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김영욱,윤봉호,서명균 대한혈관외과학회 1994 Vascular Specialist International Vol.10 No.1
Juxtarenal aortic occlusion(JRAO) is defined as an occlusive lesion involving the aortic segment immediately beneath the level of origin of the renal artery. The two major goals of the surgical treatment for JRAO are improvement of lower extremity perfusion and elimination of the risks for cephald propagation of aortic thrombus that, eventually, may lead to renal or visceral artery ischemia. The keys in the operation for JRAO are temporary suprarenal aortic control, removal of aortic thrombus, and standard infrarenal aortic graft implantation. However, suprarenal aortic clamping carries the risk of intraoperative cardiac and renal complications. During the period from March, 1991 to September, 1994, we experienced 67 patients with chronic aortoiliac occlusive disease(AIOD) at Department of Surgery, Kyung-pook National University Hospital. Suprarenal aortic clamping were needed in 38.7%(12/31) during aorto- femoral bypasses. Our indications for suprarenal aortic clamping were juxtarenal total aortic occlusion(8), juxtarenal aortic obliteration by thrombus(3), and 1 suprarenal aortic occlusion which was excluded in this study. The site selected for 11 suprarenal aortic clampings was a short aortic segment between superior mesenteric artery and renal artery. To minimize renal ischemic time and avoid renal artery embolism, we followed Gupta and Veith's method during the suprarenal aortic clamping. Aortic clamping time was shorter than 20 minutes in all cases. To determine the effect of suprarenal aortic clamaping on the renal function, preoperative and postoperative serum creatinine were compared (mean preoperative serum creati- nine: 1.11±0.13mg/dl, mean postoperative serum creatinine: 1.09±0.13mg/dl). It revealed no evidence of renal functional impairment after temporary, suprarenal aortic clamping.
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김영욱,정한준,윤봉호,김신윤,이상국,변경환,김태헌 경북대학교 병원 1997 경북대학교병원의학연구소논문집 Vol.1 No.1
Deep vein thrombosis is recognized as a common complication in surgical patients in western countries especially in patients with high risk factors. The purposes of this study were to detect leg DVTs in early postoperative period by non-invasive surveillance and to analyze the risk factors of DVT. One hundred seventy one patients who underwent major operations(67 curative resection of colorectal cancer, 64 total hip replacement, 38 femur operation for fracture, and 2 colon resections for benign colon disease) were included for the prospective surveillance of leg DVT within 2 weeks after the operations. For the surveillance of leg DVT, strain gauge plethysmography(SPG) and Duplex scanning of both legs were completed for all patients except 10 patients. These 10 patients were examined in only one leg. The patients with past history of leg DVT or under prophylactic anticoagulant therapy were excluded from this study. To determine the risk factors related with leg DVT formation, age and sex of the patients, indication of surgery or surgical procedures, duration of operation, position during the operation, duration of postoperative immobilization, and preoperative serum level of antithrombin III (AT- III) were analyzed using Chi-square test. After performing SPG of 342 legs, 38 legs, showed abnormal on venous outflow/venous capacitance discriminant line chart, and 13 legs of 12 patients showed the finding(s) suggesting DVT on duplex scanning. Among the patients with abnormal duplex findings, 7 limbs(53.8%) were symptomatic, but the remaining 6 legs were silent. In 6 (15.8%) patients of 36 femur operations, 3(4.7%) of 64 total hip replacements and 3(4.5%) of 67 curative resections of colorectal cancer developed DVT by duplex scanning in the iliac(5), femoral-popliteal(6), and isolated calf(2) veins. After analyzing the risk factors, we could not find any statistically significant(p<0.05) factor related with leg DVT.
김영욱,박호용,윤봉호,전수한 대한혈관외과학회 1995 Vascular Specialist International Vol.11 No.2
Acute mesenteric artery embolism is more amenable to salvage by surgical intervention than acute mesenteric artery thrombosis, but still remains as a vascular disaster with high mortality rate. The high mortality has largely been ascribed to the failure of early diagnosis, occurrence in old age group and frequent coexistence of cardiac disease. During the period of two years from 1993 to 1995, 8 patients(male: 5, mean age: 67.2 years) with acute mesenteric artery embolism(SMA; 7, IMA; I) have been treated at Department of Surgery, Kyungpook National University Hospital. Associated cardiovascular diseases were atrial fibrillation in 5, congestive heart failure in 2, peripheral arterial embolism in 2, mitral stenosis in l, old cerebrovascular disease in 1 and leg claudication in 1 patient. Correct preoperative diagnosis was made in 5 patients(62.5%) by means of contrast enhanced abdominal CT and/or mesenteric arteriography. Duration of abdominal pain before operation varied from l4 hours to 120 hours(mean: 56.l hours). Surgical procedures for 8 patients were superior mesenteric artery(SMA) embolectomy with bowel resection in 5, bowel resection without embolectomy in 2 and aorta-inferior mesenteric artery(IMA) bypass in l patient. Overall operative mortality rate was 37.5%(3/8). All mortality occurred in the patients with their ages older than 70 years and with massive intestinal gangrene on operative findings. In conclusion, dynamic CT was a minimally invasive and simple tool for the diagnosis of acute mesenteric artery embolism, and duration of clinical symptom were not necessarily related with the extent of bowel gangrene or surgical outcome.