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KMID : 0364019720050010019
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Korean Journal of Thoracic and Cardiovascular Surgery
1972 Volume.5 No. 1 p.19 ~ p.24
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Surgic Treatment of Aortoiliac Arterial Occlusion
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馬重成/Mah, J.S.
李正浩/李浩一/柳會性/Lee, J.H./Lee, M.D/Yoo, H.S.
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Abstract
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The recent development of cardio-vascular surgery as well as aortoarteriogaphy has been established excellent operative result with great aid of limb-salvage. However, less consideration or less experience still exists on the regard of vascular accident and vascular disease, as well as vascular surgery in Korea. During the last 13 years, we experienced only two cases of aorto-iliac occlusion, acute and chronic, regardless of having had more than 300 cases of mitral valvotomy and gradual increasing tendency of arteriosclerosis and hypertension in Korea. Therefore it is noteworthy to report the cases in order to promote the consideration for vascular surgery.
Case 1: 52 year old female who had 20 years history of mitral stenosis with auricular fibrillation and received medical treatment for recent 1 year in the medical department. 10 days before admission, acute saddle emboli developed and 15 days after the onset, embolectomy through both common femoral arteries on the groin and abdominal approach was made. The progression of emboli to the right popliteal bifurcation was found by arteriography on operating table and retrograde flushing with heparin solution by the polyethylene catheter inserted through posterior tibial artery. The operation was successful, but 9 hours after operation sudden death occurred. Considering this case, first, mitral valvotomy already before might prevent peripheral embolization, secondarily, the more early detection and surgery might also prevent the progression of emboli. Thirdly, although preoperative or postoperative heparinization is controversial for mitral stenosis, heparinization might prevent additional emboli to vital organs in this case
Cases 2: 66 year old female who had 4 years history of left hip and calf intermittent claudication and has had rest pain, inability to walk and ischemic necrosis on the the left leg since last 3 months prior to admission to the orthopedic department under the suspicion of herniated disc. Absence of pulsation on the groin and aortography evidenced aortoiliac occlusion predominantly on the left side. Thromboendarterectomy was made and the operative result was successful with absence of claudication, healing of ulcer and nortographic patency of occlusive site. This chronic occlusion is considered to result from arteriosclerosis in origin with the evidence of moderate hypertension, x-ray evidence of calcified plaque on the aortic knob and operative finding of palpable plaques.
with the evidence of moderate hypertension, x-ray evidence of calcified plaque on the aortic knob and operative finding of palpable plaques.
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