Changes in the Normal Infrarenal Aortic Length and Tortuosity in Elderly People

양신석,윤우성 대한혈관외과학회 2020 Vascular Specialist International Vol.36 No.1

Purpose: To investigate the changes in the infrarenal aortic length and tortuosity in elderly patients. Materials and Methods: We retrospectively reviewed the medical records and computed tomography (CT) scans of 857 patients who underwent surgery for colorectal cancer between August 2009 and July 2012. Among these patients, 48 patients who were aged ≥60 years, underwent follow-up CT at least 5 years after surgery, did not have aortic disease, and did not receive radiation therapy were enrolled. The aortic tortuosity index (ATI) was defined by dividing the distance along the central lumen line from the lowest renal artery to the aortic bifurcation (L1) by the straight-line distance from the lowest renal artery to the aortic bifurcation (L2). Aortic diameters were measured at the lowest renal artery level (D1) and 20 mm below (D2). A paired t-test and Wilcoxon signed-rank test were used to compare lengths and diameters between the initial and final CT scan. Spearman’s correlation analysis was performed to determine the correlations between time and the changes in L1 and ATI. Results: The average follow-up period was 68 months. The mean changes in L1 and L2 were 0.69 mm and –0.59 mm, respectively, while the mean changes in D1 and D2 were 0.77 mm and 0.58 mm, respectively. The mean increase in ATI was 0.015. All findings were statistically significant. On Spearman’s correlation analysis, ΔL1 and ΔATI showed no correlation with follow-up duration. Conclusion: The infrarenal aortic length and tortuosity of elderly patients increases at a slow rate over time.

제7장 남구

양신석 부산광역시 시사편찬위원회 2006 부산의 자연마을 Vol.1 No.-

Incidence and Risk Factors for Deep Vein Thrombosis after Abdominal Surgery

양신석,최동욱,김성,최성호,손태성,노재형,허진석,이경복,김희철,김동익 대한혈관외과학회 2012 Vascular Specialist International Vol.28 No.1

Purpose: The incidence of deep vein thrombosis (DVT) after abdominal surgery has been thought to be lower in Asian populations than in Western populations, but there is little information on the incidence and risk factors in Korea. This study aimed to investigate the incidence of postoperative DVT and to analyze the risk factors for DVT in patients who were not administered perioperative prophylactic anticoagulation. Methods: On a prospective basis, we evaluated the incidence of DVT and analyzed the risk factors associated with the development of DVT in 152 patients who were scheduled to undergo abdominal surgery for gastrointestinal, hepatobiliary, or pancreatic disease. All patients were examined by duplex scanning on both of their lower extremities during hospitalization. Results: The mean patient age was 56.8±11.8 years, and the male to female ratio was 1:0.7. DVT occurred at a rate of 7.2% (11 patients). All the cases of DVT were asymptomatic and located in the calf veins. There was no statistically significant difference between the DVT and non-DVT groups for risk factors. Conclusion: The prevalence of DVT after abdominal surgery at a single institute was lower than levels currently suggested in Western countries. A larger, randomized, multi-center study is needed to establish the guidelines towards the prevention of DVT occurrence after abdominal surgery in Korea.

확장범주 신장이식의 국내 현황과 한국형 기준의 필요성

양신석,박재범 대한이식학회 2017 Korean Journal of Transplantation Vol.31 No.1

The disparity between the number of patients awaiting kidney transplantation (KT) on the list and the number of actual number of KT from deceased organ donation has become wider despite the recent increase in the number of donations. Moreover, the proportion of donors aged 60 or more has rapidly increased. KT from expanded criteria donor (ECD) has been not only been necessary, but also inevitable with respect to maximizing the use of this scarce organ resource. However, we still use the “marginal donor criteria” implemented in 2000 when KONOS (Korean Network for Organ Sharing) was established. In the Korean transplantation environment, this “marginal donor criteria” does not have the power to predict graft outcome, and fails to discern grafts with inferior transplant outcomes from successful transplants. As a result, it does not meet the role of the criteria in Korea. Therefore, we should develop our own criteria based on our deceased donor kidney transplantation experience. Here, we review the current status of ECD KT in Korea in context with the progression of the ECD criteria system in UNOS (United Network for Organ Sharing) and present some considerations for the Korean donor criteria system.

