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      • KCI등재

        Lipoprotein에 의한 혈관 평활근세포의 증식과 MCP-1 발현에 관한 연구

        박재경,박호철,주홍재,장영복 대한혈관외과학회 1999 Vascular Specialist International Vol.15 No.2

        목적: Monocyte chemotactic protein-1 (MCP-1)은 주로 혈관내피세포와 평활근세포에서 분비되며, 단핵구를 혈중에서 혈관내막으로 끌어들이는 chemokine이다. 내막으로 들어온 단핵구는 탐식세포가 되어서 여러 가지의 cytokine들을 분비하는 한편, 지질을 탐식하여 포말세포가 되는 과정이 죽상경화증의 초기 경과이다. 이어서 평활근세포들이 내막쪽으로 이동하여 증식하게 되므로써 혈관내막이 비후되고, 많은 기질단백을 생성하여 죽상경화증의 병소가 완성된다. 이와 같이 MCP-1은 죽상경화증 병소의 형성에 중요한 초기 물질이지만, 혈관평활근세포와의 관계에 대해서는 아직까지 많은 부분이 알려져 있지 않다. 산화 저밀도 지단백은 강력한 죽상경화증 유발 물질이며 단핵구의 이동과 지질 탐식에도 관여하는 한편, 세포에 대한 독성 작용이 있는데 이런 산화 저밀도 지단백이나 산화 초저밀도 지단백으로 혈관 평활근세포에 자극을 가했을 때 MCP-1이 어떻게 발현되는 지에 관해서는 아직 보고된 바가 없다. 방법: Probucol은 동물실험에서 죽상경화증을 예방하는 물질로서 임상에서도 일부 사용되고 있으나 그 구체적인 약리 작용은 아직 밝혀져 있지 않다. 따라서 이 연구에서는 산화 저밀도 지단백, 산화 초저밀도 지단백이 죽상경화증 형성에 중요한 세포인 혈관 평활근세포의 증식과 MCP-1의 발현정도에 미치는 영향을 알아 보고, Probucol이 이 과정에서 산화 저밀도 지단백의 작용을 차단할 수 있는지를 알아 보았다. 결과: 산화 저밀도 지단백, 특히 산화 초저밀도 지단백으로 자극하였을 때는 저농도에서는 평활근세포를 자극하여 증식시키지만 고농도에서는 평활근세포의 증식을 억제하여 세포에 대한 독성 작용이 있음을 확인할 수 있었으나, Probucol 처치군에서는 산화 저밀도 지단백에 대해서만 이와 같은 세포 독성 작용이 의미 있게 감소되었고 또 MCP-1의 발현 정도도 보호되고 있음을 확인하였다. 결론: 이상과 같은 결과로 산화 저밀도 지단백과 산화 초저밀도 지단백은 배양 혈관 평활근세포에 대해 저농도에서는 세포의 증식을 자극하고, 고농도에서는 독성 작용이 있어서 세포의 증식을 억제하고 MCP-1 발현을 억제하여 평활근세포가 죽상경화증의 진행을 지연시키는 자가 조절 능력이 있을수도 있다는 사실과, Probucol은 배양 혈관 평활근세포에 대한 산화 저밀도 지단백의 독성 작용을 감소시킨다는 것을 알게 되었다.

      • KCI등재후보

        수술장에서 시행한 하지 동맥 폐색성 질환의 혈관 내 수술 초기경험

        김서민,정중기,정인목 대한혈관외과학회 2011 Vascular Specialist International Vol.27 No.4

        Purpose: Endovascular surgery (EVS) has been rapidly increasing within the last two decades, changing the pattern of treatments for arterial disease. The purpose of this study was to report our initial experiences of EVS for lower extremity arterial occlusive diseases in the operation room performed solely by a vascular surgeon. Methods: Between January 2009 and June 2010, 13 EVS were performed for lower extremity arterial occlusive diseases with a mobile C-arm. Three patients underwent simultaneous bypass surgery with balloon angioplasty. Clinical characteristics, treatments, and outcomes were retrospectively reviewed. Results: Primary patency rates at 1 and 12 months following balloon angioplasty were 92.3% (12/13) and 88.9% (8/9), respectively. Only one patient had a thrombotic occlusion, resulting in an above-knee amputation. No procedure-related deaths occurred. Conclusion: We showed an initial acceptable result of EVS for lower extremity arterial occlusive diseases in the operation room. However, the data analyzed was of a small group with a short term follow-up period. More experiences, judicious planning, and efforts to optimize endovascular techniques to resolve complications are needed to be a true vascular and endovascular surgeon.

