중재시술과 부가적인 항응고요법으로 치료한 신동맥 근접 대동맥 폐색증

김건우 ( Gun Woo Kim ),문재연 ( Jae Youn Moon ),진선미 ( Sun Mi Jin ),문지혜 ( Jie Hye Moon ),김경호 ( Kyung Ho Kim ),김상훈 ( Sang Hoon Kim ),임상욱 ( Sang Wook Lim ) 대한내과학회 2013 대한내과학회지 Vol.85 No.3

Chronic atherosclerotic occlusion of the abdominal aorta is a rare disease in clinical practice. In this disease, juxtarenal aortic occlusion is defined as the condition extended, adjacent to the renal arteries. The treatment of juxtarenal aortic occlusion is more difficult than a ``simple`` abdominal aortic occlusion. Vascular surgery of a juxtarenal aortic occlusion-specifically aortic endarterectomy and bypass grafting-is a challenging procedure that almost invariably requires aortic cross-clamping above the level of the renal arteries, and may be associated with significant morbidity and mortality. With the advent of endovascular treatment, percutaneous transluminal angioplasty and stent implantation have been used increasingly as an alternative to conventional surgery in the management of patients with aortoiliac disease. However, endovascular treatment for juxtarenal aortic occlusion is not common and, also, special attention is needed with regard to possible renal complications. Here, we report the successful revascularization of a case of chronic juxtarenal aortic occlusion with endovascular treatment and adjunctive anticoagulation. (Korean J Med 2013;85:302-307)

토끼 심폐소생술 모델에서 하행대동맥의 지속적인 폐쇄가 뇌허혈에 미치는 영향

김형국,채장성,오동렬,최승필,김세경,홍태용 대한응급의학회 2002 대한응급의학회지 Vol.13 No.3

Purpose: A recent report introduce a new option for cardiopulmonary resuscitation by using of a continuous descending aortic balloon occlusion. The aim of the present study was to evaluate the effect of balloon occlusion of the descending aorta during cardiopulmonary resuscitation on brain ischemia. Methods: Twelve rabbits were enrolled in this study. A 4 French Swan-Ganz catheter was advanced through the right femoral artery into the descending aorta Ventricular fibrillation was induced with an AC current delivered through an electrode catheter advanced into the right ventricle. After 3 minutes of untreated ventricular fibrillation, the rabbits were randomized in two groups: (1) chest compression without balloon occlusion (control group) and (2) chest compression with balloon occlusion of the descending aorta (experimental group). The balloon was inflated for 3 minutes during resuscitation. Defibrillation was attempted at 3 minutes after start of chest compression. At 24 hours after return of spontaneous circulation, brain tissues were fixed in 4% paraformaldehyude and stained with hematoxylin eosin. Then, the ischemic cells in the hippocampal CA1 area were counted. Results: There was significant difference in ischemic neuronal cells between the two groups (control group: 41.8 ±10.9%, experimental group: 16.8 ±6.8%, p<0.05). In the experimental group, carotid blood flow was better than it was in the control group during chest compression (control group:2.4±1.0mL/min, experimental group: 7.6 ±1.9mL/min, p<0.05). Conclusion: These results suggests that balloon occlusion of the descending aorta during resuscitation decreases brain ischemia in rabbits during cardiac arrest.

Juxtarenal Aortic Occlusion의 임상치험

고용복(Yong Bok Koh),이광렬(Kwang Real Lee),김승남(Seung Nam Kim) 대한외과학회 1990 Annals of Surgical Treatment and Research(ASRT) Vol.39 No.4

Staged Hybrid Treatment with Branched Endovascular Aneurysm Repair of a Thoracoabdominal Aortic Aneurysm in the Presence of a Total Infrarenal Aortoiliac Occlusion

Mateja Andic,Mario Lescan 대한혈관외과학회 2021 Vascular Specialist International Vol.37 No.4

