ANNALS OF VASCULAR DISEASES

17th Congress of Asian Society for Vascular Surgery11th Asian Venous Forum

October 20-23, 2016 Singapore

AVDANNALS OF VASCULAR DISEASEShttp://www.avd.umin.jp/

Asian Society for Vascular SurgeryAsian Venous Forum

Published by the Editorial Committee of Annals of Vascular Diseasesc/o Medical Tribune Inc., 2-1-30 Kudan Minami, Chiyoda-ku 102-0074

Asian Venous ForumAsian Society for Vascular Surgery

ABSTRACT BOOK

Annals of Vascular Diseases 20162

CONTENTSCommittees 4

Abstract Listing 6

Free Paper Presentation

Oral 33

Prize Oral 83

Prize Poster 86

Poster 91

Annals of Vascular Diseases 2016 3

Editor-in-ChiefTetsuro Miyata

Associate EditorsHideo Adachi JapanStephen Cheng Hong KongTsuneo Ishiguchi JapanKimihiko Kichikawa Japan

Young-Wook Kim KoreaMasahiko Kurabayashi JapanMasataka Sata JapanNorihiko Shiiya Japan

Editorial Board Members

Abdulkarim Al-Amer YemenMussaad M.S. Al-Salman Saudi ArabiaLouay Altarazi SyriaTakayuki Asahara JapanEnrico Ascher USAJean-Pierre Becquemin FranceDavid Bergqvist SwedenAhmet Kursat Bozkurt TurkeyJan Brunkwall GermanyNiaz Ahmed Choudhury BangladeshMurnizal Dahlan IndonesiaRicardo Etcheverry ArgentinaJohn Fletcher AustraliaPeter Gloviczki USATarun Grover IndiaEiji Ikeda JapanDong-Ik Kim KoreaKimihiro Komori JapanIssei Komuro JapanByung-Boong Lee USA

Yew Pung Leong MalaysiaMauri Lepäntalo FinlandJames May AustraliaIn Sung Moon KoreaPramook Mutirangura ThailandHitoshi Ogino JapanTakao Ohki JapanPeter Robless SingaporeJosefino Sanchez PhilippinesOsamu Sato JapanHirono Satokawa JapanTorben V. Schroeder DenmarkChun Che Shih TaiwanHenrik Sillesen DenmarkBauer Sumpio USAShen Ming Wang ChinaShoei-Shen Wang TaiwanYoshikazu Yonemitsu JapanMasao Yoshizumi Japan

Advisory BoardTakehisa Iwai JapanSachio Kuribayashi JapanMasunori Matsuzaki JapanToshio Ohhashi Japan

Takashi Ohta JapanTadahiro Sasajima JapanHiroshi Shigematsu JapanYoshio Yazaki Japan

Past Editor-in-ChiefNobuyuki Nakajima

AVD Editorial Officec/o Medical Tribune Inc., 2-1-30, Kundan-Minami, Chiyoda-ku, Tokyo 102-0074, Japan

Tel: +81-3-3239-9376, Fax: +81-03-3239-9375Email: [email protected]


Congress Organizing CommitteePeter ROBLESS (Chair)Sadhana CHANDRASEKARKok Hoong CHIASiew Ping CHNGEdward CHOKEAndrew MTL CHOONGTze Tec CHONGBenjamin CHUARajesh DHARMARAJ BABUSugit Singh GILLJackie HOSteven KUMChee Wei LEEChuo Ren LEONGRaj Kumar MENONSanjay NALACHANDRANSriram NARAYANANHarvinder Raj SIDHUGlenn TANJohn TANYih Kai TANTjun TANGVikram VIJAYANJohn WANGJulian WONG

ASVS 2016 CommitteesThe 17th Congress of Asian Society for Vascular Surgery

Scientific Program Andrew MTL CHOONG Benjamin CHUA Jackie HO Steven KUM Sriram NARAYANAN Yih Kai TAN Tjun TANG Julian WONG

Abstract Review Andrew MTL CHOONG Chuo Ren LEONG Tjun TANG

Pre-Congress Workshop Sadhana CHANDRASEKAR Tze Tec CHONG Jackie HO Sriram NARAYANAN Harvinder Raj SIDHU Vikram VIJAYAN

Live Case Workshop Steven KUM Yih Kai TAN

Social Secretary Siew Ping CHNG Andrew MTL CHOONG

Trade & Sponsorship Steven KUM Vikram VIJAYAN


Council Members of Asian Society for Vascular SurgeryPresident Peter Robless Secretary-General Stephen WK. ChengTreasurer Yew Pung Leong

Councilors:Bangladesh Niaz Ahmed ChoudhuryChina Shenming WangHong Kong Stephen WK. ChengIndia Tarun GroverIndonesia Murizal DahlanJapan Tetsuo MiyataKorea In Sung MoonMalaysia Ngoh Chin LiewPhilippines Josefino I. SanchezSaudi Arabia Mussaad Al-SalmanSingapore Peter RoblessTaiwan Chun-Che ShihThailand Pramook MutiranguraTurkey Ahmet Kursat Bozkurt

Founders:USA John B. ChangKorea Yong Kak LeeJapan Yoshio MishimaChina Zhong Gao Wang

Past PresidentsJapan Yoshio Mishima (1994)Korea Young Kak Lee (1996)China Zhong Gao Wang (1998)Philippines Avenilo P. Aventura (2000)Singapore Ming Keng Teoh (2002)India S.A.Hussain (2004)Malaysia Yew Pung Leong (2006)China Yu-Qi Wang (2007)Thailand Sopon Jirasiritham (2008)Korea Young-Wook Kim (2009)Japan Hiroshi Shigematsu (2010)Taiwan Shoei-Shen Wang (2011)Japan Hiroshi Shigematsu (2012)Turkey A. Kursat Bozkurt (2013)Hong Kong Stephen WK.Cheng (2014)Thailand Pramook Mutirangura (2015)

Council Members of Asian Venous ForumPresident Yew Pung LeongVice-President Shoaib F. PadariaGeneral Secretary Ahmet Kursat BozkurtTreasurer Tomohiro Ogawa Takehisa IwaiPast President Dong-Ik KimCongress Chairman Sriram Narayanan

National DelegatesBangladesh Niaz Ahmed ChoudhuryChina Yu-Qi WangChina Xin-Wei HanChina Shen-Ming WangHong Kong Stephen WK. ChengIndia Malay PatelIndonesia Murnizal DahlanJapan Tetsuro MiyataMalaysia Ngoh Chin LiewPhilippines Josefino I. SanchezSaudi Arabia Mussaad Al-SalmanSingapore Peter RoblessTaiwan Shoei-Shen WangThailand Kamphol LaohapensangThailand Pramook MutiranguraTurkey Ahmet Kursat BozkurtUnited Arab Emirates Ramesh Tripathi


Oral Presentation 01-01 Factors associated with early vascular access (VA) failure in acute phase patients Akihito Tanaka1

1Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan

01-02 Is it worth the effort? Creation of arterio-venous fistulas in octogenarians Jennifer Diandra1, Dr Wei-wen Ang1, Dr Zhiwen Joseph Lo1, Dr Jue Fei Feng1, Dr Glenn Wei Leong Tan1, Dr Sadhana

Chandrasekar1, Dr Sriram Narayanan1

1Tan Tock Seng Hospital, Singapore, Singapore

01-03 The use of covered stent in central venous occlusive disease in hemodialysis patients Chai Hock Chua1, Dr Chia Hsun Lin1

1Shin Kong Memorial Hospital, Taipei, Taiwan, Taipei, Taiwan

01-04 Risk factors for decreased patency of Autologous Arteriovenous Fistula in the snuff-box Yasuhiro Fujii1, Ph.D. Susumu Oozawa1, M.D. Michihiro Okuyama1, Ph.D. Zenichi Masuda1, M.D. Hidemi Takeuchi1, Ph.D.

Haruhito Uchida1, Ph.D. Shunji Sano1

1Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

01-05 Intraoperative bloodflow rate as maturity predictor of brachiocephalic fistula at diabetic nephropathy patient Sandra Harisandi1, dr dedy pratama1

1Surgery Department of Ciptomangunkusomo Hospital, Jakarta, Indonesia, Jakarta, Indonesia

01-06 Role of Post-Operative Bruit as an Indicator of AVF Maturation Cristina Lajom1, Dr. Aries Garin1, Dr. Teodoro Jr. Bautista1

1UNIVERSITY OF SANTO TOMAS HOSPITAL, SAMPALOC , Philippines

01-07 Correlation between preoperative vein diameter and maturation of radiocephalic fistula Hailei Li1, Dr. Yiu-Che Chan2, Ms. Lisa Wu2, Dr. Dongzhe Cui1, Professor Stephen Cheng2

1Division of Vascular Surgery, Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, China, 2Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China

01-08 Correlation peak sistolic velocity brachial artery and blood flow rate intra operative with maturation of brachiocephalic fistula Djony Edward Tjandra, Raden Suhartono 1Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia

01-09 Predictors of radio-cephalic arteriovenous fistulae patency in an Asian population Juefei Feng1


01-10 Predictors of poor primary patency of arteriovenous fistula or graft for haemodialysis access Matthew KH Tan, Eusebio M D’Almeida, Chee Y Ng, Chieh Suai Tan, Edward Choke 1Singapore General Hospital, Singapore

01-11 Correlation Between Quick of Blood (Qb) and Adequacy of Hemodialysis in Mature Arterovenous Fistula Mursid Fadli, Akhmadu 1Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia

02-01 Factors associated with primary angioplasty durability in haemodialysis access Lester Ong, Matthew KH Tan, Eusebio M D’Almeida, Chee Y Ng, Chieh Suai Tan, Edward T Choke

02-02 Endovascular management of central vein stenosis in haemodialysis access patients. When and what surveillance imaging is appropriate

Haider Bangash1, Dr Kalpa Perera1, Ms Monique Sandford1, Mr Nishath Altaf1, Professor Patrice Mwipatayi1, Mr Patrick Tosenovsky1

1Royal Perth Hospital, Perth, Australia


02-03 Treatment strategy for cephalic arch stenosis in patients with brachiocephalic arteriovenous fistula KW Yoon1, Yang-Jin Park1, SY Woo1, SH Heo1, YW Kim1, DI Kim1

1Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea, Seoul, South Korea

02-04 Rescue of Transplant Kidney by Endovascular Revascularisation Rajendra Prasad Basavanthappa1

1M S Ramaiah Medical College & Hospitals, Bangalore, India

02-05 Clinical experience of arterial cystic adventitial disease Chi-Woo Lee1, Kyoung-Won Yoon1, Dr. Seon-Hee Heo1, MD, PhD Young-Wook Kim1, MD, PhD Yang-Jin Park1, MD, PhD

Dong-Ik Kim1

1Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

02-06 Management of splenic artery aneurysm-open surgery vs endovascular treatment Naoki Hayashida1, Dr Souichi Asano1, Dr Hasegawa Hideomi1, Dr Yutaka Wakabayashi1, Dr Takuto Maruyama1, Dr Masashi

Kabasawa1, Dr Masanao Ohba1, Dr Matsuo Kozuou1, Dr Kazuhiro Murayama1

1Chiba Cerebral and Cardiovascular Center, Ichihara, Japan

02-07 The Impact of Serum Uric Acid Level on Arterial Stiffness in Chinese Essential Hypertensive Patients Jie Liu1, Dr. Senhao Jia1, Dr. Xin Jia1, Dr. Yong Huo2, Dr. Wei Guo1

1Chinese PLA General Hospital, Beijing, China, 2Peking University First Hospital, Beijing, China

02-08 Computational Fluid Dynamics Modelling in Aortic Diseases: A Systematic Review Chi Wei Ong1, Leo Hwa Liang1, Andrew MTL Choong2,3

1Department of Biomedical Engineering, National University of Singapore, Singapore, 2Division of Vascular Surgery, National University Heart Centre, Singapore, 3School of Medicine, Griffith University, Gold Coast, Queensland, Australia

02-09 Comparison between percutaneous internal jugular vein puncture versus surgical venous cutdown in insertion of totally implantable venous access device

JungSik Choi1, Keunmyoung Park1, MD YoonMi Choe1, MD Yongsun Jeon2, MD SoonGu Cho2, MD Kee Chun Hong1

1Department of Surgery, Inha.university Hospital, Jungu, South Korea, 2Department of Radiology, Inha.university Hospital, Jungu, South Korea

02-10 Treatment of Iatrogenic Refractory Femoral Artery Pseudoaneurysm with Angioseal Vascular Closure Device: A Novel Technique Eu Jhin Loh1, Dr Robert Allen1, A Prof John Cockburn1

1ACT Health, Garran, Australia

02-11 Duplex Guided Thrombin Injection versus Compression Treatment of Femoral Artery Pseudoaneurysm. KSUMC Experience Mussaad Alsalman1

1King Saud University, Riyadh, Saudi Arabia

03-01 Development of novel stent-grafts composed of bioresorbable Poly-L-lactic acid scaffold stents and decellularized porcine blood vessels by tissue-engineering technology

Tatsuya Shimogawara1, Kentaro Matsubara1, Hideaki Obara1, Hirokazu Yamada2, Kazuki Tajima1, Hiroshi Yagi1, Yuko Kitagawa1

1Keio University School Of Medicine, Shinjukuku, Japan, 2Kyoto Medical Planning Co., Ltd, Kyoto city, Japan

03-02 Retrospective Analysis of Primary Patency of Vascular Acess Maturity: A Single Centre Experience at HTAA, Kuantan, Malaysia Abdul Rahman M N A1, Raja Othman R S1, Nurul Najwa MS1, Kamarizan M F A2, Faidzal Othman1

1Vascular Unit, Department of Surgery, Kulliyah(Faculty)Of Medicine, International Islamic University Malaysia, Kuantan, , Malaysia, 2Department of Surgery, University Hospital of Wales, Cardiff, , United Kingdom

03-03 Prevalence of heparin-induced thrombocytopenia according to 4T score in single institution of Korea from large scale database Assistant Professor Hun-Sung Kim1, BCPS Hyunah Kim2, RN Yoo Jin Jeong1, M.S. Hyunyong Lee1, MD PhD Hyeon Woo

Yim1, Professor Seung Nam Kim1, Professor Ji il Kim1, Professor In Sung Moon1, Associate Professor Yong Sung Won1, Professor Sang Seob Park1, Associate Professor Sun Cheol Park1, Assistant Professor Jeong Kye Hwang1, Clinical Professor Kang Woong Jun1, Clinical Professor Mi Hyeong Kim1, Clinical Fellow Hyun Kyu Kim1, Jang Yong Kim1

1The Catholic University of Korea, Seoul, South Korea, 2Sookmyung Women’s University, Seoul, South Korea


03-04 Combined treatment of facial vascular malformations with embolization and surgical resection (serial case) Tom Christy Adriani1, MD Raden Suhartono1

1Indonesian Society For Vascular And Endovascular Surgery, Central Jakarta, Indonesia

03-05 The Western Australian Gore Iliac Branch Endoprothesis Early Experience Wah Wah Lin1, Mr Stefan Ponosh2, Mr Marek Garbowski2, Mr Joe Hockley2, Dr Shirley Jansen2, Mr Richard Bond1, Mr

Carsten Ritter1, Mr Kishore Sieunarine3

1Fiona Stanley Hospital, Perth, Australia, 2Sir Charles Gairdner Hospital, Perth, Australia, 3Royal Perth Hospital, Perth, Australia

03-06 A randomised controlled trial on the outcome in comparing alginate silver dressing with conventional treatment of necrotizing fasciitis wound

Jarernchon Meekul1, Associate Professor Arnon Chotirosniramit1, Woraluck Himakalasa2, Antika Wongthanee3, Professor Kittipan Rerekasem3,4

1Maharaj Nakorn Chiang Mai Hospital , Chiang Mai, Thailand, 2Faculty of Economics, Chiang Mai University, Chiang Mai, Thailand, Chiang Mai , Thailand, 3 NCD Center of Excellence, RIHES, Chiang Mai University, Chiang Mai, Thailand, Chiang Mai, Thailand, 4 NCD Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, Chiang Mai, Thailand

03-07 Remote ischemic preconditioning enhances the gene expression of antioxidant enzymes and endoplasmic reticulum stress–related proteins in rat skeletal muscle

Uijun Park1, PhD Hyoung Tae Kim1, PhD Won Hyun Cho1, PhD, RN Min Young Kim2

1Keimyung University, South Korea, 2Ulsan University, , South Korea

03-08 Klippel-Trenaunay Syndrome, Presentation, Complications and Management - KKUH Experience Mussaad Alsalman1


03-09 Open Surgical versus Endovascular Treatment for Patients with Midaortic Syndrome due to Takayasu’s Arteritis Yang-Jin Park1, Pf Young-Wook Kim1, Pf Ki-Ick Sung2, Pf Young-Tak Lee2, Pf Kwang-Bo Park3, Pr Young-Soo Do3, Dr

Kyung-Won Yoon1, Dr Seon-Hee Heo1, Pf Dong-Ik Kim1, Pf Duk-Kyung Kim4

1Vascular surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul , South Korea, 2Thoracic surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul , South Korea, 3Interventional radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul , South Korea, 43Vascular Medicine, Heart, Stroke and Vascular Institute in Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul , South Korea

03-10 Vascular Malformation and Tumors: Evolving Experience of a Vascular Surgeon in a Developing Country Abul Hasan Muhammad Bashar1

1National Institute Of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh

03-11 Effectiveness of embolotherapy on peripheral arteriovenous malformations Ali Reza1, dr. Patrianef2

1Surgery Department of Cipto Mangunkusumo Hospital,Indonesian University, Jakarta, Indonesia, 2Vascular and Endovascular Surgery of Cipto Mangunkusumo Hospital, Indonesian University, Jakarta, Indonesia

04-02 Early efficacy of Clarivein device in treatment of varicose vein with chronic venous insufficiency. A single centre experience Saravana Kumar, Atifah, Zainal A 1Department of Surgery, Kuala Lumpur General Hospital, Jalan Pahang, Kuala Lumpur, Malaysia

04-03 Evaluating the effect of compression stocking on Venous Hemodynamic in Chronic Venous Insufficiency using Air Plethysmography

Feona Sibangun Joseph, Nurul Rauf, Dr Datuk Zainal Ariffin Azizi 1Hospital Kuala Lumpur, Kuala Lumpur, Malaysia

04-04 Arterial Revascularization for Radiation Arteritis Hironobou Fujimura1, Dr Takashi Shintani1

1Toyonaka Municipal Hospital, Toyonaka, Japan

Oral Presentation


04-05 Small infrarenal aortic diameter associated with lower-extremity peripheral artery disease in Chinese hypertensive adultsJie Liu1, Dr. Wei Guo1

1Chinese PLA General Hospital, Beijing, China

04-06 One-Stop Urokinase Thrombolysis Technique for Acute Lower Extremity Arterial Occlusion: Good Patency Rates after One Year Follow up

Eu Jhin Loh1, Dr Michelle Chew1, Dr Robert Allen1, A Prof John Cockburn1


04-07 One-Stop Urokinase Thrombolysis Technique for Acute Lower Extremity Occlusion of Native Arteries and Prosthetic Bypass Grafts: High Patency Rates after One Year Follow up

Eu Jhin Loh1, Dr Michelle Chew1, Dr Robert Allen1, A Prof John Cockburn1


04-08 Major lower limb amputation: Are outcomes improving? David Kelly1, Ms Stephanie Pederson1, Dr Kishore Sieunarine1


04-09 Initial and mid-term outcomes of endovascular therapy in the treatment for Leriche syndrome: Endovascular therapy vs Bypass surgery

Osamu Yamashita1, Noriyasu Morikage1, Kotaro Suehiro1, Takasuke Harada1, Makoto Samura1, Yuriko Takeuchi1, Takahiro Mizoguchi1, Kimikazu Hamano1

1Yamaguchi University Graduate School Of Medicine, Ube, Japan

04-10 Occurrence and Risk Factor of Acute Kidney Injury after Endovascular treatment of Peripheral Artery Occlusive Disease Wonpyo Cho1, MD Keun-Myoung Park1, MD Yong Sun Jeon2, MD Soon Gu Cho2, MD Kee Chun Hong1

1Department of Surgery, Inha.university Hospital, JungGu, South Korea, 2Department of Radiology, Inha.university Hospital, JungGu, South Korea

04-11 Femoral Popliteal Bypass in Octogenarians Paul Lajos1, Robert Weiss1, Alejandro Negrete, C Lutz1, A/Prof Rami Tadros1, A/Prof Ageliki Vouyouka1, Victoria Teodorescu1,

Prof Michael Marin1, Prof Peter Faries1

1Mt Sinai, Icahn School Of Medicine, New York , United States

05-01 Aorto-carotid bypass in patients with Takayasu’s arteritis Dr. Hong-seok Han1, Kyung Won Yoon2, M.D., Ph.D. Young-Wook Kim2, M.D., Ph.D. Dong-ik Kim2

1Department of Surgery, Samsung Medical Center , Seoul, Republic of Korea. , 2Division of Vascular Surgery, Samsung Medical Center, Seoul, Republic of Korea

05-02 Early Result of Directional Atherectomy using Silverhawk/Turbohawk System Yoong Seok Park1, Dr. Seon-Hee Heo1, Assistant Professor Dong-Ho Hyun2, Professor Young-Soo Do2, Professor Hong-Suk

Park2, Professor Kwang-Bo Park2, Professor Young-Wook Kim1, Professor Yang-Jin Park1, Mr. Chul-Hyung Lee1, Professor Dong-Ik Kim1

1Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Seoul, South Korea, 2Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Seoul, South Korea

05-03 Factors affecting to patency of Stenting in TASC II C or D iliac lesion Wonpyo Cho1, MD Keunmyoung Park1, MD Yong Sun Jeon2, MD Soon Gu Cho2, MD Kee Chun Hong1


05-04 Prophylaxis fasciotomy in patients with acute arterial occlusion by using only “6 hours criteria”: Is it safe? Saritphat Orrapin1, Dr Termpong Reanpang1, Dr Saranat Orrapin1, Dr Supapong Arwon1, Prof Kittipan Rerkasem1,2

1NCD Center and Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 2NCD Center of Excellence, RIHES, Chiang Mai University, Chiang Mai, Thailand


05-05 One-year Clinical Outcomes of Patients with or without Critical Limb Ischemia Underwent Percutaneous Transluminal Angioplasty

Yoong Seok Park1, Professor Michael Lee2, Professor, MD, PhD, FACC, FAHA, FESC, FSCAI, FAPSIC Seung-Woon Rha3, Master Byoung Geol Choi3, Professor Seung Kyu Han4

1Samsung Medical Center, Seoul, South Korea, 2UCLA Medical Center, Los Angeles, USA, 3Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea, 4Department of Plastic Surgery, Korea University Guro Hospital, Seoul, Korea

05-06 Cost Saving Potential of Acellular Fish Skin Graft: A Cost Simulation Study on Diabetic Foot Ulcers John Lantis, Skuli Magnusson1, Dr David Margolis3, Dr Baldur Baldursson1,2, Dr Hilmar Kjartansson1,2, Gudmundur F.

Sigurjonsson1

1Kerecis, Reykjavik, Iceland, 2Landspitali University Hospital of Iceland, Reykjavik, Iceland, 3Perelamn School of Medicine, University of Pennsylvania, Philadelphia, USA

05-07 Diabetic foot limb salvage – a Singaporean experience Dr Zhimin Lin1, Dr Zhiwen, Joseph Lo1, Dr Ruiming Teo1, Dr Zhongkai Wang1, Dr Danson Xue Wei Yeo1, Dr Bin Chet Toh1, Dr

Yiew Fah Fong1, Dr Glenn, Wei Leong Tan1, Dr Sriram Narayanan1, Dr Sadhana Chandrasekar1, Qiantai Hong1


05-08 Predictive factors to determine good atherosclerotic risk factor control for diabetic patients with peripheral arterial disease Saritphat Orrapin1, Dr Natapong Kosachunhanun2, Dr Kiran Sony4, Dr Nimit Inpankaew5, Dr Piyamitr Sritara6, Dr Arintaya

Phrommintikul2, Dr Chonlisa Chariyalertsak7, Ms Antika Wongthanee3, Ms Ampica Mangklabruks2, Ms Orapin Pongtam2,3, Prof Kittipan Rerkasem2,3

1Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), Pathumthani, Thailand, 2NCD Center, Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, 3NCD Center of Excellence, Research Institute of Health Science, Chiang Mai University, Chiang Mai, Thailand, 4Department of Internal Medicine, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand, 5Department of Internal Medicine, Lamphun Hospital, Lamphun, Thailand, 6Department of Internal Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, 7Chiang Mai Provinical Health Office, Chiang Mai, Thailand

05-09 The Prevalence of Asymptomatic Peripheral Arterial Disease in Korea: Community-based Screening study Junghyun Youm1, MD, PhD Jin Hyun Joh1

1Kyung Hee University Hospital At Gangdong, Seoul, South Korea

05-10 Validation of WIfI classification following percutaneous angioplasty for critical limb ischemia Uijun Park1, MD Won Hyun Cho1, MD Hyoung Tae Kim1, PhD, RN Min Young Kim2

1Keimyung University, Daegu, South Korea, 2Ulsan University, Ulsan , South Korea

05-11 One-Stop Urokinase Thrombolysis Technique for Thrombosed Dialysis Access: High Patency Rates after Four Year Follow up Eu Jhin Loh1, Dr Robert Allen1, A Prof John Cockburn1


05-12 Hybrid treatment for multilevel revascularization in PAD patients: multicenter study in Korea. Prof. Hyuk Jae Jung1, Dr. Yong Beum Bak1, Dr Dong Hyun Kim1, Sang Su Lee1

1Pusan National University Yangsan Hospital, Yangsan, South Korea

06-01 Follow up Results of Lower Extremity Arterial Bypass with Autogenous Arm Vein Grafts Jihee Kang1, Dr Duk-Bee Hwang2, Dr Seon-Hee Heo1, Dr Kyung-Won Yoon1, Pf Yang-Jin Park1, Pf Dong-Ik Kim1, Pf Ynoung-

Wook Kim1

1Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul , South Korea, 21Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, South Korea

06-02 Aspirin and clopidogrel resistance in peripheral arterial occlusive disease. Early results of a prospective study Mina Guirgis1, Ms Lucy Stopher1, Mr Joseph Hockley1, A/Prof Shirley Jansen1

1Sir Charles Gairdner Hospital, Perth, Australia

06-03 Natural History of Retrograde Pedal Access Site: Is it Really Safe? Professor Tae Seung Lee1, Daehwan Kim1

1Seoul National University Bundang Hospital, Sung-nam, South Korea

Oral Presentation


06-04 Diabetic foot limb salvage – A series of 809 attempts and predictors of endovascular revascularisation failure Qiantai Hong1, Dr Zhiwen Joseph Lo1, Dr Zhimin Lin3, Dr Uei Pua2, Dr Lawrence Han Hwee Quek2, Dr Bien Ping Tan2, Dr

Sundeep Punamiya2, Dr Glenn Wei Leong Tan1, Dr Sriram Narayanan1, Dr Sadhana Chandrasekar1

1Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore, 2Vascular & Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital , Singapore, Singapore, 3University Surgical Cluster, National University Health System , Singapore, Singapore

06-05 Use of Negative Pressure Wound Therapy in Lower Limb Bypass Incisions Kah Wei Tan1, Dr Zhiwen Joseph LO2, Dr Qiantai HONG2, Dr Glenn Wei Leong TAN2, Dr Sadhana CHANDRASEKAR2, Dr

Sriram NARAYANAN2

1NUS Yong Loo Lin School of Medicine, Singapore, Singapore, 2Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital , Singapore, Singapore

06-06 Quality of Life as a Predictor of Post Operative outcome following Revascularization of Peripheral Arterial Disease Shantonu Kumar Ghosh1

1National Institute of Cardiovascular Diseases, Dhaka, Bangladesh

06-07 The efficacy and safety profile of prolonged high pressure balloon angioplasty on below-the-knee lesions J X Lim, D Lim, D Ho, YK Tan, Steven Kum Changi General Hospital, Singapore

06-08 The Endovascular Repair of Blunt Traumatic Thoracic Aortic Injury in Asia: A Systematic Review Xin Nee Ho1, Lauren Wilson2, Andrew MTL Choong3,4

1Department of Vascular Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK, 2Department of Vascular Surgery, Royal Brisbane and Women’s Hospital, Queensland, Australia, 3Division of Vascular Surgery, National University Heart Centre, Singapore, 4School of Medicine, Griffith University, Gold Coast, Queensland, Australia

06-09 Emergency TEVAR for Thoracic Aortic Aneurysm Rupture of Blunt Thoracic Aortic Injuries Hiroki Uchiyama Uchiyama1, 3, Dr Kiyofumi Morishita1, Dr Toshio Baba1, Dr Masami Shingaki1, Dr Tsuyoshi Shibata1, Dr

Kouhei Narayama1, Professor Nobuyoshi Kawaharada2, 3

1Hakodate Municipal Hospital, Hakodate, Japan, 2Sapporo Medical University School of Medicine, Sapporo, Japan, 3Department of Cardiovascular Surgery, Sapporo Medical University, , Japan

06-10 Comparison of long-term results of carotid endarterectomys between primary closure and patch angioplasty groups Young-Wook Kim1, Dr Seon-Hee Heo1, Mrs Shin-Young Woo1, Dr Kyung-Won Yoon1, Pf Yang-Jin Park1, Pf Dong-Ik Kim1, Pf

Kwang-Ho Lee2, Pf Gyeong-Moon Kim2, Pf Keon-Ha Kim3

1Vascular surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul , South Korea, 2Neurology, Heart Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul , South Korea, 3Interventional radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, , South Korea

06-11 Diagnostic accuracy of multiplanar reformation in computed tomography: A comparative study to conventional angiography Uijun Park1, RN Na Yeon Jeon1, MD Hyoung Tae Kim1, MD Won Hyun Cho1

1Keimyung University, Daegu, South Korea

07-01 Advancements in treating blunt thoracic aortic injuries: Imaging evaluation and endograft sizing Seiichi Yamaguchi1, Dr. Hisanori Fujita1, Dr. Shigeyasu Takeuchi1

1Chiba Emergency Medical Center, Chiba, Japan

07-02 Surgical treatment for peripheral arterial trauma with acute ischemic limb – Experience of a single vascular surgeon in ChangHua Christian Hospital

YungKun Hsieh1, Dr ChunMing Huang2, Dr ChienHui Lee1, Dr YingCheng Chen1, PhD IngSh Chiu1

1Changhua Christian Hospital, Puyang St., Changhua City, Taiwan, 2MinShen Hospital, Taoyuan, Taiwan


Oral Presentation 07-03 Outcomes of Endovascular Treatment of Traumatic Aortic Transection in a Multi-ethnic Asian Population Dexter Yak Seng Chan1, Nicholas Syn2, Carmen Maria Paulin Vera1, Rajesh Babu1, Jackie Ho Pei1,3, Peter Robless1, Julian

Wong1, Andrew MTL Choong1,4

1Division of Vascular Surgery, National University Heart Centre, Singapore, 2Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 3Department of Surgery, National University of Singapore, Singapore, 4School of Medicine, Griffith University, Gold Coast, Queensland, Australia

07-04 Factors related to the reflux of great saphenous vein at thigh Jong Kwon Park1, Dr Hyeonseung Kim1

1Inje University Haeundae Paik Hospital, Busan, South Korea

07-05 The relationship between nerve injury and ablated length of the vein after endovenous thermal ablation of varicose veins Takashi Yamamoto1, Dr Nobuhisa Kurihara1, Dr Masayuki Hirokawa1

1Ochanomizu Vascular & Vein Clinic, Chiyoda-ku, Japan

07-06 Comparison of Monopolar versus Segmental Radiofrequency Ablation in Endovenous Treatment of Lower Limb Chronic Venous Insufficiency

Ryan Tan1, Dr Pravin Lingam1, Dr Joseph Lo1, Dr Qiantai Hong1, Dr Sadhana Chandrasekar1, Dr Sriram Narayanan1, Dr Glenn Tan1

1Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore

07-07 ClariVein™ - mechano-chemical ablation (MOCA) for treatment of truncal venous insufficiency: a systematic review James Sun1, Mr Mohammed Chowdhury1, Mr Umar Sadat1, Professor Tjun Tang2

1Vascular Unit, Cambridge University Hospital NHS Foundation Trust, Cambridge, Uk, Cambridge, United Kingdom , 2Vascular Service, Changi General Hospital, Singapore,

07-08 The results of noncomparative study of endovenous heat-induced thrombosis treatment by rivaroxaban Professor Alexey Fokin1, Denis Borsuk2

1The education department of surgery of the South Urals medical university, Chelyabinsk, Russian Federation, 2The Clinic Of Phlebology And Laser Surgery “vasculab” Ltd., Chelyabinsk, Russian Federation

07-09 Histopathological Investigations on the Great Saphenous Vein treated with Sclerotherapy Harinder Singh Bedi1, Dr Nalini Calton1, Dr Kanwardeep Kwatra1

1Christian Medical College & Hospital, Ludhiana, Ludhiana, India

07-10 The results of endovenous laser ablation of the saphenous veins more then 2 cm of the diameter Professor Alexey Fokin1, Denis Borsuk2


07-11 An Old but Remarkable Instrument for “Minimal-invasive“ Varicose Vein Surgery: Oesch PIN Strippers Mingli Li1

1China Medical University Hospital, Taiwan, Taichung City, Republic of China

08-01 Pharmacomechanical Thrombectomy (PMT) with Angiojet Solent Omni Compared with Catheter Directed Aspiration Thrombectomy (CDAT) for Treatment of Acute Deep Vein Thrombosis (DVT).

Jang Yong Kim1, Professor In Sung Moon1, Clinical Professor Mi Hyeong Kim1, Professor Seung Nam Kim1, Clinical Professor Kang Woong Jun1, Assistant Professor Jeong Kye Hwang1, Professor Ji Il Kim1, Associate Professor Yong Sung Won1, Professor Sang Seob Yun1, Associate Professor Sun Cheol Park1, Clinical Fellow Hyun Kyu Kim1

1The Catholic University of Korea, Seoul, South Korea

08-02 Correlation of obesity & chronic venous insufficiency with respect to Co-morbid pathologic conditions Sandeep Mahapatra1, Professor Pinjala Ramakrishna1

1Nizam’s Institute Of Medical Sciences, Hyderabad, India

08-03 Endovenous laser therapy in the treatment of great saphenous vein reflux: comparison between 1470nm 2ring radial fiber and 940nm bare tip fiber

Albert Ting1, Ms Grace Cheung1, Ms Silvana Lau1, Dr Yiu-che Chan1, Dr Alfred Wong1, Dr Yuk Law1, Prof Stephen Cheng1

1Division of Vascular Surgery, Department Of Surgery, University Of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong


08-04 Does ablation of great saphenous vein and simultaneous phlebectomies of varicose veins reduce incompetent perforators in primary chronic venous disease?

Tomohiro Ogawa1

1Fukushima Daiichi Hospital, Fukushima, Japan

08-05 ClariVein(r) - One Year Results of Mechano-Chemical Ablation (MOCA) for Varicose Veins in a Multi-Ethnic Asian Population from Singapore

SN Khor2, Dr L Jiang2, Dr. S Kum1, Dr. YK Tan1, Dr TY. Tang1

1Vascular Service, Department of General Surgery, Changi General Hospital, , Singapore, 2Singapore Health Services, Singapore, Singapore

08-06 Incidence and clinical feature of pulmonary embolism in patients with symptomatic deep venous thrombosis diagnosed by means of computed tomography

Uijun Park1, RN Na Yeon Jeon1, MD Won Hyun Cho1, MD Hyoung Tae Kim1, PhD, RN Min Young Kim2


08-07 Comparative study of pain at EVLT with laser wavelength 1470nm and 1560nm in patients with varicose veins Dr Oleg Guzkov1, Nikita Shichkin1, Natalya Tarasova1

1 Yaroslavl state medical University , Yaroslavl, Russian Federation

08-08 Endovenous laser treatment of incompetent perforator veins - does the ablation method matter? Chien-Chang Chen1

1CVS CLINIC, Taichung, Taiwan

08-09 Study of the relationship between static foot disorders (SFDs), clinical severity of chronic venous disease (CVD) and venous clinical severity score

Termpong Reanpang1, Dr Nattaporn Ratanasoontornchai1, Dr Saranat Orrapin1, Dr Supapong Arworn1, Dr Kittipan Rerkasem1

1Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, Chiang Mai, Thailand

08-10 Risk factors of deep venous thrombosis in a cohort of Chinese patients Hai-Lei Li1, Dr. Yiu-Che Chan2, Dr. Ning Li1, Dr. Dong-Zhe Cui1, Professor Stephen Cheng2

1Department of Surgery, The University Of Hong Kong Shenzhen Hospital, Shenzhen, China, 2Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China

08-11 Catheter-directed thrombolysis cannot prevent postthrombotic syndrome Young Ah Kim1, Dr Woo Sung Yun1, Dr Shin Seok Yang1, Dr Bo Yang Suh1

1Youngnam Medical Center, Daegu, South Korea

08-12 Incidence of chronic venous insufficiency and post thrombotic syndrome in lower limbs DVT, a 3 years follow-up Hossein Hemmati1

1Inflamatory lung disease research center guilan university of medical sciences,, Rasht, Iran , 2vascular surgery and dialysis research center guilan university of medical sciences, Rasht, Iran

09-01 Management of iliofemoral DVT in a single large tertiary hospital; a need to create greater awareness Haider Bangash1, Mr Josh Cutten1, Mr Patrick Tosenovsky1, Professor Patrice Mwipatayi1, Mr Nishath Altaf1


09-02 An Experience of Subfascial Endoscopic Perforator Surgery in Complicated Chronic Venous Insufficiency Shahzad Alam Shah1

1Fatima Jinnah Medical University & Sir Ganga Ram Hospital Lahore, Lahore, Pakistan

09-03 False-lumen Growth in the Abdominal Aortic Region after Endovascular Repair for Type-B Aortic Dissection: Computational Study of Long-term Follow-up

Jiang Xiong1, Prof. Duanduan Chen2, Mr. Huanming Xu2, Dr. Huiwu Dong1, Dr. Wei Guo1

1Dpt. Vascular And Endovascular Surgery, Beijing, China, 2Beijing Institute of Technology, Beijing, China


09-04 Thoracic endovascular aneurysm repair (TEVAR) in the management of various thoracic aorta pathologies: Hosp. Kuala Lumpur experienced

Zaharudin Ismazizi1, Dr Azizi Zainal Ariffin1

1Hospital Kuala Lumpur, Wilayah Persekutuan, Malaysia

09-05 Stent graft-induced new entry (SINE) following thoracic endovascular aortic repair Takashi Hashimoto1, Dr. Noriyuki Kato1, Dr. Takatoshi Higashigawa1, Dr. Shuji Chino1

1Mie University Hospital, Tsu, Japan

09-06 Thoracic endovascular aortic repair for Stanford type B aortic dissection with a disease-specific device. Masatoshi Komooka1, Dr Shinichi Higashiue1, Dr Satoshi Kuroyanagi1, Dr Onichi Furuya1, Dr Masahide Enomoto1, Dr Saburou

Kojima1, Dr Naohiro Wakabayashi1

1Kishiwada Tokusyukai Hospital, Kishiwada, Japan

09-07 Results of Bentall procedure in acute type A aortic Dissection - The single center experience YungKun Hsieh1, Dr YingCheng Chen1, Dr ChunMing Huang2, Dr ChienHui Lee1, PhD IngSh Chiu1

1Changhua Christian Hospital, Puyang St., Changhua City, Taiwan , 2MinShen Hospital, Taoyuan city, Taiwan

09-08 Preservation of the left subclavian artery in zone 2 TEVAR using a Relay Plus thoracic stent graft with a surgeon-crafted fenestration.

Yoshihiko Kurimoto1, Dr. Shuhei Miura1, Dr. Kosuke Ujihira1, Dr. Yutaka Iba1, Dr. Ryushi Maruyama1, Dr. Eiichiro Hatta1, Dr. Akira Yamada1, Dr. Katsuhiko Nakanishi1

1Teine Keijinkai Hospital, Sapporo, Japan

09-09 Open Aortic Arch Surgery Following Thoracic Endovascular Aortic Repair with Debranching Tetsuro Uchida1, Dr. Azumi Hamasaki1, Dr. Atsushi Yamashita1, Dr. Ken Nakamura1, Dr. Jun Hayashi1, Dr. Daisuke Watanabe1,

Dr. Shingo Nakai1, Dr. Kimihiro Kobayashi1, Dr. Seigo Gomi1, Prof. Mitsuaki Sadahiro1

1Yamagata University Faculty Of Medicine, Yamagata, Japan

09-10 Nationwide Trends of Diagnosis, Management Strategy and Mortality Among Thoracic Aortic Disease In South Korea: From 2006-2014

Joon Hyuk Kong1

1Department Of Thoracic And Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do, , South Korea

09-11 Surgical results of emergency thoracic endovascular aortic repair in patients with acute aortic syndrome Yoshinori Kuroda1, MD Tetsuro Uchida1, MD Azumi Hmasaki1, MD Atsushi Yamashita1, MD Ken Nakamura1, MD Jun

Hayashi1, MD Daisuke Watanabe1, MD Shingo Nakai1, MD Kimihoro Kobayashi1, MD Seigo Gomi1, MD Mitsuaki Sadahiro1

1Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata-shi, Japan

09-12 Initial experience with the Najuta fenestrated stent graft for the treatment of arch aneurysm requiring Zone 0 landing Naoki Toya1, Dr Soichiro Fukushima1, Dr Eisaku Ito1, Dr Yuri Murakami1, Dr Tadashi Akiba1, Dr Takao Ohki2

1The Jikei University Kashiwa Hospital, Kashiwashi, Japan, 2The Jikei University School of Medicine, Minatoku, Japan

10-01 Surgical Outcome of Acute Type A Aortic Dissection in Patients Older than 80 Years old. Reo Sakakura1, Asai Thru1

1Shiga Medical University, Otsu , Japan

10-02 Aortic root re-intervention in patients with type A acute aortic dissection. Ken Nakamura1, Dr Tetsuro Uchida1, Dr Azumi Hamasaki1, Dr Yoshinori Kuroda1, Dr Atsushi Yamashita1, Dr Jun Hayashi1,

Dr Daisuke Watanabe1, Dr Shingo Nakai1, Dr Kimihiro Kobayashi1, Dr Seigo Gomi1, Dr Mitsuaki Sadahiro1

1Yamagata University Faculty Of Medicine, Iidanishi, Japan

10-03 Changes in and Outcomes from Surgical Procedures for Acute Type A Aortic Dissection Masafumi Shibata1, Dr. Tetsuro Morota1, Dr. Takashi Nitta1

1Nippon Medical School, Bunkyo-ku, Japan

Oral Presentation


10-04 Thoracic endovascular aortic repair of acute and subacute type B aortic dissection: Early and medium term results Yoshihito Irie1, Dr. Shunichi Kondo1, Dr. Yoshiaki Katada1, Dr. Yoshiki Endo1, Dr. Tsuyoshi Fujimiya1, Professor Hitoshi

Yokoyama2

1Iwaki Kyouritsu General Hospital, Iwaki, Japan, 2Fukushima Medical University, Fukushima, Japan

10-05 A 7-year History of Endovascular Treatment of Mycotic Aortic Aneurysms in a Multi-ethnic Asian Population Dexter Yak Seng Chan1, Nicholas Syn2, Andrew MTL Choong1,3, Dharmaraj Rajesh Babu1, Jackie Ho Pei1,4, Peter Ashley

Robless1, Bernard Boon Kee Wee5, Dr Julian Chi Leung Wong1

1Division of Vascular Surgery, National University Heart Centre, Singapore, 2Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 3School of Medicine, Griffith University, Gold Coast, Queensland, Australia, 4Department of Surgery, National University of Singapore, Singapore, 5Department of Radiology, National University Hospital, Singapore

10-06 Chronic obstructive pulmonary disease effect on the prevalence and postoperative outcome of abdominal aortic aneurysms: A meta-analysis

Jiang Xiong1, Dr. Zhongyin Wu1, Dr. Chen Chen2, Dr. Wei Guo1

1Dpt. Vascular And Endovascular Surgery, The Chinese PLA General Hospital, Beijing, China, 2Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, USA

10-07 Surgical quality and enhanced recovery after surgery suppresses hospitalization costs of open repair for abdominal aortic aneurysm

Takuro Shirasu1, Dr. Takatoshi Furuya1, Dr. Yukihiro Nomura1, Dr. Nobutaka Tanaka1

1Asahi General Hospital, Asahi City, Japan

10-08 Open and endovascular techniques to overcome unfavorable iliac anatomy during endovascular aneurysm repair Jaepak Yi1, MD, PhD Jin Hyun Joh1


10-09 Comparison of local anesthesia and general anesthesia for performing endovascular aortic aneurysm repair (EVAR) Naoya Matsumoto1, Dr Osanori Sogabe1

1Mitoyo General Hospital, Kanonji, Japan

10-10 Association Between MTHFR C677T Polymorphism and Abdominal Aortic Aneurysm Risk: A Comprehensive Meta-Analysis with 10,123 Participants Involved

Jie Liu1, Xin Jia1, Senhao Jia1, Wei Guo1

1Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China

10-11 Comparison of percutaneous access versus open femoral exposure for endovascular aortic aneurysm repair in single center JungSik Choi1, MD Keunmyoung Park1, MD Yong Sun Jeon2, MD Soon Gu Cho2, MD Kee Chun Hong1


11-01 Clinical significance of early postoperative diarrhea after open surgical repair of abdominal aortic aneurysm Kyoung Won Yoon1, Seon-Hee Heo1, Yang-Jin Park1, Dong-Ik Kim1, Young-Wook Kim1

1Samsung Medical Center, Sungkyunkwan university, Seoul, South Korea

11-02 Comparable Mid-term results of Elective Endovascular and Open Aortic Aneurysm Repair in Young Patients Yang-Jin Park1, KW Yoon1, SH Heo1, SY Woo1, JG Kim1, DI Kim1, YW Kim1


11-03 Is conventional open repair for abdominal aortic aneurysm feasible in nonagenarians? Kyokun Uehara1, Dr Kenji Minatoya1, Dr Jiro Matsuo1, Dr Teppei Toya1, Dr Yosuke Inoue1, Dr Atsushi Omura1, Dr Yoshimasa

Seike1, Dr Hiroaki Sasaki1, Dr Junjiro Kobayashi1

1National Cerebral And Cardiovascular Center, Suita, Japan

11-04 Endovascular repair of abdominal aortic aneurysm with severely angulated proximal neck: Comparison between Excluder vs Aorfix stent graft

Eisaku Ito1, MD and PhD Naoki Toya1, MD Soichiro Fukushima1, MD Yuri Murakami1, MD and PhD Tadashi Akiba1, MD and PhD Takao Ohki2

1Jikei University Kashiwa Hospital, Kashiwa-shi, Japan, 2Jikei University Hospital, Minato-ku, Japan


11-05 Outcomes of elective endovascular aortic aneurysm repair: A case series in Asian octogenarians Mabel Shu Fen Yip1, Dr Joseph, Zhiwen Lo1, Dr Sadhana Chandrasekar1, Adjunct Assistant Professor Sriram Narayanan,

Adjunct Assistant Professor Glenn, Wei Leong Tan1


11-06 Outcomes of EVAR repairs in a series of 14 mycotic aortic aneurysms Dr Wee Ming Tay, Dr Jospeh Zhi Wen Lo, Adjunct Assistant Professor Glenn Wei Leong Tan, Adjunct Assistant Professor Sriram

Narayanan, Senior Consultant Sadhana Chandrasekar, Wei-En Wong 1Tan Tock Seng Hospital, Singapore, Singapore

11-07 The early mid-term results of EVAR in patients with proximal hostile neck Yasutoshi Tsuda1, Dr. Takahito Yokoyama, Dr. Hiroo Kinami, Dr. Yujirou Kawai, Dr. Hirokazu Niitsu, Dr. Gentaku Hama, Dr.

Yasuyuki Toyoda, Dr. Kazuaki Shiratori, Dr. Takahiro Takemura 1Saku Central Hospital Advanced Care Center, Saku-city, Japan

11-08 Survival of octogenarian Abdominal Aortic Aneurysm patients in Chiang Mai University Hospital Saranat Orrapin1, Professor Kamphol Laohapensang1, Professor Kittipan Rerkasem1, Supapong Arworn1, Termpong Reanpang1

1Chiang Mai University, Chiang Mai, Thailand

11-09 Carbon dioxide angiography as an adjunct for endovascular aortic aneurysm repair; how does it compare to traditional contrast? Kalpa Perera1, Mr. Kishore Sieunarine1


11-10 The Treatment Results of Emergent EVAR for Ruptured Abdominal Aortic Aneurysm Takao Miki1, Dr Kiyomitsu Yasuhara1, Dr Kyohei Hatori1, Dr Hanako Hirai1, Dr Satoshi Ohki1, Dr Tamiyuki Obayashi1

1Department of Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki City, Japan

Prize Oral PresentationPO-01 Hybrid aortic arch repairs: a 9-year single-institutional experience of 150 patients. Kiyofumi Morishita, Dr Masami Shingaki, Dr Tuyoshi Shibata, Dr Kouhei Narayama, Dr Toshio Baba, Dr Tohru Mawatari 1Hakodate Municipal Hospital, Hakodate, Japan

PO-02 Anatomical endovascular aortic arch repair with custom-made fenestrated endograft and branch grafts via neck vessels Masaki Saso1, Dr Takashi AzumaDr1, Dr Junko Katagiri1, Dr Kei Kobayashi1, Dr Masashi Hattori1, Dr Yoshihiko Yokoi1, Dr

Hideyuki Tomioka1, Dr Shigeyuki Aomi1, Dr Kenji Yamazaki1

1Tokyo Women’s Medical University, Tokyo, Japan

PO-03 Comparing the outcomes using propensity score matching analysis in carotid endarterectomy versus carotid artery stenting: Single-center data

Kyoung Won Yoon1, Shin-Young Woo1, Yangjin Park1, Young-Wook Kim1, Dong-Ik Kim1

1Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea

PO-04 Acellular Fish Skin Graft for Surgical, Trauma, Venous, Arterial and Diabetic Wounds: A Retrospective Clinical Study John Lantis, Dr Baldur T. Baldursson1,2, Skuli Magnusson1, Dr Hilmar Kjartansson1,2, G. Fertram Sigurjonsson1

1Kerecis, Reykjavik, Iceland, 2Landspitali University Hospital of Iceland, Reykjavik, Iceland

PO-06 Suggestion of Treatment Strategy Based on its Natural Course for Patients with Isolated Spontaneous Abdominal Aortic Dissection (ISAAD)

Jihee Kang1, Young-Wook Kim, Seon-Hee Heo 1Samsung Medical Center, Seoul, South Korea

Oral Presentation


Prize Poster Presentation P01 Gene therapy using hepatocyte growth factor plasmid DNA ameliorates lymphedema via promotion of lymphangiogenesis and

lymphatic-vessels remodeling. Yukihiro Saito1

1Div. of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan

P02 Hemodynamic benefit of the release of the celiac artery in ruptured right gastric artery aneurysm associated with the median acurate ligament syndrome

Tetsuro Toriumi1, Dr Yuichi Ohashi2, Dr Atushi Akai2, Dr Takuro Shirasu1, Dr Takatoshi Furuya1, Dr Yukihiro Nomura1, Dr Nobutaka Tanaka1

1Asahi General Hospital, Asahishi, Japan, 2The University of Tokyo, Bunkyoku, Japan

P03 Late surgical open conversion for endoleaks after endovascular abdominal aortic aneurysm repair Yusuke Takei1, Takayuki Hori Hori1, Toshiyuki Kuwata1, Yasuyuki Kanno1, Yuta Kanazawa1, Hironaga Ogawa1, Koji Ogata,

Ikuko Shibasaki1, Hirotsugu Fukuda1

1Dokkyo Medical University, Mibu, Shimotugagun, Japan

P04 Technical tip to overcome a tortuous aortic arch during TEVAR using a snare Hyung Sub Park1, Dr. Yoon Hyun Lee1, Dr. Dae Hwan Kim1, Prof. Taeseung Lee1

1Seoul National University Bundang Hospital, Seongnam, South Korea

P05 Clinical Outcomes of Endovenous Laser Ablation for the Treatment of Varicose Veins Atsushi Tabuchi1, Dr. Hisao Masaki1, Dr. Yasuhiro Yunoki1, Dr. Yoshiko Watababe1, Dr. Kazuo Tanemoto1

1Kawasaki Medical School, Kurashiki, Japan

P06 Combined superficial femoral endovascular treatment and popliteal-to-distal bypass for critical limb ischemia Yoshihiko Tsuji1, Dr Ikuro Kitano1

1Shinsuma General Hospital, Kobe, Japan

P07 Endovascular treatment for mycotic abdominal aneurysm with laparoscopic debridement: case report and systemic review Chai Hock Chua1

1Shin Kong Wu Ho-Su Memorial Hospital Taipei, Taiwan, Taipei, Taiwan

P08 Cilostazol improves wound healing and freedom from major amputation after infrainguinal bypass for ischemic tissue loss Shinsuke Mii1, MD, PhD Atsushi Guntani1, MD Aisuke Kawakubo1

1Saiseikai Yahata General Hospital, Kitakyushu-city, Japan

P09 Acellular Fish Skin as a Bone and Tendon Covering: Case Report John Lantis, Baldur T. Baldursson1, 2, Gudbjorg Palsdottir2, Dr. C Winters3, Skuli Magnusson1, Dr. Hilmar Kjartansson1,2, Dr.

Gunnar Johannsson1, G Sigurjonsson1

1Kerecis, Reykjavik, Iceland, 2Landspitali University Hospital of Iceland, Reykjavik, Iceland, 3American Health Network, Indianapolis, USA

P10 Angioscope assisted retrograde in-situ branched stentgraft (RIBS) for the treatment of an endoleak following custom-made fenestrated stent graft: a case report

Soichiro Fukushima1, Dr. Naoki Toya1, Dr. Eisaku Ito1, Dr. Yuri Murakami1, Dr. Tadashi Akiba1, Dr. Takao Ohki2

1Jikei University Kashiwa Hospital, Kashiwa-Si, Japan, 2Jikei University School of Medicine, Minato-ku, Nishi-shinbashi, Japan

P11 A Successful Staged Hybrid Repair of a Ruptured Type V Thoracoabdominal Mycotic Aneurysm By Visceral Debranching and Completion Endovascular Stent Grafting

Julian ZY Hong1, Raj K Menon1, Andrew MTL Choong1,2

1Division of Vascular Surgery, National University Heart Centre, Singapore, 2School of Medicine, Griffith University, Gold Coast, Queensland, Australia

P12 Fibrinogen replacement therapy guided by coagulation management reduces blood transfusion in thoracic aortic surgery: a retrospective observational study

Kazuhiro Takatoku1, Dr Junichiro Nishizawa1, Dr Motoyuki Kumagai1, Dr Masahiro Uraoka2, Dr Mutsuhito Kikura2

1Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu, Japan, 2Department of Anesthesiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan


Poster Presentation P01-01 Deep Vein Thrombosis after Abdominal Surgery in Korean Patients Fahed Aljaber1, Prof. Dong-ik Kim1

1Samsung Medical Center, South Korea, Seoul, South Korea

P01-02 Inferior vena cava filter insertion through the popliteal vein: enabling the percutaneous endovenous intervention (PEVI) of deep vein thrombosis with a single venous approach in a single session

MD Sang Young Chung1, Hong Sung Chung1, MD Ho Kyun Lee1, MD Soo Jin Na Choi1

1Chonnam National University Hospital, Gwangju, South Korea

P01-03 Recurent acute venous thrombosis of left lower extremity in a patient with hyperlipidemia Kazim Ergunes1, Dr Ihsan Peker1, Dr Ismail Yurekli1, Dr Tayfun Goktogan1, Dr Mehmet Balkanay1, Dr Orhan Gokalp1, Prof

Levent Yilik1, Prof Ali Gurbuz1

1Izmir Katip Celeby University Atatürk Training and Research Hospital, Izmir, Turkey

P01-04 A case with recurrent acute left lower deep venous thrombosis having pulmonary thromboembolism and deep venous thrombosis operated due to genital and colon cancer one year ago

Kazim Ergunes1, Dr Erturk Karaagac1, Dr Yuksel Besir1, Dr Ismail Yurekli1, Dr Bortecin Eygi1, Dr Banu Lafci1, Dr Koksal Donmez1, Prof Ali Gurbuz1


P01-05 Progression and regression of isolated calf deep vein thrombosis during a 1-year follow-up Makoto Haga1, Yutaka Hosoi1, Tooru Ikezoe1, Masao Nunokawa1, Hiroshi Kubota1

1Kyorin University School Of Medicine, Mitaka, Japan

P01-06 Total endovascular treatment for acute deep venous thrombosis by catheter-directed thrombolysis Kimihiro Igari1, Dr Toshifumi Kudo1, Dr Takahiro Toyofuku1, Dr Yoshinori Inoue1

1Tokyo Medical And Dental University, Bunkyo-ku, Japan

P01-07 Clinical outcome of edoxaban for treatment of venous thromboembolism in Japanese population Shinichi Imai1, Medical Doctor Shinichi Hiromatsu1, Medical Doctor Kanako Sakurai1, Medical Doctor Ryou Kanamoto1,

Medical Doctor Shohei Yoshida1, Medical Doctor Mau Amako1, Medical Doctor Hiroyuki Otsuka1, Medical Doctor Satoru Tobinaga1, Medical Doctor Seiji Onitsuka1, Professor Hiroyuki Tanaka1

1 Kurume University Surgery, Kurume, Japan

P01-08 Clinical characteristics of May-Thurner’s syndrome with thrombus extension to IVC Heungman Jun1, Dr. Cheol Woong Jung1, Dr. Sung Bum Cho1

1Korea University Anam Hospital, Seoul, South Korea

P01-09 Patients with epithelial ovarian cancer and DVT can be treated safely with standard DVT treatment. Jang Yong Kim1, Clinical Professor Eun Young Ki1, Professor Jong Sup Park1, Professor Young Ju Suh2, Professor Soo Young

Hur1, Professor Seung Nam Kim1, Professor In Sung Moon1

1The Catholic University of Korea, College of Medicine, Seoul, South Korea, 2Inha University, College of Medicine, Incheon, South Korea

P02-01 Endovascular treatment considerations for an acute subclavian pseudoaneurysm after fracture of the clavicle Ching Siang Cheng1

1The Royal Brisbane And Women’s Hospital, Herston, Australia

P02-02 Vascular Complications Related to Lumbar Disc Surgery Sang Young Chung1, MD Soo Jin NA Choi1


P02-03 Cardiopulmonary Arrest Due to Rupture of Pseudo-Aneurysm of Superior Mesenteric Artery Caused by Blunt Trauma: Case Report

Baku Takahashi1, Dr. Yoshihiro Nakayama1, Dr. Shinyu Shiroma2

1Department of Cardiovascular Surgery, Osumikanoya Hospital, Kanoya, Kagoshima, Japan, Kanoya, Japan, 2Department of General Surgery, Uwajima Tokushukai Hospital, Kanoya, Kagoshima, Japan , Uwajima, Japan


P02-04 TEVAR for Blunt Thoracic Aortic injury without left subclavain artery coverage Dr. Kritaya Kritayakirana1, Dr. Natawat Narueponjirakul1, Apinan Uthaipaisanwong1

1King Chulalongkorn Memorial Hospital, , Thailand

P02-05 Stages of an emergency surgical procedure of a 4-year-old patient with post-traumatic 90º angulation of left brachial artery Assist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, Specialist Köksal Dönmez2, Assist.Prof. Özhan Pazarcı3, Prof.Dr.

Öcal Berkan1, Ufuk Yetkin1

1Cumhuriyet University Medical Faculty, SİVAS, Turkey, 2Katip Celebi University Izmir Ataturk Training and Research Hospital, Izmir, Turkey, 3Cumhuriyet University, Dept. of Medical Faculty, SİVAS, Turkey

P02-06 Fasciotomy Due to Compartment Syndrome and Amputation Rates of Our Post-traumatic Extremity Vascular Injury Series Assist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, Ufuk Yetkin1, Specialist Köksal Dönmez2, Prof.Dr. Öcal Berkan1

1Cumhuriyet University Medical Faculty, Department of Cardiovascular Surgery, SİVAS, Turkey, 2Katip Celebi University Izmir Ataturk Training and Research Hospital, Izmir, Turkey

P02-07 Hybrid approach to a work-related accident with suspicion of vascular injury caused by metallic object stabbed to the neck Assist. Prof. Sabahattin Göksel1, Specialist Köksal Dönmez2, Assist.Prof. Özge Korkmaz1, Prof.Dr. Öcal Berkan1, Ufuk Yetkin1

1Cumhuriyet University Medical Faculty,Department of Cardiovascular Surgery, SİVAS, Turkey, 2Katip Celebi University Izmir Ataturk Training and Research Hospital, Izmir, Turkey

P02-08 Our Principles At Post-traumatic Extremity Vascular Injuries: Operation Steps And Early Post-operative Period Assist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, Ufuk Yetkin1, Specialist Köksal Dönmez2, Prof.Dr. Öcal Berkan2

1Cumhuriyet University Medical Faculty, SİVAS, Turkey, 2Katip Celebi University Izmir Ataturk Training and Research Hospital, Izmir, Turkey

P03-01 Heparin bonding improves early primary patency of arteriovenous graft for hemodialysis access. Kenji Aoki1, Norihito Nakamura1, Akihiro Nakamura1, Takeshi Okamoto1, Yuka Okubo1, Osamu Namura1, Kazuhiko Hanzawa1,

Masanori Tsuchida1

1Niigata University, Niigata, Japan

P03-02 Cannulation of arterio-venous fistula after ultrasound evaluation - National Kidney and Transplant Institute experience Dr. Benito Purugganan Jr1, Rophel Miguel1, Dr. Adolfo Parayno1, Dr. Ricardo Jose Quintos1, Dr. Arwin Ronan Ronsayro1

1Philippine Society For Vascular Surgery, Inc, Quezon City, Philippines

P03-03 Percutaneous transluminal angioplasty for central vein stenosis in adults with chronic kidney disease at the National Kidney and Transplant Institute

Alexander Kent Achurra1, Dr. Benito Purugganan Jr.1


P03-04 Movement of intravascular catheters in a simulated hemodialysis environment Dr. Benito Purugganan Jr1, Joy Gali1, Dr. Ricardo Jose Quintos1


P03-05 Profile of hemodialysis patients with arteriovenous fistula presenting with venous hypertension at the National Kidney and Transplant Institute

Dr. Benito Purugganan Jr1, Eduardo Aro Jr.1, Dr. Ricardo Jose Quintos1


P03-06 Long Term Monitoring of Arteriovenous Graft for Hemodialysis by Radionuclid Methods for Early Detection of Graft Infection Petr Bachleda1, Petr Utíkal1, Jana Janečková1, Monika Váchalová1

1LF UP Olomouc, Cz, Olomouc, Czech Republic

P03-07 Comprehensive comparison of the performance of autogenous brachial-basilic transposition arteriovenous fistula (BBTAVF) and prosthetic forearm loop arteriovenous graft (AVG) in a multi-ethnic hemodialysis Asian population

Koy Min Chue1, Dr Kyi Zin Thant1, Dr Hai Dong Luo1, Dr Yu Hang Rodney Soh2, Associate Professor Pei Ho1

1National University Health System, Singapore, Singapore, 2Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore


P03-08 Feasibility of Basilic Vein Transposition AVF after side to side Brachiocephalic AVF Jungkee Chung1, Prof Inmok Jung1

1Boramae Hospital Seoul National Unversity Medical College, Seoul, South Korea

P03-09 Percutaneous transluminal angioplasty in the treatment of stenosis of arteriovenous fistulae for hemodialysis Igab Krisna Wibawa1, MD Hilman Ibrahim1


P03-10 Management of giant venous aneurysms of arteriovenous fistula in hemodialysis patients [serial case] Romzi Karim1, PhD Akhmadu Muradi1


P03-11 Impacts of Arteriovenous Hemodialysis Shunt Location and Type in Patients having coronary Artery Bypass Graft with In Situ Left Internal Thoracic Artery

Youngjin Han1

1Division Of Vascular Surgery, Department Of Surgery, Asan Medical Center, University Of Ulsan College Of Medicine, Seoul, South Korea

P03-12 6 Weeks Maturity Rate of Arteriovenous Fistula and the Affecting Factor Wahyu Wardhana, MD Dedy Pratama 1Vascular Indonesia, Central Jakarta, Indonesia

P03-13 Comparison of 4 weeks and 8 weeks AV Fistulae Maturation Muhammad Fauzi, Raden Suhartono 1Cipto Mangunkusumo Hospital Indonesia, Central Jakarta, Indonesia

P03-14 Correlation Tip Position of Catheter Double Lumen with Hemodialysis Continuity and Comfort of Long Term CDL Using Oky Noviandry Nasir, Dedy Pratama 1Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia

P03-15 Vascular Access Failure with Vertebral Subclavian Steal due to Subclavian Artery Stenosis and Myocardial Ischemia in a Hemodialysis Patient with a Left Internal Thoracic Artery Coronary Bypass Graft

Yuichi Ito1, Dr. Akihito Tanaka2, Dr. Takeshi Hattori3

1Nagoya Ekisaikai Hospital, Nagoya, Japan, 2Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan, 3Kyoto Katsura Hospital, Kyoto, Japan

P03-16 Vascular access surgery for elderly hemodialysis patients Jinichi Iwase1, Dr Hirohisa Yoshitomi1

1Narita Memorial Hospital, Toyohashi, Japan

P03-17 Hemodialysis associated carpal tunnel syndrome; single center experience Jae Young Park1, Dr Chang Hyun Yoo1

1Busan Vascular Clinic, Busan, South Korea

P03-18 Fabrication of Artificial Arteriovenous Fistula and its Flow Field and Shear Stress Analysis using u-PIV Technology Sun Cheol Park1, PhD Jinkee Lee2, MD, PhD Seung-Nam Kim1

1The Catholic University Of Korea, Uijeongbu-si, South Korea, 2Sungkyunkwan University, Suwon-si, South Korea

P03-19 The unusual causes of central venous stenosis in patients with arteriovenous access. Dr. Kittisak Thanu1, Dr. Tanop Srisuwan1,2, Kittipan Rerkasem1,3

1NCD Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, 2Interventional radiology unit, Department of Radiology Faculty of medicine, Chiang Mai University, Chiang Mai, Thailand, 3NCD Center of Excellence, Research Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand

Poster Presentation


P03-20 Nutritional Status among End Stage Renal Disease Patients with arteriovenous access at Maharaj Nakorn Chiang Mai Hospital, Thailand

Dr. Jukkrit Wungrath1, Ms. Orapin Pongtam1,2, Ms. Paweena Thongkham1,2, Ms. Waranporn Na Chiangmai1, Ms. Nipaporn Pinmars1, Kittipan Rerkasem1,2

1NCD Center of Excellence, Research Institute of Health Science, Chiang Mai University, Chiang Mai, Thailand, 2NCD Center & Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

P03-21 Short-term results of vascular access surgery for hemodialysis in patients older than 70 years Young-nam Roh Korean Society For Vascular Surgery, Goyang, South Korea

P03-22 Primary Patency Rates of Arteriovenous Fistula for Haemodialysis: A Retrospective Analysis Charley Simanjuntak1, Dr. Dedy Pratama2, Dr. Aria Kekalih3

1Department Of Surgery Cipto Mangunkusumo Hospital Indonesia, Jakarta, Indonesia, 2Vascular and endovascular surgery division, Cipto Mangunkusumo hospital, Jakarta, Indonesia, 3Community health department, Cipto Mangunkusumo hospital, Jakarta, Indonesia

P04-01 Early experience of endovenous laser ablation with single radial 1470-nm diode laser for primary varicose veins Hitoshi Endo1, Dr. Kazumi Nakamura1, Dr. Takaya Murayama1

1Kannai clinic, Yokohama, Japan

P04-02 Selection criteria of endovenous ablation and stripping and its performing rate in our hospital Takahiro Imai1

1Department Of Vascular Surgery Nishinokyo Hospital, Nara, Japan

P04-03 Improvements of deep vein reflux following radiofrequency ablation for saphenous vein incompetence In Mok Jung1, Dr. Suh Min Kim2, Dr. Jung Kee Chung1

1SMG-SNU Boramae Medical Center, Seoul, South Korea, 2Dongguk University Hospital, Ilsan, Gyeongkee --Do, South Korea

P04-04 Examination of the treatment for surgical varicose veins - Stab Avulsion vs. Varices Ablation Kazumi Nakamura1, Takaya Murayama1, Hitoshi Endoh1

1Kannnai Medical Clinic, Yokohama, Japan

P04-05 Relationship between the right heart function and varicose veins of the lower limbs in patients undergoing hemodialysis Yasuhiro Ozeki1, Ph.D. Kazuo Tsuyuki1, Ph.D. Shinich Watanabe2, Yuki Ishida1, M.D., Ph.D. Kunio Ebine1, M.D., Ph.D. Susumu

Tamura1, M.D. Toshifumi Murase1, M.D., Ph.D. Kaoru Sugi1, M.D., Ph.D. Kenta Kumagai1, M.D., Ph.D. Itaru Yokouchi1, M.D., Ph.D. Kenji Yamazaki1, M.D. Satoru Toi1

1Odawara Cardiovascular Hospital, Odawara, Japan, 2Kanagawa Institute of Technology, Atsugi, Japan

P04-06 Comparison of Radiofrequency Ablation and 1470nm Endovenous Laser Ablation for Treating Varicose Veins Yuka Sakurai1, Dr Hiroyuki Abe2, Dr Shota Kita1, Dr Hirotoshi Suzuki1, Dr Daijyun Ro1, Dr Kiyoshi Chiba1, Dr Hirokuni Ono1,

Dr Makoto Ono1, Dr Yousuke Kitanaka1, Dr Masahide Chikada1, Dr Hiroshi Nishimaki1, Dr Takeshi Miyairi1

1St.marianna University School Of Medicine, Kawasaki, Japan, 2Keiai clinic, Yokohama, Japan

P05-01 Computed Tomography angiography alone is inadequate for evaluation of the great saphenous vein conduit for infrainguinal bypass

Cassandra Hidajat1, Dr Hansraj Bookun1, Dr Daniel Nour1, Ms Kai Leong1

1The Royal Melbourne Hospital, Melbourne Health, Parkville, Australia

P05-02 Transdermal Nitroglycerin for Peripheral Arterial Disease Koksal Donmez1, Dr. Bortecin Eygi1, Dr. Sahin Iscan1, Dr. Habib Cakir1, Dr. Ismail Yurekli1, Dr. Nihan Karakas Yesilkaya1, Dr.

Mert Kestelli1

1Department Of Cardiovascular Surgery, Katip Celebi University Izmir Ataturk Training And Research Hospital, Izmir,turkey, Izmir, Turkey


Poster PresentationP05-03 Our surgical strategy in a smoker patient with hypertension, diabetes and hyperlipidemia having right femoral artery stenosis Kazim Ergunes1, Dr Erturk Karaagac1, Dr Ismail Yurekli1, Dr Ihsan Peker1, Dr Koksal Donmez1, Dr Tayfun Goktogan1, Prof

Levent Yilik1, Prof Ali Gurbuz1


P05-04 Acute arterial thromboembolism of left lower extremity in a patient with hypertension and diabetes receiving warfarin due to atrial fibrillation

Kazim Ergunes1, Dr Hasan Iner1, Dr Erturk Karaagac1, Dr Ismail Yurekli1, Dr Sahin Iscan1, Dr Yuksel Besir1, Dr Bortecin Eygi1, Prof Ali Gurbuz1


P05-05 Hybrid surgical and endovascular intervention to management of complex iliofemoral disease Jun Hayashi1, Dr Ushida Tetsuro1, Dr Azumi Hamasaki1, Dr Yoshinori Kuroda1, Dr Atsushi Yamashita1, Dr Ken Nakamura1, Dr

Daisuke Watanabe1, Dr Shingo Nakai1, Dr Kimihiro Kobayashi1, Dr Seigo Gomi1, Professor Mitsuaki Sadahiro1

1Second department of surgery, Yamagata University, Yamagata City, Japan

P05-06 Comparison of mid-term results of femoro-popliteal bypass with no cuff-combined PTFE grafts and cuff-combined PTFE grafts Ryo Kanamoto1, Dr. Shinichi Hiromatsu1, Dr. Kanako Sakurai1, Dr. Shinichi Imai1, Dr. Shohei Yoshida1, Dr. Mau Amako1, Dr.

Hiroyuki Otsuka1, Dr. Satoru Tobinaga1, Dr. Seiji Onitsuka1, Prof. Hiroyuki Tanaka1

1Department Surgery Of Kurume University, Kurume City, Japan

P05-07 Inconsistent Result of Target Lesions between Completion Angiography and Duplex Follow-up Study Prof Taeseung Lee1, Daehwan Kim1


P05-08 Prevalence and Risk Factors for the Peripheral Neuropathy in Patients with Peripheral Arterial Occlusive Disease Se Young Kim1, Dr Ho Kyeong Hwang1, Dr Kyung Bok Lee1, Dr Sol Lee1, Dr Ji Woong Jung1, Dr Yu Jin Kwon1, Dr Dong Hui

Cho1, Dr Sang Su Park1, Dr Jin Yoon1, Dr Yong Seog Jang1

1Seoul Medical Center, Seoul, South Korea

P05-09 The Open Retrograde Approach as an Alternative for Failed Percutaneous Access for Difficult Below the Knee Chronic Total Occlusions - A Case Series

Saravana Kumar1

1Dr Saravana Kumar, Kuala Lumpur General Hospital, Jalan Pahang, Malaysia

P05-10 Endovascular Treatment of extensive Aortoiliac Occlusive Lesions: Single-Center Experiences HaengJin Ohe1, Dr. Hyun Kyu KIM2, Dr. Mi Hyeong KIM2, Dr. Kang Woong JUN2, Dr. Jeong Kye HWANG2, Dr. Jang Yong

KIM2, Dr.Sun Cheol PARK2, Dr. Ji Il KIM2, Dr. Yong Sung WON2, Dr. Sang Seob YUN2, Dr. In Sung MOON2

1Department of Surgery, Division of Vascular and Transplant Surgery, Seoul Paik Hospital, Inje University, Seoul , South Korea, 2Department of Surgery, Division of Vascular and Transplant Surgery, The Catholic University of Korea College of Medicine, Seoul, South Korea

P05-11 Drug-coated balloon for femoropopliteal disease: early clinical experience in real world KW Yoon1, YJ Park1, SH Heo1, DI Kim1, YS Do2, SH Choi3, YW Kim1

1Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, 2Intervention Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, 3Intervention Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

P05-12 Can postoperative ST-segment change and blood pressure variability predict short term mortality in patients following major vascular surgery?

Dr. Aekapej Liwatthanakun A1, Associated professor Arintaya Phrommintikul2,3, Ms Orapin Pongtam3,4, Kittipan Rerkasem1,3,4

1Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 2Department of Internal Medicine, Faculty of Medicine, , Chiang Mai, Thailand, 3NCD Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 4NCD Center of Excellence, Research Institute of Health Sciences, Chiang Mai University, , Chiang Mai, Thailand


P05-13 The prevalence and risk factors of PAD in 893 HIV infected patients Associate Professor Romanee Chaiwarith1, Dr. Thananchai Kampee3, Dr. Parichat Salee1, Dr. Nontakan Nuntachit1, Dr.

Khuanchai Supparatpinyo1, Ms. Orapin Pongtam2,3, Ms. Paweena Thongkham2,3, Dr. Patcharaphan Sugandhavesa2, Dr. Taweewat Supindham2, Dr Natthapol Kosashunhanan2, Kittipan Rerkasem2,3

1Division of Infectious Disease, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand, 2NCD Center for Excellence and Center for AIDS and STDs, Research Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand, 3NCD Center & Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

P05-14 Risk of Peripheral Artery Disease among elders living with HIV, age and gender matched with non-HIV, as determined by Ankle Brachial Index

Associated professor Kriengkrai Srithanaviboonchai1, Ms Wathee Sitthi1, Dr. Arunrat Tangmunkongvorakul1, Ms Chonlisa Chariyalertsak2, Kittipan Rerkasem1,3

1NCD Center of Excellence and Center for AIDS and STDs, RIHES, Chiang Mai University, Chiang Mai, Thailand, 2Chiang Mai Provinical Health Office, Chiang Mai, Thailand, 3NCD Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

P05-15 Predictive factors to determine post-operative mortality in patients with peripheral arterial disease Rungrujee Kaweewan1, Dr. Saritphat Orrapin1, Ms Antika Wongthanee2, Kittipan Rerkasem1,2

1NCD Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 2NCD Center of Excellence, Reserach Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand

P05-16 Dietary Consumption in Patients with Peripheral Artery Disease in Maharaj Nakorn Chiang Mai Hospital Ms. Orapin Pongtam1,2, Dr. Sakda Pruenglampoo2, Kittipan Rerkasem1,2

1NCD Center, Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, 2NCD Center of Excellence, Research Institute of Health Science, Chiang Mai University, Chiang Mai, Thailand

P05-17 Value of multimodal anesthesia in peripheral artery revascularization procedure Osanori Sogabe1, Dr Naoya Matsumoto1


P05-18 Review of Transmetatarsal Amputations in the management of Peripheral Vascular Disease Ming Ngan Aloysius Tan1, Dr 2hiwen Joseph Lo1, Dr Rui Ming Teo1, Mr Soon Hong Lee2

1NHG - TTSH, Singapore, Singapore, 2NTU - LKC School of Medicine, Singapore, Singapore

P05-19 Development of the gene therapy with CRE decoy ODN to prevent vascular intimal hyperplasia Daiki Uchida1, Dr Yukihiro Saito1, Prof Nobuyoshi Azuma1

1Asahikawa Medical University Vascular Surgery, Asahikawa, Japan

P05-20 Local difference of skin perfusion pressure in lower extremity Yoshiko Watanabe1, Dr Hisao Masaki1, Dr Taishi Tamura1, Dr Hiroki Takiuchi1, Dr Takahiko Yamasawa1, Dr Hiroshi Furukawa1,

Dr Yasuhiro Yunoki1, Dr Atsushi Tabuchi1, Dr Kazuo Tanemoto1


P05-21 Outcomes of Bio-absorbable stent for Below Knee Critical Limb Ischaemia Derek Ho, Dr Jemima Xue Changi General Hospital, Singapore, Singapore

P05-22 Endovascular approach to elder patients (70 and older) treated with femoral embolectomy for acute arterial obstruction and essentials for using fractioned heparin

Assist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, Ufuk Yetkin1, Specialist Köksal Dönmez2, Assist. Prof. Osman Beton3, Prof. Dr. Öcal Berkan1

1Cumhuriyet University Medical Faculty ,Department of Cardiovascular Surgery, SİVAS, Turkey, 2Katip Celebi University Izmir Ataturk Training and Research Hospital, Izmir, Turkey, 3Cumhuriyet University, Dept. of Medical Faculty,Department of Cardiology, SİVAS, Turkey


P05-23 Peripheral arterial disease, comorbidities and level of obstruction in elder patients (70 and older) treated with femoral embolectomy for acute arterial obstruction

Assist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, Ufuk Yetkin1, Specialist Köksal Dönmez2, Assist. Prof. Osman Beton3, Prof. Dr. Öcal Berkan1

1Cumhuriyet University Medical Faculty,Department of Cardiovascular Surgery, SİVAS, Turkey, 2Katip Celebi University Izmir Ataturk Training and Research Hospital, Izmir, Turkey, 3Cumhuriyet University, Dept. of Medical Faculty,Department of Cardiology, SİVAS, Turkey

P06-01 A Case of Superficial Femoral Artery Aneurysm detected with intermittent claudication Norimasa Haijima, Dr Ichiro Hayashi, Dr Hirofumi Kasahara National Hospital Organization Saitama National Hospital, Wako-shi Suwa, Japan

P06-02 Successful endovascular repair of a recurrent femoral artery pseudo-aneurysm using a coronary covered stent Yukio Muromachi1, Shigeki Ito1, Masafumi Hashimoto1, Tadashi Amemiya1, Yasuyuki Hatano1, Michihiko Morisaki1, Hitoshi

Ogino2

1Nishitokyo Chuo General Hospital, Nisitokyo-shi, Japan, 2Tokyo Medical University, Shinjuku-ku, Japan

P06-03 The cyst evacuation with the removal of the cystic wall for Popliteal Adventitial Cystic Disease Takashi Shintani1, Hironobu Fujimura1, Takuma Iida2, Takashi Shibuya3

1Toyonaka Municipal Hospital, Toyonaka, Japan, 2Toyonaka Municipal Hospital, Toyonaka, Japan, 3Osaka University Graduate School of Medicine, Suita, Japan

P06-04 Non-traumatic brachial artery aneurysm Shuhei Suzuki1, Dr Norihito Nakamura, Dr Kenji Aoki 1Niigata Prefectural Central Hospital, Jyoetsu City, Japan

P06-05 A Case of Femoropopliteal Bypass and Transcatheter Artery Embolization for Ruptured Persistent Sciatic Artery Aneurysm. Koichi Tamai1, Dr. Kei Kazuno3, Dr. Yasushi Tashima2, Dr. Toshiyuki Kobinata1, Dr. Harunobu Matsumoto2

1Kasukabe Chuo General Hospital, Kasukabe , Japan, 2Jichi Medical University Saitama Medical center, Saitama, Japan, 3Itabashi chuo general hospital, Itabashi, Japan

P06-06 Ruptured aneurysm of the external iliac vein Yong Sung Won1, Emeritus Professor Jang Sang Part1, Associate Professor Jang Yong Kim1, Assistant Professor Mihyeong Kim1,

Associate Professor Sun Cheoll Park1

1The Catholic University Of Korea, Seoul, South Korea

P06-07 A case of right inguinal pseudoaneurysm after the simultaneous endovascular aortic repair for the thoracic and abdominal aortic aneurysms

Shinji Yamazoe1, Dr Yasuhito Sekimoto1, Dr Hirohisa Harada1, Dr Yohei Munetomo1, Dr Akira Baba1, Dr Yuko Kobashi1, Dr Takuji Mogami1

1Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan

P07-01 Protective effects of remote pre- and postconditioning on ischemia-reperfusion induced hepatic injury. Hyung Joon Ahn1, M.D. Min Su Park1, M.D. Sun Hyung Joo1

1Kyung Hee University, Seoul, South Korea

P07-03 Case Presentation of Isolated Celiac Artery Mycotic Aneurysm Dr Sungjae An1, A/Prof Vikram Vijayan Sannasi1

1Ng Teng Fong General Hospital, Jurong, Singapore

P07-04 Endovascular treatment of subclavian aortic aneurysm rupture in a Behcet disease patient with metallic allergy Mizuki Ando1, MD., PhD. Yuya Kise1, MD Tatsuya Maeda1, MD Takaaki Nagano1, MD., PhD Yukio Kuniyoshi1

1Dept. Of Thoracic And Cardiovascular Surgery, University Of The Ryukyus, Nishihara-city, Japan

P07-05 Comparison Between Radiocephalic and Brachiocephalic AV Fistula Maturity at 6 Weeks Post-Surgery Ramzi Asrial1

1dr. Ramzi Asrial, Sp.B(K)V, Bangkinang General Hospital, Pekanbaru, Indonesia

Poster Presentation


P07-06 A Novel Approach For Femoral Artery Access: Purse Suture Technique Mehmet Cakici1, Dr Alper Ozgur1, Dr Cagdas Baran1, Dr Evren Ozcinar1, Dr Canan Soykan1, Dr Levent Yazicioglu1, Dr Sadik

Eryilmaz1, Dr Bülent Kaya1, Dr Ahmet Ruchan Akar1

1Ankara University Medicine School, Ankara, Turkey

P07-07 The Endovascular Treatment of a Ruptured Aneurysm of the Middle Colic Artery Combined With an Isolated Dissection of Superior Mesenteric Artery: Report of a Case

Byung Sun Cho1, Prof. Hye Young Ahn2

1Eulji University Hospital, Daejeon, South Korea, 2Eulji University College of Nursing, Daejeon, South Korea

P07-08 Selective Angioembolization of Renal Angiomiolipoma Igab Krisna Wibawa1, MD Patrianef Patrianef1


P07-09 Medical Treatment of Internal Carotid Agenesis Dr. Banu Yürekli1, Dr. Ismail Yürekli2, Dr. Habib Cakir2, Dr. Mert Kestelli2, Köksal Dönmez2, Dr. Börtecin Eygi2, Dr. Sahin

Iscan2, Dr. Mehmet Engin Uluc3

1Department Of Endocrinology, Ege University Training And Research Hospital, Izmir, Turkey, 2Department Of Cardiovascular Surgery, Katip Celebi University Izmir Ataturk Training And Research Hospital, Izmir, Turkey, 3Department Of Radiology, Katip Celebi University Izmir Ataturk Training And Research Hospital, Izmir, Turkey

P07-10 Variations of Circle of Willis Dr. Sahin Iscan1, Dr. Habib Cakir1, Dr. Ismail Yurekli1, Dr. Mert Kestelli1, Köksal Dönmez1, Dr. Börtecin Eygi1, Dr. Nihan

Karakaş Yeşilkaya1, Dr. Hasan Iner1


P07-11 Combined ultrasound and electric field stimulation treatment of chronic wounds: Complementary therapies in wound care Diane Eng1, Sriram Narayanan1, Jonathan Rosenblum, DPM2

1Tan Tock Seng Hospital, , Singapore, 2 Shaarei Zedek MedicalCenter, , Israel

P07-12 Extreme Fistula Salvage: The Promotion of Ulno-cephalic Fistulae Development via Palmar Arch Angioplasty Following Occlusion of Radio-cephalic Fistulae Inflow

Caesar Lopez Gimao1, Raj K Menon1, Andrew MTL Choong1,2


P07-13 “Wii thumb”: Case report of symptomatic peripheral arteriovenous malformation from gaming and systematic review of vascular injuries from gaming

Mina Guirgis1, A/Prof Kishore Sieunarine1, Dr Ruben Rajan1

1Joondalup Health Campus, Perth, Australia

P07-14 Management of symptomatic isolated spontaneous dissection of superior mesenteric artery Tohru Ishimine1, Dr Hiroshi Yasumoto1, Dr Toshiho Tengan1, Dr Hidemitsu Mototake1

1Okinawa Prefectural Chubu Hospital, Miyazato Uruma, Japan

P07-15 Endovascular Treatment of Transplant Renal Artery Stenosis Kang Woong Jun, Mi Hyeong Kim, Hyun Kyu Kim, Jeong Kye Hwang, Sang Dong Kim, JangYong Kim, Sun Cheol Park, Ji Il

Kim, Yong Sung Wong, Sang Sup Yun, In Sung Moon The Catholic University of Korea, Seoul, South Korea

P07-16 Reduction of totally implantable central venous port system complication Yong Beum Bak1, Prof. Hyuk Jae Jung1, Dr. Dong Hyun Kim1, Prof. Sang Su Lee1


P07-17 Prognosis of isolated visceral artery dissection after conservative treatment Tatsuya Kaneshiro1, Dr Toshimi Yonaha1, Dr Hideyoshi Henzan1

1Nakagami General Hospital, Okinawa-city, Japan


Poster PresentationP07-18 Prevalence of lower extremity ulcer in Maharaj Nakorn Chiang Mai hospital Rungrujee Kaweewan1, Dr Christine Rojawat1, Professor Kittipan Rerkasem1,2

1NCD Center of Excellence, RIHES, Chiang Mai University, Chiang Mai, Thailand, 2NCD Center & Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

P07-19 3D Printing in Vascular Surgery: A Systematic Review Teck Ee Reyor Ko1, Yeong Xue Lun2, Andrew MTL Choong3,4

1Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 2Faculty of Medicine, University of New South Wales, New South Wales, Australia, 3Division of Vascular Surgery, National University Heart Centre, Singapore, 4School of Medicine, Griffith University, Gold Coast, Queensland, Australia

P07-20 A Novel use of the Clarivein Catheter for Pharmaco-Mechanical Thrombolysis of a Thrombosed Arteriovenous Graft D Lim, D Ho, Y K Tan, Dr Steven Kum Changi General Hospital, Singapore

P07-21 Novel use of Drug Eluting Balloon Assisted Maturation (DEBAM) in Primary Arteriovenous Fistula Creation J X Lim, D Lim, D Ho, YK Tan, Steven Kum Changi General Hospital, Singapore

P07-22 Transradial Non-coronary Peripheral Endovascular Interventions: A Systematic Review Max Meertens1, Eugene Ng2, Andrew MTL Choong3,4

1Faculty of Health, Medicine and Life Sciences, Maastricht University, Köln, Germany, 2Westmead Hospital, Sydney, Australia, 3Division of Vascular Surgery, National University Heart Centre, Singapore, 4School of Medicine, Griffith University, Gold Coast, Queensland, Australia

P07-23 Successful endovascular treatment for rectal arteriovenous fistula after pelvic trauma Yohei Munetomo, Shinji Yamazoe, Akira Baba, Yuko Kobashi, Takuji Mogami 0Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Japan

P07-24 40 Hours with a Traumatic Carotid Transection Eugene Ng1, Ian Campbell1, Andrew Choong1,2,3, Allan Kruger1, Philip J Walker1,2

1Royal Brisbane and Women’s Hospital, Queensland, Australia, 2Discipline of Surgery, School of Medicine, University of Queensland, Queensland, Australia, 3School of Medicine, Griffith University, Gold Coast, Queensland, Australia

P07-27 Three Cases of Vascular Ehlers-Danlos Syndrome Masato Nishizawa1, Dr Toshifumi Kudo1, Dr Kimihiro Igari1, Dr Takahiro Toyofuku1, Dr Yoshinori Inoue1

1Tokyo Medical And Dental University, Division Of Vascular And Endovascular Surgery, Department Of Surgery, Bunkyo-ku, Japan

P07-28 The effect of rifampicin bonded graft for bacterial infection Shinnosuke Okuma1, PhD Takeshiro Fujii1, PhD Tomoyuki Katayanagi1, MD Yoshio Nunoi1, MD Toru Kameda1, MD Kota

Kawada1, MD Tatsuaki Hosaka1, MD Takahide Yao1, PhD Hiroshi Masuhara1, MD Yuzo Katayama1, PhD Tsukasa Ozawa1, PhD Noritsugu Shiono1, PhD Yoshinori Watanabe1

1Toho University, Ota-ku, Japan

P07-29 A case of rupture was saved splenic artery aneurysm due to Segmental Arterial Modiolysis (SAM) after 7days of surgery of ascending aortic aneurysm ruptured.

