• Journal of Trauma and Injury
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• v.21 no.2
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• pp.128-135
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• 2008

Purpose: As the care of surgical patients becomes increasingly complex and catheter-based techniques are more frequently applied, the pattern of iatrogenic vascular injuries may be increasing. Major vascular injuries can jeopardize a patient's life or limb survival. The purpose of this study was to examine the current etiology and prognosis for iatrogenic vascular injuries. Methods: We reviewed medical records of 29 cases of iatrogenic vascular injury that were treated Seoul National University Bundang Hospital between October 2003 and October 2008. We studied clinical variables including demographics, cause of injury, clinical presentations, management and prognosis. Results: The mean age was 60.8 years (range: 25-86), and the male to female ratio was 1.9 : 1. The causes of injuries were operation related complication in 18 cases (62.1%), endovascular intervention and diagnostic angiography in 11 cases (37.9%). The types of vascular injury were partial severance in 14 cases, pseudoaneurysm in 8, arteriovenous fistula (AVF) in 3, thrombosis in 2, complete severance in 2. Especially, device related complication including percutaneous closing device were occurred in 9 and the others came from inadvertent physician's procedure. Primary repair were done in 12 cases, end-to-end anastomosis in 5, interposition graft in 4, ligation in 2, patch angioplasty in 1, peudoaneurysm excision and arteriorrhaphy in 1, hematoma evacuation in 1, and endovascular repair in 3. There were 2 cases of mortality, one of them due to hemorrhagic shock and the other due to septic shock. Conclusion: Proper selection of treatment modalities should be important to have better outcome according to the type of injury as well as anatomical location. Each physician should be familiar to new device as well as patient's topographical feature. Immediate referral to vascular specialist is also essential to reduce morbidity.

• Archives of Reconstructive Microsurgery
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• v.16 no.1
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• pp.30-38
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• 2007

In acute hand injury, there are sometimes hattened neglected or overlooked vascular injury by primary operators. The authors evaluated the final results and prognosis after secondary revascularization. In eight cases, the authors performed secondary revascularization after prolonged warm ischemia. Five fingers in five cases among them were successfully survived and three cases finally necrosed. The mean warm ischemic time was 56.1 hours. In revascularization procedures, end-to-end artery anastomosis was possible in six cases. In two cases, vein graft was needed to anastomose digital artery, which resulted in complete survival of the fingers. In all three cases, revision amputation of the fingers was done. In acute complex hand injury, the importance of evaluation of the vascular injury can not be overemphasized. The necessity of the early secondary revascularization as well as serious consequence caused by misdiagnosis of vascular injury should be aware.

• Journal of Trauma and Injury
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• v.28 no.1
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• pp.15-20
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• 2015

Purpose: Vascular injuries caused by traffic, industrial accidents and by outside activities have increased in Korea. Especially, vascular injuries to the extremities can lead to limb loss and even mortality if they are not appropriately treated. The aim of the study was to evaluate the surgical outcomes of femoropopliteal vascular management after trauma. Methods: The medical records of 12 patients with femoropopliteal vascular injuries who were treated at Dankook University Hospital from 2011 to 2013 were reviewed. Iatrogenic vascular injuries were excluded. The clinical data including the causes of injury, associated injuries and surgical outcomes were analyzed retrospectively. Results: All patients were male, with a mean age of $46.8{\pm}16.3years$ (range: 26~69 years). The causes of vascular injuries were four traffic accidents, three industrial accidents, two iron plates, one outside activity, one glass injury and one knife injury. The average transit time between the place of the accident place and the emergency department was $3.0{\pm}2.1$ (0.5~12.5) hours, and the average preparation time for surgery was $8.0{\pm}6.7$ (1.7~23.3) hours. The anatomic injuries included the popliteal vessel in seven cases and the femoral vessel in five cases. The average Injury Severity Score (ISS) was $12.0{\pm}5.0$ (5~17), and the average Mangled Extremity Severity Score (MESS) was $5.7{\pm}2.1$ (2~9). The operation methods were four interposition grafts, three end-to-end anastomoses, two direct repairs and three patch angioplasties. One case required amputation of the injured extremity. Conclusion: Early recognition and revascularization of the injured vessel are mandatory to reduce limb loss and to obtain satisfactory outcomes. Therefore, careful/rapid evaluation of the vascular injuries and timely/successful surgical treatment are the keys to salvaging an injured limb.

• Journal of Chest Surgery
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• v.36 no.8
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• pp.590-594
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• 2003

Vascular injury has been increased with popular outside activities. However there are only a few studies for vascular trauma. We intended to find out the relationships between the vascular trauma and its prognosis. Material and Method: Forty-four patients were diagnosed and operated on for vascular injury in the Gyeongsang National University Hospital from 1992. to 1999. We reviewed their chart and analysed their data retrospectively. We studied to causes, treatments, and prognoses of traumatic vascular injury. Result: The transfer time between accident place and emergency department was mean 3,5 hour, and the operation preparing time was 8.8 hours. Five cases required amputation of extremity. All amputation cases were combined with communited bony fractures. Thirty-eight cases had combined other injuries, and almost combined injuries were muscular and neurological damages, Conclusion: The optimal treatment plan for vascular trauma was prompt diagnosis and quick management. It may decrease amputation rate and post-traumatic complications. Therefore we must be carefully evaluated the multiple traumatic patients for early diagnosis of vascular injury and operate quickly in emergency status.

