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주윤성,김우영 대한혈관외과학회 2013 Vascular Specialist International Vol.29 No.1
An ischemic colitis of the sigmoid colon and rectum following iliac balloon and stenting can be caused by embolism. The patient was 60 years old with a 20 year history of smoking. She had chief complaints of right calf claudication. From a lower extremity computed tomography (CT) scan, right iliac total occlusion (Trans-Atlantic Inter-Society Consensus C) and internal iliac artery occlusion were both observed. The patient had a hysterectomy history about 30 years ago. To improve right leg claudication, endovascular treatment was attempted through the right common femoral artery. There was no severe resistance to pass the occluded lesion. About 5 hours after successful stenting, she complained of a vague low abdominal discomfort and pain. There were no specific changes in the intraperitoneal organ in the follow-up CT scan. On postoperative day 1, she complained of aggravated lower abdominal pain. To confirm ischemic colitis, we performed a colonoscopy and both erythematous mucosal swelling and pethechia were present. On laparotomy, transmural infarction of the sigmoid colon and rectum were found and resected. A high level suspicion and a low threshold for performing colonoscopy are important in any patient thought to have ischemic colitis after iliac stenting.
혈관 내 대동맥류 교정술 시행 후 발생한 속이식편의 폐색
주윤성 대한혈관외과학회 2012 Vascular Specialist International Vol.28 No.2
Endovascular aneurysm repair (EVAR) has been increasingly used in order to treat infrarenal aortic aneurysms. However, there have been various complications and adverse events such as endoleak, graft migration, continued aneurysm expansion, and endograft limb occlusion (ELO). I have experienced a case of ELO. In order to treat it, I performed a thrombectomy using a 5F Fogarty catheter and a 12 mm balloon angioplasty. Thus, I report the results of treatment with the review of journals. The case involves a 54 year-old male who was treated Abdominal Aovtic Aneurysm through EVAR. There was no definite anatomic contraindication for EVAR. The Zenith Flex was used and there was no specific problem during the EVAR procedure. At 6 months following EVAR, acute onset of cyanosis and coldness developed in the left leg. To minimize arterial wall injury and avoid endograft migration during balloon cather thrombectomy, fluoroscopically assisted thromboembolectomy was completed. After thromboembolectomy, balloon angioplasty was done in the stenotic lesion of the endograft. The ischemic symptoms (cyanosis, rest pain, and coldness) improved after the procedures.
중심선(Centerline)을 이용한 수술 전 복부대동맥류 혈관 내 교정술 계획
주윤성,박기혁 대한혈관외과학회 2013 Vascular Specialist International Vol.29 No.1
Purpose: Sometimes, there are endograft shortenings during endovascular aneurysm repair (EVAR). They are associated with various changes of endograft position in a 3-dimensional (3D) space. The purpose of this study is to evaluate the accuracy of central luminal line (CLL) measurements and understand the degree of endograft shortenings. Methods: Preoperative 3D computed tomographic (CT) scans were evaluated for every EVAR case. Preoperative working lengths were measured with computerized software that allowed for centerline measurements on 3D reconstructions based on CT data. We compared preoperative CLL measurements and used the endograft length. In this study, the ipsilateral limb length comparisons were excluded, because the overlapped stent-graft length can influence the total ipsilateral limb length. Hence, only the contralateral limb lengths were compared with each other. Results: Preoperative contralateral lengths in the 9 limbs were studied. There was no large difference (below 10 mm) in almost all cases except for one (15 mm shortening), which was very tortuous aortoiliac anatomy. The mean difference between preoperative CLL measurements and the used stent-graft length was 4.48 mm. Conclusion: Although these shortenings can be overcome with the deployment technique, the operator should prepare various length extensions in tortuous anatomy.