Hirokuni Ono1, Shota Kita1, Hirotoshi Suzuki1, Yuka Sakurai1, Ro Daijyun1, Tokuichirou Nagata1, Kiyoshi Chiba1, Makoto Ono1, Yosuke Kitanaka1, Masahide Chikada1, Hiroshi Nishimaki1, Takeshi Miyairi1

1St.marianna Univercity Of Medicine, Kawasaki , Japan

P07-30 Intra-luminal thrombus bleeding in abdominal aortic aneurysm as an indicator for acute or impending rupture: A case series. Abdul Rahman M N A1, Razali MR2, Faidzal Othman1

1Vascular Unit, Department of Surgery, Kulliyah(Faculty)Of Medicine, International Islamic University Malaysia, Kuanta, , Malaysia, 2Department of Radiology, Kulliyah(Faculty)Of Medicine, International Islamic University Malaysia, Kuantan, , Malaysia


P07-31 Endovascular Management of peripheral AVM (Arteriovenous malformation) & AVF (arteriovenous fistula) at Nepal Sandeep raj Pandey1

1Annapurna Neuro Hospital, Kathmandu, Nepal

P07-32 Acute lower limb ischemia in a case of ischemic & valvular heart disease patient: A case report. Mokhlesur Rahman 1National Institute of Cardiovascular Diseases, , Bangladesh

P07-33 A Multi-Discliplinary Approach to the Management of Penetrating Neck Trauma Ian J. Tan1, Lowell Leow1, Harvinder S. Raj1, Dr K.Y. Seto2, Vikram Vijayan1

1Department of Surgery, Ng Teng Fong General Hospital, , Singapore, 2Department of Radiology, Ng Teng Fong General Hospital, , Singapore

P07-34 Endovascular embolization of iatrogenic superior mesenteric arteriovenous fistula Jun Yamao1, MD Hiroyoshi Komai2, MD Masashi Okuno1

1Yoshida Hospital, Hirakata City, Japan, 2Department of Vascular Surgery, Medical Center, Kansai Medical University, Moriguchi City, Japan

P07-35 Totally implanted venous access ports at upper arm in patients with female breast cancer: early experience in comparison with trans-jugular chest port

Shin-Seok Yang1, Prof Bo-Yang Suh1, Dr Young-A Kim1

1Yeungnam Universtiy Hospital, Namgu, South Korea

P07-36 Discussion of factors effecting the stay length of venous port catheter for chemotherapy Assist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, Ufuk Yetkin1, Specialist Köksal Dönmez2, Prof.Dr. Öcal Berkan1


P07-37 En-bloc resection of tumors with infrahepatic vena cava Chun Ling Patricia Yih1, Dr Yuk Hoi Lam1, Prof Yun Wong James Lau1

1Prince of Wales Hospital, Hong Kong, Hong Kong

P07-38 A Rare Case of Clostridium Perfringes Causing an Abdominal Aortic Graft Infection Ismazizi Zaharudin, Zainal Ariffin Azizi 1Vascular unit, Department of General Surgery, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, , Malaysia

P07-39 Traumatic Right Proximal Subclavian Artery Pseudoaneurysm Treated with Hybrid Procedure Ismazizi Zaharudin, Zainal Ariffin Azizi 1Vascular Unit, Department of General Surgery, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur ,Malaysia , ,

Malaysia

P07-40 A Case Report of Thrombotic May-Thurner Syndrome with Concomitant Extrinsic Compression - Multidisciplinary Hybrid Management

Szymon Mikulski, D Lim, D Ho, YK Tan, Steven Kum Changi General Hospital, Singapore

P08-01 Endovascular Revascularization and Free Flap Reconstruction for Lower Limb Salvage Chianan Hsieh1, Honda Hsu2, Chien-Hwa Chang3

1Department Of Nursing, Dalin Tzu Chi General Hospital, Dalin, Taiwan , 2Division of Plastic Surgery, Dalin Tzu Chi General Hospital, School of Medicine, Tzu Chi University, Dalin, Taiwan, 3Division of Cardiovascular Surgery, Dalin Tzu Chi General Hospital, Dalin, Taiwan

P08-02 Can albumin level be a predictor of healing in patients with diabetic foot ulcers? Yin-Tso Liu1, Yi-Teen Wang1

1Asia University Hospital, Taiwan, Taichung City, Taiwan


Poster PresentationP08-03 Predictive factor to determine the 12 months risk of major cardiovascular events after treatment for peripheral artery disease Kittipan Rerkasem1,2, Dr. Supapong Arworn1, Dr. Pornchanok Jumroenketpratheep1, Associate professor Natapong

Kosachunhanu1, associate professor Arintaya Phrommintikul1, Dr. Kiran Sony3, Dr. Nimit Inpankaew4, Ms Antika Wongthanee2, Dr Saranat Orrapin1, Dr. Termpong Reanpang1

1NCD Center, Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, 2NCD Center of Excellence, Research Institute of Health Science, Chiang Mai University, Chiang Mai, Thailand, 3Department of Internal Medicine, Chiangrai Prachanukroh Hospital, Chiangrai , Thailand, 4Department of Internal Medicine, Lamphun Hospital, Lamphun, Thailand

P08-04 Negative Pressure Wound Therapy Instillation in Foot Ulcers Sivagame Maniya, Esther Sheau Lan Loh 1Singapore General Hospital, Singapore

P09-01 Guidelines for Carotid Artery Interventions Must Be Revised Koksal Donmez1, Dr. Habib Cakir1, Dr. İsmail Yurekli1, Dr. Mert Kestelli1, Dr. Bortecin Eygi1, Dr. Bilge Birlik2, Dr. Ersin Celik3

1Department Of Cardiovascular Surgery, Katip Celebi University Izmir Ataturk Training And Research Hospital, Izmir, Turkey, 2Department Of Radiology, Katip Celebi University Izmir Ataturk Training And Research Hospital, Izmir, Turkey, 3Department Of Cardiovascular Surgery, Afyonkarahisar State Hospital, Afyonkarahisar,Turkey, Afyonkarahisar, Turkey

P09-02 Our surgical strategy in a smoker patient with severe left internal carotid artery stenosis Kazim Ergunes1, Dr Orhan Gokalp1, Dr Ihsan Peker1, Dr Habib Cakır1, Dr Yasar Gokkurt1, Dr Banu Lafci1, Prof Levent Yilik1,

Prof Ali Gurbuz1


P09-03 Analysis of Risk Factors for Cerebral Microinfarcts After Carotid Endarterectomy and the Relevance of Delayed Cerebral Infarction

Jun Gyo Gwon1

1University Of Ulsan College Of Medicine, Asan Medical Center, Seoul, South Korea

P09-04 Clinical value (or utility) of preoperative carotid ultrasonography prior to operation for abdominal aorta aneurysm and peripheral artery disease

Prof. Hyuk Jae Jung1, Yong Beum Bak1, Dr. Dong Hyun Kim1, Prof. Sang Su Lee1


P09-05 Impact of subclinical coronary artery disease on the clinical outcomes of carotid endarterectomy Minsu Noh1

1Asan Medical Center, Seoul, South Korea

P09-06 Review of 99 consecutive carotid endarterectomies in a moderate volume centre Yongxian Thng1, Joel Lee1, Dr Julian Wong1

1Nuh, Singpore, Singapore

P10-01 Endovascular aortic aneurysm repair (EVAR): the National Kidney and Transplant Institute (NKTI) experience from 2013 to 2014

Dr Benito Purugganan Jr1, Edgar Macaraeg1, Dr. Ricardo Jose Quintos1, Dr. Leo Carlo Baloloy1, Dr. Marc Anter Mejes1


P10-02 Horns of a dilemma: Follow-up or surgery for aortic intramural hematoma? Nur Dikmen Yaman1, Mehmet Cakici1, Evren Ozcinar1, Cagdas Baran1, Levent Yazicioglu1, Bulent Kaya1


P10-03 Anatomical characteristics of an infra-renal abdominal aortic aneurysm: Can an aneurysm that is prone to enlargement after endovascular aneurysmal repair be predicted?

MD Sang Young Chung1, MD Ho Kyun Lee1, Soo Jin Na Choi1


P10-04 Can EVAR replace open repair as primary treatment for abdominal aortic aneurysm? Professor Sung Woon Chung1, Associate professor Chung Won Lee1, Fellow Up Huh1, Resident Joohyung Son1

1Pusan National University School Of Medicine, Pusan National University Hospital, Busan, South Korea


P10-05 Stent assisted Coil Embolization of a Large, Saccular, Suprarenal Aortic Aneurysm with Walled off Rupture: A Case Report Alinaya Cordero1, Dr Fabio Enrique Posas1

1Heart Institute, St. Luke’s Medical Center, Global City, Taguig City, Philippines

P10-06 Hybrid Operation for Juxta-renal Aortic Aneurysm with Fragile Neck Ida Bagus Budiarta1, MD Djony Edward Tjandra1


P10-07 Aortoiliac Unigraft with Femoro-femoral Bypass Graft on Case Abdominal Aortic Aneurysm with Ruptured Right Common Iliac Aneurysm – Case Report

Kemas Dahlan1, MD Raden Suhartono1


P10-08 Endovascular Repair Using Bifurcated Endograft for Abdominal Aortic Aneurysm with Concomitant Total Occlusion of the Common Iliac Artery

Kemas Dahlan1, MD Raden Suhartono1


P10-09 Our surgical strategy in a patient with hypertension having acute Type A aortic dissection Dr Kazim Ergunes1, Prof. Levent Yilik1, Dr Ismail Yurekli1, Dr Banu Lafci1, Dr Habib Cakir1, Dr Hasan Iner1, Dr Yasar

Gokkurt1, Prof Ali Gurbuz1


P10-10 Emergent debranching TEVAR to treat ruptured Stanford type B acute aortic dissection Onichi Furuya1, Shinnichi Higashiue1, Satoshi Kuroyanagi1, Masatoshi Komooka1, Masahide Enomoto1, Saburo Kojima1,

Naohiro Wakabayashi1


P10-11 Endovascular repair of an isolated common iliac aneurysm in 70 patients Soichiro Hase1, MD., Ph. D. Tassei Nakagawa1, MD., Ph. D. Motoshige Yamasaki1, MD. Yumi Kando2, MD., Ph. D. Mutsumu

Fukata2, MD., Ph. D. Professor Hiroshi Nishimaki3

1Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan, 2Numazu City Hospital, Numazu, Japan, 3St.Marianna University School of Medicine , Kawasaki, Japan

P10-12 Successful thoracic endovascular aortic repair for acute type B aortic dissection complicating critical lower limb ischemia Yutaka Hasegawa1, Ezure Masahiko1, Yasuyuki Yamada1, Syuichi Okada1, Shuichi Okonogi1, Hiroyuki Morishita1, Yuriko

Kiriya1, Tatsuo Kaneko1, Ren Kawaguchi1

1Gunma Prefectural Cardiovascular Center, Maebashi, Japan

P10-13 Outcomes of abdominal aortic aneurysms surgery requiring suprarenal aortic cross-clamping and their effect of postoperative renal function

Soichiro Henmi1, Hitoshi Matsuda1, Hidekazu Nakai1, So Izumi1, Masamichi Matsumori1, Hirohisa Murakami1, Masato Yoshida1, Nobuhiko Mukohara1

1Hyogo Brain And Heart Center At Himeji, Himeji-shi, Japan

P10-14 Facilitation of Approach to the Arch Vessels in Aortic Arch Translocation Mitsuharu Hosono1

1Kansai Medical University Medical Center, Moriguchi, Japan

P10-15 Case report: Successful medical treatment in a case of aortic infection after thoracic endovascular aortic repair (TEVAR) Yung-Kun Hsieh1, Dr Chun-Ming Huang2, Dr Chien-Hui Lee1, Dr Ying-Cheng Chen1, PhD Ing-Sh Chiu1


P10-16 TEVAR for uncomplicated type B aortic dissection Takahiro Ishigaki1, Hitoshi Matsuda1, Ryuta Kawasaki1, Yojiro Koda1, Naoki Tateishi1, Soichiro Henmi1, Megumi Kinoshita1,

Hidekazu Nakai1, Masamichi Matsumori1, Hirohisa Murakami1, Masato Yoshida1, Nobuhiko Mukohara1

1Hyogo Brain And Heart Center At Himeji, Himeji, Japan


Poster PresentationP10-17 Staged open surgery for aorto-esophageal fistula after TEVAR for infected thoracic aortic aneurysm MD, PhD Toru Iwahashi1, MD, PhD Nobusato Koizumi1, MD, PhD Kentaro Kamiya1, MD Masaki Kano1, Keita Maruno1,

MD Toshiki Fujiyoshi1, MD Shun Suzuki1, MD Takashi Ino1, MD Satoshi Takahashi1, MD Kayo Sugiyama1, MD, PhD Shinobu Matsubara1, MD, PhD Toshiya Nishibe1, MD, PhD Hitoshi Ogino1

1Tokyo Medical University, Shinjuku-ku, Japan

P10-18 Long-term Outcomes of Ruptured Abdominal Aortic Aneurysm in an Aging Society Akihito Kagoshima1, Dr. Hirono Satokawa1, Dr. Hiroki Wakamatsu1, Dr. Tomohiro Takano1

1Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima City, Japan

P10-19 Our experience of treatment for symptomatic superior mesenteric artery dissection Yasuhiko Kawaguchi1, Dr Hiroshi Mitsuoka1, Dr Masanao Nakai1, Dr Yujiro Miura1, Dr Shinnosuke Goto1, Dr Yasuhiko Terai1,

Dr Yuta Miyano1, Dr Shinji Kawaguchi1, Dr Fumio Yamazaki1

1Shizuoka City Shizuoka Hospital, Shizuoka City, Japan

P10-20 The results of in situ prosthetic graft replacement for an infected endograft after endovascular repair for infrarenal abdominal aortic aneurysms.

Hakyoung Kim1, Dr Youngjin Han1

1Asan Medical Center, SongPaGu, South Korea

P10-21 Sac regression after endovascular relining of perigraft seroma after open repair of abdominal aortic aneurism with PTFE graft Sang Seop Yun1, Associate Professor Jang Yong Kim1, Associate Professor Sun Cheol Park1, Associate Professor Yong Sung

Won1, Professor In Sung Moon1, Professor Ji Il Kim1


P10-22 Surgical outcome for aorta and iliac artery with infection Yojiro Koda1, Takahiro Ishigaki1, Naoki Tateishi1, Soichiro Henmi1, Hidekazu Nakai1, So Izumi1, Masamiti Matsumori1, Hirohisa

Murakami1, Tasuku Honda1, Hitoshi Matsuda1, Masato Yoshida1, Nobuniko Mukohara1

1Department Of Cardiovascular Surgery, Hyogo Brain And Heart Center, Himeji, Hyogo, Japan, Himeji, Japan

P10-23 Emergent Surgical Conversion during endovascular Procedure for Leriche’s disease Joon Hyuk Kong1

1Department Of Thoracic And Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do, , South Korea

P10-24 Prevention of type II endoleak using the aortic cuff during endovascular aneurysm repair Shinsuke Kotani1, Takumi Ishikawa1, Tadahiro Murakami1, Hirokazu Minamimura1

1Bellland General Hospital, Sakai, Osaka, Japan

P10-25 Endovascular Treatment of Type III Endoleak after EVAR Yujin Kwon1, Dr Kyoung Bok Lee1


P10-26 Successful Endovascular Treatment of Mycotic Thoracic Aneurysm with Spinal Osteomyelitis, A Case Report. Chon Wa Lam1

1Kiang Wu Hospital, Macau, China

P10-27 The structural changes of aneurysm after endovascular aneurysm repair Jae Hoon Lee1, Dr Ki Hyuk Park1

1Daegu Catholic University Hospital, Daegu, South Korea

P10-28 Infra-renal Abdominal Aortic Aneurysm Repair for the Severely Angulated Neck: The Usefulness of Precuff Kilt Technique of Endovascular Aneurysm Repair (EVAR)

Samuel Lee1, MD Young Kwon Cho1

1Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea

P10-29 A New Type of Endoleak After EVAR Induced by Stanford B Aortic Dissection and its Treatment Jie Liu1, Dr. Xin Jia1, Dr. Senhao Jia1, Dr. Wei Guo1



P10-30 Two-stage repair of extensive thoracic aortic aneurysm and aortic valve lesion associated with pseudocoarctation of the aorta Saito Masahito1, Asano Naoki1, Ohta Kazunori1, Niimi Kazuho1, Tanaka Kouyu1, Gon Shigeyoshi1, Takano Hiroshi1

1Dokkyo Medical University Koshigaya Hospital, Koshigaya-shi, Japan

P10-31 Extension of frozen stent graft for the treatment of multiple thoracic aneurysms Hideki Mishima1, M.D. Susumu Ishikawa1, M.D. Hiroki Matsunaga1, M.D. Akira Oshima1

1Tokyo Metropolitan Bokuto Hospital, Sumidaku, Japan

P10-32 Postoperative venous thromboembolism after EVAR for ruptured abdominal aortic aneurysm: report of two cases Yuri Murakami1, Dr. Naoki Toya1, Dr. Soichiro Fukushima1, Dr. Eisaku Ito1, Dr. Tadashi Akiba2, Dr. Takao Ohki3

1The Jikei University Kashiwa Hospital Department of Surgery, Division of Vascular Surgery, Kashiwa City, Japan, 2The Jikei University Kashiwa Hospital Department of Surgery, Kashiwa City, Japan, 3The Jikei University School of Medicine Department of Surgery, Division of Vascular Surgery, Minatoku, Japan

P10-33 Secondary aortoduodenal fistula following abdominal aortic reconstruction Shingo Nakai1, Dr. Tetsuro Uchida1, Dr. Azumi Hamasaki1, Dr. Yoshinori Kuroda1, Dr. Atsushi Yamashita1, Dr. Ken Nakamura1,

Dr. Jun Hayashi1, Dr. Daisuke Watanabe1, Dr. Kimihiro Kobayashi1, Dr. Seigo Gomi1, Prof. Mitsuaki Sadahiro1

1Yamagata University, Yamagata, Japan

P10-34 A Case of a Right Common Iliac Artery Aneurysm Complicate the Arteriovenous Fistula and the Common Iliac Vein Occlusion. Shinsuke Nishimura1, Dr Takashi Murakami1, Dr Hiromichi Fujii1, Dr Masanori Sakaguchi1, Dr Yosuke Takahashi1, Dr Daisuke

Yasumizu1, Dr Yoshito Sakon1, Dr Toshihiko Shibata1

1Department of Cardio Vascular Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan

P10-35 Initial Outcomes of Endovascular Stent-graft Repair of Ruptured Abdominal Aortic Aneurysms: A single-center experience Hirotoki Ohkubo1, Tadashi Kitamura1, Toshiaki Mishima1, Koichi Sughimoto1, Tetsuya Horai1, Mitsuhiro Hirata1, Shinzou

Torii1, Kagami Miyaji1

1Department of Cardiovascular Surgery, Kitasato University School Of Medicine, Sagamihara, Japan

P10-36 Floating thrombus causing systemic embolization in the ascending aorta in the absence of any coagulation abnormality Shunsuke Ohori1

1Hokkaido Ohno Hospital, Sapporo, Japan

P10-37 Vascular Caliber Changes Post PEVAR versus SEVAR in the Asian Context Daniel Ong1, Prof Uei Pua2

1Yong Loo Lin School of Medicine, Singapore, Singapore, 2Tan Tock Seng Hospital, Singapore, Singapore

P10-38 Combined Proximal Stent-Grafting with Distal Bare Stenting for Management of Three-Channeled Type B Aortic Dissection with Malperfusion Syndrome

Kimimasa Sakata1, MD,PhD Saori Nagura1, MD,PhD Toshio Doi2, MD,PhD Akio Yamashita2, MD,PhD Katsunori Takeuchi2, Prof Naoki Yoshimura2

1Shinonoi General Hospital, Nagano, Japan, 2Toyama University Hospital, Toyama, Japan

P10-39 Thrombosis of inferior vena cava caused by large left iliac artery aneurysm Yasuhito Sekimoto1, Dr Hirohisa Harada1


P10-40 Late open conversion after endovascular aortic aneurysm repair Riha Shimizu1, Takayuki Hori2, Yasushi Matsushita1, Hirotsugu Fukuda2

1Dokkyo Medical University Nikko Medical Center, Nikko, Japan, 2Dokkyo Medical University, Mibu, Japan

P10-41 Prevention of renal infarction for abdominal aortic aneurysm with mural thrombus at the proximal clamp site Nobuoki Tabayashi1, Dr Takehisa Abe1, Dr Tomoaki Hirose1, Dr Yoshihiro Hayata1, Dr Keigo Yamashita1, Dr Yoshio Kaniwa1,

Dr Rei Tonomura1, Dr Shigeki Taniguchi 1Nara Medical University, Kashihara, Japan


Poster PresentationP10-42 Does post-implantation syndrome affect perioperative and long-term outcome? Tomohiro Takano1, Dr Akihito Kagoshima1

1Fukushima Medical University, Fukushima, Japan

P10-43 Thoracic Endovascular Repair in Chronic Type B Aortic Dissection Takahiro Takemura1, Dr Takahito Yokoyama1, Dr Yuujirou Kawai1, Dr Hirokazu Niitsu1, Dr Gentaku Hama1, Dr Yasuyuki

Toyota1, Dr Yasutoshi Tsuda1

1Saku Central Hospital Advanced Care Center, Saku, Japan

P10-44 Large false lumen occlusion using Candy-plug technique in ruptured chronic type B dissecting aortic aneurysm: a case report Katsunori Takeuchi1, Dr. Akio Yamashita1, Dr. Kanetsugu Nagao1, prof. Naoki Yoshimura1

1Graduate School Of Medicine, University Of Toyama, Toyama, Japan

P10-45 Unexpected finding of single coronary artery during an emergent surgery of type A aortic dissection Kazuhito Tatsu1, Toru Uezu1, Norio Mouri1, Moriichi Sugama1

1Makiminato Chuo Hospital, Urasoe, Japan

P10-46 Introduction of less invasive treatment for Abdominal Aortic Aneurysm - Introduction of Endovascular treatment, inspection of the results for future development analysis of postoperative Quality of life using SF-36

Takayuki Uchida1

1Iizuka Hospital, Iizuka, Japan

P10-47 Repair of thoracoabdominal dissection aneurysm with Zenith® t-Branch™ Thoracoabdominal Endovascular Graft Yew Toh Wong1

1Flinders Medical Centre, Bedford Park, Australia

P10-48 Diabetic effect on prevalence and growth rate of abdominal aortic aneurysms: Systemic review and meta-analysis Dr. Jiang Xiong1, Dr. Zhongyin Wu1, Dr. Chen Chen2, Dr. Yingqi Wei3, Dr. Wei Guo1

1Dpt. Vascular And Endovascular Surgery, The Chinese PLA General Hospital, Beijing, China, 2Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, USA, 3Beijing Center for Diseases Prevention and Control, Beijing, China

P10-49 Unruptured left sinus of Valsalva aneurysm with fistulous track complicated by aortic regurgitation Satoshi Yamashiro1, Professor Yukio Kuniyoshi1, Dr Ryoko Arakaki1, Dr Hitoshi Inafuku1, Dr Yuya Kise1

1Department of Thoracic And Cardiovascular Surgery, University Of The Ryukyus, Nishihara-cho, Nakagami-gun, Japan

P10-50 Surgical, endoscopic and radiological management of infected graft and aortoduodenal fistula after EVAR Chun Ling Patricia Yih1, Dr Yuk Hoi Lam1, Prof Yun Wong James Lau1

1Prince Of Wales Hospital, Hong Kong, Hong Kong

P10-51 Left subclavian artery revascularization during thoracic endovascular aortic aneurysm repair with simple fenestrated technique Hiroaki Yusa1, Dr Tomoaki Tanabe1, Dr. Makoto Taoka1, Dr Shou Tatebe1, Dr Imun Tei1, Dr Takashi Azuma2, Dr Yoshihiko

Yokoi2

1Ayase Heart Hospital, Adachi-ku, Japan, 2Tokyo Women Medical college, Shinjuku-ku, Japan

P10-52 Aortoesophageal fistula secondary to thoracic endovascular aortic repair of an acute type B aortic dissection Weimin Zhou1

1the 2nd affiliated hospital of Nanchang University, Nanchang, China

P11-01 Symptomatic carotid artery stenosis: literature review of current standards of timing and factors to improve. Kalpa Perera1, Mr. Kishore Sieunarine1


P11-02 Trans-radial Access for Iliac Intervention: A Systematic Review Eugene Ng1, Andrew MTL Choong2,3

1Westmead Hospital, Sydney, Australia, 2Division of Vascular Surgery, National University Heart Centre, Singapore, 3School of Medicine, Griffith University, Gold Coast, Queensland, Australia


Oral Presentation 01-01Factors associated with early vascular access (VA) failure in acute phase patientsAkihito Tanaka1

1Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan

IntroductionAcute phase patients sometimes require hemodialysis therapy without vascular access (VA) present on admission. These patients require VA creation to continue hemodialysis after discharge. The risk of early VA failure in acute phase conditions is considered high due to the unstable nature of the patient’s condition. Hence, the optimal timing of VA creation is not established.

ObjectivesWe are going to clarify the factors associated with early VA failure and decide the optimal timing of VA creation.

MethodsThis retrospective study included patients who had VA (arteriovenous fistula or graft) created between May 2010 and December 2015.

ResultsDuring this study, 809 VA creations were performed among 716 patients. Of the included, 385 were acute phase patients (245 men, 140 women). The average age was 67.1 ± 14.9 years. The causes of admission were exacerbation of renal failure (244 patients, 63.4%), heart disease (53 patients, 13.8%), infectious disease (26 patients, 6.8%), and malignancy (14 patients, 3.6%). Early VA failure occurred in 47 patients (12.2%). There was no difference in causes of admission between patients with and without VA failure. The serum albumin level was significantly lower (2.7 ± 0.8 g/dL vs. 3.1 ± 0.6 g/dL, P < 0.01) in the early VA failure group than in the without early failure group. The period from admission to VA creation did not show significant differences between patients with and without early VA failure.

ConclusionsWhen we perform VA creation in acute phase patients, hypoalbuminemia is associated with the risk of early VA failure. The status of the patient is an important factor to consider when we create VA.

01-02Is it worth the effort? Creation of arterio-venous fistulas in octogenarians Jennifer Diandra1, Dr Wei-wen Ang1, Dr Zhiwen Joseph Lo1, Dr Jue Fei Feng1, Dr Glenn Wei Leong Tan1, Dr Sadhana Chandrasekar1, Dr Sriram Narayanan1


AimsTo evaluate the outcomes of arterio-venous fistulae (AVF) creation in patients aged 80 years old and above.

MethodsRetrospective study of 47 AVFs created in patients aged 80 years and above between November 2008 to December 2014. Factors investigated include patient demographics, co-morbidities, previous central venous interventions, end-stage renal failure (ESRF) status, current medication regime, pre-operative ultrasound vein map, surgeon grade and requirement for any assisted patency interventions such as tributary ligation, fistuloplasty or AVF revision.

Results Average age of the patients was 82.8 years old, with range between 80 to 91 years of age. Within the study population, 27 (57.4%) were male, 30 (63.8%) were independent in their activities of daily living (ADL) and 35 (74.5%) had permanent catheters (PC) in-situ, with haemodialysis commenced prior to AVF creation. The average vein diameter was 2.4mm while the average artery diameter was 3.5mm. There were a total of 15 (31.9%) radio-cephalic AVFs, 30 (63.8%) brachio-cephalic AVFs and 2 (4.3%) brachio-basilic transposition AVFs created. Primary AVF patency rate was 14.9% (7 patients) whilst primary failure rate was 72.3% (34 patients). There were no post-op wound infections. PC line sepsis rate was 31.4% (11 patients). A further 12.8% (6 patients) underwent additional intervention and achieved assisted primary and secondary patency. Univariate analysis did not reveal any factor to be statistically significant in predicting AVF patency. Kaplan-Meier survival curve showed a 50% survival rate at 63 months after AVF creation.

ConclusionsIn view of high AVF primary failure rate (72.3%) and relatively low PC line sepsis rate (31.4%), long-term PC as the main form of haemodialysis renal access may be a viable option in Octogenarians. However, with 50% of ESRF patients surviving up to 63 months after AVF creation, the risks and benefits of long-term PC must be balanced against those of AVF creation.

01-03The use of covered stent in central venous occlusive disease in hemodialysis patientsChai Hock Chua1, Dr Chia Hsun Lin1

1Shin Kong Memorial Hospital Taipei, Taiwan, Taipei, Taiwan

BackgroundCentral vein stenosis still remains a difficult problem for hemodialysis patients. Endovascular intervention with angioplasty is the preferred approach, but the results are suboptimal and limited. Until now, covered stent is considered a better way to maintain the patency. This study evaluated the efficacy and durability of covered stent in treating central venous occlusive disease.

ObjectivesCovered stent is considered a better way to treat central venous occlusive disease (CVOD), compared to bare mental stent or just angioplasty. This study evaluted the result of treating CVOD by covered stent in our hospital

MethodsA retrospective review was performed of all patients with clinically significant CVOD who were treated by placement of covered stents from 2012 to 2016. Demographics, lesion locations and anatomic characteristics, stent graft, and access patency rates were determined.


Oral PresentationResultsA total of 25 patients (60% men) with CVOD was treated with covered stent during the follow-up. The viabahn endoprosthesis was used in 16 patients (average size and length, 11mm *5cm) and iliac extensions was used in another 9 patients (average size, 13mm*8cm). Technical success was 100%. Covered stent primary patency, assisted primary patency, and secondary patency were 40%, 75%, and 100% at 12 months.

ConclusionsThe use of covered stent in CVOD is a promising alternative way to keep the dialysis access in function and relieve the symptoms. Further prospective and randomized studies are needed to determine whether covered stents provide superior long-term results, compared to other endovascular method.

01-04Risk factors for decreased patency of Autologous Arteriovenous Fistula in the snuff-boxYasuhiro Fujii1, Ph.D. Susumu Oozawa1, M.D. Michihiro Okuyama1, Ph.D. Zenichi Masuda1, M.D. Hidemi Takeuchi1, Ph.D. Haruhito Uchida1, Ph.D. Shunji Sano1

1Okayama University Graduate School Of Medicine, Dentistry, And Pharmaceutical Sciences, Okayama, Japan

IntroductionAutologous snuff-box arteriovenous fistula (sAVF) is the first choice procedure as the primary AVF for haemodialysis at this institution. The patency of the autologous AVF in the forearm was reported to be 43% to 85% at 1 year and 40 % to 69 % at 2 years. However, the patency of sAVF alone is not completely defined. In addition, evidence for risk factors of its failure is scarce.

ObjectivesThe purpose of this study was to describe the results of sAVF and to verify the risk factors for its failure.

MethodsA retrospective chart review was performed in 157 patients (95 male and 62 female patients) who underwent sAVF creation at this institution between March 2011 and December 2015. The average age was 65 ± 13 years (range, 23 to 90 years). The sAVF was created in the left and right arms in 132 patients and 25 patients, respectively. Seven patients had collagen vascular disease (CVD).

ResultsThe primary patency rates were 93.6%, 65.3%, and 58.2% at 1month, 1 year, and 2 years after surgery, respectively. The secondary patency rates were 98.7%, 87.8%, and 83.3% at 1 month, 1 year, and at 2 years after surgery, respectively. On multivariate analysis, older age (P = 0.016), sAVF creation in the right arm (P = 0.009), and steroid use (P = 0.030) were the significant risk factors for the decreased primary patency rate. CVD (P = 0.023), steroid use (P = 0.029), and type I diabetes (P = 0.030) were the significant risk factors for the decreased secondary patency rate.

ConclusionsThe patency rate of sAVF was comparable to previously reported patency rates for the forearm AVF. Careful observation for sAVF is needed in patients with older age, AVF creation in the right arm, CVD, steroid use, and type I diabetes.

01-05Intraoperative bloodflow rate as maturity predictor of brachiocephalic fistula at diabetic nephropathy patientSandra Harisandi1, dr dedy pratama1

1Surgery Department Of Ciptomangunkusomo Hospital, Jakarta, Indonesia, jakarta, Indonesia

IntroductionThis research is a follow-up study to determine the value limits of BFR intraoperative using Doppler ultrasound to predict maturity of brachiocephalic fistula with a larger sample and to obtain lower level of error and bias, so it can be used as a reference in the Vascular Surgery division, Cipto Mangunkusumo Hospital

MethodsCross-sectional design with analytic fashion conducted at Division of Vascular Surgery Department of the Faculty of medicine - Cipto Mangunkusumo Hospital, Jakarta. We conducted consecutive sampling, all patients with stage IV-V CKD, due to diabetic nephropathy, planned to get vascular access for hemodialysis brachiocephalic fistula.

ResultTotal number of patients are 71 people. The mean blood flow rate is found to be 249.15 + 86.86 mL / min, mean arterial diameter was found 3.3 mm (2.0 to 7.4 mm) and the mean diameter of the vein found to 3 mm (2.1 to 5.6 mm ). Only BFR associated significantly with maturity AVF (p<0.001). We found highest sensitivity and specificity values obtained when the value of intraoperative blood-flow was 211.3 mL / min. This value is determined as the cut-off value for prediction of brachiocephalic AVF maturation with a sensitivity of 95.45%, a specificity of 92.59% and 95.5% positive predictive value and 92.6% negative predictive value.

ConclusionBFR intraoperative examination using Doppler ultrasound shortly after the creation brachiocephalic AVF can predict its maturation and proved to have sensitivity and specificity more than 80%.

Key wordsIntraoperative BFR, AV fistula maturity, brachiocephalic, sensitivity, specificity.

01-06Role of Post-Operative Bruit as an Indicator of AVF MaturationCristina Lajom1, Dr. Aries Garin1, Dr. Teodoro Jr. Bautista1

1UNIVERSITY OF SANTO TOMAS HOSPITAL, SAMPALOC , Philippines

IntroductionVascular access is the lifeline of a hemodialysis patient. Arterio-venous fistulas (AVF) and grafts are the current options for permanent vascular access for hemodialysis. Vascular access dysfunction is a major contributor to the overall morbidity and mortality of hemodialysis patients, hence placing a significant burden on the health care sector. the purpose of this study is to provide a cost- efficient way to predict the maturity of AVF by using an objective indicator such as a bruit.


MethodologyA chart review of all patients with AVFs placed from January 2011 to July 2014 were done at the University of Santo Tomas Hospital. All patients underwent AVF creation. Immediate post operative bruit was noted. AVF Maturation was defined as successful cannulation and hemodialysis.

ResultsAmong the 268 AVFs created, a total of 85 were included with a majority of males (62%) and a mean age of > 60 years old (51%).

The most frequent cause for hemodialysis was Diabetic nephropathy (49%) and hypertensive nephrosclerosis (18%).

Among the 85 eligible patients, 44 were included in the Auscultation (bruit) group, while 41 were included in the Non-Auscultation (no bruit) group. In the bruit group, 84% (n=37) of the AVF created matured. While in the no bruit group, only 60 % of the AVF matured. The relative risk is 1.38. with p-value of 0.017

ConclusionPresence of a bruit immediately postoperatively, is a reliable objective indicator of AVF maturation. We strongly recommend Routine auscultation immediately after AVF creation as a cost effective indicator AVF maturation, by preventing unnecessary re-operations and decrease burden among chronically dialyzed patients.

01-07Correlation between preoperative vein diameter and maturation of radiocephalic fistulaHailei Li1, Dr. Yiu-Che Chan2, Ms. Lisa Wu2, Dr. Dongzhe Cui1, Professor Stephen Cheng2

1Division of Vascular Surgery, Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, China, 2Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China

IntroductionAutogenous arteriovenous fistula (AVF) is the optimal vascular access for hemodialysis and radiocephalic fistula is recommended as the first choice for primary AVF if the vascular anatomy is suitable. Preoperative venous mapping with ultrasound is recommended before autogenous AVF creation. Despite of routine preoperative mapping, the incidence of maturation failure remains high.

PurposeThe aim of this study was to investigate variables that affect autogenous radiocephalic AVF maturation. Especially, we focused on the influence of pre-operative vein size on fistula maturation.

MethodsThis was a retrospective analysis of patients underwent hemodialysis access creation from June 2013 to June 2015 at a single medical center. Preoperative vessel mapping was performed with ultrasound. The patients were allocated to two groups according to maturation outcome. Comparison of the variables between the two groups was performed using SPSS statistics.

ResultsA total of 43 patients were included in the study cohort. The mean age was 51.8 ± 14.9 years old (range 21 to 72). A total of 26 patients (60%) were already on hemodialysis using a temporary central vein catheter. The mean diameter of cephalic vein was 2.4 ± 0.5 mm (range 1.5 to 4.0 mm). The radial artery was 2.3 ± 0.4 mm in diameter (range 1.6 to 3.5 mm). Primary functional maturation was achieved in 32 patients (32/43, 74%), while secondary fistula maturation rate was 79% (34/43). The mean duration of follow-up was 12.6 ± 7.5 months. There was no statistical significant between the matured and unmatured group in terms of age, gender, body-mass index, diabetes and prior dialysis catheter placement. However, patients with failure maturation had a significantly small vein diameter (P=0.025).

ConclusionsCephalic vein in Chinese patient was relatively smaller. Our study shows increased vein diameter on preoperative ultrasound mapping is associated with fistula maturation.

01-08Correlation peak sistolic velocity brachial artery and blood flow rate intra operative with maturation of brachiocephalic fistulaDjony Edward Tjandra, Raden Suhartono1Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia

Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5. Vascular access for hemodialysis its associated problems is the leading cause for hospital admission and morbidity. Maturation failure is impeded by issues of maturation. The result from this study showed that correlation peak sistolik velocity brakial artery and bloodflow rate measured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predict AVF maturation. Statistic analisis use Mann Whithey and Chi Squere.

Result no correlation PSV with maturation, the intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week 679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedure was needed to repair the brachiochephalic and consequently help in reducing the rate of AVF maturation failure.

01-09Predictors of radio-cephalic arteriovenous fistulae patency in an Asian populationJuefei Feng1


PurposeTo identify predictors of arteriovenous fistula (AVF) patency in Asian patients with autogenous radiocephalicarteriovenous fistula (RCAVF).

MethodsRetrospective review of 436 RCAVFs created between 2009 and 2013. Predictors of patency were identified with univariate and multivariate analysis. Kaplan-Meier survival analysis and log-rank test were used to calculate patency rates.


ResultsOverall secondary patency rate was 72% at 12 months, 69% at 24 months, 58% at 36 months, 57% at 48 months, 56% at 60 months and 54% at 72 months. Univariate analysis showed that factors which predict for patency include male gender (p = 0.003), good diabetic control (p = 0.025), aspirin use (p = 0.031), pre-dialysis status (p = 0.037), radial artery diameter (p = 0.029) and non-calcified radial arteries (p = 0.002). Age (p = 0.866), cephalic vein diameter (p = 0.630) and surgeon grade (p = 0.472) did not predict for primary AVF failure. Multivariate analysis revealed the male gender to be an independent predictor for patency (odds ratio 1.99, p = 0.01). Subset analysis showed a significantly larger average radial artery diameter of 2.3 mm amongst males, as compared to 1.9 mm amongst females (p = 0.001) and no statistical difference in the average cephalic vein diameter.

ConclusionsWithin our Asian study population, 12-month patency rate of RCAVF is 72%, 69% at 24 months, 58% at 36 months, 57% at 48 months, 56% at 60 months and 54% at 72 months. Male gender is an independent predictor for RCAVF patency. In females or patients with calcified radial arteries, a more proximal AVF should be considered.

01-10Predictors of poor primary patency of arteriovenous fistula or graft for haemodialysis accessMatthew KH Tan, Eusebio M D’Almeida, Chee Y Ng, Chieh Suai Tan, Edward Choke1Singapore General Hospital, Singapore

Background and objectivesArteriovenous fistulas (AVF) and arteriovenous grafts (AVG) are the most commonly used access for haemodialysis but often require multiple interventions to maintain patency over their lifespan. This study retrospectively evaluated factors for poorer primary patency and increased frequency of intervention.

MethodsData from consecutive patients admitted for angioplasty or thrombolysis from January 2015 to February 2016 in single tertiary centre were retrospectively obtained from electronic medical records. Demographics, co-morbidities, previous access details, and interventions on current access were collected.

ResultsOne hundred and eighty five patients (63.7±12.0 years; 105 males; mean follow-up 3.6±2.7 years) with upper limb vascular access were included. There were 152 (82.2%) AVFs and 33 (17.8%) AVGs. Primary patency rate was 64.3% and 40.0% at 6-months and 1-year respectively. A total of 19 (10.3%) accesses reached secondary patency at 2.7±2.2 years. Multivariate Cox regression analysis with backward elimination showed predictors of poor primary patency to included ischaemic heart disease (IHD) (HR, 1.52; 95% CI, 1.12-2.04; p=0.0063), cerebrovascular disease (CVD) (HR, 1.74; 95% CI, 1.14-2.65; p=0.0104) and AVGs (HR, 1.92; 95% CI, 1.31-2.82; p=0.0008).

Primary assisted patency was 3.8±2.8 years, requiring 4.5±3.6 interventions to maintain access. Multivariate regression analysis revealed older age at access creation, diabetes mellitus (DM) and previous ipsilateral access (p=0.0104, 0.0229 and

0.0070 respectively) to be predictive of increased frequency of interventions. Groups with older age at access creation (3.00±2.32 vs 4.22±2.94 years; p=0.00106) and DM (3.08±2.26 vs 4.46±3.19 years; p=0.00139) had poorer primary assisted patency. Although ipsilateral previous access had non-significant effect on primary assisted patency (p=0.119), this group of patients required more interventions to maintain patency (5.49±4.03 vs 4.03±3.06,p=0.0263).

ConclusionsIHD, CVD and AVGs are predictors of poor primary patency. Increased frequency of interventions was predicted by older age at access creation (>60 years), DM and ipsilateral previous access.

01-11Correlation Between Quick of Blood (Qb) and Adequacy of Hemodialysis in Mature Arterovenous FistulaMursid Fadli, Akhmadu1Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia

The success of the process is determined by the fulfillment hemodialysis HD dose according to the patient’s needs. HD dosing according to patient needs can be assessed from the adequacy or adequacy of hemodialysis patients who achieved HD. Qb different with giving effect to the urea clearance is achieved. This study is expected to be useful in setting up and monitoring of the Qb so as to optimize the adequacy of dialysis patients and the creation of quality of life of patients better.

This study is to know correlation between Qb and adequacy of hemodialysis in patients with mature Arterovenous Fistula (AVF). Besides identifying patient characteristics, Qb patients with AVF were mature, identify the adequacy of hemodialysis achieved by patients with AVF were mature, analyzing the correlation between Qb and adequacy of hemodialysis in patients with AVF were mature and analyzing the correlation Among the factors confounding the adequacy of hemodialysis in patients with AVF were mature.

This research is a quantitative approach cross-sectional study. The study was conducted at Cipto Mangunkusumo hospital from September to November 2015.

The results of the analysis of the relationship between Qb and adequacy of hemodialysis (value Kt / V) showed significant results, where the p value of 0.227 (p> 0.05). Results of this study concluded that there was no significant relationship between Qb and adequacy of hemodialysis (p = 0.227).

There is no significant relationship between Qb and adequacy haemodialis (value Kt / V). In this study, there are many shortcomings including hemodialysis adequacy assessment just by looking at the Kt / V without a measurement of URR. Another Keterbatan namely HD space RSCM use dialyzer membrane type of a low flux, it is certainly affect the achievement of urea clearance which ultimately affect the achievement of the adequacy of hemodialysis

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02-01Factors associated with primary angioplasty durability in haemodialysis accessLester Ong, Matthew KH Tan, Eusebio M D’Almeida, Chee Y Ng, Chieh Suai Tan, Edward T Choke

Background and objectivesThis study evaluated the outcomes and influencing factors for primary angioplasty durability, measured by post-intervention primary patency, in failing arteriovenous fistulas (AVF) and arteriovenous grafts (AVG).

MethodsData from consecutive patients who had angioplasty as their initial intervention (primary angioplasty) from January 2015 to February 2016 in a single tertiary centre were retrospectively obtained from electronic medical records. Demographics, co-morbidities, previous access details, interventions on current access and peri-operative details were collected.

ResultsOne hundred and thirty two patients (63.3±12.4 years; 57.6% male; 87.1% AVFs) successfully underwent primary angioplasty with at least 6-months follow-up. Six-months post-intervention primary patency was 53.8%. Of the 107 patients who had 1-year follow-up, 24 (22.4%) were intervention-free at 1-year. Multivariate Cox regression analysis with backward elimination demonstrated that the presence of ipsilateral previous access (HR, 1.99; 95% CI, 1.31-3.01; p=0.0012), shorter primary patency (HR, 1.49; 95% CI, 1.00-2.22; p=0.0498) and central stenosis (HR, 1.62; 95% CI, 1.01-2.60; p=0.0469) were associated with reduction in the durability of primary angioplasty.

ConclusionThis study suggested that primary angioplasty can effectively salvage a failing haemodialysis access with reasonable post-intervention primary patency. In this series, shorter primary patency, ipsilateral previous access and presence of central stenosis were associated with decreased primary angioplasty durability.

02-02Endovascular management of central vein stenosis in haemodialysis access patients. When and what surveillance imaging is appropriateHaider Bangash1, Dr Kalpa Perera1, Ms Monique Sandford1, Mr Nishath Altaf1, Professor Patrice Mwipatayi1, Mr Patrick Tosenovsky1

1Royal Perth Hospital, Perth, AustraliaBackground/IntroductionCentral vein stenosis can be the Achilles heel of haemodialysis fistulae, and are often resistant to endovascular treatment. There is no evidence-based consensus guideline in the literature on optimal surveillance after intervention in this area. The aim of our study was to assess follow-up practices in a large metropolitan tertiary hospital in view of developing a protocol regarding frequency and type of post-intervention imaging.

ObjectivesPrimary outcome measure – primary patency.Secondary outcomes- primary assisted patency.

Materials and MethodsData was collected retrospectively using the Western Australian Nephrology Database (WAND), patients’ hospital notes and the WA radiology PACS. The study period extended from 2011-2015 inclusive. Data was analysed for type of intervention, location, and short-term primary and secondary patency.

ResultsFrom a total of 696 fistulograms, 50 cases (53 lesions) were included in our study. The majority of lesions (41) were treated with PTA only; and 12 lesions were stented. Twenty-seven lesions (50.9%) involved the cephalic arch, with the next most common being the brachiocephalic vein (19 lesions, 35.8%). Overall primary patency was 54.9% and 48%, at 3 months and 12 months respectively. Primary assisted patency was 66.7% (3 months) and 37.5% (12 months). PTA alone performed better than primary stenting at both 3 (72.3% vs 54.9%) and 12 months (62.5% vs 48%).

ConclusionThere is no consistent, standardised surveillance program employed in this cohort of patients. Our findings suggest that imaging should be performed at the initial 3-month point, and likely even earlier in patients with primary stenting.

02-03Treatment strategy for cephalic arch stenosis in patients with brachiocephalic arteriovenous fistulaKW Yoon1, Yang-Jin Park1, SY Woo1, SH Heo1, YW Kim1, DI Kim1


Background/ObjectivesCephalic arch is a common region of stenosis development which causes the access dysfunction of arteriovenous fistula. Both percutaneous angioplasty (PTA) and surgical cephalic vein transposition (CVT) can be adopted to treat cephalic arch stenosis (CAS). In this study, prevalence of CAS and efficacy of two treatment strategies were evaluated.

Material and methodsBetween January 2011 and May 2016, 462 patients were underwent brachiocephalic arteriovenous fistula (BCAVF) formation. Postoperative surveillances with duplex ultrasound (DUS) were conducted in all patients at 1 month and thereafter with 3- or 6-month interval. Treatment indications of CAS were following: more than 25% reduction of flow volume, increased venous pressure, occurring hemostasis problem of puncture site, and acute thrombotic occlusion.

ResultsSeventy-seven (16.7%) of CAS among 462 of BCAVF were detected during the follow-up periods (median 29 months, range 4.9-60.2). Details of treatment were summarized in Figure. In brief, thirty-six PTA and 6 CVT were performed as initial management. Seven CVT followed by PTA, were included to CVT group and considered to patency termination of PTA. Finally, thirty-six PTA and 13 CVT were compared. CVT showed significantly higher primary patency (90% vs. 59.1%, P=0.012), assisted primary patency (100% vs. 58.4%, P=0.01), and secondary patency (100% vs. 62.9%, P=0.015) at 6 months, as well as assisted primary patency (87.5% vs. 47.2%, P=0.016) and secondary patency


(100% vs. 47.0%, P<0.01) at 12 months. There was no significant difference in 12-month primary patency between two group (40% vs. 37.2%, P=0.508). There were three (5.5%) procedure-related complications in PTA group (rupture 2, hematoma 1), whereas no complication in CVT group.

ConclusionsCAS is not rare cause of malfunctioning BCAVF. For the treatment of frequently recurring CAS after PTA, CVT should be considered to achieve better longer-term patency in patients with CAS.

02-04Rescue of Transplant Kidney by Endovascular RevascularisationRajendra Prasad Basavanthappa1

1M S Ramaiah Medical College & Hospitals, Bangalore, India

BackgroundTransplant renal artery stenosis (TRAS) is a recognized, potentially curable cause of post transplant arterial hypertension, allograft dysfunction, and graft loss. Although non-invasive imaging can detect an underlying stenosis, angiography with subsequent angioplasty or stenting, or both, provides definitive diagnosis and treatment.

With the introduction of alternative contrast agents and newer catheter and stent technology, these procedures can be performed safely with little risk of contrast induced nephropathy or allograft loss

Objectives The aim of this study was to assess the safety and efficiency of TRAS endovascular therapy.

Material & Methods All cases of Transplant renal artery stenosis admitted for treatment in our hospital from September 2012 to January 2015 were reviewed retrospectively. The primary end point was stenosis free primary transplant renal artery patency. Secondary end points were freedom from re-intervention, graft survival, post operative serum creatinine level, blood pressure evolution, and the number of Anti–hypertensive drugs pre and post procedure. Demographics, perioperative data, and transplant function outcomes were extracted and analyzed.

ResultsOur study included 15 patients (62% men), with mean age of 50.1 yrs, 12 patients presented to us increase in hypertension, 2 patients with worsening renal function. 14 of them underwent PTA +/_ stenting. There was 67% improvement in renal function noted with 6.6% morbidity at the end of 30 days. Follow up period was 2 years.

There were no periprocedural deaths. Blood pressure control in patients with renovascular hypertension was significantly better

ConclusionPercutaneous Transluminal Angioplasty (PTA) +/- stent is a good and widespread therapeutic approach for the treatment of TRAS due to its acceptable complication rate and high technical success rate

02-05Clinical experience of arterial cystic adventitial diseaseChi-Woo Lee1, Kyoung-Won Yoon1, Dr. Seon-Hee Heo1, MD, PhD Young-Wook Kim1, MD, PhD Yang-Jin Park1, MD, PhD Dong-Ik Kim1

1Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

BackgroundArterial cystic adventitial disease (CAD) is a rare cause of intermittent claudication and nonatherosclerotic condition without cardiovascular risk factors. The etiology and treatment of CAD have remained controversial. The purpose of this study was to analyze the results of surgical treatment in arterial CAD.

MethodsWe retrospectively reviewed 18 patients with arterial CAD who have undergone surgical treatment in our hospital from 2006 to 2016. All of the patients were diagnosed with using both computed tomography and duplex sonography. Only 1 patient was performed by adding magnetic resonance imaging.

ResultsThere were 16 (88.9 %) patients in men and median age was 50.5 years old. The popliteal artery was the most commonly involved artery (88.9 %) and left side was more commonly involved rather than right side (66.7 % vs 33.3 %). There were 17 (94.4 %) symptomatic cases with claudication (16 cases, 88.9 %) or swelling (1 case, 5.5 %). Only one patient had not any symptoms related with CAD. 12 (66.7%) patients were treated with cystic resection only, 5 (28%) patients were underwent bypass with saphenous vein reconstruction, 1 (5.5%) patient was underwent bypass with synthetic graft reconstruction. Recurrence was observed in 2 (11.1 %) patients who underwent cystic resection only.

ConclusionThis study was conducted with small group of patients, so further comparative study with large group patients might be required.

02-06Management of splenic artery aneurysm-open surgery vs endovascular treatmentNaoki Hayashida1, Dr Souichi Asano1, Dr Hasegawa Hideomi1, Dr Yutaka Wakabayashi1, Dr Takuto Maruyama1, Dr Masashi Kabasawa1, Dr Masanao Ohba1, Dr Matsuo Kozuou1, Dr Kazuhiro Murayama1

1Chiba Cerebral and Cardiovascular Center, Ichihara, Japan

PurposeEndovascular treatment of splenic artery aneurysm has increased recently. We compared the results of open surgery and endovascular treatment.

SubjectsSeven patients with splenic artery aneurysm were treated in our hospital between 1999 and 2016. The male to female ratio was 4:3. The mean age was 61.7 years old. They are all asymptomatic. The indication of treatment is the patient with aneurysm diameter

Oral Presentation


larger than 20mm. The mean aneurysm diameter was 30.1 mm. The patients were divided into two groups: open surgery group (OS group, 4 cases) and endovascular group (EVT group, 3 cases). In OS group, aneurysmectomy with ligation in 2 cases and aneurysmectomy with reconstruction in 2 cases were pwerormed. In the EVT group, coil embolization was performed in all cases.

MethodsOperative mortality, operation time, intraoperative blood loss and hospital stay were compared between OS and EVT group.

ResultsThere was no operative death and hospital death in both groups. Operation time was 231 minutes in OS group and 220 minutes in EVT group. Intraoperative blood loss was 342 g in OS group and 10 g in EVT group (p<0.01). Hospital stay was 13.5 days in OS group and 6.7 days in EVT group（p<0.01（. The four cases had partial splenic infarction. In EVT group, the size of aneurysm was decreased in one aneurysm and that of the remaining 10 aneurysms was not changed (follow-up period: 57.3 months).

ConclusionsEndovascular treatment of splenic artery aneurysm was less invasive than open surgery in terms of intraoperative blood loss and hospital stay. The size of sac in endovascular treatment was not increased in the mid-term. The first line therapy of splenic artery aneurysm may be endovascular treatment from these results.

02-07The Impact of Serum Uric Acid Level on Arterial Stiffness in Chinese Essential Hypertensive PatientsJie Liu1, Dr. Senhao Jia1, Dr. Xin Jia1, Dr. Yong Huo2, Dr. Wei Guo1

1Chinese PLA General Hospital, Beijing, China, 2Peking University First Hospital, Beijing, China

AbstractBackground and objectives: The aim of the study is to investigate whether serum uric acid is associated with arterial stiffness (as measured by brachial-ankle pulse wave velocity (baPWV)) in Chinese hypertensive subjects.

MethodsParticipants were selected among 22693 candidates from two large population-based cohort-studies. Multiple linear and logistic regression models were used to evaluate the association between serum uric acid level and brachial-ankle PWV.

ResultsThere was a significant different baPWV between males and females(p < 0.0001, respectively). Both male and female subjects with hyperuricemia showed higher baPWV than subjects without hyperuricemia (p< 0.001 for males; p< 0.001 for females). In multivariate-adjusted model, serum uric acid level in male subjects was signifi¬cantly correlated with baPWV (β=0.14, p < 0.05) and there was statistically significant association between serum uric acid level and baPWV in females (β=0.17, p <0.001).Moreover, multivariate logistic analysis between serum uric acid level as a categoriy variable and baPWV was performed the association between UA and high baPWV was statistically significant, and statistical significance was maintained in both male and female.

ConclusionsSerum uric acid level could be considered an important risk factor for arterial stiffness in Chinese hypertensive subjects, whereas more studies are needed to confirm this result.

02-08Computational Fluid Dynamics Modelling in Aortic Diseases: A Systematic Review Chi Wei Ong1, Leo Hwa Liang1, Andrew MTL Choong2,3

1Department of Biomedical Engineering, National University of Singapore, Singapore, 2Division of Vascular Surgery, National University Heart Centre, Singapore, 3School of Medicine, Griffith University, Gold Coast, Queensland, Australia

BackgroundThe correlation between flow and aortic pathology through Computational Fluid Dynamics (CFD) shows promise in predicting disease progression, the effect of stent implantation and guiding patient treatment.

ObjectivesTo systematically review the published literature describing CFD in aortic diseases and their treatment.

MethodsAn electronic search of the literature in four electronic databases (Pubmed, Ovid, Cochrane, and Scopus) was performed according to the PRISMA guidelines. Animal models, studies relating to cardiac valve or aortic cannulation were excluded.

Results637 articles were retrieved, 134 duplicates removed. The majority of studies focused on abdominal/thoracic aortic aneurysms, aortic dissection and aortic coarctation.

Aortic AneurysmsIn addition to standard diameter measurements for assessment of growth and aneurysm rupture risk, hemodynamic parameters specific to CFD studies such as increase of wall shear stress (WSS) gradient and low oscillatory shear index were found to be related to aneurysm growth.

DissectionCFD has demonstrated that aortic dissection can produce abnormal flow patterns such as disturbed laminar flow and recirculation regions. These may predict aneurysmal degeneration. It may also assist in deciding who benefits most from early intervention.

CoarctationCFD analysis shows the abnormal vortical flow in the distal aortic arch with elevated WSS found due to the presence of aortic coarctation. The elevated WSS are known to cause degeneration of vessel wall and endothelial dysfunction. Alteration of WSS after successful repair with CFD studies may help to evaluate the treatment outcome.

ConclusionsContemporary evidence shows that CFD can provide additional hemodynamic parameters such as WSS, vorticity, disturbed laminar flow and recirculation regions in untreated and treated


aortic disease. These may eventually predict disease progression, guide the choice and timing of treatment to the benefit of patients and clinicians alike.

02-09Comparison between percutaneous internal jugular vein puncture versus surgical venous cutdown in insertion of totally implantable venous access deviceJungSik Choi1, Keunmyoung Park1, MD YoonMi Choe1, MD Yongsun Jeon2, MD SoonGu Cho2, MD Kee Chun Hong1

1Department of Surgery, Inha.university Hospital, Jungu, South Korea, 2Department of Radiology, Inha.university Hospital, Jungu, South Korea

Introduction Totally implantable venous access devices (TIVADs) are commonly used in pediatrics for the administration of chemotherapy, antibiotics or parenteral nutrition. The implantation of a TIVAD can be inserted by various techniques, including surgical venous cutdown and percutaneous approaches. Recently, Percutaneous TIVAD became popular like adult. So that, we compared primary success rate, procedural time, perioperative and postoperative complication.

Materials Method Data have been collected and analyzed retrospectively from total 22 TIVADs performed in Inha University hospital from September 2013 to August 2015. We examined clinical charatericstics (age, sex, indication for TIVAD) and insertion technique (insertion vein, percutaneous or cutdown and ultrasound guidance). And we divided two group and compared between percutaneous puncture (PP) and surgical cutdown(SC) group by insertion technique. The primary endpoints are the success rate and procedural time, secondary endpoints are perioperative and postoperative complications between two group.

Results10 TIVADS were inserted by percutaneous puncture (PP) and 12 TIVADs were inserted by surgical cutdown (SC). There was no statistically significant imbalance in patients characteristics between two group. Procedural time of PP group was shorter than that of SC group but there wasn’t statistically significance (28.5 min (PP) vs 36.3 min (SC) p=0.13). Reposition during insertion were in 4 cases (PP(1 case) vs SC(3 cases). Follow-up duration, there were 1 occlusion in SC group and 1 infection in PP group.

Conclusion Percutaneous puncture of IJV appears to be the method of choice for TIVAD insertion, owing to a similar success rate of implantation and complication compared with surgical cutdown.

02-10Treatment of Iatrogenic Refractory Femoral Artery Pseudoaneurysm with Angioseal Vascular Closure Device: A Novel TechniqueEu Jhin Loh1, Dr Robert Allen1, A Prof John Cockburn1

1ACT Health, Garran, AustraliaIntroductionA common complication of transfemoral procedures is femoral pseudoaneurysm with an incidence of approximately 1%. The failure rate of US-guided thorombin injection has been reported to be 4%-9%. It is postulated that the formation and recurrence of pseudoaneurysms might be related to severe calcification in the femoral arteries that may inhibit the healing of vascular wall after cannulation. Thrombin injection induced thrombosis and temporary discontinued blood flow in the cavity of pseudoaneurysm has no effect on the healing of the vessel wall. The recurrence of pseudoaneurysm is due to impulse of blood pressure breaking through a new tunnel. Treatment options include traditional surgical repair, percutaneous intrapseudoaneurysm thrombin injection, embolization and covered stents.

MethodsWe report a case series of 10 patients who had refractory iatrogenic femoral artery pseudoaneurysm after multiple failed attempts at ultrasound guided thrombin injection. Surgical repair would have been a reasonable choice, however was refused by the patient. We offered a novel approach and informed consent for “off label” use of the vascular closure device was obtained prior to the procedure. A 21 gauge puncture needle was advanced into the neck of the pseudoaneurysm with placement confirmed via ultrasound. A guidewire was passed through via a transradial vascular dilator and retrograded up the external iliac artery. An 8-F Angioseal set was then deployed with the footplace in the femoral artery and collagen plug intended to be deployed in the neck of the pseudoaneurysm.

ResultsUS showed immediate closure and follow-up scans were obtained at 1 day, 7 days, 1 month, 2 months and 12 months after the procedure demonstrated successful closure without further recurrence.

ConclusionOur case series demonstrates the effectiveness and safety of using an Angioseal vascular closure device as an alternative to surgical repair for refractory iatrogenic femoral artery pseudoaneurysm.

02-11Duplex Guided Thrombin Injection versus Compression Treatment of Femoral Artery Pseudoaneurysm. KSUMC ExperienceMussaad Alsalman1


ObjectivesFemoral Artery Pseudo-aneurysms have traditionally been treated surgically and also by Duplex Guided Compression which is time consuming, painful & sometimes unsuccessful procedure. Duplex Guided Thrombin Injection treatment has been advocated as a superior alternative. In this we compare our experience with both techniques in terms of success rate and complications.

Oral Presentation


MethodsUltra Sound Guided Compression Repair of Post Cath Femoral Pseudo-aneurysm a Prospective, non-randomized study done from Feb 1999 to march 2002 is compared with Duplex Guide Thrombin Injection Repair of Post Cath Femoral Pseudo-aneurysm a Prospective, non-randomized study started from June 2003 to December 2015. Both the groups have similar Demographics and Aneurysm sizes.

ResultsUltrasound guided compression repair the femoral pseudo-aneurysm cause in 62% was related to Cardiac Cath related procedures and others were due to femoral access for Arteriography 27% and Renal dialysis related procedures in 11%. The compression repair was successful in 81% and failed were treated surgically. Hypertension, Anticoagulation and Aneurysm size were the predictors of failure. Compression required multiple sessions (1-3) average of 30 minutes and procedure was uncomfortable & painful, needed analgesia.

Duplex guided thrombin injection repair, the femoral pseudo-aneurysm cause in 68% Cardiac Cath related procedures and others were due to femoral access for Arteriography 21% and Renal dialysis related procedures in 11%. Thrombin injection successfully treated all the pseudo-aneurysm with success rate of 100%. Hypertension, Double antiplatelet, Anticoagulation and Aneurysm size does not hinder the successful repair of pseudo-aneurysm. Thrombosis occurred within seconds of the thrombin injection required an average of 500 tO 1500 units and procedure was comfortable and analgesia was not required.Neither group had complications

ConclusionsDuplex guided thrombin injection is safe, fast, painless, effective treatment even in patients with hypertension and patient on double antiplatelet and anticoagulant medications that completely obliterated femoral pseudo-aneurysm. .

03-01Development of novel stent-grafts composed of bioresorbable Poly-L-lactic acid scaffold stents and decellularized porcine blood vessels by tissue-engineering technologyTatsuya Shimogawara1, Kentaro Matsubara1, Hideaki Obara1, Hirokazu Yamada2, Kazuki Tajima1, Hiroshi Yagi1, Yuko Kitagawa1

1Keio University School Of Medicine, Shinjukuku, Japan, 2Kyoto Medical Planning Co., Ltd, Kyoto city, Japan

BackgroundThe large numbers of several aortic diseases are treated with Endovascular aortic repair (EVAR) due to its minimal invasiveness. However, it is rarely utilized for infectious aortic diseases because of long term infectiosity of permanently implanted stent-graft.

ObjectivesThe goal of our research is to create a novel stent-graft composed of bioresorbable stents (BRS) and decellularized porcine blood vessels, expecting the disappearance of residual foreign material and the intimal fixation with own aortic wall. The aims of this study are to assess the characteristics of decellularized scaffolds and novel stent-graft, and to evaluate short term compatibility after implantation in porcine model.

Materials and methodsPorcine iliac arteries and veins were harvested and stored at -80°C until decellularization. After thawing, the vessels were decellularized with SDS and Triton X-100. The characteristics of the scaffolds were evaluated by means of histology, DNA quantification and tensile strength test. The decellularized vein was sutured inside the BRS, creating a tissue-engineered stent-graft. A surgical interposition grafting of porcine iliac artery was performed to assess the early compatibility of stent-graft prior to utilization for endovascular treatment, and stent-graft was evaluated with radiological and histological methods.

ResultsHistological analyses of the scaffolds revealed acellular features and well-preserved extracellular matrices. The DNA quantification showed more than 97% reduction as compared to fresh vessels. Veins were selected as the graft component due to its mechanical strength preservation. Surgical interposition grafting was successfully performed, and radiological evaluation with digital subtraction angiography and IVUS revealed the stent-graft maintaining its patency and morphology. The inner surface of the stent-graft was widely covered with endothelial cells.

ConclusionsA tissue-engineerd stent graft composed of BRS and decellularized vein showed permissive patency and endurance in short-term implantation in animal model.

03-02Retrospective Analysis of Primary Patency of Vascular Acess Maturity: A Single Centre Experience at HTAA, Kuantan, MalaysiaAbdul Rahman M N A1, Raja Othman R S1, Nurul Najwa MS1, Kamarizan M F A2, Faidzal Othman1

1Vascular Unit, Department of Surgery, Kulliyah(Faculty)Of Medicine, International Islamic University Malaysia, Kuantan, , Malaysia, 2Department of Surgery, University Hospital of Wales, Cardiff, , United Kingdom Keywords Arteriovenous fistula; vascular access; maturity

Introduction Arteriovenous fistula (AVF) has been proven to be the best vascular access for the purpose of haemodialyis due to its’ longevity and robustness. Unfortunately, despite of its’ popularity in Malaysia, there is a limited local data being published. HTAA is a main referral center for AVF creation for the east coast of Malaysia. We examined our data for primary patency rate and possible factors that may associates with it.

Methods Patients who underwent AVF creation created by a single surgeon from July 2012 to July 2013 in Hospital Tengku Ampuan Afzan (HTAA), Kuantan were identified using theatre list and also logbook. Data were collected retrospectively from the patients’ medical notes. A total of 89 patients were identified. Primary patency rate is being assessed at 6 weeks. Statistical analysis performed using SPSS® v20.


Results The patient’s median age of the patients was 53 years with a slight male predominance (53%). Majority of the subjects have no history of tobacco use (71.4%). The Malays make up the majority in ethnicity (79.6%). 53.1% and 18.4% have underlying diabetes mellitus and obesity respectively. Brachio-cephalic fistulas (BCF) are the majority of AVF (71.4%) that were created. 78% of our patients had already been diagnosed with ESRF and 59% was already on dialysis upon AVF creation. 57.1% of the subjects are statins users. The mean diameters of artery and veins are 2.56mm and 2.94mm respectively. Our primary patency rate is 87.8%. Multivariate analysis shows no significance between the demographics and maturity but a suggestive association of venous diameter and statins with primary patency rate with p values of 0.06 and 0.07 respectively.

ConclusionThis study described a comparable success rate of AVF creation at our centre in to other published data. We have identified, venous diameter and statins use have a positive trend with primary patency rate of our AVF in a multivariate analysis.

03-03Prevalence of heparin-induced thrombocyto-penia according to 4T score in single institution of Korea from large scale databaseAssistant Professor Hun-Sung Kim1, BCPS Hyunah Kim2, RN Yoo Jin Jeong1, M.S. Hyunyong Lee1, MD PhD Hyeon Woo Yim1, Professor Seung Nam Kim1, Professor Ji il Kim1, Professor In Sung Moon1, Associate Professor Yong Sung Won1, Professor Sang Seob Park1, Associate Professor Sun Cheol Park1, Assistant Professor Jeong Kye Hwang1, Clinical Professor Kang Woong Jun1, Clinical Professor Mi Hyeong Kim1, Clinical Fellow Hyun Kyu Kim1, Jang Yong Kim1

1The Catholic University of Korea, Seoul, South Korea, 2Sookmyung Women’s University, Seoul, South Korea

IntroductionsHIT occurs due to heparin induced antibody in 0.5-5% of patients with heparin. Instead, 4T’s score is recommended for diagnosis of HIT. Those have high 4T score are likely to be diagnosed as HIT. This study is to evaluate prevalence of HIT using 4T scores and clinical characteristics among patients medicated different kinds of heparin.

Methods This is a retrospective study from large-scaled retrospective cohort study conducted on patients over 18 years old in the Seoul St. Mary’s hospital in Korea from January 2009 to December 2014. Patients who were injected heparin more than 96hours was enrolled.Those who had received a surgery within 72 hours after heparin injection were excluded. Patients who have Platelet counts before and after heparin included. To evaluate the probability of HIT, the study used 4T scoring. “Acute thrombocytopenia” was defined as platelet count decreased of >50% and nadir ≥ 20,000/mm3 (2 points), and 2 points was added when onset timing was between day5-day10 after administration of heparin.

Results6,046 patients were enrolled from 18,405 patients who prescribed heparin. Among 6,046 patients, HIT occurred 641 cases (10.6%, 641/6,046), The UFH showed the highest rate of incidence with 13.9% (559/4,030), while dalteparin had 11.5% (13/113) and enoxaparin had 3.9% (69/1760). No HIT was occurred in Fondaraprinux and Nadroparine.

ConclusionHIT occurred in 10.6% according to 4T score, which is a significant number. Also this study showed lack of awareness of HIT in clinical practice. Clinicians need to understand HIT when they prescribe heparin and follow up of patients with platelet count. This study is limited by study design using 4T score and retrospective study.

03-04Combined treatment of facial vascular malformations with embolization and surgical resection (serial case)Tom Christy Adriani1, MD Raden Suhartono1


Background and objectivesArteriovenous malformations (AVM) is one of the subtypes of vascular malformations in the vascular anomalies system, as stated in the Internationa Society for Study Anomalies (ISSVA) 2015. AVM has many options for therapy and can be a life-threatening problem if the treatment does not suit the clinical features. To provide data for the future research and effective therapy, we design a review on a retrospective study to look at how many patients have been treated in which treatment.

MethodsData of patients with facial AVM were collected from the Cipto-Mangunkusumo Hospital from 2013 to 2015 (n=179). The patiens were grouped as Male and Female. The therapies were divided into 8 categories (embolization, angiography, angioplasty, surgical excision, ligation and sclerotherapy injection).

ResultsIn 2013, there was 56 cases in total and the highest 26% of cases were female underwent surgical excision. Different in 2015, which were around 30% of cases were female treated with embolization. The greatest number of facial AVM cases came up in total 70, in 2014. Most combined therapy options used was embolization followed with surgical excision in both male and female.

ConslusionsThis review only provides data of total patients and the treatment within 3 consecutive years but still can be a point of departure for the future clinical studies for AVM and the choice of therapies.

Oral Presentation


03-05The Western Australian Gore Iliac Branch Endoprothesis Early ExperienceWah Wah Lin1, Mr Stefan Ponosh2, Mr Marek Garbowski2, Mr Joe Hockley2, Dr Shirley Jansen2, Mr Richard Bond1, Mr Carsten Ritter1, Mr Kishore Sieunarine3

1Fiona Stanley Hospital, Perth, Australia, 2Sir Charles Gairdner Hospital, Perth, Australia, 3Royal Perth Hospital, Perth, Australia

IntroductionThe presence of a common iliac artery (CIA) or internal iliac artery (IIA) aneurysm represents a challenge in the management of conventional endovascular abdominal aortic aneurysm repair (EVAR). The development of iliac branching devices has appealed the challenges and complications due to the ectatic or aneurysmal iliac arteries.

ObjectivesThe Gore Excluder lilac Branch Endoprosthesis (IBE) has been approved for the endovascular treatment of aneurysms involving the common iliac arteries in November 2013. It promotes a simple deployment system, low profile technology, and long-term durability. However, there is a paucity of studies investigating its technical difficulties and patency of the graft. The aim of this study is to summarize the WA experience regarding complications and patency of the Gore IBE graft.

Materials and MethodsAn observational retrospective medical record and medical imaging review of patients with aneurysmal disease involving one or both common iliac arteries who underwent endovascular repair with Gore IBE graft at the three Western Australian tertiary hospitals.

Results13 cases were identified. All patients were men. The average age was 71.5 years (range 51-84 years). Of these, 11 cases were single IBE and 2 cases were bilateral IBE. The average (mean) size of the common iliac artery aneurysm was 4cm. There was a 100% technical success and 100% clinical success with the average (mean) length of stay in hospital of 5 days. There were not intraoperative IBE related complications, however, 3 cases needed a contralateral embolectomy. 100% patency of the iliac branch and no clinical problems were identified over mean of 7 months follow up.

ConclusionOur early experience with the Gore IBE graft shows excellent early patency rates without any technical failures. This would suggest that it is a feasible alternative to other iliac branch devices on the market.

03-06A randomised controlled trial on the outcome in comparing alginate silver dressing with conventional treatment of necrotizing fasciitis woundJarernchon Meekul1, Associate Professor Arnon Chotirosniramit1, Woraluck Himakalasa2, Antika Wongthanee3, Professor Kittipan Rerekasem3,4

1Maharaj Nakorn Chiang Mai Hospital , Chiang Mai, Thailand, 2Faculty of Economics, Chiang Mai University, Chiang Mai, Thailand, Chiang Mai , Thailand, 3 NCD Center of Excellence, RIHES, Chiang Mai University, Chiang Mai, Thailand, Chiang Mai, Thailand, 4 NCD Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, Chiang Mai, Thailand

BackgroundNecrotising fasciitis(NF) is a rapidly progressive soft tissue infection and consequently high morbidity and mortality. Vascular surgeons need to involve this pathology frequently because it is commonly occur in diabetic-ischemic foot. Debridement and wide open is an essential part of NF treatment and these lead to large wound. So far the best type of wound dressing is still controversial.

ObjectiveTo compare the result of wound dressing in NF wound between saline dressing and silver dressing

MethodA prospective randomised controlled trial was conducted in our center. The patients, who underwent debridement due to NF between April2013 and May2016, were randomised to have wound dressing using either saline dressing(group A) or silver dressing(group B). The main outcome was collected in 3 outcomes: the duration for wound bed preparation (duration of wound bed ready to skin graft or closure), cost and length of hospital stay.

Result39 consecutive patients were included in this study. There were 25 male and 14 female. There were 19 patients in groupA and 20 patients in groupB. The mean area was not significantly different between two groups (285.16 cm2(groupA)and 215.75 cm2(groupB) respectively (P = 0.38). The mean duration of wound bed preparation was longer in groupA(31.87days) than those in groupB(21.39days), but this trend was not statistically significant(P=0.057). The mean cost of treatment in groupA and groupB was not different(P =0.434 ). (3308.8 USD(groupA) and 2647.8 USA(groupB). Length of hospital days in two groups was not significantly different either (29.19 days(groupA) and 20.99 days (groupB)( P=0.22) . ConclusionAlthough Ag dressing is usually expensive, but the cost of treatment and the duration of hospital stay were not significantly different between groups. However the duration of wound bed preparation show trend favor toward silver dressing group. More data will shed more light on this field.


03-07Remote ischemic preconditioning enhances the gene expression of antioxidant enzymes and endoplasmic reticulum stress–related proteins in rat skeletal muscleUijun Park1, PhD Hyoung Tae Kim1, PhD Won Hyun Cho1, PhD, RN Min Young Kim2

1Keimyung University , South Korea, 2Ulsan University, , South Korea

BackgroundIschemic preconditioning (IPC), including remote IPC (rIPC) and direct IPC (dIPC), is a promising method to decrease ischemia-reperfusion (IR) injury. This study tested the effect of both rIPC and dIPC on the genes for antioxidant enzymes and endoplasmic reticulum (ER) stress–related proteins.

MethodsTwenty rats were randomly divided into the control and study groups. In the control group (n=10), the right hind limb was sham-operated. The left hind limb (IscR) of the control group underwent IR injury without IPC. In the study group (n=10), the right hind limb received IR injury after 3 cycles of rIPC. The left hind limb received IR injury after 3 cycles of dIPC. Gene expression was analyzed by qPCR from the anterior tibialis muscle.

ResultsThe expression of the antioxidant enzyme genes including GPx, SOD1 and CAT were significantly reduced in IscR compared with sham treatment. In comparison with IscR, rIPC enhanced the expression of GPx, SOD2, and CAT genes. dIPC enhanced the expression of SOD2 and CAT genes. The expression of SOD2 genes was consistently higher in rIPC than in dIPC, but the difference was only significant for SOD2.

The expression of genes for ER stress–related proteins tended to be reduced in IscR in comparison with sham treatment. However, the difference was only significant for CHOP. In comparison with IscR, rIPC significantly up-regulated ATF4 and CHOP, whereas dIPC up-regulated CHOP.

ConclusionsBoth rIPC and dIPC enhanced expression of genes for antioxidant enzymes and ER stress–related proteins.

03-08Klippel-Trenaunay Syndrome, Presentation, Complications and Management - KKUH ExperienceMussaad Alsalman1


BackgroundKlippel-Trenauay Syndreome (KTS) is a mixed mesenchymal malformation characterized by varicose veins, venous and capillary malformation and hypertrophy of soft tissue and bone.

MethodsPresented herein is the largest series from a single center in Saudi Arabia comprised of 38 patients seen between 1990 – 2015. All 38 patients had multiple large angiomatous navie, hypertrophy of soft tissue with bone overgrowth in the lower limbs.

ResultsTwenty five males and 13 females mean age of 14.2 (ranged from 8 – 18 years). Four patients had surgery of their varicose vein, prior to the referral. All had varicose veins, ten patients had upper limb involvement, 5 patients had large bowel involvements. Most of the patients received conservative treatment. Four patients had orthopedics reconstruction of their skeletal changes. Other treatment include sclerotherapy and laser treatment.

ConclusionsKTS is rare disease, multifactorial disorder that required understanding the disease, proper investigation and management with early involvement of vascular and plastic surgeons.

03-09Open Surgical versus Endovascular Treatment for Patients with Midaortic Syndrome due to Takayasu’s ArteritisYang-Jin Park1, Pf Young-Wook Kim1, Pf Ki-Ick Sung2, Pf Young-Tak Lee2, Pf Kwang-Bo Park3, Pr Young-Soo Do3, Dr Kyung-Won Yoon1, Dr Seon-Hee Heo1, Pf Dong-Ik Kim1, Pf Duk-Kyung Kim4

1Vascular surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul , South Korea, 2Thoracic surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul , South Korea, 3Interventional radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul , South Korea, 43Vascular Medicine, Heart, Stroke and Vascular Institute in Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul , South Korea

ObjectivesTo compare treatment results of midaortic syndrome (MAS) due to Takayasu’s arteritis (TA) between surgical bypass and endovascular treatment.

MethodsWe retrospectively reviewed demographic, clinical data and arterial imaging of MAS patients from 2003 to 2016. For patients with MAS, 14 surgical bypasses including 6 anatomic aorto-aortic bypasses and 8 extra-anatomic bypasses(7 ascending aorta-to-abdominal aorta bypass and 1 axillo-femoral bypass) and 8 endovascular treatment of aortic lesion including 4 aortic stenting and 4 aortic balloon angioplasty were performed with or without adjuvant renal or mesenteric artery reconstructions. Patients (n=5) who underwent renal artery intervention only without treatment of aortic stenosis were excluded from the analysis. Surgical complications and postoperative events including recurrence of preoperative ischemic symptom, occlusion or critical (>70%) restenosis of the treated artery and requirement of reintervention were investigated during the follow-up period of 84.4 mo (median, IQR; 40.4-108.4mo). Event-free survival rates were compared between the surgical bypass group and endovascular treatment group.

Oral Presentation


Results140 (46%) patients showed thoracic or abdominal aortic stenosis among 307 patients with TA. Among them, critical stenosis or occlusion of aorta with or without renal artery was identified in 22 patients (median age, 47.5; IQR, 32.4-59.4 years; female, 91%) who presented with leg and/or visceral ischemic symptom (73%), medically intractable hypertension (55%), azotemia (36%). There was no operative mortality in both group while procedure-related early (<30d) complication developed more often in endovascular treatment group but was not statistically significant (25% vs. 7.1%, p=0.527). Late event-free survival rates at 1yr and 2yr was superior in open surgery group (100%, 92.3% after open surgery vs. 62.5% and 50% after endovascular treatment, p=0.017).

ConclusionsConsidering patient age and durability of an efficacy of the treatment, open surgical treatment either anatomic or extra-anatomic bypass is recommended for patients with MAS secondary to TA.

03-10Vascular Malformation and Tumors: Evolving Experience of a Vascular Surgeon in a Developing CountryAbul Hasan Muhammad Bashar1

1National Institute Of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh

ObjectivesVascular malformation (VM) is fairly common in Bangladesh. It has varying types and presentations and curative treatment is often difficult. The objective of this study was to analyze our experiences with VM in a developing country with evolution of technology.