Aortoiliac occlusive disease may limit the use of branched endovascular aneurysm repair (BEVAR) of thoracoabdominal aneurysms (TAAAs). Thus, infrarenal aortoiliac occlusion may preclude the use of BEVAR. We present a case involving a 67-yearold patient with a fast-progressing TAAA (diameter: 70 mm) and a concomitant total aortoiliac occlusion. A multi-staged treatment concept included the creation of the access and the distal landing zone for the consecutive endovascular procedures through an aorto-right femoral-left popliteal bypass. At six-week intervals, thoracic endovascular aortic repair for the creation of the proximal landing zone and a 4-vessel BEVAR were accomplished. At 36 months, a type III endoleak occurred due to the fracture of the bridging stent-graft to the celiac trunk and the superior mesenteric artery. It was successfully treated with VBX stent-grafts. This case illustrates the importance of a staged hybrid approach in the management of complex aortic pathologies with poor access and insufficient distal landing zone.

급성 복부 대동맥 폐색 후 발생한급성 허혈성 말초신경병증 -증례 보고-

김기찬,정호중,정흥채,정상욱 大韓再活醫學會 2000 Annals of Rehabilitation Medicine Vol.24 No.3

The Results of Self-Expandable Kissing Stents in Aortic Bifurcation

문재영,황홍필,곽효성,한영민,유희철 대한혈관외과학회 2015 Vascular Specialist International Vol.31 No.1

Purpose: Kissing stent reconstruction is a widely used technique for the management of aortoiliac occlusive disease involving the aortic bifurcation or proximal common iliac arteries. The purpose of this study was to evaluate the results of self-expandable kissing stents in the aortic bifurcation. Materials and Methods: We reviewed medical records of the patients treated with a kissing stent retrospectively from January 2007 to December 2012. The primary and secondary patencies were determined with Kaplan-Meier analysis, and Cox regression was used to determine the factors associated with patency. Results: A total of 21 patients were included, and all were male (median age 53±15 years, range 48?78 years). Major symptoms were claudication (n=16, 61.9%), rest pain (n=5, 23.8%) and gangrene (n=5, 23.8%). Tans-Atlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) II classification was A 2 (9.5%), B 5 (23.8%), C 7 (33.3%) and D 8 (38%). The mean follow-up was 40.7 months. Major complication occurred in only one case which consisted of distal limb ischemia by emboli. Six patients developed symptomatic restenosis or occlusion. There was no major amputation, but minor amputation occurred in 3 patients. There were 2 mortalities not associated with the procedure (lung cancer and intracranial hemorrhage). Primary patency was 89.6% at 1 year, 74.7% at 3 years and 64.0% at 5 years. Secondary patency was 94.1% at 1 year, 88.2% at 3 years and 68.6% at 5 years. No risk factors for restenosis or occlusion were identified. Conclusion: Self-expandable kissing stents can be used successfully with comparable patency for endovascular treatment of symptomatic atherosclerotic occlusive lesions in the aortic bifurcation area.

혈액투석 환자에서 대동맥궁에 의한 좌완두정맥의 외부 압박

남희철 ( Hee Chul Nam ),강승훈 ( Seung Hun Kang ),김연지 ( Yeon Ji Kim ),이수림 ( Su Lim Lee ),김영옥 ( Young Ok Kim ),윤선애 ( Sun Ae Yoon ),윤유선 ( Yu Seon Yun ) 대한내과학회 2013 대한내과학회지 Vol.84 No.4

The most common cause of central venous obstruction including left braciocephalic vein is intrinsic stenosis associated with a previous central venous catheter or other devices. Occasionally, patients with no history of central venous catheterization present with left brachiocephalic vein occlusion. This occurs as a result of extrinsic compression of the brachiocephalic vein by adjacent vascular structures, especially the aortic arch and its branches. Here, we report a case of left brachiocephalic vein compression caused by a tortuous, ectatic aortic arch in a patient with no history of central vein catheterization. To our knowledge, this is the first report of extrinsic compression of the brachiocephalic vein by the aortic arch in Korea. (Korean J Med 2013;84:597-601)

