AVDANNALS OF VASCULAR DISEASES http://www.avd.umin.jp/

Asian Society Asian Venous Forum for

17th Congress of Asian Society for Vascular Surgery 11th Asian Venous Forum

October 20-23, 2016 Singapore

ABSTRACT BOOK

Asian Society for Vascular Surgery Asian Venous Forum

Published by the Editorial Committee of Annals of Vascular Diseases c/o Medical Tribune Inc., 2-1-30 Kudan Minami, Chiyoda-ku 102-0074 CONTENTS Committees 4 Abstract Listing 6 Free Paper Presentation Oral 33 Prize Oral 83 Prize Poster 86 Poster 91

2 Annals of Vascular Diseases 2016 Editor-in-Chief

Tetsuro Miyata

Associate Editors

Hideo Adachi Japan Young-Wook Kim Korea Stephen Cheng Hong Kong Masahiko Kurabayashi Japan Tsuneo Ishiguchi Japan Masataka Sata Japan Kimihiko Kichikawa Japan Norihiko Shiiya Japan

Editorial Board Members

Abdulkarim Al-Amer Yemen Yew Pung Leong Malaysia Mussaad M.S. Al-Salman Saudi Arabia Mauri Lepäntalo Finland Louay Altarazi Syria James May Australia Takayuki Asahara Japan In Sung Moon Korea Enrico Ascher USA Pramook Mutirangura Thailand Jean-Pierre Becquemin France Hitoshi Ogino Japan David Bergqvist Sweden Takao Ohki Japan Ahmet Kursat Bozkurt Turkey Peter Robless Singapore Jan Brunkwall Germany Josefino Sanchez Philippines Niaz Ahmed Choudhury Bangladesh Osamu Sato Japan Murnizal Dahlan Indonesia Hirono Satokawa Japan Ricardo Etcheverry Argentina Torben V. Schroeder Denmark John Fletcher Australia Chun Che Shih Taiwan Peter Gloviczki USA Henrik Sillesen Denmark Tarun Grover India Bauer Sumpio USA Eiji Ikeda Japan Shen Ming Wang China Dong-Ik Kim Korea Shoei-Shen Wang Taiwan Kimihiro Komori Japan Yoshikazu Yonemitsu Japan Issei Komuro Japan Masao Yoshizumi Japan Byung-Boong Lee USA

Advisory Board

Takehisa Iwai Japan Takashi Ohta Japan Sachio Kuribayashi Japan Tadahiro Sasajima Japan Masunori Matsuzaki Japan Hiroshi Shigematsu Japan Toshio Ohhashi Japan Yoshio Yazaki Japan

Past Editor-in-Chief

Nobuyuki Nakajima

AVD Editorial Office

c/o Medical Tribune Inc., 2-1-30, Kundan-Minami, Chiyoda-ku, Tokyo 102-0074, Japan Tel: +81-3-3239-9376, Fax: +81-03-3239-9375 Email: [email protected]

Annals of Vascular Diseases 2016 3 ASVS 2016 Committees The 17th Congress of Asian Society for Vascular Surgery

Congress Organizing Committee

Peter ROBLESS (Chair) Scientific Program Andrew MTL CHOONG Sadhana CHANDRASEKAR Benjamin CHUA Kok Hoong CHIA Jackie HO Siew Ping CHNG Steven KUM Sriram NARAYANAN Edward CHOKE Yih Kai TAN Andrew MTL CHOONG Tjun TANG Tze Tec CHONG Julian WONG Benjamin CHUA Rajesh DHARMARAJ BABU Abstract Review Andrew MTL CHOONG Sugit Singh GILL Chuo Ren LEONG Tjun TANG Jackie HO Steven KUM Pre-Congress Workshop Sadhana CHANDRASEKAR Chee Wei LEE Tze Tec CHONG Chuo Ren LEONG Jackie HO Raj Kumar MENON Sriram NARAYANAN Sanjay NALACHANDRAN Harvinder Raj SIDHU Sriram NARAYANAN Vikram VIJAYAN Harvinder Raj SIDHU Live Case Workshop Steven KUM Glenn TAN Yih Kai TAN John TAN Yih Kai TAN Social Secretary Siew Ping CHNG Tjun TANG Andrew MTL CHOONG Vikram VIJAYAN Trade & Sponsorship Steven KUM John WANG Vikram VIJAYAN Julian WONG

4 Annals of Vascular Diseases 2016 Council Members of Asian Society Council Members of for Vascular Surgery Asian Venous Forum

President Peter Robless President Yew Pung Leong Secretary-General Stephen WK. Cheng Vice-President Shoaib F. Padaria Treasurer Yew Pung Leong General Secretary Ahmet Kursat Bozkurt Treasurer Tomohiro Ogawa Councilors: Takehisa Iwai Bangladesh Niaz Ahmed Choudhury Past President Dong-Ik Kim China Shenming Wang Congress Chairman Sriram Narayanan Hong Kong Stephen WK. Cheng India Tarun Grover National Delegates Indonesia Murizal Dahlan Japan Tetsuo Miyata Bangladesh Niaz Ahmed Choudhury Korea In Sung Moon China Yu-Qi Wang Malaysia Ngoh Chin Liew China Xin-Wei Han Philippines Josefino I. Sanchez China Shen-Ming Wang Saudi Arabia Mussaad Al-Salman Hong Kong Stephen WK. Cheng Singapore Peter Robless India Malay Patel Taiwan Chun-Che Shih Indonesia Murnizal Dahlan Thailand Pramook Mutirangura Japan Tetsuro Miyata Turkey Ahmet Kursat Bozkurt Malaysia Ngoh Chin Liew Philippines Josefino I. Sanchez Founders: Saudi Arabia Mussaad Al-Salman USA John B. Chang Singapore Peter Robless Korea Yong Kak Lee Taiwan Shoei-Shen Wang Japan Yoshio Mishima Thailand Kamphol Laohapensang China Zhong Gao Wang Thailand Pramook Mutirangura Turkey Ahmet Kursat Bozkurt United Arab Emirates Ramesh Tripathi Past Presidents

Japan 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)

Annals of Vascular Diseases 2016 5 Oral Presentation

01-01 Factors associated with early (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 in central venous occlusive disease in 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 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 anAsian population Juefei Feng1 1Tan Tock Seng Hospital, Singapore, Singapore

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 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

6 Annals of Vascular Diseases 2016 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 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 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

Annals of Vascular Diseases 2016 7 Oral Presentation

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 1King Saud University, Riyadh, Saudi Arabia

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 for Radiation Arteritis Hironobou Fujimura1, Dr Takashi Shintani1 1Toyonaka Municipal Hospital, Toyonaka, Japan

8 Annals of Vascular Diseases 2016 04-05 Small infrarenal aortic diameter associated with lower-extremity peripheral artery disease in Chinese hypertensive adults Jie 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 1ACT Health, Garran, Australia

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 1ACT Health, Garran, Australia

04-08 Major lower limb amputation: Are outcomes improving? David Kelly1, Ms Stephanie Pederson1, Dr Kishore Sieunarine1 1Royal Perth Hospital, Perth, Australia

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

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

Annals of Vascular Diseases 2016 9 Oral Presentation

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 1Tan Tock Seng Hospital, Singapore, Singapore

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 1ACT Health, Garran, Australia

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

10 Annals of Vascular Diseases 2016 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 & , 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 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 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

Annals of Vascular Diseases 2016 11 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 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 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 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 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

07-11 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

12 Annals of Vascular Diseases 2016 08-04 Does ablation of great saphenous vein and simultaneous phlebectomies of 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 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 1Keimyung University, Daegu, South Korea, 2Ulsan University, Ulsan , South Korea

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 ,2 vascular 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 1Royal Perth Hospital, Perth, Australia

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 : 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

Annals of Vascular Diseases 2016 13 Oral Presentation

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

14 Annals of Vascular Diseases 2016 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,4 Department 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 1Kyung Hee University Hospital At Gangdong, Seoul, South Korea

10-09 Comparison of local 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 1Department of Surgery, Inha.university Hospital, JungGu, South Korea, 2Department of Radiology, Inha.university Hospital, JungGu, South Korea

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

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

Annals of Vascular Diseases 2016 15 Oral Presentation

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 1Tan Tock Seng Hospital, Singapore, Singapore

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 1Royal Perth Hospital, Perth, Australia

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 Presentation

PO-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 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

16 Annals of Vascular Diseases 2016 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

Annals of Vascular Diseases 2016 17 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 1Izmir Katip Celeby University Atatürk Training and Research Hospital, Izmir, Turkey

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 1Chonnam National University Hospital, Gwangju, South Korea

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

18 Annals of Vascular Diseases 2016 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 andTransplant 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 1Philippine Society For Vascular Surgery, Inc, Quezon City, Philippines

P03-04 Movement of intravascular catheters in a simulated hemodialysis environment Dr. Benito Purugganan Jr1, Joy Gali1, Dr. Ricardo Jose Quintos1 1Philippine Society For Vascular Surgery, Inc, Quezon City, Philippines

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

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

Annals of Vascular Diseases 2016 19 Poster Presentation

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

P03-10 Management of giant venous aneurysms of arteriovenous fistula in hemodialysis patients [serial case] Romzi Karim1, PhD Akhmadu Muradi1 1Indonesian Society For Vascular And Endovascular Surgery, Central Jakarta, Indonesia

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

20 Annals of Vascular Diseases 2016 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

Annals of Vascular Diseases 2016 21 Poster Presentation

P05-03 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 1Izmir Katip Celeby University Atatürk Training and Research Hospital, Izmir, Turkey

