ± 34 min; p = 0.002), where there was the more common use of brachial and femoral approach simultaneously. There were two perioperative deaths associated with TASC D lesions caused by one iliac artery rupture and one postoperative hospital-acquired pneumonia. The total perioperative complication rate was higher in the TASC D lesions than in TASC C lesions [five (18.5%) vs. zero; p = 0.073]. The corresponding 2-year primary patency rates were 94.9% in TASC C lesions and 88.4% in TASC D lesions. The simultaneous brachial and femoral approach took the longest procedure time (226 ± 157 min).

Conclusion: This study demonstrated that the outcomes of endovascular treatment for TASC C and D aorto-iliac lesions were acceptable, with better technical success in TASC C lesions than in TASC D lesions. Furthermore, the 2-year patency rate for both TASC C and TASC D lesions was acceptable. Additionally, brachial access was useful for complex anatomy, but the failure rate was high.
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http://dx.doi.org/10.1016/j.asjsur.2015.11.006DOI Listing
May 2017

Clinical Importance of Intraoperative Cephalic Vein Distensibility as a Predictor of Radiocephalic Arteriovenous Fistula Maturation.

Semin Dial 2015 Nov-Dec;28(6):E64-70

Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Radiocephalic arteriovenous fistula (RCAVF) is the preferred vascular access, but the maturation failure rate is high. Poor vein distensibility is the main cause of maturation failure. There have been several studies regarding vein distensibility, but vein dilation protocol and the cut-off value predicting maturation failure were inconsistent. We were doubtful that the vein distensibility had been appropriately evaluated, and sought to determine a more clinically applicable parameter. The cephalic vein was dilated via intraluminal hydrostatic pressure during the surgery and the vein size was measured. Maturation failure occurred in 30 patients (22.4%) and was more common in females and in patients who had a previous history of arteriovenous access formation (p = 0.0095 and p = 0.014). The intraoperative postdilation diameter, and the difference between pre and postdilation diameters differed between the two groups (p = 0.0004 and p = 0.0004). The cut-off value of the postdilation diameter, which indicated a high probability of maturation success, was >4 mm, and the cut-off value which indicated a higher probability of maturation failure; that is, the difference between the pre and postdilation diameter, was ≤2.2 mm. The degree of distensibility of the cephalic vein may be an important determinant of RCAVF maturation.
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http://dx.doi.org/10.1111/sdi.12452DOI Listing
August 2016

Occurrence and Prognosis of Symptomatic Venous Thromboembolism in Colorectal Cancer Surgery Patients.

Vasc Specialist Int 2014 Jun 30;30(2):49-55. Epub 2014 Jun 30.

Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Purpose: Colorectal cancer (CRC) has a high risk for postoperative thromboembolic complications such as venous thromboembolism (VTE) compared to other surgical diseases, but the relationship between VTE and CRC in Asian patients remains poorly understood. The present study examined the incidence of symptomatic VTE in Korean patients who underwent surgery for CRC. We also identified risk factors, incidence and survival rate for VTE in these patients.

Materials And Methods: The patients were identified from the CRC database treated from January 2011 to December 2012 in a single institution. These patients were classified into VTE and non-VTE groups, their demographic features were compared, and the factors which had significant effects on VTE and mortality between the two groups were analyzed.

Results: We analyzed retrospectively a total of 840 patients and the incidence of VTE was 3.7% (31 patients) during the follow-up period (mean, 17.2 months). Histologic subtype (mucinous adenocarcinoma) and previous history of VTE affected the incidence of VTE on multivariate analysis. There was a statistically significant difference in survival rate between the VTE and non-VTE group, but VTE wasn't the factor affecting survival rate on multivariate analysis. Comparing differences in survival rate for each pathologic stage, there was only a significant difference in stage II patients.

Conclusion: Among CRC patients after surgery, the incidence of VTE was approximately 3% within 1 year and development of VTE wasn't a significant risk factor for death in our study but these findings are not conclusive due to our small sample size.
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http://dx.doi.org/10.5758/vsi.2014.30.2.49DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480307PMC
June 2014

Vascular disease prevalence and risk factors in a screened Korean male population.

Ann Vasc Surg 2015 Feb 8;29(2):215-21. Epub 2014 Nov 8.

Department of Surgery, Inha University School of Medicine, Incheon, Korea.

Background: Vascular diseases, such as carotid artery stenosis (CAS), abdominal aortic aneurysm (AAA), and peripheral arterial occlusive disease (PAD) of the lower limb, are common in elderly men. These diseases have not been thoroughly reported in Eastern countries as well as in Western countries. We compare the prevalence rates in Korea with previous reports, and evaluate correlations between known risk factors and these conditions in this population.

