Treatment Outcomes of Patients With Ruptured Abdominal Aortic Aneurysms

Kim Hyangkyoung,Kwon Tae-Won,Cho Yong-Pil,Gwon Jun Gyo,Han Youngjin,Lee Sang Ah,Kim Ye-Jee,Kim Seonok 대한의학회 2023 Journal of Korean medical science Vol.38 No.39

Background: Ruptured abdominal aortic aneurysm (rAAA) is a serious complication of abdominal aortic aneurysm associated with high operative mortality and morbidity rates. The present study evaluated the perioperative and long-term outcomes of Korean patients with rAAA based on national health insurance claims data. Methods: The National Health Insurance Service (NHIS) database was searched retrospectively to identify patients with rAAA who underwent endovascular aneurysm repair (EVAR) and open surgical repair (OSR) from 2009 to 2018. Perioperative (≤ 30 days), early postoperative (≤ 3 month), and long-term (> 3 month) survival, reinterventions, and complications were assessed. Results: The search identified 1,034 patients with rAAA, including 594 who underwent EVAR and 440 who underwent OSR. When the study period was divided into two, the total numbers of patients with rAAA, patients who underwent EVAR, and octogenarians were higher during the second half. The perioperative mortality rate was 29.8% in the EVAR and 35.0% in the OSR group (P = 0.028). Hartmann’s procedure for bowel infarction was performed more frequently in the OSR than in the EVAR group (adjusted odds ratio, 6.28; 95% confidence interval [CI], 2.33–21.84; P = 0.001), but other complication rates did not differ significantly. All-cause mortality during the entire observation period did not differ significantly in the EVAR and OSR groups (adjusted hazard ratio, 1.17; 95% CI, 0.98–1.41; P = 0.087). Abdominal aortic aneurysm-related reintervention rate was significantly lower in the OSR group (adjusted hazard ratio, 0.31; 95% CI, 0.14–0.70; P = 0.005). Conclusion: Although EVAR showed somewhat superior perioperative outcomes for rAAA, the long-term outcomes of EVAR after excluding initial 3 months were significantly worse than OSR. When anatomically feasible for both treatments, the perioperative mortality risk and reasonable prospects of long-term survival should be considered in rAAA.

Treatment of abdominal aortic aneurysms in Korea: a nationwide study

Hyangkyoung Kim,Tae-Won Kwon,Yong-Pil Cho,Jun Gyo Gwon,Youngjin Han,Sang Ah Lee,Ye-Jee Kim,Seonok Kim 대한외과학회 2023 Annals of Surgical Treatment and Research(ASRT) Vol.105 No.1

Purpose: Although endovascular aneurysm repair (EVAR) has been shown to be superior to open surgical repair (OSR) for abdominal aortic aneurysm (AAA) treatment, no large-scale studies in the Korean population have compared outcomes and costs. Methods: The National Health Insurance Service database in Korea was screened to identify AAA patients treated with EVAR or OSR from 2008 to 2019. Perioperative, early postoperative, and long-term survival were compared, as were reinterventions and complications. Patients were followed-up through 2020. Results: Of the 13,631 patients identified, 2,935 underwent OSR and 10,696 underwent EVAR. Perioperative mortality rate was lower in the EVAR group (4.2% vs . 8.0%, P < 0.001) even after excluding patients with ruptured AAA (2.7% vs . 3.3%, P = 0.003). However, long-term mortality rate per 100 person-years was significantly higher in the EVAR than in the OSR group (9.0 vs . 6.4, P < 0.001), and all-cause mortality was lower in the OSR group (hazard ratio, 0.9; 95% confidence interval, 0.87–0.97, P = 0.008). EVAR had a higher AAA-related reintervention rate per 100 person-years (1.75 vs . 0.52), and AAA-related reintervention costs were almost 10-fold higher with EVAR (US dollar [USD] 6,153,463) than with OSR (USD 624,216). Conclusion: While EVAR may have short-term advantages, OSR may provide better long-term outcomes and cost- effectiveness for AAA treatment in the Korean population, under the medical expense system in Korea.