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

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

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

22 Annals of Vascular Diseases 2016 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,3 NCD 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 1Mitoyo General Hospital, Kanonji, Japan

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 1Kawasaki Medical School, Kurashiki, Japan

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 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

Annals of Vascular Diseases 2016 23 Poster Presentation

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

24 Annals of Vascular Diseases 2016 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 1Indonesian Society For Vascular And Endovascular Surgery, Central Jakarta, Indonesia

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

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

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 1Pusan National University Yangsan Hospital, Yangsan, South Korea

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

Annals of Vascular Diseases 2016 25 Poster Presentation

P07-18 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

26 Annals of Vascular Diseases 2016 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 1Cumhuriyet University Medical Faculty, SİVAS, Turkey, 2Katip Celebi University Izmir Ataturk Training and Research Hospital, Izmir, Turkey

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

Annals of Vascular Diseases 2016 27 Poster Presentation

P08-03 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 1Izmir Katip Celeby University Atatürk Training and Research Hospital, Izmir, Turkey

P09-03 Analysis of Risk Factors for Cerebral Microinfarcts After 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 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 1Pusan National University Yangsan Hospital, Yangsan, South Korea

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

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 1Ankara University Medicine School, Ankara, Turkey

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 1Chonnam National University Hospital, Gwangju, South Korea

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

28 Annals of Vascular Diseases 2016 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 1Indonesian Society For Vascular And Endovascular Surgery, Central Jakarta, Indonesia

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

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

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

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 1Kishiwada Tokusyukai Hospital, Kishiwada, Japan

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

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

Annals of Vascular Diseases 2016 29 Poster Presentation

P10-17 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 Won 1, Professor In Sung Moon1, Professor Ji Il Kim1 1The Catholic University of Korea, Seoul, South Korea

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 1Seoul Medical Center, Seoul, South Korea

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 1Chinese PLA General Hospital, Beijing, China

30 Annals of Vascular Diseases 2016 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 1Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan

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

Annals of Vascular Diseases 2016 31 Poster Presentation

P10-42 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 1Royal Perth Hospital, Perth, Australia

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

32 Annals of Vascular Diseases 2016 Oral Presentation

Methods 01-01 Retrospective study of 47 AVFs created in patients aged 80 years Factors associated with early vascular access and above between November 2008 to December 2014. Factors (VA) failure in acute phase patients investigated include patient demographics, co-morbidities, 1 previous central venous interventions, end-stage renal failure Akihito Tanaka (ESRF) status, current medication regime, pre-operative ultrasound 1Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan vein map, surgeon grade and requirement for any assisted patency interventions such as tributary ligation, fistuloplasty or AVF revision. Introduction Acute phase patients sometimes require hemodialysis therapy without vascular access (VA) present on admission. These patients Results require VA creation to continue hemodialysis after discharge. The Average age of the patients was 82.8 years old, with range between risk of early VA failure in acute phase conditions is considered high 80 to 91 years of age. Within the study population, 27 (57.4%) were due to the unstable nature of the patient’s condition. Hence, the male, 30 (63.8%) were independent in their activities of daily living optimal timing of VA creation is not established. (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. Objectives There were a total of 15 (31.9%) radio-cephalic AVFs, 30 (63.8%) We are going to clarify the factors associated with early VA failure brachio-cephalic AVFs and 2 (4.3%) brachio-basilic transposition and decide the optimal timing of VA creation. AVFs created. Primary AVF patency rate was 14.9% (7 patients) whilst primary failure rate was 72.3% (34 patients). There were Methods no post-op wound infections. PC line sepsis rate was 31.4% (11 patients). A further 12.8% (6 patients) underwent additional This retrospective study included patients who had VA intervention and achieved assisted primary and secondary patency. (arteriovenous fistula or graft) created between May 2010 and Univariate analysis did not reveal any factor to be statistically December 2015. significant in predicting AVF patency. Kaplan-Meier survival curve showed a 50% survival rate at 63 months after AVF creation. Results During this study, 809 VA creations were performed among 716 Conclusions patients. Of the included, 385 were acute phase patients (245 men, In view of high AVF primary failure rate (72.3%) and relatively 140 women). The average age was 67.1 ± 14.9 years. The causes low PC line sepsis rate (31.4%), long-term PC as the main form of of admission were exacerbation of renal failure (244 patients, haemodialysis renal access may be a viable option in Octogenarians. 63.4%), heart disease (53 patients, 13.8%), infectious disease (26 However, with 50% of ESRF patients surviving up to 63 months patients, 6.8%), and malignancy (14 patients, 3.6%). Early VA after AVF creation, the risks and benefits of long-term PC must be failure occurred in 47 patients (12.2%). There was no difference in balanced against those of AVF creation. 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 01-03 and without early VA failure. The use of covered stent in central venous occlusive disease in hemodialysis patients Conclusions Chai Hock Chua1, Dr Chia Hsun Lin1 When we perform VA creation in acute phase patients, 1Shin Kong Memorial Hospital Taipei, Taiwan, Taipei, Taiwan 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. Background Central 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. 01-02 Until now, covered stent is considered a better way to maintain the patency. This study evaluated the efficacy and durability of covered Is it worth the effort? Creation of arterio- stent in treating central venous occlusive disease. venous fistulas in octogenarians Jennifer Diandra1, Dr Wei-wen Ang1, Dr Zhiwen Joseph Objectives Lo1, Dr Jue Fei Feng1, Dr Glenn Wei Leong Tan1, Dr Sadhana Covered stent is considered a better way to treat central venous Chandrasekar1, Dr Sriram Narayanan1 occlusive disease (CVOD), compared to bare mental stent or just 1Tan Tock Seng Hospital, Singapore, Singapore angioplasty. This study evaluted the result of treating CVOD by covered stent in our hospital Aims To evaluate the outcomes of arterio-venous fistulae (AVF) creation Methods in patients aged 80 years old and above. A 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.

Annals of Vascular Diseases 2016 33 Oral Presentation Results 01-05 A total of 25 patients (60% men) with CVOD was treated with covered stent during the follow-up. The viabahn endoprosthesis Intraoperative bloodflow rate as maturity was used in 16 patients (average size and length, 11mm *5cm) predictor of brachiocephalic fistula at diabetic and iliac extensions was used in another 9 patients (average size, nephropathy patient 13mm*8cm). Technical success was 100%. Covered stent primary 1 1 patency, assisted primary patency, and secondary patency were Sandra Harisandi , dr dedy pratama 40%, 75%, and 100% at 12 months. 1Surgery Department Of Ciptomangunkusomo Hospital, Jakarta, Indonesia, jakarta, Indonesia Conclusions The use of covered stent in CVOD is a promising alternative way Introduction to keep the dialysis access in function and relieve the symptoms. This research is a follow-up study to determine the value limits of Further prospective and randomized studies are needed to BFR intraoperative using Doppler ultrasound to predict maturity determine whether covered stents provide superior long-term of brachiocephalic fistula with a larger sample and to obtain lower results, compared to other endovascular method. level of error and bias, so it can be used as a reference in the Vascular Surgery division, Cipto Mangunkusumo Hospital

Methods 01-04 Cross-sectional design with analytic fashion conducted at Division Risk factors for decreased patency of Autologous of Vascular Surgery Department of the Faculty of medicine - Cipto Mangunkusumo Hospital, Jakarta. We conducted consecutive Arteriovenous Fistula in the snuff-box sampling, all patients with stage IV-V CKD, due to diabetic Yasuhiro Fujii1, Ph.D. Susumu Oozawa1, M.D. Michihiro nephropathy, planned to get vascular access for hemodialysis Okuyama1, Ph.D. Zenichi Masuda1, M.D. Hidemi Takeuchi1, Ph.D. brachiocephalic fistula. Haruhito Uchida1, Ph.D. Shunji Sano1 1 Okayama University Graduate School Of Medicine, Dentistry, Result And Pharmaceutical Sciences, Okayama, Japan Total 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 Introduction found 3.3 mm (2.0 to 7.4 mm) and the mean diameter of the vein Autologous snuff-box arteriovenous fistula (sAVF) is the first found to 3 mm (2.1 to 5.6 mm ). Only BFR associated significantly choice procedure as the primary AVF for haemodialysis at this with maturity AVF (p<0.001). We found highest sensitivity and institution. The patency of the autologous AVF in the forearm was specificity values obtained when the value of intraoperative blood- reported to be 43% to 85% at 1 year and 40 % to 69 % at 2 years. flow was 211.3 mL / min. This value is determined as the cut-off However, the patency of sAVF alone is not completely defined. In value for prediction of brachiocephalic AVF maturation with a addition, evidence for risk factors of its failure is scarce. sensitivity of 95.45%, a specificity of 92.59% and 95.5% positive predictive value and 92.6% negative predictive value. Objectives Conclusion The purpose of this study was to describe the results of sAVF and to verify the risk factors for its failure. BFR 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%. Methods A retrospective chart review was performed in 157 patients (95 Key words male and 62 female patients) who underwent sAVF creation at this institution between March 2011 and December 2015. The average Intraoperative BFR, AV fistula maturity, brachiocephalic, age was 65 ± 13 years (range, 23 to 90 years). The sAVF was sensitivity, specificity. created in the left and right arms in 132 patients and 25 patients, respectively. Seven patients had collagen vascular disease (CVD).