Surgical Thrombectomy for Phlegmasia Cerulea Dolens

양신석,윤우성 대한혈관외과학회 2016 Vascular Specialist International Vol.32 No.4

Phlegmasia cerulea dolens (PCD) is a medical emergency that can lead to venous gangrene of the lower extremity. Early diagnosis and prompt treatment is crucial for limb salvage. There are two treatment options (endovascular or surgical). In the endovascular era, catheter-directed thrombolysis is the treatment of choice to achieve venous outflow. However, surgical thrombectomy is indicated in certain cases. The authors report successful surgical thrombectomy in a 75-year-old man with PCD and review the treatment of PCD.

하지정맥류와 만성정맥부전증의 진단 및 치료

양신석 대한의사협회 2020 대한의사협회지 Vol.63 No.12

This study aimed to review the pathophysiology of varicose veins and chronic venous insufficiency and the recent surgical treatment trend. Varicose veins are tortuous, twisted, or lengthened veins in the lower extremities. It is part of the spectrum of chronic venous disease. Primary pathogenesis is increased chronic venous hypertension caused by valvular insufficiency, venous outflow obstruction, and calf muscle pump failure. Some patients complain of no symptoms, except report cosmetic concerns. If the varicose vein progresses to chronic venous insufficiency, it may cause edema of the lower limb. The skin lesion can present as hyperpigmentation of the median part of the ankle, congestive dermatitis, and even a skin ulcer. The varicose vein can be diagnosed easily by visual inspection after identifying the skin lesions. For non-surgical treatment, elastic stocking, Unna boots, and pneumatic compression devices are recommended to reduce venous pressure. High ligation with stripping has been the standard treatment for varicose veins to achieve symptom relief and improve cosmetic effects. Endovenous laser ablation, radiofrequency ablation, mechanochemical ablation, and the VenaSeal closure system have been introduced as surgical treatment methods. Recently, endovenous thermal/non-thermal ablations are recommended for treatment because both are less invasive techniques. The appropriate therapy should be selected after considering the patients’ symptoms and signs, anatomical structure, and economic burden of the treatment.

Results of Open Surgical Repair of Chronic Juxtarenal Aortic Occlusion

양신석,김영욱,박양진,김동익,우신영,허승,김형기 대한혈관외과학회 2014 Vascular Specialist International Vol.30 No.3

Purpose: The aim of study was to review the results of open surgical repair (OSR) of chronic juxtarenal aortic occlusion (JRAO). Materials and Methods: We retrospectively reviewed the results of OSR performed in 47 patients (male, 92%; mean age, 59.9±9.3 years [range, 44-79]) with chronic JRAO during the past 21 years. In order to reduce intraoperative renal ischemic time (RIT), we excised a portion of the occluded segment of the infrarenal aorta without proximal aortic clamping. We then performed suprarenal aortic clamping with both renal arteries clamped, removed the proximal aortic thrombus cap, confirmed both renal artery orifices, and moved the suprarenal aortic clamp to the infrarenal aorta to allow renal perfusion and standard aortoiliac reconstruction. We investigated early (<30 days) postoperative surgical morbidity (particularly renal function), operative mortality, and longterm patient survival. We conducted risk factor analysis for postoperative renal insufficiency. Results: The mean intraoperative RIT was 10.7±5.5 minutes (range, 3-25), including 6 patients who underwent concomitant pararenal aortic thromboendarterectomy. Postoperatively, five (11%) patients had transient renal insufficiency, one had pneumonia, and one patient had an acute myocardial infarction. However, there was no operative mortality or newly developed dialysis-dependent renal failure. Postoperative follow up was available in 36 (77%) patients for a mean period of 6.3 years (range, 1 month-17 years). Kaplan Meier calculations of patient survival at 5 and 10 years after surgery were 91.2% and 83.6%, respectively. Conclusion: We have experienced short RIT, acceptable early postoperative results and long-term survival after OSR of chronic JRAO.