Abdominal and Pelvic Vascular Imaging

HyangKyoung Kim 대한외과학회 2020 대한외과학회 학술대회 초록집 Vol.2020 No.11

Clinical outcome of graft removal versus preservation in abdominal aortic graft infection: a systematic review and meta-analysis

Hyangkyoung Kim,Han Zo Choi,Yujin Kwon,Nicos Labropoulos 대한외과학회 2023 Annals of Surgical Treatment and Research(ASRT) Vol.105 No.4

Purpose: The purpose of this study was to compare the clinical outcomes of abdominal aortic graft infection (AGI) treated with removal of the graft vs. graft preservation. Methods: The electronic databases PubMed, Embase, and Cochrane Library for studies that reported on AGI were searched. Observational studies and case series of at least 10 cases that reporting on the prevalence, microbiology, and outcomes of AGI were included. Results: Our search identified 23 studies that met our inclusion criteria, reporting on a total of 873 patients who underwent open surgical repair (OSR) or endovascular aneurysm repair (EVAR). Of these patients, 833 received graft removal, and 40 received graft preservation. The prevalence of AGI was reported to be 1.0% (95% confidence interval [CI], 0.5%–1.8%) after OSR and 0.4% (95% CI, 0%–1.1%) after EVAR. The pooled estimates of 1-year, 2-year, and 5-year mortality were 28.7% (95% CI, 19.4%–38.8%), 36.6% (95% CI, 24.6%–49.5%), and 51.8% (95% CI, 38.4%–65.1%) in the graft removal group and 16.1% (95% CI, 4.1%–32.2%), 18.5% (95% CI, 5.7%–35.1%), and 50.0% (95% CI, 31.6%–68.4%) in the graft preservation group. The 30-day mortality rate’s risk ratio (RR) for graft removal vs. preservation was 0.98 (95% CI, 0.40–2.38), while the 1-year mortality rate’s RR was 3.44 (95% CI, 1.60–7.42). Conclusion: The 30-day mortality rate of AGI treatment was found to be high, whether using graft removal or preservation. In selected patients, implementing antibiotics with graft preservation as an initial management may be helpful in reducing the mortality rate.

Effect of Anastomotic Method on Intimal Hyperplasia in Rabbit Aorta

Hyangkyoung Kim,Tae-Won Kwon,Yong-Pil Cho,Gi-Young Ko,Sang Seob Yun,He Nam Hong,Seong-Wook Park 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.5

Purpose: The clinical advantages of end-to-end (ETE) anastomosis have not been clear despite its biomechanical advantage over end-to-side (ETS) anastomosis. We compared the histomorphometric features of intimal remodeling after ETE and ETS anastomosis in a rabbit aortic bypass model. Methods: Thirty-two bypass operations, 16 with ETS and 16 with ETE anastomoses, were performed using aortic allografts of donor rabbits (15 per group) and polytetrafluoroethylene (PTFE) grafts (1 per group). To minimize bias from the immunologic response to aortic allografts or graft size, a long aortic tissue obtained from one donor was divided into 2 pieces and shared between each ETE and ETS bypass. PTFE graft bypasses, which are commonly used in clinical practice, were performed to provide comparison results for an allograft with a different compliance. Vessels were harvested at 1 day (1 per group), 5 days (1 per group), and 4 weeks (14 per group, including the PTFE bypass group) after surgery. Intimal thickening was evaluated with hematoxylin-eosin, van Gieson, immunohistochemical staining and Western blot analysis of TNF-α and proliferative cell nuclear antigen (PCNA) expression. Results: Mean intimal thickness and volume (0.721±0.047 ㎜, 5.734±0.387 ㎣ vs. 0.883±0.048 mm, 9.068±0.462 ㎣) and intima/media volume ratio (0.70±0.05 vs 1.08±0.06) were significantly smaller in ETE (P<0.05). Western blotting showed a marked increase in TNF-α (203.15±5.29 vs. 494.49±6.11) and PCNA concentrations (152.66±7.37 vs. 175.53±4.36) in the ETS group. Conclusion: ETE anastomosis results showed significantly decreased inflammatory reaction and volume of intimal hyperplasia, and therefore seemed to be associated with better long-term graft patency.

