• The Korean Journal of Physiology and Pharmacology
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• v.20 no.6
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• pp.657-667
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• 2016

Critical limb ischemia (CLI) is one of the most severe forms of peripheral artery diseases, but current treatment strategies do not guarantee complete recovery of vascular blood flow or reduce the risk of mortality. Recently, human bone marrow derived mesenchymal stem cells (MSCs) have been reported to have a paracrine influence on angiogenesis in several ischemic diseases. However, little evidence is available regarding optimal cell doses and injection frequencies. Thus, the authors undertook this study to investigate the effects of cell dose and injection frequency on cell survival and paracrine effects. MSCs were injected at $10^6$ or $10^5$ per injection (high and low doses) either once (single injection) or once in two consecutive weeks (double injection) into ischemic legs. Mice were sacrificed 4 weeks after first injection. Angiogenic effects were confirmed in vitro and in vivo, and M2 macrophage infiltration into ischemic tissues and rates of limb salvage were documented. MSCs were found to induce angiogenesis through a paracrine effect in vitro, and were found to survive in ischemic muscle for up to 4 weeks dependent on cell dose and injection frequency. In addition, double high dose and low dose of MSC injections increased vessel formation, and decreased fibrosis volumes and apoptotic cell numbers, whereas a single high dose did not. Our results showed MSCs protect against ischemic injury in a paracrine manner, and suggest that increasing injection frequency is more important than MSC dosage for the treatment CLI.

• Archives of Plastic Surgery
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• v.43 no.6
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• pp.544-550
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• 2016

Background Although the use of temporary shunts in proximal extremity amputations has been reported, no study has described the use of temporary shunts in distal extremity amputations that require vein grafting. Moreover, the total volume of blood loss when temporary shunts are used has not been reported. The aim of this study was to investigate the applicability of a temporary shunt for distal extremity amputations requiring repair by vessel grafting with an ischemia time of >6 hours. This study also aimed to determine the total volume of blood loss when temporary shunts were used. Methods Patients who underwent distal major extremity replantation and/or revascularization with a vessel graft and who experienced ischemia for 6-8 hours between 2013 and 2014 were included in the study. A 6-Fr suction catheter was cut to 5 cm in length after the infusion of heparin, and secured with a 5-0 silk suture between the distal and the proximal ends of the artery. While bleeding continued, the bones were shortened and fixed. After the complete restoration of circulation, the arterial shunt created using the catheter was also repaired with a vein graft. Results Six patients were included in this study. The mean duration of ischemia was 7.25 hours. The mean duration of suction catheter use during limb revascularization was 7 minutes. The mean transfusion volume was 7.5 units. No losses of the extremity were observed. Conclusions This procedure should be considered in distal extremity amputations requiring repair by vessel grafting during critical ischemia.

• Journal of Chest Surgery
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• v.48 no.2
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• pp.146-150
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• 2015

Arterial thoracic outlet syndrome (TOS) causes ischemic symptoms; it is the rarest type, occurring in 5% of all TOS cases. This paper is a case report of a 38-year-old male patient diagnosed with arterial TOS, displaying symptoms of acute critical limb ischemia caused by thromboembolism. Brachial artery of the patient has been diffusely damaged by repeated occurrence of thromboembolism. It was thought to be not enough only decompression of subclavian artery to relieve the symptoms of hand ischemia; therefore, bypass surgery using reversed great saphenous vein was performed.

• Archives of Reconstructive Microsurgery
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• v.25 no.2
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• pp.75-78
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• 2016

The method of lower limb reconstruction surgery is selected based on a patient's underlying conditions, general conditions, and wound status, and it usually varies from direct closure to skin graft and flap coverage. Herein, we describe a patient with Duchenne muscular dystrophy who developed critical limb ischemia after femoral cannulation for extracorporeal membrane oxygenation was used during knee disarticulation, which was followed by reconstruction of the defect around the knee using a pedicled anterolateral thigh flap and skin graft.

• Archives of Plastic Surgery
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• v.49 no.5
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• pp.696-700
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• 2022

We performed distal bypass and free flap transfer in a single-stage operation to repair an extensive soft tissue defect in an ischemic foot of an 84-year-old woman. The nutrient artery of the free flap was anastomosed to the bypass graft in an end-to-side manner. Subsequently, the bypass graft became occluded on several occasions. Although intravascular and surgical interventions were performed each time, the bypass graft eventually became completely occluded. However, despite late occlusion of the nutrient artery, the free flap has remained viable and the patient is ambulatory. The time required for a transplanted free flap to become completely viable without a nutrient artery is likely longer for an ischemic foot compared with a healthy foot. However, the exact period of time required is not known. A period of month was required in our patient. We report this case to help clarify the process by which a free flap becomes viable when applied to an ischemic foot.