Experiences of Surgical Treatment for Juxtarenal Aortic Occlusion

전희재 대한혈관외과학회 2014 Vascular Specialist International Vol.30 No.1

Purpose: To evaluate the outcomes of juxtarenal aortic occlusion (JRAO), a review of 15 patients who underwent aortic bypass replacement following aortorenal thrombectomy, especially focusing on the safety of suprarenal aortic clamping or transient aortic compression, was undertaken. Materials and Methods: During the period of June 2001 to November 2012, 15 patients with JRAO (chronic 10, acute 5) were analyzed retrospectively. JRAO with combined stenosis of the renal artery was found in 2 patients, renal artery thrombus in 8 patients, and normal in 5 patients. Results: All patients were males. Mean age was 61.7±11.2 years. There were 14 aortobifemoral bypass grafting and 1 aortobiiliac bypass grafting. Six Dacron and 9 PTFE artificial Y-grafts were implanted to the aorta with end-to-end anastomosis in the proximal aorta. Suprarenal aortic clamping was performed in 7 patients, supraceliac clamping in 2 patients, and transient aortic compression in 6 patients. There were 13 cases with aortic clamping time <10 minutes and 2 cases with >10 minutes. Thrombectomy of the aorta and renal artery was performed in 10 (66.7%) patients. There were no operative mortality cases. The perioperative morbidity rate was 26.7% (4/15). Preoperative renal function was impaired in four patients. The renal functions of these cases were recovered postoperatively. Conclusion: Aortic bypass replacement following aortorenal thrombectomy with suprarenal aortic clamping or transient aortic compression for JRAO is the optimal treatment. It is important to focus on short renal ischemic time during suprarenal aortic clamping for prevention of renal damage. It provides unmatched perioperative and long-term results.

Renal and abdominal visceral complications after open aortic surgery requiring supra-renal aortic cross clamping

Shin-Seok Yang,Keun-Myoung Park,Young-Nam Roh,Yang Jin Park,Dong-Ik Kim,Young-Wook Kim 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.83 No.3

Purpose: The aim of this study was to assess renal or abdominal visceral complications after open aortic surgery (OAS) requiring supra-renal aortic cross clamping (SRACC). Methods: We retrospectively reviewed the medical records of 66 patients who underwent SRACC. Among them, 17 followed supra-celiac aortic cross clamping (SCACC) procedure, 42 supra-renal, and 7 inter-renal aorta. Postoperative renal, hepatic or pancreatic complications were investigated by reviewing levels of serum creatinine and hepatic and pancreatic enzymes. Preoperative clinical and operative variables were analyzed to determine risk factors for postoperative renal insufficiency (PORI). Results: Indications for SRACC were 25 juxta-renal aortic occlusion and 41 aortic aneurysms (24 juxta-renal, 12 supra-renal and 5 type IV thoraco-abdominal). The mean duration of renal ischemic time (RIT) was 30.1 ± 22.2 minutes (range, 3 to 120 minutes). PORI developed in 21% of patients, including four patients requiring hemodialysis (HD). However, chronic HD was required for only one patient (1.5%) who had preoperative renal insufficiency. RIT ≥ 25 minutes and SCACC were significant risk factors for PORI development by univariate analysis, but not by multivariate analysis. Serum pancreatic and hepatic enzyme was elevated in 41% and 53% of the 17 patients who underwent SCACC, respectively. Conclusion: Though postoperative renal or abdominal visceral complications developed often after SRACC, we found that most of those complications resolved spontaneously unless there was preexisting renal disease or the aortic clamping time was exceptionally long.

Paraplegia due to Acute Aortic Coarctation and Occlusion

Park, Chang-Bum,Jo, Dae-Jean,Kim, Min-Ki,Kim, Sang-Hyun The Korean Neurosurgical Society 2014 Journal of Korean neurosurgical society Vol.55 No.3

Coarctation and occlusion of the aorta is a rare condition that typically presents with hypertension or cardiac failure. However, neuropathy or myelopathy may be the presenting features of the condition when an intraspinal subarachnoid hemorrhage has compressed the spinal cord causing ischemia. We report two cases of middle-aged males who developed acute non-traumatic paraplegia. Undiagnosed congenital abnormalities, such as aortic coarctation and occlusion, should be considered for patients presenting with nontraumatic paraplegia in the absence of other identifiable causes. Our cases suggest that spinal cord ischemia resulting from acute spinal subarachnoid hemorrhage and can cause paraplegia, and that clinicians must carefully examine patients presenting with nontraumatic paraplegia because misdiagnosis can delay initiation of the appropriate treatment.