1
|
Yang SS, Kim HK, Kim JY, Lee T, Lee SS, Park HS, Park SC, Park YJ. Corrigendum to "Preliminary outcomes of the LifeStream balloon-expandable stentgraft in Zenith Iliac branch device to preserve pelvic circulation: A Korean multicenter study" [Asian J Surg 46 (2023) 94-98]. Asian J Surg 2024:S1015-9584(24)00753-X. [PMID: 38704269 DOI: 10.1016/j.asjsur.2024.04.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024] Open
Affiliation(s)
- Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Seoul, South Korea
| | - Hyung-Kee Kim
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Jang-Yong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Taeseung Lee
- Division of Vascular Surgery, Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang-Su Lee
- Division of Vascular and EndoVascular Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Hyung-Sub Park
- Division of Vascular Surgery, Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sun-Cheol Park
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
2
|
Park JK, Yang SS, Kim DI, Kim YW, Kim DH, Park YJ. Outcomes of carotid endarterectomy in octogenarians compared to their younger counterparts: a retrospective observational study. Ann Surg Treat Res 2024; 106:248-254. [PMID: 38725804 PMCID: PMC11076947 DOI: 10.4174/astr.2024.106.5.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 05/12/2024] Open
Abstract
Purpose This study was performed to analyze the association between age and outcomes of carotid endarterectomy (CEA) by comparing postoperative outcomes between octogenarians and younger patients. Methods From November 1994 to December 2022, 1,585 internal carotid arteries of 1,434 patients were enrolled. Patients were stratified into 2 groups: octogenarians (≥80 years old) and non-octogenarians (<80 years old). Primary endpoints were early (≤30 days) outcomes of ipsilateral stroke, any stroke, myocardial infarction, death, and major adverse cardiovascular events (MACE). We also compared overall any stroke and death between the 2 groups. Results One of 132 octogenarians (0.8%) and 17 of 1,453 non-octogenarians (1.1%) experienced ipsilateral stroke within 30 days. Thirty-day MACE occurred in 4 of 132 octogenarians (3%) and 44 of 1,453 non-octogenarians (3%). There were no significant differences in any early (≤30 days) outcomes. Symptomatic status was associated with increased 30-day MACE (odds ratio [OR], 2.610; 95% confidence interval [CI], 1.450-4.696; P = 0.003) and 30-day any stroke (OR, 3.999; 95% CI, 1.627-9.828; P = 0.003). Symptomatic status was also associated with overall any stroke (hazard ratio [HR], 2.885; 95% CI, 1.865-4.463; P < 0.001), but age of ≥80 years was not associated with 30-day MACE, 30-day any stroke, or overall stroke. Age of ≥80 years was only associated with overall survival (HR, 2.644; 95% CI, 1.967-3.555; P < 0.001). Conclusion CEA would be a safe and effective treatment for octogenarians with low 30-day complications and long-term stroke rates, comparable with that of younger counterparts. Advanced age is not a contraindication for CEA.
Collapse
Affiliation(s)
- Joon-Kee Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Incheon Sejong Hospital, Incheon, Korea
| | - Da-Hyun Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
3
|
Bagit A, Maliyar K, Mansour M, Georgakopoulos JR, Rankin B, Lytvyn Y, Zaaroura H, Park YJ, Wang E, Mufti A, Torres T, Le AM, Vender R, Prajapati VH, Yeung J. Real-World Effectiveness and Safety of Risankizumab in Adult Patients with Plaque Psoriasis: A 1-year International Multicenter Retrospective Cohort Study. J Am Acad Dermatol 2024:S0190-9622(24)00654-6. [PMID: 38677338 DOI: 10.1016/j.jaad.2024.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/23/2024] [Indexed: 04/29/2024]
Affiliation(s)
- A Bagit
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - K Maliyar
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - M Mansour
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - J R Georgakopoulos
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - B Rankin
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Y Lytvyn
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - H Zaaroura
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Y J Park
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - E Wang
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - T Torres
- Department of Dermatology, Centro Hospitalar de Santo António, 4099-001 Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
| | - A M Le
- Department of Dermatology, Centro Hospitalar de Santo António, 4099-001 Porto, Portugal
| | - R Vender
- Dermatrials Research Inc. and Venderm Consulting, Hamilton, Ontario, Canada
| | - V H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Dermatology Research Institute, Calgary, Alberta, Canada; Probity Medical Research, Calgary, Alberta, Canada; Skin Health & Wellness Centre, Calgary, Alberta, Canada; Section of Community Pediatrics, University of Calgary, Calgary, Alberta, Canada; Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - J Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada; Probity Medical Research, Toronto, Ontario, Canada.
| |
Collapse
|
4
|
Park JK, Park YJ, Yang SS, Kim DI, Kim YW. Impact of Serum Albumin Levels and Body Mass Index on Outcomes of Open Abdominal Aortic Aneurysm Repair in Korean Population. Ann Vasc Surg 2024; 101:139-147. [PMID: 38211897 DOI: 10.1016/j.avsg.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Although obese patients seem to be susceptible to chronic diseases, obesity paradox has been observed in the field of vascular surgery, in which many previous studies have reported that overweight patients have good postoperative outcomes and underweight patients have poor postoperative outcomes. The purpose of our study is to evaluate the impact of body mass index (BMI) and serum albumin levels, which are evaluated as indicators of nutritional status, on outcomes of open abdominal aortic aneurysm (AAA) repair. METHODS We reviewed the vascular surgery database of a single tertiary referral center for all patients who underwent open AAA repair due to degenerative etiology from 1996 to 2021. To analyze the effect of BMI, patients were classified into 4 groups according to the Asian-Pacific classification of BMI: underweight (UW) (<18.5 kg/m2), normal weight (NW) (18.5-22.9 kg/m2), overweight (OW) (23-24.9 kg/m2), and obese (OB) (≥25 kg/m2). The χ2, Fisher's exact, and Kruskal-Wallis tests were used to compare demographics, comorbidities, radiologic findings, surgical details, and 1-year mortality rates between the 4 groups. We also compared the preoperative serum albumin levels of each group to assess nutritional status indirectly. Cox's proportional hazards model was performed to determine factors associated with mortality. A Kaplan-Meier survival analysis was performed, and the differences were analyzed by a log-rank test. We did not perform an analysis for 30-day mortality because cases of 30-day mortality in UW patients were rare due to the unbalanced distribution of the number of patients in the 4 groups. RESULTS Among a total of 678 patients, 22 were classified as UW (3.2%), 200 as NW (29.5%), 183 as OW (27.1%), and 273 as OB (40.1%). The median age was 70 (64-75) years and 577 of 678 (85.1%) patients were male gender. Higher serum albumin level was associated with decreased 1-year mortality (hazard ratio [HR], 0.3; 95% confidence interval [CI], 0.15-0.63; P = 0.001). UW patients had a higher 1-year mortality rate than NW patients (HR, 3.67; 95% CI, 1.02-13.18; P = 0.046). OB patients had a lower overall mortality rate than NW patients (HR, 0.73; 95% CI, 0.53-1; P = 0.05). CONCLUSIONS Low BMI (<18.5 kg/m2) and low serum albumin level were associated with poor 1-year survival after elective open AAA repair. These patients also need more careful preoperative intervention, like weight gain or nutritional support, for better outcomes. The obesity paradox existed in our study; high BMI (≥25 kg/m2) was associated with better overall survival after elective open AAA repair.
Collapse
Affiliation(s)
- Joon-Kee Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Incheon Sejong hospital, Incheon, Korea
| |
Collapse
|
5
|
Kim MK, Park YJ, Yang SS, Kim DI, Kim JG, Hyun DH, Park KB, Do YS, Kim YW. Comparison between Onyx and coil embolization for persistent type 2 endoleaks after endovascular aneurysm repair. Ann Surg Treat Res 2024; 106:178-187. [PMID: 38435491 PMCID: PMC10902624 DOI: 10.4174/astr.2024.106.3.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 03/05/2024] Open
Abstract
Purpose Type 2 endoleaks (T2EL) are the most common form of endoleaks after endovascular aneurysm repair (EVAR). Several studies on the feasibility of embolization using ethylene vinyl alcohol copolymer (Onyx, Medtronic) for T2EL have been reported. The purpose of this study was to compare coil and Onyx embolization for T2EL treatment after EVAR. Methods Between August 2005 and July 2022, 46 patients underwent endovascular embolization for treatment of T2EL (15 Onyx and 31 coils). The primary endpoint was endoleaks resolution or significant aneurysm sac growth of >5 mm in maximal diameter after T2EL embolization. In addition, periprocedural factors, reintervention, sac rupture, and survival analysis were assessed. Results The follow-up period after embolization was significantly shorter in the Onyx group (11.6 months vs. 34.7 months, P = 0.016), and there was no difference in aneurysm sac growth rate between both groups (20.0% vs. 51.6%; P = 0.472, log-rank test). However, cases with multiple endoleak origins tended to be treated with Onyx (P = 0.002). When applying Onyx, there was no significant difference in results between the transarterial and translumbar approaches. Conclusion There appears to be no significant difference in the results of Onyx and coil embolization for T2EL treatment, although it is difficult to evaluate effectiveness due to the small number of cases and short follow-up period. However, in cases of multiple origin endoleaks or when the transarterial approach is not feasible, the Onyx by translumbar approach may be a more effective method.
Collapse
Affiliation(s)
- Min-Kyu Kim
- Division of Vascular Surgery, Department of Surgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Gon Kim
- Department of Radiology, Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ho Hyun
- Department of Radiology, Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang-Bo Park
- Department of Radiology, Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Soo Do
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Young-Wook Kim
- Department of Surgery, Medi-Flex General Hospital, Incheon, Korea
| |
Collapse
|
6
|
Kang J, Kim S, Yang SS, Kim YW, Do YS, Park KB, Park YJ. Clinical Characteristics and Management of Peripancreatic Arterial Aneurysms: A 20-year Experience. Angiology 2023:33197231225281. [PMID: 38147027 DOI: 10.1177/00033197231225281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Pancreaticoduodenal and gastroduodenal artery aneurysms (PDAAs and GDAAs) are rare visceral aneurysms. Considering the rupture risk regardless of size, treatment should be provided promptly. We reviewed the characteristics and management of peripancreatic aneurysms in a retrospective, single-center review of consecutive patients with PDAAs and GDAAs between 2000 and 2022. Demographics, clinical characteristics, radiologic features, treatment, and outcomes were recorded. Nineteen PDAAs and seven GDAAs were identified in 24 patients. The median sizes of the PDAAs and GDAAs were 21 mm (range: 8-50 mm) and 14 mm (range: 11-32 mm), respectively. There were 4 ruptured cases (15.4%). Ten aneurysms (38.5%) had concomitant visceral aneurysms, and 16 (61.6%) were associated with celiac pathology. Aneurysms were managed using endovascular in 12 (46.2%), surgical in 4 (15.4%), and combined methods in 3 (11.5%) cases; 7 patients (26.9%) were lost to follow-up or refused treatments. During a median 13.8-month follow-up (range: 1-147.6), two complications (7.7%) occurred including pancreatitis and coil migration into the superior mesenteric artery after embolization within 30 days. After 30 days, aorto-common hepatic artery bypass graft stenosis was identified in one PDAA. Depending on the characteristics of peripancreatic aneurysms, endovascular, surgical, and hybrid approaches might all be practical treatment options.