Materials & MethodsBetween July 2012 and June 2016, a total of 1006 patients with VM were received at the vascular outpatient department. The patients ranged in age from 1 month to 45 years with a male female ratio of 1:1.1. Diagnostic work-up started with Duplex ultrasound. Contrast MRI was done for lesions with venous predominance. Lesions with arterial predominance underwent catheter angiogram with a view to identify and occlude feeders. 110 patients (10.9%), all under 10 years of age having a diagnosis of vascular tumor were enrolled in to quarterly follow-up with or without medication. 752 patients with venous predominant VM (74.7%) underwent staged sclerotherapy with or without surgical resection. 144 patients with arterial predominant VM (14.3%) were treated with transcatheter emolotherapy followed by surgical excision in selected patients. At follow-up, patients were evaluated for tumor size, recurrence and sensory motor deficits.

ResultsComplete or partial involution of vascular tumor was observed in 55% of the patients. Sclerotherapy alone proved curative in 46% patients with venous predominant VM. Sclerotherapy and embolotherapy supplemented by surgery resulted in cure for 77% of the patients. Catheter based treatment was successful in occluding feeders in 90% cases. Recurrence was high in arterial predominant VM (24%). Lifestyle limiting sensory or motor deficits was low (10%) and mostly observed in limb lesions.

ConclusionsIncidence of VM and tumors appears high in Bangladeshi population. Though curative treatment is difficult in a large number of patients, the use of newer technology can be beneficial for most of the patients when used judiciously according to lesion type.

03-11Effectiveness of embolotherapy on peripheral arteriovenous malformationsAli Reza1, dr. Patrianef2

1Surgery Department of Cipto Mangunkusumo Hospital,Indonesian University, Jakarta, Indonesia, 2Vascular and Endovascular Surgery of Cipto Mangunkusumo Hospital, Indonesian University, Jakarta, Indonesia

BackgroundPeripheral arteriovenous malformations (AVM), has the characteristic of locally aggresive. The recently treatment now is focused on embolotherapy as treatment of choice. Super selective embolotherapy using microcatheters aims to achieve ischemia of nidus for improvement sign and symptoms as well as the reduced size of the nidus itself until the total regression.

ObjectivesThis study aims to assess the effectiveness of embolotheraphy as a treatment of peripheral AVM in RSUPN Dr. Cipto Mangunkusumo in 4 years (2013-2016).

Materials and MethodsA cross-sectional retrospective study on 15 subjects AVM. Clinical symptoms before and after treatment emboli are evaluated. The clinical symptoms were assessed including pulsatile mass, pain, skin discoloration, bleeding, bruit, ulcers, and skin temperature. Percentage of nidus regression was measured through the data CT angiography before and after embolotherapy using Osirix program.

ResultsOf the 15 subjects, The AVM common lesion located on the head and neck. Clinical symptoms are most complained are skin discoloration and pulsatile mass. Embolotheraphy had been done once in 10 subjects, twice in four subjects, and three times on one subject. Single embolic material given to nine subjects, while the embolic material combinations are given in six subjects. Clinical symptoms were the most common change is the mass no longer has pulse and the change of skin color that is closer to normal color. Percentage of regression nidus were evaluated in 5 subjects about 16.9% (4-38%).

ConclusionsIn this study demonstrated that embolotherapy has potential as a treatment of choice because it is minimally invasive and is considered effective in improving sign and clinical symptoms, improve the function of the body, and can lead to regression of the nidus.

KeywordsArteriovenous malformation, embolotherapy, clinical symptoms, nidus


04-02Early efficacy of Clarivein device in treatment of varicose vein with chronic venous insufficiency - A single centre experienceSaravana Kumar, Atifah, Zainal A1Department of Surgery, Kuala Lumpur General Hospital, Jalan Pahang, Kuala Lumpur, , Malaysia

IntroductionClassical method of high saphenous vein ligation and stripping is associated with neurological damage ranging from paraesthesia to neuralgia in about 40 % of patients, visible scar, post-operative pain, prolonged return to normal activity, pelvic vein congestion, recurrence and neovascularization. Endovenous procedures such as Radiofrequency Ablation and Laser is also associated with postprocedural bruising and pain. Our aim is to evaluate the objective is to assess early efficacy of the ClariVein device in treatment of varicose veins. The secondary objective is to evaluate post procedural related complication of ClariVein including post procedural pain score.

Methods40 limbs in 27 patients (10 male and 17 female) with mean age of 51 were recruited. A single surgeon performed both the mechano-sclerotherapy (MOCA) using the ClariVein device and multiple stab avulsions (if indicated). Follow up was done at 48 hours, 1st, 3rd and 6th months post procedure. Patients were assessed based on clinical improvement in VCSS and CEAP classification, presence of complication, post-operative pain and patient recovery after the procedure. Duplex scan was done on all treated legs to identify thrombosis complete or partial, recanalization and presence or absence of reflux.

ResultThe closure rate intra-operatively and 48 hours post operatively was 100% and 98% at 1st month, 3rd month and 6th months post procedure. There is significant reduction (p<0.05) in VCSS and CEAP class post procedure. Erythema, phlebitis and ecchymosis rate were 22.5%, 7.5% and 2.5% respectively. The mean pain score post procedure was 1.65 at 48 hours post procedure and 0.3 at 1-month. The mean number of days for patients to return to normal activity was 2.1 days and return to work was 2.88 days respectively.Conclusion: Mechano-sclerotherapy (MOCA) has comparable efficacy and complication rates to other endovenous ablation therapies at 6 months post procedure.

KeywordsVaricose vein, mechanosclerotherapy, clarivein

04-03Evaluating the effect of compression stocking on Venous Hemodynamic in Chronic Venous Insufficiency using Air Plethysmography Feona Sibangun Joseph, Nurul Rauf, Dr Datuk Zainal Ariffin Azizi1Hospital Kuala Lumpur, Kuala Lumpur, Malaysia

IntroductionCompression stocking has been used for treatment in chronic venous insufficiency for many years. It often becomes the first line in treatment of chronic venous insufficiently (CVI). To date, the effectiveness of compression in treating chronic venous insufficiency is still debatable. The effect of compression stocking is commonly assessed by patient’s symptoms and clinical examination and are mostly based on a qualitative assessment. Another method of assessing the effect of elastic compression is by looking into the venous hemodynamic quantitatively. A number of studies were done to assess the effect of the compression stocking to venous hemodynamic to this group of patients via different methodologies.

ObjectiveTo evaluate the quantitative effect of class 2 compression stockings on venous hemodynamic flow for grade 2 and 3 chronic venous insufficiency (CVI) at baseline and at 6 weeks of compression by using air plethysmography.

Methods46 limbs in 29 patients (15 women and 14 men) with a mean age of 55 years old with grade 2 and 3 CVI were evaluated. Duplex examination scanning was done to exclude the presence of deep vein insufficiency or thrombosis.18 limbs were classified into CEAP 2 and 28 limbs into CEAP 3. Assessment using air plethysmography were taken at 3 assessment periods; before wearing stocking (T0), after 6 weeks using stocking (T1) and 1 hour after removal of stocking (T2). Patient symptoms were evaluated using a venous score scoring system (VCSS) before and after 6 weeks of continuous usage of compression stockings.A paired T-test and Wilcoxon Rank T were used for statistical analysis with P <0.05 indicating statistical significance.

ResultClass 2 compression stocking improved venous hemodynamic efficiently. Venous volume was decreased from 157.42ml at T0 to 126.41ml at T1 (p <0.05). Venous flow index reduced from 2.8 ml/s to 2.2ml/s at T0 and T1 respectively. Compression stocking potentiate the ejection fraction from 44.05% at T0 to 49.12% at T1 (p <0.05). Residual volume also were decrease from 49.98 %to 43,04% but was not statistically significant.

ConclusionClass 2 Compression stocking improve venous hemodynamic in patients with venous insufficiency after 6 weeks of continuous usage. The result showed the benefit of compression only upon wearing them.

KeywordsAir Plethysmography, Venous insufficiency, Compression stocking

Oral Presentation


04-04Arterial Revascularization for Radiation ArteritisHironobou Fujimura1, Dr Takashi Shintani1

1Toyonaka Municipal Hospital, Toyonaka, Japan

BackgroundRadiation therapy for cancer sometimes causes vascular occlusion lately, known as radiation arteritis. However, it is also known that arterial revasculatization for radiation arteritis is very difficult and has high complication rate.

ObjectivesFrom our experieneces, we discuss the best methods for that.

Material and MethodFrom 2005 we experienced five cases, ten times of arterial reconstruction fo radiation arteritis. All cases had iliac lesion disease. Two hemi-iliac cases without groin radiation inflammation were treated extra-anatomical (femoro-femoro) bypass. Procedure was performed safely and haslong time patency (7.8 years primary patency, respectively). In two cases we performed percutaneous transluminal angioplasty with stenting. The lesion of radiation arteritis were easy to pass by guidewire but hard to expand by balloon catheter, resulting restenosis was occurred in 1, 4 years. We performed reintervention using high pressure balloon cathetel. One has 4 years patency but another carused arterial rupture. Last one case showed up to femoral occlusion and we performed endoarterectomy with iliac intervention. This case showed repeated restenosis in short time (1, 1.5 year), we performed repeated operations.

Results and ConclusionsThe best method for arterial reconstruction for radiation artetitis is extra-anatomical bypass performed by avoiding direct incision. Percutaneous transluminal angioplasty with stenting was possible but long time patency is not expected. Direct procedure is most avoitable for radiation arteritis.

04-05Small infrarenal aortic diameter associated with lower-extremity peripheral artery disease in Chinese hypertensive adultsJie Liu1, Dr. Wei Guo1


Background and objectivesSeveral studies suggest that infrarenal aortic diameter is associated with lower-extremity peripheral artery disease (LE-PAD) in patients with AAA as well as those with small or enlarged non-aneurysmal aortas. However, data regarding the associations between infrarenal aortic diameter and LE-PAD are limited, especially in large sample populations and Asian or Chinese populations.

Methods Our analysis included 17290 Chinese hypertensive adults comprising 6590 men and 10700 women with a mean age of 64.73 ± 7.41 years. Participants were selected among 22693 candidates

from two large population-based cohort-studies. The primary noninvasive test for diagnosis of LE-PAD is the ankle–brachial index (ABI) at rest and typically an ABI ≤ 0.90 is used to define LE-PAD.

Results The prevalence of LE-PAD was 3.51% and the proportion was found to significantly decrease as the aortic diameter increased according to the tertile of the aortic diameter (lowest tertile vs. median tertile vs. highest tertile: 5.20% vs. 2.80% vs. 2.6%, respectively. p<0.001). LE-PAD was significant more prevalent in the lowest tertile (OR = 1.58, 95% CI=1.29-1.93, p<0.001) and similar prevalent in the highest tertile (OR=0.92, 95% CI=0.73-1.15, p=0.47) than in the median tertile. No significant interactions between the aortic diameter and any of the stratified variables were found (all p>0.05).

Conclusions Small aortic diameter (as opposed to large aortic diameter) is significantly associated with LE-PAD in Chinese hypertensive adults.

04-06One-Stop Urokinase Thrombolysis Technique for Acute Lower Extremity Arterial Occlusion: Good Patency Rates after One Year Follow upEu Jhin Loh1, Dr Michelle Chew1, Dr Robert Allen1, A Prof John Cockburn1


IntroductionCatheter directed thrombolysis is an established technique for acute lower extremity occlusions. Several patient-associated factors and occlusion-associated characteristics have been proposed to affect outcomes of thrombolysis.

Materials and Methods:We retrospectively analysed 183 native artery occlusions of the lower extremity. Diagnostic angiography of the iliac, femoropopliteal arteries and below- knee outflow were followed by insertion of an antegrade 9Fr common femoral artery (CFA) sheath. Urokinase was administered by direct intra-clot infusion of 100,000IU aliquots. Median total dose was 400,000 IU. Balloon thromboplasty, aspiration thrombectomy using an 8Fr catheter (Terumo Guidecath) and anastomosis angioplasty were used to completely clear the clot and improve flow. Thrombolysis and aspiration was discontinued when complete lysis occurred. Abandonment (12%) occurred when there was no angiographic improvement or haemorrhagic complications. We reported 7% of cases required immediate surgical intervention due to progressive ischaemia.

The severity of ischaemia was classified based on the Rutherford criteria. The median duration of symptoms before the start of thrombolysis was 3 (1-21) days. Amputation-free survival was estimated using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate analyses were performed using a Cox proportional hazards model.


ResultsComplete lysis was achieved in 76% of native arteries. The 30-day mortality rate was 3% and the 30-day amputation rate was 9%. Mean follow-up was 30 (3-62) months. Amputation-free survival at 1 year was 84% for native arteries.

ConclusionAcute lower extremity occlusions of native arteries treated at one sitting using catheter-directed urokinase thrombolysis and aspiration thrombectomy demonstrates favourable outcomes compared to large published series. Our one-year amputation-free survival of 84% compares favourably with current literature. We believe that our results reflect the extent of clot clearance with this method, and are currently analyzing radiographic data and more long-term results to further evaluate the effectiveness and mechanism of this method.

04-07One-Stop Urokinase Thrombolysis Technique for Acute Lower Extremity Occlusion of Native Arteries and Prosthetic Bypass Grafts: High Patency Rates after One Year Follow upEu Jhin Loh1, Dr Michelle Chew1, Dr Robert Allen1, A Prof John Cockburn1


IntroductionCatheter directed thrombolysis is an established for acute lower extremity occlusions of native arteries and bypass grafts. Several patient-associated factors and occlusion-associated characteristics have been proposed to affect outcomes of thrombolysis.

PurposeTo evaluate our outcome for acutely thrombosed bypass grafts using a one-stop Urokinase thrombolysis technique, and to compare with existing standards.

Methods and MaterialsWe retrospectively analysed 222 consecutive patients (152 men), median age, 74 years (range 28-99), with 183 native artery (82%), and 39 prosthetic bypass grafts (18%) occlusions of the lower extremity. The severity of ischaemia was classified based on the Rutherford criteria in both native arteries and bypass grafts. The median duration of symptoms before the start of thrombolysis was 3 (1-21) days. Amputation-free survival was estimated based on conduit type using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate analyses were performed using a Cox proportional hazards model.

ResultsComplete lysis was achieved in 76% of native arteries and 82% of bypass grafts. The 30-day mortality rate was 3% in native arteries and 5% in bypass grafts, and the 30-day amputation rate was 9% in native arteries and 26% in bypass grafts. Mean follow-up was 30 (3-62) months. Amputation-free survival at 1 year was 84% for native arteries and 67% for bypass grafts.

ConclusionAcute lower extremity occlusions of native arteries and bypass grafts treated at one sitting using catheter-directed thrombolysis demonstrate favourable outcomes compared to large published

series. We believe that our results reflect the extent of clot clearance with this method, and are currently analyzing radiographic data and more long-term results to further evaluate the effectiveness and mechanism of one-stop Urokinase for these cases.

04-08Major lower limb amputation: Are outcomes improving? David Kelly1, Ms Stephanie Pederson1, Dr Kishore Sieunarine1


Major lower limb amputation (MLLA), commonly performed among the co-morbidly unwell, has high rates of morbidity and mortality and accounts for 3-4% of all surgical cases performed by the department of vascular surgery at Royal Perth Hospital (RPH), Western Australia. This retrospective analysis is a replication study comparing outcomes of all MLLA performed by the department of Vascular Surgery at RPH between 2010-2012 and the previously published outcomes of 2000-2002.

Patients undergoing MLLA in 2010-2012 remain old (mean age 68yrs), co-morbidly unwell (median ASA 3) and predominantly male (68%), which is unchanged from 2000-2002. Critical limb ischaemia remains the most common indication for MLLA while smoking, hypertension and diabetes are the main co-morbid diseases. The ratio below knee versus above knee MLLA is 1.48:1 and at the end of follow up 30.9% of patients were bilateral amputees. The percentage of patients receiving prosthesis has fallen from 44.8% to 33.75% with poor mobility prior to MLLA the main reason for not fitting prosthesis. The rates of wound infections has fallen 26.4% to 12.4% (p=0.023), rate of admission to ICU has fallen 48.3% to 17.5 (p=0.001) and revision amputation to a higher level fallen 11.5% to 7.2% (p=0.043). Length of stay in acute hospital was 15.74 days compared with 20.29 days (p=0.075). Mortality overall has fallen from 60.92% to 46.39% (p=0.049). 30-day mortality fallen 10.34% to 5.15% (p=0.185), 6-month 28.76% to 16.5% (p=0.046) and 1-year 40.22% to 21.65% (p=0.006).

Over the decade, the case mix has remained similar however there have been improvements in preventative health care and management of co-morbid diseases, increases in re-vascularisation procedures prior to amputation, changes in anaesthetic, and improvements in recognizing and responding to the deteriorating inpatient. The rate of complications has fallen, length of stay trended down and overall mortality.

04-09Initial and mid-term outcomes of endovascular therapy in the treatment for Leriche syndrome: Endovascular therapy vs Bypass surgeryOsamu Yamashita1, Noriyasu Morikage1, Kotaro Suehiro1, Takasuke Harada1, Makoto Samura1, Yuriko Takeuchi1, Takahiro Mizoguchi1, Kimikazu Hamano1

1Yamaguchi University Graduate School Of Medicine, Ube, Japan

BackgroundBypass surgery (BS) is currently the standard treatment for Leriche syndrome (LS), endovascular therapy (EVT) has emerged as an attractive alternative.

Oral Presentation


ObjectiveWe investigated the efficacy of EVT for the treatment of LS by assessing the initial and mid-term outcomes.

MethodsThe initial and mid-term outcomes of 50 limbs from 28 patients with clinical LS treated between 2001 and 2015 were examined. Asymptomatic limbs and limbs for which EVT was not performed in a deliberate hybrid operation (unilateral EVT and femoro-femoral crossover bypass) were excluded. Study outcomes included the initial success rate, operative complications, postoperative ankle brachial pressure index (ABI), length of hospital stay, and mid-term patency.

ResultsWe performed BS for 12 patients (aorto-femoral bypass=6 and axillary-bilateral femoral bypass=6) and EVT for 16 (kissing stents=10, unilateral stent=2, deliberate hybrid operation=3, and accidental hybrid operation=1). For EVT, the initial success and procedural complication rates were 90% (26/29) and 0% (0/29), respectively. At 1, 3, and 5 years, the primary patency rates (EVT: 100%, 90%, and 90%; BS: 92%, 92%, and 92%, respectively) and assisted primary patency (EVT: 100%, 100%, 100%; BS: 92%, 92%, 92%, respectively) were similar for EVT and BS (primary patency: p=0.96; assisted patency: p=0.15). In addition, in both the groups, postoperative ABI, which was markedly increased compared to the preoperative ABI, was not significantly different (EVT: 0.87; BS: 0.86; p=0.86). Importantly, the length of the postoperative hospital stay was significantly shorter after EVT than after BS, except in patients with a Rutherford classification of category 5 (7 days vs. 17 days, p<0.0001).

ConclusionEVT can be executed without complications with a mid-term durability as favorable as that of BS in patients with LS. Thus, EVT may become the first-line treatment for LS when considering minimally invasive treatments.

04-10Occurrence and Risk Factor of Acute Kidney Injury after Endovascular treatment of Peripheral Artery Occlusive Disease Wonpyo Cho1, MD Keun-Myoung Park1, MD Yong Sun Jeon2, MD Soon Gu Cho2, MD Kee Chun Hong1


BackgroundAcute kidney injury (AKI) is an important post-operative complication that may impact on mortality and morbidity in use of contrast. The aim of this study is to assess the incidence of AKI after elective EVT in PAOD and examine the impact of AKI on mortality and cardiovascular morbidity using the current universally accepted definitions.

MethodsData have been collected and analyzed retrospectively from elective 430 EVT for PAOD among total 584 EVT performed in our hospital from January 2010 to December 2015. Exclusion criteria is EVT for acute limb ischemia, hybrid surgery with general anesthesia, ESRD patient. The primary endpoint was incidence

of AKI as per the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included AKI stage, drop in estimated glomerular filtration rate(eGFR) and mortality. We examined the risk factor associated with AKI. And, patients were divided into 2 groups as developed AKI groups and within normal kidney function groups. We compared mortality.

ResultsWe include 385 patients except exclusion criteria (324 male, 84%; mean age:69.7±15.5years), 49(12.7%) of whom developed AKI(31 patients classified as stage 1, 14 as stage 2, 4 as stage 3). Within 48 hours, those with AKI dropped their eGFR from 67±25 to 49±18mL/kg/1.73m² and those without from 69 ± 31 to 67 ± 3 mL/kg/1.73 m². There were 3 patients required dialysis during follow up (mean: 29 ±18 months). CT angiogram or intervention history within 1 week (HR 3.159 CI:1.73-5.425), no CIN prophylaxis (HR: 3.945 CI: 2.182-6.485) and preoperative eGFR (HR: 2.392 CI:1.182-3.913) affected to progress to AKI after EVT. There were more mortality in AKI groups.(Log Rank=0.02)

ConclusionsThe incidence of AKI after EVT for PAOD is related with CT angiogram or EVT history within 1 week and no CIN prophylaxis and preoperative eGFR. The AKI is associated with medium-term mortality.

04-11Femoral Popliteal Bypass in Octogenarians Paul Lajos1, Robert Weiss1, Alejandro Negrete, C Lutz1, A/Prof Rami Tadros1, A/Prof Ageliki Vouyouka1, Victoria Teodorescu1, Prof Michael Marin1, Prof Peter Faries1

1Mt Sinai, Icahn School Of Medicine, New York, United States

BackgroundAs the overall population ages, femoral-popliteal bypass surgery is being performed increasingly in older patients.

ObjectivesThis study investigated whether femoral-popliteal bypass outcomes differ in this older population.

MethodsPatients over and under 80 years old who underwent femoral-popliteal bypass between 2009-2013 were queried using an existing hospital registry. Demographics, comorbidities, intraoperative complications, perioperative outcomes, and 2-year patencies were collected and compared.

ResultsNinety-six patients were identified, 24 octogenarians and 72 non-octogenarians (mean age 85 ± 4 years and 62 ± 11 years, respectively). There was a significantly (p<0.05) lower prevalence of smoking and higher prevalence of hypertension among octogenarians. Notably, there was a significant difference (p<0.01) in indication for procedure with claudication being the indication in 44% of non-octogenarians, but 0% of octogenarians. Other characteristics (CAD, conduit type, diabetes, etc.) were statistically similar (p>0.05).

Comparing octogenarians to non-octogenarians, there were no statistical differences in 30-day readmissions (17% vs. 21%; p=0.59), and incidence of post-operative (25% vs. 19%; p=0.56)


or intra-operative complications (8.3% vs. 4.2%; p=0.52). Average length of stay (LOS) was significantly longer for octogenarians (12 days vs. 7 days; p=.032) and remained significant after multivariate linear regression (p=.015). Incidences of 30-day mortality and other perioperative outcomes were too small in both groups to statistically compare. The log-rank test was used to compare primary, primary-assisted, and secondary patencies between groups at the 3 month, 6 month, 12 month, and 24 month periods. No statistically significant (p>0.05) differences in patency were found between groups.

ConclusionsThe safety and efficacy of femoral-popliteal bypass in octogenarians may be similar to the general population despite Length of Stay in octogenarians being 5.98 days longer than non-octogenarians. A larger cohort is needed, as a limitation of this study is small sample size.

05-01Aorto-carotid bypass in patients with Takayasu’s arteritisDr. Hong-seok Han1, Kyung Won Yoon2, M.D., Ph.D. Young-Wook Kim2, M.D., Ph.D. Dong-ik Kim2

1Department of Surgery, Samsung Medical Center, Seoul, Republic of Korea., 2Division of Vascular Surgery, Samsung Medical Center, Seoul, Republic of Korea.

BackgroundTakayasu’s arteritis is considered a medically manageable disease. However, when this condition results in severe cerebrovascular ischemia, radiological intervention or bypass surgery is indicated.

ObjectivesWe reviewed the patients with Takayasu’s arteritis who received aorto-carotid bypass due to cerebrovascular ischemia.

Materials and MethodsA retrospective review was performed on 19 patients with Takayasu’s arteritis who underwent aorto-carotid bypass from March 2002 to April 2015. The indications for bypass surgery included symptoms related to cerebrovascular ischemia due to occlusion of the carotid arteries or aortic arch vessels. All patients received surgery after normalization of ESR and CRP levels. After surgery, all patients were medicated with anticoagulant agents and antiplatelet agents.

ResultsAll patients were female and their age range was 15 to 66 years with a mean age of 40.6 ± 15.3 years (mean follow-up duration: 61.0 ± 42.4 months, range: 1~138 months). Twelve (63.2%) patients underwent aorto-uni-carotid bypass and 7 (36.8%) patients underwent aorto-bi-carotid bypass. Sixteen (84.2%) patients had an interposed ePTFE graft, 1 (5.3%) patient had a Dacron graft, and 2 (10.5%) patients had a saphenous vein graft. Five (26.3%) patients suffered an intracranial hemorrhage within 1 week after bypass surgery. Of the patients with an intracranial hemorrhage, 2 (10.5%) patients expired within 30 days postoperatively, and 3 (15.8%) patients resolved spontaneously. One (5.3%) patient expired due to an intracranial infarction 9 years after bypass surgery. The intracranial ischemic symptoms resolved after bypass surgery in all of the surviving patients. None of the patients experienced an anastomosis aneurysm postoperatively.

ConclusionsAorto-carotid bypass is effective for treating patients of Takayasu’s arteritis with cerebrovascular ischemia, but the results suggest that post-operative blood pressure should be strictly managed to prevent post-operative intracranial hemorrhage.

05-02Early Result of Directional Atherectomy using Silverhawk/Turbohawk System Yoong Seok Park1, Dr. Seon-Hee Heo1, Assistant Professor Dong-Ho Hyun2, Professor Young-Soo Do2, Professor Hong-Suk Park2, Professor Kwang-Bo Park2, Professor Young-Wook Kim1, Professor Yang-Jin Park1, Mr. Chul-Hyung Lee1, Professor Dong-Ik Kim1

1Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Seoul, South Korea, 2Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Seoul, South Korea

ObjectivesDirectional atherectomy (DA) was introduced for management of infrainguinal arterial stenosis or occlusive lesions. The procedure success in DEFINITIVE LE study was determined using radiologic imaging. The aim of our study was to determine the early result of DA using Silverhawk/Turbohawk System.

MethodsThe patients for DA procedures using the SilverHawk/TurboHawk system from January 2014 to December 2014 were reviewed retrospectively. Twenty lesions from 14 patients with femoral artery stenosis (> 70% stenosis) of short segment occlusive lesion (< 2cm length for each lesion) were treated. Seventeen lesions were treated with SilverHawk system, and three lesions were treated with TurboHawk system due to lesion calcification. With the TurboHawk system, a protective device was used to prevent distal embolization. The percentage of stenosis during and after DA was determined with ultrasonography (USG).

ResultsThe median follow-up was 5.1 months (range, 1.1-13.7). The rate of procedure success (<30% stenosis at the end of the procedure) was 100% according to angiographic findings but 30% based on intraoperative USG findings. According to USG evaluation, median residual stenosis was 40% (28-42) at the end of the DA procedure, 40% (30-55) at one month, 55% (35-85) at six months, and 64% (60-100) at one year. There was one dissection, but there were no cases of perforation, pseudoaneurysm, or thrombosis. Primary patency defined as peak systolic velocity ratio (PSVR) ≤ 3.5 with no reintervention for target lesions at six months was found in 18 lesions (90%), and 11 of 14 patients (78.6%) were free of ischemic symptoms such as claudication at six months.

ConclusionOur findings demonstrated that DA using the SilverHawk/TurboHawk system are efficient treatment option for artery short segment occlusive lesion of the femoral.

Oral Presentation


05-03Factors affecting to patency of Stenting in TASC II C or D iliac lesion Wonpyo Cho1, MD Keunmyoung Park1, MD Yong Sun Jeon2, MD Soon Gu Cho2, MD Kee Chun Hong1


PurposeProgress in endovascular surgery has resulted in a continued shift for treatment of aortoiliac occlusive disease. But, purpose of this study is to evaluate midterm results of stenting in TASC II C or D aortoiliac lesion with stents and to identify factors affecting to maintain patency.

MethodsStents on aortoiliac occlusive disease were performed in 218 limbs and 183 patients form Jan. 2010 to Dec 2015. We included the 98 limbs of TASC II C or D lesion in 83 patients reviewed preoperative data (sex, indication, comorbidity, ABI, TASC II classification, length of length, grade of calcification, CFA involvement) perioperative data (stent type and number, subintimal angioplasty, concurrent treatment) and postoperative follow-up data (ABI, CT angiogram) from hospital records and radiology studies.

ResultsDuring the follow-up (mean: 15.3 ± 3.2 months), no early thrombotic reocclusions occurred within 30 days, but 78 limbs developed an in-stent restenosis. The primary patency rate at 12, 24 and 36 months was 91, 83 and 71%, and secondary patency rate 95, 89 and 80%, respectively. Young age below 60(HR 3.9, p<0.01), calcification over 50% of circumstance (HR 2.6 p<0.01), diameter under 7mm (1.8, p<0.02) and CFA involvement (HR 1.8, p<0.01 were affecting factors to re-intervention.

ConclusionThe midterm result of stent in aortoiliac occlusive disease was tolerable because primary patency rate at 3 years was 71% and secondary patency rate was 80%. Reintervention after aortoiliac artery stenting require the best of care, particularly in young patient with iliac artery of calcification and small diameter.

05-04Prophylaxis fasciotomy in patients with acute arterial occlusion by using only “6 hours criteria”: Is it safe?Saritphat Orrapin1, Dr Termpong Reanpang1, Dr Saranat Orrapin1, Dr Supapong Arwon1, Prof Kittipan Rerkasem1,2

1NCD Center and Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 2NCD Center of Excellence, RIHES, Chiang Mai University, Chiang Mai, Thailand

BackgroundProphylaxis fasciotomy was performed to avoid compartment syndrome-related morbidity included limb loss in acute lower extremity ischemia patients. Currently, this procedure was determined to performed by operating surgeon base on absolute and potential indications. Almost of potential indication which often be conduce to prophylaxis fasciotomy is acute ischemia exceeding 6 hours. These produce an effect of high fasciotomy rate in many

institutes. The excessive fasciotomy increased risk of fasciotomy-related problem. Thus, ischemic time need to reevaluated for indication of prophylaxis fasciotomy.

Patients and MethodsAll patients who underwent revascularization of lower extremity for non-traumatic acute ischemia were included in this study. Time from onset of symptom to revascularization (ischemic time), sign and symptom of compartment syndrome and intra-compartment pressure (ICP) were recorded. Compartment syndrome patients were diagnosed by clinical presentation with absolute ICP > 30 mmHg afterwards emergency fasciotomy were operated.

ResultsOf the 22 patient revascularization for acute lower extremity ischemia that match inclusion criteria, there were 5 patients (22%) of compartment syndrome diagnosed. Median ischemic time of all patients is 14 hours. More than half (52%) of non-compartment syndrome patients were ischemic time exceeding 6 hours. Only 4 in 13 (30%) of prolonged ischemic time patients were compartment syndrome. No significant differences in mean ischemic time between compartment syndrome and non-compartment syndrome patients (8.5 hours and 20 hours, respectively; P = 0.484). All revascularization patient’s limbs were salvaged.

ConclusionIschemia time exceeding 6 hours criterion may be too easy to judge for prophylaxis fasciotomy. Particularly, patients who had no sign and symptom of compartment syndrome or other indication for prophylaxis fasciotomy. More study using analytic measures and well randomization patients are needed to validate the indication for prophylaxis fasciotomy.

05-05One-year Clinical Outcomes of Patients with or without Critical Limb Ischemia Underwent Percutaneous Transluminal AngioplastyYoong Seok Park1, Professor Michael Lee2, Professor, MD, PhD, FACC, FAHA, FESC, FSCAI, FAPSIC Seung-Woon Rha3, Master Byoung Geol Choi3, Professor Seung Kyu Han4

1Samsung Medical Center, Seoul, South Korea, 2UCLA Medical Center, Los Angeles, USA, 3Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea, 4Department of Plastic Surgery, Korea University Guro Hospital, Seoul, Korea

BackgroundPercutaneous transluminal angioplasty (PTA) is an effective treatment for patients with peripheral arterial disease (PAD). Patients with critical limb ischemia (CLI) have a poor prognosis including high mortality rate. There are limited data regarding the clinical outcomes comparing patients with CLI and non-CLI following PTA.

MethodOf the 503 consecutive patients with PAD who underwent PTA enrolled from September 2004 to December 2013, 368 patients had CLI and 135 patients did not. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE).


ResultsThe CLI group had a higher prevalence of diabetes and chronic renal insufficiency. The non-CLI group had a higher prevalence of patients with dyslipidemia and history of myocardial infarction. The CLI group had a higher prevalence of diffuse long lesions, calcified lesions, infra-popliteal lesions, and active wound. Procedural complications such as pseudo-aneurysm (0.5% vs. 3.7%, p=0.017), and hemorrhagic stroke (0.0% vs. 2.2%; p=0.019) were more common in non-CLI group. The rate of angiographic success rate (residual stenosis < 50%) rate was similar in both groups. At one-year, despite the CLI group had less limb salvage rate compared to the non-CLI group (92.5% vs. 97.0%; hazard ratio, 0.128; 95% CI, 0.017 – 0.963, p=0.019), the MACCE rate was similar in both groups.

ConclusionDespite the CLI group having more unfavorable baseline clinical and lesion characteristics, PTA was equally safe and effective compared to the non-CLI group. As expected, the CLI group had less limb salvage rate but MACCE rate were similar in both groups.

05-06Cost Saving Potential of Acellular Fish Skin Graft: A Cost Simulation Study on Diabetic Foot UlcersJohn Lantis, Skuli Magnusson1, Dr David Margolis3, Dr Baldur Baldursson1,2, Dr Hilmar Kjartansson1,2, Gudmundur F. Sigurjonsson1

1Kerecis, Reykjavik, Iceland, 2Landspitali University Hospital of Iceland, Reykjavik, Iceland, 3Perelamn School of Medicine, University of Pennsylvania, Philadelphia, USA

IntroductionIn 2007, cost linked to the treatment of foot ulcers in the US was estimated be 38 billion USD with cost due to hospitalization being the highest factor. Any means to reduce hospitalization by speeding up healing of foot ulcers will contribute most to cost saving. Intact fish skin grafts* from wild Atlantic cod are rich in naturally occurring Omega3 polyunsaturated fatty acids and are used to regenerate damaged human tissue. In a randomized, double-blind clinical trial, fish skin grafts promoted significantly faster healing compared to a porcine small intestinal submucosa product.

ObjectiveTo assess the potential cost effectiveness of using fish skin grafts on diabetic foot ulcers with a cost simulation study.

MethodsThe cost-simulation study was based on a prognostic model for identifying diabetic foot ulcers that are not likely to heal. The model was generated by data from 27,630 patients with diabetic foot ulcers. The model predicts the likelihood of a wound not healing after 20 weeks based on some of all of the following parameters being met: The size of the ulcer larger than 2 sq cm; the previous duration of wound more than 2 months and ulcer grade. Data from 21 diabetic wounds treated with acellular fish skin* was inserted into the prognostic model, and compared with the actual outcome of the treatment. ResultsThe cost simulation study showed 49.6% cost saving potential per wound or 13235 USD in cost saved per healed wound.

ConclusionDiabetic foot ulcers are one of the most common and costly diabetic complications. Means to reduce the hospitalization time of diabetic foot ulcer patients thus has enormous cost saving potential. Fish skin grafts* save cost by accelerating healing of diabetic foot ulcers compared to standard of care.

*Kerecis Omega3 by Kerecis

05-07Diabetic foot limb salvage – a Singaporean experienceDr Zhimin Lin1, Dr Zhiwen, Joseph Lo1, Dr Ruiming Teo1, Dr Zhongkai Wang1, Dr Danson Xue Wei Yeo1, Dr Bin Chet Toh1, Dr Yiew Fah Fong1, Dr Glenn, Wei Leong Tan1, Dr Sriram Narayanan1, Dr Sadhana Chandrasekar1, Qiantai Hong1


ObjectivesTo review patient characteristics and outcomes of in-patient diabetic foot limb salvage at a tertiary Asian centre.

Materials and MethodsRetrospective study of 809 limb salvage attempts between January 2014 and December 2015.

ResultsOur study population had an average age at 65 years-old. Majority of patients suffer from cardiovascular comorbidities: 73% smokers, 86% hypertension, 91% hyperlipidaemia and 59% ischaemic heart disease. 36% had previous amputations. Most (91%) had infra-inguinal TASC II (trans-Atlantic inter-society consensus) patterns type B (27%), type C (37%) and type D (27%) disease. Majority (96%) of patients underwent angioplasty and 32 (4%) reverse long saphenous vein (LSV) lower limb bypasses performed. 20 (63%) were performed as salvage procedures for failed angioplasties. 11 underwent femoral-popliteal bypass (34%), 16 underwent femoral-distal bypass (50%) and 5 underwent popliteal-distal bypass (16%). The average in-patient stay was 12.3 days within the angioplasty group and 48.1 days within the bypass group (p<0.01). Limb salvage was unsuccessful in 93 patients (12%) who underwent angioplasty, as compared to 9 patients (28%) who underwent salvage bypass surgery (p=0.01). All-cause mortality was 7% within the angioplasty group and 13% within the bypass group (p=0.27). The average in-patient cost for the angioplasty group was SGD$5,518, as compared to SGD$15,141 (p<0.01) for patients who underwent bypass surgery.

ConclusionWithin our study population, most diabetic foot peripheral arterial disease (91%) were diffuse, involved long segments with multiple stenotic lesions and with no distal landing zone. Coupled with the fact that majority of patients had multiple co-morbidities and were poor surgical candidates, most were not suitable for bypass-first approach and the primary revascularisation modality was with angioplasty. Surgical bypasses were performed mainly as salvage procedures for failed angioplasties. Successful limb salvage rate for patients admitted with diabetic foot tissue was 87%, with all cause mortality rate at 7%.

Oral Presentation


05-08Predictive factors to determine good atherosclerotic risk factor control for diabetic patients with peripheral arterial diseaseSaritphat Orrapin1, Dr Natapong Kosachunhanun2, Dr Kiran Sony4, Dr Nimit Inpankaew5, Dr Piyamitr Sritara6, Dr Arintaya Phrommintikul2, Dr Chonlisa Chariyalertsak7, Ms Antika Wongthanee3, Ms Ampica Mangklabruks2, Ms Orapin Pongtam2,3, Prof Kittipan Rerkasem2,3

1Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), Pathumthani, Thailand, 2NCD Center, Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, 3NCD Center of Excellence, Research Institute of Health Science, Chiang Mai University, Chiang Mai, Thailand, 4Department of Internal Medicine, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand, 5Department of Internal Medicine, Lamphun Hospital, Lamphun, Thailand, 6Department of Internal Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, 7Chiang Mai Provinical Health Office, Chiang Mai, Thailand

BackgroundTo assess to what extent physicians follow the standard guideline of atherosclerotic risk factor control in diabetic patients with peripheral arterial disease (PAD).

ObjectiveTo assess to what extent physicians follow the standard guideline of atherosclerotic risk factor control in diabetic patients with PAD.

Materials & MethodsBetween May 2014- April 2015, 168 diabetic patients who diagnosed PAD were invited to be involved in this study. The risk factors namely smoking, low density lipoprotein, HbA1C and systolic/diastolic blood pressure were followed up at beginning and 12 months after diagnosed PAD. History, physical exam and laboratory test were reviewed. Ankle brachial index ≤ 0.9 was considered PAD. Then patients were evaluated the percentage of control in 5 risk factors according to American Heart Associated criteria. The good control was defined that patients have adequate risk factor control between 3-5 factors. Then multivariate analysis by using logistic regression was performed to identify the predictive factors that were associated with good control. This study was supported by the Health Systems Research Institute and National Research Council of Thailand.

Results286 patients were included in this study. The percentage of good control in day 0, 6 months and 12 months was 179 (56.1), 120 (50.4) and 150 (65.5) respectively. The predictive factors that associated with good risk factor control criteria were primary and secondary school graduate, The non-good risk factor control criteria were high body mass index and insulin user group.

ConclusionsThis study concluded that the risk factor control in diabetic patients with PAD was around half. More study is needed to confirm this finding.

05-09The Prevalence of Asymptomatic Peripheral Arterial Disease in Korea: Community-based Screening studyJunghyun Youm1, MD, PhD Jin Hyun Joh1


IntroductionPeripheral arterial disease (PAD) is a common vascular problem. PAD has a serious morbidity and mortality along with decreased quality of life and possible major limb loss. However, the prevalence of asymptomatic PAD in Korea has not been reported.

ObjectivesThe purpose of this study was to evaluate the prevalence and risk factors of asymptomatic PAD in Korean general population.

Materials and MethodsThe inclusion criteria for screening were men and women more than 50 years. The study was processed by visiting the community welfare centers in Korea. The screening was performed the history taking for demographic information followed by the measurement of ankle-brachial index (ABI). PAD was defined when an ABI of 0.9 or less was found in one or both legs. For statistical analysis, Student t-test, Chi-square test, Fisher’s exact test, and logistic regression were used. All statistical analyses were conducted with SPSS software version 22 (SPSS, Chicago, IL, USA). All P values were considered significant if < .05.

ResultsBetween January 2008 and December 2012, a total of 1,987 participants were included with 788 (39.7%) men and 1,199 (60.3%) women. PAD was detected in 97 (4.9%). The borderline ABI (0.91-0.99) showed in 206 (10.4%). And severe decreased ABI < 0.5 showed in 35 (1.8%). The significant risk factors for PAD were advanced age (OR 1.38; 95% CI, 1.06-1.78, P=.015), heart diseases (OR 2.06; 95% CI, 1.21-3.51, P=.008), cerebrovascular disease (OR 2.26; 95% CI, 1.23-4.15, P=.009), and smoking (OR 2.59; 95% CI, 1.47-4.55, P=.001).

ConclusionsThe prevalence of PAD in the Korean general population was 4.9%. Advanced age, heart disease, cerebrovascular disease and smoking were significant risk factors for PAD. Further nationwide study is needed.

05-10Validation of WIfI classification following percutaneous angioplasty for critical limb ischemia Uijun Park1, MD Won Hyun Cho1, MD Hyoung Tae Kim1, PhD, RN Min Young Kim2

1Keimyung University, Daegu, South Korea, 2Ulsan University, Ulsan, South KoreaObjectiveThe Society for Vascular Surgery Lower Extremity Guidelines Committee developed the Wound, Ischemia, foot Infection (WIfI) classification system to predict the amputation risk in patients


with critical limb ischemia (CLI). The purpose of the study was to validate this classification system following percutaneous angioplasty (PTA) for CLI with diabetes.

MethodFrom 2010 to 2015, a single center, retrospective study was performed for the patients undergoing PTA for CLI with diabetes. The limbs without tissue loss or missing grade in any WIfI component were excluded. Limbs were classified into four WIfi clinical stages based on the WIfI classification and compared with clinical results in terms of wound healing, length of hospital stay, major amputation and in-hospital mortality.

ResultsOne hundred five limbs in 100 patients underwent PTA for tissue loss. Median follow up was 2.7(0.2-36.6) months. Limbs were classified as very low risk in 6(6%), low risk 21(20%), moderate risk 44(42%) and high risk 34(32%). The rate of wound healing was 6(100%), 21(100%), 36(82%), and 18(53%), respectively (P=.001). The length of hospital stay were 48.3(±42.9), 46.1(±26.0), 44.1(±33.5), and 65.7(±33.7) days, respectively (P=.030). Major amputation during the hospital stay was found only in the high risk stage (n=10, P=.001). In terms of in-hospital mortality, there were no mortality in very low risk and low risk, but 3 in moderate risk and 3 in high risk (P=.001).

ConclusionsWIfI classification system was highly predictive in wound healing, length of hospital stay, major amputation and in -hospital mortality of the CLI patients with diabetes.

05-11One-Stop Urokinase Thrombolysis Technique for Thrombosed Dialysis Access: High Patency Rates after Four Year Follow upEu Jhin Loh1, Dr Robert Allen1, A Prof John Cockburn1


PurposeTo calculate patency rates for fistulas and grafts treated using the “fast urokinase” technique and compare these results with published data so as to assess efficacy.

Methods and MaterialsMedical records of patients in whom malfunctioning fistulas and grafts treated within our department were reviewed, yielding 105 fistulas and 39 grafts. An estimation of patency rates, as defined by recognised standards, was then performed using the Kaplan-Meier method and an assessment of predictors of patency was made using a Cox proportional hazards model. These results were then compared with the available published data.

ResultsPatency was measured using the Society of Interventional Radiology Technology Assessment Committee (SIRTAC) guidelines. These included post-intervention primary patency (PP- time from first radiological intervention to thrombosis or second intervention of any kind), post-intervention primary assisted patency (PAP-

time from first intervention to subsequent thrombosis) and post-intervention secondary patency (SP- time from first radiological intervention to surgical declotting/revision or abandonment). The 105 native fistulas yielded SIRTAC PP, PAP and SP rates at 48 months of 20%, 63% and 79%. The 39 grafts yielded SIRTAC PP, PAP and SP rates at 24 months of 15%, 26% and 83% respectively. NAVAC 48 month SP rates (date of fistula creation rather than first intervention to date of abandonment) for native fistulas and grafts was 82% and 80% respectively.

ConclusionMalfunctioning upper limb haemodialysis access in which thrombosis was treated at one sitting using a combination of urokinase, skin massage/balloon maceration, and aspiration demonstrate high patency rates compared to large published series including those in which tissue plasminogen activator and/or mechanical thrombectomy devices were utilised. We believe that our results may reflect the extent of clot clearance with this method.

05-12Hybrid treatment for multilevel revascularization in PAD patients: multicenter study in KoreaProf. Hyuk Jae Jung1, Dr. Yong Beum Bak1, Dr Dong Hyun Kim1, Sang Su Lee1


IntroductionRecently, endovascular treatment has been alternative first-line modality for peripheral artery disease (PAD). Hybrid treatment also has been increasingly used for multilevel revascularization procedures as vascular surgeons have embraced endovascular treatment. The goal of this study to examine the clinical and hemodynamic outcomes of hybrid treatment in patients who need multilevel revascularization

Material and Methods9 university hospitals in Korea enrolled PAD patients who need multilevel revascularization. A retrospective multicenter study was conducted to evaluate clinical outcomes of 137 Korean PAD patient with multilevel lesions who underwent hybrid treatment. Patients were enrolled from July 2014 to June 2015 and were follow up for 12 months.

ResultsThe mean age was 68.9±9.85 years old and 87.5% were male. Patients with critical limb ischemia was enrolled 41.6%. The technical success rate was 100%. The primary patency rate at 12 and 24 months were 84.4% and 77.7% respectively. The preoperative mean ankle brachial index (ABI) of 0.55 ± 0.27 increased to 6 month postoperative mean ABI of 0.89± 0.35. The amputation free survival (AFS) rate was 97.1% and freedom from re-intervention rate was 83.2%.

ConclusionsHybrid treatment for multilevel revascularization was feasible alternative for treatment of multilevel PAD patients in Korea, with satisfactory AFS and freedom from re-intervention rates.

Oral Presentation


06-01Follow up Results of Lower Extremity Arterial Bypass with Autogenous Arm Vein Grafts Jihee Kang1, Dr Duk-Bee Hwang2, Dr Seon-Hee Heo1, Dr Kyung-Won Yoon1, Pf Yang-Jin Park1, Pf Dong-Ik Kim1, Pf Ynoung-Wook Kim1

1Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul , South Korea, 21Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, South Korea

BackgroundGreat saphenous vein (GSV) is the conduit of choice for leg bypass. However, it is not always available to use due to prior use. Arm vein can be used in leg artery bypass as bypass conduit for patients who are unavailable to use GSV

ObjectiveAmong various alternative conduits for LEAB, we would like to present long-term results of arm vein grafts.

MethodsWe retrospectively reviewed database of patients who underwent infrainguinal LEAB with autogenous arm vein grafts from 2003 through 2016. All procedures were performed in an absence of adequate saphenous vein. Graft patency was determined by periodic examinations of duplex ultrasonography.

ResultsAutologous arm vein grafts were implanted for 33 limbs in 32 patients (mean age, 61.6 ± 15.9 years; range, 20 - 86 years; male, 94 %; atherosclerosis 24 (75%) and non-atherosclerotic disease 8 (25%) including 4 patients with Buerger’s disease. Mean number of prior ipsilateral leg artery interventions was 1.1±1.1 (range 0-4) either surgical or endovascular intervention. Source of arm vein were basilic 14 (42%), cephalic 4 (12%) and composition graft with other vein in 14 (42%), composition with PTFE 1. Level of distal anastomosis distributed femoral in 1 (3%) popliteal in 5 (15%), tibio-peroneal in 24 (73%) and inframalleolar artery in 3 (9%). Mean duration of follow up was 52.7 ± 58.5 month(range, 1 - 229 months). Sixteen patients (50%) were available to follow up and 9.4% of patients were dead due to underlying disease. Cumulative primary patency rates at 1, 3, 5 and 10 years are 66%, 62%, 62%, 62% and secondary patency rates at 1, 3, 5, 10 years are all 66%. There was 1 limb amputation during the follow-up period.

ConclusionsArm vein is an useful alternative conduit when great or short saphenous vein is not available during LEAB.

06-02Aspirin and clopidogrel resistance in peripheral arterial occlusive disease. Early results of a prospective studyMina Guirgis1, Ms Lucy Stopher1, Mr Joseph Hockley1, A/Prof Shirley Jansen1

1Sir Charles Gairdner Hospital, Perth, Australia

IntroductionAspirin resistance (AR) and clopidogrel resistance (CR) are defined as lower than normal ability of these antiplatelet agents to inhibit platelet aggregation following standard dosing. Platelet function tests are required to assess antiplatelet efficacy to determine whether a patient is resistant to the drug’s antiplatelet action. There is a sizeable body of research into the effects of antiplatelet resistance in Cardiology with some studies revealing a link between resistance and major adverse cardiovascular effects (MACE). There is much less data available amongst the peripheral arterial occlusive disease (PAOD) population.

ObjectivesTo measure the prevalence of aspirin and clopidogrel resistance in patients with peripheral arterial occlusive disease requiring revascularisation and to assess whether there is an association between resistance and early MACE or target vessel thrombosis requiring reintervention.

Materials and MethodsProspective study in PAOD patients on aspirin or clopidogrel therapy requiring elective revascularisation procedures (endovascular or open surgery). Multiplate® Analyzer platelet assay was used to define resistance by analysing platelet reactivity prior to the procedure. Patients were followed up to assess for early (within one month) target vessel thrombosis requiring reintervention or MACE (cardiovascular death, myocardial infarction, cerebrovascular accident or major amputation) or major bleeding events.

ResultsFirst cohort of 44 patients analysed. 95% were on daily aspirin. 45% on daily clopidogrel. 43% on both. 27.5% of aspirin cohort were AR. 30% of clopidogrel cohort were CR. 2 patients (5%) with AR experienced early stent thrombosis requiring revascularisation. No patient without antiplatelet resistance had early MACE.

ConclusionPrevalence of aspirin and clopidogrel resistance is comparable to the current PAOD data. Both patients that experienced early stent thrombosis had AR. Ongoing research may uncover significant associations between antiplatelet resistance and MACE. Individualised antiplatelet therapy based on platelet analysis may reduce the risk of MACE as has been described in Cardiology.


06-03Natural History of Retrograde Pedal Access Site: Is it Really Safe?Professor Tae Seung Lee1, Daehwan Kim1


PurposeRetrograde pedal access may be an alternative technique when recanalization fails via an antegrade approach in below-the-knee (BTK) intervention. The aim of this study was to evaluate the consequences of pedal access in patients with critical limb ischemia who had undergone retrograde recanalization.

MethodThis was a retrospective study on patients who underwent retrograde pedal access for revascularization of BTK chronic total occlusions between 2014 and 2016. After failed antegrade access attempts, retrograde pedal access was performed under fluoroscopy or ultrasound guidance using a micropuncture needle. Most retrograde interventions were performed sheathless with 1.5-3.0 mm balloons. Outcomes were analyzed with special consideration on the patency of the pedal access site after intervention.

ResultsA total of 18 patients (11 men, 7 women, mean age 72) underwent retrograde access. Among these, Rutherford grade II was present in 1 (5%) and grade III in 17 (95%) patients. The length of the target vessel was 18.22 cm and moderate or severe calcification of the target vessel was found in 13 (72%) patients. Successful crossing was achieved in 66% (12 of 18) and technical success rate was 100% (14 of 14). There were 3 cases of pedal access site delayed wound healing (cutdown = 2, puncture = 1). Two occlusions proximal to the pedal access site were found by duplex ultrasound the next day after the procedure. Two occlusion cases occurred in the anterior tibial artery with calcification. There was no 30-day mortality and major amputation.

ConclusionRetrograde pedal access is a useful technique for revascularization, but may cause occlusion of the access vessel site. Wound healing of the access site may also be delayed especially when retrograde revascularization fails. Therefore the risks of retrograde access should be taken into consideration and weighed against the benefits of successful revascularization.

06-04Diabetic foot limb salvage – A series of 809 attempts and predictors of endovascular revascularisation failureQiantai Hong1, Dr Zhiwen Joseph Lo1, Dr Zhimin Lin3, Dr Uei Pua2, Dr Lawrence Han Hwee Quek2, Dr Bien Ping Tan2, Dr Sundeep Punamiya2, Dr Glenn Wei Leong Tan1, Dr Sriram Narayanan1, Dr Sadhana Chandrasekar1

1Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore, 2Vascular & Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital , Singapore, Singapore, 3University Surgical Cluster, National University Health System , Singapore, Singapore

Background / ObjectivesTo review patient characteristics and outcomes of inpatient diabetic foot limb salvage at a tertiary centre and identify risk factors predicting for endovascular salvage failure.

MethodologyRetrospective study of 809 limb salvage attempts between January 2014 and December 2015.

Results68% of our study population were male and a majority had other cardiovascular co-morbidities. 36% of patients had previous lower limb amputations and all were of Rutherford grade 5 and 6 classification. 41% of our patients had toe pressures of less than 50mmHg and 91% had infra-inguinal TASC II patterns type B,C,D disease. 777 (96%) patients underwent endovascular limb salvage. 32 patients underwent surgical bypass limb salvage, with majority performed as salvage procedures for failed angioplasties. Limb salvage was successful in 88% of endovascular group, compared to 72% of bypass group (p=0.01). Overall survival was 93% within the endovascular group and 88% within the bypass group (p=0.27). The average in-patient cost was SGD$5,518 within the endovascular group and SGD$15,141 for bypass group (p<0.01). Multivariate analysis showed that independent predictors for failure of endovascular limb salvage include end-stage renal failure (OR 2.04, p=0.01), toe pressures <50mmHg (OR 2.15, p=0.01), infra-inguinal TASC II patterns C or D (OR 1.99, p=0.03) and post-angioplasty below-knee single-vessel flow (OR 2.03, p=0.02).

ConclusionWithin our study population of Asian ethnicity, most inpatient diabetic foot peripheral arterial disease presented with Rutherford grade 6 classification, with severe TASC II patterns C or D disease and required infra-popliteal revascularisation. Majority underwent endovascular-first approach revascularisation. Most surgical bypasses were performed as salvage procedures for failed angioplasties, hence had significantly longer in-patient stay, lower limb salvage success and more expensive in-patient cost. Independent predictors of endovascular limb salvage failure include end-stage renal failure, toe pressures <50mmHg, infra-inguinal TASC II patterns C or D and post-angioplasty infra-popliteal single-vessel flow.

06-05Use of Negative Pressure Wound Therapy in Lower Limb Bypass IncisionsKah Wei Tan1, Dr Zhiwen Joseph LO2, Dr Qiantai HONG2, Dr Glenn Wei Leong TAN2, Dr Sadhana CHANDRASEKAR2, Dr Sriram NARAYANAN2

1NUS Yong Loo Lin School of Medicine, Singapore, Singapore, 2Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore

Background and objectivesThe use of negative pressure wound therapy (NPWT) for post-surgical cardiothoracic, orthopaedics, plastics, obstetrics and gynaecology incisions has been described. However there is no data on its use in lower limb bypass wounds. We aim to investigate the outcome of negative pressure wound therapy in the prevention of surgical site infection for patients with lower limb arterial bypass incisions.

Oral Presentation


MethodsA retrospective study of conventional dressing versus single-use NPWT (PICO, Smith & Nephew, United Kingdom) for lower limb bypass incisions. Comparison between the patient characteristics and surgical site infection risk scores between the 2 groups was performed and outcomes evaluated include surgical site infection (SSI) and the need for surgical wound debridement.

Results42 patients underwent open lower limb arterial bypasses from March 2014 till February 2016. 28 (67%) received bypass incision conventional dressing whilst 14 (33%) received NPWT. There was no statistical difference for patient characteristics and mean surgical site infection risk scores between the 2 groups (13.7% for conventional versus 13.4% for NPWT, p=0.831). There were a total of 9 SSI (32%) within the conventional dressing group while there was no SSI within the NPWT group (p=0.019). 3 patients (11%) within the conventional dressing group required subsequent surgical wound debridement.

ConclusionFor patients with peripheral arterial disease, the use of NPWT for lower limb arterial bypass incisions may help to prevent surgical site infections and is superior to conventional dressing.

(This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. No conflict-of interest to declare.

06-06Quality of Life as a Predictor of Post Operative outcome following Revascularization of Peripheral Arterial DiseaseShantonu Kumar Ghosh1

1National Institute Of Cardiovascular Diseases, Dhaka, Bangladesh

BackgroundPeripheral arterial disease (PAD) is associated with a significant morbidity and mortality. In addition to physical factors, patient’s quality of life (QOL) i.e. individual’s physical health, psychological state, level of independence and social relationships also influence on post-operative outcome and there by long term survival after surgery. Health related quality of life (HRQOL) is the extent to which one’s usual or expected physical, emotional and social well-being are affected by a medical condition or its treatment. The purpose of this study was to compere the health related quality of life before and after revascularization following PAD.

MethodsCases were divided into two groups according to presence and absence of ulceration in foot. Those patients having claudication with ulceration were enrolled in group A and those having claudication without ulceration were enrolled in group B. Data were collected from both groups preoperatively and during follow up at 1 and 3 month by interviewing the patient according to SF-36.

ResultTwo groups with preoperative poorer HRQOL (n=25) or optimum HRQOL (n=25) were compared. Postoperative outcome was found poor in Group A compered to Group B. In both groups, there was little improvement in quality of life after 1 month of

surgery. In Group A QOL improved a little between 1 to 3 months postoperatively. But in Group B, there was significant improvement of postoperative QOL between 1 to 3 months. Overall, Group A patients had preoperative symptoms more prominent and their postoperative outcome was also poor.

ConclusionThose patients who had preoperative optimum quality of life had better postoperative outcome. From this study it can be concluded that quality of life can be used as a predictor of postoperative outcome in peripheral arterial disease patients.

Key WordsPeripheral Arterial Disease (PAD), Quality of Life (QOL), Health Related Quality of Life (HRQOL).

06-07The efficacy and safety profile of prolonged high pressure balloon angioplasty on below-the-knee lesions J X Lim, D Lim, D Ho, YK Tan, Steven KumChangi General Hospital, Singapore

Background and ObjectivesEarly recoil is a common occurrence in patients undergoing conventional below-the-knee (BTK) balloon angioplasty. The literature suggests that this correlates with rates of future restenosis and patency. We hypothesise that high pressure balloon (HPB) angioplasty accompanied by prolonged inflation reduces rates of early recoil, and thus, potentially improves vessel patency. The JADE non-compliant balloon (OrbusNeich Medical, HK) was utilized in this study. The primary objectives of the study were to assess the efficacy and safety profile of high pressure balloon angioplasty (at 20-24atm), coupled with prolonged inflation times (>90s) on BTK lesions. Secondary objectives included the assessment of early recoil, rates of re-intervention and rates of wound healing.

MethodsWe retrospectively reviewed the angiographic data and clinical outcomes of 23 consecutive patients with chronic limb ischaemia who underwent prolonged HPB angioplasty for BTK lesions in our institution.

Their angiographic images were evaluated prior, immediately after and 15 minutes after angioplasty with the JADE balloon. Post-op complications, re-intervention rates and wound outcomes were also reviewed.

ResultsTarget lesions included the ATA (82.6%), PTA (21.7%) and peroneal (13.0%) arteries. Mean lesion length was 198.8mm. Mean balloon diameter used was 3.02mm, and it was inflated at an average of 22atm, for 90 seconds. Good results were observed, with satisfactory wound healing rates. Reintervention was required for 1 patient (4.35%). There were no major adverse cardiac (MACE) or limb events (MALE) observed. There was a single case of unrelated mortality observed (4.35%), as a result of sepsis. Overall, a limb salvage rate of 100% was observed at 3 months.


ConclusionsOur findings support our hypothesis that prolonged HPB angioplasty is a safe and efficacious modality for the treatment of BTK lesions. Good immediate luminal gain was observed in this study. Further long term studies can be conducted to further evaluate the direct correlation between prolonged HPB angioplasty and clinically significant restenosis.

06-08The Endovascular Repair of Blunt Traumatic Thoracic Aortic Injury in Asia: A Systematic Review Xin Nee Ho1, Lauren Wilson2, Andrew MTL Choong3,4

1Department of Vascular Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK, 2Department of Vascular Surgery, Royal Brisbane and Women’s Hospital, Queensland, Australia, 3Division of Vascular Surgery, National University Heart Centre, Singapore, 4School of Medicine, Griffith University, Gold Coast, Queensland, Australia

Background and objectives Management of blunt thoracic aortic injury (BTAI) has evolved from the traditional open approach to the less invasive thoracic endovascular aortic repair (TEVAR) in recent years. As such, data on its effectiveness and outcomes, especially in Asia, is still emerging. This systematic review aims to collate all available information about this approach in Asian countries, assessing effectiveness in this population, and identifying major discrepancies between nations.

MethodsAll relevant literature from Asian countries (as defined by the UN) on the endovascular repair of BTAI was identified through a journal database and reviewed.

Results20 retrospective studies and 27 case reports from 12 countries were identified, which reported 288 cases of BTAI managed by TEVAR. Mean age of patients was 41.45 years old (range 17 - 83 years old), and 60.4% were treated within 24 hours. Postoperative complications included 5 strokes, 9 endoleaks, 3 vascular access injuries, 17 cases of renal failure (8 requiring continuous RRT), 1 aortic rupture and 1 immediate conversion to open surgery. There were no reported instances of stent migration/collapse, spinal cord ischaemia or aorto-esophageal fistula. Mean length of follow up was 23.3 months (range 0 - 132 months). 30-day mortality was 3.2%( n=8), and total overall mortality was 4.4% (n=11).

ConclusionsOverall, early and mid term results show that TEVAR for BTAI is an effective treatment in the Asian population, with relatively low mortality rates, and is increasing in incidence. The Asian countries differ in technical aspects, for example type of stent used or usage of heparin, but the difference in follow-up lengths makes it difficult to draw conclusions linking this to outcomes. As more TEVARs are carried out in the region, the corresponding increase in data will make it possible to carry out a more detailed analysis - especially of long-term outcomes.

06-09Emergency TEVAR for Thoracic Aortic Aneurysm Rupture of Blunt Thoracic Aortic InjuriesHiroki Uchiyama Uchiyama1, 3, Dr Kiyofumi Morishita1, Dr Toshio Baba1, Dr Masami Shingaki1, Dr Tsuyoshi Shibata1, Dr Kouhei Narayama1, Professor Nobuyoshi Kawaharada2, 3

1Hakodate Municipal Hospital, Hakodate, Japan, 2Sapporo Medical University School of Medicine, Sapporo, Japan, 3Department of Cardiovascular Surgery, Sapporo Medical University, , Japan

BackgroundAneurysm rupture or traumatic injury of thoracic aorta confers a significantly increased risk of adverse outcome and death. Endovascular treatment for such critically ill patients is expected to decrease procedural mortality and morbidity. The aim of this study was to evaluate the effect of endovascular repair on mid-term survival and outcome.

MethodsFrom December 2007 to March 2016, 42 patients (60% men; averaged age, 74 years) underwent thoracic endovascular aneurysm repairs (TEVAR) urgently. Operative indications were ruptured aortic aneurysm in 30 patients, traumatic aortic injury in 9, and ruptured anastomotic aneurysm in 3. The mean Japan score (mortality predicted based on Japanese data base) was 40%±23%. Seven patients suffered from shock. Associated procedures included total debranching in 4 patients and surgeon-modified fenestration in 2.

ResultsThe 30-day mortality was 12% (5 of 42). The cause of death in 4 patients was multiple organ failure. One patient in whom re-rupture occurred during balloon molding of the endograft died of massive exsanguination. Postoperative complications included 19 respiratory failures, 3 strokes, 3 renal failures, and 2 spinal cord injuries. Endgraft-related complications were endoleak in 5 patients, access trouble in 3 patients, retrograde type A aortic dissection in 1 patient, and graft migration in 1 patient. Of the 6 patients with endoleak or graft migration, 4 patients underwent re TEVAR in the follow-up period. The patient with retrograde dissection was treated medically because of complete thrombosis of false lumen. Technical success was achieved in 35 patients (83%). There were 10 late deaths. Aneurysm-related death occurred in 5 patients of them.

Kaplan-Meier survival was 60%±8% at 1 year and 56%±8% at 5 years.

ConclusionsEarly and midterm outcomes of emergency TEVAR are good when taking into account high-risk situations. However, long-term surveillance will be needed because of late aortic complications.

Oral Presentation


06-10Comparison of long-term results of carotid endarterectomys between primary closure and patch angioplasty groupsYoung-Wook Kim1, Dr Seon-Hee Heo1, Mrs Shin-Young Woo1, Dr Kyung-Won Yoon1, Pf Yang-Jin Park1, Pf Dong-Ik Kim1, Pf Kwang-Ho Lee2, Pf Gyeong-Moon Kim2, Pf Keon-Ha Kim3

1Vascular surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul , South Korea, 2Neurology, Heart Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul , South Korea, 3Interventional radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, , South Korea

BackgroundPrevious multiple studies have established that patch angioplasty(PA) following carotid endarterectomy(CEA) reduces the risk of subsequent stroke and restenosis compared with primary closure(PC).

ObjectiveWe attempted to determine whether the beneficial effect of the PA works on the long-term survival of patients.

MethodsWe retrospectively reviewed a database of 828 CEA which performed in a single institute between 2003 and 2016. After excluding 43 patients who underwent concomitant 42 CABG(n=42) and RND(n=1), we compared patient characteristics and postoperative results including operative complications, restenosis rate, stroke rates, long-term survival rates and stroke-related mortality rates between PC(n=332, 58%) and PA (n=453, 42%) groups. To determine long-term survival rates and cause of death in those patient groups, we used database of Statistics Korea. All CEAs were performed under the general anesthesia routinely using carotid shunt (Pruit-Inahara® carotid shunt, LeMaitre Vascular, Inc.) and we used bovine pericardial patch for PA. Patient stratification between PC and PA depended on the surgeon’s assertion with performing routine PC by one surgeon while routine PA by other surgeon.

ResultsPA was more frequently performed for patients with coexisting coronary artery disease (43% vs 35%, p=0.019) and symptomatic carotid stenosis (39% vs 29%, p=0.004). During follow up of mean 43±37months (range 1-154months), carotid restenosis(>70% on duplex US) was more often detected in PC group (2.7% vs 0.9%, P=0.047) but there was no statistically significant difference in early postoperative complications, stroke (1.2% vs 1.5%), stroke-related mortality rates(0.9% vs 0.2%) and long-term survival rates at 3, 5, 7 years (98%, 95%, and 94% vs 99%, 95%, and 91%) between PC and PA groups.

ConclusionThough PA following CEA reduces the risk of carotid restenosis but did not show significant beneficial effects on the stroke rate and long term survival rate.

06-11Diagnostic accuracy of multiplanar reformation in computed tomography: A comparative study to conventional angiography Uijun Park1, RN Na Yeon Jeon1, MD Hyoung Tae Kim1, MD Won Hyun Cho1

1Keimyung University, Daegu, South Korea

PurposeThe purpose of the present study was to investigate the diagnostic accuracy of mutiplanar reformation of computed tomography (CT-MPR) compared with conventional carotid angiography (CCA).

MethodsForty carotid arteries in 21 patients who performed both image studies were included in this study. Complete occluded carotid artery was excluded. Carotid stenosis degree was measured by NASCET method. Carotid stenosis in CT-MPR was compared with stenosis in CCA. Overall diagnostic validity was assessed by Spearman correlation test. Carotid stenosis was categorized into three groups; less than 50%, 50-70%, more than 70% and diagnostic validity was assessed by kappa statistics. Intraclass correlation test was performed for evaluating reliability of stenosis measurement in CT-MPR.

ResultsMean age was 66.8 years (range 55-87). Male was 15 (71.4%) and 15 (71.4%) patients were symptomatic. Spearman correlation coefficient (rho) was 0.881. In CCA, stenosis<50% was 24 (58.5%) arteries, 50-70% stenosis was 6 (14.6%), and stenosis >70% was 11 (26.8%). In MPR, stenosis<50% was 25 (61.0%) arteries, 50-70% stenosis was 11 (26.8%), and stenosis >70% was 5 (12.2%). Kappa value was 0.701 (P=0.001). Intraclass correlation coefficient was 0.934 (95% CI; 0.880-0.964).

ConclusionWith improved spatial and temporal resolution, multiplanar reformation in computed tomography permits the diagnosis of carotid stenosis with a high degree of accuracy compared with conventional carotid angiography

07-01Advancements in treating blunt thoracic aortic injuries: Imaging evaluation and endograft sizingSeiichi Yamaguchi1, Dr. Hisanori Fujita1, Dr. Shigeyasu Takeuchi1

1Chiba Emergency Medical Center, Chiba, Japan

Background/ IntroductionBlunt thoracic aortic injuries (BTAI) are morbid conditions that historically were difficult to manage.

ObjectivesThe purpose of this study is to reveal rapid change of hemodynamically unstable trauma patients and the necessity for expeditious endovascular repair selecting the appropriate-size stent graft in blunt thoracic aortic injuries.


Materials and MethodsWe retrospectively evaluated all blunt thoracic trauma patients that were admitted to our hospital from January 2014 to February 2016 (n=201). Eighteen cases suffered blunt thoracic aortic injury, representing 8.9 % (18/201).

Results56 % of BTAI patients (10/18), including six out-of-hospital cardiac arrest (OHCA) cases, died before reaching aortic repair. Five patients having acute BTAIs and multiple concomitant injuries underwent endovascular aortic repair. But one of the five cases fell into fatal ventricular fibrillation just a few minutes after stent-graft placement due to rapid hemodynamic deterioration. The mean thoracic aortic diameter in these four cases was larger at the control CT compared with the CT on admission while hemodynamically unstable. There is a very strong correlation seen between the inverse of shock index (1/SI) and the mean thoracic aortic diameter ratio (D) to control measured on admission CT. The relationship between 1/SI and D indicated very strong positive linear correlation, Pearson’s r value 0.93. D=0.2/SI + 0.7 (D =< 1.0)

Conclusions We lost five non-OHCA patients in twelve with an acute BTAI within a few hours after hospital admission, and among them four patients could not even receive operative interventions. In the aortic trauma patient at high risk due to underlying associated injuries, the acute benefits of reliable exclusion of the injury justifies the use of a stent-graft. We should know that trauma patients who admitted with hemorrhagic shock have a smaller aortic diameter compared with a control condition.

07-02Surgical treatment for peripheral arterial trauma with acute ischemic limb – Experience of a single vascular surgeon in ChangHua Christian HospitalYungKun Hsieh1, Dr ChunMing Huang2, Dr ChienHui Lee1, Dr YingCheng Chen1, PhD IngSh Chiu1


BackgroundAlthough peripheral arterial injury with acute ischemic limb composes minority of traumatic cases, it could lead to significant mortality and morbidities.

ObjectivesTo retrospectively review our cases to identify factors affecting the outcome.

Materials and MethodsWe retrospectively reviewed and analyzed cases of peripheral arterial injury with acute ischemic limb receiving surgery by a single vascular surgeon in Chang-Hua Christian Hospital (CCH) since 2011.

ResultsSince 2011/01, there were 21 cases of peripheral arterial injury with acute ischemic limb receiving surgery by a single vascular surgeon in CCH. The average age was 48.2±17.4 (15-75) and male

was 17(81.0%). There was 1 mortality due to hypovolemic shock. Among other 20 cases, limb salvage was achieved in 15 cases (75.0%). The number of the injury in upper or lower limbs was 1 and 20 respectively; 15 cases were blunt injury and 5 were penetrating injury. The number of patients receiving open extra-anatomic bypass was 13 (65.0%), in-situ repair/grafting was 3(15.0%), stenting was 3(15.0%) and hybrid operation was 1(5.0%). 1 patient receiving popliteal artery stenting needed an additional superficial femoral artery (SFA)-pedal bypass for limb salvage. Among all factors, diagnosis in emergency room (ER) instead of other department in hospital is significantly related to limb salvage (11/12, 91.7% vs. 4/8, 50.0%, p = 0.035). The presentation of class III limb ischemia is negatively correlated to limb salvage (0/3, 0% vs. 15/17, 88.2%, p = 0.0011). Although the salvage rate is acceptable, only 5 cases regained ambulation without prosthesis (5/15, 33%)

ConclusionPeripheral arterial injury with acute ischemic limb could lead to significant mortality and morbidities. Early diagnosis is very essential to limb salvage. Extra-anatomic bypass or in-situ repair are effective but endovascular surgery could be an alternative to selected cases. There is still significant functional loss of the limb despite salvage.

07-03Outcomes of Endovascular Treatment of Traumatic Aortic Transection in a Multi-ethnic Asian PopulationDexter Yak Seng Chan1, Nicholas Syn2, Carmen Maria Paulin Vera1, Rajesh Babu1, Jackie Ho Pei1,3, Peter Robless1, Julian Wong1, Andrew MTL Choong1,4

1Division of Vascular Surgery, National University Heart Centre, Singapore 2Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 3Department of Surgery, National University of Singapore, Singapore, 4School of Medicine, Griffith University, Gold Coast, Queensland, Australia

ObjectiveThe aim of this study was to evaluate our experience in the acute treatment of traumatic aortic transection with thoracic endovascular aortic repair (TEVAR).

MethodsA retrospective review of patients at the National University Hospital, Singapore from 2002-2015 who underwent TEVAR for traumatic aortic was conducted. The patients were studied for 30 day survival, 1 year survival, length of stay and technical details

ResultsA total of 18 patients had a TEVAR for traumatic aortic injury. Seventy-two percent (13of 18) were male. And the median age was 35 years (range 23-66). Ten were Chinese, 4 were indian and there were 2 Malays and Indonesian. Fourteen patients were involved in a road traffic accident, two had industrial accidents and the remaining two fell from height. All the aortic injury was located at the isthmus of the aorta. All patients also suffered other concomitant injuries. 17% (3 of 18) were hypotensive and 39% (7 of 18) were tachycardic on arrival. 11% required an additional open vascular procedure. The median length of cover was 120mm (range 77-150mm). No patients died during their admission. Three patients were lost to follow up as they went home to their respective countries for futher treatment. Of the remaining 14, all patients

Oral Presentation


survived past 30 days and 1 year. The median follow up for this group was 76 months (range 14-174 months). None of these patient required reinterventions or endoleaks from this group.

ConclusionThoracic endovascular repair of traumatic aortic injuries is an effective, rapid and safe intervention with good short and long term results.

07-04Factors related to the reflux of great saphenous vein at thighJong Kwon Park1, Dr Hyeonseung Kim1

1Inje University Haeundae Paik Hospital, Busan, South Korea

Background/ IntroductionVenous reflux can cause swelling, pain, and subsequently, varicose veins or permanent cosmetic problems in lower extremities by stasis dermatitis or ulceration.

ObjectivesThe purpose of this study was to investigate the factors related to the reflux of great saphenous vein (GSV) at thigh.

Materials and MethodsThe 278 legs of 139 consecutive patients with swelling and pain of legs were examined by Doppler Ultrasound (US). The antero-posterior diameters of GSV, common femoral (CFV), superficial femoral (SFV), profunda femoris (PFV), and popliteal (PV) veins were measured. The presence of venous reflux was determined by Doppler US if the reflux time was more than 0.5 second in superficial vein (GSV), and more than 1 second in deep veins (CFV, SFV, PFV, PV). Investigated continuous variables were age, diameters of veins, body mass index (BMI), smoking pack•year, alcohol drink days, levels of HbA1c, total cholesterol, high density lipoprotein, low density lipoprotein, triglyceride, homocysteine, uric acid, protein C, protein S, antithrombin III, factor VIII, fibrinogen, D-dimer, and rheumatis factor. Investigated nominal variables were gender, diabetes mellitus, hypertension, smoking, alcohol consumption, lupus anticoagulant, anticardiolipin antibody IgG and IgM. The patients, who have never drunk alcohol or have not drunk alcohol during the last 5 years, were defined as alcohol non-drinker, and the others were defined as alcohol drinker. Alcohol drink days were calculated by multiplying the average days of alcohol drink per month by 12 and by the number of years the person has drunk.

ResultsLogistic regression analysis showed that the independent factors determining GSV reflux were diameter of CFV (B=0.351, p=0.017), BMI (B=0.237, p=0.014), alcohol drinker (B=1.375, p=0.029), and antithrombin III (B=-0.001, p=0.001).

ConclusionsThe increased diameter of CFV, higher BMI, alcohol drinker, and lower antithrombin III level may be the risk factors of developing GSV reflux.

07-05The relationship between nerve injury and ablated length of the vein after endovenous thermal ablation of varicose veinsTakashi Yamamoto1, Dr Nobuhisa Kurihara1, Dr Masayuki Hirokawa1

1Ochanomizu Vascular & Vein Clinic, Chiyoda-ku, Japan

Background and objectivesNerve injury is reported to happen in about 5% of limbs after endovenous thermal ablation of saphenous vein. The aim of this study was to elucidate the relationship between the incidence of nerve injury and the lengths of ablated saphenous vein.

Methods The clinical records of 3,989 limbs with saphenous imcompetence which were treated with endovenous laser ablation (EVLA) or radiofrequency ablation (RFA) from May 2014 to December 2015 were reviewed retrospectively. The limbs were classified into groups according to the type of ablated vein (great saphenous vein (GSV) or small saphenous vein (SSV)). The incidences of nerve injury in each groups were calculated according to the ablated length of the vein (ALV) for every 10cm (≤ 10 cm, ≤ 20 cm, ≤ 30 cm, ≤ 40 cm, ≤ 50 cm and > 50 cm).

ResultsIn the GSV group, the incidences of nerve injury were 0.0, 0.3, 0.4, 1.0, 2.7 and 8.2% from short to long respectively. Nerve injury was increased as the ALV becomes longer and significantly when the ALV was more than 30 cm. In the SSV group, the incidences of nerve injury were 2.4, 2.2 and 1.6% respectively without significant difference between each ALV. There were no significant difference between EVLA and RFA in both groups.

ConclusionsNerve injury in relation to the GSV ablation was observed frequently as the ALV was longer as well as previous reports. However, in the SSV group, the incidences of nerve injury didn’t change with the ALV. This result suggests that nerve injury after thermal ablation of the SSV may occur at the proximal portion where the tibial nerve and its branches run close to the SSV.

07-06Comparison of Monopolar versus Segmental Radiofrequency Ablation in Endovenous Treatment of Lower Limb Chronic Venous InsufficiencyRyan Tan1, Dr Pravin Lingam1, Dr Joseph Lo1, Dr Qiantai Hong1, Dr Sadhana Chandrasekar1, Dr Sriram Narayanan1, Dr Glenn Tan1

1Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore

ObjectivesTo compare outcomes in patients with lower limb chronic venous insufficiency (CVI) who were treated with monopolar (EVRF®, F Care Systems, Belgium) versus segmental (VNUS® ClosureFastTM, Medtronic, USA) radiofrequency ablation (RFA) therapy.


MethodsRetrospective study of 288 limbs treated between January 2014 and May 2015. Demographics, co-morbidities, CEAP clinical manifestation, pre-operative venous duplex, surgical procedure and post-operative outcomes were evaluated.

Results189 patients with 288 limbs were treated with RFA. 146 limbs were treated with EVRF and 142 limbs with VNUS. Both groups were similar in demographics and co-morbidities. The average age was 58 years, with average BMI of 26. There were no patients with mixed arterio-venous disease.

Majority had long saphenous vein (LSV) reflux (99% in monopolar, 97% in segmental, p=0.44) and sapheno-femoral junction (SFJ) incompetence (88% in monopolar, 80% in segmental, p=0.07). Half had short saphenous vein (SSV) reflux (51% in monopolar, 49% in segmental, p=0.73) and a third had concomitant deep vein reflux (29% in monopolar, 34% in segmental, p=0.38). In addition to LSV RFA, 20% of patients within the monopolar group had anterior accessory great saphenous vein (AAGSV) RFA, compared to 3% of patients within the segmental group (p=0.01). RFA was performed to SSV in 14% of patients within the monopolar group and 8% of patients within the segmental group (p=0.14).

Post-operative outcomes were similar in both groups. Transient superficial neuropathy was 8% in both groups (p=0.83), phlebitis occurred in 4% of monopolar group and 1% of segmental group (p=0.28). No deep vein thrombosis nor recurrences occurred within both groups.

ConclusionsBoth monopolar and segmental RFA are safe modalities in treating lower limb CVI, with similar clinical outcomes and low complication rates. The significant advantage of monopolar is the shorter active catheter tip, which allows for treatment of shorter vein segments such as AAGSV.

07-07ClariVein™ - mechano-chemical ablation (MOCA) for treatment of truncal venous insufficiency: a systematic review James Sun1, Mr Mohammed Chowdhury1, Mr Umar Sadat1, Professor Tjun Tang2

1Vascular Unit, Cambridge University Hospital NHS Foundation Trust, Cambridge, Uk, Cambridge, United Kingdom, 2Vascular Service, Changi General Hospital, Singapore

Background/ObjectivesClariVein™ or mechano-chemical ablation (MOCA) combines mechanical damage to the endothelium caused by a rotating wire with simultaneous catheter-guided infusion of a liquid sclerosant. The aim of this review was to assess the efficacy and safety of the ClariVein™ device in the treatment of superficial venous disease.

MethodsA comprehensive search strategy was employed of the CENTRAL, MEDLINE (January 1966 to April 2016), and EMBASE (January 1980 to April 2016) databases. Primary outcomes were anatomic,

clinical and technical success. Secondary outcomes were complications, quality of life and time to return to normal work/activity. Search criteria identified 31 studies, with 11 suitable for inclusion.

Results1307 patients were included, 869 (66%) female and mean age was 55.6 (+/-14.6) years. CEAP class 1:2-3:4-6 = 9:963:292 respectively. 1242 great saphenous veins (GSV) and 237 small saphenous veins (SSV) were treated. Technical success overall = 99.9%. Anatomical success for GSV = 94.3% and for SSV 91.4% after 6 weeks and 91.7% and 93.6% respectively for at least 1 year follow-up. Clinical success measured by the VCSS improved from 4.93 (+/-1.45) at baseline to 1.69 (+/-1.22) (p <0.001) at follow-up. There was also an improvement in quality of life (QoL) measured by the AVVQ score (14.1 (+/- 2.3) to 8.3 (+/-1.6) (p=0.02)). The time for patients to return to normal activity following MOCA was 1.8 (+/-1.1) days and 2.4 (+/- 1.6) days for return to work. The most common complications were ecchymosis, induration, hyperpigmentation and thrombophlebitis.

ConclusionsPresenting the pooled data of MOCA to date, this study shows ClariVein™ is an effective treatment modality for GSV and SSV insufficiency with minimal complications and quick return to normal function. However, larger randomised trials are required to define the role of ClariVein™ further in relation to the ever increasing number of new technologies for endovenous ablation.

07-08The results of noncomparative study of endovenous heat-induced thrombosis treatment by rivaroxaban Professor Alexey Fokin1, Denis Borsuk2


After using of endovenous methods of treatment of varicose veins it had been appeared a new complication such as endovenous heat-induced thrombosis (EHIT).

The aim of our work was to investigate the efficacy of rivaroxaban for the treatment of EHIT after endovenous laser ablations (EVLA).

Materials and methodsProspective noncomparative study includes 1326 patients who had 1514 EVLA over the period from September 2014 to February 2016. In 1091 (72,1%) cases the great saphenous vein (GSV) was ablated. The anterior accessory vein (AASV) was treated in 124 (8,2%) cases and small saphenous vein (SSV) was treated in 299 (19,7%) cases.

The EHIT were found out in 21 (1,4%) cases. 19 (1,7%) patients had EHIT of GSV and in 2 (1,6%) cases there was EHIT of AASV. We didn’t observe any EHIT after treatment of SSV. All the patients with EHIT were prescribed rivaroxaban.

Oral Presentation


ResultsAccording to Kabnick classification it was the 1st class EHIT in 9 (0,6%) cases, the 2nd class in 10 (0,7%) cases and there were only 2 (0,1%) cases of 3rd class EHIT. All the patients with the 1st class were prescribed rivaroxaban 20 mg once a day and we used 15 mg twice a day for the patients of the 2nd and the 3rd classes of EHIT. We had to stop of using rivaroxaban for 1 (4,8%) patient because of dyspepsia. In this case we began to use enoxaparin in therapeutic dosage once a day. It was a complete regress of EHIT over the period of 6-25 days in all cases. In 1 (4,8%) case there was nose bleeding without major complications. This patient went on using rivaroxaban. There were no cases of pulmonary embolism.

ConclusionsRivaroxaban is an effective medicine for EHIT treatment. The other investigations are needed to point its efficacy and safety.

07-09Histopathological Investigations on the Great Saphenous Vein treated with SclerotherapyHarinder Singh Bedi1, Dr Nalini Calton1, Dr Kanwardeep Kwatra1

1Christian Medical College & Hospital, Ludhiana, Ludhiana, India

ObjectiveSclerotherapy is a minimally invasive technique to produce endoluminal ablation of a varicose vein. There is not much data on the histolo-pathologic effect of sclerotherapy on the human vein. We studied in detail the histological changes in the vessel wall of the great saphenous vein (GSV) after it was subjected to sclerotherapy.

