Background: Pulmonary thromboembolism is often complicated by deep vein thrombosis (DVT), however a part of cases are asymptomatic. It is important early detection for asymptomatic DVT. Methods: Of the 108 consecutive patients undergoing venous ultrasonography (US) between January and April 2016, we enrolled 80 patients without previous venous US. Result: DVT was observed in 29 patients (36.2%). Twenty eight patients (35%) had malignant disease and 17 patients (21.3%) had immobility in all patients. Medical history of heart failure was more prevalent in patients with DVT compared with patients without DVT (6 patients (20.6%) vs 2 patients (3.9%), p=0.024). Conclusion: D-dimer was recommended for DVT screening but it had a problem with high false positive value. We needed evaluation of combination of D-dimer and other examinations.
The timing and choice of surgical method for type B aortic dissection, is still a topic of much debate. We performed Total arch replacement using Frozen elephant trunk (TAR-FET) as a means of preventing distant aortic events, such as retrograde type A aortic dissection (RTAD). We conducted analysis of 142 patients with acute type B dissection who were admitted between January of 2010 and July of 2017. Fifty-five cases required surgical intervention to treat enlargement of the false lumen diameter and ULP formation 2 weeks after the onset of symptoms. 17 TAR-FET were performed with a mean of 42±26 days period from onset to surgery. There were no complications of RTAD or paraplegic, and 90% of patient demonstrated aortic event free survival (5 years) and false lumen reduction ratio of 35%. Based on our analysis, using TAR-FET properly avoids serious complications like RTAD, and is a viable treatment option for type B dissection.
An 81-year-old woman underwent radiofrequency ablation and hook phlebectomy for the right great saphenous varicose veins. On the postoperative day 32 (POD32), she noticed a non-tender subcutaneous mass at the internal side of her right thigh. The mass was located under the scar from hook phlebectomy. Ultrasonography and needle aspiration showed that the nodule was diagnosed as lymphocele. On the POD 43, autologous peripheral blood injection was performed, and then lymphocele was resolved until the POD 51. Autologous peripheral blood injection is expected as a safe and effective treatment method for lymphocele after varicose vein surgery.
Cystic adventitial degeneration is a rare arterial disorder that causes arterial stenosis and obstruction due to colloidal deposition at the adventitia and media. This case report describes a 53-year-old man who presented with left-sided intermittent claudication. The ABI on the left was 0.38. Weakness of pulsation was observed in the peripheral of the popliteal artery, and contrast-enhanced computed tomography and magnetic resonance imaging revealed popliteal adventitial degeneration and we performed cystectomy and saphenous vein patch angioplasty under general anesthesia. The patient has had an uneventful postoperative course for more than half a year.
A 81 year-old-man was admitted for pseudoaneurysm of femoral artery, after emergent thrombectomy for acute limb ischemia. Repair of femoral artery by end-to-end anastomosis was carried out, but groin infection,lymphorrhea, and bleeding from anastomosed site was occurred postoperatively. Although illiofemoral bypass had been performed to avoid groin region, graft infection was found at proximal anastomosed site of the common iliac artery on postoperative day (POD) 74. Therefore, axillo-femoral bypass using prior vascular graft and omental implantation were accomplished under median laparotomy. His postoperative course was uneventful, and he was discharged in good condition.
A 67-year-old man with a history of coronary artery bypass grafting 23 years previously presented with severe chest and back pain. Computed tomography showed a huge true aneurysm and a huge pseudoaneurysm of the saphenous vein graft, which was anastomosed to the right coronary artery. The aneurysm compressed the right atrium and ventricle. He successfully underwent emergent resection of the aneurysms. Coronary artery bypass grafting to the right coronary artery was not performed due to dense adhesion.
A 12-year-old boy was struck by a pickup truck while on his bike and sustained a left clavicle fracture, brachial plexus injury, and left subclavian arterial/venous injury. Revascularization was indicated, given active bleeding and young age. The injured left subclavian artery was replaced with a greater saphenous vein graft. The left subclavian vein transection was reconstructed with cephalic vein graft interposition. The C7-8-Th1 avulsion injury was repaired by neurolysis and open reduction and fixation of the left clavicle fracture. Postoperatively, left upper extremity peripheral coldness improved, and the radial artery was readily palpable.
The transdiaphragmatic approach with in-situ right gastroepiploic artery graft enables us to perform coronary artery bypass grafting (CABG) without median sternotomy or cardiopulmonary bypass. Ten patients underwent CABG via this approach and were analyzed retrospectively. In all cases, the distal right coronary artery was the target site, and the procedures were completed without intraoperative conversion to median sternotomy or cardiopulmonary bypass. Postoperative coronary angiography demonstrated that all the grafts were patent. Percutaneous coronary artery intervention has been widely performed in recent years, however, this procedure is useful in those patients unsuitable for PCI or which repeatedly develop post PCI restenosis.