Limited Feasibility in Endovascular Aneurysm Repair Using Currently Available Graft in Korea

Despite the wide acceptance of endovascular aneurysmal repair in patients with abdominal aortic aneurysm (EVAR), stringent morphologic criteria recommended by manufacturers may preclude this treatment in patients with AAA. The purpose of this study was to investigate how many patients are feasible by Zenith and Excluder stent graft system, which are available in Korea. Eighty-two AAA patients (71 men, mean age 70 yr) who had been treated surgically or medically from January 2005 to December 2006 were included. Criteria for morphologic suitability (MS) were examined to focus on characteristics of aneurysm; proximal and distal landing zone; angulation and involvement of both iliac artery aneurysms. Twenty-eight patients (34.1%) were feasible in Zenith stent graft and 31 patients (37.8%) were feasible in Excluder. The patients who were excluded EVAR had an average of 1.61 exclusion criteria. The main reasons for exclusion were an unfavorable proximal neck (n=34, 41.5%) and problem of distal landing zone (n=25, 30.5%). There was no statistical significance among gender, age or aneurysm size in terms of MS. Only 32 patients (39%) who had AAA were estimated to be suitable for two currently approved grafts by strict criteria. However, even unfavorable AAA patients who have severe co-mobidities will be included in EVAR in the near future. Therefore, more efforts including fine skill and anatomical understanding will be needed to meet these challenging cases

Two-port laparoscopic placement of a peritoneal dialysis catheter with abdominal wall fixation

We devised a new laparoscopic technique for peritoneal dialysis catheter (PDC) placement to overcome the common problem of malfunction or migration of the catheter. Between March 2005 and August 2006, 38 patients underwent laparoscopic catheter placement with lower abdominal wall fixation. Using an abdominal scout film, we checked for catheter tip migration regularly. There was no leak in the immediate postoperative period. After follow-up of 21.5 months (range 6-34), all catheters were working properly, although tip migrations were found in the iliac fossa in three patients and in the right upper quadrant in one patient. A port site hernia developed in one patient and peritonitis developed in two patients. Only one remote migration (2.6%) occurred during the study period. Thus, our method of laparoscopic catheter insertion might be a feasible option.Carrillo SA, 2007, SURG ENDOSC, V21, P825, DOI 10.1007/s00464-006-9148-xHarissis HV, 2006, AM J SURG, V192, P125, DOI 10.1016/j.amjsurg.2005.01.003Piraino B, 2005, PERITON DIALYSIS INT, V25, P107Comert M, 2005, SURG ENDOSC, V19, P245, DOI 10.1007/s00464-003-9302-7Soontrapornchai P, 2005, SURG ENDOSC, V19, P137, DOI 10.1007/s00464-004-8156-yVarela JE, 2003, SURG ENDOSC, V17, P2025, DOI 10.1007/s00464-003-8114-0OQUNC G, 2001, SURG TODAY, V31, P942Tsimoyiannis ECT, 2000, SURG LAPARO ENDO PER, V10, P218SKIPPER K, 1999, JSLS, V3, P63