• Journal of Chest Surgery
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• v.47 no.2
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• pp.174-177
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• 2014

Surgical revascularization for patients with Buerger's disease is possible only in a few cases, due to the diffuse segmental involvement and the lack of distal runoff vessels available for bypass surgery. We encountered a case of resting pain in the right foot, coldness with dysesthesia, and cyanosis on the right 1st toe. The patient was treated with an endovascular intervention after vein patch angioplasty failed due to an inflammatory reaction of Buerger's disease. We suggest that an endovascular procedure can be an effective treatment, even in addition to more conservative and surgical management, in patients with Buerger's disease and critical limb ischemia.

• Journal of Chest Surgery
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• v.28 no.10
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• pp.900-905
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• 1995

Between Jan.1990 and Mar.1994, twenty-three patients[Male:20, Female:3 with aortoilac occlusive disease had underwent reconstruction [bypass garft . Two main causes of occlusion were atherosclerosis [21 patients and chronic thromboembolism[2 patients . Indications for operation were disabling claudication in 20 patients and critical limb ischemia in 12 patients. The procedures of operation included femorofemoral[8 , axillobifemoral[6 , aorto-bifemoral[6 , axillounifemoral[2 , aortoiliac[1 bypass graft. Postoperatively one patient died for sepsis and the operative mortality was 4.3%. Various anticoagulant therapy were maintained for at least six months. The 1year, 2year, 3year and 4year patency rates of bypass graft after operation were 91.3%, 80.8%, 71.4% and 58.4% respectively.

• BMB Reports
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• v.54 no.7
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• pp.356-367
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• 2021

Cell-based therapy is a promising approach in the field of regenerative medicine. As cells are formed into spheroids, their survival, functions, and engraftment in the transplanted site are significantly improved compared to single cell transplantation. To improve the therapeutic effect of cell spheroids even further, various biomaterials (e.g., nano- or microparticles, fibers, and hydrogels) have been developed for spheroid engineering. These biomaterials not only can control the overall spheroid formation (e.g., size, shape, aggregation speed, and degree of compaction), but also can regulate cell-to-cell and cell-to-matrix interactions in spheroids. Therefore, cell spheroids in synergy with biomaterials have recently emerged for cell-based regenerative therapy. Biomaterials-assisted spheroid engineering has been extensively studied for regeneration of bone or/and cartilage defects, critical limb ischemia, and myocardial infarction. Furthermore, it has been expanded to pancreas islets and hair follicle transplantation. This paper comprehensively reviews biomaterials-assisted spheroid engineering for regenerative therapy.

• Journal of Chest Surgery
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• v.50 no.5
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• pp.371-377
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• 2017

Background: Lesions in distal target arteries hinder surgical bypass procedures in patients with peripheral arterial occlusive disease. Methods: Between April 2012 and October 2015, 16 patients (18 limbs) with lifestyle-limiting claudication (n=12) or chronic critical limb ischemia (n=6) underwent femoral-above-knee (AK) polytetrafluoroethylene (PTFE) bypass grafts with a bridging stent graft placement between the distal target popliteal artery and the PTFE graft. Ring-supported PTFE grafts were used in all patients with no available vein for graft material. Follow-up evaluations assessed clinical symptoms, the ankle-brachial index, ultrasonographic imaging and/or computed tomography angiography, the primary patency rate, and complications. Results: All procedures were successful. The mean follow-up was 12.6 months (range, 11 to 14 months), and there were no major complications. The median baseline ankle-brachial index of 0.4 (range, 0.2 to 0.55) significantly increased to 0.8 (range, 0.5 to 1.0) at 12 months (p<0.01). The primary patency rate at 12 months was 83.3%. The presenting symptoms resolved within 2 weeks. Conclusion: In AK bypasses with a diffusely diseased distal target popliteal artery or when below-knee (BK) bypass surgery is impossible, this procedure could be clinically effective and safe when used as an alternative to femoral-BK bypass surgery.

• Journal of Chest Surgery
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• v.50 no.5
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• pp.363-370
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• 2017

Background: Extracorporeal life support (ECLS) is widely used in refractory heart or lung failure, and the demand for inter-facility transportation on ECLS is expanding. However, little is known about post-transportation outcomes, the clinical safety of such transportation, or the characteristics of the transported patients. Methods: This was a retrospective review of a 3-year, single-institution experience with inter-facility ECLS transport, as well as a comparative analysis of clinical outcomes with those of in-house patients. We also analyzed the risk factors for hospital mortality in the entire ECLS population using univariate and multivariate analyses to investigate the effects of transport. Results: All 44 patients were safely transported without adverse events. The average travel distance was 178.7 km, with an average travel time of 74.0 minutes. Early survival of the transported group seemed to be better than that of the in-house group, but the difference was not statistically significant (70.5% vs. 56.6%, p=0.096). The incidence of complications was similar between the 2 groups, except for critical limb ischemia, which was significantly more common in the transported group than in the in-house group (25.0% vs. 8.1%, p=0.017). After adjusting for confounders, being part of the transported group was not a predictor of early death (adjusted odds ratio, 0.689; p=0.397). Conclusion: Transportation of patients on ECLS is relatively safe, and the clinical outcomes of transported patients are comparable to those of in-house ECLS patients. Although matched studies are required, our study demonstrates that transporting patients on ECLS did not increase their risk of hospital mortality after adjustment for other factors.