Results 01-06 The primary patency rates were 93.6%, 65.3%, and 58.2% at Role of Post-Operative Bruit as an Indicator of 1month, 1 year, and 2 years after surgery, respectively. The AVF Maturation secondary patency rates were 98.7%, 87.8%, and 83.3% at 1 month, 1 1 1 1 year, and at 2 years after surgery, respectively. On multivariate Cristina Lajom , Dr. Aries Garin , Dr. Teodoro Jr. Bautista analysis, older age (P = 0.016), sAVF creation in the right arm (P = 1UNIVERSITY OF SANTO TOMAS HOSPITAL, SAMPALOC , 0.009), and steroid use (P = 0.030) were the significant risk factors Philippines 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 Introduction risk factors for the decreased secondary patency rate. Vascular access is the lifeline of a hemodialysis patient. Arterio- venous fistulas (AVF) and grafts are the current options for Conclusions permanent vascular access for hemodialysis. Vascular access The patency rate of sAVF was comparable to previously reported dysfunction is a major contributor to the overall morbidity and patency rates for the forearm AVF. Careful observation for sAVF mortality of hemodialysis patients, hence placing a significant is needed in patients with older age, AVF creation in the right arm, burden on the health care sector. the purpose of this study is to CVD, steroid use, and type I diabetes. provide a cost- efficient way to predict the maturity of AVF by using an objective indicator such as a bruit.

34 Annals of Vascular Diseases 2016 Methodology Results A chart review of all patients with AVFs placed from January 2011 A total of 43 patients were included in the study cohort. The mean to July 2014 were done at the University of Santo Tomas Hospital. age was 51.8 ± 14.9 years old (range 21 to 72). A total of 26 patients All patients underwent AVF creation. Immediate post operative (60%) were already on hemodialysis using a temporary central bruit was noted. AVF Maturation was defined as successful vein catheter. The mean diameter of cephalic vein was 2.4 ± 0.5 cannulation and hemodialysis. 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 Results maturation rate was 79% (34/43). The mean duration of follow- Among the 268 AVFs created, a total of 85 were included with a up was 12.6 ± 7.5 months. There was no statistical significant majority of males (62%) and a mean age of > 60 years old (51%). between the matured and unmatured group in terms of age, gender, body-mass index, diabetes and prior dialysis catheter placement. The most frequent cause for hemodialysis was Diabetic nephropathy However, patients with failure maturation had a significantly small (49%) and hypertensive nephrosclerosis (18%). vein diameter (P=0.025).

Among the 85 eligible patients, 44 were included in the Auscultation Conclusions (bruit) group, while 41 were included in the Non-Auscultation Cephalic vein in Chinese patient was relatively smaller. Our study (no bruit) group. In the bruit group, 84% (n=37) of the AVF shows increased vein diameter on preoperative ultrasound mapping created matured. While in the no bruit group, only 60 % of the AVF is associated with fistula maturation. matured. The relative risk is 1.38. with p-value of 0.017

Conclusion Presence of a bruit immediately post- operatively, is a reliable 01-08 objective indicator of AVF maturation. We strongly recommend Correlation peak sistolic velocity brachial Routine auscultation immediately after AVF creation as a cost artery and blood flow rate intra operative with effective indicator AVF maturation, by preventing unnecessary re-operations and decrease burden among chronically dialyzed maturation of brachiocephalic fistula patients. Djony Edward Tjandra, Raden Suhartono 1Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia

Hemodialisis as treatment for renal replacement often patient 01-07 chronic renal disease grade 5. Vascular access for hemodialysis its Correlation between preoperative vein diameter associated problems is the leading cause for hospital admission and morbidity. Maturation failure is impeded by issues of maturation. and maturation of radiocephalic fistula The result from this study showed that correlation peak sistolik Hailei Li1, Dr. Yiu-Che Chan2, Ms. Lisa Wu2, Dr. Dongzhe Cui1, velocity brakial artery and bloodflow rate measured using Doppler Professor Stephen Cheng2 ultrasonogaphy right creation of the brachiocephalic fistula can 1Division of Vascular Surgery, Department of Surgery, The predict AVF maturation. Statistic analisis use Mann Whithey and University of Hong Kong Shenzhen Hospital, Shenzhen, China, Chi Squere. 2Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Result no correlation PSV with maturation, the intraoperative Hospital, Hong Kong, China 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 Introduction corrective procedure was needed to repair the brachiochephalic and Autogenous arteriovenous fistula (AVF) is the optimal vascular consequently help in reducing the rate of AVF maturation failure. 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 01-09 mapping, the incidence of maturation failure remains high. Predictors of radio-cephalic arteriovenous fistulae patency in an Asian population Purpose Juefei Feng1 The aim of this study was to investigate variables that affect 1 autogenous radiocephalic AVF maturation. Especially, we focused Tan Tock Seng Hospital, Singapore, Singapore on the influence of pre-operative vein size on fistula maturation. Purpose Methods To identify predictors of arteriovenous fistula (AVF) patency in This was a retrospective analysis of patients underwent Asian patients with autogenous radiocephalic hemodialysis access creation from June 2013 to June 2015 at a arteriovenous fistula (RCAVF). 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 Methods between the two groups was performed using SPSS statistics. Retrospective 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.

Annals of Vascular Diseases 2016 35 Oral Presentation

Results 0.0070 respectively) to be predictive of increased frequency Overall secondary patency rate was 72% at 12 months, 69% at 24 of interventions. Groups with older age at access creation months, 58% at 36 months, 57% at 48 months, 56% at 60 months (3.00±2.32 vs 4.22±2.94 years; p=0.00106) and DM (3.08±2.26 and 54% at 72 months. Univariate analysis showed that factors vs 4.46±3.19 years; p=0.00139) had poorer primary assisted which predict for patency include male gender (p = 0.003), good patency. Although ipsilateral previous access had non-significant diabetic control (p = 0.025), aspirin use (p = 0.031), pre-dialysis effect on primary assisted patency (p=0.119), this group of patients status (p = 0.037), radial artery diameter (p = 0.029) and non- required more interventions to maintain patency (5.49±4.03 vs calcified radial arteries (p = 0.002). Age (p = 0.866), cephalic vein 4.03±3.06,p=0.0263). diameter (p = 0.630) and surgeon grade (p = 0.472) did not predict for primary AVF failure. Multivariate analysis revealed the male Conclusions gender to be an independent predictor for patency (odds ratio 1.99, p = 0.01). Subset analysis showed a significantly larger average IHD, CVD and AVGs are predictors of poor primary patency. radial artery diameter of 2.3 mm amongst males, as compared to Increased frequency of interventions was predicted by older age 1.9 mm amongst females (p = 0.001) and no statistical difference in at access creation (>60 years), DM and ipsilateral previous access. the average cephalic vein diameter.

Conclusions 01-11 Within our Asian study population, 12-month patency rate of RCAVF is 72%, 69% at 24 months, 58% at 36 months, 57% at 48 Correlation Between Quick of Blood (Qb) months, 56% at 60 months and 54% at 72 months. Male gender and Adequacy of Hemodialysis in Mature is an independent predictor for RCAVF patency. In females or Arterovenous Fistula patients with calcified radial arteries, a more proximal AVF should be considered. Mursid Fadli, Akhmadu 1Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia

The success of the process is determined by the fulfillment 01-10 hemodialysis HD dose according to the patient’s needs. HD dosing according to patient needs can be assessed from the adequacy or Predictors of poor primary patency of adequacy of hemodialysis patients who achieved HD. Qb different arteriovenous fistula or graft for haemodialysis with giving effect to the urea clearance is achieved. This study is access expected to be useful in setting up and monitoring of the Qb so as Matthew KH Tan, Eusebio M D’Almeida, Chee Y Ng, Chieh Suai to optimize the adequacy of dialysis patients and the creation of Tan, Edward Choke quality of life of patients better. 1Singapore General Hospital, Singapore This study is to know correlation between Qb and adequacy of hemodialysis in patients with mature Arterovenous Fistula (AVF). Background and objectives Besides identifying patient characteristics, Qb patients with AVF Arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) are were mature, identify the adequacy of hemodialysis achieved by the most commonly used access for haemodialysis but often require patients with AVF were mature, analyzing the correlation between multiple interventions to maintain patency over their lifespan. This Qb and adequacy of hemodialysis in patients with AVF were mature study retrospectively evaluated factors for poorer primary patency and analyzing the correlation Among the factors confounding the and increased frequency of intervention. adequacy of hemodialysis in patients with AVF were mature.

Methods This research is a quantitative approach cross-sectional study. Data from consecutive patients admitted for angioplasty or The study was conducted at Cipto Mangunkusumo hospital from thrombolysis from January 2015 to February 2016 in single tertiary September to November 2015. centre were retrospectively obtained from electronic medical records. Demographics, co-morbidities, previous access details, The results of the analysis of the relationship between Qb and and interventions on current access were collected. adequacy of hemodialysis (value Kt / V) showed significant results, where the p value of 0.227 (p> 0.05). Results of this study Results concluded that there was no significant relationship between Qb and adequacy of hemodialysis (p = 0.227). One 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%) There is no significant relationship between Qb and adequacy AVGs. Primary patency rate was 64.3% and 40.0% at 6-months haemodialis (value Kt / V). In this study, there are many and 1-year respectively. A total of 19 (10.3%) accesses reached shortcomings including hemodialysis adequacy assessment just secondary patency at 2.7±2.2 years. Multivariate Cox regression by looking at the Kt / V without a measurement of URR. Another analysis with backward elimination showed predictors of poor Keterbatan namely HD space RSCM use dialyzer membrane primary patency to included ischaemic heart disease (IHD) (HR, type of a low flux, it is certainly affect the achievement of urea 1.52; 95% CI, 1.12-2.04; p=0.0063), cerebrovascular disease clearance which ultimately affect the achievement of the adequacy (CVD) (HR, 1.74; 95% CI, 1.14-2.65; p=0.0104) and AVGs (HR, of hemodialysis 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

36 Annals of Vascular Diseases 2016 02-01 Materials and Methods Data was collected retrospectively using the Western Australian Factors associated with primary angioplasty Nephrology Database (WAND), patients’ hospital notes and the durability in haemodialysis access WA radiology PACS. The study period extended from 2011-2015 Lester Ong, Matthew KH Tan, Eusebio M D’Almeida, Chee Y Ng, inclusive. Data was analysed for type of intervention, location, and Chieh Suai Tan, Edward T Choke short-term primary and secondary patency.