      • SCOPUSKCI등재

        중복판막수술에 대한 임상적 연구

        김승진 대한흉부심장혈관외과학회 1989 The Korean Journal of Thoracic and Cardiovascular Vol.22 No.6

        Seventy eight patients underwent operation for combined multiple valve disease, with an overall early mortality of 14.1 % from January, 1983 to September, 1988 in the department of thoracic and cardiovascular surgery of Pusan National University Hospital. All of the above cases had combined multiple valve procedures. There were 33 mitral valve replacements and tricuspid annuloplasties, 33 aortic and mitral valve replacements, 5 aortic and mitral valve replacements with tricuspid annuloplasties, 3 aortic valve replacements and mitral annuloplasties, 1 open mitral commissurotomy and tricuspid annuloplasty and, 1 mitral valve replacement and primary closure of tricuspid valve cleft, 1 mitral valve replacement and aortic commissurotomy, 1 mitral, aortic and tricuspid valve replacement were done. 44 were male and 34 were female and the age distribution was from 14 to 57 with mean 38 year old. According to NYHA[New York Heart Association] classification, 49 patients were class I, 19 patients were class Il and 10 were class IV. Average perfusion time was 205.3 minutes. The live patients perfusion time was 178.7 minutes while that of dead ones was 272.0 minutes. Early deaths within 30 days from operation were 11 cases, 6 of which were due to low cardiac output, 3 were acute renal failure and 2 were cardiac rupture. The 65 patients were followed up from 2 to 30 months for a total 20.6 patient years. 1 patient committed suicide because of postoperative depression 1 year after operation. All of the survivors were enjoying their daily life and their NYHA class was superior to the preoperative ones.

      • KCI등재후보

        신동맥하 복부대동맥류의 혈관 내 치료에서 혈관누출 발생에 영향을 미치는 인자

        조정선,이호균,정상영,김재규,최수진나 대한혈관외과학회 2013 Vascular Specialist International Vol.29 No.2

        Purpose: The purpose of this study is to evaluate the factors affecting the endoleaks of endovascular aneurysm repairs in infrarenal abdominal aortic aneurysms. Methods: On a retrospective basis, we analyzed 122 patients, who underwent endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm between March, 2006 and June, 2011. According to the endoleak, the patients were divided into 2 groups: endoleak group and non-endoleak group. We compared the following variables between the 2 groups: patient clinical characteristics (age, gender, body mass index, history of smoking, hypertension, diabetes mellitus, and coronary artery disease) and anatomical features of the aneurysms. Results: A total of 111 male and 11 female patients were included. Fifty-two patients showed endoleak (42.6%) during follow-up periods (median: 4.6 years). There was no significant difference between endoleak and non-endoleak group according to patient's clinical characteristics and used devices. However, there were significant differences between two groups according to the anatomical features of the aneurysm, such as the morphology, size of the aneurysm, and the size and angle of the neck of the aneurysm. Conclusion: Endoleak indicated high frequency when the aneurysm size is large, and when the neck aneurysm is large, with the neck angle being more than 60 degrees. Thus, patients with more than one of the above three characteristics may need more attentive and cautious procedures as well as a closer follow-up.

      • SCOPUSKCI등재

        농흉치료에 대한 조기 Minithoracotomy 와 흉관삽관술의 비교연구

        임종수 대한흉부심장혈관외과학회 1989 The Korean Journal of Thoracic and Cardiovascular Vol.22 No.6

        Fifty one patients with empyema thoracic were managed at the Kyung Hee University Medical Center during 5 years between December, 1982, and December, 1987. The patients were classified into two groups; group A [early minithoracotomy-9 patients] and group B[conventional chest tube insertion-42 patients]. Each group was retrospectively analyzed to compare the results in terms of leukocyte count change, body temperature change, duration of hospitalization, elapsed time to chest tube removal and the need for subsequent decortication and tube change. There was no statistical difference between two groups in terms of etiology, age and sex. l. In the group A, mean preoperative leukocyte count [19,300/mme] decreased to 8,688/mme postoperatively. In the group B, leukocyte count changed from 16,985/mme to 14,433/mme. Their differences were significant [P< 0.05]. 2. In the group A, mean preoperative body temperature [38.5] decreased to 36.7. In the group B, body temperature changed from 38.1oC to 37.5 oC. Their differences were significant [P < 0.05]. 3. Mean duration of Hospitalization; 18.2 days [group A], 30.2 days [group B]. Their differences were significant [P < 0.01]. 4. Mean elapsing time for chest tube removal; 15.2 days [group A], 28.5 days [group B]. Their differences were significant [P < 0.01]. 5. There was no need for subsequent decortication and chest tube change in the group A. There were 22 cases [52.3 %] for subsequent decortication and 12 cases [28.6 %] for chest tube change in the group B. Early minithoracotomy in treating empyema thoracis resulted in a shorter hospital stay and a shorter period of tube drainage than conventional method.

