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고영관,박호철,고석환,김도균,주홍재 대한혈관외과학회 1999 Vascular Specialist International Vol.15 No.1
Background: Arterial emboli remain an important cause of acute arterial ischemia. Despite simplification of operative techniques, the substantial morbidity and mortality still associated with an acute embolus remain a challenge to the vascular surgeon. We wanted to know the adequate evaluation and treatment modality for this limb threatened condition, and to evaluate the results according to etiology, location, time interval before starting treatment, clinical conditions, and limb survival rate. Material and Methods: A retrospective review was conducted on 91 patients who treated for acute lower leg thromboembolism between Jan. 1992 and Dec. 1997. Results: There were 73 men and 18 women and most prevalent age group was in the 5th and 6th decades (53.8%). Over all amputation rate was 25.3% and mortality rate was 5.5%. Cardiac problem was the most common etiologic factor. Associated diseases were cardiac problem (37.4%), hypertension (35.2%), cerebrovascular accident (17.6%), and diabetes (15.4%). Interval from attack to definite therapy, within 24 hours in 14 cases (15.4%), 1 ∼3 days in 23 (25.3%), after 4 days in 54 (59.3%) were noted. The locations were aorta and iliac in 25.3%, femoral in 38.5%, popliteal in 19.8%, tibial in 4.4%, and 15.4% in graft site in other of frequency. Clinical categories were grade I in 9.9%, IIa in 40.7%, IIb in 30.8%, and III in 18.7%. According to Eagle' s criteria, low risk group were 34 cases (37.4%), moderate risk group were 39 cases (42.9%), and high risk group were 18 cases (19.8%). Of the 91 patients, conservative treatment in 2 (2.2%), thrombolytic therapy in 33 (36.3%), thromboembolectomy in 56 (61.5%), bypass in 16 (17.6%), endarterectomy and vessel ligation were performed. The 1-month and 1-year limb salvage rates were 73.4% and 71.1%, respectively. Especially, salvage rates in the Department of Vascular Surgery were 84.9% and 83.7%, whereas that of Thoracic and Orthopedic Surgery were 44.4% and 33.0% (p=0.0001). Conclusions: Cardiac problem especially atrial fibrillation was the most common etiologic factor. Prompt balloon catheter embolectomy performed under local anesthesia is a safe, simple, and effective method of treatment and the preferred mode of management in the great majority of patients. Nonoperative management with thrombolytic agents or high-dose heparin therapy alone is occasionally indicated in highly selected patients. The prognosis of acute arterial thromboembolism of lower extremity can be improved by early detection, early adequate treatment, and the involvement of a qualified vascular surgeon.
신공여자의 신혈관 상태에 따른 수취자의 이식신 생존율 및 신기능의 변화에 관한 고찰
박호철,주흥재,정호술,홍성화 대한혈관외과학회 1992 Vascular Specialist International Vol.8 No.1
Factors that affect on the survival of transplanted kidney have been analyzed and the surgeons have been interested to the prediction of outcome for years. We compared graft survival rates and postoperative changes of renal function of grafts be- tween the group A with single renal artery(n=58), and group B with double renal arteries(N=9) of donors in transplanted kidneys. This study analized selected 67 cases which were treated by kidney transplantation at Department of Surgery, College of Medicine, Kyung Hee University, during 10years from January 1987 to December 1987. Mean age of recipients and donors was 36, 42years in group A, and 33, 44years in group B respectively. Right nephrectomy of donor was done in 5 cases, and left nephrectomy was done in 62 cases. And the serum creatinine level was used for guidance of postoperative status of renal function. Their graft survival rates of group A and B were 3 months 100%, 92%, 6 months l 00%, 87%, I year 100%, 80%, 2 years 89%, 72%, and 3 years 78%, 64%. Group A had better survival rate than group B, but there was no significant difference between the groups. And also there was no significant difference of postoperative serum creatinine level of recipients between the groups. So the result was as follows: There was no significant correlation between the graft survival rate, postoperative change of renal function of graft and the state of renal artery of donor.