Background and objectives Results This study evaluated the outcomes and influencing factors for From a total of 696 fistulograms, 50 cases (53 lesions) were included primary angioplasty durability, measured by post-intervention in our study. The majority of lesions (41) were treated with PTA primary patency, in failing arteriovenous fistulas (AVF) and only; and 12 lesions were stented. Twenty-seven lesions (50.9%) arteriovenous grafts (AVG). 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. Methods Primary assisted patency was 66.7% (3 months) and 37.5% (12 Data from consecutive patients who had angioplasty as their initial months). PTA alone performed better than primary stenting at both intervention (primary angioplasty) from January 2015 to February 3 (72.3% vs 54.9%) and 12 months (62.5% vs 48%). 2016 in a single tertiary centre were retrospectively obtained from electronic medical records. Demographics, co-morbidities, Conclusion previous access details, interventions on current access and peri- operative details were collected. There 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 Results patients with primary stenting. One 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- 02-03 up, 24 (22.4%) were intervention-free at 1-year. Multivariate Cox regression analysis with backward elimination demonstrated that Treatment strategy for cephalic arch stenosis the presence of ipsilateral previous access (HR, 1.99; 95% CI, in patients with brachiocephalic arteriovenous 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- fistula 2.60; p=0.0469) were associated with reduction in the durability of KW Yoon1, Yang-Jin Park1, SY Woo1, SH Heo1, YW Kim1, DI Kim1 primary angioplasty. 1Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea, Seoul, South Korea Conclusion This study suggested that primary angioplasty can effectively Background/Objectives salvage a failing haemodialysis access with reasonable post- Cephalic arch is a common region of stenosis development intervention primary patency. In this series, shorter primary which causes the access dysfunction of arteriovenous fistula. patency, ipsilateral previous access and presence of central stenosis Both percutaneous angioplasty (PTA) and surgical cephalic vein were associated with decreased primary angioplasty durability. 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.

02-02 Material and methods Endovascular management of central vein Between January 2011 and May 2016, 462 patients were underwent stenosis in haemodialysis access patients. When brachiocephalic arteriovenous fistula (BCAVF) formation. Postoperative surveillances with duplex ultrasound (DUS) were and what surveillance imaging is appropriate conducted in all patients at 1 month and thereafter with 3- or Haider Bangash1, Dr Kalpa Perera1, Ms Monique Sandford1, 6-month interval. Treatment indications of CAS were following: Mr Nishath Altaf1, Professor Patrice Mwipatayi1, Mr Patrick more than 25% reduction of flow volume, increased venous Tosenovsky1 pressure, occurring hemostasis problem of puncture site, and acute 1Royal Perth Hospital, Perth, Australia thrombotic occlusion. Background/Introduction Central vein stenosis can be the Achilles heel of haemodialysis Results fistulae, and are often resistant to endovascular treatment. There is Seventy-seven (16.7%) of CAS among 462 of BCAVF were no evidence-based consensus guideline in the literature on optimal detected during the follow-up periods (median 29 months, range surveillance after intervention in this area. The aim of our study 4.9-60.2). Details of treatment were summarized in Figure. In brief, was to assess follow-up practices in a large metropolitan tertiary thirty-six PTA and 6 CVT were performed as initial management. hospital in view of developing a protocol regarding frequency and Seven CVT followed by PTA, were included to CVT group and type of post-intervention imaging. 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 Objectives patency (100% vs. 58.4%, P=0.01), and secondary patency (100% Primary outcome measure – primary patency. vs. 62.9%, P=0.015) at 6 months, as well as assisted primary Secondary outcomes- primary assisted patency. patency (87.5% vs. 47.2%, P=0.016) and secondary patency

Annals of Vascular Diseases 2016 37 Oral Presentation (100% vs. 47.0%, P<0.01) at 12 months. There was no significant 02-05 difference in 12-month primary patency between two group (40% vs. 37.2%, P=0.508). There were three (5.5%) procedure-related Clinical experience of arterial cystic adventitial complications in PTA group (rupture 2, hematoma 1), whereas no disease complication in CVT group. Chi-Woo Lee1, Kyoung-Won Yoon1, Dr. Seon-Hee Heo1, MD, PhD Young-Wook Kim1, MD, PhD Yang-Jin Park1, MD, PhD Conclusions Dong-Ik Kim1 CAS is not rare cause of malfunctioning BCAVF. For the treatment 1Division of Vascular Surgery, Department of Surgery, Samsung of frequently recurring CAS after PTA, CVT should be considered Medical Center, Sungkyunkwan University School of Medicine, to achieve better longer-term patency in patients with CAS. Seoul, South Korea

Background Arterial cystic adventitial disease (CAD) is a rare cause of 02-04 intermittent claudication and nonatherosclerotic condition without Rescue of Transplant Kidney by Endovascular cardiovascular risk factors. The etiology and treatment of CAD have remained controversial. The purpose of this study was to Revascularisation analyze the results of surgical treatment in arterial CAD. Rajendra Prasad Basavanthappa1 1M S Ramaiah Medical College & Hospitals, Bangalore, India Methods We retrospectively reviewed 18 patients with arterial CAD who Background have undergone surgical treatment in our hospital from 2006 to Transplant renal artery stenosis (TRAS) is a recognized, potentially 2016. All of the patients were diagnosed with using both computed curable cause of post transplant arterial hypertension, allograft tomography and duplex sonography. Only 1 patient was performed dysfunction, and graft loss. Although non-invasive imaging can by adding magnetic resonance imaging. detect an underlying stenosis, angiography with subsequent angioplasty or stenting, or both, provides definitive diagnosis and Results treatment. There were 16 (88.9 %) patients in men and median age was 50.5 years old. The popliteal artery was the most commonly involved With the introduction of alternative contrast agents and newer artery (88.9 %) and left side was more commonly involved rather catheter and stent technology, these procedures can be performed than right side (66.7 % vs 33.3 %). There were 17 (94.4 %) safely with little risk of contrast induced nephropathy or allograft symptomatic cases with claudication (16 cases, 88.9 %) or swelling loss (1 case, 5.5 %). Only one patient had not any symptoms related with CAD. 12 (66.7%) patients were treated with cystic resection Objectives only, 5 (28%) patients were underwent bypass with saphenous vein reconstruction, 1 (5.5%) patient was underwent bypass with The aim of this study was to assess the safety and efficiency of synthetic graft reconstruction. Recurrence was observed in 2 (11.1 TRAS endovascular therapy. %) patients who underwent cystic resection only.

Material & Methods Conclusion All cases of Transplant renal artery stenosis admitted for treatment This study was conducted with small group of patients, so further in our hospital from September 2012 to January 2015 were comparative study with large group patients might be required. 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, 02-06 perioperative data, and transplant function outcomes were extracted Management of splenic artery aneurysm-open and analyzed. surgery vs endovascular treatment Naoki Hayashida1, Dr Souichi Asano1, Dr Hasegawa Hideomi1, Results Dr Yutaka Wakabayashi1, Dr Takuto Maruyama1, Dr Masashi Our study included 15 patients (62% men), with mean age of Kabasawa1, Dr Masanao Ohba1, Dr Matsuo Kozuou1, Dr Kazuhiro 50.1 yrs, 12 patients presented to us increase in hypertension, 2 Murayama1 patients with worsening renal function. 14 of them underwent PTA 1Chiba Cerebral and Cardiovascular Center, Ichihara, Japan +/_ 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. Purpose Endovascular treatment of splenic artery aneurysm has increased There were no periprocedural deaths. Blood pressure control in recently. We compared the results of open surgery and endovascular patients with renovascular hypertension was significantly better treatment.

Conclusion Subjects Percutaneous Transluminal Angioplasty (PTA) +/- stent is a good Seven patients with splenic artery aneurysm were treated in our and widespread therapeutic approach for the treatment of TRAS hospital between 1999 and 2016. The male to female ratio was due to its acceptable complication rate and high technical success 4:3. The mean age was 61.7 years old. They are all asymptomatic. rate The indication of treatment is the patient with aneurysm diameter

38 Annals of Vascular Diseases 2016 larger than 20mm. The mean aneurysm diameter was 30.1 mm. Conclusions The patients were divided into two groups: open surgery group Serum uric acid level could be considered an important risk factor (OS group, 4 cases) and endovascular group (EVT group, 3 for arterial stiffness in Chinese hypertensive subjects, whereas cases). In OS group, aneurysmectomy with ligation in 2 cases and more studies are needed to confirm this result. aneurysmectomy with reconstruction in 2 cases were pwerormed. In the EVT group, coil embolization was performed in all cases.