Materials And Methods: From November 2008 to December 2012, elderly men (≥65 years) were randomly referred from the Incheon Federation of the Korean Senior Citizens' Association, which is one of the major organizations representing retired individuals in Korea. CAS was defined as ≥50% of internal CAS, AAA was defined as ≥3 cm aortic diameter, and PAD of the lower limb was defined as an ankle brachial index ≤0.9.

Results: The average age was 72.14 ± 5.15 years. CAS was detected in 116 subjects (7.2%), AAA was detected in 52 subjects (3.2%), and PAD was detected in 79 subjects (4.9%). On multivariate analysis, octogenarian status and coronary artery disease were significantly associated with CAS and current smoking was significantly associated with PAD (P < 0.001).

Conclusions: The Korean prevalence rates of CAS and PAD in this study are similar to previous reports. The prevalence of AAA in Korea is lower compared with western reports, but higher than previous Asian reports. It is presently necessary to conduct major clinical studies throughout Asian countries to prepare for a rapid increase in the prevalence of major vascular diseases in Asia.
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http://dx.doi.org/10.1016/j.avsg.2014.08.005DOI Listing
February 2015

Internal iliac artery embolization during an endovascular aneurysm repair with detachable interlock microcoils.

Korean J Radiol 2014 Sep-Oct;15(5):613-21. Epub 2014 Sep 12.

Department of Vascular Surgery, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, Korea.

Objective: The purpose of this study was to evaluate the effectiveness of detachable interlock microcoils for an embolization of the internal iliac artery during an endovascular aneurysm repair (EVAR).

Materials And Methods: A retrospective review was conducted on 40 patients with aortic aneurysms, who had undergone an EVAR between January 2010 and March 2012. Among them, 16 patients were referred for embolization of the internal iliac artery for the prevention of type II endoleaks. Among 16 patients, 13 patients underwent embolization using detachable interlock microcoils during an EVAR. Computed tomographic angiographies and clinical examinations were performed during the follow-up period. Technical success, clinical outcome, and complications were reviewed.

Results: Internal iliac artery embolizations using detachable interlock microcoils were technically successful in all 13 patients, with no occurrence of procedure-related complications. Follow-up imaging was accomplished in the 13 cases. In all cases, type II endoleak was not observed with computed tomographic angiography during the median follow-up of 3 months (range, 1-27 months) and the median clinical follow-up of 12 months (range, 1-27 months). Two of 13 (15%) patients had symptoms of buttock pain, and one patient died due to underlying stomach cancer. No significant clinical symptoms such as bowel ischemia were observed.

Conclusion: Internal iliac artery embolization during an EVAR using detachable interlock microcoils to prevent type II endoleaks appears safe and effective, although this should be further proven in a larger population.
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http://dx.doi.org/10.3348/kjr.2014.15.5.613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170162PMC
November 2014

Mechanical thrombectomy with Trerotola compared with catheter-directed thrombolysis for treatment of acute iliofemoral deep vein thrombosis.

Ann Vasc Surg 2014 Nov 7;28(8):1853-61. Epub 2014 Jul 7.

Division of Vascular and Endovascular Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. Electronic address:

Background: Mechanical thrombectomy (MT) of acute deep vein thrombosis (DVT) is safe and effective in reducing thrombus burden. MT utilizing a percutaneous thrombectomy device confers a great advantage because it may reduce both the dose of the thrombolytic agent and the overall procedure time compared with a conventional catheter-directed thrombolysis (CDT). We examined the results of MT using the Trerotola device and evaluated factors affecting patient outcome.

Methods: This retrospective study was performed using data from a database of patients who had undergone treatment for an acute iliofemoral DVT from January 2005 to December 2011, at 2 institutions. The patients' clinical characteristics and procedures were compared, and the outcomes of treatment with the Trerotola in the MT group were compared with those obtained with CDT.

Results: There were a total of 98 DVTs (left 76; right 22) in 90 patients (34 men); 53 DVTs were treated with MT and 45 with CDT. There were no statistical differences in the clinical characteristics among the MT with CDT, MT only and CDT group. Inferior vena cava filters were placed in 93 DVTs (95%), and iliac vein stenting was used in 64 (65%). Symptom improvement was seen in 78% (18 limbs) of the MT group, 80% (24 limbs) of the MT with CDT group, and 71% (32 limbs) of the CDT group (P = 0.498). The procedure time was shorter in the MT with CDT group (18.2 ± 8.2 hr) or in the MT only group (2.7 ± 2.0 hr) compared with the CDT group (29.3 ± 9.4 hr; P < 0.001). Urokinase dose was lower in MT only (0 million units) or in the MT with CDT group (5.13 ± 3.72 million units) than in the CDT group (7.51 ± 4.54 million units; P < 0.001). There was no difference in complications during the procedures or in primary patency rate during the follow-up period (mean 16.0 ± 19.1 months; range: 0-78 months).

