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CEAP 분류에 따른 하지 내측부의 부전 관통정맥 특성에 대한 고찰
박기혁,박성환,유용운,박기호,이태순 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.1
Purpose: The contribution of perforation vein incompetence to the hemodynamic derangement in the chronic venous disease (CVD) remains a topic of debate. This study was designed to define the characeristics of IPV according to CEAP classification with development of CVD. Method: From March 1999, to August 2001, 145 patients were treated for CVD in out hospital. Of these, 15 patients with CEAP class 4,5,6 (Group Ⅰ) and 130 patients with class 2 (Group Ⅱ). Medial side of calf was assessed in the sitting position for looking IPVs by duplex scan. The number, location, and diameter at the fascia level of IPVs were determined. The characteristics of IPVs between two group were compared. Airplethysmogram (APG) was checked pre and postoperatively in 18 patients with class 2 without any procedure to IPVs. Result: 17 IPVs were found in 11/15 (73%) patients in group Ⅰ and 36 IPVs were found in 29/145 (20%) in group Ⅱ. The mean number of IPVs in each limb of group Ⅰ and Ⅱ was 1.54, 1.09 (P>0.05) and the mean diameter was 0.52㎝, 0.38㎝ (P=0.001). The 96% (51/56) of IPVs were found in lower half of the calf. All hemodynamic parameter of APG was improved statistically significantly after operation without ligation of IPVs in class 2 patients. Conclusion: With advancing of CVD (class 4,5,6), IPVs was found more and larger. This suggest significant hemodynamic role of IPVs in progression of CVD. So careful attention should be payed to IPVs in treatment of CVD. But it was doubted benefit of direct treatment of IPVS in class 2.
하지동맥 우회수술을 위한 대복재정맥 절편의 내시경적 채취방법
김정경,박기혁,박성환,유용운,박기호 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.1
Purpose: The autologous greater saphenous vein (GSV) is the most frequently used graft for leg artery bypass. But vein harvesting with long open incision as traditional method can be complicated by wound problem. Since we experienced endoscopic vein harvesting in leg artery bypass, we reviewed its advantage and indication. Method: Six patients received the endoscopic saphenous vein harvesting precedure for their leg artery bypass surgery. The endoscopic procedure was limited above knee avoiding of the injury to saphenous vein because it has more branching at below knee. We studied endoscopic using time, number of branch ligated, wound closure time, wound complication, postoperative pain and admission duration. Result: In one patient the procedure was failed because many branch and small GSV. In five patients mean endoscopic using time was twenty two minutes and 2.2 branch was ligated. There was no wound complication. Wound closure time and operation time was decreased but the statistical variables difficult to decide. In one patient for redo operation, contralateral GSV was harvested. Conclusion: Endoscopic GSV harvesting is technically simple procedure, which can reduce wound size in using reversed way of GSV in leg artery bypass. We also believe it reduce operation time, wound pain, hospital stay. But it needs further study and skill in our study.
원발성 하지 정맥류의 성공적 치료를 위한 Duplex Scan의 역할
박성환,박기호,박기혁,이한일,주대현,정덕수,유용운,석상보 대한혈관외과학회 1999 Vascular Specialist International Vol.15 No.2
Purpose: Anatomy and morphology of superficial veins vary from patient to patient. Thorough assessment of variations is mandatory for successful treatment of primary varicose vein. Alos in complex case clinical examination alone is unable to achieve diagnostic goals. Duplex scan is a highly accurate, noninvasive technique that can provide both anatomic and physiologic information. Methods: Thirty-eight legs in 30 patients with primary varicose veins were examined clinically first then with portable doppler. Patients then underwent duplex scanning by surgical team and results of tests were compared with other clinical examinations. Results: On duplex scanning, 25 legs (66%) had saphenofemoral junction (SFJ) incompetence, 9 legs (24%) had saphenopopliteal junction (SPJ) incompetence and 4 legs (10%) had perforator incompetence. The respective sensitivity of clinical examination with portable doppler in SFJ, SPJ was 91.6%, 81.8%. Conclusion: Clinical and doppler assessment was unreliable. Routine preoperative duplex scanning is likely to reduce recurrence by identifying sites of reflux with greater accuracy.