Methods 02-08 Operative mortality, operation time, intraoperative blood loss and hospital stay were compared between OS and EVT group. Computational Fluid Dynamics Modelling in Aortic Diseases: A Systematic Review Results Chi Wei Ong1, Leo Hwa Liang1, Andrew MTL Choong2,3 There was no operative death and hospital death in both groups. 1Department of Biomedical Engineering, National University of Operation time was 231 minutes in OS group and 220 minutes in Singapore, Singapore, 2Division of Vascular Surgery, National EVT group. Intraoperative blood loss was 342 g in OS group and University Heart Centre, Singapore, 3School of Medicine, Griffith 10 g in EVT group (p<0.01). Hospital stay was 13.5 days in OS University, Gold Coast, Queensland, Australia 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 Background was not changed (follow-up period: 57.3 months). The correlation between flow and aortic pathology through Computational Fluid Dynamics (CFD) shows promise in predicting disease progression, the effect of stent implantation and guiding Conclusions patient treatment. Endovascular 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 Objectives increased in the mid-term. The first line therapy of splenic artery To systematically review the published literature describing CFD aneurysm may be endovascular treatment from these results. in aortic diseases and their treatment.

Methods An electronic search of the literature in four electronic databases 02-07 (Pubmed, Ovid, Cochrane, and Scopus) was performed according The Impact of Serum Uric Acid Level on Arterial to the PRISMA guidelines. Animal models, studies relating to Stiffness in Chinese Essential Hypertensive cardiac valve or aortic cannulation were excluded. Patients Results Jie Liu1, Dr. Senhao Jia1, Dr. Xin Jia1, Dr. Yong Huo2, Dr. Wei Guo1 637 articles were retrieved, 134 duplicates removed. The majority 1Chinese PLA General Hospital, Beijing, China, 2Peking University of studies focused on abdominal/thoracic aortic aneurysms, aortic First Hospital, Beijing, China dissection and aortic coarctation.

Abstract Aortic Aneurysms Background and objectives: The aim of the study is to investigate In addition to standard diameter measurements for assessment whether serum uric acid is associated with arterial stiffness (as of growth and aneurysm rupture risk, hemodynamic parameters measured by brachial-ankle pulse wave velocity (baPWV)) in specific to CFD studies such as increase of wall shear stress (WSS) Chinese hypertensive subjects. gradient and low oscillatory shear index were found to be related to aneurysm growth. Methods Participants were selected among 22693 candidates from two Dissection large population-based cohort-studies. Multiple linear and logistic CFD has demonstrated that aortic dissection can produce abnormal regression models were used to evaluate the association between flow patterns such as disturbed laminar flow and recirculation serum uric acid level and brachial-ankle PWV. regions. These may predict aneurysmal degeneration. It may also assist in deciding who benefits most from early intervention. Results There was a significant different baPWV between males and Coarctation females(p < 0.0001, respectively). Both male and female subjects CFD analysis shows the abnormal vortical flow in the distal with hyperuricemia showed higher baPWV than subjects without aortic arch with elevated WSS found due to the presence of aortic hyperuricemia (p< 0.001 for males; p< 0.001 for females). In coarctation. The elevated WSS are known to cause degeneration multivariate-adjusted model, serum uric acid level in male subjects of vessel wall and endothelial dysfunction. Alteration of WSS was signifi¬cantly correlated with baPWV (β=0.14, p < 0.05) and after successful repair with CFD studies may help to evaluate the there was statistically significant association between serum uric treatment outcome. 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 Conclusions between UA and high baPWV was statistically significant, and Contemporary evidence shows that CFD can provide additional statistical significance was maintained in both male and female. hemodynamic parameters such as WSS, vorticity, disturbed laminar flow and recirculation regions in untreated and treated

Annals of Vascular Diseases 2016 39 Oral Presentation aortic disease. These may eventually predict disease progression, 02-10 guide the choice and timing of treatment to the benefit of patients and clinicians alike. Treatment of Iatrogenic Refractory Femoral Artery Pseudoaneurysm with Angioseal Vascular Closure Device: A Novel Technique 02-09 Eu Jhin Loh1, Dr Robert Allen1, A Prof John Cockburn1 1ACT Health, Garran, Australia Comparison between percutaneous internal Introduction jugular vein puncture versus surgical venous A common complication of transfemoral procedures is femoral cutdown in insertion of totally implantable pseudoaneurysm with an incidence of approximately 1%. The venous access device failure rate of US-guided thorombin injection has been reported to be 4%-9%. It is postulated that the formation and recurrence JungSik Choi1, Keunmyoung Park1, MD YoonMi Choe1, MD 2 2 1 of pseudoaneurysms might be related to severe calcification in Yongsun Jeon , MD SoonGu Cho , MD Kee Chun Hong the femoral arteries that may inhibit the healing of vascular wall 1Department of Surgery, Inha.university Hospital, Jungu, South after cannulation. Thrombin injection induced thrombosis and Korea, 2Department of Radiology, Inha.university Hospital, Jungu, temporary discontinued blood flow in the cavity of pseudoaneurysm South Korea has no effect on the healing of the vessel wall. The recurrence of pseudoaneurysm is due to impulse of blood pressure breaking Introduction through a new tunnel. Treatment options include traditional surgical repair, percutaneous intrapseudoaneurysm thrombin injection, Totally implantable venous access devices (TIVADs) are commonly embolization and covered stents. 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 Methods cutdown and percutaneous approaches. Recently, Percutaneous We report a case series of 10 patients who had refractory iatrogenic TIVAD became popular like adult. So that, we compared primary femoral artery pseudoaneurysm after multiple failed attempts at success rate, procedural time, perioperative and postoperative ultrasound guided thrombin injection. Surgical repair would have complication. been a reasonable choice, however was refused by the patient. We offered a novel approach and informed consent for “off label” use Materials Method of the vascular closure device was obtained prior to the procedure. A 21 gauge puncture needle was advanced into the neck of the Data have been collected and analyzed retrospectively from total pseudoaneurysm with placement confirmed via ultrasound. A 22 TIVADs performed in Inha University hospital from September guidewire was passed through via a transradial vascular dilator and 2013 to August 2015. We examined clinical charatericstics (age, retrograded up the external iliac artery. An 8-F Angioseal set was sex, indication for TIVAD) and insertion technique (insertion vein, then deployed with the footplace in the femoral artery and collagen percutaneous or cutdown and ultrasound guidance). And we divided plug intended to be deployed in the neck of the pseudoaneurysm. 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 Results endpoints are perioperative and postoperative complications US showed immediate closure and follow-up scans were obtained at between two group. 1 day, 7 days, 1 month, 2 months and 12 months after the procedure demonstrated successful closure without further recurrence. Results 10 TIVADS were inserted by percutaneous puncture (PP) and Conclusion 12 TIVADs were inserted by surgical cutdown (SC). There was Our case series demonstrates the effectiveness and safety of using no statistically significant imbalance in patients characteristics an Angioseal vascular closure device as an alternative to surgical between two group. Procedural time of PP group was shorter than repair for refractory iatrogenic femoral artery pseudoaneurysm. 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. 02-11

Conclusion Duplex Guided Thrombin Injection versus Percutaneous puncture of IJV appears to be the method of choice Compression Treatment of Femoral Artery for TIVAD insertion, owing to a similar success rate of implantation Pseudoaneurysm. KSUMC Experience and complication compared with surgical cutdown. Mussaad Alsalman1 1King Saud University, Riyadh, Saudi Arabia

Objectives Femoral 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.