Collapse
Affiliation(s)
- Jihee Kang
- Division of Vascular Surgery, Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Sejun Kim
- Division of Vascular Surgery, Department of Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Department of Surgery, Incheon Sejong Hospital, Incheon, Korea
| | - Young-Soo Do
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang-Bo Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
7
|
Cho IY, Koo HY, Han K, Lee KN, Cho M, Jin SM, Cho YH, Lee JH, Park YJ, Shin DW. Metabolic syndrome and the risk of abdominal aortic aneurysm: A nationwide cohort study. Atherosclerosis 2023; 386:117329. [PMID: 37839934 DOI: 10.1016/j.atherosclerosis.2023.117329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/03/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND AND AIMS The association between metabolic syndrome (MetS) and abdominal aortic aneurysm (AAA) remains unclear. We investigated the potential association between AAA and MetS and its components in a large population-based cohort. METHODS We used the Korean National Health Insurance Service database including 4,162,640 participants aged ≥50 years who received a routine health examination in 2009. Cox proportional hazards models were used to analyze the association between MetS and its components (elevated waist circumference, blood pressure, glucose, triglycerides, and reduced high-density lipoprotein cholesterol [HDL-C]) with AAA incidence, with adjustment for confounders. RESULTS During a median 9.4 years of follow-up, 18,160 participants developed incident AAA. MetS was associated with an increased risk of AAA compared to the non-MetS group (adjusted hazard ratio [aHR], 1.38; 95% confidence interval [CI], 1.34-1.43). Among the individual components, elevated waist circumference, blood pressure, triglycerides, and reduced HDL-C were associated with increased AAA risk, while elevated glucose alone was associated with reduced AAA risk (aHR, 0.85; 95% CI, 0.82-0.87). AAA risk also increased linearly with the increasing number of MetS components, with the highest risk found in the presence of all 5 components (aHR, 1.98, 95% CI, 1.83-2.15). CONCLUSIONS MetS and its individual components, with the exclusion of elevated glucose, were associated with higher risk of AAA. Further studies are warranted to elucidate the association between MetS and AAA.
Collapse
Affiliation(s)
- In Young Cho
- Department of Family Medicine, Kangbuk Samsung Hospital Sungkyunwan University, School of Medicine, Seoul, South Korea; Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hye Yeon Koo
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Kyu Na Lee
- Department of Biomedicine and Health Science, The Catholic University of Korea, Seoul, South Korea
| | - Mihee Cho
- Samsung C&T Medical Clinic, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang-Man Jin
- Division of Endocrinology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jun Ho Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong Wook Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Clinical Research Design and Evaluation/ Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
| |
Collapse
|
8
|
Heo EJ, Kim M, Park CG, Chang KH, Kim KH, Shim JB, Park YJ, Kim CY, Lee NK, Lee S. The Feasibility of Fast, Four-Dimensional Computed Tomography-Based O-Ring Linac Plans for Stereotactic Body Radiotherapy in Patients with Poor Performance Status. Int J Radiat Oncol Biol Phys 2023; 117:e672. [PMID: 37785984 DOI: 10.1016/j.ijrobp.2023.06.2120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) As patients with poor performance status cannot endure long treatment times, it can lead to unplanned and prolonged radiation treatment or discontinuation of treatment. Moreover, prolonged radiation treatment appears to negatively affect survival for patients. We aimed to verify the feasibility of fast 4DCT-based O-ring linear accelerator (LINAC) treatment in lung 4D stereotactic body radiotherapy (SBRT). MATERIALS/METHODS This study included data of 38 patients who received lung 4D-SBRT. Gating20-70% plans were based on 4DCT data obtained at phase values ranging from 20-70% using a C-arm LINAC. Non-GatingFB plans were retrospectively established based on 4DCT data obtained at phase values of 0-90% using an O-ring LINAC. The prescribed dose of 4,800 cGy was delivered to PTV in four fractions. The conformity index (CI), homogeneity index (HI), and gradient measurement (GM) of the PTV were analyzed to compare dosimetric data between Gating20-70% and Non-GatingFB plans. Organs at risks (OARs) were analyzed in accordance with the RTOG 0915 protocol. Treatment delivery time and total monitor units (MU) were analyzed to compare the efficiency of treatment delivery. Statistical comparisons were performed using the Wilcoxon signed-rank test (p<0.05). RESULTS For the PTV, there was no significant difference in the CI or HI between Gating20-70% and Non-GatingFB plans (CI: 1.337±0.137, 1.335±0.174, HI: 0.939±0.015, 0.939±0.016, all at p>0.05). However, there was a significant difference in GM between Gating20-70% and Non-GatingFB plan (1.528±0.206 cm, 1.381±0.222 cm, p<0.001). For OARs, all plans met the criteria for dose constraint. There was a significant difference between Gating20-70% and Non-GatingFB plans except in the spinal cord. In particular, D1000cc and D1500cc values for the ipsilateral lung for Gating20-70% plans were 31.6% and 59.9% lower than those for Non-GatingFB plans (D1000cc: 50.780±132.061 cGy, 34.755±102.480 cGy, p<0.001, D1500cc: 6.641±14.598 cGy, 2.666±7.926 cGy, p<0.001). Treatment delivery time was 92% longer for Gating20-70% plans than for Non-GatingFB plans (5.0±0.4 min, 9.6±3.3 min, p = 0.043). The total MU value for Gating20-70% plans was 9.6% higher than that for Non-GatingFB plans (3665.8±230.7, 4016±236.9, p = 0.039). CONCLUSION When compared to OARs both plans were acceptable per RTOG-0915 protocol, but significant differences were between Non-GatingFB and Gating20-70% plans. However, treatment delivery time of Non-GatingFB plans decreased by 47.9% than Gating20-70% plans. We verified the feasibility of fast 4DCT-based O-ring LINAC treatment for patients who cannot endure long treatment times due to poor performance status in lung 4D-SBRT. In further study, we will analyze dosimetric differences and treatment delivery efficiency considering tumor motion according to tumor location.
Collapse
Affiliation(s)
- E J Heo
- Department of Radiation Oncology, College of Medicine, Korea University, Seoul, Korea, Republic of (South) Korea; Department of Bio-medical Science, Graduate School of Korea University, Sejong, Korea, Republic of (South) Korea
| | - M Kim
- Department of Biostatistics and Computing, Yonsei University Graduate school, Seoul, Korea, Republic of (South) Korea
| | - C G Park
- Department of Mathematics, Kyonggi University, Gyeonggi, Korea, Republic of (South) Korea
| | - K H Chang
- Department of Radiologic Science, Far East University, Chungcheongbuk-do, Korea, Republic of (South) Korea
| | - K H Kim
- Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea, Republic of (South) Korea
| | - J B Shim
- Department of Radiation Oncology, Guro Hospital, Korea University Medical Center, Seoul, Korea, Republic of (South) Korea
| | - Y J Park
- Department of Radiation Oncology, College of Medicine, Korea University, Seoul, Korea, Republic of (South) Korea
| | - C Y Kim
- Department of Radiation Oncology, College of Medicine, Korea University, Seoul, Korea, Republic of (South) Korea
| | - N K Lee
- Department of Radiation Oncology, College of Medicine, Korea University, Seoul, Korea, Republic of (South) Korea
| | - S Lee
- Department of Radiation Oncology, College of Medicine, Korea University, Seoul, Korea, Republic of (South) Korea
| |
Collapse
|
9
|
Kim MK, Shin SH, Han IW, Heo JS, Lee SJ, Lee KW, Park JB, Woo SY, Park YJ, Yang SS. Cryopreserved allografts versus end-to-end anastomosis for the reconstruction of a segment-resected portomesenteric vein during advanced pancreatic cancer surgery. Asian J Surg 2023; 46:3741-3747. [PMID: 36813675 DOI: 10.1016/j.asjsur.2023.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Porto-mesenteric vein (PMV) infiltration of pancreatic cancer is classified as borderline resectable cancer. For en-bloc resectability, the probability of PMV resection and reconstruction is the most decisive factor. The purpose of this study was to compare and analyze PMV resection and reconstruction during pancreatic cancer surgery using end-to-end anastomosis (EA) and a cryopreserved allograft (AG) and to verify the effectiveness of reconstruction using an AG. METHODS Between May 2012 and June 2021, 84 patients (65 underwent EA, and 19 received AG reconstruction) underwent pancreatic cancer surgery with PMV reconstruction. An AG is a cadaveric graft with a diameter of 8-12 mm and is obtained from a liver transplant donor. Patency after reconstruction, disease recurrence, overall survival, and perioperative factors were assessed. RESULTS The median age was higher in EA patients (p = .022) and neoadjuvant therapy (p = .02) was more in AG patients. Upon histopathological examination, the R0 resection margin did not show a significant difference by reconstruction method. During a 36-month survival analysis, primary patency was significantly superior in EA patients (p = .004), and there was no significant difference in recurrence-free survival (p = .628) or overall survival (p = .638) rates. CONCLUSION Compared with EA, AG reconstruction after PMV resection during pancreatic cancer surgery showed a lower primary patency, but there was no difference in recurrence-free or overall survival rates. Therefore, the use of AG can be a viable option for borderline resectable pancreatic cancer surgery if the patient is properly followed-up postoperatively.
Collapse
Affiliation(s)
- Min-Kyu Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang-Hyun Shin
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - In-Woong Han
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin-Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Su-Jeong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyo-Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae-Berm Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Shin-Young Woo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
10
|
Park JK, Woo SY, Park YJ, Kim DI, Kim GM, Seo WK, Jung JW, Jeon P, Kim KH, Kim YW, Yang SS. The Impact of age and outcomes of high-risk patients on carotid revascularization. Vascular 2023:17085381231155035. [PMID: 36794829 DOI: 10.1177/17085381231155035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVES To validate the accuracy of high-risk criteria for carotid endarterectomy (CEA) and analyze the correlation between age and outcome of CEA and carotid artery stenting (CAS) in risk groups. METHODS We reviewed a prospectively managed vascular surgery database in a single tertiary referral center, and 2482 internal carotid arteries (ICAs) had undergone carotid revascularization from November 1994 to December 2021. To validate high-risk criteria for CEA, patients were classified as high risk (Hr) and normal risk (Nr). Subgroup analysis was performed with patients older or younger than 75 years to investigate the relationship between age and outcome in each group. Primary endpoints were 30-day outcomes including stroke, death, stroke/death, myocardial infraction (MI), and major adverse cardiovascular events (MACEs). RESULTS A total of 2345 ICAs in 2256 patients were enrolled. The number of patients in the Hr group was 543 (24%) and the number in the Nr group was 1713 (76%). CEA and CAS were performed on 1384 (61%) and 872 (39%) patients, respectively. The 30-day stroke/death rate was higher with CAS than CEA in both the Hr (1.1% vs. 3.9%, p = 0.032) and Nr (1.2% vs. 6.9%, p < 0.001) groups. In unmatched logistic regression analysis of the Nr group (n = 1778), the rate of 30-day stroke/death (OR, 5.575; 95% CI, 2.922-10.636; p < 0.001) was higher for CAS than CEA. In propensity score matching of the Nr group, the rate of 30-day stroke/death (OR, 5.165; 95% CI, 2.391-11.155; p < 0.001) was also higher for CAS than CEA. In the age <75 subgroup of the Hr group (n = 428), CAS was associated with higher 30-day stroke/death (OR, 14.089; 95% CI, 1.314-151.036; p = 0.029). In the age ≥75 subgroup of the Hr (n = 139), there was no difference in 30-day stroke/death between CEA and CAS. In the age <75 subgroup of the Nr group (n = 1318), 30-day stroke/death (OR, 6.300; 95% CI, 2.797-14.193; p < 0.001) was higher in CAS. In the age ≥75 subgroup of the Nr group (n = 460), 30-day stroke/death (OR, 6.468; 95% CI, 1.862-22.471; p = 0.003) was higher in CAS. CONCLUSIONS In patients older than 75 years in the Hr group, there were relatively poor 30-day treatment outcomes in both CEA and CAS. Alternative treatment is needed that can expect better outcomes in older high-risk patients. In the Nr group, CEA has a significant benefit compared with CAS, and CEA should be recommended more to these patients.