Report of a case of ischemic colitis with bilaterally patent internal iliac arteries after endovascular abdominal aneurysm repair

Hyangkyoung Kim,Tae-Won Kwon,Yong-Pil Cho,Ki-Myung Moon 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.82 No.3

During endovascular aneurysm repair (EVAR), interruption of the internal iliac arteries (IIAs) or the inferior mesenteric artery by stents or embolization is thought to cause colon ischemia. To minimize this risk, attempts have been made to preserve the IIAs using iliac branch devices or IIA revascularization. Here we present our experience of colon ischemia after EVAR in a patient with bilaterally patent IIAs without evidence of embolism. A 70-year-old man had abdominal pain and a ruptured abdominal aortic aneurysm was found. We performed EVAR with custom-made tube grafts preserving the bilateral IIAs. On postoperative day 2, the patient complained of abdominal pain, a sigmoidoscopy was performed revealing colon ischemia. On laparotomy, transmural infarction of the sigmoid colon was found and resected. Because IIA preservation cannot guarantee protection against colon ischemia, surgeons should maintain a high level of suspicion and use surveillance liberally after EVAR for early diagnosis of colon ischemia, even if both IIAs are preserved.

Management of Cephalic Arch Stenosis in Hemodialysis Access: Systematic Review and Meta-analysis

Hyangkyoung Kim,Kwangjin Lee,Sungsin Cho,Jin Hyun Joh,Nicos Labropoulos 대한외과학회 2022 대한외과학회 학술대회 초록집 Vol.2022 No.11

Technique of Ultrasound Guided Vascular Access

HyangKyoung Kim 대한외과학회 2020 대한외과학회 학술대회 초록집 Vol.2020 No.11

A Right Gastroepiploic Artery Aneurysm Treated by Surgical Excision

Hyangkyoung Kim,Yong-Pil Cho,Ki-Myung Moon,Sang-Joon Park,Tae-Won Kwon 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.6

Ultrasound Elastography to Differentiate the Thrombus and Plaque in Peripheral Arterial Diseases

Ki Duk Kim,Hyangkyoung Kim,조성신,Seung Hwan Lee,조진현 대한혈관외과학회 2022 Vascular Specialist International Vol.38 No.4

Purpose: Arterial stiffness and steno-occlusion of the lower-extremity can result from many vascular lesions, including acute thromboembolisms, soft plaques, calcified plaques, or inflammatory disease. Ultrasound (US) elastography measures the tissue deformation response to compression and displays tissue stiffness. This study aimed to evaluate the characteristics of arterial lesions in the lower extremities using US elastography. Materials and Methods: We retrospectively analyzed the data of 20 patients who visited our institute for arterial disease treatment between May 2016 and November 2017. An US examination with B-mode and strain elastography (SE) was performed of four different lesion types at 45 sites: acute and subacute thromboembolisms, soft plaques, calcified plaques, and thromboangiitis obliterans lesions (TAOs). During SE, stress was externally applied by the operator using the transducer. Strain ratio (SR) was calculated as the fraction of the average strain in the reference area divided by the average strain in the lesion. The SR was compared among different lesion types, with the accompanying vein as the reference region of interest. Results: The strain was highest in the soft plaques (0.63%±0.23%), followed by the TAOs (0.45%±0.11%), calcified plaques (0.44%±0.13%), and acute thromboembolisms (0.34%±0.23%), which were statistically significant (P=0.026). However, the mean SR was highest for the calcified plaques (2.33%±0.80%), followed by the TAOs (1.63%±0.40%), acute thromboembolisms (1.60%±0.48%), and soft plaques (1.51±0.39), and which were statistically significant (P=0.013). Conclusion: Despite several limitations, vascular elastography may be useful for differentiating between lesion types in peripheral arterial disease.