40 Annals of Vascular Diseases 2016 Methods Materials and methods Ultra Sound Guided Compression Repair of Post Cath Femoral Porcine iliac arteries and veins were harvested and stored at Pseudo-aneurysm a Prospective, non-randomized study done -80°C until decellularization. After thawing, the vessels were from Feb 1999 to march 2002 is compared with Duplex Guide decellularized with SDS and Triton X-100. The characteristics Thrombin Injection Repair of Post Cath Femoral Pseudo-aneurysm of the scaffolds were evaluated by means of histology, DNA a Prospective, non-randomized study started from June 2003 to quantification and tensile strength test. The decellularized vein was December 2015. Both the groups have similar Demographics and sutured inside the BRS, creating a tissue-engineered stent-graft. A Aneurysm sizes. 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 Results radiological and histological methods. Ultrasound 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 Results dialysis related procedures in 11%. The compression repair was Histological analyses of the scaffolds revealed acellular features successful in 81% and failed were treated surgically. Hypertension, and well-preserved extracellular matrices. The DNA quantification Anticoagulation and Aneurysm size were the predictors of failure. showed more than 97% reduction as compared to fresh vessels. Compression required multiple sessions (1-3) average of 30 minutes Veins were selected as the graft component due to its mechanical and procedure was uncomfortable & painful, needed analgesia. strength preservation. Surgical interposition grafting was successfully performed, and radiological evaluation with digital subtraction angiography and IVUS revealed the stent-graft Duplex guided thrombin injection repair, the femoral pseudo- maintaining its patency and morphology. The inner surface of the aneurysm cause in 68% Cardiac Cath related procedures and stent-graft was widely covered with endothelial cells. 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 Conclusions 100%. Hypertension, Double antiplatelet, Anticoagulation and A tissue-engineerd stent graft composed of BRS and decellularized Aneurysm size does not hinder the successful repair of pseudo- vein showed permissive patency and endurance in short-term aneurysm. Thrombosis occurred within seconds of the thrombin implantation in animal model. injection required an average of 500 tO 1500 units and procedure was comfortable and analgesia was not required. Neither group had complications 03-02 Conclusions Retrospective Analysis of Primary Patency Duplex guided thrombin injection is safe, fast, painless, effective treatment even in patients with hypertension and patient on of Vascular Acess Maturity: A Single Centre double antiplatelet and anticoagulant medications that completely Experience at HTAA, Kuantan, Malaysia obliterated femoral pseudo-aneurysm. . 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, , 03-01 Malaysia, 2Department of Surgery, University Hospital of Wales, Development of novel stent-grafts composed of Cardiff, , United Kingdom Keywords bioresorbable Poly-L-lactic acid scaffold stents Arteriovenous fistula; vascular access; maturity and decellularized porcine blood vessels by tissue-engineering technology Introduction Tatsuya Shimogawara1, Kentaro Matsubara1, Hideaki Obara1, Arteriovenous fistula (AVF) has been proven to be the best vascular Hirokazu Yamada2, Kazuki Tajima1, Hiroshi Yagi1, Yuko Kitagawa1 access for the purpose of haemodialyis due to its’ longevity and 1 2 Keio University School Of Medicine, Shinjukuku, Japan, Kyoto robustness. Unfortunately, despite of its’ popularity in Malaysia, Medical Planning Co., Ltd, Kyoto city, Japan there is a limited local data being published. HTAA is a main referral center for AVF creation for the east coast of Malaysia. We Background examined our data for primary patency rate and possible factors that may associates with it. The 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 Methods of long term infectiosity of permanently implanted stent-graft. Patients who underwent AVF creation created by a single surgeon from July 2012 to July 2013 in Hospital Tengku Ampuan Afzan Objectives (HTAA), Kuantan were identified using theatre list and also logbook. Data were collected retrospectively from the patients’ The goal of our research is to create a novel stent-graft composed medical notes. A total of 89 patients were identified. Primary of bioresorbable stents (BRS) and decellularized porcine blood patency rate is being assessed at 6 weeks. Statistical analysis vessels, expecting the disappearance of residual foreign material performed using SPSS® v20. 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.

Annals of Vascular Diseases 2016 41 Oral Presentation

Results Results The patient’s median age of the patients was 53 years with a 6,046 patients were enrolled from 18,405 patients who prescribed slight male predominance (53%). Majority of the subjects have no heparin. Among 6,046 patients, HIT occurred 641 cases (10.6%, history of tobacco use (71.4%). The Malays make up the majority 641/6,046), The UFH showed the highest rate of incidence in ethnicity (79.6%). 53.1% and 18.4% have underlying diabetes with 13.9% (559/4,030), while dalteparin had 11.5% (13/113) mellitus and obesity respectively. Brachio-cephalic fistulas (BCF) and enoxaparin had 3.9% (69/1760). No HIT was occurred in are the majority of AVF (71.4%) that were created. 78% of our Fondaraprinux and Nadroparine. 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 Conclusion 2.56mm and 2.94mm respectively. Our primary patency rate is HIT occurred in 10.6% according to 4T score, which is a significant 87.8%. Multivariate analysis shows no significance between the number. Also this study showed lack of awareness of HIT in clinical demographics and maturity but a suggestive association of venous practice. Clinicians need to understand HIT when they prescribe diameter and statins with primary patency rate with p values of heparin and follow up of patients with platelet count. This study 0.06 and 0.07 respectively. is limited by study design using 4T score and retrospective study.

Conclusion This study described a comparable success rate of AVF creation at our centre in to other published data. We have identified, venous 03-04 diameter and statins use have a positive trend with primary patency Combined treatment of facial vascular rate of our AVF in a multivariate analysis. malformations with embolization and surgical resection (serial case) Tom Christy Adriani1, MD Raden Suhartono1 03-03 1Indonesian Society For Vascular And Endovascular Surgery, Central Jakarta, Indonesia Prevalence of heparin-induced thrombocyto- penia according to 4T score in single institution Background and objectives of Korea from large scale database Arteriovenous malformations (AVM) is one of the subtypes of Assistant Professor Hun-Sung Kim1, BCPS Hyunah Kim2, RN vascular malformations in the vascular anomalies system, as stated Yoo Jin Jeong1, M.S. Hyunyong Lee1, MD PhD Hyeon Woo Yim1, in the Internationa Society for Study Anomalies (ISSVA) 2015. Professor Seung Nam Kim1, Professor Ji il Kim1, Professor In AVM has many options for therapy and can be a life-threatening Sung Moon1, Associate Professor Yong Sung Won1, Professor problem if the treatment does not suit the clinical features. To Sang Seob Park1, Associate Professor Sun Cheol Park1, Assistant provide data for the future research and effective therapy, we design Professor Jeong Kye Hwang1, Clinical Professor Kang Woong a review on a retrospective study to look at how many patients have Jun1, Clinical Professor Mi Hyeong Kim1, Clinical Fellow Hyun been treated in which treatment. Kyu Kim1, Jang Yong Kim1 1 2 The Catholic University of Korea, Seoul, South Korea, Sookmyung Methods Women’s University, Seoul, South Korea Data of patients with facial AVM were collected from the Cipto- Mangunkusumo Hospital from 2013 to 2015 (n=179). The patiens Introductions were grouped as Male and Female. The therapies were divided HIT occurs due to heparin induced antibody in 0.5-5% of patients into 8 categories (embolization, angiography, angioplasty, surgical with heparin. Instead, 4T’s score is recommended for diagnosis of excision, ligation and sclerotherapy injection). 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 Results clinical characteristics among patients medicated different kinds of heparin. In 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. Methods The greatest number of facial AVM cases came up in total 70, This is a retrospective study from large-scaled retrospective in 2014. Most combined therapy options used was embolization cohort study conducted on patients over 18 years old in the Seoul followed with surgical excision in both male and female. St. Mary’s hospital in Korea from January 2009 to December 2014. Patients who were injected heparin more than 96hours was Conslusions enrolled.Those who had received a surgery within 72 hours after heparin injection were excluded. Patients who have Platelet counts This review only provides data of total patients and the treatment before and after heparin included. To evaluate the probability of within 3 consecutive years but still can be a point of departure for HIT, the study used 4T scoring. “Acute thrombocytopenia” was the future clinical studies for AVM and the choice of therapies. 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.

42 Annals of Vascular Diseases 2016 03-05 03-06 The Western Australian Gore Iliac Branch A randomised controlled trial on the outcome Endoprothesis Early Experience in comparing alginate silver dressing with Wah Wah Lin1, Mr Stefan Ponosh2, Mr Marek Garbowski2, Mr conventional treatment of necrotizing fasciitis Joe Hockley2, Dr Shirley Jansen2, Mr Richard Bond1, Mr Carsten 1 3 wound Ritter , Mr Kishore Sieunarine 1 1 1 2 Jarernchon Meekul , Associate Professor Arnon Chotirosniramit , Fiona Stanley Hospital, Perth, Australia, Sir Charles Gairdner 2 3 3 Woraluck Himakalasa , Antika Wongthanee , Professor Kittipan Hospital, Perth, Australia, Royal Perth Hospital, Perth, Australia Rerekasem3,4 1Maharaj Nakorn Chiang Mai Hospital , Chiang Mai, Thailand, Introduction 2Faculty of Economics, Chiang Mai University, Chiang Mai, The presence of a common iliac artery (CIA) or internal iliac Thailand, Chiang Mai , Thailand, 3 NCD Center of Excellence, artery (IIA) aneurysm represents a challenge in the management RIHES, Chiang Mai University, Chiang Mai, Thailand, Chiang of conventional endovascular abdominal aortic aneurysm repair Mai, Thailand, 4 NCD Center, Faculty of Medicine, Chiang Mai (EVAR). The development of iliac branching devices has appealed University, Chiang Mai, Thailand, Chiang Mai, Thailand the challenges and complications due to the ectatic or aneurysmal iliac arteries. Background Necrotising fasciitis(NF) is a rapidly progressive soft tissue Objectives infection and consequently high morbidity and mortality. Vascular The Gore Excluder lilac Branch Endoprosthesis (IBE) has been surgeons need to involve this pathology frequently because it is approved for the endovascular treatment of aneurysms involving commonly occur in diabetic-ischemic foot. Debridement and wide the common iliac arteries in November 2013. It promotes a open is an essential part of NF treatment and these lead to large simple deployment system, low profile technology, and long-term wound. So far the best type of wound dressing is still controversial. durability. However, there is a paucity of studies investigating its technical difficulties and patency of the graft. The aim of this study Objective is to summarize the WA experience regarding complications and patency of the Gore IBE graft. To compare the result of wound dressing in NF wound between saline dressing and silver dressing

Materials and Methods Method An observational retrospective medical record and review of patients with aneurysmal disease involving one or both A prospective randomised controlled trial was conducted in common iliac arteries who underwent endovascular repair with our center. The patients, who underwent debridement due to NF Gore IBE graft at the three Western Australian tertiary hospitals. 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: Results the duration for wound bed preparation (duration of wound bed 13 cases were identified. All patients were men. The average age ready to skin graft or closure), cost and length of hospital stay. 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 Result the common iliac artery aneurysm was 4cm. There was a 100% technical success and 100% clinical success with the average (mean) 39 consecutive patients were included in this study. There length of stay in hospital of 5 days. There were not intraoperative were 25 male and 14 female. There were 19 patients in groupA IBE related complications, however, 3 cases needed a contralateral and 20 patients in groupB. The mean area was not significantly embolectomy. 100% patency of the iliac branch and no clinical different between two groups (285.16 cm2(groupA)and 215.75 problems were identified over mean of 7 months follow up. 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 Conclusion significant(P=0.057). The mean cost of treatment in groupA and Our early experience with the Gore IBE graft shows excellent early groupB was not different(P =0.434 ). (3308.8 USD(groupA) and patency rates without any technical failures. This would suggest 2647.8 USA(groupB). Length of hospital days in two groups was that it is a feasible alternative to other iliac branch devices on the not significantly different either (29.19 days(groupA) and 20.99 market. days (groupB)( P=0.22) .