Conclusions: MT with the Trerotola device for acute iliofemoral DVT required shorter procedure times and lower urokinase doses than conventional CDT, while providing the same results.
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http://dx.doi.org/10.1016/j.avsg.2014.06.056DOI Listing
November 2014

Mechanical thrombectomy-assisted thrombolysis for acute symptomatic portal and superior mesenteric venous thrombosis.

Ann Surg Treat Res 2014 Jun 23;86(6):334-41. Epub 2014 May 23.

Department of Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.

Acute portal vein and mesenteric vein thrombosis (PVMVT) can cause acute mesenteric ischemia and be fatal with mortality rate of 37%-76%. Therefore, early diagnosis and prompt venous revascularization are warranted in patients with acute symptomatic PVMVT. Due to advances in catheter-directed treatment, endovascular treatment has been used for revascularization of affected vessels in PVMVT. We report two cases of symptomatic PVMVT treated successfully by transhepatic percutaneous mechanical thrombectomy-assisted thrombolysis.
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http://dx.doi.org/10.4174/astr.2014.86.6.334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4062453PMC
June 2014

Relining technique for continuous sac enlargement and modular disconnection secondary to endotension after endovascular aortic aneurysm repair.

Ann Surg Treat Res 2014 Mar 24;86(3):161-4. Epub 2014 Feb 24.

Department of Surgery, Inha University School of Medicine, Incheon, Korea.

Endotension is an unpredictable late complication of endovascular aortic aneurysm repair (EVAR). This case report will discuss the successful treatment of enlarged aneurysmal sac due to endotension using the relining technique. An 81-year-old male complained of nondecreasing huge aneurysm sac. He had undergone EVAR for infrarenal abdominal aortic aneurysm 7 years prior and no endoleak was found through follow-up. Initially computed tomography-guided sac aspiration was tried, but in vain, Relining using the double barrel technique and tubular endograft for modular diconnection, which was unexpectedly found in the original endograft, were performed sucessfully. During follow-up after the relining procedure, the size of aneurysm sac continued to decrease in size. The relining technique is effective mothod for treating endotension.
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http://dx.doi.org/10.4174/astr.2014.86.3.161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3994625PMC
March 2014

Iliac vein stenting as a durable option for residual stenosis after catheter-directed thrombolysis and angioplasty of iliofemoral deep vein thrombosis secondary to May-Thurner syndrome.

Phlebology 2014 Aug 28;29(7):461-70. Epub 2013 May 28.

Department of Surgery, Inha University School of Medicine, Incheon, Korea.

Introduction: This study aims to evaluate the primary patency and clinical outcomes after stenting for residual iliac venous stenosis during catheter-directed thrombolysis treatment of acute iliofemoral deep vein thrombosis arising from May-Thurner syndome.

Methods: A retrospective study was done for the all patients who underwent iliac vein stenting after catheter-directed thrombolysis treatment of acute iliofemoral deep vein thrombosis due to May-Thurner syndrome from January 2005 to April 2011 in Inha University Hospital. Patient information was assembled from the electronic medical records, imaging and interview. The patency of iliac vein stent was evaluated with serial computed tomography.

Results: Fifty-one patients were enrolled. The median age was 70 years (range 44-86). There were 37 females (72.5%). The duration of symptoms of acute deep vein thrombosis before catheter-directed thrombolysis treatment was 6 days (median, range 1-33). Self-expanding stent was used for iliac vein stenting. Initial technical success rate was 94.1%. There were two complications (3.9%): an arteriovenous fistula formation in left popliteal area and a right inguinal hematoma. Mean follow-up was 15.6 months (range 6 days-80.8 months). Primary patency rate after iliac vein stenting was 95.8% at 6 months, 87.5% at 12 months and 84.3% at 24 months. Four patients had recurrent thrombotic occlusion (7.8%) during the follow-up.

Conclusion: Iliac vein stenting showed good primary patency rate with few complications. Iliac vein stenting is a durable option for residual stenosis after catheter-directed thrombolysis treatment of acute deep vein thrombosis in May-Thurner syndrome.
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http://dx.doi.org/10.1177/0268355513491724DOI Listing
August 2014

Endovascular repair with chimney technique of abdominal aortic aneurysm with hostile aortic neck.

Vascular 2013 Oct 7;21(5):323-9. Epub 2013 May 7.

Department of Surgery.

Abdominal aortic aneurysm (AAA) with hostile aortic neck is not a good candidate for conventional endovascular aneurysm repair (EVAR), and a recent paper showed that EVAR with chimney technique (Ch-EVAR) yielded reasonable outcome. We report here a case of successful Ch-EVAR treatment of AAA with hostile neck. An 81-year-old man presented with a 71-mm AAA during evaluation of a gastric ulcer. Aortic neck was 30 mm in diameter, 10-15 mm in length and angulated by 100°. EVAR was performed with chimney stenting to both renal arteries, and the patient recovered after transient hematuria. At one-year follow-up, AAA had increased by 7 mm with delayed type I endoleak control without renal insufficiency. The patient needed close follow-up.
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http://dx.doi.org/10.1177/1708538113478743DOI Listing
October 2013

Coherent piezoelectric strain transfer to thick epitaxial ferromagnetic films with large lattice mismatch.