Collapse
Affiliation(s)
- Joon-Kee Park
- Division of Vascular Surgery, Department of Surgery, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin-Young Woo
- Division of Vascular Surgery, Department of Surgery, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong-Moon Kim
- Department of Neurology, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo-Keun Seo
- Department of Neurology, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Won Jung
- Department of Neurology, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyoung Jeon
- Department of Radiology, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon-Ha Kim
- Department of Radiology, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, 58920Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
11
|
Han A, Lee T, Lee J, Song SW, Lee SS, Jung IM, Kang JM, Gwon JG, Yun WS, Cho YP, Ko H, Park YJ, Min SK. A multicenter, randomized, open-labelled, non-inferiority trial of sustained-release sarpogrelate versus clopidogrel after femoropopliteal artery intervention. Sci Rep 2023; 13:2502. [PMID: 36781928 PMCID: PMC9925771 DOI: 10.1038/s41598-023-29006-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/30/2023] [Indexed: 02/15/2023] Open
Abstract
Optimal antiplatelet therapy after endovascular therapy (EVT) for peripheral artery disease is controversial. This trial aimed to evaluate whether sarpogrelate plus aspirin was non-inferior for preventing early restenosis after femoropopliteal (FP) EVT compared to clopidogrel plus aspirin. In this open-label, prospective randomized trial, 272 patients were enrolled after successful EVT for FP lesions. Patients in each group received aspirin 100 mg and clopidogrel 75 mg or sarpogrelate 300 mg orally once per day for 6 months. The primary outcome was target lesion restenosis at 6 months, tested for noninferiority. Patient characteristics and EVT patterns were similar, except for increased inflow procedures in the sarpogrelate group and increased outflow procedures in the clopidogrel group. The sarpogrelate group showed a tendency of less restenosis at 6 months than the clopidogrel group (13.0% vs. 19.1%, difference 6.1 percentage points, 95% CI for noninferiority - 0.047 to 0.169). Secondary endpoints related to safety outcomes were rare in both groups. Risks of target lesion restenosis of the two intervention arm were uniform across most major subgroups except for those with coronary artery disease. In conclusion, Sarpogrelate plus aspirin is non-inferior to clopidogrel plus aspirin in preventing early restenosis after FP EVT. Larger multi-ethnic trials are required to generalize these findings. Trial registration: National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier: NCT02959606; 09/11/2016).
Collapse
Affiliation(s)
- Ahram Han
- Division of Vascular Surgery, Department of Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
- Seoul National University College of Medicine, Seoul, South Korea
| | - Taeseung Lee
- Seoul National University College of Medicine, Seoul, South Korea
- Division of Vascular Surgery, Bundang Seoul National University Hospital, Seongnam, South Korea
| | - Joongyub Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Suk-Won Song
- Department of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang-Su Lee
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yangsan Hospital, Pusan National University, Yangsan, South Korea
| | - In Mok Jung
- Seoul National University College of Medicine, Seoul, South Korea
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jin Mo Kang
- Department of Surgery, Gil Hospital, Gachon University of Medicine and Science, Incheon, South Korea
| | - Jun Gyo Gwon
- Department of Surgery, Korea University Hospital, Seoul, South Korea
| | - Woo-Sung Yun
- Department of Surgery, Yeungnam University Medical Center, Daegu, South Korea
| | - Yong-Pil Cho
- Division of Vascular Surgery, Department of Surgery, Asan Medical Center, Seoul, South Korea
| | - Hyunmin Ko
- Department of Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea.
| | - Seung-Kee Min
- Division of Vascular Surgery, Department of Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea.
- Seoul National University College of Medicine, Seoul, South Korea.
| |
Collapse
|
12
|
Kang J, Choi KW, Han A, Min S, Heo SH, Yang SS, Park YJ, Min SK. Venous Reconstruction in Extremity Soft Tissue Sarcoma Is Not Essential. Vasc Endovascular Surg 2023; 57:365-372. [PMID: 36592476 DOI: 10.1177/15385744221150737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Limb salvage is an important concern following complete oncologic resection for extremity soft tissue sarcoma (STS). Vascular reconstruction is essential for limb salvage. The purpose of this study was to evaluate the outcomes of vascular reconstruction in patients with extremity STS. METHODS This is a retrospective, multi-center, case series of consecutive patients who underwent vascular reconstruction during extremity STS resection at 2 major centers in Korea. Demographics, reconstruction methods, type of conduit, surgical complications, graft patency, limb salvage rate, and patient survival were reviewed. RESULTS From March 2005 to December 2020, 43 patients underwent vascular reconstructions during STS resection. Among the patients, 22 (51.2%) received arterial only, and 21 (48.8%) received simultaneous arterial and venous reconstructions. For the types of conduits, autologous saphenous veins (56.2%), artificial grafts (26.3%), and cryopreserved allografts (15.8%) were used. During a median follow-up of 23.8 months (interquartile range; 7.7-54.5), the overall primary patency of the reconstructed vessels was significantly higher in arteries than in veins (82.5% vs 56.3% at 12 months, P < .001). According to the type of conduit, the primary patency rate of autogenous vein seemed higher in venous reconstruction, however, there was no statistical significance in both arterial and venous reconstruction. There was no significant difference in primary arterial patency rate (P = .132) or incidence of surgical complications including postoperative edema or wound problem whether or not simultaneous venous reconstruction was performed with arterial reconstruction. The overall limb salvage rate and patient survival were 97.4%, 95.1%, and 89.4% and 91.9%, 81.7%, and 65.4% at 12, 24, and 36 months, respectively. CONCLUSIONS Patency rates were poorer in venous reconstruction than in arterial reconstruction. In terms of arterial patency and postoperative complication, the role of simultaneous arterial and venous reconstruction seems not essential, however, it needs to be evaluated in future studies.
Collapse
Affiliation(s)
- Jihee Kang
- Division of Vascular Surgery, Department of Surgery, Inha University Hospital, Inha University School of Medicine, Jung-gu, Incheon, Korea
| | - Kwang Woo Choi
- Division of Vascular Surgery, Department of Surgery, 37990Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
| | - Ahram Han
- Division of Vascular Surgery, Department of Surgery, 37990Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
| | - Sangil Min
- Division of Vascular Surgery, Department of Surgery, 37990Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
| | - Seon-Hee Heo
- Department of Surgery, Yonsei Severance Hospital, 37991Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea
| | - Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, Heart Vascular Stroke Institute, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Heart Vascular Stroke Institute, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea
| | - Seung-Kee Min
- Division of Vascular Surgery, Department of Surgery, 37990Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
| |
Collapse
|
13
|
Yang SS, Kim HK, Kim JY, Lee T, Lee SS, Park HS, Park SC, Park YJ. Preliminary outcomes of the LifeStream balloon-expandable stentgraft in Zenith Iliac branch device to preserve pelvic circulation: A Korean multicenter study. Asian J Surg 2023; 46:94-98. [PMID: 35123861 DOI: 10.1016/j.asjsur.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/01/2022] [Accepted: 01/15/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To evaluate early outcomes of aortoiliac or isolated iliac artery aneurysm repair using the Zenith® Bifurcated Iliac Side (ZBIS) stent graft combined with the LifeStream™ Balloon Expandable Vascular Covered Stent as a bridging stentgraft. METHODS Between August 2018 and February 2020, 38 patients (37 male, mean age 72.7 years) received 46 LifeStream stents in conjunction with 38 ZBIS stent grafts to bridge hypogastric arteries for aneurysm repair in six university hospitals in Korea. The primary outcomes were technical success rate and procedure-related complications. Secondary outcomes were bridging stent graft patency and re-intervention. RESULTS All procedures were performed as elective standard endovascular aortic aneurysm repair (EVAR) and unilateral iliac branch device (IBD). Mean follow-up was 13.1 months, and patient overall survival rate was 96.7%. Technical success rate was 76.3% (n = 29). Causes of failure included seven total endoleaks; six type Ic and one type IIIc from the IBD junction, one unintentional IIA coverage, and one failure to deploy the IIA stent graft. Procedure-related complications occurred in two patients: one LifeStream migration and one ZBIS stent graft migration. Overall patency rates for the LifeStream and ZBIS stents were 97.4% and 97.2%, respectively. CONCLUSION This multicenter preliminary experience with the LifeStream™ Balloon Expandable Vascular Covered Stent in IBD demonstrated good patency; however, an unexpectedly high rate of type Ic endoleaks was observed. Combined use of the LifeStream stent with the ZBIS stent graft is safe and feasible to preserve pelvic circulation with good patency and a low rate of device-related reintervention.
Collapse
Affiliation(s)
- Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Seoul, South Korea
| | - Hyung-Kee Kim
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Jang Yong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Taeseung Lee
- Division of Vascular Surgery, Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang Su Lee
- Division of Vascular and EndoVascular Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Hyung Sub Park
- Division of Vascular Surgery, Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sun Cheol Park
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
14
|
Kim MK, Kim JG, Kim CS, Park KB, Yang SS, Park YJ. Repeated Pseudoaneurysm after Endovascular Repair of Popliteal Aneurysm due to Graft Disintegration and Fabric Tear. Vasc Specialist Int 2022; 38:31. [PMID: 36510690 DOI: 10.5758/vsi.220035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 12/15/2022] Open
Abstract
Endovascular repair of popliteal artery aneurysms (PAA) using a stent graft is suitable for patients with favorable anatomy. In the domestic situation where Gore Medical withdrew, we report two cases of unusual complications of pseudoaneurysm after endovascular repair of PAA. A 44-year-old male with a history of bypass surgery for a PAA presented with recurrent vein graft pseudoaneurysm. Endovascular treatment using a domestic stent graft was performed. However, pseudoaneurysm developed due to the graft fabric tear 1 month later, requiring surgical removal. In another case, an 84-year-old female presented with acute limb ischemia related to PAA. Endovascular aneurysm repair with the same domestic stent graft was performed. However, stent graft failure occurred 2 years later and the patient underwent open surgical repair. There was a graft fabric disintegration. When proper endovascular device is not available, open surgical treatment is the best option for treating PAA.