      • SCOPUSKCI등재

        후천성 심질환의 인공판막치환술에 대한 임상적 고찰

        이준영,지행옥,Lee, Jun-Yeong,Ji, Haeng-Ok 대한흉부심장혈관외과학회 1989 The Korean Journal of Thoracic and Cardiovascular Vol.22 No.6

        Between September, 1972 and September, 1989, total 359 patients were operated for acquired heart disease at Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital. A consecutive series of 293 prosthetic valve replacement was also performed during this period. The results were summarized as follows; 1. There were 141 men and 218 women, whose ages ranged from 6 to 64 years, [mean 35.5 years] 2. Out of 293 cases, mitral valve replacement was 182 cases, aortic valve replacement was 39 cases and double valve replacement was70 cases. 3. Early post-operative death was 30 cases [Mortality; 8.4 %] and late death was 9 cases in the survivors. 4. Re-operation was 30 cases and operative mortality was 10%. 5. Mean post-operative interval was 76 months. [Ranged from 216 months to 2 months] 6. Among re-operation cases, primary prosthetic valve failure was 16 cases and paravalvular leakage was 2 cases. 7. Since January 1988, 79 cases of prosthetic valve replacement were performed and then 1 case was expired. [Mortality; 1.2 %]

      • KCI등재후보

        장의 허혈-재관류로 유도된 급성 폐손상에서 산화성 스트레스에 관여하는 group II phospholipase $A_2$의 역할

        전상훈,김근,이상철,김성은,이영만,이종태,Jheon, Sang-Hoon,Kim, Keun,Lee, Sang-Cheol,Kim, Seong-Eun,Lee, Young-Man,Lee, Jong-Tae 대한흉부심장혈관외과학회 2002 The Korean Journal of Thoracic and Cardiovascular Vol.35 No.7