• BMB Reports
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• v.55 no.5
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• pp.244-249
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• 2022

Characterized by abnormal proliferation and migration of vascular smooth muscle cells (VSMCs), neointima hyperplasia is a hallmark of vascular restenosis after percutaneous vascular interventions. Vaccinia-related kinase 1 (VRK1) is a stress adaption-associated ser/thr protein kinase that can induce the proliferation of various types of cells. However, the role of VRK1 in the proliferation and migration of VSMCs and neointima hyperplasia after vascular injury remains unknown. We observed increased expression of VRK1 in VSMCs subjected to platelet-derived growth factor (PDGF)-BB by western blotting. Silencing VRK1 by shVrk1 reduced the number of Ki-67-positive VSMCs and attenuated the migration of VSMCs. Mechanistically, we found that relative expression levels of β-catenin and effectors of mTOR complex 1 (mTORC1) such as phospho (p)-mammalian target of rapamycin (mTOR), p-S6, and p-4EBP1 were decreased after silencing VRK1. Restoration of β-catenin expression by SKL2001 and re-activation of mTORC1 by Tuberous sclerosis 1 siRNA (siTsc1) both abolished shVrk1-mediated inhibitory effect on VSMC proliferation and migration. siTsc1 also rescued the reduced expression of β-catenin caused by VRK1 inhibition. Furthermore, mTORC1 re-activation failed to recover the attenuated proliferation and migration of VSMC resulting from shVrk1 after silencing β-catenin. We also found that the vascular expression of VRK1 was increased after injury. VRK1 inactivation in vivo inhibited vascular injury-induced neointima hyperplasia in a β-catenin-dependent manner. These results demonstrate that inhibition of VRK1 can suppress the proliferation and migration of VSMC and neointima hyperplasia after vascular injury via mTORC1/β-catenin pathway.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.1
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• pp.31-34
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• 2015

Vascular injury caused by a central venous catheter (CVC) has been reported to be a rare complication, especially delayed vascular injury due to CVC has a few cases and it can be fatal because of delayed recognition and more serious complications. A 59-year-old woman with no available medical history was admitted for treatment of ovarian cancer. For the surgery, a triple-lumen CVC was placed through the left subclavian vein. Parenteral nutrition through the CVC was used for postoperative nutritional management in the first postoperative day. On the sixth postoperative day (POD), the patient suddenly complained of dyspnea. The CT revealed bilateral pleural effusion and irregular soft tissue density and air bubble in anterior mediastinum suggesting migration of the distal portion of the CVC into the anterior mediastium. In the intensive care unit (ICU) bilateral thoracentesis and percutaneous drainage were performed. She was discharged from the ICU in 3 days later and transferred to the general ward. This case emphasizes the possibility of the delayed vascular injury related to CVC and some strategies for prevention of vascular injury.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.5
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• pp.447-451
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• 2001

With the exception of gun shot wound, the incidence of penetrating injury of face and neck areas nonorganic foreign bodies is relative low. But the diagnostic evaluation and therapeutic management of penetrating facial wounds need careful decision, when the anatomic proximity of the major vessels and nerve is considered. Penetrating facial trauma with concomitant vascular injury present challenging problems, the immediate complication of this vascular injury are severe bleeding, hematoma formation, shock, obstruction of airway. The vascular injury is conformed by angiography. In this report, a industrial tool(long tack) fired by explosive air is penetrated into face and to neck. In angiograms penetrating injury of the vertebral artery is detected. We performed the embolization of the vertebral artery with coils and manual removal of the foreign body without any complication was followed.

• Neonatal Medicine
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• v.18 no.2
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• pp.177-181
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• 2011

Bronchopulmonary dysplasia (BPD) is characterized by arrest of vascular and alveolar development in premature infants. Recent advances in neonatology have increased the survival of immature babies. Consequently, the prevalence of BPD is increasing. Animal studies and autopsy findings of BPD have demonstrated interruption in vascular development and reversal of lung injury through promotion of vasculogenesis. Normal lung development is driven by temporal and spatial specific growth factors and cellto-cell signaling in vascular development. Lung injury through various pathways causes disruption in this complex interactive process and results in aberrant vascular development and subsequent BPD. By understanding the regulation of vascular growth of the lung, it would be possible to find new targets in the treatment and prevention of BPD in premature infants.

• Journal of Trauma and Injury
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• v.36 no.1
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• pp.60-64
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• 2023

Upper extremity vascular injuries occurring with acute compartment syndrome are very challenging to manage in an emergency context in resource-poor settings. The need to always recognize the likelihood of coexisting compartment syndrome guides surgeons to perform concomitant fasciotomy to ensure a better outcome. We managed three vascular injuries in the upper extremities in two patients with concomitant imminent compartment syndrome observed intraoperatively. The first injury was complete brachial artery disruption following blunt trauma, while the second and third injuries were radial and ulnar artery transection caused by sharp glass cuts. Both patients were treated with vascular repair and fasciotomy. Secondary wound coverage was applied with split-thickness skin grafting, and the outcomes were satisfactory. Concomitant fasciotomy potentially improves the outcomes of vascular repair in emergency vascular surgery and should be considered for all injuries with the potential for acute compartment syndrome.

• Archives of Reconstructive Microsurgery
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• v.21 no.1
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• pp.27-33
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• 2012

We studied the results of the immediate microsurgical reconstruction of the distal digit injury with short vascular pedicled partial toe transfer. Thirteen patients with amputation or crush injury of the distal digit who underwent partial toe transfer at the authors' institute over 8-year period were reviewed. Delay between initial injury and reconstruction ranged from 1 to 9 days. All flaps were harvested on a short vascular pedicle, with anastomoses performed at a proximal interphalangeal joint level on the fingers and metacarpophalangeal joint level on the thumbs. Good to excellent cosmetic and functional results were obtained in all cases, with nearly normal-looking fingertip. The mean static two point discrimination was 10 mm. Immediate reconstruction with short vascular pedicled partial toe transfer is an excellent option for the reconstruction of the compostie defect of the distal digit.