Conclusion Although 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.

Annals of Vascular Diseases 2016 43 Oral Presentation 03-07 Methods Presented herein is the largest series from a single center in Saudi Remote ischemic preconditioning enhances the Arabia comprised of 38 patients seen between 1990 – 2015. All 38 gene expression of antioxidant enzymes and patients had multiple large angiomatous navie, hypertrophy of soft endoplasmic reticulum stress–related proteins tissue with bone overgrowth in the lower limbs. in rat skeletal muscle Uijun Park1, PhD Hyoung Tae Kim1, PhD Won Hyun Cho1, PhD, Results RN Min Young Kim2 Twenty five males and 13 females mean age of 14.2 (ranged from 1Keimyung University , South Korea, 2Ulsan University, , South 8 – 18 years). Four patients had surgery of their varicose vein, Korea 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 Background had orthopedics reconstruction of their skeletal changes. Other Ischemic preconditioning (IPC), including remote IPC (rIPC) and treatment include sclerotherapy and laser treatment. direct IPC (dIPC), is a promising method to decrease ischemia- reperfusion (IR) injury. This study tested the effect of both rIPC Conclusions and dIPC on the genes for antioxidant enzymes and endoplasmic reticulum (ER) stress–related proteins. KTS is rare disease, multifactorial disorder that required understanding the disease, proper investigation and management with early involvement of vascular and plastic surgeons. Methods Twenty 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 03-09 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 Open Surgical versus Endovascular Treatment received IR injury after 3 cycles of dIPC. Gene expression was for Patients with Midaortic Syndrome due to analyzed by qPCR from the anterior tibialis muscle. Takayasu’s Arteritis Yang-Jin Park1, Pf Young-Wook Kim1, Pf Ki-Ick Sung2, Pf Young- Results Tak Lee2, Pf Kwang-Bo Park3, Pr Young-Soo Do3, Dr Kyung-Won The expression of the antioxidant enzyme genes including GPx, Yoon1, Dr Seon-Hee Heo1, Pf Dong-Ik Kim1, Pf Duk-Kyung Kim4 SOD1 and CAT were significantly reduced in IscR compared 1Vascular surgery, Samsung Medical Center, Sungkyunkwan with sham treatment. In comparison with IscR, rIPC enhanced the University School of Medicine, Seoul , South Korea, 2Thoracic expression of GPx, SOD2, and CAT genes. dIPC enhanced the surgery, Samsung Medical Center, Sungkyunkwan University expression of SOD2 and CAT genes. The expression of SOD2 genes School of Medicine, Seoul , South Korea, 3Interventional radiology, was consistently higher in rIPC than in dIPC, but the difference was Samsung Medical Center, Sungkyunkwan University School of only significant for SOD2. Medicine, Seoul , South Korea, 43Vascular Medicine, Heart, Stroke and Vascular Institute in Samsung Medical Center, Sungkyunkwan The expression of genes for ER stress–related proteins tended to University School of Medicine, Seoul , South Korea be reduced in IscR in comparison with sham treatment. However, the difference was only significant for CHOP. In comparison with Objectives IscR, rIPC significantly up-regulated ATF4 and CHOP, whereas To compare treatment results of midaortic syndrome (MAS) due to dIPC up-regulated CHOP. Takayasu’s arteritis (TA) between surgical bypass and endovascular treatment. Conclusions Both rIPC and dIPC enhanced expression of genes for antioxidant Methods enzymes and ER stress–related proteins. We 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 03-08 aorta bypass and 1 axillo-femoral bypass) and 8 endovascular treatment of aortic lesion including 4 aortic stenting and 4 aortic Klippel-Trenaunay Syndrome, Presentation, balloon angioplasty were performed with or without adjuvant renal Complications and Management - KKUH or mesenteric artery reconstructions. Patients (n=5) who underwent Experience renal artery intervention only without treatment of aortic stenosis were excluded from the analysis. Surgical complications and Mussaad Alsalman1 postoperative events including recurrence of preoperative ischemic 1King Saud University, Riyadh, Saudi Arabia symptom, occlusion or critical (>70%) restenosis of the treated artery and requirement of reintervention were investigated during Background the follow-up period of 84.4 mo (median, IQR; 40.4-108.4mo). Event-free survival rates were compared between the surgical Klippel-Trenauay Syndreome (KTS) is a mixed mesenchymal bypass group and endovascular treatment group. malformation characterized by varicose veins, venous and capillary malformation and hypertrophy of soft tissue and bone.

44 Annals of Vascular Diseases 2016 Results Conclusions 140 (46%) patients showed thoracic or abdominal aortic stenosis Incidence of VM and tumors appears high in Bangladeshi among 307 patients with TA. Among them, critical stenosis or population. Though curative treatment is difficult in a large number occlusion of aorta with or without renal artery was identified in of patients, the use of newer technology can be beneficial for most 22 patients (median age, 47.5; IQR, 32.4-59.4 years; female, 91%) of the patients when used judiciously according to lesion type. 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%, 03-11 p=0.527). Late event-free survival rates at 1yr and 2yr was superior Effectiveness of embolotherapy on peripheral in open surgery group (100%, 92.3% after open surgery vs. 62.5% arteriovenous malformations and 50% after endovascular treatment, p=0.017). Ali Reza1, dr. Patrianef2 1Surgery Department of Cipto Mangunkusumo Hospital,Indonesian Conclusions University, Jakarta, Indonesia, 2Vascular and Endovascular Considering patient age and durability of an efficacy of the treatment, Surgery of Cipto Mangunkusumo Hospital, Indonesian University, open surgical treatment either anatomic or extra-anatomic bypass is Jakarta, Indonesia recommended for patients with MAS secondary to TA. Background Peripheral arteriovenous malformations (AVM), has the characteristic of locally aggresive. The recently treatment now is 03-10 focused on embolotherapy as treatment of choice. Super selective Vascular Malformation and Tumors: embolotherapy using microcatheters aims to achieve ischemia of Evolving Experience of a Vascular Surgeon nidus for improvement sign and symptoms as well as the reduced size of the nidus itself until the total regression. in a Developing Country Abul Hasan Muhammad Bashar1 Objectives 1National Institute Of Cardiovascular Diseases (NICVD), Dhaka, This study aims to assess the effectiveness of embolotheraphy as a Bangladesh treatment of peripheral AVM in RSUPN Dr. Cipto Mangunkusumo in 4 years (2013-2016). Objectives Vascular malformation (VM) is fairly common in Bangladesh. It Materials and Methods has varying types and presentations and curative treatment is often A cross-sectional retrospective study on 15 subjects AVM. Clinical difficult. The objective of this study was to analyze our experiences symptoms before and after treatment emboli are evaluated. The with VM in a developing country with evolution of technology. clinical symptoms were assessed including pulsatile mass, pain, skin discoloration, bleeding, bruit, ulcers, and skin temperature. Materials & Methods Percentage of nidus regression was measured through the data CT Between July 2012 and June 2016, a total of 1006 patients with VM angiography before and after embolotherapy using Osirix program. were received at the vascular outpatient department. The patients ranged in age from 1 month to 45 years with a male female ratio of Results 1:1.1. Diagnostic work-up started with Duplex ultrasound. Contrast Of the 15 subjects, The AVM common lesion located on the MRI was done for lesions with venous predominance. Lesions head and neck. Clinical symptoms are most complained are skin with arterial predominance underwent catheter angiogram with discoloration and pulsatile mass. Embolotheraphy had been done a view to identify and occlude feeders. 110 patients (10.9%), all once in 10 subjects, twice in four subjects, and three times on one under 10 years of age having a diagnosis of vascular tumor were subject. Single embolic material given to nine subjects, while the enrolled in to quarterly follow-up with or without medication. 752 embolic material combinations are given in six subjects. Clinical patients with venous predominant VM (74.7%) underwent staged symptoms were the most common change is the mass no longer sclerotherapy with or without surgical resection. 144 patients with has pulse and the change of skin color that is closer to normal color. arterial predominant VM (14.3%) were treated with transcatheter Percentage of regression nidus were evaluated in 5 subjects about emolotherapy followed by surgical excision in selected patients. At 16.9% (4-38%). follow-up, patients were evaluated for tumor size, recurrence and sensory motor deficits. Conclusions Results In this study demonstrated that embolotherapy has potential as a treatment of choice because it is minimally invasive and is Complete or partial involution of vascular tumor was observed considered effective in improving sign and clinical symptoms, in 55% of the patients. Sclerotherapy alone proved curative in improve the function of the body, and can lead to regression of the 46% patients with venous predominant VM. Sclerotherapy and nidus. 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 Keywords VM (24%). Lifestyle limiting sensory or motor deficits was low Arteriovenous malformation, embolotherapy, clinical symptoms, (10%) and mostly observed in limb lesions. nidus