Collapse
Affiliation(s)
- Min-Kyu Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Gon Kim
- Department of Radiology, Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cho-Shin Kim
- Division of Transplantation and Vascular Surgery, Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Kwang-Bo Park
- Department of Radiology, Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Kang J, Woo SY, Yang SS, Park YJ, Kim DI, Jeon P, Kim GM, Kim YW. Treatment results of carotid endarterectomy and carotid artery stenting for patients with radiation-induced carotid stenosis. Ann Surg Treat Res 2022; 103:112-118. [PMID: 36017138 PMCID: PMC9365643 DOI: 10.4174/astr.2022.103.2.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/24/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Exposure to ionizing radiation over the head and neck accelerates atherosclerotic changes in the carotid arteries. Owing to the characteristics of radiation-induced carotid stenosis (RICS), the results regarding the optimal revascularization method for RICS vary. This study compared treatment outcomes between carotid endarterectomy (CEA) and carotid artery stenting (CAS) in RICS. Methods This was a single-center retrospective review of consecutive patients who underwent CEA or CAS for carotid stenosis. RICS was defined as carotid stenosis (>50%) with the prior neck irradiation for cancer treatment on either side. For the analyses, demographics, comorbid conditions, carotid lesion characteristics based on imaging studies, surgical complications, neurologic outcomes, and mortality during the follow-up period were reviewed. To compare CEA and CAS results in RICS, a 1:1 propensity score matching was applied. Results Between November 1994 and June 2021, 43 patients with RICS and 2,407 patients with non-RICS underwent carotid revascularization with CEA or CAS. RICS had fewer atherosclerotic risk factors and more frequent severe carotid stenosis and contralateral carotid occlusions than non-RICS. CAS was more commonly performed than CEA (22.9% vs. 77.1%) for RICS due to more frequent unfavorable carotid anatomy (0 vs. 16.2%). Procedure-related complications were more common in the CEA than in the CAS. However, there was no significant difference in neurologic outcomes and restenosis rates between CEA and CAS in RICS. Conclusion Considering its lesion characteristics and cumulative incidence, RICS requires more attention than non-RICS. Although CAS has broader indications for RICS, CEA has shown acceptable results if selectively performed.
Collapse
Affiliation(s)
- Jihee Kang
- Division of Vascular Surgery, Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Shin-Young Woo
- Division of Vascular Surgery, Department of Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyoung Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
16
|
Park JK, Kang J, Kim YW, Kim DI, Heo SH, Gil E, Woo SY, Park YJ. Outcomes after Elective Open Abdominal Aortic Aneurysm Repair in Octogenarians Compared to Younger Patients in Korea. J Korean Med Sci 2021; 36:e314. [PMID: 34873883 PMCID: PMC8648610 DOI: 10.3346/jkms.2021.36.e314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although the first choice of treatment for abdominal aortic aneurysm (AAA) is endovascular aneurysm repair, especially in elderly patients, some patients require open surgical repair. The purpose of this study was to compare the mortality outcomes of open AAA repair between octogenarians and younger counterparts and to identify the risk factors associated with mortality. METHODS All consecutive patients who underwent elective open AAA repair due to degenerative etiology at a single tertiary medical center between 1996 and June 2020 were included in this retrospective review. Medical records and imaging studies were reviewed to collect the following information: demographics, comorbid medical conditions, clinical presentations, radiologic findings, surgical details, and morbidity and mortality rates. For analysis, patients were divided into two groups: older and younger than 80 years of age. Multivariate analysis was performed to identify factors associated with mortality after elective open AAA repair. RESULTS Among a total of 650 patients who underwent elective open AAA repair due to degenerative AAA during the study period, 58 (8.9%) were octogenarians and 595 (91.1%) were non-octogenarians. Patients in the octogenarian group were predominantly female and more likely to have lower body weight and body mass index (BMI), hypertension, chronic kidney disease, and lower preoperative serum hemoglobin and albumin compared with patients in the non-octogenarian group. Maximal aneurysm diameter was larger in octogenarians. During the median follow-up duration of 34.4 months for 650 patients, the median length of total hospital and intensive care unit stay was longer in octogenarians. The 30-day (1.7% vs. 0.7%, P = 0.374) and 1-year (6.9% vs. 2.9%, P = 0.108) mortality rates were not statistically significantly different between the two groups. Multivariate analysis showed that low BMI was associated with increased 30-day (odds ratio [OR], 16.339; 95% confidence interval [CI], 1.192-224.052; P = 0.037) and 1-year (OR, 8.236; CI, 2.301-29.477; P = 0.001) mortality in all patients. CONCLUSION Because the mortality rate of octogenarians after elective open AAA repair was not significantly different compared with their younger counterparts, being elderly is not a contraindication for open AAA repair. Low BMI might be associated with increased postoperative mortality.
Collapse
Affiliation(s)
- Joon-Kee Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jihee Kang
- Division of Vascular Surgery, Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seon-Hee Heo
- Department of Surgery, Yonsei University School of Medicine, Seoul, Korea
| | - Eunmi Gil
- Department of Critical Care Medicine and Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin-Young Woo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
17
|
Kang J, Kim YW, Kim DK, Woo SY, Park YJ. Comparable surgical outcomes of abdominal aortic aneurysm repair in patients with and without Marfan syndrome. J Vasc Surg 2021; 74:1163-1171. [PMID: 33887426 DOI: 10.1016/j.jvs.2021.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/19/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Marfan syndrome (MFS) affects the cardiovascular system. Aortic root aneurysm is a pathognomonic feature of MFS; however, the abdominal aorta is rarely affected. A consensus on surveillance for the abdominal aorta in patients with MFS has not been established. In the present study, we compared the outcomes after open surgical repair (OSR) of abdominal aortic aneurysms (AAAs) in patients with and without MFS. METHODS We conducted a retrospective, single-center cohort study from 2003 to 2020. We reviewed and compared 28 patients with MFS and 426 patients without MFS who had undergone OSR for AAAs. The baseline characteristics, medical comorbidities, previous cardiovascular surgery, anatomic features of the AAAs, and surgical treatment outcomes were compared between the two groups. RESULTS The patients with MFS were younger than those without MFS at the AAA diagnosis (47.2 ± 12.3 vs 70.6 ± 7.9 years; P < .001). The proportion of women was also greater for those with MFS (46.4% vs 15.7%; P < .001). The AAAs were most often located at the infrarenal aorta in both groups. However, thoracoabdominal AAAs were more often found among patients with MFS (10.7% vs 0.9%; P < .012). The proportion of symptomatic patients was lower in the MFS group (3.6% vs 21.6%; P = .022). The maximum median diameter of the AAA at surgery was smaller in the patients with MFS (52 mm vs 58 mm; P = .001). However, concomitant aortic dissection (32.1% vs 3.3%; P < .001) was more prevalent among the patients with MFS. Consequent aneurysmal changes in the iliac artery after AAA repair were more frequent in the patients with MFS (7.1% vs 0%; P = .004). No significant differences were found in 30-day or overall mortality between the patients with and without MFS during a median follow-up period of 71 months (interquartile range, 24.7-121.1 months) and 26.7 months (interquartile range, 7.4-69.5 months), respectively. CONCLUSIONS The surgical outcomes of OSR for AAAs for patients with MFS were not significantly different from those for patients without MFS in a well-established surveillance program of MFS.
Collapse
Affiliation(s)
- Jihee Kang
- Division of Vascular Surgery, Department of Surgery, Inha University Hospital, Inha University School of Medicine, Joong-gu, Incheon, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seodaemun-gu, Seoul, Korea
| | - Duk-Kyung Kim
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea
| | - Shin-Young Woo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea.
| |
Collapse
|
18
|
Jung KS, Heo SH, Woo SY, Park YJ, Kim DI, Kim YW. Factors associated with long-term graft patency after lower extremity arterial bypasses. Ann Surg Treat Res 2021; 100:175-185. [PMID: 33748031 PMCID: PMC7943280 DOI: 10.4174/astr.2021.100.3.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/18/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose This study was conducted to determine factors associated with long-term graft patency after lower extremity arterial bypass (LEAB). Methods Database of LEABs for patients with chronic arterial occlusive disease (CAOD) at a single institution was retrospectively reviewed. To determine the factors we compared demographic, clinical, and procedural variables between 2 patient groups; group I (graft patency < 2 years) and group II (graft patency ≥ 5 years after LEAB) using univariable and multivariable analyses. Results Among 957 LEABs, 259 limbs (group I, 125 limbs and group II, 134 limbs) in 213 patients were included for the analysis. On a univariable analysis, younger age (69 years vs. 66 years, P = 0.024), hypertension (60.8% vs. 74.6%, P = 0.017), claudication (51.2% vs. 70.9%, P = 0.001), absence of prior intervention (50.4% vs. 73.9%, P < 0.001), common femoral artery based bypass (57.6% vs. 70.1%, P = 0.035), above-the knee bypass (36.8% vs. 64.2%, P < 0.001), postoperative graft salvage procedure (3.2% vs. 14.8%, P = 0.001), and statin use (75.2% vs. 88.8, P = 0.004) were associated with long-term patency. On a multivariate analysis hypertension (odds ratio [OR], 1.91; P = 0.038), claudication (OR, 2.08; P = 0.032), no prior intervention (OR, 2.48; P = 0.001), vein graft (OR, 4.36; P = 0.001), above-the knee bypass (OR, 4.68; P < 0.001), and graft salvage procedures (OR, 7.70; P < 0.001) were identified as independent factors. Conclusion These factors can be considered in decision making before treatment of patients with CAOD.
Collapse
Affiliation(s)
- Ki-Sang Jung
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin-Young Woo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
19
|
Park YJ, Kim SH, Kim TS, Lee SM, Cho BS, Seo CI, Kim HD, Kim J. Ribosomal protein S3 associates with the TFIIH complex and positively regulates nucleotide excision repair. Cell Mol Life Sci 2021; 78:3591-3606. [PMID: 33464383 DOI: 10.1007/s00018-020-03754-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 12/14/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
In mammalian cells, the bulky DNA adducts caused by ultraviolet radiation are mainly repaired via the nucleotide excision repair (NER) pathway; some defects in this pathway lead to a genetic disorder known as xeroderma pigmentosum (XP). Ribosomal protein S3 (rpS3), a constituent of the 40S ribosomal subunit, is a multi-functional protein with various extra-ribosomal functions, including a role in the cellular stress response and DNA repair-related activities. We report that rpS3 associates with transcription factor IIH (TFIIH) via an interaction with the xeroderma pigmentosum complementation group D (XPD) protein and complements its function in the NER pathway. For optimal repair of UV-induced duplex DNA lesions, the strong helicase activity of the TFIIH complex is required for unwinding damaged DNA around the lesion. Here, we show that XP-D cells overexpressing rpS3 showed markedly increased resistance to UV radiation through XPD and rpS3 interaction. Additionally, the knockdown of rpS3 caused reduced NER efficiency in HeLa cells and the overexpression of rpS3 partially restored helicase activity of the TFIIH complex of XP-D cells in vitro. We also present data suggesting that rpS3 is involved in post-excision processing in NER, assisting TFIIH in expediting the repair process by increasing its turnover rate when DNA is damaged. We propose that rpS3 is an accessory protein of the NER pathway and its recruitment to the repair machinery augments repair efficiency upon UV damage by enhancing XPD helicase function and increasing its turnover rate.
