Regarding "Aortofemoral bypass in young patients with premature atherosclerosis: is superficial femoral vein superior to Dacron?".
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Adult↗
Biomedical subjects
Geun Eun Kim
Publications and source records attributed to Geun Eun Kim.
Relationship between circle of Willis morphology on 3D time-of-flight MR angiograms and transient ischemia during vascular clamping of the internal carotid artery during carotid endarterectomy.
BACKGROUND AND PURPOSE: A potential source of complication at carotid endarterectomy (CEA) is cerebral ischemia caused by hypoperfusion during clamping of the carotid artery. Configuration of primary collateral pathways may be a major risk factor for development of transient cerebral ischemia during clamping. We investigated whether circle of Willis morphology on 3D time-of-flight (TOF) MR angiograms can reliably predict transient ischemia during vascular clamping of the internal carotid artery (ICA) in patients undergoing CEA. METHODS: Three-dimensional TOF MR angiography and CEA were performed in 117 patients. Patients had unilateral stenosis (n = 86), unilateral stenosis with contralateral occlusion (n = 21), or bilateral severe stenosis (n = 10) of the ICA. Circle of Willis morphology on preoperative 3D TOF MR angiograms was analyzed and correlated with intraoperative history of ischemia during vascular clamping of the ICA. RESULTS: Patients with unilateral stenosis or bilateral severe stenosis experienced transient ischemia during clamping of ICA at a low rate (11 [11%] of 96). In these groups, we found no specific circle of Willis patterns associated with development of intraoperative ischemia. However, patients with contralateral ICA occlusion experienced ischemia frequently during clamping of the ICA (12 [57%] of 21). In this group, incompleteness of the circle of Willis was significantly related to the risk of intraoperative ischemia (P =.005). CONCLUSION: In patients without contralateral ICA occlusion, circle of Willis morphology on 3D TOF MR angiograms cannot predict the development of intraoperative ischemia. However, in patients with contralateral ICA occlusion, incompleteness of the posterior part of the circle of Willis is a significant risk factor for development of ischemia during vascular clamping of the ICA.
Aged↗
Mesenteric Buerger's disease.
A young male patient with a history of heavy smoking and low-extremity Buerger's disease was operated on because of small bowel infarction. The postoperative histopathological diagnosis was mesenteric involvement of Buerger's disease. Mesenteric Buerger's disease is extremely rare, the early diagnosis is difficult, and the prognosis is poor. Considering the difficulty in diagnosis and the poor prognosis, patients with Buerger's disease presenting with gastrointestinal manifestations should be carefully evaluated, and early surgical intervention is recommended.
Humans↗
Mesenchymal chondrosarcoma originating from the femoral vein.
Mesenchymal chondrosarcoma is a rare variant of chondrosarcomas characterized by a bimorphic pattern with areas of the undifferentiated malignant small cells and well differentiated cartilaginous islands.(1) It occurs most commonly in the bone but can also occur in the extraskeletal soft tissues, the brain, and the meninges. This type of tumor has also been described in the eyelids, parapharyngeal space, mediastinum, and the kidney.(1-5) An origin from the large vessels has not been reported in the medical literature. The authors report a case of mesenchymal chondrosarcoma originating from the femoral vein in a 28-year-old female patient, treated by the wide-margin resection.
Adult↗
Metabolic changes after revascularization in a patient with innominate artery occlusion by localized in vivo proton magnetic resonance spectroscopy.
Localized in vivo proton magnetic resonance spectroscopy ((1)H-MRS) has been used to measure the metabolic status of the human brain in a non-invasive manner; thus, it is often called "a non-invasive biochemical assay". MRS is more sensitive than magnetic resonance imaging (MRI) in detecting ischemic damage by measuring the metabolic changes that occur prior to the anatomic changes. We report a patient who presented with innominate artery occlusion and symptoms of posterior circulation insufficiency and showed favorable metabolic changes by (1)H-MRS after revascularization. He showed no visible lesion in brain MRI, but in (1)H-MRS, decreased N-acetylaspartate (NAA) signal was noted in a resting state. After revascularization, both symptomatic improvement and recovery of NAA signal were observed. (1)H-MRS may provide valuable clinical information in diagnosis and management of cerebral hypoperfusion at a much earlier stage prior to the anatomic changes.