The Need for New Donor Stratification to Predict Graft Survival in Deceased Donor Kidney Transplantation

양신석,박재범,양재석,안규리,민상일,하종원,김성주 연세대학교의과대학 2017 Yonsei medical journal Vol.58 No.3

Purpose: The aim of this study was to determine whether stratification of deceased donors by the United Network for Organ Sharing (UNOS) criteria negatively impacts graft survival. Materials and Methods: We retrospectively reviewed deceased donor and recipient pretransplant variables of kidney transplantationsthat occurred between February 1995 and December 2009. We compared clinical outcomes between standard criteria donors(SCDs) and expanded criteria donors (ECDs). Results: The deceased donors consisted of 369 patients. A total of 494 transplant recipients were enrolled in this study. Mean age was 41.7±11.4 year (range 18–69) and 273 patients (55.4%) were male. Mean duration of follow-up was 8.8±4.9 years. The recipients from ECD kidneys were 63 patients (12.8%). The overall mean cold ischemia time was 5.7±3.2 hours. Estimated glomerular filtrationrate at 1, 2, and 3 years after transplantation were significantly lower in ECD transplants (1 year, 62.2±17.6 vs. 51.0±16.4, p<0.001; 2 year, 62.2±17.6 vs. 51.0±16.4, p=0.001; 3 year, 60.9±23.5 vs. 54.1±18.7, p=0.047). In multivariate analysis, donor age (≥40 years) was an independent risk factor for graft failure. In Kaplan-Meier analyses, there was no significant difference in death-censored graft survival (Log rank test, p>0.05), although patient survival was lower in ECDs than SCDs (Log rank test, p=0.011). Conclusion: Our data demonstrate that stratification by the UNOS criteria does not predict graft survival. In order to expand the donor pool, new criteria for standard/expanded donors need to be modified by regional differences.

하지정맥류에 대한 오해와 진실

양신석,김서민 대한의사협회 2022 대한의사협회지 Vol.65 No.4

Background: Varicose veins are a common chronic venous disorder that leads to a significantly reduced quality of life and high healthcare resource burden. There is a large amount of research-based data and opinions regarding varicose veins. There are also some common myths and misconceptions about the treatment options. Current Concepts: Management options include compression therapy, open venous surgery, and endovenous therapy. An appropriate treatment option must be selected on a case-by-case basis based on the symptoms, severity, and duplex ultrasonography findings. Venous intervention should be considered if the condition is symptomatic and often, there is no need for urgent surgery or endovenous therapy because the symptoms usually progress slowly and severe cardiac problems are rare. According to previous studies, there is no difference between the endovenous therapy modalities and the traditional surgical method (i.e., high ligation and stripping) in terms of recurrence rates. Therefore, case-specific factors, such as anatomy and economic factors, should be considered. When compression therapy is considered, graduated compression stocking with suitable pressure should be prescribed. Venoactive drugs can be suggested in addition to compression therapy for symptomatic varicose veins or venous ulcers. Discussion and Conclusion:. Correct information regarding treatment for varicose veins based on the best available evidence must be provided to patients. The treatment options for varicose veins should be selected on a case-by-case basis considering the patient`s symptoms, anatomy and economic factors.

[Poster] Rena and visceral complications after open aortic surgery requiring supra-renal aortic clamping

양신석,박근명,박양진,김동익,김영욱 대한외과학회 2011 대한외과학회 학술대회 초록집 Vol.2011 No.11