Collapse
Affiliation(s)
- Y J Park
- Lab of Biochemistry, Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - S H Kim
- Lab of Biochemistry, Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - T S Kim
- Lab of Biochemistry, Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - S M Lee
- Lab of Biochemistry, Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - B S Cho
- Lab of Biochemistry, Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - C I Seo
- Lab of Biochemistry, Division of Life Sciences, Korea University, Seoul, 02841, Korea
| | - H D Kim
- TechnoComplex Building, HAEL Lab, Korea University, Seoul, 02841, Korea
| | - J Kim
- Lab of Biochemistry, Division of Life Sciences, Korea University, Seoul, 02841, Korea. .,TechnoComplex Building, HAEL Lab, Korea University, Seoul, 02841, Korea.
| |
Collapse
|
20
|
Heo SH, Park YJ, Kim YW. An internal carotid artery aneurysm in a 15-year-old girl. J Vasc Surg 2020; 72:714-715. [PMID: 32711911 DOI: 10.1016/j.jvs.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/03/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Seon-Hee Heo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
21
|
Chung BH, Heo SH, Park YJ, Kim DI, Kim DK, Kim YW. Strategy to avoid open surgical conversion after endovascular aortic aneurysm repair for patients with infrarenal abdominal aortic aneurysm. Ann Surg Treat Res 2020; 99:344-351. [PMID: 33304862 PMCID: PMC7704275 DOI: 10.4174/astr.2020.99.6.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/11/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Open surgical conversion (OSC) is the last treatment option for patients with endovascular aneurysm repair (EVAR)failure. We investigated the underlying causes of EVAR failure requiring OSC and attempted to determine strategies to avoid OSC after EVAR. Methods We retrospectively reviewed the database of patients who underwent OSC after EVAR from 2005 to 2018 in a single institution. Twenty-six OSCs were performed in 24 patients (median age, 74.5 years; 79.2% of males) who had undergone standard EVAR. We investigated pre-, intra-, and postoperative computed tomography or angiographic images and outcomes of the OSCs. Results Two main indications for OSC were persistent endoleak (50.0%) and endograft infection (EI) (38.5%). All 13 patients who underwent OSC due to endoleaks received EVAR outside of indications for use. Among 10 patients who underwent OSC due to EI, we found overlooked infection sources in 7 (70.0%) at the time of EVAR or during the surveillance period. OSC was performed at a median of 31.8 months (interquartile range, 9.4-69.8) after EVAR as an emergency (15.4%) or elective (84.6%) surgery. Aortic endograft was removed in 84.6% of cases (totally, 57.7%; partially, 26.9%), whereas it was preserved in 4 cases (15.4%). After 26 OSCs, 2 early deaths (7.7%) and 2 aortoenteric fistulae (7.7%) developed as major complications. Conclusion OSC after EVAR was associated with relatively higher perioperative morbidity and mortality. To avoid OSC after EVAR, we recommend careful assessment of coexisting infection sources and avoidance of EVAR for patients with especially unfavorable anatomy for EVAR, particularly the in proximal neck.
Collapse
Affiliation(s)
- Byeoung-Hoon Chung
- Department of Surgery, Jeonbuk National University Hospital, Jeonju, Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Cardiac and Vascular Center, Samsung Medical Center, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Cardiac and Vascular Center, Samsung Medical Center, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Cardiac and Vascular Center, Samsung Medical Center, Seoul, Korea
| | - Duk-Kyoung Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Cardiac and Vascular Center, Samsung Medical Center, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Kangbuk Samsung Hospital, Seoul, Korea
| |
Collapse
|
22
|
Kang J, Kim YW, Kim DI, Woo SY, Park YJ. Outcomes of Carotid Revascularization versus Optimal Medical Treatment Alone for Asymptomatic Carotid Stenosis: Inverse-Probability-of-Treatment Weighting Using Propensity Scores. World Neurosurg 2020; 146:e419-e430. [PMID: 33223129 DOI: 10.1016/j.wneu.2020.10.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The benefits and necessity of revascularization for asymptomatic carotid stenosis remains under debate. This study aimed to determine the more durable and beneficial alternative between carotid revascularization and optimal medical treatment (OMT) alone for asymptomatic carotid stenosis. METHODS We performed a retrospective analysis of patients with asymptomatic severe carotid stenosis at a tertiary institution between 1994 and 2017. We compared revascularization (carotid endarterectomy [CEA] and carotid artery stenting [CAS]) with OMT alone by using inverse-probability-of-treatment weighting with propensity scores to account for selection bias. The primary end point was a composite of any stroke, myocardial infarction, and death within 30 days, plus ipsilateral stroke thereafter. RESULTS A total of 1089 patients were included in the analysis (56% CEA, 25% CAS, 19% OMT alone). Patients who underwent CAS consistently showed greater risk regarding the primary composite end point compared with those who received OMT alone (hazard radio [HR] 3.32, 95% confidence interval 1.014-10.868; P = 0.047), but the CEA group showed no significant difference (HR 1.19, 95% confidence interval 0.385-4.584; P = 0.761). The CAS group had the greatest rates of any stroke within 30 days (4.0%, P = 0.0006) and ipsilateral stroke thereafter (3.68%, P = 0.0009). There was no death within 30 days. In the long-term outcomes, neither CEA nor CAS showed significant differences in HR compared with OMT alone. CONCLUSIONS Our study suggests that for stroke prevention in asymptomatic severe carotid stenosis, CAS might be inferior to the other 2 options regarding early outcomes. However, further investigation is required regarding the efficacy and durability of OMT alone.
Collapse
Affiliation(s)
- Jihee Kang
- Division of Vascular Surgery, Department of Surgery, Inha University Hospital, Inha University School of Medicine, Joong-gu, Incheon, South Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seodaemun-gu, Seoul, South Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - Shin-Young Woo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea.
| |
Collapse
|
23
|
Kang J, Heo SH, Park YJ, Kim DI, Kim YW. Differential Diagnosis and Treatment Outcomes of Tumors at the Carotid Bifurcation. Vasc Specialist Int 2020; 36:128-135. [PMID: 32759464 PMCID: PMC7531300 DOI: 10.5758/vsi.200022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/17/2020] [Accepted: 07/07/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose Primary tumor at the carotid bifurcation is uncommon, which includes paraganglioma, schwannoma, and lymphoma. Due to their rarity, characteristics of these tumors and problems related to their surgical treatment have not been well known. We tried to elucidate different clinical characteristics and surgical complications of these tumors. Materials and Methods We retrospectively reviewed 21 patients with carotid bifurcation tumor from the Vascular Surgery division of a Korean tertiary institution from 1995 to 2018. We investigated patients' demographics and clinical features, image characteristics, treatment details, and surgical outcomes. Results During the period from January 1995 to January 2018, we experienced surgical resections of 21 carotid bifurcation tumors which included 16 (76.2%) paragangliomas and 5 (23.8%) schwannomas. The most common clinical feature was a non-tender cervical mass. According to Shamblin classification, paragangliomas were classified into class II in 68.8% and class III in 25.0%. On the preoperative computed tomography images, all the paragangliomas showed characteristic splaying of the carotid bifurcation and hypervascularity of the tumors. On the contrary, all the schwannomas showed hypovascularity and splaying sign in 60%. Surgical complications related to cervical nerve injury developed in 50% and 60% of patients with Shamblin class III paraganglioma and schwannoma, respectively. During the mean follow-up period of 25 months (range, 1 to 163 months), distant metastases developed in 2 (12.5%) of paraganglioma patients. Conclusion Neurologic complications were more common after surgical resection of Shamblin class III paraganglioma and schwannoma. For patients with paraganglioma, postoperative periodic follow-up examination is advised to detect distant metastasis.
Collapse
Affiliation(s)
- Jihee Kang
- Division of Vascular Surgery, Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
24
|
Min SK, Han A, Min S, Park YJ. Inconsistent Use of Terminology and Different Treatment Outcomes of Venous Adventitial Cystic Disease: A Proposal for Reporting Standards. Vasc Specialist Int 2020; 36:57-65. [PMID: 32611837 PMCID: PMC7333088 DOI: 10.5758/vsi.200029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/21/2020] [Indexed: 01/21/2023] Open
Abstract
Adventitial cystic disease (ACD) is a very rare condition characterized by the accumulation of a cyst filled with gelatinous substance in the adventitia of a vessel adjacent to the joint area. The cyst usually compresses the vessel lumen, causing claudication or leg swelling. The disease usually affects the popliteal artery. However, several cases of venous ACDs particularly in the common femoral or external iliac vein have been reported. The definition, diagnosis, and optimal treatment of ACD remain controversial because of its rarity and the inconsistent use of terminology. The heterogeneity of the reported cases is more prominent in venous ACD. Herein, the accurate terminology of cysts correlated to the joint (synovial cyst, ganglion cyst, and adventitial cyst) and the pathogenesis, anatomy, and optimal therapy of venous ACD are discussed in detail to establish reporting standards for future studies.
Collapse
Affiliation(s)
- Seung-Kee Min
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ahram Han
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sangil Min
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
25
|
Kang J, Park YJ. Erysipelas after Femoro-Tibial Bypass Surgery. Vasc Specialist Int 2020; 36:49-50. [PMID: 32274374 PMCID: PMC7119151 DOI: 10.5758/vsi.2020.36.1.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jihee Kang
- Department of Surgery, Inha University Hospital, Incheon, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
26
|
Kang J, Chung BH, Hyun DH, Park YJ, Kim DI. Clinical outcomes after internal iliac artery embolization prior to endovascular aortic aneurysm repair. INT ANGIOL 2020; 39:323-329. [PMID: 32214071 DOI: 10.23736/s0392-9590.20.04328-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aortic anatomy is important in determining the success or failure of endovascular aortic aneurysm repair (EVAR). Endoleak is another issue which should be addressed for a long-term durability of the procedure. Internal iliac artery (IIA) embolization is required to prevent type II endoleak when the iliac landing zone is not sufficient such that the iliac limb should be extended down to the external iliac artery (EIA). Pelvic ischemia is an important complication of IIA embolization, but its incidence and severity is not exactly known. Our experience suggests this to be common but not severe. In this study we reviewed the clinical outcomes of patients who underwent IIA embolization to facilitate EVAR at one of the major tertiary medical centers in South Korea. METHODS We performed a retrospective review of the patients who underwent IIA embolization prior to EVAR between November 2005 and June 2018 at a single tertiary medical center in South Korea. Patients were interviewed via telephone to determine the severity of buttock claudication according to a previously defined pain scale. RESULTS The majority of 139 patients in both the unilateral and bilateral IIA embolization groups experienced no (N.=83, 60.0%) or mild (N.=51, 36.7%) buttock claudication. Only three patients in the unilateral IIA embolization group reported that their symptoms affected daily life, but without need for any measures for pain relief. Symptom duration was longer in the bilateral embolization group (12.6 months) compared to the unilateral group (6.6 months) without statistical significance (P=0.559). There were no critical complications such as buttock necrosis, spinal cord ischemia, or ischemic colitis. CONCLUSIONS Based on our experience, IIA embolization does cause buttock claudication of a certain degree. However, the most of them experienced mild discomfort rather than such symptoms severely affect their quality of life. Considering the risks of general anesthesia and complications of surgical procedures, IIA reconstruction along with EVAR may not be necessary.