MethodWe studied the effect of sclerotherapy with sodium tetradecyl sulphate on 5 pieces of the human GSV. A short piece of vein was removed at the start to serve as control (labelled control 1). Another short piece was gently filled with isotonic blood-saline solution and clipped at both ends. This was labeled as control 2. Foam was prepared using Tessari’s technique. A vein cannula was used to inject the foam solution into the test vein which was covered with warm packs at body temperature. After 1 minute the foam was gently flushed with saline-blood solution and clipped at both ends. After 5 minutes the clips were removed from the test and control 2 and all 3 specimens were preserved in 10% buffered formaline and subsequently sectioned and stained with haemotoxylin and eosin and subjected to HPE.

ResultsOn gross inspection there were no apparent changes. On detailed histopathology there was a loss of 63.5% of the endothelium (range 62.2–82.8) and an injury to the media (median depth 43.4 μm (42.1–46.7) and % media injury 5.3% (3.7–6.0).

ConclusionWe believe that these findings have great clinical relevance. They will help us to further fine tune the volume and dose of sclerosant used for ablation to get a maximal therapeutic effect. This technique may also become a standard method to try out newer sclerosing agents since it uses human saphenous vein .

07-10The results of endovenous laser ablation of the saphenous veins more then 2 cm of the diameter Professor Alexey Fokin1, Denis Borsuk2


Prospective noncomparative study includes 64 patients who were operated from November 2014 until September 2015 and they had 67 EVLA of great saphenous veins (GSV). We used 1470 Nm laser, radial fibers and special pull-back device. All veins were treated under tumescent anesthesia. The diameter of the veins close to sapheno-femoral junction was from 21 to 43 mm (mean 27±4,3 mm). In all cases we used the power of 8-10W. The LEED in dilated segments was from 83,3 to 142 J/cm. The observation period was from 68 to 340 days (mean 138±37 days). The patients were examined by ultrasound the next day, a week later and 2 and 6 months later.

In this investigation we were interested technical result which was existed in occlusion of treated veins. Also we appreciated in absence of presence of reflux in nonoccluded veins. The next day after EVLA 60 (89,5%) of the veins were occluded. In 7 (10,5%) cases the rest lumen in dilated segments was found but it was closed for 3 patients after 7 days. In 4 (6%) cases we did ultrasound-guided foam-form sclerotherapy (UGST). Over the period of 6 months the small stumps of GSV (mean 21 mm ± 5 mm) were found of 3 (4,5%) patients. In all cases it wasn’t reflux in this stumps. Also only in 1 (1,6%) case we found recanalization with pathological reflux. This patient was treated by UGST. There was no necessary to retreat patients by EVLA.

EVLA 1470 nm by radial fibers are really effective also for the veins of the diameter more than 2 cm. We have found occlusion of GSV of 99,5% cases in early follow-up period. In 4,5% cases UGST has been done.

07-11An Old but Remarkable Instrument for “Minimal-invasive“ Varicose Vein Surgery: Oesch PIN Strippers Mingli Li1

1China Medical University Hospital, Taiwan, Taichung City, Republic of China

BackgroundThere are several varicose vein stripping instruments developed for “traditional” trunk varicose vein surgery. The old-fashioned, stainless, flexible, 90cm-in-length cable with variable changeable metal or plastic probe tips and olives (Nabatoff vein stripper) is familiar to most vascular surgeons. The experience of using a stick-like Oesch PIN stripper (Credenhill, UK ) for stripping a trunk saphenous vein is scarce in many medical centers.

ObjectivesComparison of cable strippers and PIN strippers used in thigh, leg and calf trunk varices


Materials and MethodsWe use PIN strippers in patients who can’t afford the cost of endoluminal thermal therapy or foam sclerotherapy and compare the post-op satisfaction with cable stripping.

ResultsPatients are greatly satisfied with the PIN stripping due to no need of distal trunk vein exploration wound. The truly invaginated vein stripping largely decreases the postoperative pain, bruising and peripheral nerve injuries. We believe that the PIN stripping combined with hook miniphlebectomies can be done under tumescent anesthesia on outpatient basis.

ConclusionsPIN stripping has many unique advantages which should be popularized and inherited in medical centers and clinics.

08-01Pharmacomechanical Thrombectomy (PMT) with Angiojet Solent Omni Compared with Catheter Directed Aspiration Thrombectomy (CDAT) for Treatment of Acute Deep Vein Thrombosis (DVT)Jang Yong Kim1, Professor In Sung Moon1, Clinical Professor Mi Hyeong Kim1, Professor Seung Nam Kim1, Clinical Professor Kang Woong Jun1, Assistant Professor Jeong Kye Hwang1, Professor Ji Il Kim1, Associate Professor Yong Sung Won1, Professor Sang Seob Yun1, Associate Professor Sun Cheol Park1, Clinical Fellow Hyun Kyu Kim1


BackgroundConventional anticoagulation for acute DVT can cause post thrombotic syndrome (PTS). Therefore, early thrombus removal strategies for acute DVT are widely appreciated across different societies. PMT is recently-established therapy to manage acute DVT, when experts and resources are available. In Korea, CDAT is popular options for acute DVT because PMT devices are limited by reimbursement issues. We compared the results of PMT with Angiojet with CDAT and evaluated risk factors affecting patients’ outcome.

Materials and MethodThis is a retrospective study from prospectively registered database of the patients, who underwent interventional procedures due to acute DVT in Seoul St. Mary’s Hospital from 2013 to 2015. PMT with AngioJet and Solent Omni catheter was compared to CDAT for acute DVT. Patients’ demographics, procedural information, their results and complications were retrieved from EMR and PACS and analyzed with SPSS 10.1.

ResultsFifty eight patients were enrolled. 22 patients were treated by PMT, and 36 by CDAT. There was no procedure or inhospital mortality in both groups. There were 3 additional thrombolysis in PMT group and 6 in CDAT group. There was no difference of technical success rate between PMT and DCAT regardless of thrombolysis (P=0.4183, P=9.205). The limitation of PMT with Angiojet was short operating time of AngioJet(less than 5mins) with residual thrombus while large thrombus embolization in DCAT.

ConclusionPMT with AngioJet and DCAT are a safe and effective strategy for early thrombus removal of patients with acute DVT with different pitfalls. This study is limited by small number and retrospective study.

08-02Correlation of obesity & chronic venous insufficiency with respect to Co-morbid pathologic conditionsSandeep Mahapatra1, Professor Pinjala Ramakrishna1

1Nizam’s Institute Of Medical Sciences, Hyderabad, India

IntroductionChronic venous insufficiency symptomatology is commonly observed in obese patients

ObjectivesThe aim of the cross sectional observational study is to evaluate the relation of morbid obesity with the severity of the venous disease and the impact of different pathological conditions on the venous disease distribution.

Method200 morbid obese patients were evaluated in the outpatient department with respect to age, gender, lower limb affected, CEAP (Clinical, Etiological, Anatomical, Pathological) classification, Diabetes, Hypertension and Hypothyroidism . Obesity was defined by Body mass index more than 30kg/m2. Clinical examination of the lower limb was assessed by the grades of the venous sign with documented reflex by duplex imaging.

ResultsThere is a significant association of male patients presenting with left leg (85.7%) high grade Chronic venous insufficiency (CVI) symptoms (P value=0.05), having primary etiology of CVI in CEAP (p value=0.078 )classification .Superficial venous system was involved in the disease pathology in 192 cases (99%) with 91% of the patients having truncal valvular reflux in Duplex scan .High BMI is associated with higher grades of Clinical scoring ( P value0.053).The primary or the idiopathic etiology is having statistically significant association with BMI>40kg/m 2(p value=0.007).Duplex confirmed significant reflux is observed in patients with higher BMI(P value=0.006)).Spearman correlation showed that Age is positively correlated with Clinical score (r=0.176 , P value =0.013).Pairwise correlation between BMI with clinical score and age is statistically significant (Non-Parameteric test)

ConclusionsThe study confirmed that older age gentleman with high BMI having primary venous reflux are at increased risk of the clinical progression of CVI from varicose veins to chronic venous insufficiency with trophic skin changes and venous ulcers. We could not establish primary influence of Diabetes, Hypertension or Hypothyroidism on the severity of CVI.

Oral Presentation


08-03Endovenous laser therapy in the treatment of great saphenous vein reflux: comparison between 1470nm 2ring radial fiber and 940nm bare tip fiberAlbert Ting1, Ms Grace Cheung1, Ms Silvana Lau1, Dr Yiu-che Chan1, Dr Alfred Wong1, Dr Yuk Law1, Prof Stephen Cheng1

1Division of Vascular Surgery, Department Of Surgery, University Of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong

Background and objectivesEndovenous laser therapy (EVLT) has emerged as a popular treatment for great saphenous vein (GSV) reflux. We performed EVLT procedures with 1470nm 2ring radial fiber (1470nm laser) since February 2014. The clinical outcomes and efficacy were compared with those treated with 940nm bare tip fiber (940nm laser).

MethodsEighty-eight legs with GSV reflux received EVLT using 1470nm laser under local tumescent anaesthesia as day surgery procedures between February 2014 and May 2016. They were compared with another 88 legs treated with 940nm laser prior to February 2014. The safety and efficacy as well as the early results including postoperative pain, the degree of bruises and the time before resuming normal activities were compared. Venous clinical severity score (VCSS) assessment and Duplex scans were performed at one month and one year after operation.

ResultsThe success rate as defined by the absence of GSV reflux at one month Duplex scan were 100% in both groups. No major complications were recorded. Pain score (Visual analogue scale) at one week was significantly lower in 1470nm laser (Median: 1.21 vs. 2.57) although the numbers of analgesic required were comparable (Median: 6 tablets in both groups). There was significantly less bruises in 1470nm laser and the time before resuming normal activities was also significantly shorter (Median: 2 days in 1470nm laser vs. 3 days in 940nm laser). VCSS showed significant improvement at one year in both groups (Median: from 4 to 1 in 1470nm laser; 5 to 2 in 940nm laser). Recurrence of GSV reflux noted at one year was comparable (0% in 1470nm laser vs. 5% in 940nm laser).

ConclusionBoth procedures were safe and effective in ablating GSV reflux with similar recurrence rate at one year. 1470nm was associated with decreased pain and bruises with earlier return to normal activities.

08-04Does ablation of great saphenous vein and simultaneous phlebectomies of varicose veins reduce incompetent perforators in primary chronic venous disease?Tomohiro Ogawa1

1Fukushima Daiichi Hospital, Fukushima, JapanThe role of incompetent perforators (ICP) in the recurrence of varicose veins and the development of skin changes (C4-6)

after treatment for superficial incompetence in primary CVD is controversial. Direct interruption of ICP is often considered using sclerotherapy, endovenous and surgical ablation in addition to the ablation of proximal saphenous truncal reflux and simultaneous phlebectomies. This study was conducted to identify the effect on the ICP by the ablation of varicose veins using endovenous and surgical procedures.

Methods36 consecutive cases (45 legs, CEAP C classification; C2: 16, C3: 20, C4a: 9) with primary CVD due to GSV incompetence and varicose veins with concomitant ICPs participated in this study. In all affected legs, ablation of truncal and branch great saphenous vein using laser or radiofrequency with stab avulsion of varicose veins was performed. Venous reflux in the leg was examined using duplex ultrasound and physical assessment was performed at pre and post-operative 1 month.

ResultsIn 44 medial, 1 lateral and 5 thigh ICP detected at pre-operation, 22 medial and 1 thigh ICP disappeared, 9 medial and 1 thigh IPC remained, 13 medial, 3 thigh and 1 lateral ICP became competent at postoperative 1 month (Residual IPC rate: 18 %). The averaged diameter of ICP significantly decreased from 3.1 mm to 1.7 mm after operation. 29 % legs had residual varicose vein after operation. The rate of residual IPC in the group of residual varicose vein (60 %) is higher than that of non-residual varicose vein (20 %).

ConclusionThe ablation of truncal and branch great saphenous vein with stab avulsion of varicose veins for primary varicose vein can reduce number of incompetent perforators without direct treatment for incompetent perforators.

08-05ClariVein(r) - One Year Results of Mechano-Chemical Ablation (MOCA) for Varicose Veins in a Multi-Ethnic Asian Population from SingaporeSN Khor2, Dr L Jiang2, Dr. S Kum1, Dr. YK Tan1, Dr TY. Tang1

1Vascular Service, Department of General Surgery, Changi General Hospital, , Singapore, 2Singapore Health Services, Singapore, SingaporeIntroductionClariVein(r) is a novel non thermal, non-tumescent catheter technique, which uses mechanical and chemical ablation (MOCA) to occlude the superficial vein. This study aims to assess its effectiveness and patient experience in a multi-ethnic Asian population in Singapore.

Methods121 patients (141 legs; 180 procedures) underwent ClariVein(r) treatment. 49 (40.5%) for great saphenous vein (GSV) incompetence, 16 (13.2%) bilateral GSV, 13 (10.8%) short saphenous vein (SSV), 4 (3.3%) bilateral SSV and 39 (32.2%) combined unilateral GSV and SSV reflux. 49/180 legs (27.2%) had C4 -C6 disease. Patients were reviewed at an interval of 1 week, 3, 6 and 12-months post procedure and underwent Duplex ultrasound assessment. Post-operative complications were recorded along with patient satisfaction.


ResultsThere was 100% technical success. 63/121 (52.1%) had concomitant phlebectomies. All procedures were very well tolerated with a mean post-op pain score of 0.8 (range 0-4). After 3 months, median patient satisfaction of the treatment was 9 (IQR 9-10). At 1 week, the GSV was completely occluded in 114/118 (96.6%) veins and SSV completely closed in 58/59 (98.3%) veins. At 3 months follow up, the GSV was occluded in 89/98 (90.8%) veins and SSV completely closed in 48/50 (96.0%) veins. At 6 months follow up the GSV was completely occluded in 93/107 (86.9%) veins and SSV completely closed in 50/55 (90.9%) veins. At 1 year, GSV and SSV occlusion rates were 78/92 (84.8%) and 50/53 (94.3%).

ConclusionsClariVein(r) can be used safely to ablate both long and short saphenous varicose veins in a multi ethnic Asian population. Bilateral procedures can be successfully performed and these are well tolerated as can multiple veins in the same leg. Early results are similar to what is described so far in the literature but recurrences although in the majority of cases required no reintervention, are more than expected.

08-06Incidence and clinical feature of pulmonary embolism in patients with symptomatic deep venous thrombosis diagnosed by means of computed tomographyUijun Park1, RN Na Yeon Jeon1, MD Won Hyun Cho1, MD Hyoung Tae Kim1, PhD, RN Min Young Kim2


PurposeComputed tomography pulmonary angiography (CTPA) is currently the preferred imaging test for pulmonary embolism (PE). This study was performed to evaluate the incidence, radiologic and clinical severity of PE in patients with symptomatic deep vein thrombosis (DVT).

Material and MethodsAmong the patients who took CTPA and CT venography of lower extremity concomitantly due to leg swelling, the patients who confirmed lower leg DVT with CT venography were enrolled. The incidence and clinical feature of PE was retrospectively studied.

ResultsTotal of the 103 patients diagnosed DVT in CT venography. Iliac DVT was 47.6%, femoral DVT 23.3%, popliteal DVT 18.4% and calf DVT 10.7%. Sixty one patients (59.2%) had PE concomitantly in CTPTA. The lesions were evenly distributed in both lungs and bilateral pulmonary artery involvement was in 39.8%. PE involving main pulmonary artery was 42.6%, lobar pulmonary artery 42.6% and segmental pulmonary artery 14.8%. The frequency of PE in calf DVT was 63.6%, in popliteal DVT 73.7%, in femoral DVT 54.2%, and in iliac DVT 55.1%. Forty-nine percent of PE was clinically silent and 43.7% showed mild clinical symptoms, however 2.9% of PE showed hemodynamic unstability.

ConclusionsThis study showed the high frequency of PE in patients with symptomatic DVT, but half of PE was asymptomatic and severe symptomatic PE was rare. There was no significant difference between the occurrence of PE in relation to the location and extension of DVT.

08-07Comparative study of pain at EVLT with laser wavelength 1470nm and 1560nm in patients with varicose veinsDr Oleg Guzkov1, Nikita Shichkin1, Natalya Tarasova1

1 Yaroslavl state medical University , Yaroslavl, Russian Federation

ObjectivesEvaluation of pain syndrome after performing EVLT of GSV in the early postoperative period using wavelength 1470 nm and 1560 nm.

Methods256 patients with primary varicose veins of the lower extremities. CEAP: C2 - C5. EVLT performed by diode laser 1470 nm (N=191) and 1560 nm (N=65). Assessment of pain was performed according to the visual analogue scale (VAS). The follow up was performed at 1, 3, 5, 7, 14 and 21 days after EVLT.

ResultsComparing the two groups (1470 nm and 1560 nm), a significant difference between at various times after EVLT it was not detected. In the group where the used wavelength of 1470 nm, was an increase in the level of pain on 1st day after EVLT to 6% compared to preoperative pain from 3,4 to 3,6 points (р=0,03). On day 7, pain was lower values by 35% (р<0,0001). On the 14th and 21th day the pain was significantly lower in the 1,9 and 4,3-fold respectively. In the group with the wavelength 1560 nm decreased pain syndrome since postoperative days 3 to 24%. The median pain score was 2,8 (IQR 0-3,3, р=0,01). On the 7th and 14th day reduced pain by 41 and 51%, respectively. On the 21th day of the median pain score was 0 points, IQR 0-1,9, p<0,0001).

ConclusionsIn applying the wavelength of 1470 nm was a significant increase in pain on the first postoperative day, while at the wavelength of 1560 nm is not amplified pain. A significant reduction in pain in the preoperative period was in both groups: at 1470 nm with 7 days of the postoperative period, and at 1560 nm with 3 days

08-08Endovenous laser treatment of incompetent perforator veins - does the ablation method matter?Chien-Chang Chen1

1CVS CLINIC, Taichung, Taiwan

Background Endovenous laser treatment (EVLT) of incompetent perforator vein (IPV) has the advantage of fast recovery and low risk of wound complication.

Oral Presentation


ObjectivesIn this study, we reported the clinical outcome of the patients treated for IPVs with EVLT and compare the sonographic results of two different ablation methods.

Materials and Methods30 IPVs in 26 patients were treated with EVLT. The surgical indications were IPV diameter > 3.5mm with symptomatic varicose veins or dermatologic complications. The IPVs were ablated directly if the whole routes could be cannulated (direct ablation). If the IPVs were too tortuous to be cannulated, their exits were sealed by ablating the outflow veins (indirect ablation). The preoperative and postoperative venous clinical severity score (VCSS) were recorded. Duplex ultrasound was used to follow up the change of IPVs preoperatively, 6 weeks, 24 weeks postoperatively.

ResultsThe mean age was 50.9 years (26-79 years). The mean clinical follow-up period was 56.8±29.5 weeks. Direct and indirect ablation was done in 15 patients (57.7%) and 11 patients (42.3%), respectively. All patients had clinical improvement after EVLT with the mean preoperative and postoperative VCSSs being 6.9±3.5 and 1.6±1.9 (p< 0.05), respectively. Technical success was achieved in 14 of the 15 direct-ablation patients (93.3%) and 100% of the indirect-ablation patients. A successful redo procedure was achieved in the failed direct-ablation patient. Ultrasonography follow-up of the mean diameters of all treated IPVs reduced from 6.5±3.8mm preoperatively to 3.5±1.0mm at 6 weeks and 1.4±0.9mm at 24 weeks postoperatively. At 24 weeks, complete sealing and reflux-free were found in 100% of the directly ablated IPVs and 61.5% of the indirectly ablated IPVs (p< 0.05).

ConclusionsEVLT is effective in clinical improvement of IPV-related chronic venous disease. IPVs treated by direct ablation tend to have higher reflux-free rate than those by indirect ablation.

08-09Study of the relationship between static foot disorders (SFDs), clinical severity of chronic venous disease (CVD) and venous clinical severity scoreTermpong Reanpang1, Dr Nattaporn Ratanasoontornchai1, Dr Saranat Orrapin1, Dr Supapong Arworn1, Dr Kittipan Rerkasem1

1Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, Chiang Mai, Thailand

BackgroundTo study the relationship in between static foot disorders and the CEAP clinical severity in Thai populations.

Material and methods178 CVD patients were recorded using standardized record form that includes finding from duplex ultrasound, the clinical CEAP classification, and the venous clinical severity score. The clinical CEAP classification was determined in both limbs. A standardized measurement of the Djian-Annonier angle was used to quantify and identify the presence of SFDs. The normal angle is between 119° and 128°. The angle < 119° is called hollow foot and the angle > 128° is called flat foot.

ResultsThere were 27 (15%) men and 151 (85%) women. 356 limbs were included in this study and 346 limbs were measured the Djian-Annonier angle. The C0-C1 group were 196 (55%) limbs and the CVD group (C2 or more) were 160 (45%) limbs. The SFDs were found 172 (49.7%) limbs in this study. 90 (47%) limbs were found in the C0-C1 group and 82 (52.5%) limbs were found in the CVD group. The flat foot in the CVD group were 59 (37.8%) limbs that higher than the other groups significantly (p < 0.001). The hollow foot was no different in both groups. The mean Djian-Annonier angle was significantly (p < 0.001) increased when compared to C0-C6 classification. The C5-C6 group (healed and unhealed ulcer patients) had the widest of the Djian-Annonier angle. Higher of the venous clinical severity score (VCSS) was significantly related to wider the Djian-Annonier angle (p<0.001) when the hollow feet were excluded.

ConclusionsThe static foot disorders are commonly found in Thai population. The flat foot strongly relate to more severity of chronic venous disease. For the clinical practice, the detection of SFDs is a new key. The CVD symptoms will improve when the SFDs are corrected.

08-10Risk factors of deep venous thrombosis in a cohort of Chinese patientsHai-Lei Li1, Dr. Yiu-Che Chan2, Dr. Ning Li1, Dr. Dong-Zhe Cui1, Professor Stephen Cheng2

1Department of Surgery, The University Of Hong Kong Shenzhen Hospital, Shenzhen, China, 2Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China

IntroductionDespite the great impact of deep venous thrombosis (DVT) on health, there are few published studies on underlying risk factors of DVT in Chinese patients. Pulmonary embolism (PE) is frequently unsuspected or undiagnosed.

ObjectivesTo investigate the risk factors and prevalence of PE in a cohort of Chinese patients with DVT at a single medical center.

MethodsA retrospective review of patients with DVT from August 2013 to May 2016 was performed. Demographic data was retrieved from electronic medical record system. Risk factor of DVT and incidence of PE were analyzed using SPSS.

ResultsA total of 94 patients (49 female, 52.1%) were included in this study. The mean age of patients was 54.2 ± 17.2 (range 25 to 88) years old. Most of them (75 patients, 80%) had acute DVT. Majority of the patients’ thrombosis was located at the left leg (52 patients, 53.3%). The other locations including right lower limb (29 patients, 30.9%), bilateral lower limbs (8 patients, 8.5%) and left subclavian vein (4 patients, 4.3%). Femoral vein was involved in 32 patients (34%), while iliac vein thrombosis was identified in 30 patients (31.9%). Limb swelling and pain were presented in 87 (92.6%) and 83 (88.3%) patients, respectively. The most common causes of DVT were immobility (30.8%), trauma or surgery (20.2%) and malignancy (8.5%). Contrast CT scan of the lung was performed in 50 patients who had proximal DVT, 27 patients (54%) had PE,


however, only one was symptomatic. The dosage of warfarin was 3.6 ± 1.6 mg to achieve a target INR of 2.0-3.0. Revascularization was identified in 54 (91.5%) out of 59 patients who had follow-up duplex ultrasound.

ConclusionImmobility, trauma and surgery are still the most common risk factors for DVT. The incidence of silent PE in patients who had proximal DVT was high.

08-11Catheter-directed thrombolysis cannot prevent postthrombotic syndromeYoung Ah Kim1, Dr Woo Sung Yun1, Dr Shin Seok Yang1, Dr Bo Yang Suh1

1Youngnam Medical Center, Daegu, South Korea

BackgroundPost-thrombotic syndrome (PTS) is a most common chronic complication of deep vein thrombosis (DVT).

ObjectivesThe aims of this study are to identify risk factors and to evaluate an efficacy of catheter-directed thrombolysis (CDT) for preventing development of PTS in patient with lower extremity DVT.

Materials and MethodsFrom 2005 Jan to 2013 Dec, 138 limbs of 125 patients who had the first episode of proximal DVT at the affected limb and visited our out-patient clinic to check Villalta scale were enrolled in this study. The PTS was defined as ≥ 5 points of the Villalta scale. We retrospectively reviewed medical records for possible predictors of PTS.

ResultsDuring 82.5 months (30 – 136 months) of median follow-up, CDT was performed in 54 limbs (39%, male 27, mean age 57.9±14.8 years). After thrombolysis, iliac vein stent was placed in 28 limbs (20%). We achieved complete recanalization in 38 limbs (70%) and partial recanalization (residual thrombus < 50%) in 16 limbs (30%). No differences between CDT and non-CDT group were found in baseline characteristics, duration of symptom, use of anticoagulation and recurrence of DVT. Inferior vena cava filter was more frequently placed in CDT group (p = 0.007). A significant higher thrombotic burden was observed in CDT group (p = 0.013). In multivariate analysis, patients with PTS had significantly higher body mass index (BMI) (hazard ratio, 1.036; p = 0.005) and longer thrombotic burden involved in ilio-femoro-popliteal DVT (hazard ratio, 3.722; p = 0.033). CDT did not influence the risk of PTS (p > 0.05).

ConclusionsWe suggest that higher BMI and longer thrombotic burden are associated with development of PTS in patients with DVT. CDT is not effective in preventing PTS in this observational study.

08-12Incidence of chronic venous insufficiency and post thrombotic syndrome in lower limbs DVT, a 3 years follow-up Hossein Hemmati1

1Inflamatory lung disease research center guilan university of medical sciences,, Rasht, Iran , 2vascular surgery and dialysis research center guilan university of medical sciences, Rasht, IranHossein Hemmati, Pantea Hajireza, Kambiz Farid Marandi, Hanif Balasi IntroductionDVT has been attracting many clinical attentions due to its long and short terms complications.can be Post-thrombotic syndrome and chronic venous insufficiencywhich occurs even after an appropriate anticoagulant therapy.The clinical evidence and evaluation of venous valves using Doppler test or Plethysmography can help with the diagnosis of DVT in symptomatic patients. In spite of extensive studies for the DVT’s prevention and treatment in the last several years,the chronic venous insufficiency has not investigated thoroughly.

ObjectiveThe purpose of the proposed study is to determine the incidence of chronic venous insufficiency,suggest optimized treatment methods to reduce the patients’pain.

Material and methodsDVT patients from 1389 to 1392 have been considered for the survey.We chose the patients who had suffered DVT in lower limbs for the first time. Each patient went through a Photoplethysmography(PPG)test and the results along with information obtained from history and physical examhave been recorded,The information such as age,gender,weight,claudication,heaviness, pigmentation,telangiectasia,varicose veins, edema, pulse, venousulcers, location of DVT and underlying diseases. SPSS version21 has been employed for data analyzing with a threshold of p<0.05.

ResultsIn total 153 cases with an average age of 50±14 have been contributed in this studywith a DVT average time of 2.08±08 years.The results show that in 43.1% of the cases the DVT has been involved in Iliofemoral area which had not shown a significant correlation with PTS in our study.The evaluation of the clinical evidence in the recruited DVT patients showed that 101,101,73 and 67 cases had been suffering from edema,heaviness,Telangiectasiaand pain respectively.The PPG results of 94.8% of the cases were positive.

ConclusionConsidering the fact that the majority of the patients were symptomatic,a more optimized method may can be essential for future studies.

KeywordsDeep Vein Thrombosis, PostthromboticSyndrome, Venous Insufficiency.

Oral Presentation


09-01Management of iliofemoral DVT in a single large tertiary hospital; a need to create greater awarenessHaider Bangash1, Mr Josh Cutten1, Mr Patrick Tosenovsky1, Professor Patrice Mwipatayi1, Mr Nishath Altaf1


IntroductionIliofemoral Deep Vein thrombosis (DVT) is associated with significant morbidity and long term adverse outcomes. Since the publications of numerous randomised controlled trials, several guidelines advocate the use of intervention in suitable patients with iliofemoral DVT. With this change in recommended treatment, the aim of this study is to evaluate the referral patterns of patients diagnosed with iliofemoral DVT in our tertiary hospital.

ObjectivePrimary objective was to evaluate number of patients with acute iliofemoral DVT that were referred to the vascular surgery unit. Secondary objective was to evaluate the number of patients that were not referred to vascular surgery who would have been suitable for vascular intervention based on a comprehensive selection criterion.

Results114 patients had radiologically confirmed iliofemoral DVT. Of these patients, 64 (56%) were male and 50 (43.8%) female with the mean age of 62.8±19.4 years. 42 patients (36.8%) were considered suitable for intervention and only 12 patients were referred to vascular surgery department for review and evaluation for further treatment. Majority of referrals occurred in the year 2016 with 6 patients (31.5%). 8 out of 12 patients referred underwent surgical intervention for their symptomatic iliofemoral DVT.

ConclusionThere still appears to be a large proportion of patients with symptomatic iliofemoral DVT who despite being potentially suitable for intervention are not being referred to the vascular services. More awareness needs to be created about the benefits of vascular intervention for iliofemoral DVT so that these patients can have improved short and long term outcomes

09-02An Experience of Subfascial Endoscopic Perforator Surgery in Complicated Chronic Venous InsufficiencyShahzad Alam Shah1

1Fatima Jinnah Medical University & Sir Ganga Ram Hospital Lahore, Lahore, Pakistan

BackgroundIn varicose veins disease the incompetent perforators has a major contribution in the development of complications. Conventionally, in patients that have associated incompetent perforators require multiple incisions for ligation of these perforators. The advancement in the endoscopic techniques has permitted the use of this modality for perforator surgery.

ObjectiveTo study the outcome and post-operative complication of Subfascial Endoscopic Perforator Surgery (SEPS) for treating complicated chronic venous insufficiency.

MethodsA total of sixty patients were included in this non randomized interventional study.conducted at surgical department of Sir Ganga Ram Hospital Lahore. The data was collected from September 2013 till March 2016. Non probability purposive sampling technique was used for sample selection.

ResultsA total of 66 procedures were performed in 60 patients having mean age of 41.1 years. An average of four perforators were dealt with endoscopic surgery. Post-operative pain, hematoma 14.2%, edema in 15 cases (28.7%), surgical emphysema at port site in 15 patients (28.7%), bleeding due to slippage of clip in three patient (4.76%), saphenous neuralgia in three patient (4.76%) were main complications.Wound infection not seen in any case and there was no evidence of wound infection recorded during one month post-operatively. Mean hospital stay was 1.5 days. At 3 months follow up ulcers healing was 90% in patients with active ulcers.

ConclusionSEPS is a better and minimally invasive technique as compared to old Linton approach for management of venous ulcers leading to early patient mobility, early return to work and better ulcer healing.

09-03False-lumen Growth in the Abdominal Aortic Region after Endovascular Repair for Type-B Aortic Dissection: Computational Study of Long-term Follow-upJiang Xiong1, Prof. Duanduan Chen2, Mr. Huanming Xu2, Dr. Huiwu Dong1, Dr. Wei Guo1

1Dpt. Vascular And Endovascular Surgery, Beijing, China, 2Beijing Institute of Technology, Beijing, China

BackgroundThoracic endovascular aortic repair (TEVAR) is commonly applied in type-B aortic dissection (AD). For patients with long dissection, post-TEVAR, false lumen (FL) expansion, especially in the infrarenal aorta, might occur. Hence, wise medical decision regarding re-intervention or surgery is required: this relies on effective prediction of the development of the dissection.

Objective According to the long-term follow-up CT image of post-TEVAR type-B AD, using computational study to predict false-lumen growth in the abdominal aortic region.

Methods and Results Patient-specific models were established based on CTA of long-term follow-ups of type-B AD with stable (7 follow-ups in 53months) and expanded (5 follow-ups in 35months) FL post-TEVAR. Doppler ultrasound velocimetry was applied to obtain individualized flow boundary conditions and to validate the computational results; the finite volume method was employed to solve the transport equations. Growth/reduction of surface thrombosis in the proximal FL along the flap is repeatedly occurred and is consistent to the


longitudinal variation of local wall shear stress (WSS). The spatial-variant pressure difference (PD) between FL and true lumen (TL) is related to luminal remodelling. Its relative magnitude during early-stage post-TEVAR may be suggestive of subsequent FL remodelling. In long-term follow-up, the position of the largest PD is consistent with the greatest increase of FL width. When the maximum PD is large, FL growth and TL collapse are found at the same axial position. The position of the first flow entry of FL is the watershed of negative-and-positive values of PD.

Conclusions Medical imaging techniques together with computational analyses can quantitatively identify the FL entries and thus find the watershed of PD. PD and WSS may predict regional luminal remodelling and partial thrombosis establishment, which altogether assist in further treatment decision-making.

09-04Thoracic endovascular aneurysm repair (TEVAR) in the management of various thoracic aorta pathologies: Hosp. Kuala Lumpur experiencedZaharudin Ismazizi1, Dr Azizi Zainal Ariffin1

1Hospital Kuala Lumpur, Wilayah Persekutuan, Malaysia

PurposeTo present our single-center experience of endovascular management of various thoracic aorta pathologies

MethodsAll patients between the period of 2006-2015 with various thoracic aorta pathologies who were treated with thoracic endovascular repair (TEVAR) were included in the review. All data obtained were entered into an Excel worksheet for further analysis.

ResultsDuring the period, 69 patients with thoracic aorta pathologies were treated with TEVAR. There were 57 males and 12 females. Patients were divided into 4 groups based on their pathologies namely aneurysms, pseudo aneurysms, aortic dissection and traumatic injuries of the thoracic aorta. Median age for each group that underwent the procedure were 66.8 yrs , 67.8 yrs , 60.9 yrs 22.2 yrs respectively. The number of procedures for each group were 29, 15, 8 and 17 respectively. Twelve patients required an additional debranching procedure. Out off twelve patients seven were required carotid-carotid bypass, five carotid–subclavian, one chimney graft to left subclavian artery and two abdominal viscera bypass . Perioperative mortality was 8.3% (5 patients). One patient died due to rupture of the traumatic pseudoaneurysm and four patients died because of comorbidities. Eleventh endoleaks were recorded and divided into 4 types, type Ia, Ib, II and III. The numbers of endoleak were six, one, three and one. Three ruptures were observed during the follow-up period. Major adverse event which include neurological deficit were recorded in seven patients (10%) three had paraplegia and four had paraperesis of the lower limbs. The number of patients with stent graft infection detected on follow up was 4(5%).

ConclusionOur experienced support the safety and efficacy of TEVAR for aortic pathologies with a low morbidity and mortality rate. The use of TEVAR in young patient need a further followed up for long term outcome.

09-05Stent graft-induced new entry (SINE) following thoracic endovascular aortic repairTakashi Hashimoto1, Dr. Noriyuki Kato1, Dr. Takatoshi Higashigawa1, Dr. Shuji Chino1

1Mie University Hospital, Tsu, Japan

BackgroundThoracic endovascular aortic repair (TEVAR) is now a mainstream therapy of patients with aortic dissection (AD). Stent graft-induced new entry (SINE) has been recognized as one of important adverse events observed in them.

ObjectivesThe objective is to report our experience of SINE.

Materials and MethodsSince 1997 through 2016, 141 patients with aortic dissection underwent TEVAR in our hospitals. Among them, 13 patients (9.2%) developed SINE following TEVAR. There were 10 men and 3 women. The mean age was 63.1±9.1 years old. One of them had Marfan’s syndrome. Their medical records were reviewed retrospectively.

ResultsFive patients underwent TEVAR within a month from the onset of AD, 1 within 3 months, 2 within a year, and 5 beyond a year. Twelve patients underwent TEVAR with hand-made device and one with Talent. The mean oversizing of the device was 30±12% to the diameter of the true lumen. The interval between TEVAR and SINE was 7 days in 1 patient, within 2 months in 4, and beyond a year in 8. All five patients who developed SINE within 2 months had undergone TEVAR within a month from the onset of AD. There were no symptoms at the onset of SINE in all patients. The interval between TEVAR and SINE had a high positive correlation with the interval between the onset of AD and TEVAR (Pearson correlation coefficient = 0.817).

ConclusionsWhile SINE can develop immediately following TEVAR, it can be observed even years after TEVAR. Therefore, close follow-up should be mandatory in patients who underwent TEVAR for the treatment of aortic dissection to avoid catastrophic events associated with SINE.

Oral Presentation


09-06Thoracic endovascular aortic repair for Stanford type B aortic dissection with a disease-specific deviceMasatoshi Komooka1, Dr Shinichi Higashiue1, Dr Satoshi Kuroyanagi1, Dr Onichi Furuya1, Dr Masahide Enomoto1, Dr Saburou Kojima1, Dr Naohiro Wakabayashi1


Background/IntroductionIn the treatment of Stanford type B aortic dissection TEVAR in addition to best medical treatment is associated with improved 5 year aorta specific survival and delayed disease progression as well as improvement in aortic remodeling.

ObjectiveThis study objective was to evaluate the feasibility, safety, and early technical and clinical success rate of a new endovascular device specially designed for aortic dissection that has been available since October 2015 in Japan.

Materials and MethodsFrom October 2015 to March 2016, the Zenith Dissection Endovascular System (Zenith TXD) was used in 6 nonconsecutive patients with Stanford type B aortic dissection (3 complicated cases; 2 bowel ischemia, 1 lower limb ischemia). Indications were compression and collapse of the true lumen and abdominal side branches and/or symptomatic malperfusion. Patients were studied for computed tomography imaging, operative complications, and technical aspect of the procedure.

ResultsAll patients were male with a median age of 63.3 years (range 31-82 years) and were managed with conservative therapy at first of admission.The median interval between the clinical presentation of the aortic dissection and the endovascular procedure was 51 days (range 16-200 days). In 4 patients, right-to-left subclavian artery bypass was performed before device deployment to obtain adequate proximal landing zone. Mean operation time was 135±52 minutes and mean hospital stay was 22±9 days. No 30-day complication including spinal cord ischemia were found and preoperative symptomatic malperfusion was abolished. Postoperative imaging prior to discharge showed that false lumen was thrombosed for the most part and the compressed true lumen enlarged without any obstruction of the abdominal side branches.

ConclusionsThe perioperative and early follow-up results showed that the Zenith TXD can be safely used without affecting the patency of the abdominal side branches covered by the bare stent including uncomplicated cases.

09-07Results of Bentall procedure in acute type A aortic Dissection - The single center experienceYungKun Hsieh1, Dr YingCheng Chen1, Dr ChunMing Huang2, Dr ChienHui Lee1, PhD IngSh Chiu1

1Changhua Christian Hospital, Puyang St., Changhua City, Taiwan, 2MinShen Hospital, Taoyuan city, Taiwan

PurposeAnastomosis above sino-tubular junction is the standard method of proximal anastomosis of ascending aortic grafting (AsAo grafting) in acute type A dissection. However, in some cases, total aortic root replacement, i.e., Bentall procedure, is required due to root destruction. We retrospectively reviewed the results of Bentall procedure in acute type A DAA in our hospital. Materials and MethodsWe retrospectively reviewed the patients with type A dissection receiving Bentall procedure from 2011/01 to 2016/09. The results are analyzed and compared to patients with ordinary AsAo grafting.

ResultsSince 2011/01, there are 20 cases receiving Bentall procedure in 143 type A dissection (14.0%) in our hospital. We used mechanical valve in all cases. The age is 50.7 ± 16.3 and male are 13 cases (65.0%). 1 case was iatrogenic aortic root injury in coronary artery catheterization. 1 case was traumatic aortic root injury. 4 cases received pre-op CPR (20.0%). The reasons of Bental procedure including: intimal tear in Sinus Valsalva 11, intimal tear near or into coronary artery orifice 8, aortic annulus ectasia 4 and severe AR 10. The operation method includes: standard Bentall procedure 11, Bentall procedure + TEVAR 1, and Bentall procedure + total arch replacement + TEVAR 8. There are 6 cases with CABG and 5 cases with Cabrol modification. ECMO was used in 5 cases. The survival rate was 75.0% (15/20) and 1 late death. The freedom from stroke rate was 80.0% (12/15). 1 case received 2nd aortic cross-clamp for bleeding from Cabrol modification and another 1 case received re-sternotomy for hemostasis. There is 1 case requiring hemodialysis and tracheotomy. Compared with ordinary AsAo grafting, the Bentall procedure has the slightly inferior survival (15/20, 75% vs 104/123, 84.5%, p = 0.29), higher bleeding, stroke rate (p = 0.33, 0.34), and significantly higher ECMO usage (5/20, 25.0% vs. 12/123, 9.8%, p =0.05)

ConclusionBentall procedure is not common in type A dissection surgery. But it is required in dissection into sinus Valsalva or coronary artery and aortic aortic ecstasia. With careful operation, it does not carry poorer outcome. But higher ECMO usage rate in Bentall procedure in our hospital.


09-08Preservation of the left subclavian artery in zone 2 TEVAR using a Relay Plus thoracic stent graft with a surgeon-crafted fenestrationYoshihiko Kurimoto1, Dr. Shuhei Miura1, Dr. Kosuke Ujihira1, Dr. Yutaka Iba1, Dr. Ryushi Maruyama1, Dr. Eiichiro Hatta1, Dr. Akira Yamada1, Dr. Katsuhiko Nakanishi1

1Teine Keijinkai Hospital, Sapporo, Japan

BackgroundThe left subclavian artery (LSA) has been surgically reconstructed or simply covered in zone 2 TEVAR. We report our clinical results concerning the use of the Relay Plus thoracic stent graft system (Relay), considered a structurally suitable stent graft for physicians, to craft a fenestration in order to preserve the LSA in zone 2 TEAVR.

MethodsThose believed to be appropriate subjects for zone 2 TEVAR treatment were considered for this study. A fenestration was created using a cautery on the back table during TEVAR based on a configuration of the distal aortic arch around the LSA.

ResultsFrom November 2014 to May 2016, 13 patients underwent zone 2 TEVAR using Relay. Etiology consisted of a type B aortic dissection in 9 patients (patent false lumen in 7, ULP in 1, thrombosed false lumen in 1), degenerative thoracic aortic aneurysm in 2 and blunt traumatic aortic transection in 2. The mean age was 59.8±18.0 years old and 9 of the patients were male (69.2%). Two patients (15.4%) – 1 from the type B aortic dissection group and 1 from the traumatic group - required emergency TEVAR. There was no early or late death. There was also no stroke or spinal cord ischemia following TEVAR. The LSA could be preserved by a fenestration in 11 patients (84.6%). No patient suffered any LSA-related event in the follow-up period although additional stent-placement was necessary in one patient (7.7%) during TEVAR due to an embolism in the LSA. A mild type I endoleak was noted in one patient (7.7%) with a degenerative aortic aneurysm treated by non-fenestrated Relay.

ConclusionRelay provided an excellent apposition in zone 2 TEVAR. A surgeon-crafted fenestration on Relay allowed for a less invasive preservation of the LSA.

09-09Open Aortic Arch Surgery Following Thoracic Endovascular Aortic Repair with DebranchingTetsuro Uchida1, Dr. Azumi Hamasaki1, Dr. Atsushi Yamashita1, Dr. Ken Nakamura1, Dr. Jun Hayashi1, Dr. Daisuke Watanabe1, Dr. Shingo Nakai1, Dr. Kimihiro Kobayashi1, Dr. Seigo Gomi1, Prof. Mitsuaki Sadahiro1

1Yamagata University Faculty Of Medicine, Yamagata, Japan

ObjectiveThoracic endovascular aortic repair (TEVAR) with supra-aortic debranching has been considered as therapeutic options for aortic arch disease in high-risk patients. However, with the increase of endovascular cases, open aortic arch reoperation subsequent

to TEVAR is highlighted. The purpose of this study is to retrospectively evaluate our surgical strategy and outcome of these kinds of patients.

MethodsBetween November 2012 and June 2016, 103 patients with different aortic arch pathologies underwent primary TEVAR at our institution, 31 patients required supra-aortic debranching to obtain adequate proximal endograft fixation.

ResultsFour of 31 patients, open aortic arch reoperation had been performed during mid-term follow-up. There were 3 females and 1 male, with the mean age of 70 years old. Three of 4 patients required secondary procedures due to stent-related complications. After TEVAR complications comprised progressive type Ia endoleaks (N=2) and retrograde type A aortic dissection (N=1). The other showed impending rupture of aortic root pseudoaneurysm which was not associated with primary TEVAR. All 4 patients underwent total (N=2) or partial (N=2) arch replacement via median sternotomy. The adjunctive surgical technique included a total cardiopulmonary bypass, moderate hypothermia, and circulatory arrest with the aid of selective antegrade cerebral perfusion (ACP). Debranching bypass grafts were divided and used as an inflow of bilateral ACP individually. Furthermore, transected distal stump of the aortic arch was reinforced with previously inserted stent grafts and Teflon strips. Distal anastomosis was completed in usual end-to-end fashion. There was no operative death in this series.

ConclusionsDespite the high-risk nature of the complications, secondary open aortic arch reconstructions after TEVAR were successfully performed. Our proposed technique was expected to make these complex operations safe, simple and less invasive.

09-10Nationwide Trends of Diagnosis, Management Strategy and Mortality Among Thoracic Aortic Disease In South Korea: From 2006-2014Joon Hyuk Kong1

1Department Of Thoracic And Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do, South Korea

BackgroundThe Prevalence, management strategy and mortality were not elucidated in nation-wide data in South Korea.

ObjectiveThe purpose of this study was to investigate temporal trend and management strategy of patients diagnosed with thoracic aortic disease (TAD) in Korea between 2006 and 2014.

Materials and MethodsTo determine the number of TAD, we searched the database of the Health Insurance Reimbursement Association for codes 71.0, 71.1, 71.2, 71.5, 71.6. And, we searched the database of HIRA for codes O2031, O2032, O2033 for open surgical repair (OSR) and M6611 for thoracic endovascular treatment (TEVAR). To discern the number of TAD-related deaths in Korea, we searched the number of deaths from the suggested diseases counted by Korean Standard Classification of Disease.

Oral Presentation


ResultsBetween 2006 and 2014, the annual rate of aortic dissection has been increased 2.4 times. Those of Thoracic aortic aneurysm (TAA) and thoraco-abdominal aortic aneurysm (TAAA) have been increased 28 and 1.8 times, respectively. Especially, the incidences of non-ruptured TAA and TAAA significantly increased, contrary to those of ruptured TAA and TAAA (3.3 and 1.9 vs. 1.2 and 1.5 times, P-value < 0.01) However, the disease-specific mortality rate of TAD has been decreased annually, especially in aortic dissection, but not in ruptured TAA and TAAA. For the management of TAD, proportion of TEVAR in TAD has been increased. (P for trend <0.001).

ConclusionWhile annual rates of TAD have been increased from 2006 to 2014, the mortality has been steadily decreased but contrary in ruptured TAA or TAAA. Adoption of TEVAR for TAD has been increased.

09-11Surgical results of emergency thoracic endovascular aortic repair in patients with acute aortic syndromeYoshinori Kuroda1, MD Tetsuro Uchida1, MD Azumi Hmasaki1, MD Atsushi Yamashita1, MD Ken Nakamura1, MD Jun Hayashi1, MD Daisuke Watanabe1, MD Shingo Nakai1, MD Kimihoro Kobayashi1, MD Seigo Gomi1, MD Mitsuaki Sadahiro1

1Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata-shi, Japan

BackgroundAcute thoracic aortic emergencies have been particularly challenging for surgeons. Thoracic endovascular aortic repair (TEVAR) has been contributed to improved mortality and rapid postoperative recovery even in high-risk patients compared with open aortic surgery. The purpose of this study is to evaluate the clinical results of emergency TEVAR in patients with acute aortic syndrome.

MethodsBetween May 2010 and July 2016, 102 consecutive patients with various aortic pathologies involving descending aorta underwent TEVAR at our institution. Of these, 7 patients required emergency TEVAR (3 men and 4 women; mean age, 74.2 ± 7 years). Three patients had Stanford type B acute or chronic aortic dissections, 2 had atherosclerotic thoracic aortic aneurysms and 2 had traumatic aortic injuries. Simultaneous supra-aortic debranching was performed in 1 patient.

ResultsEmergency TEVAR was completed in all patients without open conversion. The mean operation time was 76 min. Despite completion of endovascular therapy, 1 patient died of prolonged shock state due to preoperative rupture of thoracoabdominal aortic aneurysm. Respiratory failure requiring prolonged mechanical ventilation was noted in 3 patients. One patient underwent tracheostomy. The mean duration of intensive care unit and postoperative hospital stay were 2 and 34 days, respectively. During the mid-term follow-up, relevant complication was not observed.

Conclusions

Although the pre-operative statuses of the patients were extremely severe, the operative mortality and morbidity were acceptable. Endovascular management of acute thoracic aortic emergencies was considered to improve surgical results even in high-risk patients, but length of hospital stay tended to be prolonged in patients experiencing emergency TEVAR.

09-12Initial experience with the Najuta fenestrated stent graft for the treatment of arch aneurysm requiring Zone 0 landingNaoki Toya1, Dr Soichiro Fukushima1, Dr Eisaku Ito1, Dr Yuri Murakami1, Dr Tadashi Akiba1, Dr Takao Ohki2

1The Jikei University Kashiwa Hospital, Kashiwashi, Japan, 2The Jikei University School of Medicine, Minatoku, Japan

IntroductionA major issue in thoracic endovascular aneurysm repair (TEVAR) of aortic arch aneurysm with a short proximal neck is the necessity to cover the origin of arch branches to achieve an adequate proximal landing zone. Zone 0 TEVAR using fenestrated stent graft in the aortic arch could achieve a better sealing zone while preserving branch flow.

ObjectiveHere we present the initial result of zone 0 TEVAR using the Najuta stent graft.

Materials and MethodsThe Najuta thoracic stent graft is a customized fenestrated device comprising of a self-expandable stainless-steel Z-stent and an e-PTFE graft, which was approved for use in Japan in January 2013.

We performed a retrospective review of patients who underwent zone 0 TEVAR with the Najuta stent graft at Jikei University Kashiwa Hospital, Chiba, Japan during the last 18 months.

ResultsA total of 9 patients underwent zone 0 TEVAR using the Najuta. Patients were predominantly male (67 %), with a mean age of 74 years. The mean follow-up period was 7 months. Simultaneously performed procedures included debranching bypass (n=5; 45%) and EVAR (n=1; 11%). In 8 cases (89%), we used additional distal stent grafts to achieve secure fixation and a tight seal. One patient (11%) who underwent Zone 0 TEVAR with concomitant endovascular repair for thoracoabdominal aorta and received dialysis preoperatively died within 30 days due to non-obstructive mesenteric ischemia. Postoperative stroke occurred in one patient. No type 1a endoleak was identified after procedure on follow-up CT

ConclusionsAlthough adverse events were encountered in 22%, the Najuta may be a reasonable treatment option for arch aneurysms that requires Zone 0 landing and warrants further investigation.

10-01


Surgical Outcome of Acute Type A Aortic Dissection in Patients Older than 80 Years old.Reo Sakakura1, Asai Thru1

1Shiga Medical University, Otsu, JapanBackground/IntroductionPatients with acute aortic dissection are becoming older due to a rising proportion of elderly patients in Japan. We have been performing aggressive emergency surgical treatment even if the patient is old age.

ObjectivesTo evaluate the outcome of surgical repair for acute type A aortic dissection in patients aged 80 years or older.

Material and MethodsFrom January 2002 to December 2015, 238 patients underwent graft replacement for acute type A aortic dissection at our institute (range 28-95). Follow-up was 79.2% complete. Of these, 43(18.1%) patients were 80 years old or more. We examined them.

ResultsRange of replacement were ascending aorta n=40, hemiarch n=1 and arch n=2. The hospital death was 6/43 (14.0%) and 20/195 (10.3%) in patients 80 years and older but 79 years or younger, respectively. Cause of death were stroke (n=2), bleeding at operative field(n=1), mediastinitis(n=1), intestinal bleeding(n=1), rupture of descending aorta(n=1). Of the deaths, one patient had cardiopulmonary resuscitation and two had stroke before operarion.

ConclusionAlthough the hospital mortality of patients older than 80 years old was slightly higher than 79 years or younger in operation acute type A aortic dissection, it was acceptable outcome.

10-02Aortic root re-intervention in patients with type A acute aortic dissectionKen Nakamura1, Dr Tetsuro Uchida1, Dr Azumi Hamasaki1, Dr Yoshinori Kuroda1, Dr Atsushi Yamashita1, Dr Jun Hayashi1, Dr Daisuke Watanabe1, Dr Shingo Nakai1, Dr Kimihiro Kobayashi1, Dr Seigo Gomi1, Dr Mitsuaki Sadahiro1

1Yamagata University Faculty Of Medicine, Iidanishi, Japan

ObjectiveThe aortic dissection extending to the aortic root is a common finding. In order to prevent late aortic root complications, precise recognition of the proximal dissection and appropriate aortic root reconstructive procedure is important. The purpose of this study is to evaluate the incidence of reoperations after surgical treatment of type A aortic dissection with proximal involvement.

PatientsBetween July 1997 and October 2015, 133 consecutive patients underwent emergency surgery for acute type A aortic dissection in our institution. Dissection reaching around the coronary artery orifice was observed in 31 patients. In 12 patients, both left and right coronary artery orifices were involved with extensive proximal aortic dissection. Eighteen patients had dissection extended to right coronary artery orifice. In 1 patient, left coronary artery orifice was involved with root dissection.

ResultsFive of 133 patients required reoperations at long-term follow-up. An aortic root redissection with severe aortic regurgitation was observed in all 5 patients. All of them required surgical re-intervention of aortic root. Intervals between the initial surgery and re-intervention were 8, 12, 18, 20 and 108 months, respectively. In all 5 cases, aortic root dissection was reached around both left and right coronary artery orifices. Broad aortic root disruption including both coronary arteries and commissures were characteristic in these patients. Furthermore, at the initial operation, the dissected aortic layers were reinforced by GRF glue in all reoperative cases. There were no operative death.

ConclusionsThe excellent outcome was demonstrated in patients underwent aortic root re-interventions. Late aortic root redissection was considered to be associated with the broad root dissection at initial operation and the inappropriate use of GRF glue.

10-03Changes in and Outcomes from Surgical Procedures for Acute Type A Aortic DissectionMasafumi Shibata1, Dr. Tetsuro Morota1, Dr. Takashi Nitta1

1Nippon Medical School, Bunkyo-ku, Japan

BackgroundTotal arch replacement has previously been the primary procedure of choice at our department for treatment of acute type A aortic dissection; however, from April 2013 onward, this stance was changed to the use of ascending aortic replacement as a basic policy, with additional arch replacement at the arch entry.

ObjectivesTo investigate acute surgical outcomes of different treatment strategies.

Material and MethodsThe subjects comprised 44 patients who underwent emergency surgery for type A aortic dissection between April 1 2011 and July 2015. We compared the 23 patients who were treated while our primary procedure was total arch replacement (in or before March 2013; early period group) with 21 patients who were treated while ascending aortic replacement (from April 2013 onward; latter period group). For the early and latter period groups, the means of age were 63±15 and 65±11 years, preoperative factors showed no significant differences. Duration of surgery, heart-lung machine time, amount of blood loss, intensive care ward stay, hospital days and perioperative complications were retrospectively investigated.

ResultsIn the early and latter period groups, duration of surgery (minutes) was 566±147 and 496±169, heart-lung machine time (minutes) was 316±85 and 272±183, the amount of blood loss (ml) was 2890±2900 and 924±567, ICU stay (nights) was 7.7±7.1 and 5.9±2.9, hospital stay (days) was 36±27 and 24±11 and in-hospital mortalities amounted to 5(21.7%) and 2 (9.5%), respectively. Perioperative complications were cerebral infarction in 2 and 3 cases, long-term mechanical ventilation (>72h) in 8 and 5 cases, infection in 4 and 3 cases and new requirement of blood purification in 6 and 2 cases, respectively.

Oral Presentation


ConclusionsAscending aortic replacement, which aims at entry resection, appears to reduce invasion and thus contribute to improved surgical outcomes in the acute phase. Further follow-up is required to investigate long-term prognosis.

10-04Thoracic endovascular aortic repair of acute and subacute type B aortic dissection: Early and medium term resultsYoshihito Irie1, Dr. Shunichi Kondo1, Dr. Yoshiaki Katada1, Dr. Yoshiki Endo1, Dr. Tsuyoshi Fujimiya1, Professor Hitoshi Yokoyama2

1Iwaki Kyouritsu General Hospital, Iwaki, Japan, 2Fukushima Medical University, Fukushima, Japan

IntroductionRecent data suggest that early thoracic endovascular aortic repair (TEVAR) of type B dissection lowers aortic related events and improves long-term survival.

ObjectivesThis study aimed to investigate early and medium term results of our aggressive management by TEVAR for acute (>2 weeks) and subacute (2 to 8 weeks) type B aortic dissection.

Materials and MethodsFrom January 2008 to June 2016, 49 consecutive patients underwent TEVAR for management of acute (n=41) and subacute (n=8) type B dissection. Mean age was 65.4 years (min 41, Max 85) ; 39 cases (80%) were male. The mean follow-up period was (22 ± 18) months.

ResultsThere were 41 cases performed in acute phase including 31 complicated cases of rupture in 4 (9.8%), ulcer like projection (ULP) expansion in 13 (31.7%), rapid dilatation of aorta in 9 (22.0%), organ malperfusion in 5 (12.2%). There were 8 cases performed in subacute phase and all of them were complicated cases with 3 (37.5%) ULP expansion, 4 (50%) rapid dilatation of aorta, and 1 (12.5%) organ malperfusion. A total of 35 (71%) devices were accessed through external iliac artery and 4 (8.2%) case were performed under local anesthesia. There were 2 Zone-1, 14 Zone-2, 30 Zone-3, 1 Zone-4 and 2 previous total arch replacement grafts selected as landing zone. There were no complications occur regarding to the procedure and 30 days mortality was 4% (two rupture cases) ; three cases (6.1%) needed additional therapies included 2 TEVARs and 1 total arch replacement.

ConclusionAlthough re-intervention were required in three patients, this study confirms the excellent early and medium term outcomes of TEVAR of acute and also subacute type B dissection. However most cases tend to have the residual dissection in thoraco-abdominal area after TEVAR. These cases must be followed up carefully.

10-05A 7-year History of Endovascular Treatment of Mycotic Aortic Aneurysms in a Multi-ethnic Asian PopulationDexter Yak Seng Chan1, Nicholas Syn2, Andrew MTL Choong1,3, Dharmaraj Rajesh Babu1, Jackie Ho Pei1,4, Peter Ashley Robless1, Bernard Boon Kee Wee5, Dr Julian Chi Leung Wong1

1Division of Vascular Surgery, National University Heart Centre, Singapore, 2Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 3School of Medicine, Griffith University, Gold Coast, Queensland, Australia, 4Department of Surgery, National University of Singapore, Singapore, 5Department of Radiology, National University Hospital, Singapore

Background and objectiveWe present our single centre series from 2007 – 2016 of endovascularly (with debranching or endovascular adjuncts) treated mycotic aneurysms in a multi-ethnic Asian population.

MethodsA retrospective review of 22 patients with MAP treated endovascularly between 2009 and 2016 was carried out. Patients were diagnosed based on clinical imaging and/or a positive blood culture or clinical impression of infection. Patients were assessed for their 30 day mortaliy, median survival and post EVAR complications.

ResultsData from 22 patients were retrieved. There were more males (M:F=9:2). The median age was 71(range 47-84). Majority of the patients were Chinese (81%), the others were Malays and Indo-Chinese. The commonest symptoms were fever and pain (68% each). 59% of patients had a raised white cell count whilst 94% had a raised C-reactive protein count. Blood cultures were positive in 77% of the patients. 36% had signs of rupture radiologically. 8 patients had AAA, 11 had TAA and 3 were thoraco-abdominal in location. The 30 day survival rate was 95.45% (95% CI, 71.87 – 99.35) and the 1 year survival rate was 70.69% (95% CI, 45.75 – 85.74). The median survival is 5.3 years. 6 cases of endoleaks were reported, of which one was a type 1b requiring reintervention. The others were type 2 and resolved spontaneously. On CT follow up, 68% of the MAPs had a size reduction and 18% remained stable. Of the 4 cases that had ongoing sepsis, 2 passed away from an aorto-esophageal fistula. There was 1 NSTEMI and 2 acute kidney injuries post EVAR.

ConclusionsEndovascular stenting is a feasible and minimally-invasive option for the treatment of MAP with good mid-term prognosis and an acceptable complication rate. Such patients do not have ongoing sepsis but require long-term antibiotics. The exact duration of antibiotics requires further investigation.


10-06Chronic obstructive pulmonary disease effect on the prevalence and postoperative outcome of abdominal aortic aneurysms: A meta-analysisJiang Xiong1, Dr. Zhongyin Wu1, Dr. Chen Chen2, Dr. Wei Guo1

1Dpt. Vascular And Endovascular Surgery, The Chinese PLA General Hospital, Beijing, China, 2Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, USA

BackgroundEpidemiologic evidence suggested chronic obstructive pulmonary disease (COPD) might increase risk for abdominal aortic aneurysm (AAA). However, the association between COPD and AAA remains inconclusive.

ObjectiveTo access the effect of COPD on prevalence and clinical outcome of AAA.

MethodsA systematic literature search in PubMed and Cochrane databases was conducted. Studies reporting AAA prevalence and AAA clinical outcomes among COPD patients were identified. Meta-analysis was performed using the generic inverse variance method.

ResultsForty-eight articles were included for meta-analysis. COPD was found to be positively associated with AAA, regardless of study design and smoking status. AAA postoperative mortality is higher among COPD patients compared with non-COPD patients (short-term [adjusted OR 2.11; 95% CI 1.33-3.34]; long-term [adjusted OR 1.70; 95% CI 1.37-2.12]). But the association between short-term mortality and COPD was not found to be significant in patients underwent endovascular aneurysm repair (mixed OR 2.53; 95% CI 0.70-9.18). Rupture AAA may increase the postoperative mortality in COPD patients (rupture [adjusted OR 4.75; 95% CI 2.07-10.89]; non-rupture [adjusted OR 1.97; 95% CI 1.11-3.49]). The AAA short-term postoperative morbidity was found to be positively associated with COPD (adjusted OR 1.59; 95% CI 1.14-2.21). Increased COPD severity may increase the long-term postoperative mortality (medical versus oxygen dependent: [OR 1.26; 95% CI 1.07-1.49] versus [OR 2.79; 95% CI 2.24-3.49]).

ConclusionAs COPD may increase the risk of AAA, AAA postoperative morbidity and mortality, for COPD patients, vascular specialists should pay more attention on AAA prevention and make low-risk AAA treatment.

10-07Surgical quality and enhanced recovery after surgery suppresses hospitalization costs of open repair for abdominal aortic aneurysmTakuro Shirasu1, Dr. Takatoshi Furuya1, Dr. Yukihiro Nomura1, Dr. Nobutaka Tanaka1

1Asahi General Hospital, Asahi City, Japan

BackgroundAmong the treatment of abdominal aortic aneurysm (AAA), open

surgery (OS) has an advantage of less reintervention after initial operation compared to endovascular aneurysm repair. Suppression of hospitalization costs of OS can provide socioeconomic benefit.

ObjectiveTo determine the factors to increase the hospitalization costs of OS for AAA.

MethodsA total of 607 consecutive patients who underwent OS for intact AAA and survived between 1998 and 2015 at Asahi General Hospital in Japan were included in the analysis. Patients’ characteristics, morphology of aneurysm, operative procedures, postoperative complications and postoperative courses were analyzed in relation to the hospitalization costs.

ResultsMean age was 74.7 ± 7.9 years old, and 517 patients (85.2%) were male, with mean aortic diameter of 57 ± 11mm. Operation time was 215 ± 57 minutes with estimated blood loss of 449 ± 314 grams. Only 31 patients (5.1%) received transfusion. The days of postoperative mobilization and resumption of normal diet were 1.4 ± 0.8 and 3.7 ± 1.3, respectively. Embolic complications occurred in 33 patients (5.4%), additional bypasses were required in 18 (3.0%) patients, and redo surgery in 20 patients (3.3%). Five hundred ninety five patients (98.0%) were discharged home. The length of stay was 8.1 ± 4.3 days. Total hospitalization costs were 1,312,548 ± 390,061 Japanese Yen. In the multivariate analysis, the factors which increased the total hospitalization costs were operation time ≥ 3.5 hours, estimated blood loss ≥ 400 grams, additional bypass, redo surgery, postoperative fasting ≥ 5 days, length of hospitalization ≥ 8 days and failure to discharge home.

ConclusionsHigh-quality operations with short time, less blood loss and fewer complications, combined with enhanced recovery (early mobilization and enteral feeding) can reduce the total hospitalization costs.

10-08Open and endovascular techniques to overcome unfavorable iliac anatomy during endovascular aneurysm repairJaepak Yi1, MD, PhD Jin Hyun Joh1


IntroductionIliac artery anatomy plays an integral role when performing endovascular aortic aneurysm repair (EVAR). The special attention was required due to unfavorable iliac anatomy in 47% of patients.

ObjectivesThe purpose of our study is to evaluate types of unfavorable iliac anatomy and its management.

Materials and methodsFrom 2009 to February 2016, patients who underwent EVAR were consecutively included in the study. Unfavorable iliac anatomy was defined as iliac artery diameter < 7mm, iliac tortuosity index ≥ 1, iliac neck length < 15 mm, and concomitant internal iliac artery (IIA) aneurysm. Operation results of patients with additional

Oral Presentation


procedure due to unfavorable iliac anatomy were compared with the patients with routine procedure. For statistical analysis, data were analyzed using SPSS 22.0 software (IBM Corp, Chicago, Ill). All P values were considered significant if <0.05.

ResultsWe included 127 iliac arteries in 70 patients with a mean age of 73.5±9.4 years (range, 51-98 years). Iliac tortuosity was the most common unfavorable iliac anatomy. It could be dealt with stiff wire insertion in most cases. In one patient, resection of tortuous segment and end-to-end anastomosis was performed. Small caliber of iliac artery was overcome with temporary iliac conduit in 2 patients and endoconduit in one patient. Short distal landing was dealt with external iliac to internal iliac bypass in 2 patients, use of custom-made iliac branched device in one patient. Concomitant IIA aneurysm was overcome with iliac sandwich technique in one patient and hybrid surgery in one patient. The operation time was significantly longer in patients with additional procedure than one with the routine procedure (347 min vs. 154 min, P<.001)

ConclusionsUnfavorable iliac artery anatomy is not an obstacle for successful EVAR. However, we should consider the longer operation time in patients with additional procedure.

10-09Comparison of local anesthesia and general anesthesia for performing endovascular aortic aneurysm repair (EVAR)Naoya Matsumoto1, Dr Osanori Sogabe1


BackgroundThere are some reports of comparisons between general anesthesia and local anesthesia for endovascular aortic aneurysm repair (EVAR). These reports showed that cardiac events, pulmonary morbidity and the length of stay are occur less frequently when using local anesthesia than when using general anesthesia for EVAR.

ObjectivesWe currently perform EVAR under iliohypogastric nerve block, femoral nerve block and local anesthesia using tumescent local anesthesia (TLA) with intravenous anesthesia with either dexmedetomidine or propofol. In this study, we compared the use of iliohypogastric nerve block, femoral nerve block and local anesthesia by TLA with intravenous anesthesia (TLA group) and general anesthesia (GA group) for EVAR.

Materials and MethodsTwenty-three successive cases of EVAR were compared (TLA group: 9 cases, GA group: 14 cases) regarding age, gender, American Society of Anesthesiologists physical status (ASA-PS) score, postoperative hospital days, surgical time, usage rate of vasopressors and the incidence rate of postoperative arrhythmia.

ResultsThe usage rate of vasopressors was significantly higher in the GA group. There were no significant differences between both groups regarding the other factors. However, there were 2 cases with an ASA-PS score of 4 in the TLA group (respiratory failure and renal dysfunction). On the other hand there were no such cases in the

GA group. There were also 2 cases of postoperative arrhythmia (no cases in the TLA group). Transfusion was not performed either during or after the operation in all cases.

ConclusionsEVAR can thus be performed without any adverse events in high risk cases under iliohypogastric nerve block, femoral nerve block and local anesthesia by tumescent local anesthesia.

10-10Association Between MTHFR C677T Polymorphism and Abdominal Aortic Aneurysm Risk: A Comprehensive Meta-Analysis with 10,123 Participants InvolvedJie Liu1, Xin Jia1, Senhao Jia1, Wei Guo1

1Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China

Background Abdominal aortic aneurysm (AAA) is a life-threatening condition. A number of studies reported the association between methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and AAA risk, but substantial controversial findings were observed and the strength of the association remains unclear.

Objectives The aim of the study was to investigate the aforementioned association in the overall population and different subgroups.

Materials and Methods PUBMED and EMBASE databases were searched until March 2016 to identify eligible studies, restricted in humans and articles published in English. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the susceptibility to AAA. Subgroup meta-analyses were conducted on features of the population such as ethnicity, sex of participants, study design (source of control), and so on.

Results A total of 12 case-control studies on MTHFR C677T polymorphism and AAA risk, including 3,555 cases and 6,568 case-free controls were identified. The results revealed no significant association between the MTHFR C677T polymorphism and AAA risk in the overall population and within Caucasian or Asian subpopulations in all five genetic models. Following further subgroup meta-analysis, significantly increased risks were observed among cases with a mean age < 70 years (OR = 1.73, 95% CI = 1.10-2.12, P = 0.02), among cases with prevalence of smoking <60% ( OR = 1.39, 95% CI = 1.02-1.90, P = 0.04), and among cases with aneurysms diameter ≥55 mm( OR = 1.55, 95% CI = 1.07-2.24, P = 0.02) in the dominant genetic model. No publication bias was found in the present study.

Conclusions Our comprehensive meta-analysis suggests that the MTHFR C677T polymorphism may play an important role in AAA susceptibility, especially in younger, non-smoking, and larger-AAA-diameter subgroups.


10-11Comparison of percutaneous access versus open femoral exposure for endovascular aortic aneurysm repair in single center JungSik Choi1, MD Keunmyoung Park1, MD Yong Sun Jeon2, MD Soon Gu Cho2, MD Kee Chun Hong1


IntroductionDue to the utility of vascular closure devices, their use has been adapted to common femoral artery closure as percutaneous endovascular aortic aneurysm repair (PEVAR). We evaluate the effectiveness and safety of PEVAR on comparison of standard femoral exposure (SEVAR) because there were no data that PEVAR compare with SEVAR in Korea.

Method and patients We reviewed 68 patients that underwent EVAR between January 2012 and July 2015. During this period, 32 patients were performed by percutaneous femoral artery access and closure and 36 patients were performed by open femoral exposure. PEVAR procedure were performed the 8F Perclose Proglide closure device. We compared procedural technical success, characteristics, clinical result and vascular complication between PEVAR and EVAR groups. Procedural time, blood laboratory analyses and hospital stay time were also evaluated.

ResultThere no difference in patients characteristics and procedural details between two groups. Especially, procedural time of PEVAR was also similar to that of SEVAR (135 min vs 146 min, p=0576). There were three complications in PEVAR group (Bleeding [n=1], Dissection [n=2]) although there were 3 complications in SEVAR group (Lymphorrhea [n=1], Hematoma [n=2]). There was 1 open conversion in PEVAR group due to retroperitoneal bleeding. But, postoperative pain score of PEVAR was less than that of SEVAR (4.5 vs 6.4 p<0.03). There were no difference in ICU stay and hospital stay.

ConclusionPEVAR is relatively safe and effective comparing standard open femoral exposure with less pain. But, for success without vascular complication careful patients selection and sufficient comprehension of procedure is important.

11-01Clinical significance of early postoperative diarrhea after open surgical repair of abdominal aortic aneurysmKyoung Won Yoon1, Seon-Hee Heo1, Yang-Jin Park1, Dong-Ik Kim1, Young-Wook Kim1

1Samsung Medical Center, Sungkyunkwan university, Seoul, South Korea

PurposeTo determine frequency of early postoperative diarrhea (EPD) after open surgical repair (OSR) of abdominal aortic aneurysm (AAA) and its clinical significance.

MethodsWe retrospectively reviewed database of patients who had suffered from EPD after OSR of AAA during the period between January 2011 and May 2016. EPD was defined as loose form bowel movements > 3 times a day during early (< 2 weeks) postoperative period. To identify causes of EPD, we investigated past history of colonic disease of the patients and performed Clostridium difficile (CD) toxin assay/culture and/or colonoscopic examination.

ResultsAmong 262 OSRs of AAA (213 infrarenal, 33 juxtarenal, 16 suprarenal AAAs; 229 elective and 33 emergent OSRs), 57 (21.8%) patients developed EPD. The frequencies of EPD was not different between elective and emergent OSR (22.3% vs 18.2%, p=.595). EPD developed at mean 5.16±1.96 days after surgery. We performed CD test in patients with EPD persist for 2 days or longer and colonoscopic examinations for patients showing left abdominal pain or tenderness, leukocytosis and/or metabolic acidosis. Among the patients with EPD, 25 (43.9%) patients underwent CD test and 13 (22.8%) patients underwent colonoscopic examinations. Among those patients who underwent CD test or colonoscopic examinations, eight (32.0%) patients showed positive on CD test and three (23.1%) patients showed left colon ischemia including 2 mucosal and 1 mural types. During the study period, two more patients were identified as colon gangrene without performing colonoscopic examination.

ConclusionEPD was not uncommon after OSR of AAA. Among patients with EPD, 14% of EPD was caused by CD–related diarrhea and 5.3% of EPD was associated with left colon ischemia.

11-02Comparable Mid-term results of Elective Endovascular and Open Aortic Aneurysm Repair in Young PatientsYang-Jin Park1, KW Yoon1, SH Heo1, SY Woo1, JG Kim1, DI Kim1, YW Kim1


ObjectivesTo compare the mid-term outcomes and re-intervention rates following elective open (OAR) and endovascular (EVAR) repair of infrarenal aortic aneurysms in patients aged 65 years or younger.

MethodsA retrospective review of a prospectively collected vascular surgery database was performed to identify all patients aged 65 years or younger at the time of repair who underwent elective repair of an abdominal aortic aneurysm (AAA) between September 2003 and June 2016.

ResultsThe study cohort comprised 173 patients 65 years of age or younger (mean age, 59.8 ± 4.7 years) (114 OAR, 59 EVAR). Two patient cohorts had similar comorbidities. The overall 30-day mortality rate was 0%. Six patients (3.5%, 5 OAR and 1 EVAR) had died at a median follow-up of 40.8 months (interquartile range, 30.1–85 months) and no aneurysm-related deaths or late aneurysm ruptures were observed. There was no significant difference of

Oral Presentation


long-term survival (10 years, 81.4% OAR, 97% EVAR, P=0.559), but re-intervention rates (0.9% OAR, 8.5% EVAR, P=0.018) had significant differences. The most common cause of long-term mortality was malignancy and comorbidities. Re-interventions in OAR were exclusively laparotomy-related (adhesive ileus), whereas all re-interventions in EVAR were aneurysm-or graft-related.

ConclusionsAfter elective aneurysm repair, EVAR offered comparable durability and long-term survival compared to OAR in young patients and improving results with EVAR over time may increase the role of EVAR in these patients group as long as aneurysm anatomy is adhere to.

11-03Is conventional open repair for abdominal aortic aneurysm feasible in nonagenarians?Kyokun Uehara1, Dr Kenji Minatoya1, Dr Jiro Matsuo1, Dr Teppei Toya1, Dr Yosuke Inoue1, Dr Atsushi Omura1, Dr Yoshimasa Seike1, Dr Hiroaki Sasaki1, Dr Junjiro Kobayashi1

1National Cerebral And Cardiovascular Center, Suita, Japan

ObjectivesAlthough endovascular repair for abdominal aortic aneurysm has been considered beneficial procedure for very elderly patients, the results of open repair for nonagenarians are unclear. The purpose of this study was to compare the early and mid-term outcomes of open repair and endovascular repair for abdominal aortic aneurysm in the nonagenarian patients.

MethodsThis study included 14 and 24 nonagenarians patients (mean age 92.2±1.9 years) who underwent open surgical repair and endovascular repair for abdominal aortic aneurysm, respectively, from 2005 to 2015. Of those, 5 and 4 patients with ruptured or impending ruptured aneurysm required emergency surgeries (35.7% vs 16.7% , P=0.11).

ResultsThere was no significant difference in early mortality between the open and endovascular groups (0 vs 4.1%, P = 0.16). Early morbidity was equivalent in both groups (P=0.11), but hospital stay was shorter in the endovascular group (27.3 vs 10.6 days, P = 0.003). During the mean follow-up with 24.4±24.7months, Cumulative estimated 1-year and 3-year survival rates were 88.9% and 71.1% in the open repair group , and 90.1%, and 77.3% in the endovascular group (P=0.60). The rates of freedom from reintervention at 1 year were 88.9 % in the open group and 95.2% in the endovascular group (P =0.91).

ConclusionsAlthough endovascular repair was superior in recovery after the procedure, the results of conventional open repair were acceptable even in nonagenarian patients. Open repair for abdominal aortic aneurysm would remain a good option even in emergency cases for very elderly patients.

11-04Endovascular repair of abdominal aortic aneurysm with severely angulated proximal neck: Comparison between Excluder vs Aorfix stent graftEisaku Ito1, MD and PhD Naoki Toya1, MD Soichiro Fukushima1, MD Yuri Murakami1, MD and PhD Tadashi Akiba1, MD and PhD Takao Ohki2

1Jikei University Kashiwa Hospital, Kashiwa-shi, Japan, 2Jikei University Hospital, Minato-ku, Japan

IntroductionAnatomical characteristics of an infrarenal abdominal aortic aneurysm (AAA) are important factors to consider in planning an endovascular abdominal aneurysm repair (EVAR). Notably, severe proximal aortic neck angulation increases the risk of type I endoleaks.

ObjectivesTo evaluate the safety and early outcomes of various grafts in patients with AAA with severely angulated neck (> 90°).

Materials and MethodsThis was a retrospective non-randomized observational study. Between July 2011 and June 2016, 296 patients underwent EVAR for AAA at our hospital. Thirty six (12%) had AAA with severely angulated neck. Mean age and mean neck angle of these 36 patients were 79 and 103°, respectively. Mean follow-up period was 16 months.

ResultsThe Excluder™ graft was used in 28 cases and the Aorfix™ graft in 8. No aneurysm-related ruptures or deaths occurred. Two endograft occlusions were observed. Snorkel EVAR was performed in 4 patients. At 1 month, type Ia endoleak was observed in six cases (21.4%) with Excluder™ grafts and none with Aorfix™ grafts. Aneurysm sac size decreased in five cases (17.8%) with Excluder™ grafts and in three (37.5%) with Aorfix™ grafts.

ConclusionsThe results of this study supports EVAR for the treatment of AAAs with severely angulated neck. Although the number of cases was small, the Aorfix™ graft appeared to be the best graft for such cases.

11-05Outcomes of elective endovascular aortic aneurysm repair: A case series in Asian octogenariansMabel Shu Fen Yip1, Dr Joseph, Zhiwen Lo1, Dr Sadhana Chandrasekar1, Adjunct Assistant Professor Sriram Narayanan, Adjunct Assistant Professor Glenn, Wei Leong Tan1


Introduction With increasing life expectancies and aging populations, the prevalence of abdominal (AAA) and thoracic-aortic aneurysms (TAA) is rising. Meanwhile, technical advancements in endovascular aneurysm repair has made it an appealing option in


elderly patients due to its association with lower morbidity and mortality compared to open aortic repair.

Objective To evaluate the outcomes of elective endovascular repair of aortic aneurysms in Asian octogenarians in our centre.

MethodsRetrospective review of medical records was performed on octogenarians who underwent elective endovascular aneurysm repair (EVAR) or thoracic endovascular aneurysm repair (TEVAR) between May 2008 to December 2015 in Tan Tock Seng Hospital (TTSH). Factors evaluated include population demographics, pre-operative risks and functional status. Outcomes of endovascular intervention such as complication rates, length of hospital stay, 30-day re-admission rates and mortality were also analysed. Survival probability was illustrated using the Kaplan-Meier curve.

ResultsOut of 271 endovascular aortic aneurysm repairs identified, 172 were elective cases and 45 were performed on octogenarians. The mean age was 84.3yrs (80-91yrs). Common comorbidities include hypertension (83.3%, n=35), hyperlipidaemia (78.6%, n=33), ischaemic heart disease (33.3%, n=14), stroke (26.2%, n=11) and diabetes mellitus (21.4%, n=9). The average size of AAA and TAA was 6.1cm (3.8- 9.3cm) and 7.5cm (6.1- 9.8cm) respectively. There were 38 (84.4%) EVARs and 5 (11.1%) TEVARs. There was 100% technical success. Main post-operative complications include nosocomial infections (28.9%, n=12), myocardial infarction (6.7%, n=3) and wound infection (4.4%, n=2). There were 5 (11.1%) cases of endoleaks which required secondary interventions. Mean duration of hospital stay was 9.8 days and 30-day mortality was 4.8% (n=2). The Kaplan-Meier curve illustrated a survival probability of 55% at 3 years post-primary intervention.

ConclusionThis study supports that in carefully selected patients, elective EVAR in octogenarians is associated with low mortality and morbidity and a 3-year survival rate of 55%.

11-06Outcomes of EVAR repairs in a series of 14 mycotic aortic aneurysmsDr Wee Ming Tay, Dr Jospeh Zhi Wen Lo, Adjunct Assistant Professor Glenn Wei Leong Tan, Adjunct Assistant Professor Sriram Narayanan, Senior Consultant Sadhana Chandrasekar, Wei-En Wong1Tan Tock Seng Hospital, Singapore, Singapore

AimTo evaluate characteristics and outcomes of patients with mycotic aortic aneurysms who underwent endovascular aortic repair (EVAR).

MethodologyRetrospective study of 14 patients who underwent EVAR for aortic mycotic aneurysms between January 2008 and August 2015.

ResultsFrom the study population, 10 patients were male (71%), with the average age of study population at 62 years-old. 10 patients (71%) had decreased immunity from illnesses such as HIV (21%), steroid use (14%) and type 2 diabetes mellitus (T2DM) (36%). 64% (9/14) of the patients had positive blood cultures, of which 67% (6/9) grew Salmonella Enteritidis. On average, patients received 19 days of pre-operative antibiotics prior to stenting. All patients received post-op life-long antibiotics therapy. Prior to surgery, 8 patients (57%) had raised white cell count (>10x10^9/L). 7 patients (50%) had low haemoglobin (<10g/dL) while 13 patients (93%) had raised C-reactive protein (>5mg/L). All patients had low albumin prior to surgery (<35g/L). 2 patients (14%) had thoracic aneurysm and 11 patients (79%) had infra-renal aneurysm. 1 patient (7%) had both thoracic and abdominal aneurysm. The average size of the aneurysms was 3.8cm (range 1.1–6.8). 3 patients (21%) presented with a ruptured or leaking aneurysm. There was no 30-day post surgery mortality. On surveillance, endoleak was present in 2 cases (14%) (Type 1b and Type 3b), for which both underwent stent re-lining. The average length of hospital stay was 29 days. 1 patient suffered from aneurysm-related mortality (aorto-oesophageal fistula).

ConclusionEndovascular stent grafting is a feasible and invaluable tool in the management of mycotic aortic aneurysms. However, this does not address the issue of sepsis hence pre-operative antibiotics treatment and life-long antibiotics therapy is imperative. There are satisfactory outcomes in this limited series and further follow-up is required to evaluate long term outcomes of the procedure.

11-07The early mid-term results of EVAR in patients with proximal hostile neckYasutoshi Tsuda1, Dr. Takahito Yokoyama, Dr. Hiroo Kinami, Dr. Yujirou Kawai, Dr. Hirokazu Niitsu, Dr. Gentaku Hama, Dr. Yasuyuki Toyoda, Dr. Kazuaki Shiratori, Dr. Takahiro Takemura1Saku Central Hospital Advanced Care Center, Saku-city, Japan

BackgroundEndo-vascular aortic repair (EVAR) must be performed even for patients with a hostile neck(HN) by increasing numbers of elderly and high-risk patients.

ObjectiveTo evaluate the early and mid-term results of EVAR in patients with HN primarily in terms of type Ia endoleaks (EL)

Subjects289 patients underwent EVAR for abdominal aortic aneurysms (AAA ) between May 2009 and April 2016, we selected 69 patients with HN .((HN was defined as AAA with proximal neck length ≤15 mm, proximal neck diameter ≥29 mm, or angulated neck (degree of neck angulation ≥60° or degree of infrarenal angulation ≥45°)).

ResultsShort neck, enlarged neck, and angulated neck were found in 20, 4 and 57 patients. Persistent intraoperative type Ia EL were observed in 20 patients, all of whom underwent intraoperative adjunctive

Oral Presentation


procedures (proximal cuff insertion for 17 patients, the chimney technique for 1 patients, and repeated only balloon molding for 2 patients); in final intraoperative imaging, type Ia EL had disappeared in 13 , had markedly decreased in 2 , and remained in 2 patients, while confirmation could not be obtained in 1 patients. Reintervention for type Ia EL was performed for three patients with a highly angulated neck, but none of them with a short neck or enlarged neck. No patient with type Ia EL in final intraoperative imaging. Reintervention consisted of the chimney technique, graft replacement, and proximal cuff insertion . In all three patients, type I EL disappeared following reintervention. At six months post-operation, contrast CT was performed for 36 of 69 patients, none of whom demonstrated type Ia EL.

ConclusionEarly outcomes in EVAR for AAA with HN were relatively favorable. However, in the long term, morphological changes in aneurysms are considered to recurrence of type I EL, therefore requiring careful selection of patients and follow-up.

11-08Survival of octogenarian Abdominal Aortic Aneurysm patients in Chiang Mai University HospitalSaranat Orrapin1, Professor Kamphol Laohapensang1, Professor Kittipan Rerkasem1, Supapong Arworn1, Termpong Reanpang1

1Chiang Mai University, Chiang Mai, Thailand

BackgroundManagement of Abdominal aortic aneurysm (AAA) operation in octogenarian has high mortality and morbidity due to underlying diseases and co-morbidities and they themselves might had severe underlying disease that cause dead at anytime. An octogenarian AAA in our institute is 14.9%. In this study, we compared patient’s survival between the operated group and non-operated group.

