Dong Hyeok Shin

Clinical outcomes of endovascular treatments for critical limb ischemia with chronic total occlusive lesions limited to below-the-knee arteries

Background Diabetes mellitus tends to have the greatest impact on the smaller vessels and contributes significantly to occlusive disease from the popliteal artery distally. Purpose To evaluate the clinical outcomes after a balloon angioplasty with or without stent placement in diabetic patients with critical limb ischemia (CLI) by chronic total occlusion (CTO) limited to below-the-knee (BTK) arteries. Material and Methods From August 2005, patients who presented CLI and CTO limited to the BTK arteries, and who underwent endovascular treatment, were included in this study. The primary endpoints evaluated were technical success, limb salvage, and primary patency. The secondary endpoints evaluated were 30-day access site, intervention site, and systemic complications. Patency and limb salvage were evaluated using the Kaplan-Meier method and compared using Fishers exact test. Results The BTK endovascular treatment (EVT) was performed on 64 limbs. Technical success rate was 93.8% and limb salvage rate was 90.6%. Three of four limbs with technical failure and three of 60 limbs with technical success underwent BTK amputation and the comparison of these rates were significantly different (75% vs. 5%, P = 0.002). Primary patency rates for the limbs were 75% and 59.1% at 6-month and 12-month follow-up, respectively. Minor complications disappeared through the follow-up periods and there was no 30-day complication or systemic adverse events for the treated vessel. Conclusion Even though EVT for CLI in patients with diabetes and CTO in isolated BTK arteries does not have comparable primary patency, it can lead to a very high rate of limb salvage. This result can accentuate the importance of more blood flow to the foot by means of successful revascularization using EVT rather than long-term patency in CTO of isolated BTK arteries.

Analysis of the midface, focusing on the nose : an anthropometric study in young Koreans

Abstract Improvements in both living standards and incomes have meant that many more people are now able to undergo elective plastic surgery for facial improvement. The nose and midface are the most frequent surgical target in Korea. However, the lack of reliable and precise anthropological data is a hindrance for effective surgical applications in this area. In the current study, 21 different lengths and angles of the midface and nose were measured in 2065 volunteers. The data were analyzed to establish sex and racial differences. Most of the measurements obtained from male volunteers were 5% to 10% greater than for the females, exceptions being the nasofrontal, nasolabial, and nasal tip angles. The biggest sex difference was found for depth of pupil, and the smallest difference was for intercanthal distance. For each measurement, the ratio of proportional differences was similar to that for whites. Many Koreans exhibited a columella protrusion of 4 to 5 mm; that parameter measures 2 to 3 mm in whites. The prevention of a hanging columella is important in nasal tip surgery. The intercanthal distance was also relatively large compared with the facial width. In females, the intercanthal distance was similar to the length of the nasal dorsum and the width of the nose. Surgeons may find this analysis useful for surgical planning. The present study provides basic clues for planning and practice in reconstructive and aesthetic facial surgery.