Collapse
Affiliation(s)
- Jihee Kang
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byeoung-Hoon Chung
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong-Ho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea -
| |
Collapse
|
27
|
Kong SH, Kim JH, Park YJ, Lee JH, Hong AR, Shin CS, Cho NH. Low free T3 to free T4 ratio was associated with low muscle mass and impaired physical performance in community-dwelling aged population. Osteoporos Int 2020; 31:525-531. [PMID: 31784788 DOI: 10.1007/s00198-019-05137-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/16/2019] [Indexed: 10/25/2022]
Abstract
UNLABELLED In aged population, the association of thyroid hormones on physical performance, especially within their normal range, has yet to be elucidated. In this study, individuals with low serum free T3/free T4 were likely to have low muscle mass and impaired physical performance. PURPOSE We aimed to evaluate the associations of muscle mass, strength, and physical performance with thyroid hormone in an aged euthyroid population from a community-based cohort. METHODS We examined 918 men aged over 60 years and 1215 postmenopausal women from the Ansung cohort study. Appendicular skeletal muscle mass divided by square of height (ASM/ht2) was used as the muscle mass index. Hand grip strength was measured using a hydraulic dynamometer. Physical performance was assessed using the short physical performance battery (SPPB). RESULTS Participants with higher tertiles of free T3 and free T3/free T4 were younger and had higher ASM/ht2, stronger hand grip strength, and higher SPPB scores than those in the lower tertiles. In adjusted models, men within higher tertiles of free T3 had higher ASM/ht2 compared with those within lower tertiles (p = 0.033), whereas subjects with higher tertiles of free T4 had lower ASM/ht2 compared with those within lower tertiles (p = 0.043). Subjects within higher tertiles of free T3/free T4 had higher ASM/ht2 (p < 0.001) and better physical performance (p = 0.048) than those within lower tertiles after adjustments. However, free T3, free T4, or free T3/free T4 was not related to hand grip strength after adjustment for covariates. CONCLUSION Our results thus indicate that in an aged euthyroid population, low serum free T3/free T4 was a better index for low muscle mass and impaired physical performance than serum free T3 or free T4 alone.
Collapse
Affiliation(s)
- S H Kong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - J H Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Y J Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - J H Lee
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - A R Hong
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam, South Korea
| | - C S Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - N H Cho
- Department of Preventive Medicine, Ajou University School of Medicine, Suwon, 443-721, Republic of Korea.
| |
Collapse
|
28
|
Lim JH, Chung BH, Kang JH, Heo SH, Kim DI, Kim YW, Park YJ. Surgical Strategy to Reduce the Recurrence of Adventitial Cystic Disease after Treatment. Vasc Specialist Int 2019; 35:217-224. [PMID: 31915666 PMCID: PMC6941769 DOI: 10.5758/vsi.2019.35.4.217] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/17/2019] [Accepted: 11/21/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Adventitial cystic disease (ACD) is a rare condition that causes intermittent claudication and non-atherosclerotic disease without cardiovascular risk factors. The etiology and optimal treatment of ACD remain controversial. The purpose of this study was to analyze surgical treatment results for ACD and to elucidate optimal treatment options. Materials and Methods We retrospectively reviewed 30 patients with ACD who underwent surgery from 2006 to 2018. Twenty-two patients had arterial ACD, six had venous ACD, and two had combined venous and arterial ACD. We reviewed demographic and clinical characteristics, treatment details, and procedure outcomes. Results Recurrence occurred in 6 cases either after cyst excision alone (4/17) or patch angioplasty (2/2). There was no recurrence after vessel excision with interposition grafting (0/7). Therefore, vessel excision was a statistically significant factor in recurrence prevention (P=0.026). Among the six recurrences, joint connections of the cystic lesions were found in four of the six (66.7%). Conclusion As a curative surgery for ACD, vessel excision with interposition grafting is a better strategy to prevent recurrence than simple cyst excision alone.
Collapse
Affiliation(s)
- Ji-Ha Lim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byeong-Hoon Chung
- Department of Surgery, Chonbuk National University Hospital, Jeonju, Korea
| | - Ji-Hee Kang
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Department of Surgery, Kangbuk Samsung Hospital, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
29
|
Kang J, Kim YW, Park YJ, Kim DI, Heo SH, Woo SY. Risk Factors for Development of Perioperative Stroke After CEA. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
30
|
Kang J, Kim YW, Park YJ, Heo SH, Kim DI, Woo SY. Outcomes of Carotid Artery Endarterectomy (CEA) vs Carotid Artery Stenting (CAS) vs Optimal Medical Treatment (OMT) for Asymptomatic Carotid Stenosis: Inverse Probability of Treatment Weighting Using Propensity Scores. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
31
|
Park YJ, Lee JH, Park BE, Kim HN, Jang SY, Bae MH, Yang DH, Park HS, Cho Y, Chae SC. P3617Systolic blood pressure, glycemic control and clinical outcome in diabetic patients with acute myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recent blood pressure guidelines recommend intensive blood pressure control in diabetic patients with cardiovascular disease.
Purpose
We sought to investigate combined impact of intensive blood glucose lowering and blood pressure control on clinical outcome in diabetic patients with acute myocardial infarction (AMI) has not been fully investigated yet.
Method
Korean Acute Myocardial Infarction Registry (KAMIR) – National Institute of Health (NIH) database included 12,179 patients (9,046 men; mean age = 63.6±12.6 year-old) who were discharged alive. Among them, 3,430 (28.2%) had a diabetes mellitus (DM). MACCEs were defined as a composition of all cause death, non-fatal MI, repeat revascularizations including repeated percutaneous coronary intervention and coronary bypass grafting, cerebrovascular accident and rehospitalizations at 1 year. This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.
Result
We determined cut-off value of discharge systolic blood pressure (SBP) to predict 1-year MACCE in DM and non-DM patients. Discharge SBP of less than 130mmHg was associated with a lower MACCE at 1 year compared to SBP level of 130mmHg or greater (10.8% versus 15.4%; log-rank p=0.001) in DM patients, whereas discharge SBP cut-off level was 140mmHg to discriminate 1-year MACCE in non-DM patients (6.4% versus 8.5%, log-rank p=0.045). In DM patients, there were no significant difference in 1-year MACCEs between patients with HbA1c less than 7% versus 7% or greater (12.0% versus 10.7%; log-rank p=0.325). DM patients were categorized into 4 groups; discharge SBP <130mmHg and HbA1c <7% (Group 1); discharge SBP <130mmHg and HbA1c ≥7% (Group 2); discharge SBP ≥130mmHg and HbA1c <7% (Group 3); discharge SBP ≥130mmHg and HbA1c ≥7% (Group 4). Intensive BP control was associated lower 1-year MACCEs in patients with good glycemic control (Group 1 & 3; 10.7% versus 16.7%; log-rank p=0.009). However, in patients with poor glycemic control, intensive BP control did not improve 1-year MACCEs (Group 2 & 4; 10.6% versus 11.1%; log-rank p=0.761).
Conclusion
Strict BP control is more important than glycemic control to improve short-term clinical outcome in DM patients with AMI. However, in patients with poor glycemic control, strict BP control did not improve clinical outcome.
Collapse
Affiliation(s)
- Y J Park
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - J H Lee
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - B E Park
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - H N Kim
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - S Y Jang
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - M H Bae
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - D H Yang
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - H S Park
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - Y Cho
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - S C Chae
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| |
Collapse
|
32
|
Park YJ, Lee JH, Park BE, Kim HN, Jang SY, Bae MH, Yang DH, Park HS, Cho Y, Chae SC. P3583Optimal procedural strategy to improve clinical outcome in primary percutaneous coronary intervention. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Current guideline recommends potent antiplatelet agents and transradial intervention. However, it is uncertain whether routine use of IVUS, thrombus aspiration and glycoprotein IIB-IIIA inhibitor is beneficial for improving clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI).
Purpose
The aim of this study was to investigate optimal procedural strategy to improve clinical outcome.
Methods
A total of 6,046 patients who underwent primary percutaneous coronary intervention (PCI) for STEMI were analyzed from the Korean Acute Myocardial Infarction Registry (KAMIR) – National Institute of Health (NIH) database. MACCEs were defined as a composition of all cause death, non-fatal MI, repeat revascularizations including repeated percutaneous coronary intervention and coronary bypass grafting, cerebrovascular accident and rehospitalizations. This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.
Results
During the primary PCI, potent antiplatelet agents such as prasugrel and ticagrelor were used in 2342 (38.4%). PCI was performed through transradial approach in 1490 (25.2%). Thrombus aspiration and intravascular ultrasound (IVUS) examination was done in 2204 (36.1%) and 1079 (18.1%), respectively. Glycoprotein IIB-IIIA inhibitor was administered in 1295 (21.7%). Among them, potent antiplatelet agents, transradial intervention, IVUS, and thrombus aspiration significantly reduced MACCEs at 1 year. Glycoprotein IIB-IIIA inhibitor was not effective to improved clinical outcome. In Cox-proportional hazards model, potent antiplatelet agents (hazard ratio 0.82, 95% confidence interval 0.67–0.99; p=0.045) and transradial intervention (hazard ratio 0.61, 95% confidence interval 0.47–0.78; p<0.001) was an independent predictor of MACCEs after adjusting for confounding variables. Combined use of potent antiplatelet agents and transradial intervention (hazard ratio 0.54; 95% confidence interval 0.37–0.80; p=0.002) substantially reduced MACCEs at 1 year.
Conclusion
Among evidence based procedures during the primary PCI, combined use of potent antiplatelet agents and transradial intervention was optimal procedural strategy to improve clinical outcome.
Collapse
Affiliation(s)
- Y J Park
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - J H Lee
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - B E Park
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - H N Kim
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - S Y Jang
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - M H Bae
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - D H Yang
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - H S Park
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - Y Cho
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| | - S C Chae
- Kyungpook National University Hospital, Daegu, Korea (Republic of)
| |
Collapse
|
33
|
Park MS, Kwon S, Lee MJ, Kim KH, Jeon P, Park YJ, Kim DI, Kim YW, Bang OY, Chung CS, Lee KH, Kim GM. Identification of High Risk Carotid Artery Stenosis: A Multimodal Vascular and Perfusion Imaging Study. Front Neurol 2019; 10:765. [PMID: 31379719 PMCID: PMC6647800 DOI: 10.3389/fneur.2019.00765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 07/01/2019] [Indexed: 12/04/2022] Open
Abstract
Background: Risk stratification of asymptomatic carotid artery stenosis (ACAS) is still an issue for carotid revascularization. We sought to identify factors associated with symptomatic carotid artery stenosis (SCAS) using multimodal imaging techniques. Methods: We retrospectively collected data on patients who underwent carotid artery revascularization. Results from duplex sonography, computerized tomography angiography, brain magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), perfusion-weighted imaging, and demographic profiles were compared between ACAS and SCAS patients. Differences in baseline characteristics between the two groups were balanced by the propensity matching score method. Multivariable regression analysis was performed to identify factors associated with symptomaticity of carotid artery stenosis. We compared the strength of associations between significant imaging factors and symptomatic carotid stenosis using C statistics. Results: A total of 259 patients (asymptomatic 57.1%, symptomatic 42.9%) with carotid stenosis were included. After 1:1 propensity score matching, the multivariable regression analysis revealed that the absence of plaque calcification [Odds ratio 0.41, 95% confidence interval (CI) 0.182–0.870, p = 0.023], deep white matter hyperintensity (DWMH; Odds ratio 3.46, 95% CI 1.842–6.682, p < 0.001), susceptibility vessel sign seen on gradient-echo MRI (Odds ratio 2.35, 95% CI 1.113–5.107, p = 0.027), and increased cerebral blood volume (CBV) seen on perfusion-weighted MRI (CBV; Odds ratio 2.17, 95% CI 1.075–4.454, p = 0.032) were associated with SCAS. The combination of these variables had a fair accuracy to classify SCAS (Area under the curve 0.733, 95% CI 0.662–0.803). Conclusions: We identified several multimodal imaging markers independently associated with SCAS. These markers may provide information to identify ACAS patients with high risk of ischemic stroke. Future studies are needed to predict SCAS using our findings in other independent cohorts.