Research methodologyThis study is a retrospective review study of octogenarian Abdominal Aortic Aneurysm patients in our institution between January 2006 and December 2015. All patients whose age over 80 year old with surgical indicated AAA were included. Ruptured AAA patients were excluded.

Result148 patients were enrolled to this study, 73 patient was operated by both open surgical repair (OSR) and endovascular aneurysm repair (EVAR) and 78 remain was refuse for operative treatment. There was no difference in demographic study between two groups except underlying disease of cancer was significant higher in non-operated group. Overall mortality of operated group was significant lower than non-operated group (56.2% vs 85.3% p = 0.0001) Mean survival of patient were 32.2 month in operated group and 16.6 month in non- operated group ( p = 0.0001) but there were no significant different in aneurysm related dead ( 30 mortality in operated group vs Ruptured AAA in non-operated group , p = 0.792) Subgroup analysis of operated group shown that there were no significant different in morbidity and mortality outcome between EVAR and OSR.

ConclusionThe study showed differences in overall mortality of octogenarian Abdominal Aortic Aneurysm patients, but no different in aneurysm related dead between operated and non- operated group. That mean patient might had morbidity and mortality by their underlying condition than by AAA. From our study may conclude that AAA operative intervention in octogenarian might be less benefit to patient overall survival.

11-09Carbon dioxide angiography as an adjunct for endovascular aortic aneurysm repair; how does it compare to traditional contrast?Kalpa Perera1, Mr. Kishore Sieunarine1


Background/IntroductionRenal impairment can be a significant impediment to endovascular aortic aneurysm repair (EVAR). Carbon dioxide (CO2) is a non-nephrotoxic agent that has been suggested as an alternative.

ObjectivesWe describe our series using CO2 for effective aortic stent-graft deployment using a historical control for comparison.

Materials and MethodsWe performed a retrospective analysis of all EVARs using CO2 contrast in our institution over the past 12 months. We compared a historical control using standard iodinated contrast EVARs over the preceding 12 months. Both standard and fenestrated EVARs (FEVAR) were included. Screening time, radiation dose, CO2 and iodinated contrast volume, and pre and post-operative renal function was assessed. Data was collected using the Western Australian Electronic Bookings System (EBS) database, patient files and documented radiography notes.

ResultsEighteen patients (11 EVAR, 7 FEVAR) had CO2 angiography and twelve (10 EVAR, 2 FEVAR) were performed with iodinated contrast only. All grafts were deployed successfully, with no leak evident on the final run. Five cases (all EVAR) utilised CO2 angiography only, without iodinated contrast. Mean screening time and radiation dose were lower in the CO2 compared to the contrast EVAR population (1375.7 sec & 182.4 Gy/cm2 vs. 1486 & 220.8), but markedly higher in the FEVAR cases (6448.1 & 751.1 vs. 4718.5 & 435). At two days post-op, renal function (Cr) was preserved at baseline for EVAR CO2 cases, compared to a mean 17.0% increase in iodinated contrast procedures (p=0.78). Mean pre-operative creatinine was higher in the contrast cohort (99.67 µmol/L vs. 90.29; p=0.163).

ConclusionUsing CO2 angiography results in better renal function in EVAR cases. Yet, no prospective randomised trial exists to provide high quality evidence for this benefit. Based on our initial study, we have designed a prospective randomised trial comparing CO2 to iodinated contrast in endovascular aortic stent-grafts.


11-10The Treatment Results of Emergent EVAR for Ruptured Abdominal Aortic AneurysmTakao Miki1, Dr Kiyomitsu Yasuhara1, Dr Kyohei Hatori1, Dr Hanako Hirai1, Dr Satoshi Ohki1, Dr Tamiyuki Obayashi1

1Department of Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki City, Japan

BackgroundRuptured abdominal aortic aneurysm (rAAA) is a lethal condition, which requires emergent operation. Recently, emergent endovascular aneurysm repair (eEVAR) has been widely used for the treatment of rAAA instead of the conventional open repair. We have chosen eEVAR first as the treatment of rAAA in cases with suitable anatomy since August 2013. We investigated the treatment results of eEVAR for rAAA compaired with open repair.

MethodsWe evaluated 54 patients who underwent emergent operation for rAAA from January 2000 to May 2015. They were devided into two groups, Group O (n=47, 72.3±10.3 years old) who underwent open surgery, and Group E (n=7, 74.5±6.2 years old) who underwent eEVAR. We made a comparative review of these two groups.

ResultsGroup O contained 22 (46%) patients with acute shock (sBP（80) preoperatively, while Group E contained 3 (43%), and there were no statistically significant differences between two groups. Group E had statistically significant less operative time and blood loss than Group O (p（0.05). However, there were no statistically significant differences in perioperative complications rate (34% vs. 29%), and hospital stays (28.8 days vs. 20.5 days). Perioperative mortality was 6.3% (n=3/47) in Group O. Group E had no fatal cases, however there were 3 patients whose postoperative CT revealed type（ endoleak and two of them required the additional treatment of coil embolization.

ConclusionsConsidering our investigation, the treatment results of rAAA were almost acceptable. Our study indicated that eEVAR had tendency to shorten operation time and reduce blood loss compared with conventional open repair. Thus, eEVAR was thought to be more suitable for elderly patients or “hostile” abdomen who were not candidates for conventional open repair. In addition, it was important to check the anatomic suitability for eEVAR with preoperative CT, and follow up by continuous CT scans in preparation for additional treatments of residual endoleak.

Oral Presentation


Prize Oral PresentationPO-01Hybrid aortic arch repairs: a 9-year single-institutional experience of 150 patients.Kiyofumi Morishita, Dr Masami Shingaki, Dr Tuyoshi Shibata, Dr Kouhei Narayama, Dr Toshio Baba, Dr Tohru Mawatari1Hakodate Municipal Hospital, Hakodate, Japan

ObjectivesDespite the evolution of technology, aortic arch aneurysm repairs remain challenging in high-surgical-risk patients. Recently, hybrid arch repair has emerged as a potentially less invasive treatment. The aim of this study was to analyze our results of hybrid aortic arch repairs.

MethodsFrom June 2007 to March 2016, 150 patients underwent hybrid arch repairs. Indications included degenerative aneurysm (119 patients), dissection (21), and stent-graft failure (5). Thirteen patients underwent emergency repairs due to rupture.

The techniques of incorporating arch vessels into the repair have evolved over time. Initially, we created oval or scallope-shaped fenestrations in hand-made endografts (n=20). Subsequently, debranching and revascularization was performed using commercially available endografts (n=110). Recently, we have used surgeon-modified fenestration combined with debranching in 40% of candidates for hybrid aortic arch repairs (n=20). JapanScore (mortality predicted from the Japanese database) was 16%±17%.

ResultsThe 30-day mortality was 1.3% (2/150 patients). Persistent neurologic deficits occurred in 3 patients and spinal cord injury in 4.

Three patients experienced bypass graft occlusion without neurologic complications. Respiratory complications occurred in 6 patients. Aortic dissection was observed in 3 patients. Type Ia endoleak occurred in 55%(11/20) of patients with fenestrated hand-made devices, 20%(22/110) of patients undergoing debranching, and zero of patients undergoing surgeon-modified fenestration combined with debranching (p≤0.01). Fifteen patients required re-TEVAR because of progressive dilatation (11 patients), stent failure (2), another lesion (1), and rupture (1).

Ten aneurysm-related deaths occurred during follow-up period. One patient refused a further operation. Five patients died of other aortic pathologies. Kaplan Meier 1-year and 5-year survival rates were 87%±3% and 58%±6%, respectively.

ConclusionsHybrid arch repairs can successfully reduce postoperative mortality in high-surgical-risk patients. However, these procedures are associated with late aneurysm-related complication rates. The evolving technology of preserving cerebral circulation has led to a decrease in incidence of type Ia endoleak.

PO-02Anatomical endovascular aortic arch repair with custom-made fenestrated endograft and branch grafts via neck vesselsMasaki Saso1, Dr Takashi AzumaDr1, Dr Junko Katagiri1, Dr Kei Kobayashi1, Dr Masashi Hattori1, Dr Yoshihiko Yokoi1, Dr Hideyuki Tomioka1, Dr Shigeyuki Aomi1, Dr Kenji Yamazaki1

1Tokyo Women’s Medical University, Tokyo, Japan

ObjectivesThoracic endovascular repair (TEVAR) is increasingly applied for thoracic aortic aneurysm. In most cases of arch aneurysm, precurved fenestrated endograft provides adequate sealing zone. But There are some extended aneurys cases more suitable for branched graft.

Otherwise there are no available manufactured branched graft for Aortic aneurysm in our country. Therefore we used to use the fenestrated Najuta endograft and some debranching technique in cases of aortic aneurysm extended zone 2.

MethodsWe used the precurved fenestrated Najuta endograft. The custom-made fenestrations are about the same size as the orifices of neck vessels and can be modified as ring ports for branches as needed. The ring port was made of a long platinum coil sutured cylindrically around the fenestration. For branches, we used the Aorfix AAA Stent Graft Plug-in Leg, which has a ring stent structure and connects well with the ring port.

ResultsWe underwent this technique for ten cases of arch aneurysms since October 2014. In detail, 7 cases of them were treated with single branch, 2cases of them with double, and 1 case with triple branches. The proximal landing zone was zone 0 in almost all cases.

The technical success rate was 100%. There was no endoleak seen on Postoperative computed tomography in this series. Perioperative cerebral infarction occurred in 1case.

ConclusionsA fenestrated endograft with branches avoids extra anatomical bypass and achieves complete anatomical repair in arch aneurysms. The technique for an additional branch is simple. However, this procedure has moderate potential risk of a cerebrovascular accident.

PO-03Comparing the outcomes using propensity score matching analysis in carotid endarterectomy versus carotid artery stenting: Single-center dataKyoung Won Yoon1, Shin-Young Woo1, Yangjin Park1, Young-Wook Kim1, Dong-Ik Kim1

1Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea

BackgroundDespite of many reports, there continues to be debate in efficacy between carotid endarterectomy (CEA) and carotid stenting (CAS).


One of the major advantages of propensity score matching (PSM) methods is making possible observational studies to be designed similar to randomized controlled trials (RCTs). In this study, we used PSM as statistical technique to balance the covariates and mimic randomization.

ObjectivesTo compare early outcomes of CEA and CAS procedure for carotid artery stenosis revascularization with single-center data and PSM methods.

Materials and MethodsFrom January 2002 to December 2015, 1403 cases of CEA (n=793) or CAS (n=610) with embolic protection device were performed in our institute. Primary endpoint was defined as any clinical stroke, transient ischemic attack, myocardial infarction and death within postoperative 30 days. Secondary endpoint was defined as restenosis rates after postoperative 30 days.

Results197 pairs of asymptomatic (n=394) and 152 pairs of symptomatic cases (n=304) able to match between CEA and CAS procedure. In PSM cohort, CAS was associated with a higher risk for the all of the items of primary endpoints in both asymptomatic group (odds ratio [OR], 3.409; 95% confidence interval [CI], 1.092-10.645) and symptomatic group ([OR], 11.364; 95% [CI], 2.607-49.534). There was no significant difference in rate of restenosis between CEA and CAS in overall matched cases.

ConclusionsIn this study with propensity score matching analysis, CEA showed better 30 days outcome than CAS for revascularization of carotid artery stenosis.

PO-04Acellular Fish Skin Graft for Surgical, Trauma, Venous, Arterial and Diabetic Wounds: A Retrospective Clinical StudyJohn Lantis, Dr Baldur T. Baldursson1,2, Skuli Magnusson1, Dr Hilmar Kjartansson1,2, G. Fertram Sigurjonsson1

1Kerecis, Reykjavik, Iceland, 2Landspitali University Hospital of Iceland, Reykjavik, Iceland

IntroductionAcellular Fish skin* grafts that contain natural antibacterial and anti-inflammatory omega-3 polyunsaturated fatty acids are fundamentally different from other advanced tissue based products from mammalian sources. Mammalian products carry the risk of disease transmission to humans that is nonexistent from the Atlantic cod (Gadus morhua) to humans. Mammalian tissues are subjected to viral inactivation methods involving detergents that remove lipids from the tissues and denature the native structure leaving behind only insoluble collagens. A randomized double blind clinical trial demonstrated significantly faster wound healing with fish skin* compared to a mammalian matrix product.

ObjectivesEvaluate the clinical efficacy of a fish skin graft* on non healing surgical-, trauma-, venous- and arterial wounds.

Prize Oral PresentationMethod54 non healing wounds were treated with fish skin grafts* for a period of four weeks and 2 applications on average. Improvement is defined as >20% reduction of wound area. Data was extracted from the patient records database at the Landspitali University Hospital in Reykjavik, Iceland. Study was approved by the National Bioethics Committee of Iceland (VSN-15-137).

ResultsVenous, arterial or mixed venous/arterial ulcers: 7 (20,6%) healed, 24 (70,6%) improved and 4 (11,8%) did not respond. Surgical and trauma wounds: 5 (41,7%) healed, 5 (41,7%) improved, and 2 (16,7%) did not respond. Diabetic foot ulcers: 4 (50%%) healed, 3 (37,5%) improved and 1 (12,5%) did not respond. Additionally treatment with the fish skin graft* showed a 38% reduction in antibiotics at the end of the trial. Antibiotics therapy was not a predetermined endpoint since this was a retrospective study.

ConclusionThis study shows that treatment with fish skin grafts* is effective on a range of different types of non healing wounds. The fish skin graft* also reduces the need for antibiotics, potentially due to its omega-3 content.*Kerecis™ Omega3 by Kerecis

PO-06Suggestion of Treatment Strategy Based on its Natural Course for Patients with Isolated Spontaneous Abdominal Aortic Dissection (ISAAD) Jihee Kang1, Young-Wook Kim, Seon-Hee Heo1Samsung Medical Center, Seoul, South Korea

Background/introductionIsolated abdominal AD is rare and has not been well known in its etiology, natural course, or an optimal management.

ObjectivesTo establish indications for treatment by reviewing the clinical features and natural course of isolated spontaneous abdominal aortic dissection (ISAAD).

Materials and MethodsA retrospective review of ISAAD patients from a single institution. Patient searching from interpretation reports of abdominal or thoraco-abdominal CTs from 2003 to 2015 with key words of “aortic dissection” or “dissection AND aorta”. ISAAD defined as a spontaneous aortic dissection confined to the abdominal aorta regardless of its extension to the iliac or visceral branches. ADs involving thoracic aorta, or by traumatic or iatrogenic causes excluded. Demographic and clinical features, coexisting diseases, aorta-related events and morphologic changes were investigated.


ResultsDuring 12 years, 1,958 patients with AD detected on the primary screening. Among them, 210 ISAADs enrolled for analysis excluding traumatic or iatrogenic ADs (n=6). Median age 69.3 years (30-93 years), 73.8% male. Among all ISAADs, 12.9% symptomatic. Hypertension, AAA, connective tissue disease (CTD) coexisted in 62.9%, 16.6%, and 1.9%. ISAAD distributed at infrarenal, paravisceral and supraceliac in 86.7%, 5.2% and 8.1%. Median dissection length 17.5mm (2 - 290mm). During 40months follow-ups(1-158 months), CT images available in 68% and clinical follow-ups in 89.5% (n=188). AD progression, false lumen enlargement and aortic rupture detected in 7%, 8%, and 1%. 2 rupture patients in Ehlers-Danlos syndrome. 5 elective repairs (1 open, 4 EVARs) due to coexisting AAA at the initial presentation. No aorta-related death except 2 aortic ruptures in patients with CTD.

ConclusionsProgression of AD, expansion of false lumen or visceral artery involvement noted but uncommon. Aortic rupture occurred only in patients with CTD. ISAAD can be observed as the same size criteria for the intact AAA treatment unless symptomatic or associated with CTD.


Prize Poster PresentationP01Gene therapy using hepatocyte growth factor plasmid DNA ameliorates lymphedema via promotion of lymphangiogenesis and lymphatic-vessels remodeling.Yukihiro Saito1

1Div. of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan

Background and Objectives Lymphedema is an intractable disease caused by anatomic or functional obstruction of the lymphatic system. There is no cure for lymphedema at this time. The goal of the present study was to investigate the novel gene therapy for lymphedema using hepatocyte growth factor (HGF) plasmid DNA.

Methods Human lymphatic endothelial cells (LECs) were treated with several dose of HGF protein (0-100 ng/ml) or transfected with HGF plasmid, and examined MTS assay, Boyden chamber method, Western blot, immunoassays, and qPCR. All animal protocols were approved by the Animal Ethics Committee of Asahikawa Medical University. Lymphedema was induced by dissection of lymphatic tissue at tail or forelimb in SD rat. Lymphatic flow was observed directly with a fluorescent lymphography system in vivo.

Results LECs express the HGF receptor, c-Met, and treatment of LECs with HGF results in the increase of LEC proliferation and migration in a dose dependent manner. Both ERK and Akt are phosphorylated after HGF is added to LECs. Furthermore, weekly HGF gene transfer into rats with lymphedema results in amelioration of the lymphedema by tail thickness or forelimb volume, and expression of two lymphatic endothelial cell markers (LYVE-1 and Prox1) increases only in the HGF-injected group. Notably, new extra-anatomical lymphatic flow was observed only in the HGF-injected group. Small lymphatic vessels, which may have been induced by lymphangiogenesis, had extended around the operation (HGF-injected) site, and these vessels were connected with the existing lymphatic vessels. HGF plasmid significantly ameliorated the lymphedema via lymphangiogenesis and lymphatic-vessels remodeling in the rats.

Conclusions Given with these data, we started a phase 1/2a clinical trial of HGF gene therapy in 2013 October. We believe that these results will be of benefit to patients with lymphedema, and hope to overcome the lymphedema.

P02Hemodynamic benefit of the release of the celiac artery in ruptured right gastric artery aneurysm associated with the median acurate ligament syndromeTetsuro Toriumi1, Dr Yuichi Ohashi2, Dr Atushi Akai2, Dr Takuro Shirasu1, Dr Takatoshi Furuya1, Dr Yukihiro Nomura1, Dr Nobutaka Tanaka1

1Asahi General Hospital, Asahishi, Japan, 2The University of Tokyo, Bunkyoku, Japan

IntroductionGastric or pancreaticoduodenal artery aneurysms are associated with median arcuate ligament syndrome (MALS) because hemodynamic change plays an important role in their development. However the necessity of the revascularization of the celiac artery remains unclear.

MethodWe reviewed a case of right gastric artery (RGA) aneurysm with MALS.

ResultThis is a case report of a 51-year old man who presented with a sudden epigastric pain. Contrast-enhanced abdominal CT demonstrated a ruptured RGA aneurysm in moderately dilated RGA. Replaced common hepatic artery branched from superior mesenteric artery (SMA) and lead to RGA. In addition, the celiac axis was severely stenosed, and dorsal pancreatic artery communicated from SMA to splenic artery. We diagnosed that MALS caused RGA aneurysm. We performed laparotomy, resected the aneurysm and transected the median arcuate ligament. In the intraoperative aortogram, we confirmed the revascularization of the celiac artery. As a result, blood flowed from the celiac artery to the splenic artery and the dorsal pancreatic artery narrowed. He was discharged on postoperative day 9 without any sign of organ ischemia. The follow-up CT at 6 month after surgery showed; enlarged diameter of the celiac artery, narrowed SMA and dorsal pancreatic artery. This suggests that the transection of the median arcuate ligament decreases the shear stress on the dorsal pancreatic artery and prevents the formation of an aneurysm in the collateral vessels. There was no other de-novo aneurysm.

ConclusionWhile there is a discussion on the necessity of the celiac artery revascularization, the present case supports the hemodynamic benefit of the MALS transection.

P03Late surgical open conversion for endoleaks after endovascular abdominal aortic aneurysm repairYusuke Takei1, Takayuki Hori Hori1, Toshiyuki Kuwata1, Yasuyuki Kanno1, Yuta Kanazawa1, Hironaga Ogawa1, Koji Ogata, Ikuko Shibasaki1, Hirotsugu Fukuda1

1Dokkyo Medical University, Mibu, Shimotugagun, Japan

BackgroundEndovascular aneurysm repair (EVAR) has become the preferred treatment for AAA. However, a small number of patients required an open conversion in surveillance.The most reason of late open conversion is Endoleak (EL). Morbidity and mortality rates with that can be high. We review our experience with emphasis on the surgical management and clinical course.

ObjectiveTo evaluate operative methods of late open surgical conversion for EL following EVAR.

MethodsBetween Jun 2008 and May 2016, 339 EVARs were performed. 13 patients required late open surgical conversion because of sac


expansion due to EL. Our operative methods are preparing for endovascular surgery: transperitoneal approach, femoral cut down for wire access or endovascular occlusion balloon (EOB) prior to open the sac.

ResultsData was reviewed for 13 patients with a mean age of 79±8 years old .The median interval from the initial implantation was 3.8 years. Three patients were presented with type （a EL, 8 patients were type （ EL and 2 patients were type （b EL. Four patients required an endovascular procedure（three for EOB and one for EVAR. In Type （a EL, a stent graft was partially explanted in one patient and proximal neck banding was performed on 2 patients. A stent graft was preservation in all cases of type（and type （ EL. The 30-day mortality rate was 7.6%. There was no aneurysm–related death during median follow up period of 21months.

ConclusionOur operative methods of late open conversion are of safety and efficacy.

P04Technical tip to overcome a tortuous aortic arch during TEVAR using a snareHyung Sub Park1, Dr. Yoon Hyun Lee1, Dr. Dae Hwan Kim1, Prof. Taeseung Lee1

1Seoul National University Bundang Hospital, Seongnam, South Korea

Challenging aortic arch anatomy during thoracic endovascular aneurysm repair (TEVAR) can be troublesome and can seriously influence the outcomes of treatment. We herein present a case of a patient with an aortic aneurysm just distal to the origin of the left subclavian artery, in which passage of the endovascular device through the aortic arch was only successful after use of a snare to bend the proximal delivery system and accommodate for the severe angulation of the aortic arch. A 74 year-old male patient presented with an increasing 5.6 cm descending thoracic aortic aneurysm. The patient had a type 3 aortic arch with severe angulation in both cranio-caudal and anterior-posterior aspects. A TEVAR procedure was planned with proximal landing in zone 2 and carotid-subclavian bypass. During the procedure, the TEVAR device (Zenith TX2, Cook Medical Inc., Bloomington, IN, USA) failed to pass through the tortuous aortic arch even with the support of a superstiff wire. Manual bending of the olive tip and the delivery system prior to insertion also failed to pass the arch area.

Therefore a snare system was used which was placed in the proximal part of the device and pulled firmly to physically bend the delivery system, allowing for advancement into the aortic arch. The device was placed just distal to the left carotid artery origin and deployed, but due to the severe angulation, the device migrated distally. Therefore an extender graft was introduced and the procedure was finished with coil embolization of the left subclavian artery origin. The adjunct use of a snare to create a bend on the device can be a good technical tip for cases with severely angulated aortic arches in which passage of the device is hindered.

P05Clinical Outcomes of Endovenous Laser Ablation for the Treatment of Varicose VeinsAtsushi Tabuchi1, Dr. Hisao Masaki1, Dr. Yasuhiro Yunoki1, Dr. Yoshiko Watababe1, Dr. Kazuo Tanemoto1


Background and ObjectivesWe evaluated the surgical outcomes, improvements in subjective and objective symptoms of varicose veins, and changes in venous function after endovenous laser ablation (EVLA) using a 980-nm diode laser.

MethodsBetween October 2011 and September 2015, 704 limbs (525 patients) were treated for incompetent saphenous veins at our institution. We studied the operative complications, venous clinical severity score (VCSS), and surgical outcomes of the treated limbs. We assessed saphenous vein occlusion, endovenous heat-induced thrombus (EHIT), and deep vein thrombosis (DVT) using duplex ultrasonography and measured venous filling index (VFI) using air plethysmography, preoperatively and 1, 6, 12, and 24 months postoperatively.

ResultsTwenty-four months after surgery, the technical success rate (cumulative occlusion rate) was 99.2%. Although EHIT occurred in 8.3% of limbs, class 3 EHIT occurred in only 0.9%. Severe complications such as DVT and skin burns were not observed. The mean preoperative VCSS was 5.1 ± 2.2, and this value improved to 2.1 ± 1.1 at 1 month, 0.7 ± 1.1 at 12 months, and 0.6 ± 0.9 at 24 months postoperatively. The mean preoperative VFI was 6.0 ± 3.4 mL/s, and this value improved to 2.2 ± 1.4 mL/s at 1 month, 2.3 ± 1.7 mL/s at 12 months, and 2.5 ± 1.9 mL/s at 24 months postoperatively. At 24 months after EVLA, the mean VCSS and VFI values were significantly lower than the preoperative values.

ConclusionsEVLA did not cause severe complications, and good surgical outcomes were obtained. VCSS and venous function were significantly improved at 24 months postoperatively. EVLA is a safe and effective treatment for incompetent saphenous veins.

P06Combined superficial femoral endovascular treatment and popliteal-to-distal bypass for critical limb ischemiaYoshihiko Tsuji1, Dr Ikuro Kitano1

1Shinsuma General Hospital, Kobe, Japan

ObjectivesThe aim of this study was to evaluate graft patency and limb salvage rates of combined endovascular treatment (EVT) for lesions in the superficial femoral artery (SFA) and popliteal-to-distal bypass for patients with critical limb ischemia.

Patients and MethodsBetween January 2005 and December 2015, we encountered 324 critical ischemic limbs categorized Rutherford 5/6, 138 of them were treated by infrainguinal bypass including 88 distal bypass.


In this study, we reviewed 14 cases (16%) who were treated by combined EVT for the SFA lesions and popliteal-to-distal bypass. There were 10 men and 4 women and the mean age was 72 years (58-81), and all of them had ischemic forefoot or toe wound (Rutherford 5: 10 cases, Rutherford 6: 4 cases). All of them had hypertension and diabetes mellitus, and 6 (43%) of them received hemodialysis. The SFA lesions included 3 TASC-A, 8 TASC-B, 3TASC-C, and no TASC-D. For the SFA lesions, balloon dilatation was performed in 9 and self-expandable stent was placed in 5. The saphenous vein graft was used in all of popliteal-to-distal bypass, and the target arteries were posterior tibial artery in 2 and dorsalis pedis artery in 12.

ResultsInitial success was obtained in all cases. At 12 and 24 months, primary-assisted and secondary patency rates were 92%, 74%, limb salvage rates were 92%, 92%, and survival rates were 91%, 82% (SE<10%). Restenosis after EVT for the SFA lesions occurred in 2 cases and vein graft stenosis occurred in 2 cases during follow-up period, and all of them were successfully revised by additional EVT.

ConclusionsCombined endovascular treatment for the SFA lesions and popliteal-to-distal bypass were considered to be useful procedures for appropriately selected patients with critical limb ischemia. Careful follow-up for endovascular treated lesions and vein graft is necessary.

P07Endovascular treatment for mycotic abdominal aneurysm with laparoscopic debridement: case report and systemic reviewChai Hock Chua1

1Shin Kong Wu Ho-Su Memorial Hospital Taipei, Taiwan, Taipei, Taiwan

BackgroundMycotic aortic aneurysm remains a rare but life-threatening disease. Among of these, infrarenal abdominal mycotic aneurysm is the most common anatomy. Endovascular aortic repair (EVAR) for these infective aortic aneurysm is feasible and a durable treatment option but high recurrent infection is noted. Further aggressive treatment after endovascular treatment is warranted to prevent recurrent infection. Laparoscopic debridement via retroperitoneal approach is considered a promising method to control the infection after the endovascular treatment.

ObjectivesIn our experience, there are total five cases of mycotic abdominal aortic aneurysm, in which EVAR was performed and then followed by laparoscopic retroperitoneal debridement. No recurrent infection was found during the follow-up.

MethodsThere were total 5 cases of mycotic abdominal aortic aneurysm, treated in this method, during these 3 years.

ResultsEVAR was performed in these five patients first and then followed by laparoscopic retroperitoneal debridement later (one or two days after EVAR). All patients were successfully discharged in two to 6 weeks with oral antibiotics control in OPD. No recurrent infection was noted during the follow-up.

ConclusionEndovascular treatment is now considered a durable option for mycotic aortic aneurysm. Recurrent infection is still a problem since the infective aneurysm is not excised and deployment of a stent graft can aggravate the infection. Laparoscopic retroperitoneal approach can provide adequate drainage and debridment for these patients and the result is good.

P08Cilostazol improves wound healing and freedom from major amputation after infrainguinal bypass for ischemic tissue lossShinsuke Mii1, MD, PhD Atsushi Guntani1, MD Aisuke Kawakubo1

1Saiseikai Yahata General Hospital, Kitakyushu-city, Japan

Background and purposeSome beneficail effects of cilostazol for critical limb ischemia (CLI) have been reported in several articles. The aim of this retrospective study is to evaluate the efficacy of postoperative cilostazol use in patients who undergo surgical bypass for tissue loss.

Patients and methodsFrom December 2010 to December 2015, a total of 145 consecutive patients underwent infrainguinal bypass for tissue loss due to arteriosclerosis obliterans (ASO). Excluding 6 patients who died and 3 patients who lost the legs within 30 days after surgery, 136 patients divided into 2 groups by postoperative use of cilostazol (cilostazol group: 42 and non-cilostazol group: 94). Wound healing (WH) was defined as the primary endpoint and freedom from major amputation (ffMA) was defined as the secondary endpoints. The clinical outcomes of the 2 groups were compared using the Kaplan-Meier method and the significant predictors of each outcome were determined by a Cox proportional hazards analysis.

ResultsThe Kaplan-Meier survival curves demonstrated that WH and ffMA of the cilostazol group was superior to that of the non-cilostazol group ([cilostazol vs. non-cilostazol] one-year WH rate. 100% vs. 86%; mean wound healing time. 34 days vs. 82 days; P < 0.01, and one-year ffMA rate. 100% vs. 90%; P < 0.05). A Cox proportional hazards regression analysis showed that cilostazol use, direct angiosome, no diabetes mellitus, no coronary artery disease, and no wound infection were positive predictors of WH, and cilostazol use and male were positive predictors of ffMA.

ConclusionsPostoperative use of cilostazol may improve WH and ffMA after infrainguinal bypass for tissue loss due to ASO.

Prize Poster Presentation


P09Acellular Fish Skin as a Bone and Tendon Covering: Case ReportJohn Lantis, Baldur T. Baldursson1, 2, Gudbjorg Palsdottir2, Dr. C Winters3, Skuli Magnusson1, Dr. Hilmar Kjartansson1,2, Dr. Gunnar Johannsson1, G Sigurjonsson1

1Kerecis, Reykjavik, Iceland, 2Landspitali University Hospital of Iceland, Reykjavik, Iceland, 3American Health Network, Indianapolis, USA

Introduction and ObjectiveThe aim of this case report was to evaluate fish skin grafts* for wounds with exposed bone or tendon.

MethodsData was gathered from patient database in Landspitali University Hospital of Iceland and the American Health Network Indianapolis. The fish skin graft was used in complicated cases where standard of care had failed after at least 4 weeks of treatment.

Results1: 69 y.o. male with 64 week old necrotic surgical wound with exposed achilles tendon. Healed in 10 weeks with 6 applications of fish skin *.2: a 48 y.o. female with iatrogen wound on forearm with exposed tendons, deteriorating for 8 weeks. Healed in 6 weeks with 6 fish skin applications*.3: 63 y.o. female with >4 week with exposed bone on elbow and puncture through the bursa olecranii. Healed in 3 weeks with 2 fish skin applications*.4: 60 y.o. male with >4 weeks old DFU with exposed caput of the 5th metatarsal. Healed in 14 weeks with 5 fish skin applications*.5: 59 y.o. male with >4 weeks old DFU and exposed tendon and joint over 5th MTP. Unresponsive to NPWT. Healed in 4 weeks with 4 fish skin applications*.6: 53 y.o. female with wound on to dorsal surface of the 5th MTP joint with exposed tendon. Healed in 4 weeks with 3 fish skin applications*.7: 55 y.o. male with DFU after partial 5th ray amputation due to diabetes. Healed in 8 weeks with 5 fish skin applications*.8: 56 y.o. male with haemophilia, diabetes and hepatitis C. Post midfoot amputation, unresponsive to collagen matrix#. Healed in 16 weeks with 6 fish skin applications*.

ConclusionFish skin* with facilitates granulation and tissue mass creation over exposed bone and tendons where other treatments faile.*Kerecis™ Omega3 by Kerecis #Primatrix by Integra

P10Angioscope assisted retrograde in-situ branched stentgraft (RIBS) for the treatment of an endoleak following custom-made fenestrated stent graft: a case reportSoichiro Fukushima1, Dr. Naoki Toya1, Dr. Eisaku Ito1, Dr. Yuri Murakami1, Dr. Tadashi Akiba1, Dr. Takao Ohki2

1Jikei University Kashiwa Hospital, Kashiwa-Si, Japan, 2Jikei University School of Medicine, Minato-ku, Nishi-shinbashi, JapanBackgroundRetrograde in-situ fenestration is one of a less invasive method for the branch reconstruction during thoracic endovascular aneurysm repair（TEVAR（ for high risk aortic arch disease. However, we sometimes experience a difficult case for the in-situ fenestration because of their anatomical background. Here we report a case of a patient who underwent retrograde in-situ fenestration using angioscpe for aortic arch aneurysm with an endoleak after TEVAR by the Najuta® custom-made thoracic fenestrated stentgraft（SG（.

Case presentationAn 83-year old man underwent endovascular aortic arch aneurysm with the Najuta® custom-made 3-fenestrated SG in 2011 at another institution. He was referred to our institution after complaining of hoarseness, and computed thomography (CT（imaging showed an endoleak through the SG fenestrations with aneurysm sac enlargement. Because of the presence of pre-existing fenestrations, we decided to perform additional TEVAR with retrograde in-situ fenestration for the carotid artery using an angioscope. During the fenestration for the left common carotid artery, we observed both the SG and the puncture needle through an angioscope which enabled us to avoid double puncture of the SGs, which may lead to the inability of puncture site expansion. Postoperative CT imaging confirmed the resolution of the endoleak, and the patient was discharged without complications.

ConclusionsRetrograde in-situ fenestration is a less invasive option for branch reconstruction during TEVAR for high risk aortic arch disease. Angioscope may be a useful tool in performing redo in-situ fenestration.


P11A Successful Staged Hybrid Repair of a Ruptured Type V Thoracoabdominal Mycotic Aneurysm By Visceral Debranching and Completion Endovascular Stent Grafting Julian ZY Hong1, Raj K Menon1, Andrew MTL Choong1,2


IntroductionSurgical management of type V thoracoabdominal aneurysms (TAAA) remains a surgical challenge, especially in an emergency setting. We report the successful staged hybrid repair of a leaking mycotic TAAA repair, with Salmonella Enteritidis as the offending organism.

ResultsA 69-year-old lady presented with worsening low back pain, dysphagia and an acute drop in haemoglobin levels from 10.4 to 7.0 g/dL. Bedside ultrasound revealed an abdominal aortic aneurysm (AAA) which was further delineated by a Computerised Tomography (CT) scan of her Aorta revealing a 7.2cm saccular TAAA, arising from the left lateral wall of the descending aorta, at the level of the aortic hiatus and extending inferiorly to the level of the coeliac axis.

She was admitted to the high dependency unit for preoperative optimization for surgery as a planned semi elective open TAAA repair. However an interval CT Aortogram revealed an interval increase in aneurysm size to 7.8cm with associated pleural effusion suggesting a contained leak.

An emergency partial visceral hybrid repair of her type V presumed mycotic TAAA was performed. Exploratory laparotomy, retrograde bypass from right iliac to superior mesenteric artery, jump graft from bypass graft to coeliac trunk and completion thoracic endovascular stent grafting.

Interval CT Aortogram 1 week later depicted a rebound increase in aneurysm size. Decision to return to operating theatre was made. Further debranching was performed of both renal arteries onto the previous right ilial-superior mesenteric artery graft. Previous stent graft was lengthened with additional stents beyond the renal arteries, and stents ballooned in place.

The patient was discharged well on post-operative day 41

ConclusionsThe visceral hybrid repair of visceral debranching and completion endovascular stent grafting is a robust and useful tool in the armamentarium of vascular surgeon. A staged approach to may be of benefit in complex aortic aneurysm repair particularly in an emergency setting.

Key words: Mycotic, Thoracoabdominal Aneurysm, Leaking

P12Fibrinogen replacement therapy guided by coagulation management reduces blood transfusion in thoracic aortic surgery: a retrospective observational studyKazuhiro Takatoku1, Dr Junichiro Nishizawa1, Dr Motoyuki Kumagai1, Dr Masahiro Uraoka2, Dr Mutsuhito Kikura2

1Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu, Japan, 2Department of Anesthesiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan

Background and ObjectivesCoagulation management is important for perioperative hemostasis in cardiovascular surgery. We evaluated the effects of fibrinogen replacement therapy guided by coagulation management for thoracic aortic surgery. We studied 53 consecutive patients who underwent thoracic aortic surgery with cardiopulmonary bypass (CPB) between January 2009 and July 2016. We excluded cases of descending thoracic aortic surgery, aortic rupture, re-do cardiovascular surgery, and those requiring additional surgery during the postoperative 24 hours. We compared the transfusion outcomes between 31 patients (control group) who underwent conventional management before December 2012, and 22 patients (algorithm-guided group) who received fibrinogen replacement therapy guided by coagulation management after January 2013.

MethodsIn the algorithm-guided group, fibrinogen level and fibrin polymerization (FIBTEM) were measured by the Clauss method and thromboelastometry (ROTEM®), respectively, during the re-warming phase of CPB and stratified the starting fresh-frozen plasma (FFP) volume according to the 4-group classification with fibrinogen level ≥150mg/dL and FIBTEM(A10) ≥6mm. After January 2014, we used fibrinogen concentrate (2-3g) when the fibrinogen level was <130mg/dL. We compared the postoperative bleeding and blood transfusion volumes within the first postoperative 24 hours between the groups.

ResultsThere were no significant differences between the control group and the algorithm-guided group in age (65±12 vs. 64±14 years; p=0.87), CPB time (230±65 vs. 226±47 min; p=0.76), operation time (509±140 vs. 523±103 min; p=0.69), postoperative chest-tube drainage (676±410 vs. 584±289 mL; p=0.34), intra-and postoperative FFP (1827±1261 vs. 1341±1020 mL; p=0.12), or platelet concentrate volume (522±192 vs. 490±274 mL; p=0.64). Compared with the control group, the algorithm-guided group required a lower red blood cell volume (2831±1354 vs. 2036±860mL; p=0.01) and a lower total blood transfusion volume (5181±2495 vs. 3869±1996mL; p=0.03).

ConclusionsFibrinogen replacement therapy guided by fibrinogen level and fibrin polymerization reduces blood transfusion in thoracic aortic surgery.

Prize Poster Presentation


Poster PresentationP01-01Deep Vein Thrombosis after Abdominal Surgery in Korean PatientsFahed Aljaber1, Prof. Dong-ik Kim1

1Samsung Medical Center, South Korea, Seoul, South Korea

IntroductionDeep vein thrombosis (DVT) is a postoperative complication and may manifest as pulmonary embolism, which causes 300,000 deaths annually in the United States alone. The incidence of DVT after abdominal surgery has been reported in the literature to be lower in Asian countries, particularly in countries farther to the east. Although the relationship between thrombosis and malignancy is well known, little information is available regarding the incidence.

ObjectiveThe purpose of this study was to prospectively investigate the incidence of deep vein thrombosis (DVT) after abdominal surgery in Korean patients.

Materials and MethodsTwo hundred and two patients who underwent surgery for pancreaticobiliary, lower gastrointestinal or stomach disease were enrolled. Duplex scanning for diagnosis of DVT was performed one day preoperatively and on postoperative day 7.

ResultsPatients were divided into two groups, those who received mechanical thromboprophylaxis (n = 50) and those who did not (n = 152). There was no statistically significant difference in demographics between the two groups. Soleal vein thrombosis occurred in 11 of 152 (7.2%) patients who did not receive mechanical thromboprophylaxis and 2 of 50 (4%) patients who did; there were no significant differences in the incidence of DVT between the two groups. No progression of thrombosis into the main deep vein system was observed during the follow-up period (6 months postoperative).

ConclusionsThis study demonstrated a low incidence of DVT after abdominal surgery in Korean patients. A large, randomized, multi-center study is needed to establish guidelines for DVT prevention and management after surgery in

P01-02Inferior vena cava filter insertion through the popliteal vein: enabling the percutaneous endovenous intervention (PEVI) of deep vein thrombosis with a single venous approach in a single sessionMD Sang Young Chung1, Hong Sung Chung1, MD Ho Kyun Lee1, MD Soo Jin Na Choi1


Background/ IntroductionRetrievable inferior vena cava (IVC) filters and prophylactic IVC filter insertion is approached two venous access sites.

ObjectivesTo evaluate the feasibility and usefulness of placing an IVC filter through the same popliteal vein access site used for PEVI in patients with extensive lower extremity DVT;

Materials and MethodsDuring a 3 years, a total of 21 patients undergoing IVC filter insertion through the popliteal vein. In all patients, a popliteal vein approach in the leg with the venous thrombosis was attempted. A double-basket shaped retrievable IVC filter equipped with a 90 cm length introducer set (OptEase filter; Cordis, Warren, NJ, USA) was deployed in the infra-renal IVC under fluoroscopic guidance. After IVC filter insertion, endovascular treatment, including aspiration thrombectomy or thrombolysis, was performed for iliofemoral vein thromboses to prevent thrombus migration into the IVC

ResultsProphylactic infra-renal IVC filter insertion were successfully deployed in all patients. In all patients, recanalization procedures were preformed: Aspiration thrombectomy (n=21), Catheter directed thrombolysis (n=16), Adjuvant endovascular treatment, including venous stent or balloon angioplasty (n=15). Mean filter tilt; 7.14 ± 4.48 ° in the coronal plane, 8.77 ± 5.49 ° in the sagittal plane. (*P= 0.238, paired t-test) Significant filter tilt (filter tilt ≥ 15°)= 3 patients (14.3%)- maximum filter tilt= 18°. Filter retrieval was attempted in 17/21 patients. Persistent DVT (n=3), Patient refusal of the retrieval procedure (n=1). Filter was successfully removed in 16/17 (94.1%). Mean filter dwell time (20.13 days).

ConclusionsTranspopliteal IVC filter insertion is enable a single session procedure using a single venous access and site for filter insertion and PEVI. PEVI is feasible and useful theraphy that results in low rates of significant filter tilt.

P01-03Recurent acute venous thrombosis of left lower extremity in a patient with hyperlipidemiaKazim Ergunes1, Dr Ihsan Peker1, Dr Ismail Yurekli1, Dr Tayfun Goktogan1, Dr Mehmet Balkanay1, Dr Orhan Gokalp1, Prof Levent Yilik1, Prof Ali Gurbuz1


ObjectiveVenous thrombosis is important factor affecting morbidity and mortality. We presented a patient with hyperlipidemia having recurrent acute venous thrombosis of the left lower extremity.

MethodsA 62-year old woman admitted to the outpatient clinic of our hospital in November, 2015. She had pain and edema in the left lower extremity. She had hyperlipidemia.

ResultsVenous Doppler ulrasonography detected thrombosis in the deep venous system of left lower extremity. She used warfarin due to venous thrombosis of the left lower extremity five years ago. Anticoagulant therapy with low-molecular-weight heparin (LMWH) was immediately started. The patient!s symptoms,


particularly pain and edema continued to improve in left lower extremity. She was discharged after seven days with warfarin treatment.

ConclusionsLow-molecular-weight heparin and warfarin are important in treatment of acute recurrent deep venous thrombosis of the lower extremity in patients with hyperlipidemia.

P01-04A case with recurrent acute left lower deep venous thrombosis having pulmonary thromboembolism and deep venous thrombosis operated due to genital and colon cancer one year agoKazim Ergunes1, Dr Erturk Karaagac1, Dr Yuksel Besir1, Dr Ismail Yurekli1, Dr Bortecin Eygi1, Dr Banu Lafci1, Dr Koksal Donmez1, Prof Ali Gurbuz1


ObjectiveVenous thromboembolism has multiple risk factors and tends to recur. We reported a case with acute left lower deep venous thrombosis having pulmonary thromboembolism and deep venous thrombosis operated due to genital and colon cancer one year ago

MethodsA 44-year old woman admitted to emergency department of our hospital on November, 2015. She had pain and edema in the left lower extremity.

ResultsVenous Doppler ulrasonography detected thrombosis in the deep venous system of left lower extremity. The low-molecular-weight heparin (LMWH) was immediately started. Symptoms of patient particularly pain and edema continued to improve in left lower extremity. She was discharged six days after LMWH treatment. Anticoagulant therapy was changed to oral warfarin as a permanent medication.

ConclusionsPulmonary thromboembolism and deep venous thrombosis, genital and colon cancer operations are important factors in the recurrent lower extremity venous thrombosis.

P01-05Progression and regression of isolated calf deep vein thrombosis during a 1-year follow-upMakoto Haga1, Yutaka Hosoi1, Tooru Ikezoe1, Masao Nunokawa1, Hiroshi Kubota1

1Kyorin University School Of Medicine, Mitaka, Japan

BackgroundIsolated calf deep vein thrombosis (ICDVT) is common in clinical practice; however, the treatment of ICDVT remains controversial.

The current recommendations range from watchful waiting to full-dose anticoagulation.

ObjectivesThe purpose of the present study was to investigate the progression and regression of thrombi and to identify the patterns of serial changes in patients with ICDVT during a 1-year follow-up.

MethodsA retrospective chart review was performed for patients with ICDVT in a single institution between 2013 and 2014. Diagnosis was established with duplex ultrasound (DUS) examination. All deep veins in the calf, excluding the anterior tibial vein, were imaged. We evaluated patients who were followed up clinically and who underwent DUS at 1, 3, and 6 months, and up to 12 months. Additionally, the rate of anticoagulant therapy and compression were investigated.

ResultsThe study included 218 patients (163 women and 55 men). The mean age of the patients was 73.9 ± 11.0 years (range, 39-93 years). The majority of the patients were asymptomatic (167 patients, 76.6%). With regard to limb preference, 104 cases occurred in the right limb, 56 occurred in the left limb, and 58 occurred bilaterally. Among the 218 patients, 181 (83%) received anticoagulant therapy, and 211 (96%) received compression therapy. Complete recanalization of ICDVT was observed in 66 patients (30%), while 102 patients (47%) showed residual thrombosis, and 40 patients (18%) showed recurrence in the calf. Proximal vein propagation was noted in 10 patients (5%), and concomitant pulmonary embolisms (PE) were noted in 9 patients (4.1%). Patients with PEs or proximal vein propagation of DVT were treated without sufficient anticoagulant therapy.

ConclusionsAlthough most of the patients in our study were asymptomatic, there was a substantial risk for PE and proximal vein propagation. Sufficient anticoagulant therapy is necessary in such a high-risk group of patients.

P01-06Total endovascular treatment for acute deep venous thrombosis by catheter-directed thrombolysisKimihiro Igari1, Dr Toshifumi Kudo1, Dr Takahiro Toyofuku1, Dr Yoshinori Inoue1

1Tokyo Medical And Dental University, Bunkyo-ku, Japan

ObjectivesThe present study aimed to investigate our treatment for acute deep venous thrombosis (DVT) by endovascular procedure, and to evaluate the treatment outcomes.

MethodsWe retrospectively reviewed the charts of patients who underwent endopvascular treatment (EVT) for acute DVT between January 2015 and June 2016. For the EVT procedure, we inserted a 4 or 5 Fr sheath through popliteal or short saphenous vein under the local anesthesia. The infusion catheter for thrombolysis was positined between iliac vein and femoral vein, and thrombolysis with urokinase was done. After the operation, we performed

Poster Presentation


thrombolysis with urokinase through the infusion catheter which was posintined intraoperatively. Furthermore, we conducted the ballon dilatation for the stenotic segment of iliac vein.

ResultsThree patients (one male, and 2 female) were included in this study. In all patients, the EVT procedure was successful in achieving re-canalisation of the iliofemoral veins at the end of the intraoperative thrombolysis with urokinase (median dose of 360,000 unit). We peformed the postoperative thrombolysis with urokinase (dose of 240,000 unit /day, and median duration of 3 days). Two of 3 patinents were treated by ballon dilatation for the stenotic lesion of liac vein. During the follow-up period (median : 15 months), all patients kept the affected venous lesions patent.

ConclusionOur treatment with EVT procedure might be a safe and feasible treatment for acute DVT.

P01-07Clinical outcome of edoxaban for treatment of venous thromboembolism in Japanese populationShinichi Imai1, Medical Doctor Shinichi Hiromatsu1, Medical Doctor Kanako Sakurai1, Medical Doctor Ryou Kanamoto1, Medical Doctor Shohei Yoshida1, Medical Doctor Mau Amako1, Medical Doctor Hiroyuki Otsuka1, Medical Doctor Satoru Tobinaga1, Medical Doctor Seiji Onitsuka1, Professor Hiroyuki Tanaka1

1 Kurume University Surgery, Kurume, Japan

ObjectivesThe purpose of this study is to evaluate our recent clinical experience with edoxaban for treatment of venous thromboembolism (VTE).

PatientsWe retrospectively reviewed 39 patients(pts) (12 men and 27women, mean age 62.6± 19.7 years) to whom edoxaban was administrated for treatment of VTE from January 2015 until December 2015.

ResultsThe distribution of VTE included 9 pts (23.4%) who had a PE with DVT, 3(8%) who had only PE, 24(61.5%) who had only DVT. 21 pts (53.8%) were DVT with proximal type and 12 pts (30.7%) DVT with distal type. The cause of VTE included the following: 2 pts who had previous VTE, 12 pts (30.8%) who had cancer, 25 pts (64.1%) who had temporary risk factor. Daily dose of edoxaban for these pts was 60mg (20.5%), 30mg (53.8%) and 15mg (25.6%). The mean follow-up period was 103±87 days. The plasma D-dimer level were 6.6μg/ml (range 0.8 to 39.2) before receiving edoxaban. The plasma D-dimer level decreased to 1.2μg/ml (range 0.4 to 5.5) over one month of initial treatment. There were 9 complications due to edoxaban. Clinically relevant nonmajor bleeding occurred in 6 patients. Liver dysfunction was observed in 2 patients. Paradoxical cerebral infarction occurred in one patient.

DiscussionEast Asian pts tend to have bleeding complications for receiving warfarin as compared with non East Asian pts. For this reasons, treatment alternatives to warfarin might be of particular relevance

to this population. The results of the sub analysis of the Hokusai-VTE trial revealed that edoxaban was associated with significantly less clinically relevant bleeding than warfarin. Our clinical outcome showed remarkable efficacy of initial treatment with edoxaban in patients with VTE.

ConclusionIn the future, large-scale and precise investigation for use of edoxaban in the real world are required to validate the efficacy and safety for treatment of VTE.

P01-08Clinical characteristics of May-Thurner’s syndrome with thrombus extension to IVCHeungman Jun1, Dr. Cheol Woong Jung1, Dr. Sung Bum Cho1

1Korea University Anam Hospital, Seoul, South Korea

IntroductionWith an increase in lower extremity deep vein thrombosis (DVT), interest in May-Thurner’s syndrome (MTS) accompanying iliac vein compression is also on the rise. In particular, it is observed that some patients with MTS have IVC thrombosis. And if IVC thrombosis is present, mortality as well as significant complications including postthrombotic syndrome (PTS) and pulmonary thromboembolism (PTE) will rise.

ObjectivesTo find the different characteristics of MTS with thrombosis extending stenotic lesion of iliac vein into IVC, compared to MTS without IVC thrombosis.

MethodA total of 35 patients with MTS were treated with many interventional modalities including catheter directed thrombolysis, percutaneous mechanical thrombectomy and iliac vein stent from January 2012 to December 2015. The data on the current history, the stenotic feature (stenotic size, stenotic ratio compared form the other side) and clinical outcomes (PTE, PTS) were retrospectively reviewed by dividing into groups with IVC thrombosis and without. The patency in the two groups was compared with log-rank test.

ResultsEight patients (22.85%) had thrombus extension to IVC (TEIVC) in 35 patients of MTS. The group with TEIVC showed higher measurement in stenotic size and ratio, which was statistically significant (P<0.001, P=0.001). The group with TEIVC presented more with PTE compared to the group without, which was statistically significant (P=0.007). But there were no statistical differences of PTS. In follow-up of mean 11 months, there were no statistical differences of patency in the two groups (P=0.501).

Conclusions In MTS, TEIVC is likely to develop in cases where the iliac venous size of stenotic lesion and the stenotic ratio compared from the other side is shown to be greater. Also, PTE occurred more frequently in MTS with TEIVC. Thus, patients with MTS require thorough inspection on TEIVC, and large scale research with long term results is also necessary.


P01-09Patients with epithelial ovarian cancer and DVT can be treated safely with standard DVT treatment. Jang Yong Kim1, Clinical Professor Eun Young Ki1, Professor Jong Sup Park1, Professor Young Ju Suh2, Professor Soo Young Hur1, Professor Seung Nam Kim1, Professor In Sung Moon1

1The Catholic University of Korea, College of Medicine, Seoul, South Korea, 2Inha University, College of Medicine, Incheon, South KoreaObjectiveThe aim of this study was to evaluate the prevalence of deep vein thrombosis (DVT) and the influence of DVT on patients’ survival with epithelial ovarian cancer with standard DVT treatment.

MethodsThis is a retrospective study from prospectively registered data base of patients who underwent cytoreductive surgery and adjuvant chemotherapy from January 2010 to December 2014 at Seoul St. Mary’s Hospital. Electronic medical records(EMR) and picture archiving and communication system(PACS) was used to evaluate patient’s clinical characteristics, treatment results and the influence of DVT.

ResultsTwo hundred eighty four patients were identified. There were 260 patients without DVT and 24 patients with DVT. Among 24 patients, 9 patients had pulmonary embolism. All patients with DVT were treated with anticoagulation. Patients with DVT were older (61.0 vs 51.2 years, P=0.009), and diagnosed at more advanced stages (P for trend: 0.029, Cochran-Armitage trend test) at initial diagnosis than those without. The overall survival was not significantly different between two groups (P=0.14) by using the log rank test. The stage was associated with shorter overall survival (for stage IV: hazard ratio (HR) 17.0, 95% CI 3.4-83.6, P<0.05 ); however, the presence of DVT was not associated with poor prognosis (HR 0.8, 95% CI, 0.1.0-1.06, P=0.61).

ConclusionThe incidence of DVT was 8.5% in patients with epithelial ovarian cancer. DVT can cause a fatal complication. However, Patients with epithelial ovarian cancer and DVT can be safely treated with standard treatment of DVT.

P02-01Endovascular treatment considerations for an acute subclavian pseudoaneurysm after fracture of the clavicleChing Siang Cheng1

1The Royal Brisbane And Women’s Hospital, Herston, Australia

Pseudoaneurysm of the subclavian artery is an uncommon complication following fracture of the clavicle. Reports of endovascular repair have been published since 2003, but discussions concerning implications of the remaining orthopaedic injury on the stented area were not often detailed.

Poster PresentationWe report a case of 69 year old man with a subclavian artery pseudoaneurym following a closed fracture of a clavicle. Vascular surgery intervention was indicated as he presented with an acute upper limb from distal embolisation into his brachial artery, with a surgical thromboembolectomy performed followed by stenting of the pseudoaneurysm with a self expanding covered stent.

While he recovered well from the procedure, there remained concerns about stent deformation or perforation from the pointed fracture edge that remained unfixed. Discussions with the orthopaedic team and our investigations to rule out risk of stent damage will feature in our poster presentation.

P02-02Vascular Complications Related to Lumbar Disc SurgerySang Young Chung1, MD Soo Jin NA Choi1


Background/ IntroductionVascular complications related to lumbar disc operation are rare but extremely fatal conditions. The vascular related symptoms that warn the surgeon may be late to appear: they usually turn out to be mortal.

ObjectivesThe hypotension during the operation, tachycardia and pulsatile unstoppable hemorrhage observed in the disc space are major findings, urgent detection of this complication and the repair of the vascular injury prevent the case from turning out to be fatal.

Materials and MethodsWe report our experience 4 cases with vascular complications that occurred during lumbar disc operations performed.

ResultsOne patient underwent an L5-S1 procedure and the remaining underwent L4-5 surgery. Missed injuries which were found during the late postoperative period, including pseudoaneurysm in one case and 3 cases with complications occurring early in postoperative period, the all cases left common iliac arteryIn two cases shock or pre-shock due to hemorrhage developed during the early phase. 3cases the lesion was repaired using primer suture techniques and the other case performed endovascular graft insertion.There was no surgery-related death and none of the patients suffered any problem related to vascular injury

ConclusionsDespite its low incidence, iatrogenic vascular injury related to lumbar disc surgery is a possible complication. During lumbar disc operation early diagnosis of vascular injuries and urgent transperitoneal surgery can save patients’ lives.


P02-03Cardiopulmonary Arrest Due to Rupture of Pseudo-Aneurysm of Superior Mesenteric Artery Caused by Blunt Trauma: Case ReportBaku Takahashi1, Dr. Yoshihiro Nakayama1, Dr. Shinyu Shiroma2

1Department of Cardiovascular Surgery, Osumikanoya Hospital, Kanoya, Kagoshima, Japan, Kanoya, Japan, 2Department of General Surgery, Uwajima Tokushukai Hospital, Kanoya, Kagoshima, Japan , Uwajima, Japan

Pseudo-aneurysm of the superior mesenteric artery is rare condition, however, potentially life-threatening complication after abdominal trauma.

A 61-year-old man was admitted to the emergency department of another hospital for complaining of severe back pain because an epigastric region was pushed away by a cow. Laboratory tests were unremarkable. Contrast-enhanced computed tomography (CT) detected the pseudo-aneurysm of superior mesenteric artery (SMA) that placed at the about 3cm from the origin of the SMA. The patient was treated by conservative treatment with blood pressure (BP) control because his vital signs was stable, and the pain disappeared. However, his back pain developed again and follow-up CT revealed enlargement of SMA pseudo-aneurysm. The patient was conveyed to our hospital. His back pain persisted and BP fell, therefore we diagnosed with impending rupture and decided to perform urgent surgery. During the anesthesia introduction, the patient fell into shock and cardiopulmonary arrest. With cardiopulmonary resuscitation, we performed urgent laparotomy and clamped abdominal aorta above the celiac artery, recovery of spontaneous circulation was obtained in several minutes. Laparotomy revealed active bleeding from SMA and superior mesenteric vein (SMV), therefore we repaired them with interrupted sutures urgently and went back to ICU room as a damage control surgery. In ICU room, because BP was unstable and progressing anemia and acidosis, we performed laparotomy on the same day. We detected bleeding from SMV and ischemic ascending colon, therefore we repaired SMV and resected the colon. 2 days later, we performed second look operation, and we confirmed non-bleeding and anastomosed the appendix and transverse colon. His postoperative course was uneventful and the patient was discharged on foot on postoperative day 30.

The SMA pseudo-aneurysm is fatal disease when it ruptures. Before rupture, endovascular treatment may be available, however, emergency laparotomy is mandatory when rupture is suspected.

P02-04TEVAR for Blunt Thoracic Aortic injury without left subclavain artery coverageDr. Kritaya Kritayakirana1, Dr. Natawat Narueponjirakul1, Apinan Uthaipaisanwong1

1King Chulalongkorn Memorial Hospital, , Thailand

Background Endovascular treatment for blunt traumatic aortic injury (BAI) was standard treatment but coverage of left subclavian artery was questionable.

Methods 19 Patients who were undergone TEVAR for BAI since 2012 to 2016 in King Chulalongkorn Memorial Hospital were analyzed for demographic data, technique of TEVAR and early complication.

Results Among 19 patients, Most of cases were male (75%) in mean aged 38.5 years (range : 21-70 years) with injury from traffic with injury from traffic accident (73%). Most associated injuries were chest injury (Lung contusion in 73%, Pneumohemothorax in 58%, Fracture rib in 32%). All of cases were grade 3 injury. Location of aortic injuries were distal to left subclavain artery with average distant from left subclavain artery to it was 14.14 mm (range : 0-20 mm). Proximal landing zone diameter was 23.9 mm (range : 16.2-30 mm). Common size of stent grafts were 26 about 40%. Over-sizing of stent graft was about 10%. Stent grafts were 68% Valiant Thoracic and 32% Zeninth TX2. Technical success was achieved in 100% of cases. No case was required left subclavain artery coverage. Only 1 case (5%) ,the injury was pseudoaneurysm at aortic arch between innominate artery and left subclavain artery. In this case, we performed chimney TEVAR at innominate artery, carotid-carotid bypass and left carotid to left subclavain bypass with proximal landing zone at zone 0. No early endoleak was occurred after procedures. No other perioperative complication such as transient or permanent paraplegia, or cerebral complication. Mean ISS score was 36±20.3.

Conclusion Most common location of BAI was distal to left subclavian artery. In our study, without left subclavain artery coverage, TEVAR was done successfully without endoleak and other perioperative complications.

P02-05Stages of an emergency surgical procedure of a 4-year-old patient with post-traumatic 90º angulation of left brachial arteryAssist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, Specialist Köksal Dönmez2, Assist.Prof. Özhan Pazarcı3, Prof.Dr. Öcal Berkan1, Ufuk Yetkin1

1Cumhuriyet University Medical Faculty, SİVAS, Turkey, 2Katip Celebi University Izmir Ataturk Training and Research Hospital, Izmir, Turkey, 3Cumhuriyet University, Dept. of Medical Faculty, SİVAS, Turkey

ObjectiveIn daily vascular surgery practice, emergency interventions to pediatric patient group have great variety and severe difficulties.

MethodA 4-year-old girl patient admitted to our emergency department. She fell from her bicycle one hour before admitting. She had an open-fracture at her left upper extremity. Patient was examined by Orthopedic surgeons first. Direct radiographies revealed a left open supracondylar fracture. Amplitude of radial and ulnar pulses and temperature of left hand were lesser than right. Further investigations were planned. Duplex ultrasonography was achieved firstly. CT angiography was planned afterwards.


ResultsAbout a 6 cm part of left brachial artery was not visualized at both investigations. Patient underwent emergent reduction by orthopedic surgeons. As vascular surgery team, we attended to operation. Under general anesthesia, we used a standard S incision for left brachial artery. Area had severe hematoma. Proximal dislocation of fracture caused a 90 º angulation distal brachial artery. Pulsation was very weak after this point. Neural and venous structures were suspended and checked for their integrity. After vascular exploration, orthopedic surgeons fixated and repositioned the bones with instrumentation. Distal pulses were absent with continuous wave Doppler after intervention. Distal brachial artery was re-explored. Artery had kinking due to instrumentation and it was compressed between repositioned bones. Instruments were extracted and artery was released from adjacent tissues with sharp dissection. Distal pulses were achieved. Re-reduction was completed.

Distal pulses were palpable in control examination. Addition to other medications, iloprost and pentoxifylline treatment were initiated with appropriate dosage according to patient’s weight. Patient recovered uneventfully.

ConclusionIn vascular surgery practice, treating pediatric patients requires more experience. Multiple episodes may be required and multidisciplinary approach may be necessary due to accompanying pathologies.

P02-06Fasciotomy Due to Compartment Syndrome and Amputation Rates of Our Post-traumatic Extremity Vascular Injury SeriesAssist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, Ufuk Yetkin1, Specialist Köksal Dönmez2, Prof.Dr. Öcal Berkan1


ObjectiveCompartment syndrome may occur after revascularization. If ischemia period of extremity exceeds 6 hours, compartment syndrome is more common and patients may undergo prophylactic fasciotomy. We aimed to present fasciotomy due to compartment syndrome and amputation rates in patients with vascular injuries of extremities from admittance to Emergency Department to diagnosis and treatment between dates January 2013 and December 2015. We retrospectively investigated our modalities and assessed with up-to-date literature.

MethodBetween dates January 2013 and December 2015, thirty-four patients who were treated surgically for peripheral vascular injury by the same surgical team were investigated retrospectively. Twenty-nine patients were male (85.3%) and 5 patients were female (14.7%). Mean age of patients were 32.00±14.67 (between 10 to 68 years). According to trauma site, patients were examined with a multidisciplinary approach including cardiovascular surgeon, orthopedic surgeon and/or plastic surgeon.

ResultsCompartment syndrome occurred in postoperative period of three (8.8%) patients. Two of these patients had popliteal artery injury. Compartment syndrome occurred after 6th to 12th hours of revascularization and a fasciotomy was performed. Remaining patient had a brachial artery injury with extensive tissue damage. Fasciotomy was performed after 8th hour of revascularization for compartment syndrome. One patient had below-knee and one patient had forearm amputation. None of the remaining 32 patients had a complication causing amputation. There was not any mortality in our series.

ConclusionAmputation may be inevitable in trauma patients with vascular injury, bone fracture, nerve damage and extensive tissue damage. Revascularization may not be performed in these patients with major tissue loss. One patient (2.9%) had lower extremity amputation after bypass grafting to popliteal artery with saphenous vein. Other patient (2.9%) had amputation after bypass grafting to brachial artery with saphenous vein. Amputation rates in our series are significantly lower than literature.

P02-07Hybrid approach to a work-related accident with suspicion of vascular injury caused by metallic object stabbed to the neckAssist. Prof. Sabahattin Göksel1, Specialist Köksal Dönmez2, Assist.Prof. Özge Korkmaz1, Prof.Dr. Öcal Berkan1, Ufuk Yetkin1


ObjectiveMetallic objects penetrating to especially upper part of body due to work-related accidents may cause to various vascular trauma and complications.Emergency interventions for these pathologies are rare but important in daily vascular surgery practice.

MethodOur case was a 49-year-old male patient.In his medical history,he had a penetrating trauma four hours ago with an approximately 10mm long piece of iron from an instrument he was working with,fromright anterolateral part of his neck.An entry site of 1 cm long was visualized at anterolateral–supraclavicular right neck.Minimal edema and hematoma was available around the tissue of entry site.There was not any active bleeding.Contrasted thorax CT revealed a hyper dense object with metallic artefact and a size of 1,5cm localized at right clavicular,anterior of superior jugular vein.There was hematoma at surrounding muscles.Due to foreign body at vascular site and hematoma,an emergency exploration was planned.

ResultsPatient underwent emergent operation.Under general anesthesia and laryngeal intubation,we preferred a transvers incision at right medial supraclavicular area.Dermis and subdermal tissues were passed.By using a right-angle forceps,muscles were separated with blunt dissection at their anatomic plans.Objects localization was confirmed with C-armScopy.With a very restricted dissection,object was localized adjacent to adventitia of internal jugular vein.A metallic object with a size of 10x5mm was successfully extracted

Poster Presentation


from the area.After optimal bleeding control and hemostasis,tissues were restored at their anatomic planes.Patient was extubated and transferred to intensive care unit.Patient recovered uneventfully and discharged at postoperative 4th day.He is still followed-up by our outpatient clinic.

ConclusionPenetrating trauma of upper body with metallic objects and suspicion of vascular injury is an absolute surgical indication.Foreign object must be extracted and vascular structures must be checked for injury.We believe that hybrid intervention with help of a C-armScopy will reduce the surgery time to explore the object site and increase the success rate of operation in vascular surgery practice.

P02-08Our Principles At Post-traumatic Extremity Vascular Injuries: Operation Steps And Early Post-operative Period Assist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, Ufuk Yetkin1, Specialist Köksal Dönmez2, Prof.Dr. Öcal Berkan2


ObjectivesWe performed a retrospective investigation for operation steps and treatment principles in early postoperative period on patients with vascular injury of extremity between dates January 2013 and December 2015.

MethodsThirty-four patients who were treated surgically for peripheral vascular injury.Twenty-nine of these patients were male (85.3%) and 5 patients were female (14.7%).Mean age of patients were 32.00±14.67.

ResultsAnesthesia type (local/general)was selected according to wound type,simultaneous operations and patient’s general status.Unless there is a life threatening condition, all other operations including orthopedic interventions were performed after revascularization or vessel repair.Incisions were performed at projection of trauma site.Bleeding artery and/or vein was suspended from proximal part.Intravenous 100 IU/Kg heparin was administered.If it was necessary distal and proximal embolectomy was performed to artery and was irrigated with heparinized saline.If damaged segment was longer than two centimeters or there is tension at end-to-end anastomosis site,saphenous vein graft was preferred for interpositioning.Polytetrafluoroethylene (PTFE) or Dacrongraft was used in patients without appropriate saphenous veins.If there is not a possibility for primary repair in venous injuries,vein was ligated or repaired by using saphenous vein graft.Bone stabilization,tendon and nerve repairs were performed after vascular repair.Anastomosis and/or repair sites were checked again before suturation of wound.Each patient was followed up in intensive care unit for vascular problems.Continuous infusion of heparin was administered with perfusors.ACT levels were stabilized at 220±20 seconds. Vascular structures were controlled with duplex ultrasonography.Control CT angiography was performed if necessary.Continuous heparin infusion was stopped at postoperative third day and proper

dosage of low molecular weight heparin was administered.At postoperative 6th day,Clopidogrel (75 mg)was added to treatment.Low molecular weight heparin therapy was maintained for ten days after discharged.Each patient was invited to our outpatient clinic for control ten days after discharge.

ConclusionIn peripheral vascular injuries, early diagnosis and urgent initiation of treatment reduces extremity loss and mortality significantly.

P03-01Heparin bonding improves early primary patency of arteriovenous graft for hemodialysis accessKenji Aoki1, Norihito Nakamura1, Akihiro Nakamura1, Takeshi Okamoto1, Yuka Okubo1, Osamu Namura1, Kazuhiko Hanzawa1, Masanori Tsuchida1

1Niigata University, Niigata, Japan

BackgroundEfficacy of heparin bonding is still controversial in arteriovenous graft (AVG) for hemodialysis access.

ObjectiveWe compared the patency of heparin-bonded grafts (Gore Propaten) with standard expanded polytetrafluoroethylene (ePTFE) grafts.

MethodsForty patients underwent forearm loop AVG creation using 4- to 6-mm tapered ePTFE graft. During the first period (October 2012 to March 2014), standard ePTFE grafts were used in 17 patients. During the latter period (April 2014 to July 2016), Propaten grafts were used in 23 patients. The patency of Propaten grafts was compared with standard grafts.

ResultsMean follow-up period was 12.3 ± 9.4 months in the Propaten group and 33.1 ± 14.9 months in the standard graft group. Primary patency was 90.0（ and 90.0% in the Propaten group, and 70.6（ and 51.3% in the standard graft group at 6 months and 12 months, respectively. Propaten demonstrated significantly improved primary patency, compared to the standard grafts (P = 0.0204). There was a trend to reduction of early occlusion during the first 6 months in the Propaten group (8.7% versus 23.5%). Secondary patency was 94.4（ and 94.4% in the Propaten group, and 88.2% and 81.9% in the standard graft group at 12 months and 24 months, respectively. There was a trend to improved secondary patency in the Propaten group, but no statistical difference was found in both groups.

ConclusionsHeparin bonding reduced incidence of early occlusion after AVG creation. This advantage may improve long-term patency of ePTFE grafts and become a great benefit to hemodialysis patients.


P03-02Cannulation of arterio-venous fistula after ultrasound evaluation - National Kidney and Transplant Institute experienceDr. Benito Purugganan Jr1, Rophel Miguel1, Dr. Adolfo Parayno1, Dr. Ricardo Jose Quintos1, Dr. Arwin Ronan Ronsayro1


BackgroundInitiation of hemodialysis for end stage renal disease patients (ESRD) usually starts with non-tunneled temporary catheters insertions and creation of permanent accesses weeks to months later. Arteriovenous fistula (AVF), requires a period of maturation.Patients are at risk of developing catheter related complications. Ultrasonography with Doppler study (DUS) offers a means to evaluate AVF maturation earlier than 6 weeks allowing earlier use of these AV fistulas.

MethodologyA chart review was conducted involving patients who underwent AVF creation and ultrasound assessed clearance to determine whether there are significant cannulation injury attributable to early cannulation and to determine what factors may have contributed to this.

ResultsA total of 73 patients were included in the study. There were 24 documented injuries.Injury between groups at different maturation period with respect to length of maturation period, outflow vein diameter and compliance to the K/DOQI guidelines were determined to be not significantly different statistically. With regards to the outflow vein wall thickness, all complied with the ≥0.6mm but development of injury across both groups was not decreased even if the wall thickness was increased to 0.07mm or ≥0.8mm.

ConclusionThe absence of statistically significant difference in incidence of injury between use of AVF at less than 6 weeks and more than 6 weeks of maturation period, provided that appropriate DUS evaluation was done, suggests that the cannulation of the former does not result into major injury that can compromise the AVF function. Length of maturation period, anatomical factor particularly vein diameter and compliance to K/DOQI guidelines have not been shown to independently increase risk of injury.

(Keywords: AV fistula maturation, vein diameter, cannulation injury, AVF intima-media thickness, AVF ultrasound evaluation)

P03-03Percutaneous transluminal angioplasty for central vein stenosis in adults with chronic kidney disease at the National Kidney and Transplant InstituteAlexander Kent Achurra1, Dr. Benito Purugganan Jr.1


Background and ObjectiveCentral vein stenosis is a common cause of venous hypertension after a successful peripheral access creation. Percutaneous intervention with transluminal angioplasty is the preferred treatment for central vein stenosis. Literature states that initial success rates for angioplasty alone ranges from 70-100%, and a 6 month patency drop to between 13-86%. There is no local experience on efficacy and safety of percutaneous transluminal angioplasty in the treatment of central vein stenosis.

MethodsRecords of patients managed with percutaneous transluminal angioplasty from catheterization laboratory is documented. The success rate of percutaneous transluminal angioplasty to salvage a failing hemodialysis fistula was documented. Estimates of central tendency for continuous variables, and frequency tables for categorical variables were used to present data. SPSS version 20 was used for cross tabulations.

ResultsOnly 22 patients were included in the study. Chronic Glomerulonephritis (50%), hypertensive nephrosclerosis (22.8%), and diabetes mellitus nephropathy (18.2%) were the predominant cause of their chronic kidney disease. These patients consulted late in the course of their disease, presenting with Grade 2 (36.4%) to Grade 3 (63.3%) venous hypertension, and severe stenosis (>75%) on venogram. Venography showed the brachiocephalic vein to be the most common area involved (81.82%). Statistical analysis showed that only the residual lumen post venoplasty significantly influenced the primary patency rate (p value = .006).

ConclusionThis observation is supportive to the recommendation that a primary stent insertion is indicated for significant recoil (>30%). The grade of venous hypertension, location and stenosis severity, balloon size used for venoplasty, were not statistically proven to significantly affect the immediate resolution of arm swelling and patency after 6 months. The safety profile of the procedure is acceptable with no perioperative morbidity or mortality noted. The primary patency rate of 68% at 6 months in our institution is at par NKF-KDOQI standards.

Poster Presentation


P03-04Movement of intravascular catheters in a simulated hemodialysis environmentDr. Benito Purugganan Jr1, Joy Gali1, Dr. Ricardo Jose Quintos1


IntroductionThis experimental study was the first of the many studies that will explore the possibility of the movement of the catheter as the cause for the development of central venous occlusive disease. No literature has yet published the type of intravascular movement of catheters during dialysis. This experimental study explored and described the phenomenon of catheter movement in a simulated hemodialysis environment.

ObjectivesThe study documented the changes of catheter movement (in mm) in relation to different flow rates using the four (4) different catheters during the 1st, 2nd, 3rd, 4th and 5th minute of the experiment. It also described of the movement of catheter during simulated dialysis using the different flow rates. It also determined if there is significant difference in the change of movement of catheter per catheter and if there is a significant relationship in the flow rate and change of catheter movement.

MethodsThe four catheters were subjected to different flow rates, starting at 100 ml/ min up to 440ml/min. The treatment per catheter was five minutes and the displacement or movement of the catheter per blood flow rate was recorded. The recording was reviewed to document and tabulate the displacement.

ConclusionThere indeed displacement or movement of catheter in a simulated dialysis environment. Displacement of catheter becomes constant at a certain period. Displacement between the tunneled catheter and non – tunneled catheter is significantly different. Displacement of catheter is highly related to the flow rate.

Keywords: Catheters, Catheters – Indwelling, Movement, MVascular Access Device,

P03-05Profile of hemodialysis patients with arteriovenous fistula presenting with venous hypertension at the National Kidney and Transplant InstituteDr. Benito Purugganan Jr1, Eduardo Aro Jr.1, Dr. Ricardo Jose Quintos1


BackgroundVenous hypertension secondary to central vein stenosis or occlusion is a complication of an arteriovenous fistula affecting the quality of an already miserable life of a chronic kidney disease patient. This commonly occurs after cannulation of major thoracic veins.

ObjectiveTo determine and describe the profile of hemodialysis patients with arteriovenous fistula presenting with venous hypertension at the National Kidney and Transplant Institute and to determine the significant factors related to its occurrence.

MethodsThe profiles of end stage renal disease patients on hemodialysis with arteriovenous fistula presenting with peripheral venous hypertension who consulted at the outpatient vascular clinic, emergency room, vascular laboratory and in-patient referrals were collected and tabulated. The charts and records of the patients at the medical records were reviewed.

ResultsA total of 45 ESRD patients presented with venous hypertension at the National Kidney and Transplant Institute from January 1, 2011 to July 30, 2013. All patients presented with arm edema. The most common location of catheterization was the internal jugular vein. Total duration (for both single catheterization and multiple catheterizations) of catheters for 16 patients was all more than 1 month before these were removed. Of the 42 patients who underwent venogram, the most common site of both occlusion and stenosis was the brachiocephalic vein.

ConclusionsA larger number of study population or at least 30 patients with complete data will be needed to be able to make an inference/generalization, with level of significance between risk factors and the occurrence of venous hypertension secondary to central vein occlusion or stenosis.

P03-06Long Term Monitoring of Arteriovenous Graft for Hemodialysis by Radionuclid Methods for Early Detection of Graft InfectionPetr Bachleda1, Petr Utíkal1, Jana Janečková1, Monika Váchalová1

1LF UP Olomouc, Cz, Olomouc, Czech Republic

Background and ObjectivesThe use o arteriovenous graft (AVG) for hemodialysis (HDL) is connected with two main complications – AVG thrombosis and AVG infection. AVG monitoring for stenosis is performed by ultrasound or by MRA. Early detection of AVG infection is still complicated. Radionuclide methods are emerging as a promising tool to detect infection of AVG. The aim of our study was to evaluate the options and benefits of PET/CT and labeled leukocytes scintigraphy (LLS) in early detection of AVG infection.

MethodsBetween 1/2009-12/2014 were 80 AVG inserted in 65 patients. During the 70 weeks since the insertion of AVG patients were monitored by protocol - clinical, bacteriological and laboratory. PET/CT and LLS were performed after 10, 30, 50 and 70 weeks from the insertion of AVG.

ResultsFrom the group of 80 AVGs, the 70-week monitoring was closed only in 25 AVGs; 5 had to be excluded for non-compliance, in 38 patients there were repeated graft closures, in 2 patients we had to remove the prosthesis due to infection progresion and 11


patients died. PET/CT and LLS showed infection in 13 AVGs. All these patients were given antibiotic treatment according to microbiological findings. Clinical manifestations of developed infection occured in 3 AVGs, both grafts had to be removed. In 10 patients AVG infection was treated successfully and access to HD rescued.

ConclusionsEvaluation with PET/CT and LLS seems to be sensitive for the detection of early AVG infection with poor or no clinical signs. For practical use, it is necessary to specify the frequency and timing of radionuclide controls. We estimate that 20, 40 and 70 weeks from the insertion of AVG is the best timing for radionuclid control.

P03-07Comprehensive comparison of the performance of autogenous brachial-basilic transposition arteriovenous fistula (BBTAVF) and prosthetic forearm loop arteriovenous graft (AVG) in a multi-ethnic hemodialysis Asian population Koy Min Chue1, Dr Kyi Zin Thant1, Dr Hai Dong Luo1, Dr Yu Hang Rodney Soh2, Associate Professor Pei Ho1

1National University Health System, Singapore, Singapore, 2Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

AimMaintaining a working vascular access is a major problem facing patients on dialysis. For patients who have exhausted cephalic vein arteriovenous fistulas (AVF) options, controversy exists on whether brachial-basilic AVF with transposition (BBTAVF) or a forearm arteriovenous graft (AVG) should be the next vascular access of choice. This study compared the clinical outcomes of these two modalities.

MethodsA retrospective study of 122 Asian multi-ethnic patients who underwent either a BBTAVF (81) or a forearm AVG (41) procedure in a tertiary referral centre. Maturation rate, maturation time, and intervention rates were analyzed. Functional primary, secondary and overall patency rates were evaluated using the Kaplan-Meier analysis.

ResultsThe maturation rate of AVGs was higher than BBTAVFs though not reaching a statistical significance. The maturation time for BBTAVFs was significantly longer than AVGs. There was also a longer deliberation time before surgeons abandon a failing BBTAVF compared to an AVG. Both functional primary and secondary patency rates were significantly higher in the BBTAVF group at 1-year follow-up: 73.2% vs 34.1% (p<0.001) and 71.8% vs 54.3% (p=0.022) respectively. AVGs also required more interventions to maintain patency. When maturation rate were considered, the overall patency of AVGs were initially superior to the BBTAVFs in the first 25 weeks post-creation, then became inferior afterwards.

ConclusionBBTAVFs had superior primary and functional patency, and required lesser salvage interventions than forearm AVG. The forearm AVG might have a role in patients who require early vascular access due to complications from central venous catheters or with limited life expectancy.

P03-08Feasibility of Basilic Vein Transposition AVF after side to side Brachiocephalic AVFJungkee Chung1, prof inmok jung1

1Boramae Hospital Seoul National Unversity Medical College, Seoul, South Korea

Background/ IntroductionBasilic Vein Transposition AVF(BVT AVF) was considered 3rd optional procedure and its efficiency was well accepted in spite of high operative morbidity.

ObjectivesUpper arm brachio-cephalic AVF(B-C AVF) was 2ndary optional procedure and sometimes by using perforating branches side to side (S-S) B-C AVF would be made to maintain high basilic vein fistula flow. Under the background of S-S B-C AVF, later BVT AVF could be more easily performed and better results were expected.

Materials and MethodsWe made BVT AVF 16 cases since 2002 and previous S-S BC AVF group (SS group) and other procedures (such as S-E B-C AVF or GraftAVF) group (OT group) were separated and clinical parameters were compared to evaluate the advantage of side to side anastomosis.

Results6 cases of SS group and 9 cases of OT group were compared as below (SS group/OT group) i) age distributions (years) were 61.1±10.7/63.0+12.0 ii) M:F ratio were 5:2/7:2 iii) Intervals between previous operations and BVT AVF (months) were 51.2±13.3/47.6±12.4 vi) Diameters of basilic vein(mm) were 4.3±0.5/3.9±0.4 (p>0.05) v) Complications such as hematoma cases were 2/2 vi) Maturation periods (wks) were 4.7±1.8/4.6±1.2 vii) 1 year primary & secondary patency rates were 100%,100%/88.9%,88.9% and 3years P& S PR were 87%, 87%/78.8%,88.9% (p>0.05)

Conclusions i) Both groups had nodifference in age, sex, complications, maturation periods and waiting periods. ii) In SS group preop basilic vein diameters were slightly enlarged (p>0.05) and 1,3 year patency rates were slightly better but not significant (p>0.05) So during 2ndary procedures, side to side brachio-cephalic AVF would be more recommendable expecting better results in BVT AVF procedures.

Poster Presentation


P03-09Percutaneous transluminal angioplasty in the treatment of stenosis of arteriovenous fistulae for hemodialysisIgab Krisna Wibawa1, MD Hilman Ibrahim1


BackgroundThrombosis following stenosis of arteriovenous fistulae resulting in the loss of vascular access for hemodialysis is an important complication in patients with chronic renal failure. Percutaneous transluminal angioplasty is being used more frequently in the treatment of stenosis aiming at increasing the patency of arteriovenous fistulae.

Case ReportReporting a case,man 65 years old,who has undergone rutine hemodialysis since 7 month ago. A month later,the patient underwent left radiocephlic fistulae operation and the fistulae has been used for the least 5 month. Two week before admission,patient complain swollen at the left hand. The angiography resulted as direct puncture at the left cephalic vein with stenosis present > 70%, 3 cm proximal to the anastomosis. Angioplasty was performed with HP balloon catheter size 50 x 80. The balloon was inflated with 8 atm pressure for 2 minutes. Stenotic lesion recoil > 50 % was profounded.

DiscussionIn recent years, several studies have demonstrated that angioplasty is efficacious with some advantages compared to the conventional surgical treatment such as a shorter time needed to perform the procedure and shorter hospitalization, less discomfort for the patient, and lower infection rates. Complications of angioplasty have been reported in about 2 to 16% of cases, with the most common being immediate venous rupture during the procedure, the formation of pseudoaneurysms, acute thrombosis and periprocedural bacteremia. In this study, 2 complications (9%) occurred: 1 venous rupture which was successfully treated by surgery and 1 case of acute thrombosis with loss of the fistula three days after angioplasty.

ConclusionPercutaneous transluminal angioplasty is an efficacious method for the correction of stenosis of arteriovenous fistulae for hemodialysis, prolonging the patency of the fistula and enabling new interventions

P03-10Management of giant venous aneurysms of arteriovenous fistula in hemodialysis patients [serial case]Romzi Karim1, PhD Akhmadu Muradi1


ObjectiveAn aneurysm draining vein formation may occur because of repeating puncture that can weaken the wall and it can became complication. This study shows the efficacy and results of giant

venous aneurysm reconstruction that was developed for relieving the patients from pain and other complication.

MethodsEleven patients with giant venous aneurysm of the AVF underwent surgical procedure at our hospital from August 2015 to May 2016. The diagnoses were made by physical examination and Color Doppler Ultrasonography. The aneurysm was repair under local anesthesia.

ResultsThere were 6 male and 5 female patients ranging in age from 33 to 66 years with a mean age of 48,73 ±9,81. Plication of the aneurysmal was performed in 6 patients,and 1 patient was venoplasty to repair central vein stenosis. Five patients were resected and repair by end to end anastomosis. There were no vascular complications during the follow up period. All patients are relieved from pain, distanded mass effect, and dyspnea.