        Background: The various pathogeneses of acute respiratory distress syndrome have been suggested but not established yet. In the present study, the role of group II phospholipase $A_2$($PLA_2$) in the pathogenesis of gut ischemia-reperfusion(I/R) induced acute lung injury (ALI), especially in the pulmonary oxidative stress with infiltration of neutrophils was investigated. Material and Method: To induce ALI, reperfusion of mesentery was done for 120 min after clamping of superior mesenteric artery for 60 min in Sprague-Dawley rats that weighed about 300g. To exmaine the role of group II $PLA_2$ in ALI, especially endothelial injury associated with the action of neutrophils, lung myeloperoxidase activity, lung leak index, bronchoalveolar lavage fluid protein were measured, and pulmonary $PLA_2$ activity changes in gut I/R were also measured. The role of group II $PLA_2$in the neutrophilic generation of free radicals was assessed by inhibiting group II $PLA_2$ with rutin, manoalide and scalaradial. Furthermore, to verify the oxidative stress in the lung, histologic and free radical detecting cytochemical electron microscopy were done. Result: After reperfusion, ALI was developed with accumulation of neutrophils in the lung, which was confirmed by the increase of myeloperoxidase activity, lung leak index and bronchoalveolar lavage protein (p<0.001). The pulmonary and intestinal group II $PLA_2$ activities significantly increased after gut I/R which were reversed by rutin(p<0.001). In vitro, cytochrome-c reduction assay denoted the inhibitory effects of rutin, scalaradial and manoalide on the production of free radicals from isolated human neutrophils. Histologically, neutrophilic accumulation and pericapillary edema in the lung after gut I/R was detected by light microscopy which was suppressed by rutin. In $CeCl_3$ cytochemical electron microscopy, the increased production of hydrogen peroxide in the lung after gut I/R was confirmed and also the production of hydrogen peroxide was decreased by rutin. Conclusion: On the basis of these experimental results, the inhibition of group II $PLA_2$ seemed to mitigate gut I/R-induced ALI by suppressing the production of free radicals from the infiltrated neutrophils. Collectively, group II $PLA_2$ seems to play a crucial role in gut I/R-induced ALI by neutrophilic oxidative stress. 배경: 급성 호흡곤란증후군은 다양한 병인에 의해 발병하지만 그 병인론이 아직까지 확립되어 있지 않다. 본 연구에서는 장의 허혈-재관류시에 발병하는 급성 호흡곤란증후군에서 group II phospholipase $A_2$ ($PLA_2$)의 역할을 알아보기 위하여 시행되었다. 특히 폐장내의 호중구의 침윤과 더불어 유발되는 산화성 스트레스에서 group II $PLA_2$의 역할을 규명하려 하였다. 대상 및 방법: 체중 300g 내외의 Sprague-Dawley 종 흰쥐에서 급성 폐손상을 유발하기 위하여 상장간막동맥을 60분간 차단한 후 120분간 재관류를 시행하였다. Group II $PLA_2$가 폐장의 손상, 특히 혈관 내피세포의 손상에 미치는 영향을 호중구의 작용과 연관하여 알아보기 위하여 폐누출지수, 폐장내 myeloperoxidase의 활성도, 폐포세척액내의 단백함량을 측정하였다. 또한 장의 허혈-재관류에 따른 폐장내 $PLA_2$ 활성도의 변화를 검사하였고, 호중구에서의 산소기 형성에 미치는 group II $PLA_2$의 역할은 분리된 호중구에 rutin, manoalide, scalaradial과 같은 group II $PLA_2$ 억제제를 이용하여 산소기 생성이 억제됨을 확인함으로써 알아보았다. 장의 허혈-재관류에 따른 폐장 조직의 산화성 스트레스를 확인하기 위해 광학현미경법 및 cerium chloride를 이용한 세포화학적인 전자현미경법을 이용하여 폐장내 산소기의 생성을 확인하였다. 결과: 장의 허혈-재관류 후 폐장내 호중구의 침윤과 함께 급성 폐손상이 유발되었고, 폐장내 myeloperoxidase 활성도, 폐누출지수 및 폐세척액내의 단백함량이 대조군에 비해 유의하게 증가하였다(p<0.001). 폐장 및 장에서의 group II $PLA_2$ 활성도는 허혈-재관류 후 폐장, 장 모두에서 유의하게 증가하였고, rutin에 의해서 현저히 감소하였다(p<0.001). 사람의 혈액에서 분리된 호중구에서의 산소기 생성을 cytocrhome-c reduction assay를 통해 알아본 결과 rutin, manoalide, scalaradial 같은 group II PLA, 억제제에 의해 호중구의 산소기 생성이 감소함을 알 수 있었다. 허혈-재관류 후 광학현미경적 소견은 폐장내 염증세포의 침윤 및 모세혈관 주위의 부종이 관찰되었으나 rutin에 의해 이러한 변화는 억제되었다. $CeCl_3$을 이용한 세포화학적 전자현미경 실험에서 허혈-재관류 후 과산화수소의 생성이 증가하고 rutin에 의해서는 억제됨을 확인하였다. 결론: Croup II $PLA_2$의 억제는 침윤된 호중구로부터 산화기 생성을 억제함으로써 급성 폐손상을 완화하는 것으로 보이며, 따라서 group II $PLA_2$는 장 허혈-재관류로 유도된 급성 폐손상의 산화성 스트레스에서 중요한 역할을 하는 것으로 보인다.

      • KCI등재

        Carvedilol이 배양된 사람 혈관 평활근 세포의 증식과 그에 관여하는 세포내 신호전달계에 미치는 영향

        박제현,하헌주,오재원,김명수,서지연,김혜진,박기일,김유선 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.1