Collapse
Affiliation(s)
- Moo-Seok Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Soonwook Kwon
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mi Ji Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Keon Ha Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Pyoung Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang-Jin Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong-Ik Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Wook Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chin-Sang Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kwang Ho Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| |
Collapse
|
34
|
Chung BH, Kang JH, Heo SH, Park YJ, Kim YW, Woo SY, Kim DI. The Effect of Left Renal Vein Division on Renal Function Following Open Abdominal Aortic Surgery Using Propensity Score Matching Analysis. Ann Vasc Surg 2019; 62:232-237. [PMID: 31075465 DOI: 10.1016/j.avsg.2019.02.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/14/2019] [Accepted: 02/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Open surgery of abdominal aortic aneurysm (AAA) or aortoiliac occlusive disease (AIOD) sometimes requires left renal vein division (LRVD) to gain adequate exposure of the abdominal aorta. The aim of this study is to evaluate the effect of LRVD on the postoperative renal function using propensity score matching (PSM). METHODS From July 1996 to January 2018, we retrospectively reviewed 698 patients who underwent open aortic surgery, including 543 AAAs and 155 AIODs, at a single institution. 66 patients (9.6%, 47 AAAs, 19 AIODs) needed LRVD during the operation. A 1:3 ratio PSM was used to control the selective bias between the LRVD and non-LRVD groups. We investigated preoperative and postoperative renal function including serum creatinine (sCr) level and estimated glomerular filtration rate (eGFR, mL/min/1.73 m2). Major complications, long-term renal function, and 30-day mortality were also compared. RESULTS The LRVD group had a significantly higher rate of renal artery reconstruction (15.2% vs. 3.3%, P < 0.001) and suprarenal clamping (54.6% vs. 9.5%, P < 0.001) and higher incidence of juxtarenal AIOD (24.2% vs. 5.4%, P < 0.001). With PSM, 63 patients in the LRVD group and 144 patients in the non-LRVD group were enrolled in this study. The baseline characteristics were well balanced in the groups after PSM. There were no significant differences in preoperative eGFR (72.4 ± 21.3 vs. 76.1 ± 25.0, P = 0.306) and postoperative eGFR on day 3 (69.5 ± 26.6 vs. 77.5 ± 28.5, P = 0.065), day 7 (73.3 ± 24.8 vs. 78.5 ± 27.4, P = 0.264), and in the long-term follow-up period (69.0 ± 22.2 vs. 68.9 ± 27.1, P = 0.986, 50.2 month ± 45.50) in the 2 groups. Only the sCr level (1.40 ± 0.59 vs. 1.21 ± 0.62, P = 0.045) and eGFR (59.5 ± 23.9 vs. 71.4 ± 26.0, P = 0.002) were significantly worse on postoperative day 1 in the LRVD than in the non-LRVD group. There were no significant differences in 30-day mortality (1.6% vs. 1.6%, P = 1.00). CONCLUSIONS The patients in the LVRD group underwent initial drop in renal function; however, eGFR improved during the follow-up period. There was no difference in renal function and postoperative mortality between LRVD and non-LRVD groups. Therefore, LRVD is a safe and durable procedure during complex abdominal aortic surgery.
Collapse
Affiliation(s)
- Byeoung-Hoon Chung
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji-Hee Kang
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Shin-Young Woo
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
35
|
Chung BH, Heo SH, Park YJ, Kim YW, Woo SY, Kim DI. Comparative Analysis Using Propensity Score Matching Analysis: Primary Closure versus Patch Angioplasty During Carotid Endarterectomy. Ann Vasc Surg 2019; 62:166-172. [PMID: 30763710 DOI: 10.1016/j.avsg.2018.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/29/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Primary closure (PC) and patch angioplasty (PA) during carotid endarterectomy (CEA) have been disputed in many studies. Some studies announced that PC is associated with a higher restenosis rate. The aim of this study was to evaluate the outcomes of PC and PA using propensity score matching (PSM). METHODS Between November 1994 and October 2016, 1,044 patients underwent primary CEA procedures at our institution and were retrospectively analyzed. The study endpoints included rates of ipsilateral stroke, any clinical stroke, cranial nerve palsy, hematoma, bleeding warranting repeat surgery within 30 postoperative days. We also investigated the restenosis rates, overall survival, stenosis-free survival, and stroke-free survival during follow-up (median follow-up 37.1 months). RESULTS This study includes 435 cases of PC and 476 cases of PA. After PSM analysis, baseline characteristics (age, gender, hypertension, diabetes, dyslipidemia, smoking, atrial fibrillation, previous percutaneous coronary intervention or coronary artery bypass grafting, contralateral carotid occlusion, degree of carotid stenosis, and symptomatic status within 6 months) were balanced. Finally, 377 pairs of matched cases were analyzed. Statistical analysis showed no significant differences between the 2 groups in ipsilateral stroke (P = 0.45), clinical stroke (P = 0.75), cranial nerve palsy (P = 1), hematoma (P = 0.18), bleeding which required reoperation (P = 0.12) within 30 postoperative days, and restenosis rates during follow-up (P = 0.16). In addition, there were no differences between the 2 groups during follow-up in overall, stroke-free, and restenosis-free survival with P values of 0.136, 0.07, and 0.06, respectively. CONCLUSIONS According to the analysis using PSM, there were no significant differences between PC and PA closure during CEA in perioperative and long-term outcomes.
Collapse
Affiliation(s)
- Byeoung-Hoon Chung
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Shin-Young Woo
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
36
|
Kim SM, Yoon KW, Woo SY, Heo SH, Kim YW, Kim DI, Park YJ. Treatment Strategies for Cephalic Arch Stenosis in Patients with Brachiocephalic Arteriovenous Fistula. Ann Vasc Surg 2019; 54:248-253. [DOI: 10.1016/j.avsg.2018.04.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/23/2018] [Accepted: 04/26/2018] [Indexed: 10/28/2022]
|
37
|
Abstract
Intravascular fasciitis is a rare variant of nodular fasciitis, which can be easily misdiagnosed as a tumorous condition. We had a patient with an intravenous mass of a neck vein, and surgical excision was successful. Although all preoperative imaging studies and intraoperative pathologic reports suggested certain tumorous conditions as differential diagnosis results, the final diagnosis confirmed that it was an intravascular fasciitis based on its fibromixoid tissues with the proliferation of spindle cells and positive immunohistochemical staining for smooth muscle actin. Unless a physician has an insight of the disease or a suspicion to initiate running differential markers, it may be confused with other intravascular lesions and cause unnecessary radical surgery. Here we report our experience with a patient having this rare vascular disease.
Collapse
Affiliation(s)
- Ji-Hee Kang
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Heart, Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Hoon Chung
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
38
|
Park J, Kim J, Hwang S, Lee MK, Jang HR, Eun Lee J, Park YJ, Huh W, Kim YG, Oh HY, Joong Kim D. Arteriovenous graft patency outcomes and prognostic factors. Vascular 2018; 27:128-134. [PMID: 30360702 DOI: 10.1177/1708538118807844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Arteriovenous graft for hemodialysis shows poorer outcomes than arteriovenous fistula, due to frequent stenosis and thrombosis. We investigated arteriovenous graft patency outcomes and prognostic factors for these outcomes. METHODS We included a single-center cohort of patients receiving arteriovenous graft for hemodialysis access from 2010 to 2014. Demographics, laboratory data, comorbidities, and medications were collected from medical records. Surgical factors related to graft operation including the type and diameter of connected vessels, graft location, and type of operation (elective or emergency) were also recorded. Outcomes included primary and secondary patency. Survival analysis was conducted using the Kaplan-Meier method; univariate and multivariate analyses were used to evaluate the prognostic factors. RESULTS Data from 225 grafts were analyzed. During the follow-up period (mean: 583 days, range: 1-1717 days), 138 (61%) grafts required intervention and 46 (20%) permanently failed. Primary patency at one, two, and three years was 42%, 20%, and 16%, respectively. Secondary patency at one, two, and three years was 85%, 72%, and 64%, respectively. Multivariate analysis showed that primary patency was negatively associated with increasing age and location of vessel anastomosis (reference-brachiobrachial anastomosis; brachiobasilic - HR, 0.569; 95% CI, 0.376-0.860; p = 0.007; brachioaxillary anastomosis - HR 0.407; 95% CI, 0.263-0.631; p < 0.0001); secondary patency was positively associated with diastolic blood pressure, serum albumin level, and hemoglobin over 10 g/dL. Adverse events other than stenosis or thrombosis, such as infection/inflammation or pseudoaneurysm were observed in approximately 20% of grafts. CONCLUSIONS Factors associated with diminished primary arteriovenous graft patency included increased patient age and location of vessel anastomosis (brachiobrachial type compared to brachiobasilic or brachioaxillary type); diminished secondary patency was associated with low diastolic blood pressure, low serum albumin, and hemoglobin level under 10 g/dL. Among these factors, diastolic blood pressure, serum albumin, and hemoglobin level may be modifiable and could improve arteriovenous graft patency outcomes.
Collapse
Affiliation(s)
- Jeeeun Park
- 1 Division of Nephrology, Department of Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Gangwon-do, South Korea
| | - Jinhae Kim
- 2 Nephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Subin Hwang
- 3 Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Mi Kyoung Lee
- 4 Dialysis Unit, Samsung Medical Center, Seoul, South Korea
| | - Hye Ryoun Jang
- 2 Nephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung Eun Lee
- 2 Nephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang-Jin Park
- 5 Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Wooseong Huh
- 2 Nephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoon-Goo Kim
- 2 Nephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ha Young Oh
- 2 Nephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dae Joong Kim
- 2 Nephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| |
Collapse
|
39
|
Lee JH, Park BE, Park YJ, Kim HN, Kim NK, Song JH, Jang SY, Bae MH, Yang DH, Park HS, Cho Y, Chae SC, Jeong MH. P5533Impact of thrombus aspiration and Glycoprotein IIb/IIIa inhibitor between new antiplatelet agents and clopidogrel in patients undergoing primary percutaneous coronary intervention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J H Lee
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - B E Park
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - Y J Park
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - H N Kim
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - N K Kim
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - J H Song
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - S Y Jang
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - M H Bae
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - D H Yang
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - H S Park
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - Y Cho
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - S C Chae
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - M H Jeong
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | | |
Collapse
|
40
|
Lee JH, Pakr BE, Park YJ, Kim HN, Song JH, Kim NK, Jang SY, Bae MH, Yang DH, Park HS, Cho Y, Chae SC, Jeong MH. P5575Practice-level variation in use of optimal medical treatment during hospitalization: a multi-level methodological approach. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J H Lee
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - B E Pakr
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - Y J Park
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - H N Kim
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - J H Song
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - N K Kim
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - S Y Jang
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - M H Bae
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - D H Yang
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - H S Park
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - Y Cho
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - S C Chae
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - M H Jeong
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | | |
Collapse
|
41
|
Lee JH, Yoon JY, Park BE, Park YJ, Kim HN, Kim NK, Jang SY, Bae MH, Yang DH, Park HS, Cho Y, Chae SC. P3576Impact of intravascular ultrasound and final kissing balloon dilatation on 10-year clinical outcome in percutaneous revascularization with 1-stent strategy for left main coronary artery stenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J H Lee
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - J Y Yoon
- Gumi Cha Hospital, Internal Medicine, Gumi, Korea Republic of
| | - B E Park
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - Y J Park
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - H N Kim
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - N K Kim
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - S Y Jang
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - M H Bae
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - D H Yang
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - H S Park
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - Y Cho
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - S C Chae
- Kyungpook National University Hospital, Daegu, Korea Republic of
| |
Collapse
|
42
|
Lee SB, Kim DH, Kim T, Lee SH, Jeong JH, Kim SC, Park YJ, Lim D, Kang C. Anion gap and base deficit are predictors of mortality in acute pesticide poisoning. Hum Exp Toxicol 2018; 38:185-192. [PMID: 30001645 DOI: 10.1177/0960327118788146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Acute pesticide poisoning has long been a serious problem as a method of suicide worldwide. This poisoning is a highly fatal condition that requires a rapid and precise diagnosis for adequate treatment. However, various studies on mortality predictor factors have been insufficient for whole pesticide treatments. We hypothesized that the initial plasma anion gap (AG) and base deficit (BD) are reliable prognostic factors. METHODS: A retrospective study analyzed 561 patients with a diagnosis of acute pesticide poisoning between January 1, 2014 and June 30, 2017. The initial AG and BD values were divided into quartiles according to the number of patients. Survival at 30 days from admission was estimated using the Kaplan-Meier survival analysis. Receiver-operator characteristic (ROC) curves were drawn, and the areas under the curve for AG and BD for mortality were calculated. RESULTS: Fifty-eight (10.3%) of 561 patients died within 30 days. The highest AG quartile (>22 mEq/L) was associated with an increased risk of 30-day hospital mortality. Compared to patients with an AG less than 14.7 mEq/L, these patients had a 4.18-fold higher risk of 30-day hospital mortality and the highest BD quartile (>7.9 mEq/L) was associated with an increased risk of 30-day hospital mortality. Compared to patients with a BD less than 1.4 mEq/L, these patients had 2.23-fold higher risk of 30-day hospital mortality. The areas under the ROC for AG and BD curve were 0.699 and 0.744, respectively. CONCLUSIONS: Initial high AG and BD values could predict mortality and require precise intensive care.