ConclusionsSurgical reconstruction of the arteriovenous fistula aneurysm can be safely and effective in controlling venous dilatation and achieving patency. We have 2 modality that used to repair giant venous aneurysm, there are plication and resection anastomosis with or without graft.

P03-11Impacts of Arteriovenous Hemodialysis Shunt Location and Type in Patients having coronary Artery Bypass Graft with In Situ Left Internal Thoracic ArteryYoungjin Han1

1Division Of Vascular Surgery, Department Of Surgery, Asan Medical Center, University Of Ulsan College Of Medicine, Seoul, South Korea

BackgroundThe coronary steal in having coronary artery bypass graft (CABG) with in situ internal thoracic artery (ITA) and ipsilateral upper extremity arteriovenous (AV) hemodialysis shunt has been reported in some cases. But the long-term clinical effect in this phenomenon is not clear.

ObjectiveThe aim of this study was to determine the impact of upper extremity AV hemodialysis shunt location and type in patients having CABG with in situ ITA.

MethodsBetween January 2001 and December 2014, 111 patients received upper extremity AV hemodialysis shunt creation after CABG using in situ TIA were analyzed retrospectively in this study. All patients underwent CABG using in situ left ITA (LITA) to revascularize the left anterior descending artery (LAD). 93 patients (84%, ipsilateral group) underwent AV shunt on left upper extremity and 18 patients (16%, contralateral group) on right were compared in the clinical characteristics and outcomes. The primary end point was defined the adverse cardiac events.


ResultsThe mean interval periods of AV hemodialysis shunt creation after CABG were 34months. After AV shunt creation, the mean follow-up periods were 39 months. Kaplan-Meier analysis showed that the two groups had no significant difference in the primary end point (P = 0.257) and the overall survival (P = 0.167) during follow-up. In multivariate logistic regression analysis, previous cerebrovascular disease (harzard ratio, 2.686 [95% CI, 1.16 to 6.16], P = 0.020) and AV shunt using the prosthetics graft (harzard ratio, 2.921 [95% CI, 1.24 to 6.87], P = 0.014) were the risk factors of adverse cardiac events.

ConclusionThe ipsilateral AV hemodialysis shunt creation is not associated with the adverse cardiac events in patients having CABG with in situ LITA during follow-up. But AV shunt using the prosthetics graft can increase the risk of late cardiac adverse events.

P03-126 Weeks Maturity Rate of Arteriovenous Fistula and the Affecting FactorWahyu Wardhana, MD Dedy Pratama1Vascular Indonesia, Central Jakarta, Indonesia

IntroductionGuideline of KDOQI defines as the “rule of 6s” for the criteria of maturity of the avshunt. The components assessed are venous diameter (6 mm), flow rate of the draining vein (600 mL / min), and draining vein distance from the skin (less than 6 mm). Multi-center study conducted by the National Institutes of Health (NIH) reported the numbers fail mature and can not be cannulated from avshunt reached 62%.

Objective To determine the outcome of the arteriovenous fistula (AVF) created in our centre and the other hospital in Jakarta, Indonesia. Mainly to study asses 6 weeks maturity rate of AVF. And the affecting factor.

MethodologyProspective observational study of all patients who underwent AVF creation at Ciptomangunkusumo hospital and the other hospital in jakarta form march 2015 to may 2015, Assesment of patient, clinical and ultrasound done at pre op, 4 weeks, 6 weeks and 8 weeks. At 6 weeks assesment for maturity Data on patients demographic, pre morbid disease, operation procedure were analyzed.

ResultsResult was found that the rate of fistula maturation av 6 weeks was 69%. Maturity av fistula based on three criteria KDOQI is 50.77%. Maturity av fistula 6 weeks did not differ between men and women. To create the av fistula in the elbow area, preoperative brachial artery diameter of less than 3 mm 75% have a tendency not to be mature. While in the wrist area of the radial artery diameter less than 2.5 mm have a tendency to not mature 41.4%. In this study found no association between comorbid age, sex, blood pressure, smoking habits and weight at maturity av fistula 6 weeks.

Conclusion6 Maturity av fistula 6 weeks comorbidities not related to age, sex, blood pressure, smoking habits and weight.

P03-13Comparison of 4 weeks and 8 weeks AV Fistulae MaturationMuhammad Fauzi, Raden Suhartono1Cipto Mangunkusumo Hospital Indonesia, Central Jakarta, Indonesia

Chronic kidney disease (CKD) is the decreasing of kidney function more than 3 months before diagnosis. The problem of vascular access of hemodialysis still becomes morbidity factor and treatment causing of stage V CKD patients. Couple studies showed that artery-vena fistulae (AV Fistulae) decreased morbidity and mortality of CKD patients. After AV Fistulae creation, it needs time for maturating so that it has adequate for vascular access hemodialysis. The time needed is about 4 to 8 weeks. KDOQI guideline defined as “rule of 6 s”, vena diameter 6 mm, flow rate 600 mL/min, and vena distance to skin 6 mm, of maturity criteria.

This study aims to assess AV Fistulae maturity of 4 and 8 weeks, and the comparison of AV Fistulae maturity of 4 and 8 weeks. Design of this study is prospective observational of all patient who were undergone AV Fistulae creation at Cipto Mangunkusumo hospital from March to June 2015. Patients were assessed using USG Doppler before operation, 4 weeks, and 8 weeks.

Result showed that maturity of 4 and 8 weeks AV Fistulae was 27.69% and 58.46% respectively. There was no different maturity of 4 and 8 week AV Fistulae.

P03-14Correlation Tip Position of Catheter Double Lumen with Hemodialysis Continuity and Comfort of Long Term CDL UsingOky Noviandry Nasir, Dedy Pratama1Cipto Mangunkusumo Hospital, Central Jakarta, IndonesiaHemodialysis is the most common procedure of renal replacement in patients with stage 5 chronic renal failure, vascular access complications and morbidity as a result of access is a major cause of hospitalization. In 1989 to the present position of the tip of double lumen catheter is still no uniformity. The core of this difference is of interest to patient safety and the desire for optimal performance in terms of catheters for hemodialysis access adequate. The study design was a prospective cross-sectional study of patients with renal failure undergoing hemodialysis using tunneling CDL. This research is a correlative analytic, looking for a correlation between the position of the tunneling tip CDL smoothly or not smooth hose pull quick CDL and force of blood when hemodialysis.

The results obtained CAJ thorax X-ray positioning more comfortable for patients compared to the SVC. Statistical test shows that there is a significant relationship between Ro Thorax with comfort (p <0.05). Position tip at SVC have blood flow <300 mL. whereas in patients with tip position in the CAJ have blood flow> 300 mL. Statistical tests showed no significant association between ro thorax with blood flow (p> 0.05).

Poster Presentation


P03-15Vascular Access Failure with Vertebral Subclavian Steal due to Subclavian Artery Stenosis and Myocardial Ischemia in a Hemodialysis Patient with a Left Internal Thoracic Artery Coronary Bypass GraftYuichi Ito1, Dr. Akihito Tanaka2, Dr. Takeshi Hattori3

1Nagoya Ekisaikai Hospital, Nagoya, Japan, 2Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan, 3Kyoto Katsura Hospital, Kyoto, Japan

Background and ObjectiveThe cause of subclavian steal syndrome are subclavian artery stenosis or arteriovenous hemodialysis fistula. Inadequate retrograde blood flow of vertebral subclavian steal can lead vascular access failure and myocardial ischemia in hemodialysis patients with left internal thoracic artery (LITA) coronary artery bypass Graft (CABG).

MethodsWe report on a 76-year-old chronic hemodialyzed female with end-stage renal disease (ESRD) who underwent CABG surgery using LITA previously. She had vascular access failure due to reduction of arterial flow without venous problem. The result of the myocardial scintigram revealed myocardial ischemia. Coronary angiography was performed to detect the cause of vascular access failure and myocardial ischemia.

ResultsAngiographic left subclavian stenosis was defined as 90% stenosis and 50mmHg pressure difference across the lesion. Angiography revealed slow and low flow to LITA and laminar flow of left vertebral artery (VA) on origin. Magnetic Resonance Angiography (MRA) revealed bilateral intracranial VA. The diagnosis of vertebral subclavian steal syndrome was made. There are no neurological symptoms associated with the vertebral subclavian steal.

The cause of vascular access failure was inadequate retrograde flow of vertebral subclavian steal due to left subclavian stenosis and maintaining blood flow to LITA. However, the flow of LITA was reduced, therefore inadequate flow of LITA caused myocardial ischemia. Percutaneous stenting of the left subclavian artery via left brachial artery was performed successfully. After stenting, angiography revealed adequate flow of LITA and left subclavian artery, and antegrade flow of left VA.

ConclusionThis is the first case that the subclavian artery stenosis caused vascular access failure and myocardial ischemia in spite of the presence of subclavian steal in hemodialyzed patients with CABG surgery. Percutaneous stenting for stenosis is very effective to improve subclavian steal, myocardial ischemia, and vascular access failure in hemodialyzed patients with CABG surgery using LITA.

P03-16Vascular access surgery for elderly hemodialysis patientsJinichi Iwase1, Dr Hirohisa Yoshitomi1

1Narita Memorial Hospital, Toyohashi, Japan

ObjectivesThe purpose of this study is to assess the outcome of surgically created vascular access and clarify what factors affect the vascular access conduits patency in the elderly.

MethodsA retrospective study was made of patients with end stage renal disease required hemodialysis from 2011 to 2014 at our vascular access referral institutes. All vascular access surgeries were performed in patients forearm with autologous vessels（(AVF) or prosthetic grafts(AVG) when inadequate for AVF. Among the elderly patients (aged ≥80 years old), patients with conduit failure within 1 year after surgery were allocated to group A (9 AVFs and 3 AVGs) and patients with conduit kept functioning over 1 year were allocated to group B (21 AVFs and 1 AVG). Elderly patients demographics such as gender, maturation time, diabetes mellitus (DM), and intervention were statistically analyzed between group A and B.

ResultsOf 238 patients who had vascular access surgery, 34 elderly patients and 103 non-elderly patients (aged <80 years old) could be followed up. The primary patency rate at 2 years in the elderly and non-elderly patients were 25% vs 45% (p= .003). The secondary patency rates at 2 years were 44% vs 67% (P= .017). Significant difference were not found regarding gender (6 males and 3 femal in group A, 10 males and 10 females in group B, p= 0.83), maturation time (33.5 days vs 41 days, p= 0.71), DM (42% vs 37%, p=0.23), and intervention (42% vs 45%, p=0.83).

ConclusionsThis study revealed surgically created vascular access conduits in the elderly have significant lower patency rate compared with the non-elderly. In the elderly, intervention had little correlation in maintaining patency due to poor vessel quality. The number were limited and randomized controlled study will be needed to confirm this results.

P03-17Hemodialysis associated carpal tunnel syndrome; single center experienceJae Young Park1, Dr Chang Hyun Yoo1

1Busan Vascular Clinic, Busan, South Korea

Background and objectivesCarpal tunnel syndrome (CTS) is more common in hemodialysis (HD) patients than in the general population. Vascular surgeons often meet HD-associated CTS during regular access surveillance.

MethodsFrom November 2011 to March 2016, total 63 patients who were undergone CTS surgery were included. Patients’ characteristics and clinical responses were reviewed with medical records.


ResultsTotal 73 carpal tunnel surgeries were performed for 63 patients in our vascular center. Median age was 61.0 years, and there were more female patients (36/63, 57.0%) than male (27/63, 43.0%). Median HD period was 8 years. Hand paresthesia was shown ipsilaterally with arteriovenous fistula in 47 patients (47/63, 74.6%), contralaterlly in 6 patients (6/63, 9.5%), and bilaterally in 10 patients (10/63, 15.9%), Median follow-up period was 6 month. Hand paresthesia was disappeared within 2 weeks in most cases (65/73, 89.0%) after CTS surgery. In 5 cases (5/73, 6.8%), paresthesia was slowly improved and disappeared in 3 months. But, in 3 patients (3/73, 4.2%), there was no clinical response after CTS surgery. And 1 of these 3 patients, steal syndrome was diagnosed and hand paresthesia was improved after arteriovenous fistula ligation. There was no significant postoperative complication.

ConclusionIn our experience, HD-associated CTS can be improved with simple CTS surgery without significant complication. Vascular surgeons should consider CTS surgery for HD-associated CTS during regular HD access surveillance.

P03-18Fabrication of Artificial Arteriovenous Fistula and its Flow Field and Shear Stress Analysis using u-PIV TechnologySun Cheol Park1, PhD Jinkee Lee2, MD, PhD Seung-Nam Kim1

1The Catholic University Of Korea, Uijeongbu-si, South Korea, 2Sungkyunkwan University, Suwon-si, South Korea

IntroductionRadio-cephalic arteriovenous fistula (RC-AVF) is an operation performed to achieve vascular access for hemodialysis. Although it is a very reliable and well-known method, RC-AVF still has high rates of early failure depending on the vessel condition.

ObjectivesThe blood shear stress around the anastomosis site and the vascular access failure caused by thrombosis secondary to stenosis formation, as well as vascular access re-occlusion after percutaneous interventions contributes to failures.

Materials and MethodsWe fabricate in-vitro 3D RC-AVF using poly (dimethylsiloxane) (PDMS) and 3D printing technology to understand this mechanism and predict AVF failure. The micro-particle image velocimetry (μ-PIV) considering the cardiac pulse cycle is used to measure the velocity field within the artificial blood vessel.

ResultsThe results are confirmed by a numerical simulation. Accordingly, the in-vitro AVF model agrees well with the simulations.

ConclusionsThis research would provide the future possibility of using the proposed method to reduce in-vivo AVF failure for various conditions in each patient.

Keywords: Arteriovenous fistula (AVF); Hemodynamics; Micro-particle image velocimetry (μ-PIV); 3D printing technology; Wall shear stress (WSS)

P03-19The unusual causes of central venous stenosis in patients with arteriovenous accessDr. Kittisak Thanu1, Dr. Tanop Srisuwan1,2, Kittipan Rerkasem1,3

1NCD Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, 2Interventional radiology unit, Department of Radiology Faculty of medicine, Chiang Mai University, Chiang Mai, Thailand, 3NCD Center of Excellence, Research Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand

BackgroundCentral venous stenosis(CVS) was a common problem in hemodialysis dependent patients. Hemodialysis catheter insertion was believed the major causes of CVS. However, without history of hemodialysis catheter insertion, some patients were still developed CVS. That raise the questions on the causes of CVS in patients without history of central venous catheter insertion.

ObjectivesTo evaluate the causes of CVS in patients without a history of previous catheter insertion

MethodsWe retrospectively review patients in our hospital. We collected data from computed tomographic venography (CTV) result between January 2010-December 2012. Patients who was performed CTV due to CVS were include in our study. Clinical picture, history of hemodialysis catheter placement and CTV findings were recorded and analyzed. This study was supported by Health Systems Research Institute of Thailand

Results76 patients was enrolled in this study and we distributed CVS by side to study the effect of catheter insertion. In 152 sides of central vein were assessed by taking into account the presence of the history of central vein catheter insertion. Patients with history of central vein catheter insertion had 6.93 times higher chance to develop CVS than those without such history (p <0.0001). 22 CVS (14.5%) was occurred in patients without history of hemodialysis catheter insertion (in that side) previously. External compression by aortic branch or aortic dissection was found in 10 patients.

ConclusionMajor cause of CVS was still associated with the history of hemodialysis catheter insertion. However, CVS can occur in patients who did not have a history of catheter placement and one of common cause is due to the external compression of aortic branches.

Poster Presentation


P03-20Nutritional Status among End Stage Renal Disease Patients with arteriovenous access at Maharaj Nakorn Chiang Mai Hospital, ThailandDr. Jukkrit Wungrath1, Ms. Orapin Pongtam1,2, Ms. Paweena Thongkham1,2, Ms. Waranporn Na Chiangmai1, Ms. Nipaporn Pinmars1, Kittipan Rerkasem1,2

1NCD Center of Excellence, Research Institute of Health Science, Chiang Mai University, Chiang Mai, Thailand, 2NCD Center & Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

BackgroundDiet plays a critical role in the care of patients with renal failure. A well-planned diet can replace lost protein and ensure efficient utilization of ingested proteins through provision of adequate calories.

ObjectiveTo investigate nutrition status among end stage renal disease patients with hemodialysis in Maharaj Nakorn Chiangmai Hospital.

MethodThe researcher collected patient’s biochemical data from medical record of hemodialysis unit during November 2014 to January 2015. The instruments used in the research was Modified from Bhumibol Adulyadej Hospital Nutrition Triage, which is the established method in Thailand. This study was supported by the Health Systems Research Institute, Thailand.

Results120 random subjects had body mass index (BMI) less than 18.5 kg/ m2, 18.5≥ BMI < 24.99 kg/ m2 and BMI ≥ 25 kg/ m2 percentage of 16.27, 58.14 and 25.59, respectively. Systolic and diastolic blood pressure before dialysis was 133.80 ± 27.42/70.50 ± 12.75 mmHg, blood urea nitrogen and serum creatinine before dialysis was 49.28 ± 27.28 mg/dl and 7.26 ± 3.00 mg/dl, respectively, serum albumin 4.00 ± 0.50 mg/dl potassium 4.56 ± 0.87 mEq/l phosphorus 3.99 ± 1.89 mg/dl, Dietary energy and protein intake was 19.55 ± 6.75 kcal/kg/day and 0.82 ± 0.60 g/kg/day, respectively. The percentage of mild, moderate and severe malnutrition was 70.67, 24.89 and 4.44 respectively.

ConclusionHemodialysis patients had a risk of malnutrition, a multidisciplinary team approach to the nutrition care planning and monitoring nutrition status of patients.

P03-21Short-term results of vascular access surgery for hemodialysis in patients older than 70 yearsYoung-nam Roh1

1Korean Society For Vascular Surgery, Goyang, South Korea

Background/IntroductionIn elderly patients, creating a successful arteriovenous fistula is challenging because of their comorbidities and the presence of age-associated changes in vascular biology.

ObjectivesWe aimed to investigate the results of vascular access formation and the risk factors associated with early dialysis suitability failure in patients older than 70 years old.

Materials and MethodVascular access creation procedures that were performed in elderly patients (≥70 years old) at a tertiary medical center by single surgeon between March 2012 and November 2015 were retrospectively reviewed. “Early dialysis suitability failure” was defined as an access that cannot be used successfully for dialysis by the third month following its creation despite radiological or surgical intervention.

ResultsDuring the study period, 53 patients had 58 new accesses. There were 29 autogenous accesses (4 forearm, 25 upper arm) and 29 prosthetic accesses (24 forearm, 5 upper arm). 23 patients (40%) needed central venous catheter for urgent hemodialysis, and 22 patients (38%) needed convalescent hospital. According to ECOG performance status classification, 25 patients (43%) were grade 0~2 and 33 (57%) patients were grade 3~4. The maturation rate of all patients was 80% (46/58), and immediate occlusion rate happened in 4 (7%) patients. In risk factor analysis for early dialysis suitability failure, the presence of peripheral vascular disease is independent risk factor (p=0.013).

ConclusionsThe 70 years and older patients who need vascular access surgery have poor prognosis and it reinforces the need of careful selection and evaluation prior referral. In these patients, the need of artificial graft was high, and the existence of peripheral vascular disease was independent risk factor for early dialysis suitability failure.

P03-22Primary Patency Rates of Arteriovenous Fistula for Haemodialysis: A Retrospective AnalysisCharley Simanjuntak1, Dr. Dedy Pratama2, Dr. Aria Kekalih3

1Department Of Surgery Cipto Mangunkusumo Hospital Indonesia, Jakarta, Indonesia, 2Vascular and endovascular surgery division, Cipto Mangunkusumo hospital, Jakarta, Indonesia, 3Community health department, Cipto Mangunkusumo hospital, Jakarta, Indonesia

Background and objectivesThe success of haemodialysis relies on the success of the vascular access, whether achieved with an arteriovenous fistula (AVF), an arteriovenous graft (AVG), or a central venous catether (CVC). Among other access options, arteriovenous fistula is the preferred long-term haeemodialysis vascular access due to longer patency and low complication rate. However, AVF maturation failure rates are high, ranging from 43 to 63%. Cipto Mangunkusumo Hospital, the largest tertiary referral hospital in Indonesia, lacks data on AVF patency rates. This study is aimed to determine the primary patency rates of AVF in Cipto Mangunkusumo Hospital.

MethodsA single-centre retrospective study was performed in all patients who had primary arteriovenous fistulas created at Cipto Mangunkusumo Hospital during the period between January 2011 and December 2013.


ResultsOf 269 patients (mean age 53.1 ± 13.9), 190 (70.6%) patients underwent brachiocephalic fistula creation, 71 (26.4%) patients underwent radiocephalic fistula creation, and 7 (2.6%) patients underwent other fistula types creation during the two-year study period. The first year patency rate was 71.4%.

ConclusionsIn this setting, the rate of AVF creation for end-stage renal disease patients meets the standard of the target goals set forward by the National Kidney Foundation published updated Dialysis Outcomes Quality Initiative (NKF/DOQI) Guidelines. Our study suggested that venous diameter was significantly correlated with primary patency rates of AVF. Other factors were not associated with primary patency.

P04-01Early experience of endovenous laser ablation with single radial 1470-nm diode laser for primary varicose veinsHitoshi Endo1, Dr. Kazumi Nakamura1, Dr. Takaya Murayama1

1Kannai clinic, Yokohama, Japan

Background/IntroductionEndovenous laser ablation (EVLA) using the 980nm diode laser and a bare- tip fiber has been covered by Japanese National Health system since 2011.Various laser fibers and radiofrequency ablation (RFA) had reported.

ObjectivesTo assess the results of the treatment with a single radial 1470-nm diode laser for the primary varicose vein, we investigate the early experience of endovenous laser ablation (EVLA) with a single radial 1470-nm diode laser.

Materials and MethodsFrom January to June 2016, about 100 patients who underwent EVLA with a single radial 1470-nm diode laser, ENDOTHERMELASER™ 1470(LSO Medical) for primary varicose veins were studied. We assess the short-term results (clinical examination, venous occlusion rate, EHIT and complications) of EVLA in our clinic. In all patients, laser fiber was inserted into saphenous vein by the percutaneous puncture method. Laser energy was administered at 10W of power with constant pullback of the laser fiber from 2cm distal SFJ and SPJ under the tumescent local anesthesia.

Results All treated veins were occluded and major complications such as deep vein thrombosis and skin burns were not seen.

ConclusionsEVLA using a single radial 1470-nm laser is an efficient and safe treatment for primary varicose vein.

P04-02Selection criteria of endovenous ablation and stripping and its performing rate in our hospitalTakahiro Imai1

1Department Of Vascular Surgery Nishinokyo Hospital, Nara, Japan

Background and objectivesIn 2011 Endovenous ablation for varicose vein was covered by national insurance and after that endovenous ablation are becoming increasingly popular in Japan. We started Endovenous ablation treatment using ELVeS laser 980nm in 2013 and we changed standard method to Radiofrequency Ablation using “ClosureFast™ “ and stab avulsion in 2014. The ratio of Endovenous ablation for varicose veins gradually increases. In 2015, Stripping was 16.8% and ablation was 83.2%.

MethodsEndovenous ablation is a minimally invasive treatment and suitable for day surgery, but not applicable to all cases. We examined the factors affecting selection of operative method in our hospital.

ResultAccording to the package insert provided with the ELVeS Laser device, blood vessel diameter must be less than 20mm. [Superficial varicose veins] Endovenous ablation is chosen, because we can secure distance between fiber and the skin surface by giving TLA. For young woman, we make a difficult choice considering a risk of pigmentation. [Growth of saphenofemoral junction tributaries] Endovenous Ablation is usually chosen. When the tributaries are not presumed to be completely occluded according to their locations on ultrasonography, stripping is chosen. [Patients on oral anticoagulants and antiplatelet drug] We perform Endovenous ablation with less bleeding during surgery. [Highly meandering blood vessel] Endovenous ablation is chosen because the guidewire is more likely to pass through the vein than stripper. [Varicose veins complicated by thrombophlebitis] Stripping was chosen before, now Endovenous ablation is mostly chosen. [Recurrent case] We decide method considering the last operative method. [Operation invasion] In stripping, the surgical wound is small and the day surgery is possible, therefore operative method is not judged based on the patient wishes to have the day surgery or their cosmetic aspects.

ConclusionsHere we report examination results of the factors affecting selection of operative method.

P04-03Improvements of deep vein reflux following radiofrequency ablation for saphenous vein incompetenceIn Mok Jung1, Dr. Suh Min Kim2, Dr. Jung Kee Chung1

1SMG-SNU Boramae Medical Center, Seoul, South Korea, 2Dongguk University Hospital, Ilsan, Gyeongkee --Do, South Korea

ObjectivesThe aim of this study was to describe the changes of deep vein reflux after radiofrequency ablation for great saphenous vein incompetence.

Poster Presentation


Materials and MethodsThe data on 139 limbs which were treated with radiofrequency ablation for great saphenous vein incompetence were prospectively collected and reviewed.

ResultsDeep vein reflux was present in 43 of 139 limbs (30.9%). There were no significant differences in the rate of successful closure, the incidence of procedure-related complications, and the improvements of symptoms and quality of life between the limbs with or without deep vein reflux. With a mean follow-up of 5.9 months, the peak reflux velocity and duration of reflux were improved in all limbs with deep vein reflux and it was completely corrected in 13 limbs (30.2%) after radiofrequency ablation.

ConclusionsThe presence of deep vein reflux does not affect the treatment outcomes of radiofrequency ablation for great saphenous vein incompetence and is improved in all patients. Deep vein reflux is not a barrier to performing radiofrequency ablation.

P04-04Examination of the treatment for surgical varicose veins - Stab Avulsion vs. Varices AblationKazumi Nakamura1, Takaya Murayama1, Hitoshi Endoh1

1Kannnai Medical Clinic, Yokohama, Japan

IntroductionFDA approved Diomed 810nm system (Angio Dynamics, Queensbury, NY, USA) as a brand-new treatment for saphenous type varicose veins in 2002. In next 10years, we put some devices into practical use, for example 980nm and 1470nm Endovenous Laser Ablation (EVLA) and Radio Frequency Ablation (RFA). Now in Japan these have been recognized as major method of treatment for truncal varicose veins.

On the other hand, what should we do for superficial varicose veins? I guess many surgeons do phlebectomy like Stab Avulsion, and other surgeons do sclerotherapy or nothing. Which way to take depends on surgeon. In our clinic, we have done“Varices Ablation”for superficial varicose veins since September 2014. It is laser ablation using bare-tip fiber under the tumescent local anesthesia.

Materials and MethodsFirst, you puncture superficial varicose veins with a long type indwelling needle, like barbecue. And then, you replace bare-tip fiber with the indwelling needle under local anesthesia. After that, you can do laser ablation. This time, we use the 810nm or 1470nm diode laser (Endovenous Laser Treatment DT-810 / Venocure 1470nm, DIOTECH, Korea). We named this method as“Varices Ablation”.

ResultsWe had more than 10 patients with this method, and no patients had complication such as skin burn or sensory nerve disorder. Their superficial varicose veins had been occluded satisfyingly in 1 month.

ConclusionsWe have results that this new approach for superficial varicose veins is going well.

P04-05Relationship between the right heart function and varicose veins of the lower limbs in patients undergoing hemodialysisYasuhiro Ozeki1, Ph.D. Kazuo Tsuyuki1, Ph.D. Shinich Watanabe2, Yuki Ishida1, M.D., Ph.D. Kunio Ebine1, M.D., Ph.D. Susumu Tamura1, M.D. Toshifumi Murase1, M.D., Ph.D. Kaoru Sugi1, M.D., Ph.D. Kenta Kumagai1, M.D., Ph.D. Itaru Yokouchi1, M.D., Ph.D. Kenji Yamazaki1, M.D. Satoru Toi1

1Odawara Cardiovascular Hospital, Odawara, Japan, 2Kanagawa Institute of Technology, Atsugi, Japan

Background and ObjectivesWe previously reported that the incidence of varicose veins of the lower limbs in patients undergoing hemodialysis was significantly lower than in healthy adults. As the reason, we indicated that the blood flow velocity of lower limb veins in hemodialysis patients was significantly higher than in healthy adults. In our previous study, pulse Doppler waveforms of the common femoral vein were pulsatile and synchronized with the heart rate in dialysis patients, whereas they were constant in healthy adults, suggesting that the right ventricle is involved in an increase in the velocity of lower limb venous blood flow and beats in the former. In this study, we examined the relationship between the right heart function in dialysis patients or healthy adults.

MethodsThe subjects consisted of 8 patients (hemodialysis group), undergoing dialysis, with sinus rhythm and a left ventricular ejection fraction (LVEF) of ≥50% in the absence of valvular disease, such as tricuspid valve insufficiency, and 8 healthy adults (non-hemodialysis group). The right heart function was measured, and the results were compared using the Mann-Whitney U-test. As parameters of the right heart function, we used the tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) on echocardiography.

ResultsThe mean TAPSE (mean_standard deviation)(paired test) in the hemodialysis and non-hemodialysis groups was 23.5_5.5 and 19.0_2.9 mm, respectively. The mean FAC was 38.9_6.5 and 30.4_5.6%, respectively. Both values were significantly higher in the former (p<0.001).

ConclusionsThe right heart function of the hemodialysis patients was significantly higher than in the healthy adults. It may have advanced through continuous internal shunt venous return loading, increasing the lower limb venous blood flow velocity and contributing to a decrease in the incidence of lower limb varices.


P04-06Comparison of Radiofrequency Ablation and 1470nm Endovenous Laser Ablation for Treating Varicose VeinsYuka Sakurai1, Dr Hiroyuki Abe2, Dr Shota Kita1, Dr Hirotoshi Suzuki1, Dr Daijyun Ro1, Dr Kiyoshi Chiba1, Dr Hirokuni Ono1, Dr Makoto Ono1, Dr Yousuke Kitanaka1, Dr Masahide Chikada1, Dr Hiroshi Nishimaki1, Dr Takeshi Miyairi1

1St.marianna University School Of Medicine, Kawasaki, Japan, 2Keiai clinic, Yokohama, JapanBackgroundEndovenous thermal ablation is one of the most accepted treatment options for varicose veins

ObjectiveTo compare the efficacy of radiofrequency ablation (RFA) and 1470 nm endovenous laser ablation (EVLA) in the treatment of patients with varicose veins.

MethodsWe shared with the crowd RFA to the varicose vein and EVLA from July, 2015 to May, 2016. The age before the way, the sex ratio, CEAP classification, cauterization time during an operation, the cauterization distance and a sharp pain after an operation sell at a sacrifice price subcutaneously, and relational item is endothermal heat-induced thrombosis (EHIT).

ResultsA total of 57 patients (76 limbs) and 32 patients (41 limbs) were included in the RFA and EVLA groups, respectively. No significant differences were observed in the age, sex, and CEAP classification between the two groups. Occlusion rates at one month were 100% in both groups. Ablation time was significantly shorter in the RFA group. No significant difference was observed in the incidence of EHIT between the groups. No significant difference was observed in the incidence of postoperative pain and nerve injury between the groups, but the incidence of bruising was significantly higher in the RFA group. No procedure-related major complications (DVT, pulmonary embolism, or skin burns) occurred in this study.

ConclusionWe suggest that RFA and EVLA have similar success rates and are better suited for the short-term treatment of patients with varicose veins. Results of longer-term clinical studies are awaited for further evidence.

P05-01Computed Tomography angiography alone is inadequate for evaluation of the great saphenous vein conduit for infrainguinal bypassCassandra Hidajat1, Dr Hansraj Bookun1, Dr Daniel Nour1, Ms Kai Leong1

1The Royal Melbourne Hospital, Melbourne Health, Parkville, Australia

BackgroundThe great saphenous vein (GSV) is a common conduit for infrainguinal bypass, with vein mapping performed to assess its suitability.

ObjectiveOur aim was to determine whether GSV measurements from computed tomography angiography (CTA) of lower limbs closely correlated with duplex ultrasonography (US), and if it could be used as primary mode of assessment.

MethodsPatients from January 2010 to Feburary 2016, who underwent both CTA of their lower limbs and US vein-mapping within 3 months were included. Measurements were taken at 5 levels: proximal thigh, mid-thigh, knee, calf and ankle. CTA measurements were taken both anteroposteriorly (AP) and laterally. US measurements were perpendicular to skin surface. Pearson correlation coefficient was calculated at each level.

Results 472 CTA points from 25 patients were collected (82 proximal thigh, 140 mid-thigh, 75 knee, 129 calf, 46 ankle). 282 US points were obtained (65 proximal thigh, 72 mid-thigh, 50 knee, 67 calf, 28 ankle). Overall correlation was moderately positive(r=0.48 laterally; 0.46 AP). At both proximal and mid-thigh, moderate positive association was found (rproximal thigh=0.57 laterally and 0.50 AP; rmid-thigh= 0.58 laterally; 0.47 AP). Very strong positive correlation was found at the knee AP(r=0.84) and laterally(r=0.81). Strong positive correlation was found at the calf laterally(r=0.68) and a moderately positive one AP(r=0.41). Very strong positive correlation was found at the ankle laterally(r=0.92) and a strong positive one AP(r=0.63).

ConclusionCTA measurements are moderately positively correlated with US. Lateral CTA measurements provide better correlation than AP. CTA measurements at knee and ankle levels showed the strongest correlation. Pre-operative US vein mapping is necessary to provide more accurate assessment of GSV suitability as a bypass conduit.

P05-02Transdermal Nitroglycerin for Peripheral Arterial DiseaseKoksal Donmez1, Dr. Bortecin Eygi1, Dr. Sahin Iscan1, Dr. Habib Cakir1, Dr. Ismail Yurekli1, Dr. Nihan Karakas Yesilkaya1, Dr. Mert Kestelli1


IntroductionLocal treatment of peripheral arterial disease should be considered as an alternative to oral treatment in elder patients.

ObjectivesWe aimed to present a case who is treated with transdermal nitroglycerin for peripheral arterial disease.

MethodA eighty-three year old male patient was followed-up by our outpatient clinic for peripheral arterial disease. He had a femoropopliteal bypass grafting operation for his right lower extremity before and graft was already occluded. Measuring blood flow volume at ankle level was shown as an important method for

Poster Presentation


this disease. Blood flow was measured as 15 ml/min at posterior tibial artery. Transdermal 5 mg nitroglycerin patch/daily was initiated. Patch was localized at dorsum of foot.

ResultsPatient was controlled a week later. Pulses of popliteal, dorsalis pedis artery and posterior tibial artery very still absent. Blood flow was measured as 100 ml/min at posterior tibial artery (almost five times of normal flow). Varicosities appeared at leg and they were similar to ones in arteriovenous fistula.

Patient’s vertigo did not regress with this therapy. Trimetazidine was stopped and Cilostazol (2x100 mg/day) was initiated. Her vertigo and symptoms regressed gradually after this revised therapy.

DiscussionWe believe that local treatment of peripheral arterial disease may be a strong alternative of common oral treatment, in especially elder patients.

P05-03Our surgical strategy in a smoker patient with hypertension, diabetes and hyperlipidemia having right femoral artery stenosis Kazim Ergunes1, Dr Erturk Karaagac1, Dr Ismail Yurekli1, Dr Ihsan Peker1, Dr Koksal Donmez1, Dr Tayfun Goktogan1, Prof Levent Yilik1, Prof Ali Gurbuz1


ObjectivesPeripheral arterial disease is a worldwide problem that has significant impact on quality of life and can also lead to mortality. We presented a case with right femoral artery stenosis.

MethodsA 65-year old man was hospitalized in our clinic in April , 2016. He had hypertension, diabetes and hyperlipidemia. The right lower extremity distal pulses were non-palpable. The digital substraction angiography showed stenosis of right superficial femoral artery stenosis.

ResultsOperation was performed with general anesthesia. The right femoro-popliteal bypass was performed with reversed right great saphenous vein graft. The right tibialis anterior and posterior pulses recovered postoperatively. The patient was discharged 7 days after operation with antiplatelet and antiaggregant drugs.

ConclusionsAutogenous great saphenous vein is the conduit of choice for infra-inguinal bypass.

P05-04Acute arterial thromboembolism of left lower extremity in a patient with hypertension and diabetes receiving warfarin due to atrial fibrillationKazim Ergunes1, Dr Hasan Iner1, Dr Erturk Karaagac1, Dr Ismail Yurekli1, Dr Sahin Iscan1, Dr Yuksel Besir1, Dr Bortecin Eygi1, Prof Ali Gurbuz1


BackgroundAcute ischemia resulting from embolic or thrombotic arterial occlusion is associated with morbidity and mortality. We presented a patient with hypertension and diabetes receiving warfarin due to atrial fibrillation.

MethodA 78-year old woman was referred to the emergency department of our hospital in December, 2015. He had pain and coldness in the left lower extremity. Electrocardiography showed atrial fibrillation. Pulses of the popliteal, tibialis anterior and tibialis posterior arteries were nonpalpable. The hand-held Doppler found no audible signals in the the popliteal, tibialis anterior and tibialis posterior arteries. The Doppler ultrasonography showed occlusion in the popliteal, tibialis anterior and tibialis posterior arteries.

ResultsThromboembolectomy was performed to the femoral, popliteal, tibialis anterior and tibialis posterior arteries. Abundant thrombus was thrown out from femoral, popliteal, tibialis anterior and tibialis posterior arteries. Pulses of these arteries recovered postoperatively. Low-molecular-weight heparin was given postoperatively. The patient was discharged five days after operation with warfarin treatment.

ConclusionsAcute arterial thromboembolism is important complication in patients with hypertension, diabetes and atrial fibrillation. The thromboembolectomy is effective and safe treatment method.

P05-05Hybrid surgical and endovascular intervention to management of complex iliofemoral diseaseJun Hayashi1, Dr Ushida Tetsuro1, Dr Azumi Hamasaki1, Dr Yoshinori Kuroda1, Dr Atsushi Yamashita1, Dr Ken Nakamura1, Dr Daisuke Watanabe1, Dr Shingo Nakai1, Dr Kimihiro Kobayashi1, Dr Seigo Gomi1, Professor Mitsuaki Sadahiro1

1Second department of surgery, Yamagata University, Yamagata City, Japan

BackgroundEndovascular therapy (EVT) has been shown to be a comparable therapeutic option to standard surgical intervention for iliac occlusive disease. However, it is not suitable for common femoral artery (CFA) in the groin. Therefore, the surgical strategy for complex iliofemoral disease is controversial. Herein, we present 2 cases of successful hybrid procedure consisted of an endovascular iliac repair combined with a surgical common femoral endarterectomy.


Case reportsA 75-year-old male presented with left calf claudication. An ankle-brachial index (ABI) was 0.46 (left). Computed tomographic (CT) scan revealed a long segment of total occlusion from the left external iliac artery (EIA) to the middle superficial femoral artery (SFA). One stage hybrid therapy was performed by cardiologist and vascular surgeon at hybrid operating theater. At first, the anterior aspect of CFA was incised longitudinally and endarterectomy was performed. After that, 8 mm diameter stent was implanted from EIA to proximal portion of CFA. Subsequent angiography confirmed patent EIA and deep femoral artery. Six months after the hybrid procedure, EVT was performed for SFA. Postoperative course was uneventful. The patient is asymptomatic with an improved ankle-brachial index of 1.02. Another patient was a 71-year-old male with complains left calf claudication. On CT, he had total occlusion from the left EIA to the distal CFA. He underwent hybrid procedure consisted of an endovascular EIA repair and a surgical CFA endarterectomy. His postoperative course was entirely uneventful. Left ABI also improved from 0.60 to 1.09.

ConclusionsThe surgical results of hybrid therapy were excellent. This attractive procedure was expected to be effective, safe and less-invasive alternative to conventional approach for patients with complex iliofemoral disease.

P05-06Comparison of mid-term results of femoro-popliteal bypass with no cuff-combined PTFE grafts and cuff-combined PTFE graftsRyo Kanamoto1, Dr. Shinichi Hiromatsu1, Dr. Kanako Sakurai1, Dr. Shinichi Imai1, Dr. Shohei Yoshida1, Dr. Mau Amako1, Dr. Hiroyuki Otsuka1, Dr. Satoru Tobinaga1, Dr. Seiji Onitsuka1, Prof. Hiroyuki Tanaka1

1Department Surgery Of Kurume University, Kurume City, Japan

ObjectiveThe purpose of this study is to compare mid-term results between no cuff-combined PTFE grafts (Advanta VS) and cuff-combined PTFE grafts (Flared-end Advanta VXT and Distaflow) in above-the-knee femoro-popliteal bypass (ATKFPB).

MethodsWe retrospectively reviewed 67 patients who underwent 79 ATKFPB between April 2003 and March 2014. No cuff-combined PTFE grafts were used for 37 limbs (29 men and 2 women, mean age 73.1 years) ATKFPB. The cuff-combined PTFE grafts were used for 42 limbs (24 men and 12 women, mean age 73.8years) ATKFPB. We compared the mid-term clinical outcomes between 2 groups.

ResultsThere were no significantly differences between the two groups regarding to characteristics demography. The primary patency rates were not significantly different between no cuff-combined PTFE grafts and cuff combined PTFE grafts at 5 years after surgery (87.5% vs. 78.6%). The secondary patency rates were also no significantly different between two groups at 5 years after surgery (97.2% vs. 83.3%). There were no statistically significant differences between the two groups. However no cuff-combined PTFE grafts tended to show higher patency rate compared to cuff combined PTFE graft.

DiscussionCuff–combined PTFE grafts had been developed to prevent intimal hyperplasia on the anastomosis site due to wall shear stress. Some previous report described higher patency rates in cuff-combined PTFE grafts than no cuff-combined PTFE grafts. However, it is still controvertial. In addition, recent development of heparin-bonding PTFE grafts was expected to imporove lomg term patency in ATKFPB.

ConclusionOn the basis of our outcomes, cuff-combined PTFE grafts did not contributed to higher patency rates as compared to no cuff-combined PTFE grafts. In the future, PTFE grafts in ATKFPB will be replaced by heparin-bonding PTFE grafts.

P05-07Inconsistent Result of Target Lesions between Completion Angiography and Duplex Follow-up Study Prof Taeseung Lee1, Daehwan Kim1


PurposePercutaneous transluminal angioplasty (PTA) is widely being used for femoropopliteal artery (FP) lesions and immediate technical success is usually defined as a residual stenosis of less than 30% on final angiography. However, final angiography may not truly reflect the real outcome of the procedure since it is mostly performed at a time point before elastic recoil occurs. Therefore we compared the results of final angiography with duplex ultrasound (DUS) performed within 48 hours after the procedure to assess whether final angiography accurately reflects the technical success of PTA.

MethodsThe data of 152 atherosclerotic lesions (116 patients) of the FP between March 2013 and February 2016 were retrospectively reviewed. All lesions were treated primarily with balloon angioplasty with or without selective spot stenting. Final angiography was mainly performed between 5 – 15 min after PTA. As DUS follow-up, moderate stenosis was defined as >2.5 peak systolic velocity ration or occlusion on B-mode.

ResultsFP total occlusion in 51 limbs (33%). The length of the target vessel was 15±8.2cm. Technical success was achieved in 149 of 152 limbs on final angiography. On follow-up DUS, 7 limbs showed moderate residual stenosis and 7 cases showed occlusion. Seven thrombotic occlusions occurred from conventional PTA. Among the 7 cases of stenosis, two cases occurred adjacent to the edges of the stents. And the other cases set in conventional PTA.

ConclusionsOur results suggest that there is a discrepancy between final angiography and follow-up DUS in up to 9% of FP PTA cases. The timing of final angiography does not allow for accurate evaluation of elastic recoil or thromboembolic lesion by local thrombus after PTA. Therefore the definition of technical success rate as measured by final angiography should be used with caution since it may underestimate the “true” procedural technical success.

Poster Presentation


P05-08Prevalence and Risk Factors for the Peripheral Neuropathy in Patients with Peripheral Arterial Occlusive DiseaseSe Young Kim1, Dr Ho Kyeong Hwang1, Dr Kyung Bok Lee1, Dr Sol Lee1, Dr Ji Woong Jung1, Dr Yu Jin Kwon1, Dr Dong Hui Cho1, Dr Sang Su Park1, Dr Jin Yoon1, Dr Yong Seog Jang1


Background/IntrodectionPeripheral neuropathy (PN) is known as a major contributor of the worsening of ischemic symptoms and the foot ulceration in patients with peripheral arterial occlusive disease (PAOD). However, there are few studies reporting the prevalence and risk factors for PN in PAOD.

ObjectivesThis study aimed to evaluate these issues for PN and to establish the importance of screening as additional treatment target for PN in PAOD.

Materials and MethodsA total of 52 limbs with PAOD were enrolled from January 2011 to December 2012. PN was divided into radiculopathy, ischemic PN (IPN), and diabetic PN (DPN), based on electromyographic findings. We investigated the prevalence of overall PN and subtypes of PN and then analyzed the risk factors.

ResultsThe prevalence of overall PN in PAOD was 43 of 52 limbs (82.7%). In terms of subtypes of PN, the prevalence rate of radiculopathy and IPN was 30.8% and 23.1%, respectively. DPN showed in 22 limbs (73.3%) among 30 diabetic limbs. There was no significant correlation between each type of PN and ischemic symptoms. Our analysis showed that coronary artery disease (CAD) was a significant risk factor (P=0.01) for IPN, however, did not identify any significant risk factors for DPN.

ConclusionThis present study indicated that most patients with PAOD had PN and CAD was a risk factor for IPN. In particular, PAOD with diabetes represented a higher prevalence for DPN. Our study suggests that PN should be evaluated and considered as another treatment target in patients with PAOD.

P05-09The Open Retrograde Approach as an Alternative for Failed Percutaneous Access for Difficult Below the Knee Chronic Total Occlusions - A Case SeriesSaravana Kumar1

1Dr Saravana Kumar, Kuala Lumpur General Hospital, Jalan Pahang, Malaysia

AbstractRetrograde puncture via patent pedal vessels can be attempted in failed antegrade approach for infrapopliteal long chronic total occlusion. However in cases where the pedal vessels are unable to be visualized via duplex ultrasonography or fluoroscopy an open

approach offers an additional option to a vascular surgeon for successful recanalization. Our case report highlights 3 cases where successful hybrid open retrograde approach was able to achieve recanalization of long chronic total occlusion.

Presentation of casesThe three cases in our series presented with critical limb ischaemia. All three cases had undergone duplex imaging of the affected arterial system. As the antegrade approach to cross the lesion failed a retrograde approach was attempted in all 3 cases however the usual modality of retrograde puncture via the use of ultrasound or fluoroscopy failed we proceeded with a cutdown or open approach.

DiscussionRetrograde approach usually offers a better chance of successfully crossing a chronic total occlusion lesion. However puncturing a distal vessel successfully and traversing a catheter or guidewire across proves to be a challenge. An open approach offers an additional pathway for puncturing the target vessel when duplex imaging or fluoroscopic guidance fails.

ConclusionOpen approach is usually attempted as a last resort by many endovascular surgeons. However procedural time, contrast and radiation usage could have been cut short in cases where the distal target vessels pose a technical challenge for approach via a percutaneous method.

P05-10Endovascular Treatment of extensive Aortoiliac Occlusive Lesions: Single-Center ExperiencesHaengJin Ohe1, Dr. Hyun Kyu KIM2, Dr. Mi Hyeong KIM2, Dr. Kang Woong JUN2, Dr. Jeong Kye HWANG2, Dr. Jang Yong KIM2, Dr. Sun Cheol PARK2, Dr. Ji Il KIM2, Dr. Yong Sung WON2, Dr. Sang Seob YUN2, Dr. In Sung MOON2

1Department of Surgery, Division of Vascular and Transplant Surgery, Seoul Paik Hospital, Inje University, Seoul , South Korea, 2Department of Surgery, Division of Vascular and Transplant Surgery, The Catholic University of Korea College of Medicine, Seoul, South Korea

Background and objectives Endovascular treatment of aortoiliac occlusive disease is challenging and still on the debate. Authors reviewed our experience of endovascular management for aortoiliac occlusive disease(AIOD), focusing on short-term outcomes.

Methods Retrospective study was done from prospectively registered data for the patient with aortoiliac occlusive disease(AIOD) treated by endovascular means in vascular and transplantation surgery in Seoul St. Mary’s hospital from May 2012 to May 2016. Patient’s clinical characteristics, procedure in details and post operative record were summarized.

Results Nine patients was enrolled. The mean age was 55.5 years (range, 43-67 years). The indication of the treatment was 6 acute attack on chronic AIODS, 1 chronic limb threatening Ischemia and 2 chronic short distance claudication. Thrombectomy was done in 6 cases : 5 open thrombectomy and 1 AngioJet thrombectomy. Stents was used in all cases including 1 covered stent. The median procedure


time was 251 minutes (range, 115-395 minutes). The 30-day post procedural mortality and morbidity rate was 0%. Three patients had compartment syndrome and fasciotomy. Two of 3 patients had a skin graft. With a mean follow-up of 574 days), 100% of reperfusion is valid.

Conclusions Endovascular treatment for AIOD showed the feasibility as alternative procedure for open surgical treatment. Long-term results and further graft improvements will define their role in the treatment of patients with aortoiliac occlusive disease.

P05-11Drug-coated balloon for femoropopliteal disease: early clinical experience in real worldKW Yoon1, YJ Park1, SH Heo1, DI Kim1, YS Do2, SH Choi3, YW Kim1

1Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, 2Intervention Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, 3Intervention Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

PurposeTo assess the clinical outcomes of Drug-coated balloon (DCB) for femoropopliteal (FP) disease

MethodsThis retrospective, single-center study analyzed 31 patients (median age of 75 years old, 28 male) with 40 FP lesions in 34 limbs, who underwent angioplasty with 62 DCBs (IN.PACT Admiral, Medtronic) for symptomatic FP disease (Rutherford classification 2-5) from April 2013 to January 2016. The primary endpoint was primary patency, defined as freedom from restenosis (PSVR>2.4) or clinically driven (CD)-target lesion revascularization (TLR). The second-endpoint was 30-day or late freedom from procedure- or device-related death and target limb major amputation.

ResultsMedian cumulative lesion length and diameter stenosis was 90 mm (10-360) and 90% (70-100) including 17.5% of chronic total occlusion, respectively. 42.5% of lesions involved popliteal artery and 25% showed severe calcification. Provisional stent was used in 9 (22.5%) lesions of which major cause was post-ballooning dissection (n=7). Primary patency at 6 months and 12 months was 91.1% and 86.8%, respectively as Figure. The CD-TLR performed only in 2 patients during the follow-up (median 9.6 months, 1-35.5). There was no procedure- or device-related death and no major amputation.

ConclusionsDCB had a favorable safety and promising clinical outcomes for the treatment of patients with symptomatic FP disease.

P05-12Can postoperative ST-segment change and blood pressure variability predict short term mortality in patients following major vascular surgery?Dr. Aekapej Liwatthanakun A1, Associated professor Arintaya Phrommintikul2,3, Ms Orapin Pongtam3,4, Kittipan Rerkasem1,3,4

1Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 2Department of Internal Medicine, Faculty of Medicine, , Chiang Mai, Thailand, 3NCD Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 4NCD Center of Excellence, Research Institute of Health Sciences, Chiang Mai University, , Chiang Mai, Thailand

BackgroundPatients with peripheral arterial disease carried a very high risk of cardiovascular morbidity and mortality after operation. Therefore we tried to identify predictive factors for these event.

ObjectiveTo evaluate the association between the ST-segment abnormality, blood pressure variability, and short term mortality in patients who have undergone major vascular surgery.

Materials and MethodsA prospective cohort study of 71 patients underwent major vascular surgery between June 2011 and May 2013 at Maharaj Nakorn Chiang Mai Hospital. Blood pressure was recorded for the first week after surgery, as well as electrocardiograms at baseline for the first 4 postoperative days. The association between abnormality of ST-segment, blood pressure variability (BPV), and short-term mortality were analysed.

Results9 (13%) patients had ST-segment change and were identified as having postoperative myocardial ischemia. 18 (25%) patients had blood pressure variability the first week of post operation. The median follow-up was 11 months. 13 (18%) patients died during follow up. Postoperative ST-change was associated with a significant increased risk of short-term mortality (hazard ratio (HR) 24.74%, 95% confidence interval (95% CI) 6.23-98.27). BPV was also associated with short-term mortality (HR 4.65, 95%CI 1.31-16.49). Also the risk of stroke in patients with BPV was 20.6 times higher than those without BPV.

ConclusionST-change and blood pressure variability after major vascular surgery are associated with a significantly increased risk of short-term mortality.

Poster Presentation


P05-13The prevalence and risk factors of PAD in 893 HIV infected patientsAssociate Professor Romanee Chaiwarith1, Dr. Thananchai Kampee3, Dr. Parichat Salee1, Dr. Nontakan Nuntachit1, Dr. Khuanchai Supparatpinyo1, Ms. Orapin Pongtam2,3, Ms. Paweena Thongkham2,3, Dr. Patcharaphan Sugandhavesa2, Dr. Taweewat Supindham2, Dr Natthapol Kosashunhanan2, Kittipan Rerkasem2,3

1Division of Infectious Disease, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand, 2NCD Center for Excellence and Center for AIDS and STDs, Research Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand, 3NCD Center & Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

BackgroundHIV infected patients seems to be at high risk of cardiovascular disease (CVD). Peripheral arterial disease (PAD) has been a major problem in CVD because it is associated with myocardial infarction and stroke. Nevertheless the incidence of PAD is still unknown in HIV infected patients.

ObjectiveTo identify the prevalence and risk factors for PAD in HIV infected patients

MethodAuthors prospectively recruited HIV infected patients from our outpatient clinic at Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. Authors assessed ankle brachial index (ABI), cardiovascular index and carotid intimal medial thickness (CIMT). ABI less than 0.9 was considered PAD. This project was supported by National Research University Project, Chiang Mai University under the Office of the Higher Education Commission.

Result867 patients were recruited. The mean age is 42.84 years ± 0.33 (standard error of the mean). There were 459 males (51.4%). 39 patients had PAD. The prevalence is 4.37% (95% confidence interval (3.02-5.71). Female, higher education, history of arrthymia, diastolic pressure less than 80 mmHg and duration on antiretrovirus less than 1 year were associated with PAD.

ConclusionThe prevalence of PAD in HIV infected Thais was 4.37%. The risk factors appeared poor correlation with traditional risk factor of atherosclerosis, perhaps the pathology of vascular disease in HIV infected patients is mainly not atherosclerosis.

P05-14Risk of Peripheral Artery Disease among elders living with HIV, age and gender matched with non-HIV, as determined by Ankle Brachial Index Associated professor Kriengkrai Srithanaviboonchai1, Ms Wathee Sitthi1, Dr. Arunrat Tangmunkongvorakul1, Ms Chonlisa Chariyalertsak2, Kittipan Rerkasem1,3

1NCD Center of Excellence and Center for AIDS and STDs, RIHES, Chiang Mai University, Chiang Mai, Thailand, 2Chiang Mai Provinical Health Office, Chiang Mai, Thailand, 3NCD Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

IntroductionHighly active antiretroviral therapy (HARRT) has helped reduce death and increase life expectancy of PLHIV. Majority of PLHIV in Thailand will approach elderly age faster and at larger number than other developing countries due to severe AIDS epidemic in the past and better coverage of high quality HAART program. Elders living with HIV age faster and have higher chance to suffer from cardiovascular related conditions such as diabetes and hyperlipidemia. However, little is known about risk of PAD in HIV-infected elders compared to their un-infected counterparts.

MethodThis comparative survey study was conducted at 12 community hospitals in Chiang Mai, Northern Thailand in 2015. The 30 oldest HIV patients of each hospital were invited to participate in the study. The comparative group were HIV-negative or HIV status not-knowns who came for OPD cares at the days of the survey, matched to the recruited HIV patients by age and gender. The ABI of both sides of the body were measures using the automatic ABI measuring machine (VS-1500N; Fukuda Denshi, Japan). The lower of the two ABIs (left or right) was used to represent each person ABI. The ABI of ≤ 0.9 was considered abnormal and higher risk of PAD.

ResultThe number of participants (364), the median age (57 years old) and the proportion of female (57%) were the same for both groups. The prevalence of higher risk of PAD among elderly HIV patients was 4.95% (18/364) and among the comparison group was 6.87% (25/364). The difference was not statistically significance (p value = 0.27)

ConclusionIn our study, the prevalence of risk of PAD as measured by ABI were not different between the elders living with HIV and the HIV-negative out-patient age and gender matched. Further study is needed to confirmed this finding and gain more insight into the issue.


P05-15Predictive factors to determine post-operative mortality in patients with peripheral arterial diseaseRungrujee Kaweewan1, Dr. Saritphat Orrapin1, Ms Antika Wongthanee2, Kittipan Rerkasem1,2

1NCD Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 2NCD Center of Excellence, Reserach Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand

BackgroundMajor vascular surgery of peripheral arterial disease (PAD) is a high post-operative mortality procedure. Studies in predictive factors for post-operative mortality in Asian populations are few.

ObjectiveTo assess the predictive factors preoperatively determine mortality in patients undergoing vascular surgery.

Material and MethodsThe prospective study included patients with PAD who had major vascular surgery from December 2002 to December 2005 at Maharaj Nakorn Chiang Mai Hospital. Survival status and predictive factors of mortality were contemplated.

Results101 patients were included in the study. 53 patients died (62.3%) with 4.19 years of median survival time; 5 year survival was 47.28%. The predictive factors effecting mortality were hyponatremia (Hazard ratio (HR) 17.69; 95% confidence interval (CI) 2.02-154.91), respiratory distress sign (shortness of breath at rest) (HR 12.36, 95% CI 2.12-71.75), atrial fibrillation (HR 3.18, 95% CI 1.39-7.29), abnormal plasma potassium (HR 2.80, 95% CI 1.28-6.15), and preoperative hypertension (HR 0.5495% CI 0.30-0.98).

ConclusionSerum hyponatremia, shortness of breath, atrial fibrillation, abnormal plasma potassium level, and hypertension were the predictive factor for high mortality in patients with PAD.

P05-16Dietary Consumption in Patients with Peripheral Artery Disease in Maharaj Nakorn Chiang Mai HospitalMs. Orapin Pongtam1,2, Dr. Sakda Pruenglampoo2, Kittipan Rerkasem1,2

1NCD Center, Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, 2NCD Center of Excellence, Research Institute of Health Science, Chiang Mai University, Chiang Mai, Thailand

BackgroundNutrition is an important factor for healing in chronic foot ulcer. However such data is shortage in literature especially ischemic foot ulcer.

ObjectiveThis pilot study was aimed to assess the eating habits of patients with leg ischemia-peripheral arterial disease (PAD) in our hospital. MethodThis study included 30 consecutive patients in our OPD. Patients were interviewed using a Food Frequency Questionnaire (FFQ) for the last 30 days, and a 24 hours recall record. The data were analyzed and presented in percentage, mean, and standard deviation. This assessment included the frequency of food intake, ingredients, processed food, cooking method, and alcohol consumption. This study was supported by Health Systems Research Institute of Thailand

ResultsThis study included 30 patients, which were classified into 3 groups according to the severity of PAD, and consisted of 9 cases of mild PAD(Rutherford stage 0 ) (group 1), 9 cases of moderate PAD (Rutherford stage 1-3) (group 2), and 12 cases of severe PAD (Rutherford stage 4-6 ) (group 3). The baseline characteristic was not different between the three groups apart from the body mass index, waist circumference and exercise rate which was statistically significant lower in group 3 than the other two groups. Patients in group 3 consumed carbohydrates more frequently, but fat less frequently than other groups, There was no significant difference between the three groups in terms of the amount of trace elements. It is important to note that patients in group 2 cooked food by streaming, frying and stir, whereas patients in group 3 cooked their food by boiling, grilling and soup.

ConclusionPatients in group 3 who mainly needed high protein to heal the wound, but this group had low BMI and high level of carbohydrate taking. Better nutritional policy is needed in place.

P05-17Value of multimodal anesthesia in peripheral artery revascularization procedureOsanori Sogabe1, Dr Naoya Matsumoto1

1Mitoyo General Hospital, Kanonji, JapanTitle: Value of multimodal anesthesia in peripheral artery revascularization procedure

PurposeThe advantages of peripheral nerve block over general anesthesia include earlier postoperative recovery, lower morbidity, and a shorter hospital stay. In several reports on nerve block use in peripheral artery bypasses, patients required the maximum (and potentially toxic) doses of local anesthetics, which were administered without ultrasonography. Solutions of lidocaine 0.1% with epinephrine 1:100,000 are safely used in the treatment of varicose veins. The ultrasound-guided method is associated with a higher success rate and lower morbidity than previous nerve block techniques.

MethodFor peripheral artery bypasses, we performed ultrasound-guided blocks on the transversus abdominis plane and on the femoral and sciatic nerves. We also administered solutions of lidocaine 0.1% plus epinephrine 1:100,000 as infiltrative anesthetics. Patients received the minimum amount of dexmedetomidine required to maintain a -1 on the Richmond Agitation-Sedation Scale. They were neither premedicated nor required to restrict their fluid intake.

Poster Presentation


ResultsForty-nine peripheral artery revascularization procedure were performed; these include 7 lower limb artery and 13 femoropopliteal artery bypasses. There were no cardiovascular or respiratory complications and no postoperative declines in swallowing or motor function. There was no shift to general anesthesia, and only 9 of 49 patients intraoperatively needed dopamine (maximum 5ɤ). 5 patients were categorized as ASA III and 2 as ASA IV in the American Society of Anesthesiologists (ASA) Classification and the average Rutherford’s classification score was 5.6 in patients undergoing lower limb artery bypass.

ConclusionA combination of ultrasound-guided nerve blocks; local infiltration with lidocaine 0.1% plus epinephrine 1:100,000; and intravenous dexmedetomidine could provide successful peripheral artery revascularization, even in patients in poor condition. Furthermore, this less invasive method could result in fewer postoperative complications and less expensive peripheral artery bypasses.

P05-18Review of Transmetatarsal Amputations in the management of Peripheral Vascular DiseaseMing Ngan Aloysius Tan1, Dr 2hiwen Joseph Lo1, Dr Rui Ming Teo1, Mr Soon Hong Lee2

1NHG - TTSH, Singapore, Singapore, 2NTU - LKC School of Medicine, Singapore, Singapore

BackgroundDespite advancements in revascularisation techniques, amputation still plays a key role in the management of Peripheral Vascular Disease(PVD).

ObjectivesThe study objective was to evaluate transmetatarsal amputation(TMA) as a viable treatment option for PVD and identify risk factors associated with failure of treatment.

Materials and MethodsThe retrospective study was conducted in a large tertiary hospital, reviewing 147 patients with PVD who had undergone TMA between 2008 and 2014.

Results54 patients (36.7%) required a subsequent major amputation, and Type 2 Diabetes Mellitus was the only risk factor shown to be significantly associated (p value<0.05) with these patients. Patients who subsequently needed major amputations were also more likely to develop nosocomial infections during their stay, and have a higher re-admission rate within 30 days (p<0.05). Significantly, ischemic heart disease, end-stage renal failure, poor glycemic control, having previous amputations or the number of occluded crural vessels did not significantly affect the outcomes of patients.

ConclusionsTMA is a viable option for the treatment of PVD, but diabetic patients should be considered for upfront major amputation.

P05-19Development of the gene therapy with CRE decoy ODN to prevent vascular intimal hyperplasiaDaiki Uchida1, Dr Yukihiro Saito1, Prof Nobuyoshi Azuma1

1Asahikawa Medical University Vascular Surgery, Asahikawa, Japan

Objective Intimal hyperplasia (IH) is the main cause of vein graft stenosis or failure after bypass surgery. However, in the previous study derived from an animal model, no therapeutic targets for the treatment of IH have been identified. Our recent research using human vein graft samples have been reported that the inhibition of Cyclic adenosine monophosphate response-element (CRE) binding protein (CREB) activation is a key role for suppressing IH. We focused on decoy oligodeoxynucleotide (ODN) transfection as gene therapy strategy of IH.The goal of the present study is to identify whether the CRE decoy ODN had the therapeutic efficacy for suppressing IH.

Methods and ResultsWe designed and synthesized phosphorothioated CRE decoy ODN and checked binding capacity to CRE sequence of CREB cis-element. Transfer of the CRE decoy ODN to vascular smooth muscle cells (VSMCs) strongly repressed CRE activity and decreased proliferation and migration in vitro. Now we check the therapeutic efficacy of the decoy therapy on mouse model.

ConclusionsThe present result suggested that CRE decoy ODN provide an effective therapeutic approach to suppressing IH.

P05-20Local difference of skin perfusion pressure in lower extremityYoshiko Watanabe1, Dr Hisao Masaki1, Dr Taishi Tamura1, Dr Hiroki Takiuchi1, Dr Takahiko Yamasawa1, Dr Hiroshi Furukawa1, Dr Yasuhiro Yunoki1, Dr Atsushi Tabuchi1, Dr Kazuo Tanemoto1


Background and objectivesAs well as transcutaneous oxygen tension (tcPO2), skin perfusion pressure (SPP) is useful in the evaluation of limb ischemia. The SPP >30 or 40 mmHg is supposed to indicate adequate perfusion for wound healing, however, almost based on the experiments at dorsum of the feet. TcPO2 appears similar in any body area according to the previous reports, whereas SPP may differ. We investigated the local difference of SPP in the lower extremity.

MethodsWe measured SPP and tcPO2 among the healthy volunteers aged 20 or 21 years: at two points in the dorsum of 48 feet ([1] between first and second metatarsal heads, [2] between fourth and fifth metatarsal heads), and at two points in other 50 legs ([3] shin, [4] calf). Similarly, we also measured SPP using a thermostatic heating probe that heats up to 44（ as same as tcPO2 probes.

ResultsBoth SPP and tcPO2 values at shins and calves were lower than those values at dorsum of the feet (p <0.001, respectively). The


mean values of SPP measured using a plain probe were [1] 57.2 mmHg, [2] 51.1 mmHg, [3] 31.3 mmHg, and [4] 34.6 mmHg, and those of tcPO2 were [1] 68.8 mmHg, [2] 66.3 mmHg, [3] 54.1 mmHg, and [4] 45.5 mmHg. At the lower leg areas, SPP values measured using a plain probe were similarly low regardless of the tcPO2 values. When measured using a thermostatic probe, the SPP values increased with closing the gap from the tcPO2 values.

ConclusionsWhen evaluating the SKIN PERFUSION PRESSURE values, the characteristics of the measurement site might have to be considered. Local temperature can affect SPP measurements more at the lower leg than at dorsum of the foot. Careful examinations and total assessment should be required for assessment of limb ischemia.

P05-21Outcomes of Bio-absorbable stent for Below Knee Critical Limb Ischaemia Derek Ho, Dr Jemima Xue1Changi General Hospital, Singapore , Singapore

BackgroundStenting of infrapopliteal lesions are often limited by a relatively high restenosis rate and subsequent late in-stent thrombosis. The bioabsorbable stent is a novel development that provides initial scaffolding support, elutes anti-proliferative drugs to prevent vessel restenosis and reabsorbs subsequently to reduce risk of in stent thrombosis. It hopes to address issues with pre-existing stents and promises to be the next frontier in endovascular revascularisation.

AimsThe study aims to investigate the early outcomes, efficacy and safety of a bioabsorbable stent (BVS) in patients with below knee critical limb ischaemia.

MethodsA case series of 13 patients with median age 67 (range 46-89) who underwent stenting of below knee arterial diseases with Bioabsorbable Everolimus Eluting Bioresorbable Vascular Scaffold System developed by Abbott Vascular (Abbott, Illinois, USA). The primary outcomes measured were stent patency, target lesion revascularization (TLR) and limb salvage rates.

Results30 BVS were inserted for 14 below knee lesions. The median length of the lesions was 25mm (range10-70). Majority of patients has significant critical limb ischemia (Rutherford 5-6). Technical success was 100%. 6 months vessel patency, TLR and limb salvage rates were 75%, 8.3% and 91.7% respectively. There were no procedure related complications or deaths.

ConclusionsOur study shows that BVS for below knee diseases have fairly good early outcomes, is safe and technically feasible. Longer follow-up and more rigorous clinical trials for BVS are required to determine its clinical benefits over pre-existing stents.

P05-22Endovascular approach to elder patients (70 and older) treated with femoral embolectomy for acute arterial obstruction and essentials for using fractioned heparinAssist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, Ufuk Yetkin1, Specialist Köksal Dönmez2, Assist. Prof. Osman Beton3, Prof. Dr. Öcal Berkan1

1Cumhuriyet University Medical Faculty ,Department of Cardiovascular Surgery, SİVAS, Turkey, 2Katip Celebi University Izmir Ataturk Training and Research Hospital, Izmir, Turkey, 3Cumhuriyet University, Dept. of Medical Faculty,Department of Cardiology, SİVAS, Turkey

ObjectiveIn acute leg ischemia,hemodynamic balance and status of organs may detorioriate in patients who lately admitted to hospital or treatment is delayed.In endovascular approach,thrombolytic agents are applied to obstructed vessels which are targeted angiographically.This method helps to create passage in smaller distal vessels but may cause to contrast nephropathy,thrombosis due to catheter and bleeding.Heparin may be preferred to prevent accumulation of secondary thrombus in patients if an acute embolectomy session is not possible.In addition, it may be preferred to prevent secondary embolic events after embolectomy or thrombectomy.

MethodForty-five patients, who were 70 years old or over admitted to our emergency department or out-patient clinic with acute femoral artery obstruction and were treated with emergent femoral embolectomy by the same cardiovascular surgery team of our Cardiovascular surgery department. Mean age of patients were 78.53±5.85. Thirty-one patients were male (68.9%) and fourteen were female (31.1%).

ResultsWe excluded endovascular interventions because our patient population was elder and had additional comorbidities(hypertension, diabetes mellitus etc.)which may easily deteriorate renal functions.Our stages of heparin use in and after conventional embolectomy were:common femoral artery was explored from appropriate incision and 100 IU/kg intravenous heparin was administered before femoral arteriotomy.After extraction of thrombus material, distal segments of artery were irrigated with heparinized physiologic saline solution.Heparin was administered intravenously after operation.Continuous infusion was preferred by perfusor with an ACT value of 220±20seconds.At fifth postoperative day, heparin infusion was stopped.Low molecular weight heparin was used with appropriate posology and combined with 5 mg oral warfarin.Both drugs were used together for 4 days.

ConclusionWe suggest conventional surgery in elder patients with acute arterial obstruction and require emergent femoral embolectomy.Also we recommend heparin at each stage of surgery because it has anti-inflammatory features by inhibiting cell adhesion molecules and providing protective effects on tissue reperfusion damage.We administered heparin intra and perioperative period.

Poster Presentation


P05-23Peripheral arterial disease, comorbidities and level of obstruction in elder patients (70 and older) treated with femoral embolectomy for acute arterial obstruction Assist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, Ufuk Yetkin1, Specialist Köksal Dönmez2, Assist. Prof. Osman Beton3, Prof. Dr. Öcal Berkan1

1Cumhuriyet University Medical Faculty,Department of Cardiovascular Surgery, SİVAS, Turkey, 2Katip Celebi University Izmir Ataturk Training and Research Hospital, Izmir, Turkey, 3Cumhuriyet University, Dept. of Medical Faculty,Department of Cardiology, SİVAS, Turkey

ObjectiveAcute atherosclerotic thrombus is the underlying cause of majority of patients with acute peripheral arterial obstruction and it’s caused by atherosclerotic changes in arterial structure of lower extremities.

MethodsBetween January2007 and December2015,forty-five patients,who were 70years old or over admitted to our emergency department or out-patient clinic with partial functional loss,coldness,pain and discoloration.After confirmation of acute femoral artery obstruction,all of these patients were treated with emergent femoral embolectomy by the same cardiovascular surgery team of our Cardiovascular surgery department.Mean age of patients were 78.53±5.85.Thirty-one patients were male(68.9%)and fourteen were female(31.1%).

ResultsTwenty-four(54,3%)patients had prior diagnosis and treatment for peripheral arterial disease.Male gender was significantly higher in this group(p: 0,025).When we consider the time passed before admitting to hospital,12 patients(50%)admitted to hospital after 48 hours or more(late term).Our series consists of elder patients and 44.4%(20 patients)had chronic obstructive pulmonary disease,51%(23 patients)had smoking habit,44.4%(20 patients)had diabetes and 15.6%had cerebrovascular event.Although 24 patients had peripheral arterial disease diagnosis,high incidence of risk factors in our series made us thought that real peripheral arterial disease rate with undiagnosed patients is much higher.Chronic obstructive pulmonary disease(p: 0,037),history of smoking habit(p: 0,001)and diagnosed peripheral arterial disease(p: 0,025)were significantly higher in male patients.Diabetes(p: 0,001)and atrial fibrillation(p: 0,020)were significantly higher in female patients.According to the site of occlusion,common femoral artery(37.7%,17 patients),superficial femoral artery(46,7%,21 patients)and both superficial and profound femoral arteries(15.6%,7 patients)were obstructed.

ConclusionMost common cause of acute arterial thrombosis is atherosclerosis obliterans.Fast-progressing thrombosis may have a similar clinic with embolic events but with lesser complaints.Many patients may not have any specific finding accept claudication.This is caused by creation of collateral vasculature while progression of atherosclerosis.Progression of ischemia is much slower and daily activities of these patients are not enough to cause ischemia in muscular tissue.This situation causes delays of hospital admission and may be responsible for limb-loss and life-threatening post-ischemic syndrome.

P06-01A Case of Superficial Femoral Artery Aneurysm detected with intermittent claudicationNorimasa Haijima1, Dr Ichiro Hayashi, Dr Hirofumi Kasahara1National Hospital Organization Saitama National Hospital, Wako-shi Suwa, Japan

We experienced one case of a rare superficial femoral artery aneurysm in peripheral aneurysms, we report it including some discussion from literatures.

The case is a 67 years old man. There is no medical history. He had intermittent claudication at 1km from one year ago. He had intermittent claudication at 300m for half a year from before and was introduced this hospital.It is aneurysms of 42mm in the distal superficial femoral artery by CT

The high-grade stenosis that there are aneurysms with the mural thrombosis in to a popliteal artery.We performed graft replacement for a superficial femoral artery aneurysmWe performed the superficial femoral artery - posterior tibial artery bypass operation using SVG graft for the arteriosclerosis obliterans that was lower than popliteal artery aneurysms.A postoperative course is good

P06-02Successful endovascular repair of a recurrent femoral artery pseudo-aneurysm using a coronary covered stentYukio Muromachi1, Shigeki Ito1, Masafumi Hashimoto1, Tadashi Amemiya1, Yasuyuki Hatano1, Michihiko Morisaki1, Hitoshi Ogino2

1Nishitokyo Chuo General Hospital, Nisitokyo-shi, Japan, 2Tokyo Medical University, Shinjuku-ku, Japan

We report on a case having a recurrent femoral artery (FA) pseudo-aneurysm treated successfully with a coronary stent covered with a great saphenous vein (GSV). The patient was a 74-year-old gentleman who had undergone a right femoro-popliteal artery bypass due to peripheral artery disease one year before. Six months after surgery, a pseudo-aneurysm developed on the proximal anastomosis site of femoro-popliteal bypass on the right common FA with complete occlusion of the prosthetic bypass graft. An open repair of the pseudo-aneurysm with direct aneurysmorrhaphy was performed. In another six months, the patient was again suffered from a recurrent pseudo-aneurysm on the same site. The patient and his family consistently refused its redo open repair, although the pseudo-aneurysm was gradually enlarged. It was also expected that its direct repair would be extremely difficult because of dense adhesion due to the several-times previous surgeries. Consequently, an endovascular repair using a coronary covered stent (TERUMO Ultimaster 3.5/38 mm) with GSV was attempted. We approached the right common FA through the left common FA. The GSV covered coronary stent was placed from the right common FA to the deep FA. The postoperative course was uneventful with remarkable reduction of the size of pseudo-aneurysm.

The redo open repairs for recurrent and refractory FA pseudo-aneurysms are considerably troublesome with some technical difficulties and potential risks of infection. Endovascular repairs


with covered stents would be useful alternative treatments. In particular, for the peripheral arteries with small diameters, percutaneous trans-catheter repairs with coronary covered stents would be good options with less-invasiveness.

P06-03The cyst evacuation with the removal of the cystic wall for Popliteal Adventitial Cystic DiseaseTakashi Shintani1, Hironobu Fujimura1, Takuma Iida2, Takashi Shibuya3

1Toyonaka Municipal Hospital, Toyonaka, Japan, 2Toyonaka Municipal Hospital, Toyonaka, Japan, 3Osaka University Graduate School of Medicine, Suita, Japan

IntroductionAdventitial Cystic Disease (ACD) is an uncommon non-atherosclerotic condition in which a cystic collection of mucinous material accumulates in the adventitial layer of the vessel. This cystic formation is predominantly located in the popliteal artery (85%). Some case reports have been published, but the management and operative procedure of ACD is still remains unclear.

CaseA 67-year-old woman presented with intermittent claudication in the left calf. The right and left ankle brachial pressure indexes (ABI) were 1.20 and 0.55, respectively. Duplex ultrasound scanning and computed tomography angiogram (CTA) and angiography were performed. From the above, we diagnosed ACD of the popliteal artery and performed cyst evacuation with the removal of the cystic wall through the posterior approach. Among the surgical findings, there was revealed the cystic enlargement on the dorsomedial aspect of the popliteal artery and compression of the artery lumen due to a cyst which subadventitially contained jelly-like material. Postoperatively, the left ABI improved to 1.23.

DiscussionThe etiology of ACD is still under debate. Trauma, ganglion, systemic disorder, embryonic development have been proposed. The management of ACD varies depending on the condition of the affected vessels. Cyst aspiration and Endovascular treatment are less invasive, but it is associated with a high rate of recurrence. Resection of the affected segment of the vessel and interposing a vein graft or prosthesis is promising, but it is more invasive and has the risk of graft occlusion. Removal of the cyst content (evacuation) while preserving the involved artery can be effective.

ConclusionWe performed the procedure with the cyst evacuation and cystic wall excision. The patient remained free of symptoms after the procedure, and postoperative CTA showed good patency. Long-term follow up is mandatory because of the potential for recurrence.

P06-04Non-traumatic brachial artery aneurysmShuhei Suzuki1, Dr Norihito Nakamura, Dr Kenji Aoki1Niigata Prefectural Central Hospital, Jyoetsu City, Japan

BackgroundUpper extremity artery aneurysms are uncommon. Most of them are pseudo-aneurysms and caused by trauma or iatrogenic injury. Non-traumatic cases are extremely rare and their clinical features are unclear.

MethodsWe experienced a case of brachial artery aneurysm of unknown cause.

ResultsCaseA 79-year-old woman noticed a pulsatile mass in the left arm. She had no history of trauma or medical treatment to the arm. Computed tomography showed a saccular aneurysm of 15 mm in diameter in the brachial artery. She underwent aneurysmectomy. The artery was segmentally resected and reconstructed with end-to-end anastomosis. Postoperative course was uneventful. Pathological examination revealed absence of arterial layers in the aneurysmal wall; the most compatible diagnosis was pseudo-aneurysm.

ConclusionsNon-traumatic pseudo-aneurysm of the brachial artery was successfully repaired. Surgical treatment is recommended because pseudo-aneurysm has a potential risk of rupture or thrombosis. Etiology, symptoms, imaging characteristics and surgical options including vascular reconstruction are reviewed and discussed.

P06-05A Case of Femoropopliteal Bypass and Transcatheter Artery Embolization for Ruptured Persistent Sciatic Artery AneurysmKoichi Tamai1, Dr. Kei Kazuno3, Dr. Yasushi Tashima2, Dr. Toshiyuki Kobinata1, Dr. Harunobu Matsumoto2

1Kasukabe Chuo General Hospital, Kasukabe , Japan, 2Jichi Medical University Saitama Medical center, Saitama, Japan, 3Itabashi chuo general hospital, Itabashi, Japan

BackgroundPersistent sciatic artery aneurysm is a rare congenital vascular anomaly. When the femoral artery is formed during early embryogenesis, the sciatic artery basically regresses. Most cases of the persistent sciatic artery can be detected by the symptoms of occlusion and aneurysm.

ObjectivesA 66-years old female presented with uncontrolled right buttock pain. She has a history of end-stage breast cancer, so her pain was considered by bone metastasis at first. According to CT image, a ruptured persistent sciatic artery aneurysm was located below her right gluteus maximus muscle. Her ABI was 0.73/1.07. Therefore she was transferred to our hospital for the surgery.

Poster Presentation


MaterialsCT showed right persistent sciatic artery aneurysm was an incomplete type. And the patient state was end-stage breast cancer. Thus femoropopliteal bypass and transcatheter embolization of right internal artery by using an Amplatzer Vascular Plug was performed because we intended to treat her less invasive.

ResultsHer postoperative course was uneventful and ABI has improved to 1.04/1.17. CT after surgery has showed sciatic artery was occluded and femoropopliteal bypass was patent. And her right buttock pain has resolved after surgery.

ConclusionsWe experienced a case of ruptured persistent sciatic artery aneurysm and successfully treated by femoropopliteal bypass and transcatheter embolization.

P06-06Ruptured aneurysm of the external iliac veinYong Sung Won1, Emeritus Professor Jang Sang Part1, Associate Professor Jang Yong Kim1, Assistant Professor Mihyeong Kim1, Associate Professor Sun Cheoll Park1

1The Catholic University Of Korea, Seoul, South Korea

Primary iliac venous aneurysm is an extremely rare vascular abnormality that is associated with the likelihood of rupture, embolism, and thrombosis. In this report, we describe the case of a ruptured aneurysm of the external iliac vein in a 63- year-old woman who was admitted to the emergency department and diagnosed by computed tomography.

Computed tomography indicated a 4 3 5-cm ruptured aneurysm in the right external iliac vein that was surrounded by hematoma in the right side of the pelvis. The aneurysm was successfully treated by tangential aneurysmectomy and lateral venorrhaphy.

P06-07A case of right inguinal pseudoaneurysm after the simultaneous endovascular aortic repair for the thoracic and abdominal aortic aneurysmsShinji Yamazoe1, Dr Yasuhito Sekimoto1, Dr Hirohisa Harada1, Dr Yohei Munetomo1, Dr Akira Baba1, Dr Yuko Kobashi1, Dr Takuji Mogami1


BackgroundPseudoaneurysm formation at the access site is one of the complications after endovascular aortic repair for aneurysms. The reported frequency of the access site complications after endovascular aortic repair is 4.4%. Although the major complication of the access site is known to be the femoral arterial trouble, we recently experienced an inguinal pseudoaneurysm that had arisen from the distal lumbar artery. Here we present the case that we could treat with the direct embolization by needle puncture.

CaseThe patient was an about-70-year-old woman. She underwent total aortic arch replacement for the dissecting thoracic aortic aneurysm in January 2014. After the operation, aneurysms of the descending aorta (60 mm in diameter) and the abdominal aorta (50 mm in diameter) remained. Then we performed simultaneous endovascular aortic repair for those aneurysms in December 2014. After the procedure, massive hematoma in the right inguinal area was observed. The hematoma was increasing in size and CT angiography revealed a pseudoaneurysm under inguinal ligament, which was then confirmed to be arisen from the distal lumbar arterial branch by angiography. The cause of the pseudoaneurysm was unknown but we supposed that muscle retractors used during the surgery had injured the small artery.

Because the size was increasing, we performed percutaneous embolization for this aneurysm by direct puncture. We punctured this aneurysm by a 21G-needle under ultrasound guidance, and confirmed the pseudoaneurysm and its origin artery by injecting contrast medium from the needle. We then performed embolization using 50% n-butyl-2-cyanoacrylate (NBCA), and the pseudoaneurysm was disappeared without any complication.

Conclusion We experienced an inguinal pseudoaneurysm from distal lumbar artery caused by open femoral access trouble for endovascular repair. Direct puncture embolization is safe, convenient, and effective treatment compared with catheter embolization especially for superficial pseudoaneurysms like this case.

P07-01Protective effects of remote pre- and postconditioning on ischemia-reperfusion induced hepatic injuryHyung Joon Ahn1, M.D. Min Su Park1, M.D. Sun Hyung Joo1

1Kyung Hee University, Seoul, South Korea

PurposeHepatic ischemia-reperfusion injury (IRI) is considered a major cause of hepatic damage in liver surgery. The aim of this study was to investigate the effect of the remote ischemic perconditioning method on hepatic IRI in a rat model.

MethodsSeventeen rats underwent hepatic IRI for 30 minutes followed by reperfusion, and were divided into three groups: group I, the only hepatic IRI (n=5); group II, the hepatic IRI with remote perconditioning (n=7); and group III, the hepatic IRI with remote postconditioning (n=5).

ResultsFor Bax/β-actin, mean values of the three groups (± SD) were 1.29 ± 0.26 (I), 0.89 ± 0.15 (II), and 1.02 ± 0.23 (III). The level of Bax/β-actin in group II was significantly lower than in group I (P <0.01). The cleaved Caspase-3/β-actin ratio for groups I, II, and III were 0.93 ± 0.22, 0.46 ± 0.16, and 0.63 ± 0.22, respectively. The level of cleaved Caspase-3/β-actin in groups II and III were significantly lower than in group I (P <0.01 and P <0.05, respectively) The Bcl-2/β-actin ratio for groups I, II, and III were 1.01 ± 0.09, 1.19 ± 0.39, and 1.20 ± 0.12, respectively. However, there were no significant difference between groups II & III and group I.


ConclusionThe remote perconditioning on rat hepatic IRI downregulated the Bax and cleaved Caspase-3 expression.

Keywords: remote perconditioning, ischemia-reperfusion injury, liver

P07-03Case Presentation of Isolated Celiac Artery Mycotic AneurysmDr Sungjae An1, A/Prof Vikram Vijayan Sannasi1

1Ng Teng Fong General Hospital, Jurong, Singapore

Background/ IntroductionIsolated celiac artery mycotic aneurysm is extremely rare, with few reported cases until yet. And there is no randomized trials to guide the management of mycotic aneurysm.

ObjectivesTo share this rare case of isolated celiac artery mycotic aneurysm of clinicaly presentation, relavent investigations, our management, and progress.