J Phys Condens Matter 2013 Feb 31;25(8):082205. Epub 2013 Jan 31.

NanoSpin, Department of Applied Physics, Aalto University School of Science, PO Box 15100, FI-00076 Aalto, Finland.

Strain control of epitaxial films using piezoelectric substrates has recently attracted significant scientific interest. Despite its potential as a powerful test bed for strain-related physical phenomena and strain-driven electronic, magnetic, and optical technologies, detailed studies on the efficiency and uniformity of piezoelectric strain transfer are scarce. Here, we demonstrate that full and uniform piezoelectric strain transfer to epitaxial films is not limited to systems with small lattice mismatch or limited film thickness. Detailed transmission electron microscopy (TEM) and x-ray diffraction (XRD) measurements of 100 nm thick CoFe(2)O(4) and La(2/3)Sr(1/3)MnO(3) epitaxial films on piezoelectric 0.72Pb(Mg(1/3)Nb(2/3))O(3)-0.28PbTiO(3) substrates (+4.3% and -3.8% lattice mismatch) indicate that misfit dislocations near the interface do not hamper the transfer of piezoelectric strain. Instead, the epitaxial magnetic oxide films and PMN-PT substrates are strained coherently and their lattice parameters change linearly as a function of applied electric field when their remnant growth-induced strain state is negligible. As a result, ferromagnetic properties such as the coercive field, saturation magnetization, and Curie temperature can be reversibly tuned by electrical means. The observation of efficient piezoelectric strain transfer in large-mismatch heteroepitaxial structures opens up new possibilities for the engineering of strain-controlled physical properties in a broad class of hybrid material systems.
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http://dx.doi.org/10.1088/0953-8984/25/8/082205DOI Listing
February 2013

Stent fractures after superficial femoral artery stenting.

J Korean Surg Soc 2012 Sep 27;83(3):183-6. Epub 2012 Aug 27.

Department of Surgery, Inha University School of Medicine, Incheon, Korea.

Stent fracture is one of the major factors compromising implanted stent patency due to its consequences including in-stent restenosis, thrombosis, perforation, and migration. Stent fracture can occur from stress (extrinsic or intrinsic) and biomechanical forces at different implantation sites. We report on 2 cases of stent fractures and pertinent literature. One patient, a 75-year-old male, presented with recurrence of claudication 14 months after superficial femoral artery stenting; a femoral artery occlusion with stent fracture was found, and he underwent femoropopliteal bypass. The other patient, a 72-year-old male presented with recurrence of claudication; a stent fracture was found without femoral artery occlusion, and he was treated with additional femoral artery stenting to secure the fracture site.
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http://dx.doi.org/10.4174/jkss.2012.83.3.183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433557PMC
September 2012

Risk factors and incidence of deep vein thrombosis in lower extremities among critically ill patients.

J Clin Nurs 2012 Jul;21(13-14):1840-6

College of Medicine, Inha University, Incheon, Korea.

Aims And Objectives: To investigate how many critically ill patients developed deep vein thrombosis (DVT) during their admission to intensive care units (ICU) and to compare the characteristics of patients with and without deep vein thrombosis.

Background: Critically ill patients are a high-risk group for deep vein thrombosis because they typically have multiple risk factors, such as prolonged immobility, mechanical ventilation and old age.

Design: A prospective observational study was employed.

Methods: The subjects were 90 patients who were older than 18 years of age, who were admitted to an intensive care unit for more than five days and were not provided any prophylactic measures. Data were collected at a university hospital for five months. A duplex scan was performed on day 2.4 on average and repeated between days 5-7 to diagnose deep vein thrombosis. The iliac, femoral, popliteal and tibial veins were examined by compression and colour Doppler methods of the duplex scan by one technician.

Results: Age, gender and body mass index were significant factors for deep vein thrombosis development (p < 0.05). Ten patients (11.1%) developed deep vein thrombosis during their stay in the intensive care units.

Conclusions: The incidence was lower than in Western studies in which patients were not provided prophylaxis, but may increase with an extended observation period as in previous studies.

Relevance To Clinical Practice: The results of this study could allow ICU nurses to recognise the DVT incidence in critically ill patients. This result could lead to more active prevention and monitoring of DVT by ICU nurses, especially for high-risk patients, such as older or obese patients.
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http://dx.doi.org/10.1111/j.1365-2702.2012.04112.xDOI Listing
July 2012
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