        장기이식 후 만성거부반응이나 혈관손상 후 재협착 등의 복원과정(remodeling) 그리고 동맥경화증의 병태생리는 비슷하여 물리적 손상이나 면역학적 또는 비면역학적 원인에 의해서 혈관내피의 손상이 발생하면 혈관 평활근 세포의 증식과 이동이 항진되며 세포 외 기질이 과다 생산되어 혈관의 내막증식과 섬유화가 초래된다. 이러한 병태 생리과정을 효과적으로 제어하는 방법은 매우 제한적으로 여러 약제를 사용하여 다양한 cytokine과 성장인자의 생성과 빈혈을 억제함으로써 혈관 병변과 재협착을 억제하고자 하는 시도가 있어왔으나 임상에서 사용할 정도로 그 효과가 확연하게 밝혀진 제제는 아직까지 없다)1-3). 연구자들은 최근에 항고혈압제로 사용중인 carvedilol 제제가 백서의 혈관 평활근세포의 증식과 이동을 효과적으로 억제함을 관찰하여 보고한 바 있다(4-5). 아드레날린성 β억제제로 개발된 carvedilol은 아드레날린성 α억제제 및 항산화제 등 다양한 기능을 가진 제제로서(6) 다양한 혈관 병변을 가진 환자나 신장이식환자에서 항고혈압제제의 복용이 필요한 상황을 고려해 보면 carvedilol의 투여는 혈압 강하효과 이외에도 혈관병변의 예방과 치료에 효과가 있을 것으로 사료된다. 세포의 성장과 증식은 이를 촉진하거나 억제하는 유전자 발현과 단백질 합성에 의해 이루어지며 정상 생리 상태에서는 유기적으로 잘 조절되는 신호변환기전에 의해서 조절된다. 성장인자는 세포막에 있는 수용체와 결합하여 그 수용체를 활성화시킨 후 신호변환기전을 경유하여 핵내의 유전자 발현을 조절한다. 특히, mitogen-activated protein kinases (MAPK)는 세포질에 존재하는 단백질의 인산화 효소로서 extra-cellular-regulatory protein kinase (ERK), c-jun N-terminal kinase (JNK), p38 MAPK의 세 가지 형태가 있으며, 각각 세포외부의 각종 자극 인자들에 의해 연속적으로 활성화되어 전사조절인자를 활성화한다(7-11). 최근의 보고에 따르면 MAPK나 전사조절인자의 활성조절에는 활성산소족(reactive oxygen species)과 이들에 의해 유도되는 세포내 산화-환원 상태의 변화가 상당부분 관여하는 것으로 알려져 있다(7,12,13). 따라서, 본 연구자들은 carvedilol 제제가 인체 유래 혈관 평활근세포의 증식에 미치는 영향과 이에 관여하는 신호 전달계 중 활성산소족생성과 MAPK의 활성화에 미치는 영향을 규명하기 위하여 본 실험을 실시하였다. Purpose: Vascular smooth muscle cells (VSMSs) migration and proliferation play important roles in transplant vascular sclerosis and restenosis afer balloon vascular injury. The antiproliterative and anti-migratory effects of carvedilol (CA), a unique α-and β-blocking anti-hypertensive drug, on the VSMCs were confirmed previously. Since reactive oxygen species (ROS) and mitogen-activated protein kinases (MAPK) family play important roles in proliferation of VSMCs, the present study examined the effects of CA on intracellular ROS generation, activation of ERK 1/2 and p38 MAPK, and proliferation of VSMCs were cultured with RPMI-1640 containing 10% fetal bovine serum. Near confluent VSMCs were incubated with serum-free media for 48 hours to arrest and synchronize the cell growth. CA was administered 1 hour before the addition of PDGF. 5-(and-6)-chloromethy-2',7'-dichlorodihydrofluo-rescein (DCF)-sensitive intracellular ROS was detected by FACS. Activations of ERK 1/2 and p38 MAPK were measured by Western blot analysis, Proliferation of VSMCs was assessed by [^3H]-thymidine incorporation. Results: PDGF at 10 ??/㎖, which induced human VSMCs proliferation, rapidly increased intracellular ROS by 1.6-fold (P < 0.01), ERK 1/2 activation by 2.1-fold (P < 0.01), and p38 MAPK activation by 1.9-fold (P < 0.01), respectively, as compared to the control. CA 1 and 10μM effectively inhibited PDGF-induced human VSMCs proliferation. CA also effectively inhibited PDGF-induced intracellular

      • SCOPUSKCI등재

        폐의 저량보존법이 폐기능 회복에 미치는 영향

        이만복,김우종,강창희,이길노,Lee, Man-Bok,Kim, U-Jong,Gang, Chang-Hui,Lee, Gil-No 대한흉부심장혈관외과학회 1997 The Korean Journal of Thoracic and Cardiovascular Vol.30 No.3