Materials and Methods73 year old man presented with lower abdominal pain due to recurrent diverticulitis exacerbation. CT-abdomen/pelvis to examine the extent of diverticulitis revealed celiac artery lesion, and further imaging of CT mesenteric angiogram showed isolated celiac artery aneurysm measuring 1.7 x 1.5 x 0.9cm. Patient was treated with antibiotics and endovascular intervention.

ResultsFollow-up CT mesenteric artery showed successful placement of celiac artery endovascular stent.

ConclusionsIsolated celiac artery aneurysm is a rare case, with only few cases reported in the literature so far. Endovascular stenting is one of the treatment options, weighing the risks and benefits among different management strategies.

P07-04Endovascular treatment of subclavian aortic aneurysm rupture in a Behcet disease patient with metallic allergyMizuki Ando1, MD., PhD. Yuya Kise1, MD Tatsuya Maeda1, MD Takaaki Nagano1, MD., PhD Yukio Kuniyoshi1

1Dept. Of Thoracic And Cardiovascular Surgery, University Of The Ryukyus, Nishihara-city, Japan

Open surgical treatment is recommended for most patients with Behçet disease, but postoperative complications such as graft occlusion or anastomotic pseudo-aneurysm formation are frequently reported. Endovascular treatment is a recent innovation that may provide an alternative treatment of choice in patients

with major risk factors for open surgery, such as Behçet disease. However, using stent grafts for patients with metallic allergy remains controversial.

We encountered a 29-year-old man with metallic allergy who had suffered from rupture of the subclavian aortic aneurysm. Moreover, Behçet disease was also suspected. Open surgical treatment was recommended, but since Behçet disease was suspected, the risk of recurrence was expected to be high. Endovascular treatment was recommended instead, but since he was allergic to metals, he was considered to be at high risk of recurrence or allergic shock due to the stent components. Even though he was allergic to metals, the emergency nature of the case was considered to warrant endovascular treatment. We describe herein the endovascular treatment of this case.

P07-05Comparison Between Radiocephalic and Brachiocephalic AV Fistula Maturity at 6 Weeks Post-SurgeryRamzi Asrial1

1dr. Ramzi Asrial, Sp.B(K)V, Bangkinang General Hospital, Pekanbaru, Indonesia

Background Autogen AV fistula is currently the best hemodialysis access choice for stage 5 chronic kidney disease (CKD) patients. AV fistulas can be made at the radiocephalic (wrist) and brachiocephalic (cubiti fossa). Comparison between radiocephalic and brachiocephalic AV fistula maturity at 6 weeks post-surgery according to KDOQI has not yet been made.

Method This study is a prospective cohort study on stage 5 CKD patients who underwent either brachiocephalic (FAVBC) or radiocephalic (FAVRC) AV fistula surgery, which are evaluated via USG before and 6 weeks after surgery. Data are collected and, if fulfilling inclusion criterias and n1=n2, analyzed statistically with Mann-Whitney U test.

ResultsThe successful rate of FAVRC and FAVBC 6 weeks post-surgery are 61,4% and 86,4%, respectively. Further detailed analysis using KDOQI criterias showed a draining vein diameter ≥6 mm rate on FAVBC are 64,4%, while on FAVRC are 35,6%, which correlates with a volume flow ≥ 600 dL/minutes of 66,7% and 33,3% on FAVBC and FAVRC respectively. Fistule-skin distance are < 6 mm on both procedures.

ConclusionThere is a significant difference between FAVBC and FAVRC maturity with a p value < 0,05 according to Mann-Whitney U and Wilcoxon W tests. FAVBC 6 weeks post-surgery maturity reaches 86,4%, compared to 61,4% on FAVRC. Analysis using KDOQI criterias showed a draining vein diameter ≥6 mm rate on FAVBC are 64,4%, while on FAVRC are 35,6%. Volume flow ≥ 600 dL/minutes are 66,7% and 33,3% on FAVBC and FAVRC respectively with a p value < 0,05. Fistule-skin distance of < 6 mm are 100% on both procedures.

Poster Presentation


Key words: Brachiocephalic AV fistule, radiocephalic AV fistule, AV fistule maturity, chronic kidney disease, draining vein, volume flow.

P07-06A Novel Approach For Femoral Artery Access: Purse Suture TechniqueMehmet Cakici1, Dr Alper Ozgur1, Dr Cagdas Baran1, Dr Evren Ozcinar1, Dr Canan Soykan1, Dr Levent Yazicioglu1, Dr Sadik Eryilmaz1, Dr Bülent Kaya1, Dr Ahmet Ruchan Akar1


IntroductionFemoral artery (FA) is the main access route in patients who underwent minimally invasive cardiac (MICS) and endovascular aortic surgery. Different techniques have been reported for the exploration and repair of FA after surgical procedure. In our clinic, a modified approach (group PT) to the conventional technique (group CT), was the method of choice since May 2013; which specifies a shorter groin incision and diamond shaped hemostatic suture for arteriotomy closure without a need for cross-clamping.

ObjectivesWe aimed to evaluate early outcomes and the complication profiles of two techniques for femoral access.

Materials and MethodsIn our clinic, between May 2011 and December 2015, we evaluated 476 FA cannulations in 325 patients who underwent MICS (n:105;mean age:44.4±18.8;F/M:70/35), endovascular aneurysm repair (EVAR) (n:151;mean age:72.5±9.35;F/M:15/136), thoracic endovascular aneurysm repair (TEVAR) (n:45;mean age:64.9±15.6;F/M:12/33) and trans-femoral aortic valve implantation (TAVI) (n:24;mean age:81.5±5.7;F/M:12/12). A total number of 278 FAs were exposed via mini incision and repaired with purse suture technique. We compared duration of femoral closure, wound infection, vascular complications including bleeding-hematoma, thromboembolic and ischemic events, pseudoaneurysm, seroma, surgical reintervention rates, delayed hospital stay for groin complications and existence of postoperative local narrowing of FA over 25 % for both groups.

ResultsDuration of femoral closure, frequency of bleeding-hematoma and prolonged hospital stay for groin complications were significantly lower in PT group. There were no differences in terms of ischemic events, wound infection rates, development of pseudoaneurysm and seroma, surgical reintervention rates and local narrowing of FA over %25 during 54 months follow up.

ConclusionWe suggest performing a smaller skin incision for FA access and utilizing purse sutures that allow completing the procedure without cross-clamping, thus providing a favorable approach and excellent comfort for the surgeon especially in cases of calcific vessels which are prone to complications.

P07-07The Endovascular Treatment of a Ruptured Aneurysm of the Middle Colic Artery Combined With an Isolated Dissection ofSuperior Mesenteric Artery: Report of a CaseByung Sun Cho1, Prof. Hye Young Ahn2

1Eulji University Hospital, Daejeon, South Korea, 2Eulji University College of Nursing, Daejeon, South Korea

Background/ IntroductionRuptured aneurysm of the middle colic artery is very rare. Its concomitance with isolated dissection of the superior mesenteric artery (SMAD) has not yet been reported in the literature.

ObjectivesWe would like to know the feasibility of endovascular treatment for a ruptured middle colic artery aneurysm with a concomitantly detected isolated SMAD.

Materials and MethodsA previously well 56-year-old man was referred to our hospital with acute-onset pain throughout the entire abdomen. A ruptured aneurysm of the middle colic artery and isolated SMAD were revealed using a computed tomography (CT) scan.

ResultsCoil embolization was successfully performed for a ruptured aneurysm of the middle colic artery. During the immediate postprocedural period, the patient had ischemic colitis, but he recovered in a few days with conservative treatment. Close observation was elected to address the SMAD because thecondition was not thought to be responsible for any symptoms. The CT scan followed after 2 years showed no change in SMAD.

ConclusionsWe successfully performed endovascular treatment for a ruptured aneurysm of the middle colic artery. For the incidentally detected SMAD, close observational management was chosen.

P07-08Selective Angioembolization of Renal AngiomiolipomaIgab Krisna Wibawa1, MD Patrianef Patrianef1


BackgroudAMLs ( angiomyolipoma ) are benign mesenchymal tumors, composed of blood vessels, smooth muscle, and mature adipose tissue, that arise primarily in the kidneys. Angiomyolipomas (AMLs) are the most common benign renal neoplasm and are often discovered incidentally.. It has an incidence of about 0.3-3%. Two types are described: isolated angiomyolipoma and angiomyolipoma that is associated with tuberous sclerosis. As these lesions are benign, there is good evidence that the majority of them can be safely followed up without treatment.


Case ReportThe 53-year-old Man with history of abdominal dyscomfort was admitted due to left flank pain, abdominal fullness and urine retention. However, abdominal CT and MRI revealed enlarged lesions and dystrophic calcification within a mass in left kidney ( Calcified Angiomyolipoma ). The patient was sent to vascular surgery for embolization. This patient good candidate for embolization, an effective treatment modality, useful to control active bleeding and for management of symptomatic AMLs.

ResultsThe patient tolerated the procedure well and selective angioembolization was performed.

ConclusionAngioembolization an effective treatment modality for symptomatic Angiomyolipoma (AMLs)

P07-09Medical Treatment of Internal Carotid AgenesisDr. Banu Yürekli1, Dr. Ismail Yürekli2, Dr. Habib Cakir2, Dr. Mert Kestelli2, Köksal Dönmez2, Dr. Börtecin Eygi2, Dr. Sahin Iscan2, Dr. Mehmet Engin Uluc3

1Department Of Endocrinology, Ege University Training And Research Hospital, Izmir, Turkey, 2Department Of Cardiovascular Surgery, Katip Celebi University Izmir Ataturk Training And Research Hospital, Izmir, Turkey, 3Department Of Radiology, Katip Celebi University Izmir Ataturk Training And Research Hospital, Izmir, Turkey

IntroductionInternal carotid artery artery is a rare pathology in our daily practice.

ObjectivesWe aimed to present a case with internal carotid artery agenesis. Due to complications of this anomaly, these patients need a serious follow-up.

Materails and MethodsA thirty-three year old female patient admitted to our outpatient clinic. Patient had Diabetes Mellitus in her medical history. Diabetes Mellitus was diagnosed while patient was investigated for infertility. Agenesis of internal carotid artery was revealed after imaging of loss of cavernous bone in cerebreal computerized tomography. Perfussion and diffusion magnetic resonance imaging were normal. Internal Carotid artery was reported as occluded in duplex ultrasonography. Her LDL level was 173 mg/dl. We initiated her medical treatment with Clopidogrel (75 mg/day), Atorvastatin (20 mg/day), pentoxifylline (2x600 mg/day) and trimetazidine (2x35 mg/day).

ResultsPatient’s vertigo did not regress with this therapy. Trimetazidine was stopped and Cilostazol (2x100 mg/day) was initiated. Her vertigo and symptoms regressed gradually after this revised therapy.

ConclusionWe believe that Cilostazol is an essential medication in treatment of agenesis of internal carotid artery.

P07-10Variations of Circle of WillisDr. Sahin Iscan1, Dr. Habib Cakir1, Dr. Ismail Yurekli1, Dr. Mert Kestelli1, Köksal Dönmez1, Dr. Börtecin Eygi1, Dr. Nihan Karakaş Yeşilkaya1, Dr. Hasan Iner1

1Department Of Cardiovascular Surgery, Katip Celebi University Izmir Ataturk Training And Research Hospital, Izmir, Izmir, Turkey

IntroductionThere are several papers on hypoplasia and incompleteness of Circle of Willis. We decided to explain the general opinion. Brain tissue, with over 100.000 axons and dendrites at each millimeter, is indispensable. ObjectivesThis situation suggests that cerebral perfusion is extremely important at carotid interventions and management of carotid artery disease.

Materials and MethodsWe examined two important anatomy textbooks for Circle of Willis.1-Vankov’s anatomy. Central nervous system. Steno publishing house. M Vankova page:882-Sobotta Atlas of Human Anatomy. Elsevier Urban&Fisher !4th edition Edited by Putz and R. Pabst 2009 Munich page:705 fig:1269 a-g

ResultsBoth textbooks considered hypoplasia and/or incompleteness of arteries building Circle of Willis as variations.

ConclusionWe do believe that hypoplasia and/or incompleteness of arteries building Circle of Willis should not be considered as variations. Because:1) Surgical interventions would not be necessary in subclavian steal syndrome2) Shunt usage at carotid endarterectomy would be unnecessary3) Cilostazol and anti-aggregation drugs would be unnecessary in internal carotid artery agenesis.

P07-11Combined ultrasound and electric field stimulation treatment of chronic wounds: Complementary therapies in wound care Diane Eng1, Sriram Narayanan1, Jonathan Rosenblum, DPM2

1Tan Tock Seng Hospital, Singapore, 2 Shaarei Zedek MedicalCenter, , Israel Chronic wounds are increasing rapidly owing to increasing healthcare costs, an aging population, and increasing co morbidities. Lowering the burden of wounds by optimising healing is perceived as a key factor in reducing wound care cost. During the past two decades, numerous wound interventions have been developed to expedite healing by addressing the principles of wound bed preparation as well as managing cytokines and proteases and by stimulating expression of growth factors. To address these and

Poster Presentation


other needs of chronic wounds, frequently standard wound care is employed alone or in combination with adjunctive wound therapies that deliver several types of biophysical energy to further enhance healing.

The effectiveness of ultrasound (US) as a non-invasive diagnostic tool has led to investigation into its potential benefits for wound healing. Although there appears to be considerable laboratory evidence that US leads to faster and/or improved wound healing, the clinical evidence has been less convincing. Electric Stimulation (ES) has likewise been used for more than a century in the treatment of chronic wounds. The purpose of this paper aimed to describe a novel device which combines the use of both US and ES and the biologic basis for both individual modalities and their combined effect on the wounds in both gross and histological terms as well as to examine the clinical effectiveness of the device as an adjunctive therapy in treating chronic leg ulcers.

P07-12Extreme Fistula Salvage: The Promotion of Ulno-cephalic Fistulae Development via Palmar Arch Angioplasty Following Occlusion of Radio-cephalic Fistulae Inflow Caesar Lopez Gimao1, Raj K Menon1, Andrew MTL Choong1,2


Radio-cephalic arteriovenous fistulae has a higher failure rate as compared to the other autologous limb vascular accesses. Factors such as distal vessel size, patient age, peripheral vascular disease and other medical comorbidities all contribute to this failure. Salvage for failing radio-cephalic fistulae are challenging and therefore, frequently abandoned for more proximal vascular access options.

Palmar arch angioplasty has been utilized as a method to treat critical hand ischemia but there few description of it as a means of improving arteriovenous fistula inflow. We present two recent cases of patients with primary radio-cephalic fistulae who developed radial artery inflow occlusions. We were able to salvage them by palmar arch angioplasty allowing the ulnar to become the dominant inflow vessel, via the palmar arch and then through the collaterals that had developed.

The first case has a severely stenosed left distal radial artery that compromised fistula inflow. Arteriotomy, thrombectomy and bovine patch repair were undertaken restoring borderline flow to the fistula. Palmar arch angioplasty was done to improve flow and allow formation of ulnar-cephalic fistula. The second case has a stenosed juxta-anastomotic segment that impaired adequate arterial inflow. Palmar arch angioplasty was likewise employed to augment fistula inflow and develop the ulnar-cephalic segment as a viable source of arterial flow.

We report these two recent cases of stenosed radio-cephaluic arteriovenous fistulae who underwent palmar arch angioplasties with better results. Both patients would need angiographic follow-up to determine restonoses along the palmar arch. A larger series of similar angioplasties along this arterial segment needs to be pursued to fully determine its effectivity in improving arteriovenous fistula stenosis.

P07-13“Wii thumb”: Case report of symptomatic peripheral arteriovenous malformation from gaming and systematic review of vascular injuries from gamingMina Guirgis1, A/Prof Kishore Sieunarine1, Dr Ruben Rajan1

1Joondalup Health Campus, Perth, Australia

IntroductionA 28 year old patient presented to the vascular service with an exquisitely tender lump on his right thumb. He played Nintendo Wii daily for extended periods. Sudden pain occurred after playing a thumb driven console for 14 continuous hours. Examination revealed an erythematous lesion on the pulp of his right thumb which was focally tender. MRI revealed a vascular malformation on the volar distal phalanx of the thumb was detected. Excision of the lesion by a vascular surgeon under general anaesthesia was performed. Histology revealed a circumscribed lesion composed of capillaries and venous structures consistent with an arterio-venous malformation (AVM). The only activity attributed to the symptomatic AVM of his thumb was trauma from prolonged periods of video gaming using a hand held console. This lead to the development of a painful traumatic AVM which was refractory to multimodal analgesia and eventually required surgery.

ObjectivesA 2016 systematic review of all reported vascular injuries caused by video games.

MethodsMedline and Pubmed searches including the following keywords: “Thrombosis” or “Artery” or “Vascular” or “ethrombosis” AND “Video game” or “Wii” or Nintendo” or “Wiiitis” or “Computer game”.

ResultsA total of 11 case reports reporting 12 vascular injuries related to video gaming. Nine vascular injuries from gaming were associated with venous thromboembolism (VTE). 67% of cases resulted in major pulmonary emboli, one fatal. In the majority of VTE cases, the only risk factor known was prolonged immobility, an unusual finding with regards to the multi-factorial nature of VTE pathogenesis. All cases had negative thrombophilia screens or no history of thrombophilia. Two injuries occurred from intense physical activity on Nintendo Wii causing internal carotid artery dissection and permanent disability.

ConclusionMost vascular injuries from gaming are VTE related. We report the first known case of gaming associated symptomatic peripheral AVM.


P07-14Management of symptomatic isolated spontaneous dissection of superior mesenteric arteryTohru Ishimine1, Dr Hiroshi Yasumoto1, Dr Toshiho Tengan1, Dr Hidemitsu Mototake1

1Okinawa Prefectural Chubu Hospital, Miyazato Uruma, Japan

ObjectiveIsolated spontaneous dissection of superior mesenteric artery (SMA) is extremely rare, and treatment of it is not established. In this study, we present our experience in the treatment of symptomatic isolated spontaneous dissection of SMA.

MethodsBetween 2005 and 2016, 15 consecutive patients (12 men; mean age, 49 ± 6.5 years) with symptomatic isolated spontaneous dissection of SMA were retrospectively reviewed. The mean follow-up period was 20.9 ± 28.9 months.

ResultsAll patients had acute-onset abdominal pain. Three patients (20%) had hypertension, 4 (26.7%) had hyperlipidemia, and 11 (73.3%) were smokers. All cases were diagnosed by computed tomography (CT) angiography. Twelve patients were treated conservatively (with the use of anticoagulation or anti-platelet in ten and without in two patients) . Three patients with signs or symptoms of intestinal ischemia underwent emergent surgery (iliomesenteric bypass using saphenous vein in two and exploratory laparotomy in one patient) as a primary treatment. Iliomesenteric bypass was additionally performed in one patient in whom initial conservative treatment failed (reappearance of abdominal pain after resuming diet and progression of the false lumen on CT angiography). During the follow-up period, all patients were free from aneurysmal formation of SMA or chronic intestinal ischemia.

ConclusionsMost patients with Isolated spontaneous dissection of SMA can be treated conservatively. However, surgical treatment should be considered if there is suspicion of intestinal ischemia.

P07-15Endovascular Treatment of Transplant Renal Artery StenosisKang Woong Jun1, Mi Hyeong Kim1, Hyun Kyu Kim1, Jeong Kye Hwang1, Sang Dong Kim1, JangYong Kim1, Sun Cheol Park1, Ji Il Kim1, Yong Sung Wong1, Sang Sup Yun1, In Sung Moon1

1The Catholic University of Korea, Soeul , South Korea

PurposeTransplant renal artery stenosis(TRAS) is most common(1-23%) vascular complication following kidney transplantation, which most clinicians regard percutaneous transluminal angioplasty(PTA) with/without stent placement to be the treatment of choice for TRAS.The aim of this study was to review our experience with an endovascular approach to TRAS.

MethodsWe retrospectively reviewed the kidney transplant recipients those who underwent PTA due to TRAS in our institute from January

2009 to December 2015.We analyzed the patient’s baseline characteristics, postoperative renal function, blood pressure evolution, and the number of antihypertensive drugs pre- and postprocedure.

ResultA total 21 patients(M:15, F: 6) were treated with endovascular technique.The mean age was 49.2 years(31-65 years), mean time to treatment was 44.8 days(4-230 days). The predominant presentation was graft function alteration(76.2%). Stenosis or hemodynamic kinking were located at the anastomosis 7(33.3%), proximal 13(61,9%), distal 1(4.8%). Number of donor renal artery was single in 11(52.4%), multiple in 10(47.6%;double 8, triple 2). The PTA without stent placement was performed in 7(33.3%), PTA with stent placement was performed in 14(67.7%).Serum creatinine levels demonstrate no difference between preprocedure and discharge day(1.61mg/dl(0.47-3.29mg/dl) vs 1.46 mg/dl(0.47-3.08mg/dl) at discharge(p=.33).The glomerular filtration rate(GFR) also showed no difference between preprocedure and discharge day(53.6 ml/min(22.4-145.7 ml/min) to 57.0 ml/min(17.56 -145 ml/min) (p=.084). Systolic and diastolic blood pressure varied from 137mmHg(120-160mmHg) and 84mmHg(70-100mmHg) to 129mmHg(90-150mmHg) and 79mmHg(60-90mmHg), respectively(p=.124 and p=.07)).The preoperative number of antihypertensive medication was significantly decreased from 1.5(0-6) to 0.5(0-2)(p=.023).In our study, there was no technical failure and no procedure related complication or mortality.During follow up period free from reintervention rate was 100%, graft failure was occurred in 2(9.5%) due to rejection.

ConclusionEndovascular procedure in TRAS shows high technical success rate with favorable result and low morbidity.In our experience, its impact on serum creatinine levels and GFR do not seem to improve, however, number of antihypertensive drug could be reduce after procedure.

P07-16Reduction of totally implantable central venous port system complicationYong Beum Bak1, Prof. Hyuk Jae Jung1, Dr. Dong Hyun Kim1, Prof. Sang Su Lee1


PurposeThe aim of this study is to describe our procedure of totally implantable central venous port system (TICVPS) insertions and to investigate TICVPS complications.

MethodsWe retrospectively investigated 827 patients who underwent a single-type TICVPS from January 2013 to July 2015. The length of the procedure, long-term device function, angle (chamber-to-tip), and complications of TICVPS, such as infections, skin erosion, occlusions, dislocations, and thrombosis, were analyzed from medical records.

ResultsA total of 843 TICVPS insertions were performed in 827 patients. The TICVPS implantation was successful in all cases (100%). The mean indwelling time was 275.4 days per patient (range 1-782 days), and 325 (38.6%) patients had more than 300 days of indwelling

Poster Presentation


time. The mean catheter angle was 72.5°. Among the patients, 766 (90.8%), 71 (8.4%), and 6 (0.7%) had solid tumors, hematologic/oncologic cancers, and no cancer but whose peripheral vein was difficult to access for administration of fluid resuscitation, parental nutrition, or transfusion. A total of 34 (4.0%) complicated cases were recorded. Chamber insertion site complications occurred in 11 patients (5 infection and 6 erosion cases). All patients with chamber insertion site infection were treated with antibiotic administration and dressing. Two patients with chamber insertion site erosion were treated with TICVPS removal and reinsertion. Four patients who had chamber insertion site erosions were treated with debridement, irrigation, and resuture. The most common complication was catheter-related complications (19 cases). Among these, 7, 8, 4, and 2 patients had catheter-related infection, catheter migration confirmed by chest radiography, catheter-related thrombosis, and chamber malposition, respectively.

ConclusionOur large retrospective study of TICVPS revealed a low complication rate (4.0%) compared with literature (5%-20%). Well-designed procedure, experienced vascular surgeons, aseptic operating room environment, ultrasound-guided puncture, wide angle (chamber-to-tip), and using fluoroscopy with contrast can help in reducing the complication rate of TICVPS insertion.

P07-17Prognosis of isolated visceral artery dissection after conservative treatmentTatsuya Kaneshiro1, Dr Toshimi Yonaha1, Dr Hideyoshi Henzan1

1Nakagami General Hospital, Okinawa-city, Japan

BackgroundIsolated visceral artery dissections not associated with aortic dissection are relatively rare. Recently, these have been diagnosed more frequently due to advances in diagnostic imaging technology. There is no consensus on optimal management or prognosis. Here, we report the short- to mid-term prognosis of isolated visceral artery dissection after conservative treatment.

MethodsA total of 22 consecutive patients with isolated visceral artery dissection were seen between October 2006 and May 2016. All patients received conservative management, including antihypertensive or anticoagulant therapy. The locations of dissection were the celiac artery (CA) in 8 patients; superior mesenteric artery (SMA) in 10; and 1 each involving both CA, SMA and bilateral renal arteries (RA), both CA and left RA, inferior mesenteric artery (IMA), and left RA. The mean age was 54 years. There were 18 men and 4 women.

ResultsThe mean follow-up duration was 33 months (range: 3 to 117 months). Four patents (7 arteries) had patent false lumens, 8 had thrombosed false lumens with ulcer-like projection (ULP), and 10 patients (11 arteries) had a completely thrombosed false lumen. During follow-up, the false lumen were disappeared in 12 cases, while a patent false lumen and thrombosed false lumen with or without ULP persisted in 12 cases. One patient developed a visceral artery aneurysm after the false lumen disappeared. Eight dissections with a thrombosed false lumen disappeared, although only 2 dissections with a patent false lumen and only 3 with a thrombosed false lumen with ULP disappeared.

No progression of the false lumen or newly developed organ ischemia was observed.

ConclusionsIsolated visceral artery dissection with a completely thrombosed false lumen disappeared rapidly, while only one-third of dissections disappeared in case with a patent false lumen or thrombosed false lumen with ULP.

P07-18Prevalence of lower extremity ulcer in Maharaj Nakorn Chiang Mai hospitalRungrujee Kaweewan1, Dr Christine Rojawat1, Professor Kittipan Rerkasem1,2

1NCD Center of Excellence, RIHES, Chiang Mai University, Chiang Mai, Thailand, 2NCD Center & Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

BackgroundPatients with ulcer of the legs are becoming more and more common. Many Western studies indicates that the most common cause of lower extremity ulcers is due to chronic venous insufficiency and arterial disease. However this prevalence in Asian countries is still controversial.

ObjectiveTo find out the causes of lower extremity ulcer in patients of Maharaj Nakorn Chiang Mai Hospital, Thailand.

MethodData collection was carried out in consecutive patients who came to vascular clinic from March 2014 to March 2016 with the problem of lower extremity wounds. This included demographic data, etiology, location.

ResultsThere were 321 patients in this study. There were 173 men and 148 women. The average ages were 62.51 years old. The cause of lower extremity ulcer was Ischemic ulcer 116 patients (36.13%) , venous ulcer 72 patients ( 22.4%), Neuropathic ulcer 60 patients (18.69%), Infected ulcer 59 patients (18.38%) and other cause 14 patients (4.36%). Venous ulcer was seen commonly above medial malleolus 62 out of 72 patients (86.11%) and 23 (31.94%) patients had ulcer both legs. All 116 patients with Ischemic ulcer, ulcer commonly located at foot, in 59 patients (64.66%), toe 26(22.41%) patients. Besides infection was also present in these patients or wet gangrene we found in 20 (17.2%) patients.

ConclusionThe most common cause of lower extremity ulcer in our center was ischemic ulcer which differ from previous Western studies .Further study are needed to clarify the difference.


P07-193D Printing in Vascular Surgery: A Systematic Review Teck Ee Reyor Ko1, Yeong Xue Lun2, Andrew MTL Choong3,4

1Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 2Faculty of Medicine, University of New South Wales, New South Wales, Australia, 3Division of Vascular Surgery, National University Heart Centre, Singapore, 4School of Medicine, Griffith University, Gold Coast, Queensland, Australia

Background3D printing technology is an exciting technology that has made rapid progress since its first introduction. There are now multiple applications within medicine. We systematically review the published literature and report on the myriad of roles 3D printing plays within the domain of cardiovascular surgery.

MethodsA systematic review of 5 electronic databases (Cochrane, PubMed, Ovid, Scopus, Google Scholar) was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included studies reporting on any use of 3D technology in cardiovascular surgery. 3D printing in neurosurgery (defined as being intracranial) were excluded.

ResultsA total of 289 articles were identified but only 18 studies met our search criteria including twelve case reports, four case series and two comparative studies.

14 studies investigated the use of 3D printing technology in aiding surgeons understand critical surgical anatomies and using these patient-specific models for pre-operative surgical simulation. All reported excellent outcomes in guiding therapeutic decisions in the pre-operative phrase.

10 studies appraised the use of 3D printed models to test the viability of stent-graft. All studies reported good to excellent degree of accuracy of these models to evaluate the viability of intra-operative devices.

6 studies assessed the value of 3D printed models in aiding the training of surgical trainees. All 6 studies showed varying degree of educational benefits of trainees.

Conclusions3D printing has the potential to significantly advance both patient care and training in cardiovascular surgery. Further studies regarding the long-term benefits of 3D printing are warranted.

P07-20A Novel use of the Clarivein Catheter for Pharmaco-Mechanical Thrombolysis of a Thrombosed Arteriovenous GraftD Lim, D Ho, Y K Tan, Dr Steven KumChangi General Hospital, Singapore

Introduction and BackgroundArteriovenous grafts (AVG) for dialysis access are commonly required in patients with poor quality veins for autogenous arteriovenous fistulas (AVF). However, the primary patency of these AVGs are as low as 42% at 1 year. Percutaneous interventions are commonly used to restore patency of the access circuit. Phamacomechanical Thrombolysis (PMT) is one of several techniques to restore flow. We describe a technique of using the Clarivein catheter (Vascular Insights, Madison CT) to successfully perform PMT in a thrombosed AVG.

Methods and Description of ProcedureA 65 year old male was admitted for a thrombosed AVG. Under local anaesthetic, the AVG accessed and pharmacomechanical thrombolysis of the AVG was done with 120,000 units of Urokinase delivered via the Clarivein device. Angiogram revealed satisfactory thrombolysis of the AVG and an offending stenosis at the venous end of the AVG. Balloon angioplasty of the graft-venous anastomosis and subsequent stent graft placement with Viabahn endoprostheis was performed. Simultaneous balloon angioplasty of the graft-artery anastomosis was performed resulting in a good angiographic result with no residual stenosis or clot in the AVG. Time to successful thrombolysis was 10 minutes and time for the entire intervention was 65 min. We encountered no procedural complications.

ConclusionOff-label use of the Clarivein catheter for PMT to restore flow in an AVG is safe and technically feasible. It allows rapid restoration of flow to the access circuit with a low dose of thrombolytic agent.

P07-21Novel use of Drug Eluting Balloon Assisted Maturation (DEBAM) in Primary Arteriovenous Fistula CreationJ X Lim, D Lim, D Ho, YK Tan, Steven KumChangi General Hospital, Singapore

Background and ObjectivesArteriovenous fistula (AVF) creation is the first line option in renal replacement therapy of patients suffering from end stage renal failure. One of the main concerns of vascular surgeons performing this procedure is the availability of adequately sized veins for anastomosis. This is especially challenging in our local population as the average calibre is smaller than their Caucasian counterparts. Various means have been employed in attempts to circumvent this issue.

Over the years, the use of Balloon-Assisted Maturation (BAM), or primary balloon angioplasty at the time of AVF creation have been described. More recently, the use of Drug-Eluting Balloons (DEBs) have been shown in studies to improve patency outcomes and reduce restenosis rates in the treatment AVFs with dialysis access issues. There is some early evidence that it is does so via

Poster Presentation


the inhibition of smooth muscle proliferation and neointimal hyperplasia. Medtronic received the CE Mark this year for usage of its IN.PACT DEBs in the maintenance of hemodialysis access.

We took this a step further, and in this paper, describe the novel usage of DEB at the time of AVF creation in a patient with a small calibre vein, to assist in the subsequent maturation of the fistula.

MethodsTechnical note describing the usage of DEB at the time of primary AVF creation in a patient with a 1.5mm scarred cephalic vein, who would otherwise not be a candidate for autogenous AVF creation.

ConclusionsWe propose that DEBAM is a viable option in patients with small veins, who would otherwise be deemed unsuitable for AVF creation. The long term clinical outcomes, however, are not established and we propose future prospective studies to investigate this.

P07-22Transradial Non-coronary Peripheral Endovascular Interventions: A Systematic Review Max Meertens1, Eugene Ng2, Andrew MTL Choong3,4

1Faculty of Health, Medicine and Life Sciences, Maastricht University, Köln, Germany, 2Westmead Hospital, Sydney, Australia, 3Division of Vascular Surgery, National University Heart Centre, Singapore, 4School of Medicine, Griffith University, Gold Coast, Queensland, Australia

ObjectiveThe transradial (TR) approach has been proven to be safer than transfemoral (TF) access in coronary interventions. The chance for major hemorrhage is decreased and also for other major complications. Furthermore is the mortality is reduced. Nevertheless, percutaneous TR access remains underused in other endovascular procedures.

MethodsWe performed a systematic literature review according to the PRISMA guidelines looking at TR access for non-coronary peripheral endovascular interventions. We excluded all articles which focused coronary treatment, AV shunts or non endovascular procedures.

ResultsWe included 18 articles which looked at iliac/femoral, popliteal, renal, carotid, tibial, axilary, subclavian, vertebral artery, peripheral interventions and endoleak or peripheral artery embolization representing 1985 patients and 2639 lesions.

We found access problems in 79 patients (3,9%), major complications (MI, bleeding, stroke) in 11 patients (0,42%), 31 patients (1,2%) with minor (small hemorrhage, TVI) complications and 2 patients (0,07%) died.

After a follow up period of at least on month we saw post operatively RA occlusion (RAO) 2,61% (0 16,3%) of the patients. Furthermore was one pseudo aneurysm reported from 1985 patients. A makeable limitation is that wires can be to short in really tall patients.

Overall procedures through the RA were successful in 96,2% of the lesions. RAO clearly reduced in better trained doctors. Length of hospitalization within the iliac interventions was 2,75 (95%CI 95% ;1,4 and 4) days.

ConclusionTransradial access for peripheral endovascular interventions is safe and feasible with potentially lower complication rates than traditional TF access. More studies are required and training in appropriate methods is essential if this is to be reproduced more widely. TR interventions seem to be saver than TF interventions and hospitalization is shorter.

P07-23Successful endovascular treatment for rectal arteriovenous fistula after pelvic traumaYohei Munetomo, Shinji Yamazoe, Akira Baba, Yuko Kobashi, Takuji Mogami0Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Japan

BackgroundArterial trauma may lead to the development of arteriovenous fistula (AVF). In previous literature, about 1 % of acquired AVF were due to blunt trauma, while penetrating trauma, stab wounds, and gunshot wounds accounted for the vast majority of these lesions. And there are few reports of acquired rectal AVF after trauma.

We present a successful case in that we treated lower gastrointestinal bleeding caused by rectal AVF after pelvic trauma.

CasePatient was an about-80-year-old man. He fell down at home two months ago, and he had back pain from 1 month ago. Three weeks ago he was diagnosed as sacral fracture by previous doctor. On February 25 2016, he was admitted to our emergency room because of massive melena and hemorrhagic shock. Dynamic CT showed high enhancement lesions and extravasation in rectum. Colonoscopic examination showed elevated lesions with bleeding in the lower rectum. We suspected acute rectal variceal hemorrhage and performed endoscopic variceal ligation (EVL) . However 6 days after EVL, lower gastrointestinal bleeding occurred again. So we performed angiography for localization and evaluation of bleeding. The angiography including pelvic vessels demonstrated rectal AVF supplied by middle rectal artery of the left internal iliac artery. We diagnosed as rectal AVF caused by pelvic trauma. The AVF was high-flow type, so we perfomed embolization in 2 sessions with 5% ethanolamine oleate under balloon occlusion without complication. After the embolization, melena and rectal varices were disappeared by enhanced CT and colonoscopy. ConclusionWe experienced a case of rectal AVF after pelvic trauma. There are few reports of acquired rectal AVF after trauma, but it is necessary to consider AVF as the cause of lower gastrointestinal bleeding after brunt pelvic trauma.


P07-2440 Hours with a Traumatic Carotid Transection Eugene Ng1, Ian Campbell1, Andrew Choong1,2,3, Allan Kruger1, Philip J Walker1,2

1Royal Brisbane and Women’s Hospital, Queensland, Australia, 2Discipline of Surgery, School of Medicine, University of Queensland, Queensland, Australia, 3School of Medicine, Griffith University, Gold Coast, Queensland, Australia

BackgroundAlthough penetrating neck trauma is uncommon, it is associated with significant morbidity and mortality. The management of penetrating neck trauma has changed significantly over the past 50 years with radiological assessment now a vital part of management alongside traditional surgical exploration.

A 22 year old male was assaulted with a screw driver and sustained multiple penetrating neck injuries. A contrast computed tomographic scan revealed a focal pseudoaneurysm in the left common carotid artery bulb. There was no active bleeding or any other vascular injuries and the patient remained hemodynamically stable. In view of these findings, he was initially managed conservatively without open surgical exploration. However, repeat radiological via catheter directed angiography raised further concern for vascular injury. Surgical exploration 40 hours following the initial injury revealed a contained through and through transection of the left carotid bulb which was repaired with a great saphenous vein patch. A percutaneous drain was inserted in the carotid triangle and a course of intravenous antibiotics for 5 days was commenced. The patient recovered well from his operation with no complications and remained asymptomatic on followup at 5 months.

P07-27Three Cases of Vascular Ehlers-Danlos SyndromeMasato Nishizawa1, Dr Toshifumi Kudo1, Dr Kimihiro Igari1, Dr Takahiro Toyofuku1, Dr Yoshinori Inoue1

1Tokyo Medical And Dental University, Division Of Vascular And Endovascular Surgery, Department Of Surgery, Bunkyo-ku, Japan

Ehlers-Danlos syndrome (EDS) is a rare connective tissue disorder, which is characterized by fragility of the skin, blood vessels, and joints. Arterial rupture is one of the most severe complications in patients with vascular type EDS. We herein report three cases with vascular type EDS.

First case was a 27-year-old male with swelling of the left calf. His brother had a history of carotid artery aneurysm. Computed tomography (CT) showed bilateral posterior tibial artery aneurysms, sized 10 mm, and a left aneurysm ruptured. We selected conservative management. His clinical symptoms were relieved, and no further rupture of the aneurysms occurred.

Second case was a 34-year-old female with the swelling and pain of the left calf. CT showed a rupture of popliteal arterial aneurysm in her left side. We conducted an emergent operation by superficial femoral artery - peroneal artery bypass surgery. Even though she got a limb salvage, she died due to alveolar hemorrhage.

Third case was a 31-year-old male with the swelling and pain of the left calf. CT showed an intramuscular hematoma in his left side of calf; then we selected conservative management. After the treatment, his clinical symptoms were relieved, and no further hematoma appeared.

These three cases presented with thin skin and hyperextensibility of skin, and arterial fragility or rupture. These findings suggested the vascular type EDS.

Patients with vascular type EDS should be promptly evaluated, and we should select the treatment, especially with conservative management, by taking into account the fragility of skin and blood vessels.

P07-28The effect of rifampicin bonded graft for bacterial infectionShinnosuke Okuma1, PhD Takeshiro Fujii1, PhD Tomoyuki Katayanagi1, MD Yoshio Nunoi1, MD Toru Kameda1, MD Kota Kawada1, MD Tatsuaki Hosaka1, MD Takahide Yao1, PhD Hiroshi Masuhara1, MD Yuzo Katayama1, PhD Tsukasa Ozawa1, PhD Noritsugu Shiono1, PhD Yoshinori Watanabe1

1Toho University, Ota-ku, Japan

ObjectiveThe infection in vascular prosthetic conduits is one of the most threatening complication of cardiovascular surgery. It has been reported that rifampicin bonded graft (RBG) is effective for the prosthetic graft infection. We investigated about the effect of RBG.

MethodsStudy 1: Gelatin-coated Dacron vascular grafts were cut into 6cm segment. Two RBG grafts and two saline bonded grafts were placed U-shaped configuration on culture plate. The saline was added into the inside of four grafts and 106CFU/ml and 108CFU/ml suspended Pseudomonas aeruginosa were added to the outside each by two grafts. Samples taken from inside and outside the grafts every six hours by twenty-four hours were spread on LB agars.

Study 2: Three RBG grafts were soaked in each saline for 24 hours. The saline was added into the inside of three grafts and 104 CFU/ml, 106 CFU/ml and 108 CFU/ml suspended Pseudomonas aeruginosa were added to the outside each by these grafts. Samples were taken.

ResultStudy1: We did not detect the bacteria inside the rifampicin bonded graft spread 106CFU/ml suspended Pseudomonas aeruginosa. The bacteria have decreased outside of the graft. On the other hand, the sample inside the rifampicin bonded graft spread 108CFU/ml suspended Pseudomonas aeruginosa were the same concentration of saline bonded graft after a period of 24 hours.

Study2: The sample inside the rifampicin bonded graft spread 106CFU/ml and 108CFU/ml suspended Pseudomonas aeruginosa increased the rapidly after a period of 24 hours.

ConclusionRBG is effective to protect bacterial invasion if the bacterial concentration is less than 106CFU/ml outside. The concomitant intravenous antibiotic administration is important to prevent the

Poster Presentation


vascular prosthetic conduit infection using RBG, because the rifampicin is not effective after 24 hours in this study.

P07-29A case of rupture was saved splenic artery aneurysm due to Segmental Arterial Modiolysis(SAM) after 7days of surgery of ascending aortic aneurysm rupturedHirokuni Ono1, Shota Kita1, Hirotoshi Suzuki1, Yuka Sakurai1, Ro Daijyun1, Tokuichirou Nagata1, Kiyoshi Chiba1, Makoto Ono1, Yosuke Kitanaka1, Masahide Chikada1, Hiroshi Nishimaki1, Takeshi Miyairi1

1St.marianna Univercity Of Medicine, kawasaki , Japan

Background Segmental arterial mediolysis (SAM) is a rare noninflammatory, nonatherosclerotic disease of unknown etiology typically affecting medium-sized abdominal arteries. It is characterized histologically by vacuolization and lysis of the outer arterial media leading to dissecting aneurysms and vessel rupture presenting clinically with self-limiting abdominal pain or catastrophic hemorrhages in the abdomen. Patients of all ages are affected with a greater incidence at the fifth and sixth decades. There is a slight male predominance.

Patient date: 79 years old,female. Medical history:hypertension.

Clinical course & ResultsBecause of the patient occurred severe acute chest and back pain, transported to the Emergency center. We diagnosed an ascending aortic aneurysm rupture. The patient was underwent the urgent surgery.

At postoperative day 7, the patient occurred severe acute abdominal pain and fell into a state of really shock vital. We admitted Intraperitoneal hemorrhage in emergency CTA examination, confirmed the blood vessel leakage of the contrast agent from the splenic artery aneurysm.

We performed selectively embolization of splenic artery and hemostasis in emergency catheter intervention.

In catheter angiography showed a severe stenosis and pseudoaneurysm in the splenic artery distal portion. Left gastric artery and left hepatic artery was recognized beaded aneurysm. the right gastroepiploic artery showed saccular aneurysm,spindle-shaped extension and spasm.Diagnosis was strongly suspected the SAM.

DiscussionOriginally described as “segmental mediolytic arteritis” by Slavin and Gonzales-Vitale in 1976, this disease has been renamed “segmental arterial mediolysis” due to lack of inflammatory changes. It is the most of a abdominal branch of the aneurysm.

A mortality rate of 50% has been attributed to the acute presentation with aneurysm rupture necessitating urgent surgical or endovascular treatments.

ConclusionsIt will be necessary to long-term follow-up.

P07-30Intra-luminal thrombus bleeding in abdominal aortic aneurysm as an indicator for acute or impending rupture: A case seriesAbdul Rahman M N A1, Razali MR2, Faidzal Othman1

1Vascular Unit, Department of Surgery, Kulliyah(Faculty) of Medicine, International Islamic University Malaysia, Kuanta, Malaysia, 2Department of Radiology, Kulliyah(Faculty)Of Medicine, International Islamic University Malaysia, Kuantan, Malaysia

Keywords: Hyper attenuating crescent sign Aneurysm rupture

Bleeding into Intra luminal thrombus, famously known as “hyper attenuating crescent sign”, due to blood entering the ILT, has been advocated to be associated with impending rupture of abdominal aortic aneurysm (AAA). We present two cases of patients presenting to our centre with a finding as described above. The importance of these finding correlating with intra-operative findings and review of relevant literatures will be highlighted.

P07-31Endovascular Management of peripheral AVM (Arteriovenous malformation) & AVF (arteriovenous fistula) at NepalSandeep raj Pandey1

1Annapurna Neuro Hospital, Kathmandu, Nepal

Background/ IntroductionPeripheral AVM & AVF are rare congenital lesions. Complete eradication of the nidus of an AVM is the only potential cure. However, surgical resection is often difficult, and recurrence of the AVM is common with incomplete resection.Transcatheter embolisation now plays a significant role in the treatment of AVM & AVF.

Objective:To assess the treatment results of coils & glue embolization of peripheral AVM & AVF at Nepal.

Materials & methods: Case of AVM:A 20 yr old male found a painful pulsatile nodules on his left lower thigh which was progressively enlarging for several months. CT-angio showed AVMs draining from SFA with multiple feeders on lt lower thigh.Patient undergone embolization of SFA feeders with n-butyl cyanocryalte and lipidurol via right side CFA approach with 5 fr sheath & progreat microcatheter.

Case of AVF:A 60 yr old female c/o pain & pulsation in lt buttock post fall.Ct-angio showed very high flow AV fistula from inferior gluteal artery with large venous varix of draining vein.She underwent coil embolisation of feeding artery followed by glue embolisation via right femoral approach.It was followed by percut lipidurol injection.

Results:Both of patient got relieved of pain & significantly decreased mass n pulsation. The outcome was satisfactory without complication.


Conclusion:Treatment for peripheral AVM & AVF is a challenge because of their unpredictable behaviour. There is a wide plethora of embolic agents, each with its own particular characteristics that makes it ideal for certain situations. Familiarity with these and their modes of use and action can help in selecting the correct agent depending on the goal of embolization

P07-32Acute lower limb ischemia in a case of ischemic & valvular heart disease patient: A case reportMokhlesur Rahman1National Institute of Cardiovascular Diseases, , Bangladesh

Abstract: A female patient with valvular heart disease and atrial fibrillation presenting with acute both lower limb ischemia, successful embolectomy was performed through bi-femoral approach 16 hours after onset of symptoms. After operation patient was recovered well and patient’s both lower limbs were saved. Patient was discharged from hospital on 10th postoperative day. Coronary artery bypass graft and double valve replacement operation of same patient was done successfully after two months of embolectomy.

Keywords:Valvular heart disease, saddle thrombus, aortic occlusion, acute lower limb ischemia, embolectomy.

P07-33A Multi-Discliplinary Approach to the Management of Penetrating Neck TraumaIan J. Tan1, Lowell Leow1, Harvinder S. Raj1, Dr K.Y. Seto2, Vikram Vijayan1

1Department of Surgery, Ng Teng Fong General Hospital, , Singapore, 2Department of Radiology, Ng Teng Fong General Hospital, , Singapore

IntroductionPenetrating neck injuries have traditionally been managed by the trauma surgeon. We present a case of a man who sustained an internal jugular vein (IJV) tear due to a penetrating neck injury who underwent surgical management by a multi-disciplinary team involving a vascular surgeon and an interventional radiologist.

Case DescriptionA 44 year old Chinese man presented to the emergency department with a zone 2 penetrating neck injury secondary to an industrial-related high velocity shrapnel injury. He presented with a large, bleeding but initially non-expanding neck hematoma. At presentation, there was no evidence of compression of the aero-digestive track but as time progressed he developed some tracheal shift to the contralateral side.

A multi-disciplinary (vascular surgeon and interventional radiologist) surgical approach was adopted and a neck exploration was performed in a hybrid operating theatre. Due to the tissue damage along the path of the penetrating projectile and a continually expanding and profusly bleeding hematoma from a torn IJV, there was severe anatomical distortion which proved

technically challenging. Via an endovascular route, a balloon angioplasty catheter was passed into the IJV and inflated to achieve proximal and distal control of the haemorrhage as well as identifying the anatomical position of the vein in the wound. This allowed controlled dissection and facilitated definitive surgical intervention with minimal blood loss. There were no neurological or aero-digestive tract injuries and the patient was subsequently discharged well 5 days after the initial injury.

ConclusionA multi-disciplinary approach with the incorporation of endovascular techniques are good adjuncts to surgical intervention and should be considered for complicated penetrating neck trauma with vascular injuries.

P07-34Endovascular embolization of iatrogenic superior mesenteric arteriovenous fistulaJun Yamao1, MD Hiroyoshi Komai2, MD Masashi Okuno1

1Yoshida Hospital, Hirakata City, Japan, 2Department of Vascular Surgery, Medical Center, Kansai Medical University, Moriguchi City, Japan

Iatrogenic arteriovenous fistula between the superior mesenteric artery and vein is extremely rare. We herein report a case of an 85-year-old male with an iatrogenic superior mesenteric arteriovenous fistula that developed after a small bowel resection. The patient presented with lower abdominal pain and vomiting, and was admitted to our hospital. He was diagnosed intestinal volvulus and underwent massive small bowel resection. Three weeks after the intestinal resection abdominal bruit and thrill was appeared in the right upper quadrant. An abdominal ultrasound examination demonstrated an arteriovenous fistula between the super mesenteric artery and vein without any sign of hepato-splenomegaly. The findings were also confirmed with volume-rendered computed tomography and superior mesenteric angiogram. The fistula showed a U shape and was about 1.3 mm in diameter. The patient suffered from ascites, pleural effusion and hypotension caused by high flow congestive heart failure. Because the shunt flow was predicted to be high and coil embolization seemed to be unsuitable, endovascular embolization of the fistula was performed with embolic agent: AMPLATZER™ Vascular Plug 4 (AVP 4) at the arterial side of the fistula, resulted in reducing the sign of congestive heart failure and stabilizing the blood pressure. However, five days after the endovascular treatment the patient was died of pneumonia. Endovascular embolization with AVP 4 is expected to be one of the feasible treatment choices for arteriovenous fistula in severe cases.

P07-35Totally implanted venous access ports at upper arm in patients with female breast cancer: early experience in comparison with trans-jugular chest portShin-Seok Yang1, Prof Bo-Yang Suh1, Dr Young-A Kim1

1Yeungnam Universtiy Hospital, Namgu, South Korea

BackgroundTotally implantable venous access ports (TIVAPs) are widely used for chemotherapy in patients with breast cancer.

Poster Presentation


ObjectivesThe purpose of this study is to retrospectively analyze the safety, technical feasibility and complication of TIVAPs at the upper arm and to compare with trans-jugular chest port in patients with breast cancer.

Materials and MethodsBetween July 2014 and February 2016, 223 consecutive female breast cancer patients who underwent a TIVAP at the upper arm or the chest were included. All procedures were performed with sonogrpahic and fluroscopic-guided approach under local anesthesia. We reviewed medical records for technical success, pain scale, early (≤30day) and late (>30day) complication.

ResultsA total of 231 devices were implanted at the upper arm (n=176, 76%; 159 basilic veins and 17 brachial veins) and the chest (n=55, 24%; 46 internal jugular veins and 9 external jugular veins). The mean implantation time of TIVAPs was 181.7±109.2 days (range, 9-460 days; upper arm 175.2±102.7 days vs. 202.4±126.6 days, p>0.05) with a total of 41,974 catheter-days. A total of 14 complications (6.1%) occurred in 14 patients (0.33/1000 catheter-days). There was no significant difference in complication-free survival of patients with upper arm and trans-jugular chest TIVAPs. Mean amount of 2% lidocaine for local anesthesia was 3.3±1.7 ml at the upper arm and 14.5±4.1 ml at the chest, respectively (p<0.001). High body mass index was significant risk factor of catheter-related infection.

ConclusionsImplantation of TIVAPs at upper arm is a safe procedure with low rates of complications in patients with breast cancer. High body mass index is associated with a higher risk of catheter-related infection. This method can be performed less painful compared with trans-jugular chest TIVAPs.

P07-36Discussion of factors effecting the stay length of venous port catheter for chemotherapy Assist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, Ufuk Yetkin1, Specialist Köksal Dönmez2, Prof.Dr. Öcal Berkan1


ObjectiveOncologic patients are subject to many venous interventions because of long therapy term and vein wall injury caused by chemotherapeutic agents. This situation resulted with preferring central venous lines for longer periods. Insertable port catheter is closed system which is located under the skin as a central venous line. This system is safer for chemotherapy, especially in patients with problematic peripheral veins. Also, with low infection rates, easy-to-use for longer periods, less reduction of patient’s daily activities, this system is more suitable and more generally used for daily and weekly chemotherapies at out-patient clinics.

MethodsBetween January 2013 and December 2015, 109 permanent port catheters for chemotherapy were placed to 98 patients with malignancy in our clinic. Mean age of patients were 51.63±11.45. Between these patients 57 of them were male (58,1%) and 41 of them were female (48,9%).

ResultsPort catheters were placed to all patients for chemotherapy due to malignancy. Mean follow-up term for ports was 386.46±268.713 days and mean stay length of port was 553.29±234.051days. Mean stay length of port catheters are between 61 and 512 days in literature. When compared to literature, our series has a longer port stay length.

ConclusionMaintenance and usage of port catheters must be performed with a strict protocol. Maximal care should be taken when inserting and extracting the needle. Especially blunt-tipped needles (ports with Huber needle), will reduce the risk of septum damage while inserting. Also, using ports with Huber needle, increases the success rates of therapy protocols and effective usage period of post catheters. Maintenance of catheter is directly involved with efficient usage period. Every step of usage must be handled with extreme caution.

P07-37En-bloc resection of tumors with infrahepatic vena cavaChun Ling Patricia Yih1, Dr Yuk Hoi Lam1, Prof Yun Wong James Lau1


Background and objectivesInvolvement of inferior vena cava (IVC) by tumors was thought to be a contraindication to resection. In many such patients, en bloc tumor resection with IVC is the only option. We report a series of patients who underwent such a resection.

MethodsAll patients who underwent en-bloc resection of infrahepatic IVC with tumours at a tertiary referral centre. Baseline, operative and postoperative data were analyzed.

ResultsThere were nine patients (M:F 3:6), at a median age of 58 at operation (range, 27-73). Median OT time was 480 minutes (range, 300-720), with a median transfusion requirement of 6 units (range, 2-16). Median size of tumour was 9cm (range, 3.5-19). Diverse pathology was noted including leiomyosarcomas (n = 3), schwannoma, para-ganglioneuroma, carcinoma of head of pancreas, chondrosarcoma, renal cell carcinoma and germ cell tumour (n = 1 each). Seven (78%) of the patients required concomitant visceral resection in addition to the caval resection (5 right nephrectomies, 2 duodenal resections). Complex vascular resection was performed in 2 patients (one aortocaval resection in para-ganglioneuroma, one IVC and right common iliac artery resection in chondrosarcoma). In all cases, the resected segment of IVC was reconstructed using prosthetic graft. Two patients had complications in the early postoperative period (1 duodenojejunostomy leakage, 1 subphrenic collection). There were no 30-day mortalities. The median follow-up was 57 months (range, 4-73), with 5 long-term survivors past 50 months.

ConclusionsEn-bloc resection of the infrahepatic IVC with tumours is a safe procedure with an acceptable risk of postoperative complications. Concomitant multi-visceral resections are often required. After a margin-free resection, long term survival is possible.


P07-38A Rare Case of Clostridium Perfringes Causing an Abdominal Aortic Graft InfectionIsmazizi Zaharudin, Zainal Ariffin Azizi1Vascular unit, Department of General Surgery, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia

Introduction Aortic graft infection with anaerobic organism is a rare incidence. The clinical implications, natural history, and optimal therapy of anaerobic infections are still unknown. Extensive review of the literature disclosed only one case of Clostridium perfringes aortic graft infection1. There are infrequent reports of aortic graft infection by anaerobic organism. The infection are closely related to large bowel pathologies.

Case reportWe are presenting a case report of a patient that was admitted under our care with an infected aortic graft following an emergency repair of a ruptured abdominal aortic aneurysm with underlying diverticular disease.

ConclusionAortic graft infection with anaerobic bacteria represents a clinical entity distinct from infection with enteric bacteria and Staphylococcus. Isolation of clostridia sp is closely related with large bowel pathologies. Optimal treatment and the natural history of anaerobic graft infection are still in the evolutionary stage.

Key words: aneurysm, diverticular disease, anaerobic organism

P07-39Traumatic Right Proximal Subclavian Artery Pseudoaneurysm Treated with Hybrid Procedure Ismazizi Zaharudin, Zainal Ariffin Azizi1Vascular Unit, Department of General Surgery, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur ,Malaysia , , Malaysia

IntroductionBlunt trauma to the right proximal subclavian artery is quite rare and tends to be associated with pseudoaneurysme formation post trauma .

Case ReportA 53 years old patient was admitted following a major road accident. Computed tomography (CT) and aortography on admission disclosed an right proximal subclavian artery pseudoaneurysm. The lesion was stable, so an elective endoluminal repair and carotid-carotid crossover bypass was undertaken as hybrid procedure once the patient was treated for his other injuries. The carotid-carotid crossover bypass was performed followed by the aneurysm was excluded by transluminal implantation of a balloon-expandable Atrium V12 covered stent-graft. A CT scan at 1 month and duplex scans at 6-month intervals documented good stent-graft positioning and aneurysm exclusion over a period of 12 months.

ConclusionThis case illustrates the potential durability of endovascular repair with carotid-carotid crossover bypass of innominate artery lesions and highlights the potential role of this minimally invasive alternative to surgery in these clinical situations.

Key words: Pseudoaneurysm, endovascular, bypass, hybrid procedure

P07-40A Case Report of Thrombotic May-Thurner Syndrome with Concomitant Extrinsic Compression - Multidisciplinary Hybrid ManagementSzymon Mikulski, D Lim, D Ho, YK Tan, S Kum

Introduction/BackgroundMay-Thurner syndrome (MTS) occurs when the left common iliac vein is compressed against the lower lumbar vertebrae by the right common iliac artery. It remains an underdiagnosed cause of uni-lateral left lower limb deep vein thrombosis (DVT). Treatment of thrombotic MTS is targeted at pre-vention of pulmonary embolism and of post-thrombotic syndrome (PTS) and is accomplished by ear-ly thrombus removal and iliac vein angioplasty with stent implantation.

Methods/ResultsWe report a case of a 46-year-old female who presented with extensive left lower limb DVT, sec-ondary to extrinsic compression of the left common iliac vein by a large uterine fibroid with concomi-tant MTS. The patient underwent an open hysterectomy, followed by femoral vein endophlebectomy, catheter-directed angiojet thrombolysis, followed by intravenous ultrasound and stenting of her left common iliac vein. To improve inflow and maintain stent patency, a common femoral artery to com-mon femoral vein loop arteriovenous graft (AVG) was created. The patient recovered well post-op and showed almost complete clinical resolution of her symptoms at two-week follow-up.

ConclusionThis report elucidates the successful use of a novel hybrid technique to treat extensive and symp-tomatic left lower limb DVT in the setting of MTS.

P08-01Endovascular Revascularization and Free Flap Reconstruction for Lower Limb SalvageChianan Hsieh1, Honda Hsu2, Chien-Hwa Chang3

1Department Of Nursing, Dalin Tzu Chi General Hospital, Dalin, Taiwan , 2Division of Plastic Surgery, Dalin Tzu Chi General Hospital, School of Medicine, Tzu Chi University, Dalin, Taiwan, 3Division of Cardiovascular Surgery, Dalin Tzu Chi General Hospital, Dalin, Taiwan

ObjectiveCombined bypass surgery with free flap reconstruction is an established method for lower limb salvage. But the success of combining endovascular revascularization together with free tissue transfer has not been well established.

Poster Presentation


MethodsRetrospective review of all patients who had undergone endovascular revascularization followed by reconstruction with a free flap for lower limb salvage at Dalin Tzu Chi General Hospital between April 2008 and April 2013 were included in the study.

ResultsTotal of 35 legs underwent limb salvage in 33 patients. There were 17 male and 16 female patients. Their average age was 72.5 years old. The average time interval between endovascular intervention till free tissue transfer was 8 days. There was 100% flap survival but partial flap necrosis was seen in 4 patients. A high rate of wound infection was seen in 10 patients. One patient died during the perioperative period. In one patient further limb amputation was required 6 months later due to acute thrombosis of her lower leg vessels. One patient underwent below knee amputation, 21 months later due to deep-seated foot infection. The overall limb salvage rate among 1-year survivors was 96%, and was 92% among the 2-year survivors.

ConclusionsThe success rate of lower limb salvage using a combination of endovascular revascularization together with free tissue reconstruction is acceptable with a high limb salvage rate, but requires team work between the vascular and the reconstructive surgeon

P08-02Can albumin level be a predictor of healing in patients with diabetic foot ulcers?Yin-Tso Liu1, Yi-Teen Wang1

1Asia University Hospital, Taiwan, Taichung City, Taiwan

BackgroundAlbumin has always been used worldwide for improving wound healing in recent years. It is well known that albumin has many physiological effects, including regulation of colloid osmotic pressure, binding and transportation of various substances. It is also well established that low serum albumin levels are associated with worse outcomes in ill patients. However, there is no good rationale for use of albumin in diabetic foot ulcers for wound healing. The purpose of this study is to try to find the relationship between serum albumin levels and wound healing.

MethodsWe reviewed 112 medical records with a diagnosis of diabetic foot ulcers (DFU) in a regional hospital. Every patient’s serum albumin level was collected upon admission. Of these cases, 42 patients’ albumin level were equal or greater than 3g/dl. The others’ albumin were below 3 g/dl. The primary outcome was the length of wound healing time. Secondary outcome was the length of hospital stay.

ResultsThere was a significant increase in granulation formation in the wound of elevated albumin group within the first month of treatment (P<0.05). Mean wound healing time in the elevated serum albumin group was 54.12 ±5.81 days. Those patients in the other group was 75.62 ± 9.22 days (P<0.05). At 30 days, 18 of 42 patients (42.8%) in the higher albumin group and 12 of 70(17.1%) patients achieved complete wound healing (P<0.05). No significant difference in secondary outcome was observed between the two groups.

ConclusionsAlthough routine replacement of albumin is not warranted in all patients, but there is a demonstrating outcome benefit. This study could provide some suggestions and guidance for albumin use based on the result of wound healing time in patients with diabetic foot ulcers. Albumin level could also be a predictor of complete wound closure in diabetic foot ulcers.

P08-03Predictive factor to determine the 12 months risk of major cardiovascular events after treatment for peripheral artery diseaseKittipan Rerkasem1,2, Dr. Supapong Arworn1, Dr. Pornchanok Jumroenketpratheep1, Associate professor Natapong Kosachunhanu1, associate professor Arintaya Phrommintikul1, Dr. Kiran Sony3, Dr. Nimit Inpankaew4, Ms Antika Wongthanee2, Dr Saranat Orrapin1, Dr. Termpong Reanpang1

1NCD Center, Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, 2NCD Center of Excellence, Research Institute of Health Science, Chiang Mai University, Chiang Mai, Thailand, 3Department of Internal Medicine, Chiangrai Prachanukroh Hospital, Chiangrai , Thailand, 4Department of Internal Medicine, Lamphun Hospital, Lamphun, Thailand

BackgroundPeripheral arterial disease (PAD) in diabetic patients is associated with high morbidity and mortality. Prognosis after treatment for PAD is mainly determined by the occurrence of major adverse cardiovascular events (MACE). Therefore the predictive factor of this MACE is important, but the study for such predictive factors are scarce in Asia.

ObjectiveTo identify the predictive factors determine MACE in diabetic patients with PAD

MethodThe prediction model was developed in a consecutive cohort of 500 diabetic patients in the Northern part of Thailand who were diagnosed as PAD between 2014 and 2015. Primary end point was MACE and encompassed non fatal myocardial infarction, non fatal stroke, worsening PAD and death. 16 potential clinical predictors were entered into a Cox proportional hazard model with backward stepwise regression was performed. This study was supported by Health Systems Research Institute (HSR) Thailand.

ResultDuring a mean follow-up of 12 months period, 55 events occurred, corresponding to a cumulative incidence of 15.4%. The number of death was 34 patients. Clinical predictors in the final model were history of gangrene or chronic ulcer (harzard ratio (HR) 2.3, 95%confidence interval (95%CI) 1.25-4.24), chronic kidney disease (HR2.15, 95%CI1.22-3.77), History of aortic surgery (HR 13.90, 95%CI 2.92-66.18), history of amputation of ischemic limb (HR 2.69(1.34-5.41), BMI<19 (HR2.62, 95%CI1.29-5.30) patients with history of taking warfarin (HR3.63,95%CI1.52-8.67), patients with history of taking sulfonylureas (HR0.32,95%CI0.14-0.70).


ConclusionThe clinical prediction model for MACE in the first 12 months after detection of PAD in diabetic patients may be used to identify high-risk patients to assist optimize medical treatment and risk factor control as part of secondary prevention to increase life expectancy free from MACE.

P08-04Negative Pressure Wound Therapy Instillation in Foot UlcersSivagame Maniya, Esther Sheau Lan Loh1Singapore General Hospital, Singapore

BackgroundNegative pressure wound therapy utilisation in wound care has been established over the years. Topical antiseptics have been proven useful to combat microbes in wounds. Biofilms Poly-microbial burdened wound beds are common in postoperative vascular wound beds. Biofilms are known to be present in chronic wounds and can responsible for chronic wound infections. Negative pressure wound therapy instillation with antiseptics irrigation may be an optimistic adjunct therapy in such bio-burdened wounds.

AimThis paper reports the preliminary findings of the combination of NPWT and antiseptics instillation use in postoperative wounds in diabetic patients with peripheral vascular disease.

MethodsThe three case studies reported here, underwent revascularization (angioplasty) and were treated with appropriate antibiotics accordingly. Patients who had positive postoperative tissue cultures in their wounds were initiated with NPWT instillation. The decision for the type of antiseptic use was decided based on the culture result. The amount of solution was dependent on the size of the wound bed and the frequency of the intermittent irrigation ranged between 4-6 hourly.

ResultsNPWT instillation was discontinued in patients when surface granulation was achieved and subsequently appropriate dressing products was applied for the patients. Patients 1 and 2 achieved wound closure. Patient 3 Lisfranc amputation wound was noted to be progressing on last follow-up visit.

ConsiderationsThe amount of solution instillation and frequency has to be assessed with each dressing change. Periwound protection is imperative with NPWT instillation dressings.

ConclusionNegative Pressure Wound Therapy instillation with antiseptics may be beneficial in controlling bacterial burden and promoting granulation in postoperative vascular wounds.

P09-01Guidelines for Carotid Artery Interventions Must Be RevisedKoksal Donmez1, Dr. Habib Cakir1, Dr. İsmail Yurekli1, Dr. Mert Kestelli1, Dr. Bortecin Eygi1, Dr. Bilge Birlik2, Dr. Ersin Celik3

1Department Of Cardiovascular Surgery, Katip Celebi University Izmir Ataturk Training And Research Hospital, Izmir, Turkey, 2Department Of Radiology, Katip Celebi University Izmir Ataturk Training And Research Hospital, Izmir, Turkey, 3Department Of Cardiovascular Surgery, Afyonkarahisar State Hospital, Afyonkarahisar,Turkey, Afyonkarahisar, Turkey

IntroductionWe investigated studies to explain cerebral perfusion and perfusion pattern after carotid artery occlusion and clamping at surgery. Circle of Willis acts as a safety switch for brain tissue. Incompleteness of circle of Willis or hypoplasia of arteries building the circle is very important.

ObjectivesDue to two important articles, we aimed to present this paper.

MethodTwo recent studies (1,2) were examined. These studies represented a very important anatomic variation. [1] BioMed Chuanya Qiu, Yong Zhang, Caixia Xue, Shanshan Jiang, and Wei Zhang. “MRA study on variation of the circle of willis in healthy Chinese male adults”. Research International, Volume 2015, Article ID 976340Non-integrity of posterior circulation rate was found as 83,9%. [2] Naveen SR, Bhat V, Karthik GA. “Magnetic resonance angiographic evaluation of circle of Willis: A morphologic study in a tertiary hospital set up. “ Ann Indian Acad Neurol 2015;18:391-7Completeness of anterior circulation was found as 77,3%, completeness of posterior circulation was found as 33%. Isolated posterior circulation was found in 32,6% of the patients.Isolated hypoplasia of arteries of anterior circle of Willis was 11,6%. Hypoplastic arteries accompanying incomplete circle of Willis is 15,6%.

ResultsAs vascular surgeons, we ignore incompleteness of Circle of Willis. This variation is more common than we thought.

ConclusionWe believe that due to high incompleteness rates, Circle of Willis must be evaluated in all patients who are candidates for carotid interventions or surgery. Carotid angiography is essential for evaluating intracranial arteries.

Poster Presentation


P09-02Our surgical strategy in a smoker patient with severe left internal carotid artery stenosis Kazim Ergunes1, Dr Orhan Gokalp1, Dr Ihsan Peker1, Dr Habib Cakır1, Dr Yasar Gokkurt1, Dr Banu Lafci1, Prof Levent Yilik1, Prof Ali Gurbuz1


BackgroundThe carotid artery stenosis is associated with severe morbidity and mortality .We presented a smoker patient with severe left internal carotid artery stenosis .

MethodA 70-year-old woman was hospitalized in ourclinic on February 15, 2016. She had chronic obstructive pulmonary disease. The electrocardiography showed sinus rhythm. She had ischemic stroke six years ago. The angiography showed severe left internal carotid artery stenosis (Figure 1).

ResultsCarotid endarterectomy was performed with regional anesthesia. An arteriotomy was made on the anterior wall of the left common and internal carotid arteries extending to the region not including plaque. The left internal carotid endarterectomy was performed without using shunt. Arteriotomy was closed with Dacron patch. The patient was discharged after three days with clopidogrel and aspirin.

ConclusionCarotid endarterectomy is effective and safe method in appropriate patients. Careful and appropriate dissection of carotid artery is important to decrease morbidity.

P09-03Analysis of Risk Factors for Cerebral Microinfarcts After Carotid Endarterectomy and the Relevance of Delayed Cerebral InfarctionJun Gyo Gwon1

1University Of Ulsan College Of Medicine, Asan Medical Center, Seoul, South Korea

BackgroundCarotid endarterectomy (CEA) is performed to prevent cerebral infarction; however, cerebral microinfarcts are a common side effect of CEA.

ObjectivesThis study aimed to analyze the variables related to microinfarcts during CEA as well as to determine their association with delayed postoperative infarction.

Materials and MethodsThis was a retrospective review of prospectively collected data from 548 patients who underwent CEA. Patient clinical characteristics, incidence rates, and microinfarcts causes were analyzed. Microinfarcts were diagnosed by diffusion-weighted magnetic

resonance imaging. The microinfarcts-positive and -negative groups were compared for delayed postoperative infarction.

ResultsA total of 76 (13.86%) patients were diagnosed with microinfarcts. Preoperative neurological symptoms were significantly related to the incidence of microinfarcts [odds ratio (OR), 2.93; 95% confidence interval (CI), 1.72–5.00; p < 0.001]. Shunt insertion during CEA was the only significant procedure-related risk factor (OR, 1.42; 95% CI, 1.00–2.19; p = 0.05). The presence of microinfarcts did not significantly increase the incidence of delayed postoperative infarction (p = 0.204).

ConclusionsIn the present study, risk factors for microinfarcts after CEA included preoperative symptoms and intraoperative shunt insertion. Microinfarcts was not associated with delayed postoperative infarction.

P09-04Clinical value (or utility) of preoperative carotid ultrasonography prior to operation for abdominal aorta aneurysm and peripheral artery diseaseProf. Hyuk Jae Jung1, Yong Beum Bak1, Dr. Dong Hyun Kim1, Prof. Sang Su Lee1


BackgroundCarotid ultrasonography (CUS) is one of useful screening modality for internal carotid artery stenosis (ICAS) associated with vascular disease. We assessed severe (>70%) ICAS by type of vascular surgery, lesion of peripheral artery disease (PAD), and ankle brachial index (ABI).

Material and MethodsFrom 2011 to 2015, we retrospectively evaluated 341 patients who underwent preoperative CDS for vascular surgery. Radiologist estimated degree of ICAS using ECST. We compared the prevalence of severe ICAS between abdominal aortic aneurysm (AAA) and PAD, and evaluated risk factors of ICAS in PAD patients. For statistical analysis, data were tested by multiple logistic regression analysis and Chi-square test.

ResultsPrevalence of severe ICAS was significantly higher in PAD compared to AAA (15.2% vs. 7.3% ; P = 0.041). Among 231 PAD patients, multi-level lesion revealed significantly higher incidence of severe ICAS than iliac and infrainguinal lesion (22.5% vs. 9.4% vs. 8% ; P = 0.016). chronic kidney disease (CKD, OR:6.19, 95% CI: 1.47-26.06: P = 0.013) and cerebral vascular disease (CVD, OR:4.08, 95% CI: 1.09-15.30: P = 0.037) were significant risk factors of severe ICAS in multivariate analysis. Prevalence of severe ICAS according to ABI in PAD was not significant.

ConclusionsCUS can be a useful non invasive preoperative screening imaging tool for PAD patients with multi-level lesion, CKD, and CVA


P09-05Impact of subclinical coronary artery disease on the clinical outcomes of carotid endarterectomyMinsu Noh1

1Asan Medical Center, Seoul, South Korea

IntroductionControversy persists regarding the optimal management of subclinical coronary artery disease (CAD) prior to carotid endarterectomy (CEA) and the impact of CAD on clinical outcomes after CEA.

ObjectivesThis study aimed to evaluate the short-term surgical risks and long-term outcomes of patients with subclinical CAD who underwent CEA.

Materials and MethodsThe authors performed a retrospective study of data from a prospective CEA registry. They analyzed a total of 702 cases involving patients without a history of CAD who received preoperative cardiac risk assessment by radionuclide myocardial perfusion imaging (MPI) and underwent CEA over a 10-year period. The management strategy was determined according to the presence, severity, and extent of CAD as determined by preoperative MPI and additional coronary computed tomography angiography and/or coronary angiography. Perioperative cardiac damage was defined on the basis of postoperative elevation of the blood level of cardiac troponin I (0.05–0.5 ng/ml) in the absence of myocardial ischemia. The primary endpoint was the composite of any stroke, myocardial infarction, or death during the perioperative period and all-cause mortality within 4 years of CEA. The associations between clinical outcomes after CEA and subclinical CAD were analyzed.

ResultsConcomitant subclinical CAD was observed in 81 patients (11.5%). These patients did have a higher incidence of perioperative cardiac damage (13.6% vs 0.5%, p < 0.01), but they had similar primary endpoint incidences during the perioperative period (2.5% vs.1.8%, p = 0.65) and similar estimated 4-year primary endpoint rates (13.6% vs 12.4%, p = 0.76) as the patients without subclinical CAD. Kaplan-Meier survival analysis showed that the 2 groups had similar rates of overall survival (p = 0.75).

ConclusionsPatients with subclinical CAD can undergo CEA with acceptable short- and long-term outcomes provided they receive selective coronary revascularization and optimal perioperative medical treatment.

P09-06Review of 99 consecutive carotid endarterectomies in a moderate volume centreYongxian Thng1, Joel Lee1, Dr Julian Wong1

1Nuh, Singpore, Singapore

IntroductionCarotid endarterectomy has been established by 2 randomised controlled trials ECST ( European carotid surgery trial ) and NASCET ( North American Symptomatic Carotid Endarterectomy trial ) as an important surgical procedure in preventing disabling strokes. It has been suggested that for good surgical outcomes carotid endarterectomies should only be performed in high volume centres.

AimTo review the outcome of a consecutive series of patients undergoing carotid endarterectomies in a moderate volume setting.

MethodsA retrospective case review was performed from 2005 to 2015. During which we performed 99 elective carotid endarterectomies on patients with severe carotid stenosis. Follow-up data was mostly attained from the outpatient setting.

ResultsThe mean age was 69 with the age range from (41 to 86). 85% of the patients were Chinese, 10 % were Malays and 5% were Indians. There were no deaths in this series of 99 cases. All our patients came through surgery without major neurologic deficit. One patient had a peri-operative TIA and two other patients developed neck hematomas.

ConclusionCarotid endarterectomies can be safely performed in moderate volume hospitals with excellent outcomes.

P10-01Endovascular aortic aneurysm repair (EVAR): the National Kidney and Transplant Institute (NKTI) experience from 2013 to 2014Dr Benito Purugganan Jr1, Edgar Macaraeg1, Dr. Ricardo Jose Quintos1, Dr. Leo Carlo Baloloy1, Dr. Marc Anter Mejes1


BackgroundEndovascular aortic aneurysm repair (EVAR) is an emerging technique worldwide. NKTI is one of the pioneers of EVAR in the country. This study will document the outcomes of EVAR done and demonstrate its possible advantages.

ObjectivesTo show the clinical results, perioperative complications and parameters of patients at NKTI who underwent EVAR from 2013 to 2014.

Poster Presentation


Materials and MethodsThis is a retrospective descriptive study of EVAR cases at NKTI from 2013 to 2014.

A chart review was done wherein significant data were obtained needed for the study.

ResultsThere were ten cases of EVAR done at NKTI from 2013 to 2014. Eight of these cases were abdominal aneurysms while two of the cases involved the thoracic aorta.

The average duration of procedure is 4 hours and 22 minutes. In terms of blood loss, the mean blood loss is 415ml. Out of 10 patients, only 3 required blood transfusions. All patients were admitted at the intensive care unit post-operatively. Four out of the ten patients required mechanical ventilation post-operatively. The average hospital stay for all 10 cases is 8 days.

In terms of morbidity, none of the cases had surgically related morbidities. One of the ten cases died due to a complicated case of suprarenal aneurysm with concomitant lower gastrointestinal bleeding and pneumonia.

ConclusionThe experience of NKTI on EVAR is still limited but it continues to grow and expand. Despite the limited number of cases, data shows better outcome.

Keywords: Aortic Aneurysm, Endoleak, length of stay, Intensive Care Unit (ICU), Hypertension

P10-02Horns of a dilemma: Follow-up or surgery for aortic intramural hematoma?Nur Dikmen Yaman1, Mehmet Cakici1, Evren Ozcinar1, Cagdas Baran1, Levent Yazicioglu1, Bulent Kaya1


IntroductionManagement of aortic intramural hematoma remains controversial.Most surgeons advocate emergency surgery in manner similar to frank to acute aortic dissection.

MethodsA 63-year-old female with hypertension and recent coronary artery bypass was admitted complaining of angina.Initial troponin was normal.Patient was transferred to cardiovascular intensive care unit where echocardiogram showed normal function,no significant valvular abnormalities,suspected intramural hematoma,aortic wall thickening.Shortly thereafter,CT revealed ascending aortic aneurysm of 50 mm in arch,heterogeneous aortic wall was visualised-12 mm hyperdense area most likely resulting from IMH at ascending aorta,extending down to descending.Maximal medications was given,CT was performed serially,demonstrated stable hematoma.Patient was discharged with optimal medications.On follow-up,15 days after discharge,she had similar complaints.CT showed intimal tear,dissection flap at ascending aorta on area of previous IMH.Based on clinics,patient was scheduled for urgent replacement of aorta.Procedure conducted in extracorporeal circulation,under deep hypothermia.After axiller artery and

femoral vein cannulation and clamping aorta,aneurysmal sac was excised,dissection extending from aortic bulb was visualised.Supracoronary tubuler graft interposition implanting 28mm graft,suturing outlet of saphenous venous coronary bypass to right and left coronary artery trunk end-to-side of prosthesis was performed.Patient was discharged in good condition.

ConclusionManagement and outcomes differ about types.Type B IMH has favorable outcomes in comparison with type A IMH and type B AD.These don’t mean type B IMH is benign.Rates to progression to AD are variable both in frequency and time.11% progressing from IMH to AD is described in among published series.Treatment selection is challenging and should be based on comprehensive evaluation.

P10-03Anatomical characteristics of an infra-renal abdominal aortic aneurysm: Can an aneurysm that is prone to enlargement after endovascular aneurysmal repair be predicted?MD Sang Young Chung1, MD Ho Kyun Lee1, Soo Jin Na Choi1


Background/ IntroductionAn attempt was made to identify the morphological determinants of an infra-renal AAA, which could result in aneurysmal sac expansion after EVAR.

ObjectivesThis study was conducted to identify the anatomical characteristics of an infra-renal abdominal aortic aneurysm (AAA) that may cause a poor result of endovascular aneurysmal repair (EVAR).

Materials and MethodsThe datasets of 60 patients were retrospectively analyzed. All the patients were underwent EVAR for an infra-renal AAA, followed by computed tomography angiography (CTA), at a routine schedule of more than a year. With the final follow-up CTA findings, the EVAR results were classified into three groups [Group I that showed a more than 10% aneurysm shrinkage, Group II that showed minimal (less than 10%) or no aneurysmal area change; and Group III that showed a more than 10% post-EVAR aneurysmal expansion] and then re-classified into two groups (Group A that showed no post-EVAR aneurysmal expansion and Group B that showed post-EVAR aneurysmal expansion).

ResultsThe proximal neck length was significantly shorter in Group I than in Group II and Group III (p = 0.016). Moreover, the AAA in Group I showed a much larger maximum aneurysm lumen diameter (p = 0.017) and area (p = 0.009) than that in the other groups. The proximal neck length of Group A was significantly shorter than that of Group B (p = 0.004). In the binary regression test, the shorter proximal aortic neck length was the only statistically significant difference, with an odds ratio of 0.436.

ConclusionsAn AAA with a shorter proximal aortic neck and a larger lumen diameter/area could result in AAA sac expansion after EVAR.


P10-04Can EVAR replace open repair as primary treatment for abdominal aortic aneurysm?Professor Sung Woon Chung1, Associate professor Chung Won Lee1, Fellow Up Huh1, Resident Joohyung Son1

1Pusan National University School Of Medicine, Pusan National University Hospital, Busan, South Korea

Background With significant reduction in the number of open aneurysm repairs, endovascular aneurysm repair (EVAR) has dramatically transformed the management of abdominal aortic aneurysm (AAA). This paper compares the demographics, operative data, complications, and mortalities associated with AAA after treatment with open repair and EVAR.

Methods A retrospective review was performed on 136 patients with AAA who were treated with either open repair or EVAR over a period of eight years

ResultsMean age in the EVAR group was higher than that in the open repair group (p = 0.001). Hospital mortality showed no significant difference between the groups (p = 0.360). However, the overall survival rate was significantly lower in the EVAR group (p = 0.033). In 21 cases of ruptured AAA, two patients underwent EVAR and 19 patients underwent open repair. The two patients who underwent EVAR are still alive (follow-up duration, 49 months and 24 months). Mortality rate associated with open repair in ruptured AAA was 52.6%.

Conclusion It would be ideal to set stricter criteria for EVAR, particularly for younger patients. EVAR seems to be more advantageous in cases of emergency ruptured AAA rather than as an elective procedure.

P10-05Stent assisted Coil Embolization of a Large, Saccular, Suprarenal Aortic Aneurysm with Walled off Rupture: A Case ReportAlinaya Cordero1, Dr Fabio Enrique Posas1

1Heart Institute, St. Luke’s Medical Center, Global City, Taguig City, Philippines

Background/ IntroductionSuprarenal and thoracoabdominal aortic aneurysms portray significant surgical challenges given their anatomical locations and associated difficulties with surgical procedure. In patients with suitable anatomy, or prohibitive surgical risk, endovascular aneurysm repair offers a less invasive alternative. Special strategies are needed to attain favorable repair outcome.

ObjectivesWe report a case of a 59 year old male with a large, suprarenal, saccular aortic aneurysm with probable walled off rupture who underwent aneurysm repair with stent assisted coil embolization technique. Surgical repair in this case otherwise required thoracoabdominal incisions, intensive dissection and cross-clamp above the celiac trunk.

Materials and MethodsStent assisted coil embolization is a novel approach in the management of complex, life threatening abdominal aortic disease such as this case.

ResultsOn follow-up, patient remains asymptomatic with evidence of sac thrombus on follow-up CT Angiogram of the abdomen, two months after the procedure.

ConclusionsStent assisted coil embolization of saccular, suprarenal aortic aneurysm is a promising technique of abdominal aneurysm repair for patients with difficult and complex surgical anatomy. The long-term impact will be defined via serial CT-scan follow-up.

P10-06Hybrid Operation for Juxta-renal Aortic Aneurysm with Fragile NeckIda Bagus Budiarta1, MD Djony Edward Tjandra1


BackgroudThe proximal aortic neck is one of the limiting factors for endovascular aneurysm repair (EVAR) and represents a crucial factor for success or failure of the procedure. A hybrid procedure was chosen: juxtarenal aortic banding and EVAR. The banding allowed a successful EVAR by reshaping the juxtarenal aneurysmal aortic segment for the treatment endoleak type 1. The EVAR of juxtarenal aneurysms could be performed through fenestrated endovascular repair or “chimney or snorkel” technique.

Case ReportA 70-years-old male with hypertention due to pulsatile abdominal mass since 2 years ago.

From Physical examination there was palpable pulsatile mass, at the upper left abdomen about 8x12 cm. From CTA there was proximal landing zone RRA 6,1 mm, Neck diameter 31,4 - 31,9 mm, the largest diameter 60,7 - 60,9 mm, from renal artery to bifurcatio aorta 157,8 mm, diameter of bifurcatio 28,6 mm, calsification of RCIA and LCIA, diameter of RCIA 10,2-11,3 mm and LCIA 10,1-10,8 mm.

We did the procedure with local anaesthesia. We started EVAR procedure from the right femoral artery, we use main body and extention for the right leg and left leg. A hybrid procedure was chosen: juxtarenal aortic banding and one-stage EVAR.

ResultThe patient tolerated the procedure well and was discharged home on day 7. Subsquent postoperative CTA will be heald after 3 month as a first evaluation.

ConclusionEVAR combined with juxtarenal aortic banding is the ideal modalities procedure which minimally invasive for the treatment of AAA with endoleak type 1.