Collapse
Affiliation(s)
- S B Lee
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - D H Kim
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - T Kim
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S H Lee
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - J H Jeong
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S C Kim
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,3 Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Y J Park
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,3 Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - D Lim
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,3 Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - C Kang
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| |
Collapse
|
43
|
Lee D, Chung BH, Heo SH, Park YJ, Kim DI. Case Report of a Large Common Hepatic Artery Aneurysm. Ann Vasc Surg 2018; 52:316.e11-316.e13. [PMID: 29886208 DOI: 10.1016/j.avsg.2018.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/01/2018] [Indexed: 12/01/2022]
Abstract
Hepatic artery aneurysm is rare, but appropriate treatment is mandatory. We report a 50-year-old woman with an asymptomatic large hepatic artery aneurysm. The aneurysm was found as a result of abdominal computed tomography (CT) performed as a part of the screening. An open surgery was performed due to the size of the aneurysm. Aneurysmectomy was achieved, and the proper hepatic artery was anastomosed with gastroduodenal artery for adequate blood flow to the liver. Adequate hepatic circulation was confirmed postoperatively by duplex ultrasonography and CT. The patient was discharged on the 9th postoperative day.
Collapse
Affiliation(s)
- Dongheon Lee
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byeoung-Hoon Chung
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
44
|
Kim SH, Park YJ, Cha AR, Kim GW, Bang JH, Lim CS, Choi SB. A feasibility work on the applications of MRE to automotive components. ACTA ACUST UNITED AC 2018. [DOI: 10.1088/1757-899x/333/1/012013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
45
|
Lee DS, Lee MY, Park CM, Kim DI, Kim YW, Park YJ. Preoperative statins are associated with a reduced risk of postoperative delirium following vascular surgery. PLoS One 2018; 13:e0192841. [PMID: 29570715 PMCID: PMC5865715 DOI: 10.1371/journal.pone.0192841] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 01/31/2018] [Indexed: 12/13/2022] Open
Abstract
Delirium is a common complication of vascular surgery. The protective effect of preoperative statins on delirium after vascular surgery is controversial. The authors hypothesized that preoperative statin administration would decrease the incidence of delirium after vascular surgery. From May 2010 to May 2015, 1,132 patients underwent vascular surgery. Postoperative delirium was diagnosed from patients’ medical records. The incidence of delirium was 11.5%. The preoperative statin exposure was not associated with reduced delirium in the univariate analysis. After adjusting for covariates, preoperative statin exposure was associated with reduced delirium (OR, 0.54; 95% CI, 0.33–0.87; p = 0.011). This favor effect of statin for delirium was observed after propensity matching (OR, 0.59; 95% CI, 0.34–1.02; p = 0.060). However, the median hospital lengths of stay and in-hospital mortality were not statistically different between the two groups. CRP(C-reactive protein) levels in the unmatched population were lower in the preoperative statin group compared with the other group (p<0.001), however, there was only numerically different without statistical difference after matching (p = 0.083). Preoperative statin use was associated with a decreased incidence of postoperative delirium in patients who underwent vascular surgery. However, preoperative statin did not reduce mortality rate and hospital stay.
Collapse
Affiliation(s)
- Dae-Sang Lee
- Department of Trauma Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi Yeon Lee
- Department of Biostatistics, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Chi-Min Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Ik Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Wook Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang-Jin Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
| |
Collapse
|
46
|
Kang JH, Kim YW, Heo SH, Woo SY, Park YJ, Kim DI, Kim DK. Treatment strategy based on the natural course of the disease for patients with spontaneous isolated abdominal aortic dissection. J Vasc Surg 2017; 66:1668-1678.e3. [DOI: 10.1016/j.jvs.2017.03.435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
|
47
|
Park KM, Park YJ, Kim YW, Hyun D, Park KB, Do YS, Kim DI. Long Term Outcomes of Femorofemoral Crossover Bypass Grafts. Vasc Specialist Int 2017; 33:55-58. [PMID: 28690996 PMCID: PMC5493187 DOI: 10.5758/vsi.2017.33.2.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/05/2017] [Accepted: 04/03/2017] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Femorofemoral crossover bypass (FCB) is a good procedure for patients with unilateral iliac artery disease. There are many articles about the results of FCB, but most of them were limited to 5 years follow-up. The purpose of our study was to analysis the results of FCB with a 10-year follow-up period. MATERIALS AND METHODS Between January 1995 and December 2010, 133 patients were operated in Samsung Medical Center (median follow-up: 58.8 months). We retrospectively analysed patient characteristics, the preoperative treatment, the operative procedure, and material used. RESULTS The indications for FCB were claudication in 110 and critical limb ischemia in 23 patients. Three patients were died due to myocardiac infarction, intracranial hemorrhage, and acute respiratory failure within 30 days after surgery. The one-year primary and secondary patency rates were 89% and 97%, the 5-year primary and secondary patency rates were 70% and 85%, and the 10-year primary and secondary patency rates were 31% and 67%. The 5-year and 10-year limb salvage rates were 97% and 95%, respectively. CONCLUSION Our long term analysis suggests that FCB might be a valuable alternative treatment modality in patients with unilateral iliac artery disease.
Collapse
Affiliation(s)
| | - Yang-Jin Park
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Bo Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Soo Do
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
48
|
Heo SH, Kim YW, Woo SY, Park YJ, Park KB, Kim DK. Treatment strategy based on the natural course for patients with spontaneous isolated superior mesenteric artery dissection. J Vasc Surg 2017; 65:1142-1151. [DOI: 10.1016/j.jvs.2016.10.109] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/24/2016] [Indexed: 11/28/2022]
|
49
|
Park YS, Heo SH, Hyun DH, Do YS, Park HS, Park KB, Kim YW, Park YJ, Lee CH, Kim DI. Usefulness of intraopertive ultrasonography during directional atherectomy using SilverHawk/TurboHawk system. Ann Surg Treat Res 2017; 92:42-46. [PMID: 28090505 PMCID: PMC5234428 DOI: 10.4174/astr.2017.92.1.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/31/2016] [Accepted: 09/19/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Directional atherectomy (DA) was introduced for the management of infrainguinal arterial stenosis or occlusive lesions. The procedure success rate in the DEFINITIVE LE study was determined using radiologic imaging. The aim of our study was to determine the usefulness of intraoperative ultrasonography (USG) during DA for evaluating the early results of this procedure. METHODS Patients who underwent DA from January to December 2014 were reviewed retrospectively. Twenty lesions from 14 patients with femoral artery stenosis (>70% stenosis) with short segment occlusive lesions (<2 cm in length) were treated. Among 20 lesions, 3 were treated with the TurboHawk system with a protective device due to lesion calcification. The percentage of stenosis during and after DA was determined with USG. RESULTS Median follow-up was 5.1 months, and the procedural success rate (<30% stenosis at the end of the procedure) was 100% on angiography, but only 30% on intraoperative USG. On USG, median residual stenosis was 40% (range, 28%-42%) at the end of DA, 40% (range, 30%-55%) at 1 month, 55% (range, 35%-85%) at 6 months, and 64% (range, 60%-100%) at 1 year. There was one dissection, but no cases of perforation, pseudoaneurysm, or thrombosis. Primary patency, which was defined as a peak systolic velocity ratio ≤3.5 with no reintervention at 6 months, was found in 18 lesions (90%), and 11 of 14 patients (78.6%) were free of ischemic symptoms such as claudication at 6 months. CONCLUSION Our results demonstrated that DA with intraoperative USG is an effective treatment option for short segment occlusive lesions of the femoral artery.
Collapse
Affiliation(s)
- Yoong-Seok Park
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Soo Do
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong-Suk Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang-Bo Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chul-Hyung Lee
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
50
|
Park DJ, Park YJ, Yoon KW, Heo SH, Kim DI, Kim YW. Lower Extremity Arterial Bypass with Arm Vein Conduits and Literature Review. Vasc Specialist Int 2016; 32:160-165. [PMID: 28042555 PMCID: PMC5198762 DOI: 10.5758/vsi.2016.32.4.160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 11/24/2016] [Accepted: 12/03/2016] [Indexed: 11/20/2022] Open
Abstract
Purpose: The superiority of autogenous vein conduits is well known in lower extremity arterial bypass (LEAB). Among various alternative conduits for LEAB, long-term results of arm vein grafts were investigated in this study. Materials and Methods: We retrospectively reviewed clinical characteristics of 28 patients who underwent infrainguinal LEAB with autogenous arm vein grafts at a single institute between January 2003 and December 2015. All procedures were performed in the absence of adequate saphenous veins. Graft patency was determined by periodic examinations with duplex ultrasonography. Results: Autologous arm vein grafts were implanted for 28 patients (mean age, 60.4±16.8 years; range, 20–82 years; male, 92.9%; atherosclerosis, 19 [67.9%]; and non-atherosclerotic disease 9 [32.1%] including 5 patients with Buerger’s disease). Source of arm vein were basilic 13 (46.4%), cephalic 4 (14.3%) and composition graft with other veins in 11 (39.3%) cases. The level of distal anastomosis was distributed as popliteal in 5 (17.9%), tibio-peroneal in 21 (75.0%) and inframalleolar artery in 2 (7.1%) cases. Mean duration of follow-up was 41.5±46.9 months (range, 1–138 months). Cumulative primary patency rates at 1, 3, and 5 years were 66.5%, 60.9% and 60.9%, respectively. Assisted-primary patency rates at 1, 3 and 5 years were 66.5%, 66.5% and 66.5%, respectively. Secondary patency rates at 1, 3 and 5 years were 70.8%, 70.8% and 70.8%, respectively. There was one limb amputation during the follow-up period. Conclusion: Arm veins are a useful alternative conduit when great saphenous veins are not available during LEAB.
Collapse
Affiliation(s)
- Dae-Joon Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Won Yoon
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|