        Hypothermia during lung preservation decreases metabolic processes. After the rabbit lung was flushed with modified Euro-Collins solution, heart-lung block was harvested and the left lung was assessed after ligation of the right pulmonary artery and right main-stem bronchus. Heart-lung block was immersed in the same solution for 6 hours. The modified Euro-Collins solution and storage temperature of group 1(10 cases) was 4t, roup 2(10 cases) was l$0^{\circ}C$. On completion of the storage period, the left lung was ventilated and reperfused with blood u:high used a cross-circulating paracorporeal rabbit as a "biologic deoxygenator" for 60 minutes. Pulmonary artery pressure, airway pressure, difference in oxygen tension between mow and outflow perfusate and degree of pulmonary edema were assessed at 10-minute intervals while the left lung was ventilated at 0.8 of the inspired oxygen fraction. The mean pulmonary venous oxygen tensions at 10 and 60 minutes after reperfusion were 209.52$\pm$42.46 and 103.48$\pm$ 15.96 mmHg in group I versus 247.78$\pm$36.19 and 147.91 $\pm$ 11.07 mmHg in group II(p=0.049, (0.0001). The mean alveolar-arterial oxygen differences at 20 and 60 minutes after reperfusion were 357. 95$\pm$ 12.84 and 437.31 14.26 mmHg in group I versus 310.88$\pm$3).47 and )90.93$\pm$ 15.86 mmHg in group II (p=0.0092, (0.0001). The mean pulmonary arterial pressures at 10 and 60 minutes after reperfusion were 40.56$\pm$ 18.66 and 87. 2$\pm$ 17.22 mmHg in group I versus 31.22$\pm$6.84 and 65.78$\pm$ 11.02 mmHg in group rl (p : 0.048, 0.0062). The mean pulmonary vascular resistances at 10 and 60 minutes after reperfusion were 2.69$\pm$0.85 and 4.36$\pm$0.86 mmHg/ml/min in group I versus 1.99$\pm$0.39 and 3.29$\pm$0.55 mmHg/ml/min in group II(p : 0.0323, 0.0062). There were no difference between groups in peak airway pressure, lung compliance and degree of pulmonary edema. In conclusion that preservation of lung at l$0^{\circ}C$ was superior to preservation at 4$^{\circ}C$.}C$. 가토의 적출폐장보고시험의 모델을 이용하여 폐세척웅액과 폐장보존용액의 온도를 제 1군은 4$^{\circ}C$로 제 2군은 1$0^{\circ}C$로 하여 6시간동안 적출폐장보존후에 재관류시켜 각각의 온도차이에 따른 폐기보존효과를 비교 실험하였으며 각 군은 10례씩으로 하였다. 폐정맥혈액산소분압, 폐포-동맥간 산소분압 차, 폐동 맥압 및 폐혈관저항은제 1군보다제 2군이 재관류동안에 성적이 우수하였으며 기도내압, 폐탄성도및 폐부종의 정도는 두 군간에 통계학적 유의성은 없었다. 결론적으로 가토의 적출폐기 보존온도에 따른 실험에서 1$0^{\circ}C$의 폐수*용액과 폐기보존온도가 4$^{\circ}C$보다 재순환시 폐기능의 회복이 우수하였다.

      • KCI등재후보

        복부대동맥류의 혈관 내 치료 후 발생한 제2형 혈관누출의 자연경과

        조동민,박근명,양신석,김나리,우신영,김영욱,박광보,박홍석,도영수,김동익 대한혈관외과학회 2011 Vascular Specialist International Vol.27 No.4

        Purpose: Endovascular aneurysm repair (EVAR) for the treatment of abdominal aortic aneurysm (AAA)has shown excellent early outcomes. However, long-term durability continues to be questioned because of endoleaks. The optimal management of type II endoleaks remains controversial because little is known about their long-term natural history. The purpose of this study was to evaluate the natural history of type II endoleaks and to study factors associated with persistent type II endoleaks. Methods: On a retrospective basis, we analyzed 98 patients who underwent EVAR for incidence and outcome of type II endoleaks. Patients with type II endoleaks were evaluated using computed tomography angiography or Duplex scans at one, 6 and 12 months after their EVAR, and annually thereafter to evaluate both the persistence of the endoleak and the size of the aneurysm sac. Results: Type II endoleaks were detected during the follow-up periods in 38 patients (39.8%), who underwent EVAR (mean follow-up: 23.7 months). Spontaneous sealing of type II endoleaks by 6 months after EVAR occurred in 15 patients (39.4%), meaning that there were 23 patients (60.6%) whose leaks were ongoing for more than 6 months. Four patients were treated using embolization because of an enlarging aneurysm sac. Conclusion: Most type II endoleaks are transient and do not require intervention. However, particularly persistent endoleaks could lead to aneurysm enlargement and to delayed aortic rupture. We did not find a significant difference in any number of preoperative patient factors between patients with transient, persistent,or no type II endoleaks. Further studies based on independent data sets are needed to validate these results.

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