Arterial Occlusive Diseases↗
Sonographic appearance of a free-floating atheromatous plaque in a patient with acute stroke.
We report the case of a neurologically unstable acute stroke patient in whom carotid sonography identified the need for emergency carotid surgery because of an increased risk of distal embolization from a free-floating atheromatous plaque. Longitudinal and transverse sonograms revealed a 6-mm free-floating thrombus loosely attached to the wall of the left common carotid artery. During emergency surgery, a free-floating atheromatous plaque was seen at this location, along with extensive atheromatous lesions. The diseased segment of the common carotid artery was resected and repaired with an interposition graft, and the patient recovered uneventfully, with no recurrence of stroke.
Acute Disease↗
Can carotid endarterectomy improve metabolic status in patients with asymptomatic internal carotid artery flow lesion? Studies with localized in vivo proton magnetic resonance spectroscopy.
PURPOSE: Carotid endarterectomy (CEA) has proven to be effective in the prevention of stroke in patients with significant internal carotid artery (ICA) stenosis. However, whether increased cerebral blood flow after CEA improves the cerebral metabolism in patients with asymptomatic ICA flow lesions is unknown. Localized in vivo proton magnetic resonance spectroscopy ((1)H-MRS) has been used to measure the metabolic status of the human brain in a totally noninvasive manner. The aim of this study was to investigate the cerebral metabolism after CEA in patients with asymptomatic ICA flow lesions and no visible infarction on magnetic resonance imaging (MRI). MATERIALS AND METHODS: We designed a prospective study to investigate the metabolic changes in the middle cerebral artery (MCA) territory with (1)H-MRS for 18 consecutive patients with asymptomatic severe stenosis of the ICA (>70% reduction in diameter) and for 16 healthy control subjects. The 18 patients with ICA flow lesion and no visible infarction on MRI who underwent CEA were evaluated before and 7 days after surgery (CEA group). The 16 control subjects had never had a cerebral event, and brain MRI and carotid duplex scan study results were normal in all (control group). RESULTS: Preoperative ICA volume flow was severely decreased to less than 150 mL/min in all 18 patients, in comparison with our laboratory normal value of matched age group of 250 to 300 mL/min. After CEA, ICA volume flow was increased to greater than 300 mL/min in all patients (P =.00). For patients in the CEA group, preoperative N-acetylaspartate/creatine and choline/creatine ratios in the MCA territory were slightly decreased compared with the healthy subjects in the control group but were within normal limits. However, the postoperative values of N-acetylaspartate/creatine and choline/creatine ratios in the ipsilateral MCA territory were significantly increased as compared with the preoperative values (P <.05). In the contralateral side, the postoperative increase of choline/creatine ratio and the decrease of myo-inositol/creatine ratio were statistically significant as compared with the preoperative values (P <.05). CONCLUSION: CEA seems to improve the cerebral metabolic status in patients with asymptomatic ICA flow lesions and no visible infarction on MRI.
Aged↗
The anatomy of the circle of Willis as a predictive factor for intra-operative cerebral ischemia (shunt need) during carotid endarterectomy.
The collateral flow to the cerebral hemisphere after carotid cross clamping during carotid endarterectomy is mainly through the circle of Willis, and the circle is incomplete in the majority of cases. A correlation between the status of the circle of Willis and the necessity of shunting was evaluated in 67 carotid endarterectomies with pre-operative four-vessel cerebral angiogram. All carotid endarterectomies were performed with selective shunting, based on the change of consciousness and motor function after carotid test clamping under regional anesthesia. Of the 55 patients with either an anterior or a posterior communicating artery, only four (7.3%) required shunting. Twelve patients had neither anterior nor posterior communicating artery, and 10 (83.3%) showed signs of cerebral ischemia necessitating shunting. Mandatory shunt was significantly higher in patients with absence of collaterals (p = 0.00). The rate of intraoperative cerebral ischemia was significantly higher in patients with poor collateral circulation defined by the anatomy of the circle of Willis.
Adult↗