Poster Presentation


P10-07Aortoiliac Unigraft with Femoro-femoral Bypass Graft on Case Abdominal Aortic Aneurysm with Ruptured Right Common Iliac Aneurysm – Case ReportKemas Dahlan1, MD Raden Suhartono1


Background Endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is a minimally invasive, an alternative approach to major open repair, and the preferred choice for those with multiple comorbidities. However, the technique is challenging when encountering concomitant iliofemoral occlusive diasease.

Case Report We report a 75-years-old man who had asymptomatic infrarenal AAA.The patient had history of smoking, COPD, hypertension, and previous CABG.Physical examination revealed pulsatile abdominal mass, diminished pulse of the left femoral and popliteal arteries and non-palpable pulse of the pedal arteries. The CTA showed infrarenal AAA with largest diameter of 60 mm, 20 mm proximal neck length, but has small terminal aorta (15 mm), total occlusion of the left CIA and stenotic lesion of the right CIA (5.4 mm).

Under local anaesthesia, multiple attempts to pass the left CIA occlusion through the left and right femoral accesses using 0.035” angled guidewire failed to enter the true lumen of the aorta. Through the left brachial access, using co-axial catheter system and 0.018” extra support wire, the occlusion could be traversed. EVAR using bifurcated endograft was successfully performed. Control angiography shows limiting flow dissection in the left EIA that was treated by stent placement.

ResultAfter the procedure, the left pedal arteries were normally palpable. The patient was discharged uneventfully at post-operative day 4. No complications were observed at 1 month follow-up.

ConclusionEven though complicated, difficult, required skill-full vascular surgeons and resources,bifurcated endograft placement could avoid several complications associated with femoro-femoral bypass graft.

P10-08Endovascular Repair Using Bifurcated Endograft for Abdominal Aortic Aneurysm with Concomitant Total Occlusion of the Common Iliac ArteryKemas Dahlan1, MD Raden Suhartono1


Background Endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is a minimally invasive, an alternative approach to major open repair, and the preferred choice for those with

multiple comorbidities. However, the technique is challenging when encountering concomitant iliofemoral occlusive diasease.

Case Report We report a 75-years-old man who had asymptomatic infrarenal AAA.The patient had history of smoking, COPD, hypertension, and previous CABG.Physical examination revealed pulsatile abdominal mass, diminished pulse of the left femoral and popliteal arteries and non-palpable pulse of the pedal arteries. The CTA showed infrarenal AAA with largest diameter of 60 mm, 20 mm proximal neck length, but has small terminal aorta (15 mm), total occlusion of the left CIA and stenotic lesion of the right CIA (5.4 mm).

Under local anaesthesia, multiple attempts to pass the left CIA occlusion through the left and right femoral accesses using 0.035” angled guidewire failed to enter the true lumen of the aorta. Through the left brachial access, using co-axial catheter system and 0.018” extra support wire, the occlusion could be traversed. EVAR using bifurcated endograft was successfully performed. Control angiography shows limiting flow dissection in the left EIA that was treated by stent placement.

ResultAfter the procedure, the left pedal arteries were normally palpable. The patient was discharged uneventfully at post-operative day 4. No complications were observed at 1 month follow-up.

ConclusionEven though complicated, difficult, required skill-full vascular surgeons and resources,bifurcated endograft placement could avoid several complications associated with femoro-femoral bypass graft.

P10-09Our surgical strategy in a patient with hypertension having acute Type A aortic dissection Dr Kazim Ergunes1, Prof. Levent Yilik1, Dr Ismail Yurekli1, Dr Banu Lafci1, Dr Habib Cakir1, Dr Hasan Iner1, Dr Yasar Gokkurt1, Prof Ali Gurbuz1


ObjectiveType A aortic dissection is stil a devastating disease, which mortality rate following medical management reaches to 50% within the first 48 h. We present a case of a 40 year-old female patient with hypertension having an acute Type A aortic.

MethodsA 40-year-old female was hospitalized in our clinic in January, 2016. She had hypertension and chest pain. Echocardiography showed dissection flap in ascending aorta. CT-Scan revealed type A aortic dissection.

ResultsShe had Type A aortic dissection with intimal tear at proximal region of the ascending aorta. Native aortic valve was normal in function. Arterial cannulasyon was performed via right axillary artery. The right atrium is cannulated with a standard two-staged venous cannula. Ascending aorta was replaced by 26 mm Dacron tube


graft between supracoronary and distal ascending aorta by using hypothermic circulatory arrest and antegrade selective cerebral perfusion. Postoperative period was event-free. The patient was discharged on 12th postoperative day with acetilsalicylicasit and metoprolol treatment.

ConclusionsDacron tube graft replacement between supracoronary and distal ascending aorta by using hypothermic circulatory arrest and antegrade selective cerebral perfusion can be performed without morbidity and mortality.

P10-10Emergent debranching TEVAR to treat ruptured Stanford type B acute aortic dissectionOnichi Furuya1, Shinnichi Higashiue1, Satoshi Kuroyanagi1, Masatoshi Komooka1, Masahide Enomoto1, Saburo Kojima1, Naohiro Wakabayashi1


IntroductionA mortality of emergency surgery for ruptured Stanford type B acute aortic dissection is generally sever, lifesaving cases with thoracic endovascular aortic repair (TEVAR) have been reported. However, in emergent TEVAR, the order and whether or not to perform debranching methods for aortic arch branches is a problem. We report two cases of ruptured Stanford type B acute aortic dissection that could be treated by emergent TEVAR with left subclavian artery reconstruction.

CasesCase 1. A 79-year-old man was transferred with chest discomfort. A computed tomography (CT) scan showed a patent false lumen in the descending aorta with a mediastinum hematoma and in both sided hemothorax. We performed TEVAR (Zenith TX2 endovascular graft / COOK medical, Inc.) with left subclavian artery reconstruction by right-to-left axillary artery bypass and coil embolization of left subclavian artery. The vital signs ware stable, we performed left subclavian artery reconstruction before the stent-graft deployment. Operation time was 213 minutes. After surgery without complications, in good course. He was safely discharged. Case 2. A 71-year-old man was transferred with back pain and shock. A CT scan showed a thrombosed false lumen in the descending aorta and extensive left-sided hemothorax. We performed TEVAR (Zenith TX2 endovascular graft) with left subclavian artery reconstruction by right-to-left axillary artery bypass and coil embolization of left subclavian artery. The body pressure was able to be maintained by blood transfusion and catecholamine use, we performed left subclavian artery reconstruction before the stent-graft deployment. Operation time was 233 minutes. After surgery without complications, in good course. He was safely discharged.

ConclusionDebranching TEVAR for ruptured Stanford type B aortic dissection was able to be a life-saving alternative without complications in comparison with conventional open surgery.

P10-11Endovascular repair of an isolated common iliac aneurysm in 70 patientsSoichiro Hase1, MD., Ph. D. Tassei Nakagawa1, MD., Ph. D. Motoshige Yamasaki1, MD. Yumi Kando2, MD., Ph. D. Mutsumu Fukata2, MD., Ph. D. Professor Hiroshi Nishimaki3

1Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan, 2Numazu City Hospital, Numazu, Japan, 3St.Marianna University School of Medicine , Kawasaki, Japan

IntroductionIsolated common iliac artery aneurysms (CIAAs) occurring in the absence of abdominal aortic aneurysm are rare, and potentially lethal if they rupture. Recently, endovascular aneurysmal repair (EVAR) of CIAAs has emerged as an alternative to open repair. ObjectivesTo evaluate the clinical results in EVAR of CIAAs retrospectively. Materials and MethodsBetween June 2009 and April 2016, 70 patients (56 males) underwent EVAR for isolated CIAAs. The age ranged from 52 to 90 years (mean, 73.2 years). Unilateral involvement of CIAA was seen in 48 patients (69%), with bilateral involvement in the remaining 22 patients (31%). Internal iliac artery involvement was seen in 37 patients (39%). The maximum diameter of aneurysm ranged from 23 to 55 mm (mean, 35 mm). The bifurcated endograft in 46 (66%), iliac stent-graft deployment in 18 (26%), and others in 5 patients (9%) were used. The follow-up CT was performed at discharge, 3, 6, and 12 months and annually thereafter.

ResultsThe mean follow-up period was 634 days (range, 30-2496). Technical success was achieved in all 70 patients (100%). Aneurysm related death and aneurysmal enlargement (>5 mm) were not observed during follow-up. In 29 CIAAs (33%), shrinkage of aneurysmal sac was observed. CT endoleaks emerged in one at discharge, and three patients at follow-up.

ConclusionsEndovascular repair of an isolated common iliac aneurysm is safe and effective with a favorable mid-term result.

P10-12Successful thoracic endovascular aortic repair for acute type B aortic dissection complicating critical lower limb ischemiaYutaka Hasegawa1, Ezure Masahiko1, Yasuyuki Yamada1, Syuichi Okada1, Shuichi Okonogi1, Hiroyuki Morishita1, Yuriko Kiriya1, Tatsuo Kaneko1, Ren Kawaguchi1

1Gunma Prefectural Cardiovascular Center, Maebashi, Japan

Case ReportA 67-year-old man complained of sudden back pain and subsequent severe leg pain and he was taken to a neighboring hospital. An enhanced computed tomography (CT) showed acute B-AD. The true lumen of the abdominal aorta was compressed by the expanded false lumen, and bilateral iliac arteries were occluded. He was brought to our hospital and underwent an emergent operation. An intravascular ultrasound catheter was introduced by percutaneous

Poster Presentation


puncture of his right femoral artery, and the true lumen of the aorta was confirmed. Then his proximal entry tear was covered by a Gore TAG stent graft, subsequently two self-expanding noncovered Zenith Dissection endovascular stents were placed into the descending to the abdominal aorta to extend his true lumen. Seven hours after the onset, the blood flow of his lower limb and his symptoms were dramatically improved though he required complementary stenting to the left external iliac artery for persistent static malperfusion, Immediately after the operation, continuous hemodiafiltration (CHDF) was introduced for the treatment of reperfusion injury. The serum creatinine phosphokinase level elevated to 42,319 IU/L on postoperative day (POD) 1, and gradually decreased. CHDF was terminated on POD 6, and he was discharged ICU on POD 8. Postoperative enhanced CT showed that the patient’s true lumen was expanded and his blood flow to the true lumen and both iliac arteries was improved. The patient had uneventful postoperative course without myonephropathic metabolic syndrome and the limbs were salvaged. His state was still stable six months later, and remodelling of the thoracic to abdominal false lumen was obtained.

ConclusionTEVAR with Zenith Dissection endovascular stent can become one of the effective treatments for complicated acute B-AD.

Key words: acute aortic dissection, limb ischemia, thoracic endovascular aortic repair, Zenith Dissection endovascular stent

P10-13Outcomes of abdominal aortic aneurysms surgery requiring suprarenal aortic cross-clamping and their effect of postoperative renal functionSoichiro Henmi1, Hitoshi Matsuda1, Hidekazu Nakai1, So Izumi1, Masamichi Matsumori1, Hirohisa Murakami1, Masato Yoshida1, Nobuhiko Mukohara1

1Hyogo Brain And Heart Center At Himeji, Himeji-shi, Japan

BackgroundFew large series document surgical outcomes for patients with pararenal abdominal aortic aneurysms (PAAAs) that require suprarenal aortic clamping.

ObjectivesWe assessed early and long-term surgical outcomes of open repair in patients with pararenal abdominal aortic aneurysms and their postoperative renal function.

MethodsA retrospective review was performed of all patients underwent open replacement of abdominal aortic aneurysm required suprarenal aortic clamping between 2007 and 2015.

ResultsSeventy six patients were identified (men, n=62) with a mean age was 74years old. Mean aneurysm size was 54.5mm. 6 patients (8%) underwent hemodialysis (HD). Severe CKD (eGFR40) was 10 patients (14%), moderate CKD (40eGFR60) was 22 patients (31%), and Mild-non CKD (eGFR60) was 38 patients (54%). 31 patients(41%) required supra bilateral renal artery clamping and 45 patients(59%) required supra lateral renal artery clamping. Mean

cross-clamp time was 34±10 minutes. Renal artery reconstruction were needed 5 patients (7%) and renal artery bypass underwent 2 patients (3%). In-hospital mortality was 0% and all patients didn’t need CHDF or HD during perioperative period. Mean serum creatinine was 0.95mg/dl at pre-operative, 1.24mg/dl at maximum level during post-operative, and 0.97mg/dl. Serum creatinine levels among each CKD group were no significant difference between at preopearive and at discharge(Severe CKD:1.5mg/dl - 1.5mg/dl; p=0.39, Moderate CKD:1.1mg/dl - 1.1mg/dl; p=1.0, Mild-non CKD:0.7mg/dl - 0.7mg/dl; p=0.92). Mean follow-up period was 54 months. Three years survival was 86%, and six years survival was 71%. Freedom from denovo HD was 100%.

ConclusionsEarly and late outcomes of open surgery in patients with pararenal abdominal aneurysms were acceptable. Clamping renal artery around 35 minutes was not adverse effect on renl function after open surgery.

P10-14Facilitation of Approach to the Arch Vessels in Aortic Arch TranslocationMitsuharu Hosono1

1Kansai Medical University Medical Center, Moriguchi, Japan

Background and Objective The strategy for treatment of thoracic aortic aneurysms has recently changed in association with widespread use of the stent graft. In our institute, we sometimes adopt aortic arch translocation using an elephant trunk or open-stent-graft for aortic arch disease. In such operations, however, it is difficult to secure the operative field for the arch vessels in some cases because the aortic arch and aneurysm have not been incised open. We herein report how to facilitate the approach to the arch vessels in aortic arch translocation.

Patients and Methods We reviewed seven patients who underwent aortic arch translocation using an elephant trunk or open-stent-graft. Five patients had a distal aortic arch aneurysm and three had an aortic dissection. Concomitant coronary artery bypass grafting was performed in two patients. All operations were performed via a median sternotomy incision. After establishment of cardiopulmonary bypass, the body temperature was cooled to 26°C. Under selective antegrade cerebral perfusion, the aortic arch was transected and the elephant trunk or open-stent-graft was inserted and fixed. Three- and two-arch-vessel reconstruction was performed in five and two patients, respectively. The skin incision was extended by 2 or 3 cm toward the left upper side to facilitate the approach to the arch vessels. Furthermore, the sternohyoid and sternothyroid muscles were partially incised. The operative field around the left carotid and subclavian arteries was secured with these procedures.

Results The mean operation time was 380.1 minutes, mean cardiopulmonary bypass time was 198.0 minutes, and selective antegrade cerebral perfusion time was 127.4 minutes. No hospital deaths occurred. Recurrent nerve palsy was observed in one patient. Neither cerebral infarction nor respiratory complications were observed.

Conclusion Our technique to secure the operative field for the arch vessels during aortic arch translocation was easy and effective.


P10-15Case report: Successful medical treatment in a case of aortic infection after thoracic endovascular aortic repair (TEVAR)Yung-Kun Hsieh1, Dr Chun-Ming Huang2, Dr Chien-Hui Lee1, Dr Ying-Cheng Chen1, PhD Ing-Sh Chiu1

1Changhua Christian Hospital, Puyang St., Changhua City, Taiwan , 2MinShen Hospital, Taoyuan, Taiwan

Case ProfilesA 76-year-old Malaysian man presented to our emergency unit with acute severe back pain. Chest CT showed a penetrating aortic ulcer (PAU) over proximal descending aorta while other laboratory studies were unremarkable. He received emergent thoracic endovascular aortic repair (TEVAR) and was discharged 5 days after the operation. Post-operative course was uneventful, complete obliteration of PAU was demonstrated in post-operative CT image . However, spiking fever occurred 1 month later. Blood culture revealed Group D Salmonella. Under the impression of infected aortic aneurysm with PAU status post TEVAR, we chose intravenous Ceftrixone for 6weeks followed by oral Ciprofloxacin for 4 months instead of aortic stent removal. Under antibiotic treatment, the fever completely subsided 2 weeks later and the PAU remained completely obliterated in the followed CT image (6months post-op). The antibiotic was discontinued after the treatment course. There was no sign of relapse for 1 year after the operation. ConclusionsInfected aortic aneurysm is epidemic in Chang-Hua County. It accounts for 10% of all aortic stenting in our hospital (30/300). Group D Salmonella is the most common pathogen (56.7% ; 17/30). The standard treatment included aortic stenting to prevent rupture and adequate antibiotics to eradicate the pathogens. Although life-long oral antibiotic after operation is generally accepted, we found that the majority of our cases (13/17) can even discontinue antibiotic treatment possibly because the infection due to low pathogenicity can be completely eliminated. In this case, no persistent stent infection or other complications occurred, antibiotic treatment alone seems successful even the pathogen was found after aortic stenting without coverage of antibiotics initially.

P10-16TEVAR for uncomplicated type B aortic dissectionTakahiro Ishigaki1, Hitoshi Matsuda1, Ryuta Kawasaki1, Yojiro Koda1, Naoki Tateishi1, Soichiro Henmi1, Megumi Kinoshita1, Hidekazu Nakai1, Masamichi Matsumori1, Hirohisa Murakami1, Masato Yoshida1, Nobuhiko Mukohara1

1Hyogo Brain And Heart Center At Himeji, Himeji, Japan

BackgroundTEVAR for uncomplicated type B aortic dissection (TBAD) to close entry has been widely performed to prevent aneurysmal degeneration. However, there were few reports about its details, such as the usage of tapered stentgraft or the combination with supra-aortic bypass.

ObjectiveTo investigate early and midterm outcomes of TEVAR for uncomplicated TBAD.

MethodsIn 32 patients, TEVAR was performed in subacute phase (15 to 180 days) in 11 patients and chronic phase (>181 days) in 21. False lumen (FL) was not thrombosed only limited area near the entry in 8 (ULP type) and patent or partially thrombosed in 24 (pFL type). Supra-aortic bypass was performed concomitantly in 13; zone 1 in 5, zone 2 in 14. Devices selected were Zenith TX2 in 15, cTAG in 11, VALIANT in 5, and Excluder in 1. To adjust the difference of proximal aortic diameter and distal diameter of true lumen, tapered stentgraft were used in 14.

ResultsNo 30-day mortality was encountered and two died for non-aortic events. Minor stroke and paraparesis was observed in one respectively. Procedural success was achieved in 27. Type Ia endoleak was residual in 5, but disappeared within 6 months in 4. Complete thrombosis of FL and aortic remodeling were observed at the level of stentgrafts in all patients except for one patient in pFL group with type Ia endoleak. However, at the level of celiac artery, FL remained patent in 21 patients whose re-entry was residual in pFL group. Re-interventions were required in 3 patients for retrograde dissection, stentgraft infection and expansion of thoracic FL.

ConclusionsTEVAR for uncomplicated TBAD could be performed safely. Tapered stentgraft was useful to adjust the size difference. Close observation of residual FL is critical and the procedure to reduce the patency of FL is the most demand.

P10-17Staged open surgery for aorto-esophageal fistula after TEVAR for infected thoracic aortic aneurysmMD, PhD Toru Iwahashi1, MD, PhD Nobusato Koizumi1, MD, PhD Kentaro Kamiya1, MD Masaki Kano1, Keita Maruno1, MD Toshiki Fujiyoshi1, MD Shun Suzuki1, MD Takashi Ino1, MD Satoshi Takahashi1, MD Kayo Sugiyama1, MD, PhD Shinobu Matsubara1, MD, PhD Toshiya Nishibe1, MD, PhD Hitoshi Ogino1

1Tokyo Medical University, Shinjuku-ku, Japan

BackgroundAorto-esophageal fistula (AEF) is one of fatal complication after TEVAR. In-situ graft replacement of descending aorta, esophageal resection and omental implantation is one of common surgical treatment for AEF after TEVAR. But, sometime, it is difficult to do it depend on a condition of patient. We report on staged open surgery for AEF after TEVAR for infected thoracic aortic aneurysm (TAA), the patient who underwent total gastrectomy for gastric cancer.

Case Report A 67-year-old male presented with back pain and a high fever. 4 months ago, he underwent TEVAR for infected TAA due to anastmotic leak after total gastrectomy for gastric cancer. The preoperative CT and esophagogastroduodenoscopy found an AEF in the middle thoracic esophagus. Acute hematemesis occurred just after he transferred our institution. Then, emergency TEVAR and embolization of the bronchial artery were carried out. After recovery of general condition and antibiotics treatment, we performed extra-anatomical bypass (ascending aorta-abdominal aorta) via right retoroperitoneal space using 16mm of J-graft. Secondary, removal

Poster Presentation


of stent graft, stump formation and esophageal repair and drainage of the perigraft abscess was carried out. These operations were performed without cardiopulmonary bypass. Finally, we covered AEF with the latissimus dorsi myocutaneous flap.

The patient’s postoperative course was stable for a while, however, it was difficult to control contamination of MRSA. Finally, he died due to sepsis 4 months after last operation.

ConclusionExtra-anatomical bypass and staged esophageal repair / resection and resection of descending aorta is one of option for AEF after TEVAR, especially patient’s condition does not allow cardiopulmonary bypass.

P10-18Long-term Outcomes of Ruptured Abdominal Aortic Aneurysm in an Aging SocietyAkihito Kagoshima1, Dr. Hirono Satokawa1, Dr. Hiroki Wakamatsu1, Dr. Tomohiro Takano1

1Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima City, Japan

BackgroundRepair of a ruptured abdominal aortic aneurysm (rAAA) remains challenging despite the advent of endovascular aortic repair (EVAR). Elderly patients requiring surgery for rAAA may increase as society ages. Consideration of the prognosis after emergency surgery from the perspectives of cost and care is important, particularly for elderly patients.

ObjectivesThis study aimed to compare long-term outcomes of rAAA between elderly and young patients and to clarify the impact of age.

Materials and MethodsA total of fifty patients with rAAA were admitted to Fukushima Medical University between July 2004 and September 2015. Of these, 32 patients underwent emergency surgery and 18 did not (11 died before operation, 7 refused operation due to fragility). We retrospectively analyzed outcomes for elderly (≥76 years old) and young (<76 years old) surgical patients.

ResultsAll 7 patients who refused operation died (mean age, 86 years; median time, 4 h after admission). The elderly surgical group comprised 8 men and 2 women (mean age, 82 years; range, 76-89 years). The young surgical group comprised 19 men and 3 women (mean age, 70 years; range, 62-75 years). EVAR was performed for 1 patient in each group. No significant differences between the elderly and young groups were evident in preoperative state (hemoglobin, creatinine, loss of consciousness, electrocardiographic ischemia, hemodynamics, time from onset to operation, and Fitzgerald classification) or 30-day mortality. Among survivors, the elderly group showed lower 5-year survival (33% vs. 92%; P<0.01) and a higher complication rate (83% vs. 40%; P=0.149). Fitzgerald classification type IV was associated with a high mortality rate in elderly cases.

ConclusionsNo significant difference in 30-day mortality rate was seen between elderly and young patients, but poor prognosis and a higher complication rate were seen among elderly survivors.

P10-19Our experience of treatment for symptomatic superior mesenteric artery dissectionYasuhiko Kawaguchi1, Dr Hiroshi Mitsuoka1, Dr Masanao Nakai1, Dr Yujiro Miura1, Dr Shinnosuke Goto1, Dr Yasuhiko Terai1, Dr Yuta Miyano1, Dr Shinji Kawaguchi1, Dr Fumio Yamazaki1

1Shizuoka City Shizuoka Hospital, Shizuoka City, Japan

BackgroundSuperior mesenteric artery (SMA) dissection can occur either as spontaneously isolated dissection (SISMAD) or as a part of an extension of aortic dissection (ADSMAD). Endovascular therapy for the SMA dissection with acute abdomen has been currently in an era of intense investigation.

ObjectivesTo share our experience of endovascular stenting in two SISMAD and two ADSMAD cases. Highlighted are the importance of pathophysiological understanding of the lesions, and a feasibility of retrograde open mesenteric stenting (ROMS).

Cases Case1; A 60-year-old man presented with severe chest and back pain. CT revealed Stanford type B aortic dissection involving the SMA. Aortic stenting and primary entry closure resolved the mesenteric ischemia. Case2; A 60-year-old man presented with a severe back pain. CT showed Stanford type A aortic dissection involving the SMA and the left renal artery. Renal and SMA stenting through via the right femoral artery restored the mesenteric blood flow.Case3; A 64-year-old man presented with a sudden abdominal pain. CT showed SISMAD. Percutaneous SMA stenting via the right brachial artery avoided intestinal necrosis. Case4; A 45-year-old man presented with an aggravating abdominal pain. CT showed a truncal occlusion of the SMA. Gastrointestinal interventionist failed in endovascular procedure via the right femoral artery. ROMS was performed in midline laparotomy. The recovery from mesenteric ischemia could be confirmed under direct vision.

DiscussionIn ADSMAD cases, it is important to understand the pathophysiological condition for the successful endovascular treatment. In SISMAD cases, ROMS seems feasible especially when percutaneous endovascular procedures failed. The superior control of a guide-wire achieved by direct access would increase the technical success rate. ROMS also allows direct observation of the small intestinal damage. ROMS provides an efficient endovascular approach, while not compromising important surgical principles to deal with the mesenteric ischemia.


P10-20The results of in situ prosthetic graft replacement for an infected endograft after endovascular repair for infrarenal abdominal aortic aneurysmsHakyoung Kim1, Dr Youngjin Han1

1Asan Medical Center, SongPaGu, South KoreaObjectiveInfected endograft after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) is rare but life-threatening conditions. The aim of this study was to review the outcomes of in situ graft replacement of infected endografts.

MethodsA total of 6 consecutive patients who underwent in situ graft replacement of infected endografts at our center from January 2001 to December 2014 were retrospectively evaluated. Treatment involved removal of all infected tissue, including the infected aortic tissue and endograft, in situ prosthetic graft reconstruction, and wrapping of the graft with retrocolically transposed great omentum. Sensitive antibiotics were administered pre- and postoperatively.

Results333 patients with infrarenal AAA were treated with EVAR. The infection rates of our institution after EVAR of infrarenal AAA were 1.2% (4 patients of 333) and 2 patients with an infected endograft were transferred from other institutions. Patients with an infected aortic endograft had a mean interval of 29.1 months (range, 1–88 months) from the primary aortic procedure. The 30-day mortality was 16% (1 of 6). The cause of death was proximal anastomosis rupture on the 11th day after in situ graft replacement of an infected endograft. The reinfection rate was 0% (0 of 6) and there are no late complications during a mean follow-up of 16 months.

ConclusionIn situ graft replacements of infected endografts have acceptable outcomes if removal of all infected tissue, including the infected aortic tissue and endografts.

P10-21Sac regression after endovascular relining of perigraft seroma after open repair of abdominal aortic aneurism with PTFE graftSang Seop Yun1, Associate Professor Jang Yong Kim1, Associate Professor Sun Cheol Park1, Associate Professor Yong Sung Won1, Professor In Sung Moon1, Professor Ji Il Kim1


Background Perigraft seroma is sterile, serous fluid collection confined around the prosthetic vascular graft. Authors experienced successful endovascular treatment of perigraft seroma, which was developed after open surgical repair of abdominal aortic aneurysm(AAA).

Case Report The 75-year-old man presented with growing aneurysm after open surgical repair of AAA with PTFE bifurcated graft six years ago. He complained of abdominal discomfort and palpable mass in the

absence of tenderness, pulse and bruit. Contrast enhanced computed tomography(CT) showed huge peri-graft seroma measuring approximately 111-mm in diameter. The patient underwent endovascular relining of PTFE graft with Aortic extender, Excluder and 10-mm-10-cm sized stent-grafts, Viabahn. At 9-month and one year follow-up, CT revealed that there was no evidence flow disturbance with a decreased seroma size to 70mm in diameter.

ConclusionEndovascular Relining of perigraft seroma can be considered after open repair of abdominal aortic aneurism with PTFE graft if it is not infected.

P10-22Surgical outcome for aorta and iliac artery with infectionYojiro Koda1, Takahiro Ishigaki1, Naoki Tateishi1, Soichiro Henmi1, Hidekazu Nakai1, So Izumi1, Masamiti Matsumori1, Hirohisa Murakami1, Tasuku Honda1, Hitoshi Matsuda1, Masato Yoshida1, Nobuniko Mukohara1

1Department Of Cardiovascular Surgery, Hyogo Brain And Heart Center, Himeji, Hyogo, Japan, Himeji, Japan

ObjectiveTo describe surgical outcome for aorta and iliac artery with infection in our institution.

Patients and MethodsBetween January 2000 and July 2016, we treated 43 patients diagnosed with infectious aneurysm (for the thoracic aorta in 17, thoracoabdominal aorta in 7, abdominal aorta in 14, iliac artery in 5).

Mean age was 69 (46- 88) years old. 8 patients (19%) was female. 39 patients (91%) presented fever (> 38（) or local pain. Mean aneurysmal size was 49.6 (23- 72) mm. Mean WBC was 11200 (3300- 22400) /μl. Mean CRP was 14.4 (1.2- 33.98) mg/dl. 2 stent- graft infection, 1 graft infection, 12 rupture and 7 fistula were included. In blood/ tissue culture, 13 Staphylococcal group ( 1 methicillin resistance), 6 enterobacteriaceae, 3 streptococcal group, 3 salmonella, 9 othes, 4 negative and 4 unknown were detected.We perfomed radical debridement, in situ anatomic replacement using standard prosthesis (no antibiotics bonded) as principle. In 24 patients (56%), wrapping with omental pedicles were perfomed. Recently, wrapping with omental pedicle was performed secondary by design. Post operative antibiotics was continued for 6- 8 weeks by drip.

ResultsIntubation time was 39.4 (0- 144) hours. ICU stay was 6.9 (2- 37) days. Hospital stay was 54.5 (6- 356) days. Hospital mortality was 14%. Follow up period was 64.8 (0.7- 112.9) months. Over all survival at 5 years was 54%. The cause of death included 4 sepsis, 3 pneumonia, 2 heart failure, 1 cerebral hemorrhage, 1 rupture of proximal anastomosis, , 1 rupture of descending aorta, 1 traffic accident, 1 lung cancer, 1 liver failure, 1 pulmonary embolism and 5 unknown. The death of aortic events were 2 cases.

ConclusionOur surgical outcome for aorta and iliac artery with infection was acceptable.

Poster Presentation


P10-23Emergent Surgical Conversion during endovascular Procedure for Leriche’s diseaseJoon Hyuk Kong1

1Department Of Thoracic And Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do, , South Korea A 45-year old- male patient visited to our hospital for complaining of aggravated both limb claudication. Preoperative CT angiogram showed mild stenosis at celiac artery, severe focal stenosis at superior mesenteric artery ostium, near total occlusion at both renal artery, severe atherosclerotic obstruction at distal abdominal aorta and total occlusion of right ilio-femoral arteries up to femoral artery bifurcation (Fig. 1). Endovascular procedures were done before massive retroperitoneal bleeding at right EIA: Seal bifurcated stent graft extension (12mmx80mm) and Seal Hercules vascular(14mmx100mm) at infra-renal aorta, Absolute pro stent(8x100mm) at left iliac artery, Viabahn stent grafts(10mmx100mm and 7mmx100mm) at right iliac artery(Fig.2). Surgical conversion was decided due to these problems: 1st problem was that left renal artery was occluded due to thromboembolism and fragile floating thrombosis at infra-renal aorta, 2nd problem was uncontrolled active bleeding at right iliac artery although Viabahn stent-grafts were deployed(Fig.3). To solve 1st problem, left renal artery was dilated by 4mm stenting and 16mm stent was deployed to put the floating thrombosis up against aortic wall by periscope manner(Fig.4). To solve 2nd problem, retroperitoneal bleeding was well controlled by Medtronic distal stent graft 13-13mm insertion(Fig.5). After these procedures, we could find 3rd problem: blood flow was very sluggish because of right iliac limb stent compressed by narrow iliac bifurcation area diameter. To solve 3rd problem, aorto-uni-iliac stent graft to left limb and left-to-right femorofemoral bypass were performed(Fig.6).

There was no perioperative complications. Postoperative CT angiogram showed patent left renal artery stent, no interval change of the SMA stenosis, good blood flow in aorta to left femoral artery stent without luminal stenosis and patent femoral artery to femoral artery bypass graft with good distal right femoral arterial flow(Fig.7).

P10-24Prevention of type II endoleak using the aortic cuff during endovascular aneurysm repairShinsuke Kotani1, Takumi Ishikawa1, Tadahiro Murakami1, Hirokazu Minamimura1

1Bellland General Hospital, Sakai, Osaka , Japan

Background Type II endoleak (T2EL) is common complication after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm. Persistent T2EL has shown to be associated with a higher incidence of adverse outcomes. Prophylactic embolization of inferior mesenteric artery (IMA) may be associated with a lower incidence of T2EL, and various preoperative or intraoperative methods have been reported. However, the procedure is sometimes complex and time consuming. We report easy technique of IMA occlusion using the aortic cuff during EVAR to prevent the development of a T2EL.

Objective We report easy technique of IMA occlusion using the aortic cuff during EVAR to prevent the development of T2EL.

Method Between June 2015 and May 2016, 8 patients underwent occlusion of IMA with EXCLUDER aortic cuffs during EVAR. All patients underwent Computed tomography angiography (CTA) to confirm the anatomical factors of the IMA such as diameter, location and the aortic diameter at the ostium. The patent IMA with the diameter greater than 2.5mm was considered for embolization. The aortic diameter less than 35mm at the IMA ostium was covered with the aortic cuff. The cuff diameter was 5-10 % larger than the aortic diameter. All of the procedures were performed via 18-F femoral sheath. The aortic cuff was introduced to the aorta, and deployed to cover the ostium. After the deployment, EVAR was performed as usual. CTA was performed postoperatively to confirm successful EVAR and endoleaks.

Result The number of the aortic cuff was one in all cases. The technical success rate was 100%, with no procedurally related complications. Postoperative CTA revealed no T2EL with patent IMA in all patients.

Conclusion Although it is unavailable for IMA occlusion with large aortic diameter at the ostium, the use of the aortic cuff during EVAR is easy and feasible option that prevents T2EL from the IMA.

P10-25Endovascular Treatment of Type III Endoleak after EVARYujin Kwon1, Dr Kyoung Bok Lee1


IntroductionEndovascular aneurysm repair (EVAR) allowed the minimally invasive treatment of aortic aneurysm. However, there is high percentage of unique complication after EVAR called endoleaks. We present minimally treated Type III endoleak.

Materials and MethodsA 70-year-old male patient was diagnosed to have type III endoleak. He received branch type EVAR on Sep 25, 2012 due to both common iliac artery(CIA) aneurysm. He had taken 3 to 6 month follow up CT scan and on March 2015, contrast media extravasation was observed from right external iliac artery (EIA) and internal iliac artery (IIA) bifurcation which should be covered by the stent graft. Also, increase in size of right CIA aneurysm was observed.

ResultsAfter introducing 6Fr long sheath by open method, angiography was done. Fiber covering (IIA) stent graft was injured by the wire structure of EIA stent graft and coil embolization of Rt. IIA was done. No more endoleak was observed after the coil embolization.

ConclusionsType III endoleak was successfully treated with minimally invasive method.


P10-26Successful Endovascular Treatment of Mycotic Thoracic Aneurysm with Spinal Osteomyelitis, A Case ReportChon Wa Lam1

1Kiang Wu Hospital, MacaU, China

Mycotic aneurysm of thoracic aorta is a rare diagnosis with high mortality. We present a case of mycotic thoracic aortic aneurysm with spinal osteomyelitis. We had prescribed high dose of antibiotic treatment initially but aneurysm was enlarged after 2 weeks of treatment. Then we prescribed thoracic endovascular aortic repair (TEVAR) technique to that aortic aneurysm with prolong oral antibiotics treatment. Postoperative course was uneventful and he was in good condition. Postoperative PET/CT scan at 4 months later that didn’t show obvious residue infection over the thoracic aorta and spine.

P10-27The structural changes of aneurysm after endovascular aneurysm repairJae Hoon Lee1, Dr Ki Hyuk Park1

1Daegu Catholic University Hospital, Daegu, South Korea

BackgroundSeveral studies showed the change of neck and aneurysmal sac after endovascular aneurysm repair (EVAR), but they included the fragmentary contents of single topic.

ObjectivesWe investigated neck angle, neck length, maximal diameter, maximal area and thrombus of aneurysm after EVAR. This study assessed the changes, the association among the factors and the relationship between neck changes and type Ia endoleak.

Materials and MethodsFrom January 2010 to February 2015, 108 patients with AAA underwent EVAR in our institution. Among them, 90 patients evaluable by computer tomography (CT) were included this study. The changing factors were examined preoperatively, immediate postoperatively, after EVAR at 6 months, 1 year, and 2 years. For statistical analysis, generalized linear model was used.

ResultsMean last CT follow-up period was 30.02 ± 145.06 months. A significant decreases in the neck angle and length were found on immediate postoperative period (P<0.001 and 0.036). Maximal diameter decreased on 6 months (P=0.003). The thrombus volume in aneurysm sac increased on immediate postoperative study (P=0.008) and decreased after 6 months. The greater the preoperative values of neck angle, length and thrombus were, the greater their difference were immediately after EVAR (P=0.000, 0.000, 0.003). The greater maximal diameter was, the greater neck angle was and the shorter neck length was (P<0.001 and 0.048). Thrombus volume was great in the aneurysms with great neck angle, short neck length, great diameter and great area (P=0.002, 0.013, <0.001 and <0.001).

ConclusionsNeck angle, length and thrombus changed significantly immediately after EVAR and the greater the preoperative their values were, the greater their differences were immediately. Aneurysm sac regression occurred at 6months after EVAR. There were statistically significant correlations among the size of aneurysm, neck angle, neck length and thrombus of aneurysm.

P10-28Infra-renal Abdominal Aortic Aneurysm Repair for the Severely Angulated Neck: The Usefulness of Precuff Kilt Technique of Endovascular Aneurysm Repair (EVAR)Samuel Lee1, MD Young Kwon Cho1

1Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea

BackgroundAbdominal aortic aneurysms and difficult infra-renal necks are regarded as very challenging when performing endovascular repair. Although fenestrated and branched endografts may be the main method of repair for these patients, their current limited availability has prompted the use of alternative endovascular techniques to enhance success of endovascular aortic aneurysm repair in patients with severely angulated neck.

MethodsA retrospective review of all patients who underwent endovascular abdominal aneurysmrepair with a predeployed aortic cuff (Kilt) at Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea between January 2015 and April 2016 was performed.

Case 1. Fifty seven years old male patient was admitted for the aneurysmal clipping of the brain, who was incidentally diagnosed as AAA(abdominal aortic aneurysm) by CT angiography. AAA was infra-renal type with severely angulated neck(98°). He underwent EVAR using predeployed aortic cuff(Kilt). CT angiography revealed the type II endoleak which was decided to be followed up without any management.

Case 2.Forty five years old male patient was incidentally found to have infra-renal AAA, measured 8x5cm with severely angulated neck(80°). He underwent EVAR using predeployed aortic cuff(Kilt). Follow-up CT angiography showed no abnormal finding.

ConclusionShort-term follow-up suggests that the Kilt technique may be useful in patients with traditionally unfavorable anatomy for endovascular abdominal aortic aneurysm repair.

Anatomic features most amenable to this technique include severely angulated infrarenal necks.

Poster Presentation


P10-29A New Type of Endoleak After EVAR Induced by Stanford B Aortic Dissection and its TreatmentJie Liu1, Dr. Xin Jia1, Dr. Senhao Jia1, Dr. Wei Guo1


Background and objectiveEVAR aims at prevention of aneurysm rupture. However, endoleaks are the Achilles heel of EVAR. Endoleaks have been categorized and subcategorized according to the location of the inflow into five types, but there may be other types of endoleak. We aimed to describe a case of a new type of endoleak after EVAR induced by Stanford B aortic dissection and its treatment.

Methods An 80-year-old man was admitted to the emergency room with abdominal and lumbar pain. The patient’s history included cardiopathy, hypertension, dyslipidemia, and chronic renal insufficiency. The patient did EVAR 28 months ago due to AAA and did TEVAR 4 months ago due to Stanford B aortic dissection. An emergency CTA showed an endoleak after EVAR and the maximum diameter of AAA was 59.5 millimeter, which was 5.5 millimeter larger than 3 months ago. The DSA showed the distal tear of Stanford B aortic dissection was located near the right renal artery and the false lumen running into the sac of AAA was the inflow of the endoleak. because of high speed of blood stream in the inflow, we firstly implanted a GPS stent into the false lumen and secondly we used ten pair of coil to embolize the false lumen (the inflow).

ResultsFollow-up after 6 months, the CTA showed endoleak had disappeared and the max diameter of AAA was smaller.

ConclusionsThe endoleak induced by Stanford B aortic dissection is different from the other five types of endoleak and it might be a new type of endoleak. GPS stent and coil might be a good choice for the treatment. More studies are warranted.

P10-30Two-stage repair of extensive thoracic aortic aneurysm and aortic valve lesion associated with pseudocoarctation of the aortaSaito Masahito1, Asano Naoki1, Ohta Kazunori1, Niimi Kazuho1, Tanaka Kouyu1, Gon Shigeyoshi1, Takano Hiroshi1

1Dokkyo Medical University Koshigaya Hospital, Koshigaya-shi, Japan

Background and objectivePseudocoarctation of the aorta, which involves elongation and kinking of the aortic arch without a pressure gradient across the lesion, is a rare anomaly. Although it is considered a benign condition, association with an aortic aneurysm is an indication for surgery. We present a patient with extensive thoracic aortic aneurysm (TAA) and aortic valve lesion associated with pseudocoarctation of the aorta who underwent two-stage repair of this disorder.

MethodsA 68-year-old man was admitted to our hospital with a diagnosis of TAA and moderate aortic valve stenosis and regurgitation due to a bicuspid aortic valve. Computed tomography (CT) revealed pseudocoarctation of the aorta and dilatation of the thoracic aorta from the sinus of Valsalva to the descending aorta. Diameters of Valsalva sinus, ascending aorta, descending aorta, and narrowed segment of the arch were 46, 48, 52, and 26 mm, respectively.

ResultsAs a first-stage operation, aortic root replacement with composite graft (CEP Magna Ease and Gelweave Valsalva) and total arch replacement (Triplex four-branched arch graft ø24 mm) with frozen elephant trunk (J-Graft Open Stent Graft ø23 mm) were performed via median sternotomy. Anastomosis of the arch graft and placement of the frozen elephant trunk was performed on the narrowed segment of the arch because the wall of the dilated descending aorta was very thin. Ankle-brachial index after the first operation was >1. Nineteen days after the first operation, second-stage thoracic endovascular aortic repair (TEVAR) was performed. The postoperative course was uneventful. Postoperative chest CT revealed no evidence of endoleak or other complications.

ConclusionTwo-stage repair using frozen elephant trunk followed by TEVAR represents a reasonable option for extensive TAA associated with pseudocoarctation of the aorta if the narrowed segment of the arch can be used as an anastomotic site for the frozen elephant trunk.

P10-31Extension of frozen stent graft for the treatment of multiple thoracic aneurysmsHideki Mishima1, M.D. Susumu Ishikawa1, M.D. Hiroki Matsunaga1, M.D. Akira Oshima1

1Tokyo Metropolitan Bokuto Hospital, Sumidaku, Japan

IntroductionFor multiple aortic aneurysms, endovascular treatments and combination hybrid surgery have been recently performed. We report two cases who underwent one-staged surgery with the extended frozen stent graft for multiple thoracic aortic aneurysms of distal arch and descending aorta.

CasesCase 1; 67 -year-old female was pointed out aortic arch saccular aneurysm of 60mm and descending aortic aneurysm of 70mm in diameter. Emergency surgery was performed because of back pain. Cardio pulmonary bypass with hypothermia was used through median sternotomy. Through the incision of anterior wall of aortic arch just distal of left subclavian artery, the frozen stent graft was inserted to enclose the distal aneurysm under fluoroscopic guidance. Another graft was anastomosed to extend the frozen stent graft. The second graft was anastmosed to the native aorta at the level of aortic incinsion.

Case 2; 82-year-old male was pointed out the distal aortic arch aneurysm 60mm and descending aortic aneurysm 56mm in diameter growing rapidly during last half a year. He had the past histories of type B aortic dissection and Y-shaped graft (16 × 8mm) replacement for abdominal aortic aneurysm. Endovascular treatment was impossible because of small legs of Y-graft. Prophylactic CSF drainage was placed before surgery. Extracorporeal circulation with hypothermia was established using femoral artery and vein.


Through the left thoracotomy, half incision of anterior wall of descending aorta was made. The frozen stent graft was inserted to enclose the distal aneurysm. After distal aortic arch aneurysm was dissected, Another graft was anastmosed to the proxymal aorta just distal of the left subclavian artery. Finally, the second Dacron graft and frozen stent-graft were anastomosed.

ConclusionHybrid surgery using the extended frozen stent graft was useful for multiple aortic aneurysms. Postoperative hemodinamic maintainance and prophylactic CSF drainage were effective for the prevention of the spinal code ischemia.

P10-32Postoperative venous thromboembolism after EVAR for ruptured abdominal aortic aneurysm: report of two casesYuri Murakami1, Dr. Naoki Toya1, Dr. Soichiro Fukushima1, Dr. Eisaku Ito1, Dr. Tadashi Akiba2, Dr. Takao Ohki3

1The Jikei University Kashiwa Hospital Department of Surgery, Division of Vascular Surgery, Kashiwa City, Japan, 2The Jikei University Kashiwa Hospital Department of Surgery, Kashiwa City, Japan, 3The Jikei University School of Medicine Department of Surgery, Division of Vascular Surgery, Minatoku, Japan

Background and ObjectivesEndovascular aneurysm repair (EVAR) has been successfully used to treat ruptured abdominal aortic aneurysm (rAAA). However, postoperative venous thromboembolism (VTE) is an occasional complication after EVAR for rAAA due to prolonged bed rest and venous compression secondary to abdominal hematoma. We reported two cases of postoperative VTE after emergency EVAR for rAAA. Material and MethodsCase 1: A 65-year old man underwent an emergency EVAR for rAAA. Initially, postoperative course was unremarkable, but he complained of chest pain and cardiopulmonary arrest on postoperative day 5 when he began standing and walking. CT revealed massive pulmonary embolism (PE). Although cardiopulmonary resuscitation was successful, agnosia remained as post resuscitation hypoxic encephalopathy.

Case 2: A 72-year old man underwent an emergency EVAR for rAAA. He had a tracheotomy because of prolonged intubation after surgery. On day 33, post-operative CT scan revealed VTE extending from the iliac vein to the inferior vena cava. We decide to place a prophylactic vena cava filter to prevent pulmonary embolism. His post treatment course was otherwise uneventful

Result and ConclusionPatient who had emergency EVAR for rAAA should have a contrast enhanced CT taken before ambulating in order to rule out VTE.

P10-33Secondary aortoduodenal fistula following abdominal aortic reconstructionShingo Nakai1, Dr. Tetsuro Uchida1, Dr. Azumi Hamasaki1, Dr. Yoshinori Kuroda1, Dr. Atsushi Yamashita1, Dr. Ken Nakamura1, Dr. Jun Hayashi1, Dr. Daisuke Watanabe1, Dr. Kimihiro Kobayashi1, Dr. Seigo Gomi1, Prof. Mitsuaki Sadahiro1

1Yamagata University, Yamagata, Japan

BackgroundSecondary aortoduodenal fistula is a rare but life threating complication after abdominal aortic reconstruction. The clinical manifestation is always upper gastrointestinal bleeding. Early surgical intervention should be mandatory in this particular circumstance. Although bleeding control and management of infection are major concerns, optimal therapeutic strategy remained controversial. We report two cases of secondary aortoduodenal fistula subsequent to graft replacement of abdominal aortic aneurysm (AAA).

Case reportsA 69-year-old man was admitted to neighboring hospital with complains of abdominal pain and large amount of blood in the stool. He had a history of graft replacement of AAA via laparotomy. Computed tomographic (CT) scan showed a pseudoaneurysmal formation at proximal anastomotic site of the graft. Upper gastrointestinal endoscopy revealed duodenal ulceration an adjacent blood clot with active bleeding. He was diagnosed with aortoduodenal fistula, and emergent endovascular abdominal aortic repair (EVAR) was performed. One month following EVAR, he presented with recurrent abdominal pain and high-grade fever. An endograft infection was highly suspected and he was referred to our institution for surgical treatment. At laparotomy, aortoduodenal fistula was not identified. Infected endograft was pulled out and bifurcated graft was also explanted. Re-graft replacement with Gore-Tex graft and omentopexy were performed simultaneously. One day after the operation, he required repair of duodenum because of an uncontrolled leak from the fistula. Another patient is a 64-year-old man previously underwent graft replacement of AAA. He was admitted to our institution with complains of severe abdominal pain and hematemesis. With the diagnosis of aortoduodenal fistula, emergent EVAR was successfully performed. Two months after EVAR, he received repair of duodenal fistula, re-graft replacement and omentopexy. Postoperative course of both patients was uneventful.

ConclusionEarly surgical intervention was expected to improve the chances of successfully managing this rare but lethal complication.

Poster Presentation


P10-34A Case of a Right Common Iliac Artery Aneurysm Complicate the Arteriovenous Fistula and the Common Iliac Vein OcclusionShinsuke Nishimura1, Dr Takashi Murakami1, Dr Hiromichi Fujii1, Dr Masanori Sakaguchi1, Dr Yosuke Takahashi1, Dr Daisuke Yasumizu1, Dr Yoshito Sakon1, Dr Toshihiko Shibata1

1Department of Cardio Vascular Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan

Arteriovenous fistula (AVF) is a rare complication of abdominal or iliac artery aneurysm, usually presenting with congestive heart failure. We present an extremely rare case of lymphedema with skin ulcer as a presentation of the right common iliac artery (CIA) aneurysm.

An 86-year-old man, who suffered from a swollen left leg and lower limb ulcer with lymphorrhea for three months, was referred to our hospital. However he didn’t develop congestive heart failure.

Enhanced computed tomography (CT) showed an abdominal aortic aneurysm of 57mm and a right CIA aneurysm of 92mm. The left common iliac vein (CIV) was compressed by the aneurysm, and the veins of left side lower extremity and pelvis were enhanced in the early phase, suggesting an arteriovenous shunt, however inferior vena cava was not enhanced in the phase.

We performed a vascular prosthesis replacement with laparotomy. Upon opening the aneurysm, AVF was encountered at the right CIA to the left CIV with 20mm x 10mm in diameter, which was closed with a bovine pericardial patch.

Post operative enhanced CT showed occlusion of the left CIV as previously. However the left lower limb swelling subsided gradually with compression therapy.

AVF located in the distal part from the iliac vein compressed by aneurysm was thought to be the reason of this rare presentation of aneurysm as lymphedema, instead of congestive heart failure. High alert for pelvic evaluation would be the key to find the cause of unilateral lymphedema.

P10-35Initial Outcomes of Endovascular Stent-graft Repair of Ruptured Abdominal Aortic Aneurysms: A single-center experienceHirotoki Ohkubo1, Tadashi Kitamura1, Toshiaki Mishima1, Koichi Sughimoto1, Tetsuya Horai1, Mitsuhiro Hirata1, Shinzou Torii1, Kagami Miyaji1

1Department of Cardiovascular Surgery, Kitasato University School Of Medicine, Sagamihara, Japan

BackgroundOpen surgery for ruptured abdominal aortic aneurysms is known to have poor postoperative outcomes. Recently, the treatment of ruptured abdominal aortic aneurysms has increasingly shifted from open surgical repair to endovascular aneurysm repair (EVAR). In near future, EVAR will most likely become standard treatment. In our center, EVAR was initially used to treat ruptured abdominal aortic aneurysms in 2015. We report the outcomes of EVAR.

Material and MethodsThe study group comprised 11 patients (10 men and 1 woman) who underwent EVAR in 2015. The mean age was 74.6 ± 11.0 years, and the aneurysm diameter was 74.3 ± 19.4 mm. The Fitzgerald classification was type I in 3 patients, type II in 1, type III in 7, and type IV in 0. Four patients had shock before surgery, and 3 patients had impaired consciousness. EVAR was performed with the use of a Gore C3 Excluder stent-graft. In patients with unstable vital signs during surgery, an aortic occlusion balloon catheter was used to stabilize vital signs and thereby safely perform surgery. In patients with disturbed hemodynamics associated with abdominal compartment syndrome accompanied by a postoperative intravesical pressure exceeding 20 mm Hg, open abdominal management was performed.

ResultsMortality at 30 days was 0%. All patents were ambulatory and discharged. The operation time was 132 ± 51 min. The intraoperative transfusion volume was 1232 ± 1450 mL, and the duration of mechanical ventilation was 3.4 ± 4.4 days. The intensive care unit stay was 5.3 ± 4.8 days, and the hospital stay was 24.5 ± 19.2 days. No patient had abdominal compartment syndrome. Postoperative hemodynamics were maintained in all patients.

ConclusionsEVAR for ruptured abdominal aortic aneurysms had good outcomes in our center. Further studies of a larger numbers of patients are needed to confirm our results.

P10-36Floating thrombus causing systemic embolization in the ascending aorta in the absence of any coagulation abnormalityShunsuke Ohori1

1Hokkaido Ohno Hospital, Sapporo, Japan

Floating thrombus causing systemic embolization in the ascending aorta is very rare especially in the absence of any co-existing coagulation abnormality. We report a case of the floating thrombus causing systemic embolization. A 51 year-old previously healthy man was admitted to the hospital with left lower back pain. CT angiography showed left renal and splenic infarction. And it showed the thrombus in the ascending aorta with the rest of the aorta having no evidence of atherosclerosis. He was in sinus rhythm and heart sounds were normal. TTE did not show any intracardiac thrombus or any structural and functional cardiac abnormality. Because of the high risk of recurrent embolization, the patient underwent the replacement of ascending aorta with hypothermic circulatory arrest. Intraoperative TEE showed several mobile thrombuses in the ascending aorta. Aortotomy revealed several mobile chronic thrombuses with the atherosclerotic plaque of the ascending aorta. The postoperative course was uneventful and the patient was discharged on 17th postoperative day with anticoagulation and antiplatelet therapy. We report a case of floating thrombus in the ascending aorta causing systemic embolization. We believe the surgical removal of the thrombus and replacement of the aorta with atherosclerotic plaque to prevent further thromboembolic event.


P10-37Vascular Caliber Changes Post PEVAR versus SEVAR in the Asian ContextDaniel Ong1, Prof Uei Pua2

1Yong Loo Lin School of Medicine, Singapore, Singapore, 2Tan Tock Seng Hospital, Singapore, Singapore

Background/ IntroductionEndovascular aneurysmal repair has been gaining popularity over the years, with percutaneous access (PEVAR) becoming increasingly preferred over the conventional cut-down technique (SEVAR).

ObjectivesExisting studies of the Western population showed varying degrees of accessed common femoral artery (CFA) diameter changes post-EVAR. Aorto-iliac anatomy in Western population differ significantly from that of the Asian population. In this study, we aim to evaluate postoperative vascular caliber changes in the Asian context.

Materials and MethodsA retrospective study is conducted, identifying EVAR patients from 2011 to 2016 from our Electronic Medical Records (EMR).

Patients with complete preoperative and postoperative computed tomography (CT) aortograms were included. Demographic parameters were collected. The CFA inner diameter (ID) is measured at 3 levels distinguished by bony landmarks. Per groin analysis is then carried out after division into PEVAR and SEVAR groups.

Independent sample t-test is used for comparing differences in CFA ID change in PEVAR versus SEVAR groups. Paired sample t-test is used for evaluating CFA ID change in each group. P-value of less than 0.05 is considered statistically significant.

ResultsThe PEVAR and SEVAR groups have no significant differences demographically, except in sheath sizing used and duration of CT follow-up post-procedure. A total of 120 patients were included, of which 200 groins were analyzed. There is no significant difference in CFA ID change comparing PEVAR versus SEVAR groups (-0.12 +/- 1.05, -0.10 +/- 0.81, p = 0.36). There is no significant difference on the accessed CFA ID from baseline to follow-up for PEVAR group (7.92 +/- 1.23, 7.80 +/- 1.38, p = 0.34) and SEVAR group (7.47 +/- 1.44, 7.36 +/- 1.64, p = 0.15).

ConclusionsWithin the limitations of our study, there are no significant vascular caliber changes post-EVAR in the Asian population.

P10-38Combined Proximal Stent-Grafting with Distal Bare Stenting for Management of Three-Channeled Type B Aortic Dissection with Malperfusion SyndromeKimimasa Sakata1, MD,PhD Saori Nagura1, MD,PhD Toshio Doi2, MD,PhD Akio Yamashita2, MD,PhD Katsunori Takeuchi2, Prof Naoki Yoshimura2

1Shinonoi General Hospital, Nagano, Japan, 2Toyama University Hospital, Toyama, Japan

BackgroundThree-channeled aortic dissection is relatively rare case. Because it is easy to cause expansion of the false lumen and explosion compared with normally dissection, surgical treatment may be necessary in early phase

CaseA 51 year-old male patient with a type B aortic dissection at onset 7 years ago, was admitted to our hospital complaining of persistent back pain. Thoacoabdominal computed tomography detected tear at descending thoracic aorta, and distal aortic arch was expanded to 66mm in diameter. Descending Aorta was dissected three channeled. Only a right renal artery arose from false lumen, and the major abdominal branches otherwise arose from a true lumen. There was the narrowing of the true lumen in a descending thoracic Aorta. At this point, because there are no chief complaint that malperfusion is suspected in, the patient was treated using strict measures to control the blood pressure and heart rate.However, the patients came to gradually complained of postprandial abdominal pain from the onset seventh day .Also, a blood test showed the increase of the hepatobiliary enzyme. Because malperfusion syndrome was suspected in, a thoracic endovascular aortic repair was performed urgently. In a postoperative course, abdominal pain after eating and the biochemistry findings with suspected malperfusion were improved immediately. The patient was discharged with uneventful.

ConclusionCombined proximal stent-grafting with distal bare stenting is considered an effective method for three-channeled Type B Aortic Dissection with malperfusion syndrome

P10-39Thrombosis of inferior vena cava caused by large left iliac artery aneurysm Yasuhito Sekimoto1, Dr Hirohisa Harada1


BackgroundVenous thromboembolism caused by non-inflammatory abdominal aortic or iliac artery aneurysm is rare. We report a case of deep venous thrombosis (DVT) extended to inferior vena cava (IVC) caused by large left iliac artery aneurysm.

Poster Presentation


Case Report A 66-year-old male was sent to our emergency department with sudden onset of the left lower extremity swelling, pain, and gait disturbance. Computed tomography showed a 5cm non-inflammatory left common iliac artery aneurysm (CIAA) and DVT in the left lower extremity extended to the IVC. Left iliac vein compression by the left CIAA was considered to provoke DVT. IVC filter placement was firstly performed for thrombosis of IVC, and anticoagulation therapy was introduced. As treatment for the left CIAA, open surgical repair and reconstruction was performed. Open aneurysmectomy is considered to achieve decompression of iliac vein quickly, on the other hand, it is impossible to achieve decompression of iliac vein quickly by endovascular repair. The post-operative course was uneventful. Oral anticoagulation and compression therapy by using elastic stocking was continued, and he was discharged 10 days after the operation.

P10-40Late open conversion after endovascular aortic aneurysm repairRiha Shimizu1, Takayuki Hori2, Yasushi Matsushita1, Hirotsugu Fukuda2

1Dokkyo Medical University Nikko Medical Center, Nikko, Japan, 2Dokkyo Medical University, Mibu, Japan

ObjectiveEndovascular aortic aneurysm repair is used for the treatment of abdominal aortic aneurysm. Usually, complications secondary to EVAR are treated with endovascular technique. However, open surgical repair can be required in 0-9% of cases of EVAR. This study aims to present our experience in open conversion after EVAR.

MethodsBetween June 2010 and March 2016, 182 EVARs were performed. During the same interval, 10 patients (mean age, 75.1 years, range, 66 -87 years) were performed open conversion. Mean time interval between EVAR and open conversion was 35.3 month (range, 9-51 months).

ResultsThe indications for open conversion included type（b endoleak (n=1), type（ endoleak (n=5), type（ endoleak (n=1) with sac enlargement, stentgraft infection (n=2), and stentgraft thrombosis (n=1). All underwent elective conversion. 5 (50%) patients with type（ endoleak were treated with simple ligation of the culprit vessels, without aortic clamping and stent graft explantation. 4 (40%) patients were complete removal of the stent graft. 2 (20%) patients inserted endovascular balloon occlusion to prepare conversion to endovascular repair. The mean duration of hospital stay was 25.7±24.9 days (range 12-85 days). Operative mortality and mortality rate was 0% as well as that of first open AAA repair.

ConclusionLate open conversion after EVAR can be performed safety and successfully. For the success of operation, it is necessary preoperative planning tailored to approach.

P10-41Prevention of renal infarction for abdominal aortic aneurysm with mural thrombus at the proximal clamp siteNobuoki Tabayashi1, Dr Takehisa Abe1, Dr Tomoaki Hirose1, Dr Yoshihiro Hayata1, Dr Keigo Yamashita1, Dr Yoshio Kaniwa1, Dr Rei Tonomura1, Dr Shigeki Taniguchi1Nara Medical University, Kashihara, Japan

PurposeProximal aortic clamping during abdominal aortic aneurysm (AAA) repair seems to be a risk factor of renal infarction in the case of mural thrombus in the usual proximal clamp site. In this situation, we have applied supra-renal aortic clamping followed by renal artery perfusion for prevention of renal infarction. In this study, we estimated renal preventive effect of our technique for AAA with proximal mural thrombus.

Patients and MethodsFrom October 2007 to Jun 2016, seven patients were operated on for AAA with proximal mural thrombus. We used renal artery perfusion with 4（crystalloid solution after supra renal clamping at the healthy aorta.

ResultsThere was no 30-day mortality, nor in-hospital death. There was no postoperative renal infarction. Serum creatinine level was not changed postoperatively (pre 0.96±0.33, post 1.00±0.47, P=0.546).

ConclusionIt seems that supra-renal aortic clamping followed by renal artery perfusion for AAA with proximal mural thrombus may prevent renal infarction.

P10-42Does post-implantation syndrome affect perioperative and long-term outcome?Tomohiro Takano1, Dr Akihito Kagoshima1

1Fukushima Medical University, Fukushima, Japan

BackgroundCryptogenic fever, also known as post-implantation syndrome (PIS), can be experienced by patients following aortic endovascular therapy (EVT). We aimed to evaluate whether PIS affects perioperative and long-term outcome.

MethodsPIS was defined as the presence of fever >38（ lasting over 2 days post-operation and leukocytosis (white blood cell count>12000/μl) or CRP>10mg/dl despite antibiotic therapy and negative culture results. Infectious, inflammatory and ruptured aneurysms were excluded. This study retrospectively included 98 patients treated electively by EVT at our institution from April 2010 to March 2016. Patients were divided into 2 groups based on the occurrence or non-occurrence of PIS. Comparative analyses were performed using chi-square or Student’s t test. Statistical significance was considered as p ≤ 0.05. The Kaplan-Meier method was used to examine the cumulative survival rates and adverse event-free rates. Adverse events included re-operation, additional procedure and death associated with aortic aneurysm.


ResultsThere were 48 thoracic aortic endovascular repair cases for thoracic aortic aneurysm and chronic aortic dissection and 50 abdominal aortic endovascular repair cases for abdominal aortic aneurysm. PIS was diagnosed in 27 (28%) patients. There was no hospital death. The hospitalization was longer for the PIS group (p=0.069), and hospital cost tended to be higher in the PIS group. The survival rate was 94% at 1 year and 78% at 3 years in the PIS group, while 95% at 1 year and 84% at 3 years in the non-PIS group (p=0.851). Three and five aneurysm expansions were detected in the PIS group (11%) and non-PIS group (7%), respectively. Additionally, there was no statistical significance of adverse event-free rate between the two groups (p=0.87).

ConclusionsWe did not find any correlation between PIS and occurrence of long-term complications. However, PIS can lead to extended hospitalization and higher costs.

P10-43Thoracic Endovascular Repair in Chronic Type B Aortic DissectionTakahiro Takemura1, Dr Takahito Yokoyama1, Dr Yuujirou Kawai1, Dr Hirokazu Niitsu1, Dr Gentaku Hama1, Dr Yasuyuki Toyota1, Dr Yasutoshi Tsuda1

1Saku Central Hospital Advanced Care Center, Saku, Japan

BackgroundThe optimal management strategy for chronic type B aortic dissection, whether open or endovascular is controversial. The aim of this study is the evaluation of thoracic endovascular aortic repair (TEVAR) for chronic type B dissection.

MethodsFourteen patients (average age 65 years) were initially treated TEVAR for closing the primary entry between April 2009 and December 2015. All patients had patent false lumen and dilatation of descending thoracic aorta. The median time from onset to TEVAR was 12 month.

ResultsThere was no hospital death. No patient had stroke, paraplegia, paralysis or renal failure. Clinical and radiological follow up was complete in all patients. Mean follow up was 23 ± 18 months. During surveillance computed tomography imaging, false lumen thrombosis around primary entry was noted in all patients. Distal stent graft-induced new entry occurred in one patient 2month after TEVAR. The patient underwent additional TEVAR for closing new entry. Thoracic and abdominal aortic diameter were decreased in 8 patients. However four patients required further intervention because false lumen was dilated. 3 patients underwent hybrid TEVAR within 6 months after first TEVAR. In such cases we performed graft replacement for abdominal aorta and made bypasses between graft and visceral arteries. TEVAR performed about 1 week after open surgery. One of those patients who was treated hemodialysis died due to brain hemorrhage at 6 month after second TEVAR. 1 patients underwent endovascular repair to abdominal aorta for closing re-entry. 1 patients underwent adjunctive false lumen embolization using covered stent graft devices for impending rupture.

ConclusionProximal TEVAR of chronic type B dissection is a relatively safe and effective therapy. However rapid false lumen expansion occurred in several cases during early follow up period. Further studies are needed to evaluate this procedure.

P10-44Large false lumen occlusion using Candy-plug technique in ruptured chronic type B dissecting aortic aneurysm: a case reportKatsunori Takeuchi1, Dr. Akio Yamashita1, Dr. Kanetsugu Nagao1, prof. Naoki Yoshimura1

1Graduate School Of Medicine, University Of Toyama, Toyama, Japan

IntroductionIn recent years, Thoracic Endovascular aortic repair (TEVAR) came to be performed as treatment of complicated type B acute aortic dissection. However, TEVAR is not recommended in the chronic state because the treatment often fails due to persistent retrograde false lumen perfusion. Consequently the Candy-plug technique is used for distal occlusion of a false lumen aneurysm in chronic aortic dissection.

CaseA 73-year-old male patient with hypertension and chronic arterial fibrillation and cerebral infarction treated by apixaban. He had a history of chronic type B dissecting aortic aneurysm with onset 16 years ago. He confirmed sudden chest and back pain and a diagnosis of a ruptured dissecting aortic aneurysm by Computed Tomography (CT) was made. Emergency TEVAR was performed that covered the entry at the level of distal arch with left common carotid artery to left subclavian artery bypass. Retrograde perfusion into the false lumen from re-entry was utilized at the level of the superior mesenteric artery and terminal aorta. Furthermore, we performed embolization of false lumen by Candy-plug technique after TEVAR. Candy-plug technique was modified to 36×40mm. Excluder aortic extender was deployed proximal of the reentry in the false lumen, and a 16mm Amplatzer Vascular Plug II was deployed in the waist of the modified Excluder aortic extender for complete occlusion.

ConclusionCandy-plug technique is recommended as a good treatment for chronic aortic dissection.

P10-45Unexpected finding of single coronary artery during an emergent surgery of type A aortic dissectionKazuhito Tatsu1, Toru Uezu1, Norio Mouri1, Moriichi Sugama1

1Makiminato Chuo Hospital, Urasoe, Japan

IntroductionSingle coronary artery (SCA) is a very rare condition in which the entire coronary system arises from a solitary ostium without other major congenital cardiovascular anomalies. SCA is generally

Poster Presentation


diagnosed incidentally during conventional angiography. If SCA is not recognized preoperatively, it can lead to serious complications during cardiac surgery because of inappropriate myocardial protection or iatrogenic injury.

Case A 66-year-old female with a history of hypertension was admitted to nearby hospital with sudden onset of chest pain. Enhanced computed tomography showed acute type A aortic dissection and she was transferred to our hospital for an emergent operation. Preoperative echocardiography revealed small amount of pericardial effusion. Moreover her chest pain was persisting. So we performed an emergent operation. After cannulation of right femoral artery and vein, median sternotomy was done. Blood pericardial effusion was revealed. In addition of SVC drainage, cardiopulmonary bypass (CPB) was established , and core cooling was started. Following hypothermic circulatory arrest at core temperature of 21 （, the dissected ascending aorta was incised. The entry of aortic dissection was identified at the anterior wall of the ascending aorta, therefore,we decided to replace ascending aorta only. For selective administration of cardioplegia, we carefully observed the aortic root from the inside and recognized a solitary left coronary ostium. We could not find the right coronary ostium, so we administered first cardioplegia through left coronary ostium alone. Although cardiac arrest was obtained, we added retrograde administration of cardioplegia for secure myocardial protection. We completed ascending aortic replacement using Hemashield prosthetic graft. Weaning of CPB was smooth. Postoperative course was uneventful. We diagnosed SCA by postoperative MDCT. The type of SCA was L1.

ConclusionIn an emergent case, it is difficult to recognize SCA preoperatively. Retrograde myocardial protection and careful dissection avoiding iatrogenic injury are thought to be essential.

P10-46Introduction of less invasive treatment for Abdominal Aortic Aneurysm - Introduction of Endovascular treatment, inspection of the results for future development analysis of postoperative Quality of life using SF-36Takayuki Uchida1

1Iizuka Hospital, Iizuka, Japan

The invasiveness of operation has been compared by a mortality , hospitalization period and perioperative event rate. But in JAPAN, at AAA surgical treatment, even in open graft repair, mortality is very low(<1%). And we can’t find significant difference in mortality and morbidity between open graft replacement and EVAR. So to compare the invasiveness of EVAR and open repai of AAA, we analyze recovery of ADL or QOL after operation.

We divide AAA elective cases into two groups. (Group O; open graft replacement, Group E; EVAR. We analyze mortality, morbidity, hospital stay, SF-36 score (preop, 1M post op) between two groups. Results; mortality and major complication;0% in both groups.ope time(min) 289.1±80.3 vs 152.1±34.6 (Group O vs Group E) Hospital stay(day) 18.8±5.6VS1.1±2.0(Group O vs Group E)both significant shorter in group E.SF-36 SCORE; significantly rapid recover was detected in Group E Discussion; Recovery of QOL to

normal(especially back to office!) after operation is more rapid in Group E. So EVAR treatment is thought to have benefits in younger and lower risk patients. Conclusion Assessment of postoperative recovery of QOL was thought to be effective. Especially to enlarge the indication of EVAR to younger and lower risk patients. In group E, preoperative status was relatively poor, so we need more data, and match the preoperative status for precise analysis.

P10-47Repair of thoracoabdominal dissection aneurysm with Zenith® t-Branch™ Thoracoabdominal Endovascular GraftYew Toh Wong1

1Flinders Medical Centre, Bedford Park, Australia

BackgroundOpen repair of thoracoabdominal aneurysm (TAA) post aortic dissection is associated with major morbidity. Fenestrated and multibranched endografting (FEVAR/BEVAR) has enabled repair with lower morbidity and paraplegia risk. We described a case of large TAA after type B aortic dissection repaired with Zenith® t-Branch™ Device (T-branch).

Methods & resultsA 65 years old man with a 6.5cm TAA extending from just beyond the left subclavian artery (LSCA) to just below the renal arteries. The intima flap extended from LSCA to the right common iliac artery with long standing occlusion of the true lumen (TL) at the level of infrarenal aorta. Coeliac artery (CA), superior mesenteric artery (SMA) and right renal artery (RRA) arises from the false lumen (FL) and the left renal artery (LRA) arises from the TL. A left carotid subclavian bypass was performed and a T-branch was delivered via right femoral artery traversing into the FL and placed just above the CA. CA, SMA and RRA was sequentially cannulated and stented with covered stent (Fluency) and reinforced with non-covered balloon expandable stent (BES). LRA was accessed from the FL using OUTBACK Re-Entry Catheter. LRA was similarly stented. Standard thoracic stent graft was deployed just beyond the left common carotid artery (TL) across a large fenestration into the FL to mate with the T-branch. Abdominal aorta and iliac arteries were repaired using standard distal extensions. Completion angiogram showed successful exclusion of the aneurysm with patent branches to all visceral arteries. Postoperative recovery was complicated by paraparesis requiring four weeks of rehabilitation to enable independent walking.

ConclusionsFEVAR/BEVAR repair of post aortic dissection aneurysm is feasible. Consideration should be given to stage covered stenting for one of the visceral branches to reduce spinal cord ischaemia and to allow rapid exclusion of the aneurysm in the event of interval rupture.


P10-48Diabetic effect on prevalence and growth rate of abdominal aortic aneurysms: Systemic review and meta-analysisDr. Jiang Xiong1, Dr. Zhongyin Wu1, Dr. Chen Chen2, Dr. Yingqi Wei3, Dr. Wei Guo1

1Dpt. Vascular And Endovascular Surgery, The Chinese PLA General Hospital, Beijing, China, 2Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, USA, 3Beijing Center for Diseases Prevention and Control, Beijing, China

BackgroundEpidemiologic studies revealed that the prevalence of abdominal aortic aneurysm (AAA) might be lower in diabetic patients. However, the relationship between diabetes and AAA formation and enlargement remains unclear.

ObjectiveTo examine the effect of diabetes on prevalence and growth rate (GR) of AAA through a systematic review and meta-analysis.

MethodsA comprehensive systematic literature search (from January 1, 1982 to October 1, 2015) was conducted using PubMed, Web of Science, Scopus and Cochrane databases. Articles reporting the AAA prevalence in diabetic patients and diabetic effects in GR of AAA were included.

ResultsForty-nine studies on AAA prevalence in diabetics were included for meta-analysis by study type, geography and time of data collection. Thirteen studies were included for meta-analysis of diabetic effect on AAA growth. A strong negative association was found between diabetes and AAA in population based screening (adjusted odds ratio [OR]: 0.66; 95% confidence interval [CI]: 0.58-0.75) and prospective studies (adjusted OR: 0.52; 95%CI: 0.43-0.63), but not in case-control studies (adjusted OR: 0.48; 95%CI: 0.20-1.15). Similar association was found in North American (adjusted OR 0.62; 95% CI 0.54-0.71) and European (adjusted OR 0.45; 95% CI 0.33-0.62) studies. The strong negative association remained to be consistent when stratified by time of data collection (-1995 [adjusted OR: 0.65; 95%CI: 0.53-0.80], 1996-2005 [adjusted OR: 0.61; 95%CI: 0.47-0.78], 2006- [adjusted OR: 0.67; 95%CI: 0.53-0.85], data collection time > 10 years [adjusted OR: 0.44; 95%CI 0.34-0.58]). The annual mean diabetic effect on AAA GR was -0.53mm/y (95% CI: -0.71-0.35).

ConclusionThe strongly negative association between diabetes and AAA was independent of study type (screening and prospective study), geography (America and Europe) and time period. The negative impact of diabetes on GR of AAA has been strengthened.

P10-49Unruptured left sinus of Valsalva aneurysm with fistulous track complicated by aortic regurgitationSatoshi Yamashiro1, Professor Yukio Kuniyoshi1, Dr Ryoko Arakaki1, Dr Hitoshi Inafuku1, Dr Yuya Kise1

1Department of Thoracic And Cardiovascular Surgery, University Of The Ryukyus, Nishihara-cho, Nakagami-gun, Japan

IntroductionSinus of Valsalva aneurysms are relatively uncommon, while unruptured sinus of Valsalva aneurysm in the left coronary sinus is rare.

Case presentationA 54-year-old female was admitted for palpitations and general fatigue. Transthoracic echocardiogram revealed severe aortic regurgitation and Valsalva aneurysm of the left coronary sinus. Multi-slice computed tomography demonstrated diffuse aneurysmal dilatation of the left sinus of Valsalva without rupture. The main left coronary artery was seen arising from the tip of the aneurysm. The orifice of the tubular fistulous track was just posterior to the origin of the left main coronary artery. We applied a modified Bentall procedure using 23mm Carbo-Seal Valsalva graft. Left coronary artery reconstruction was performed using the Piehler technique with a saphenous vein graft. The right coronary artery was reconstructed using the usual Carrel’s button technique. We left an aneurysmal sac, because no bleeding from aneurysm was seen (indicating no communication with cardiac and vascular structures).

The patient’s postoperative course was uneventful, and she was discharged 21 days after this procedure.

ConclusionsThe optimal management of an asymptomatic, unruptured sinus of Valsalva aneurysm is not known, because the precise natural history of this phenomenon has not been well characterized. However, early surgery is recommended, because it provides excellent outcomes in such cases.

The precise repair technique is dependent on the number of dilated sinuses, whether the aneurysm has ruptured, and whether the aneurysm has an orifice.

P10-50Surgical, endoscopic and radiological management of infected graft and aortoduodenal fistula after EVARChun Ling Patricia Yih1, Dr Yuk Hoi Lam1, Prof Yun Wong James Lau1


Background and objectivesAortoenteric fistula after endovascular repair (EVAR) is exceedingly rare with few case reports in literature, most of which were treated by explantation and extra-anatomical bypass.

Poster Presentation


MethodsWe report a case of graft infection, paraaortic abscess and subsequent secondary aortoduodenal fistula developing more than 2 years post-EVAR as a result of salmonella bacteremia, and its multidisciplinary treatment.

ResultsThe patient is a 66-year-old man who had a 6.2cm infrarenal AAA and underwent successful EVAR in 05/2012. Surveillance ultrasound showed suspected type II endoleak with static sac size.He presented with septicaemia (high fever, chills and vomiting) in 06/2014 (25 months post-EVAR). Cultures yielded Salmonella enteritidis, and CT showed paraaortic collection which was drained percutaneously under image guidance. He was treated with a prolonged course of intravenous antibiotics and subsequently long term oral antibiotics.

However the inflammatory process persisted with increasing CRP. Follow up CT showed gas densities in the aortic sac. OGD in 06/2015 (37 months post-EVAR) showed a nodule at D3, with fistulation to the aortic sac confirmed on contrast injection. The fistula opening was endoscopically clipped (Ovesco OTSC®).

He remained well despite follow up CT showing persistence of gas density inside the sac. He had an episode of diarrhea and recurrent anaemia in 04/2016 (47 months post-EVAR). Repeated OGD showed persistent fistulation with friable tissue not suitable for further clipping. Laparotomy with division and repair of the fistula was performed in 07/2015 (50 months post-EVAR) in which the previous graft was not explanted. Recovery was uneventful and he was discharged with antibiotics.

ConclusionsSecondary infection and aortoenteric fistula development is rare in the current era of EVAR. A high index of suspicion, prompt diagnosis and appropriate multidisciplinary treatment should be instituted. Depending on the clinical status and severity of inflammation, explantation may not be necessary.

P10-51Left subclavian artery revascularization during thoracic endovascular aortic aneurysm repair with simple fenestrated techniqueHiroaki Yusa1, Dr Tomoaki Tanabe1, Dr. Makoto Taoka1, Dr Shou Tatebe1, Dr Imun Tei1, Dr Takashi Azuma2, Dr Yoshihiko Yokoi2

1Ayase Heart Hospital, Adachi-ku, Japan, 2Tokyo Women Medical college, Shinjuku-ku, Japan

Thoracic endovascular aortic repair（TEVAR) has a rule in the treatment of many pathologies of the descending thoracic aorta and aortic arch.

Especially, treating aortic arch pathology, maintaining perfusion of the innominate artery and the left common carotid artery is mandated to prevent major stroke.

But the necessity of maintaing blood flow to the left subclavian artery(LSA) remains controversial.

Intentional endograft coverage of the LSA was initially without revascurization portends significantly increased risk of subclavian steal syndrome, arm ischemia, vertebral territory stroke and spinal cord ischemia.

Although several options have been reported that allow patency of the LSA to be maintained, including elective debranching before TEVAR, the chimney technique, prefabricated branched endograft deployment, surgeon-modified endografts, the most simple method is fenestrating the endograft to revascularize the LSA duaring TEVAR.

We report the cases of simple LSA revascularization with fenestration of the endograft.

P10-52Aortoesophageal fistula secondary to thoracic endovascular aortic repair of an acute type B aortic dissection Weimin Zhou1

1the 2nd affiliated hospital of Nanchang University, Nanchang, China

IntroductionThoracic endovascular aortic repair (TEVAR) is increasingly applied in clinical practice as a novel, less invasive treatment for patients with aortic aneurysms and dissections. Secondary aortoesophageal fistula(AEF) is a relatively rare but very often lethal complication that may develop after TEVAR. The clinical syndrome is well explained by the Chiari triad and sentinel minor hematemesis followed by massive hematemesis. The incidence of this serious complication has increased with the growing number of patients undergoing TEVAR. This case report describes a patient who was admitted in our center because of fever, sepsis and thoracic pain radiating to the back and unresponsive to drug therapy, diagnosed with a secondary AEF and subsequently treated with a two stage stent-graft placement procedure.

ObjectiveWe present the case of a patient who developed an AEF 10 months after TEVAR of an acute type B aortic dissection.

Materials and MethodsA 62-year-old male Chinese patient underwent emergency stent graft placement in January 2013 because of an acute type B aortic dissection aneurysm. The patient was discharged uneventfully. Ten months later, the patient was readmitted because of recurrent hematemesis, weight loss, and malaise. A computed tomography scan and an upper gastrointestinal system (GIS) endoscopy examination revealed an AEF located at the midportion of the esophagus and at the caudal end of the stent graft. An emergency stent graft placement was performed in the distal of the previous stent graft.

ResultsHematemesis was stopped, but the patient died due to mediastinitis six months later after the second stent-graft implantation.


ConclusionsAEF is a catastrophic complication of TEVAR. Conservative treatment is often associated with fatal results. If possible, these patients should be treated with secondary major surgical procedures. Stent graft re-implant into the previous stent graft can only stop hematemesis, and prolong the lifetime.

P11-01Symptomatic carotid artery stenosis: literature review of current standards of timing and factors to improveKalpa Perera1, Mr. Kishore Sieunarine1


Background/IntroductionIn symptomatic carotid artery disease, established guidelines recommend intervention within two weeks of the index event. Studies reporting on timing to intervention have consistently found inherent delays in achieving optimal results.

ObjectivesThe aim of this literature review was to clarify the extent of the delay in the reported literature and to identify factors and suggest mechanisms to reduce this.

Materials and MethodsGeneric terms including carotid surgery, carotid endarterectomy, carotid stenting and delay to intervention/treatment were used to systematically search online, English-language, databases (e.g MEDLINE, etc.) from 1990-2016. Studies were selected according to certain inclusion and exclusion criteria. Primary outcome measure was proportion of symptomatic carotid interventions performed within two weeks of index event (SVS guidelines). The time from symptoms to intervention and factors that influenced this time in the studies were recorded.

ResultsSeventy-eight papers were identified. Only 18 studies were eligible for review. These included 17 carotid endarterectomy (CEA) and one carotid artery stenting (CAS) paper. A total of 10,023 carotid interventions were performed amongst the included studies, with 2,763 (27.6%) within the recommended two-week guideline. Specific factors affecting delays included time to initial primary care or emergency department presentation, time to vascular surgical referral and, less commonly, in-hospital operating schedule. Three studies had a specific fast track protocol (FTP), which involved a multidisciplinary TIA/stroke clinic and dedicated theatres. Of 469 FTP cases, 305 (65%) were treated within the guideline timeframe of two-weeks.

ConclusionInstitutions are failing to perform symptomatic carotid artery intervention within the recommended timeframe. Certain factors are associated with such delays and, when addressed, it is feasible to expedite treatment appropriately. A multidisciplinary fast track protocol has been proven to reduce delay.

P11-02Trans-radial Access for Iliac Intervention: A Systematic Review Eugene Ng1, Andrew MTL Choong2,3

1Westmead Hospital, Sydney, Australia, 2Division of Vascular Surgery, National University Heart Centre, Singapore, 3School of Medicine, Griffith University, Gold Coast, Queensland, Australia

AimThe radial artery is well established as a feasible and safe access site for coronary angiography and intervention. As the use of radial access for endovascular intervention has increased, so have the indications. It is now technically possible to intervene on the iliac artery via a radial artery approach.

MethodsOur review was carried out as per the Preferred Reporting Instructions for Systematic Reviews and Meta-analyses (PRISMA) guidelines. An electronic search of the public domain databases MEDLINE, EMBASE, SCOPUS, Web of Science and Cochrane Library Databases was performed to identify studies related to our intervention of interest. The selected studies were then searched for further references. Primary outcomes wereangiographic success at completion of intervention, clinical improvement in patient symptoms as determined by ankle-brachial index (ABI) or Fontaine-Rutherford classification, major and minor access or balloon related complications; radial artery patency on completion of procedure and at end of follow up period; overall length of stay and overall length of follow up.

ResultsA total of 13 studies were included in the systematic review. These comprised of 1 prospective multicenter cohort study, 2 prospective cohort studies, 1 retrospective cohort study, 2 case control studies, 3 case series and 4 case reports. A total of 388 patients underwent transradial access for revascularization of iliac arteries, of which 187 had left radial artery access (85.8%) and 31 patients had right radial artery access (14.2%). A total of 141 iliac lesions were stented. Self-expanding or balloon expandable stents were used. Procedural success defined as angiographic stenosis of less than 30% after intervention ranged from 87.9 to 100%. Access and procedural related complications occurred in 30 patients (7.7%). The total length of stay in hospital ranged from 0 to 4 days post intervention. Radial artery patency post intervention was assessed in 5 studies comprising 170 patients and was patent in 123 patients (72.4%) post intervention. Follow up period was variable across studies and ranged from 0.75 month to 23 months.

ConclusionThe results of this systematic review suggest that iliac revascularisation via the transradial route is a safe and feasible alternative which can be employed when there is unfavourable anatomy or difficulty accessing iliac lesions via the transfemoral route. Current treatment is limited by availability of interventional sheath, angioplasty balloon and stent delivery systems. Larger randomised controlled trials assessing safety, efficacy and cost effectiveness are required to further elucidate the use of this modality in the management of iliac arterial disease.

Poster Presentation


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ANNALS OF VASCULAR DISEASES