Annals of Vascular Diseases 2016 45 Oral Presentation 04-02 04-03 Early efficacy of Clarivein device in treatment of Evaluating the effect of compression stocking varicose vein with chronic venous insufficiency on Venous Hemodynamic in Chronic Venous - A single centre experience Insufficiency using Air Plethysmography Saravana Kumar, Atifah, Zainal A Feona Sibangun Joseph, Nurul Rauf, Dr Datuk Zainal Ariffin Azizi 1Department of Surgery, Kuala Lumpur General Hospital, Jalan 1Hospital Kuala Lumpur, Kuala Lumpur, Malaysia Pahang, Kuala Lumpur, , Malaysia Introduction Introduction Compression stocking has been used for treatment in chronic Classical method of high saphenous vein ligation and stripping is venous insufficiency for many years. It often becomes the associated with neurological damage ranging from paraesthesia first line in treatment of chronic venous insufficiently (CVI). to neuralgia in about 40 % of patients, visible scar, post-operative To date, the effectiveness of compression in treating chronic pain, prolonged return to normal activity, pelvic vein congestion, venous insufficiency is still debatable. The effect of compression recurrence and neovascularization. Endovenous procedures such stocking is commonly assessed by patient’s symptoms and clinical as Radiofrequency Ablation and Laser is also associated with examination and are mostly based on a qualitative assessment. postprocedural bruising and pain. Our aim is to evaluate the Another method of assessing the effect of elastic compression is by objective is to assess early efficacy of the ClariVein device in looking into the venous hemodynamic quantitatively. A number of treatment of varicose veins. The secondary objective is to evaluate studies were done to assess the effect of the compression stocking post procedural related complication of ClariVein including post to venous hemodynamic to this group of patients via different procedural pain score. methodologies.

Methods Objective 40 limbs in 27 patients (10 male and 17 female) with mean age of To evaluate the quantitative effect of class 2 compression stockings 51 were recruited. A single surgeon performed both the mechano- on venous hemodynamic flow for grade 2 and 3 chronic venous sclerotherapy (MOCA) using the ClariVein device and multiple insufficiency (CVI) at baseline and at 6 weeks of compression by stab avulsions (if indicated). Follow up was done at 48 hours, 1st, using air plethysmography. 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 Methods procedure. Duplex scan was done on all treated legs to identify 46 limbs in 29 patients (15 women and 14 men) with a mean age thrombosis complete or partial, recanalization and presence or of 55 years old with grade 2 and 3 CVI were evaluated. Duplex absence of reflux. 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 Result plethysmography were taken at 3 assessment periods; before The closure rate intra-operatively and 48 hours post operatively wearing stocking (T0), after 6 weeks using stocking (T1) and 1 hour was 100% and 98% at 1st month, 3rd month and 6th months post after removal of stocking (T2). Patient symptoms were evaluated procedure. There is significant reduction (p<0.05) in VCSS and using a venous score scoring system (VCSS) before and after 6 CEAP class post procedure. Erythema, and ecchymosis weeks of continuous usage of compression stockings. rate were 22.5%, 7.5% and 2.5% respectively. The mean pain score A paired T-test and Wilcoxon Rank T were used for statistical post procedure was 1.65 at 48 hours post procedure and 0.3 at analysis with P <0.05 indicating statistical significance. 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 Result efficacy and complication rates to other endovenous ablation Class 2 compression stocking improved venous hemodynamic therapies at 6 months post procedure. efficiently. Venous volume was decreased from 157.42ml atT0 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 Keywords potentiate the ejection fraction from 44.05% at T0 to 49.12% at Varicose vein, mechanosclerotherapy, clarivein T1 (p <0.05). Residual volume also were decrease from 49.98 %to 43,04% but was not statistically significant.

Conclusion Class 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.

Keywords Air Plethysmography, Venous insufficiency, Compression stocking

46 Annals of Vascular Diseases 2016 04-04 from two large population-based cohort-studies. The primary noninvasive test for diagnosis of LE-PAD is the ankle–brachial Arterial Revascularization for Radiation index (ABI) at rest and typically an ABI ≤ 0.90 is used to define Arteritis LE-PAD. Hironobou Fujimura1, Dr Takashi Shintani1 1Toyonaka Municipal Hospital, Toyonaka, Japan Results The prevalence of LE-PAD was 3.51% and the proportion was found to significantly decrease as the aortic diameter increased Background according to the tertile of the aortic diameter (lowest tertile Radiation therapy for cancer sometimes causes vascular occlusion vs. median tertile vs. highest tertile: 5.20% vs. 2.80% vs. 2.6%, lately, known as radiation arteritis. However, it is also known that respectively. p<0.001). LE-PAD was significant more prevalent arterial revasculatization for radiation arteritis is very difficult and in the lowest tertile (OR = 1.58, 95% CI=1.29-1.93, p<0.001) and has high complication rate. 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 Objectives between the aortic diameter and any of the stratified variables were found (all p>0.05). From our experieneces, we discuss the best methods for that.

Conclusions Material and Method Small aortic diameter (as opposed to large aortic diameter) is From 2005 we experienced five cases, ten times of arterial significantly associated with LE-PAD in Chinese hypertensive reconstruction fo radiation arteritis. All cases had iliac lesion adults. 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 04-06 arteritis were easy to pass by guidewire but hard to expand by One-Stop Urokinase Thrombolysis Technique balloon catheter, resulting restenosis was occurred in 1, 4 years. We performed reintervention using high pressure balloon cathetel. for Acute Lower Extremity Arterial Occlusion: One has 4 years patency but another carused arterial rupture. Good Patency Rates after One Year Follow up Last one case showed up to femoral occlusion and we performed Eu Jhin Loh1, Dr Michelle Chew1, Dr Robert Allen1, A Prof John endoarterectomy with iliac intervention. This case showed repeated Cockburn1 restenosis in short time (1, 1.5 year), we performed repeated 1 operations. ACT Health, Garran, Australia

Results and Conclusions Introduction The best method for arterial reconstruction for radiation artetitis Catheter directed thrombolysis is an established technique for acute is extra-anatomical bypass performed by avoiding direct incision. lower extremity occlusions. Several patient-associated factors and Percutaneous transluminal angioplasty with stenting was possible occlusion-associated characteristics have been proposed to affect but long time patency is not expected. Direct procedure is most outcomes of thrombolysis. avoitable for radiation arteritis. Materials and Methods: We retrospectively analysed 183 native artery occlusions of the lower extremity. Diagnostic angiography of the iliac, 04-05 femoropopliteal arteries and below- knee outflow were followed by insertion of an antegrade 9Fr common femoral artery (CFA) Small infrarenal aortic diameter associated sheath. Urokinase was administered by direct intra-clot infusion with lower-extremity peripheral artery disease of 100,000IU aliquots. Median total dose was 400,000 IU. in Chinese hypertensive adults Balloon thromboplasty, aspiration thrombectomy using an 8Fr 1 1 catheter (Terumo Guidecath) and anastomosis angioplasty were Jie Liu , Dr. Wei Guo used to completely clear the clot and improve flow. Thrombolysis 1Chinese PLA General Hospital, Beijing, China and aspiration was discontinued when complete lysis occurred. Abandonment (12%) occurred when there was no angiographic Background and objectives improvement or haemorrhagic complications. We reported 7% of cases required immediate surgical intervention due to progressive Several studies suggest that infrarenal aortic diameter is associated ischaemia. 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 The severity of ischaemia was classified based on the Rutherford aortic diameter and LE-PAD are limited, especially in large sample criteria. The median duration of symptoms before the start of populations and Asian or Chinese populations. 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 Methods using a Cox proportional hazards model. 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

Annals of Vascular Diseases 2016 47 Oral Presentation

Results series. We believe that our results reflect the extent of clot clearance Complete lysis was achieved in 76% of native arteries. The 30- with this method, and are currently analyzing radiographic data and day mortality rate was 3% and the 30-day amputation rate was 9%. more long-term results to further evaluate the effectiveness and Mean follow-up was 30 (3-62) months. Amputation-free survival at mechanism of one-stop Urokinase for these cases. 1 year was 84% for native arteries.

Conclusion 04-08 Acute lower extremity occlusions of native arteries treated at one sitting using catheter-directed urokinase thrombolysis and Major lower limb amputation: Are outcomes aspiration thrombectomy demonstrates favourable outcomes improving? compared to large published series. Our one-year amputation-free David Kelly1, Ms Stephanie Pederson1, Dr Kishore Sieunarine1 survival of 84% compares favourably with current literature. We believe that our results reflect the extent of clot clearance with 1Royal Perth Hospital, Perth, Australia this method, and are currently analyzing radiographic data and more long-term results to further evaluate the effectiveness and Major lower limb amputation (MLLA), commonly performed mechanism of this method. 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 04-07 comparing outcomes of all MLLA performed by the department of Vascular Surgery at RPH between 2010-2012 and the previously One-Stop Urokinase Thrombolysis Technique published outcomes of 2000-2002. for Acute Lower Extremity Occlusion of Native Arteries and Prosthetic Bypass Grafts: High Patients undergoing MLLA in 2010-2012 remain old (mean age Patency Rates after One Year Follow up 68yrs), co-morbidly unwell (median ASA 3) and predominantly Eu Jhin Loh1, Dr Michelle Chew1, Dr Robert Allen1, A Prof John male (68%), which is unchanged from 2000-2002. Critical limb Cockburn1 ischaemia remains the most common indication for MLLA while 1 smoking, hypertension and diabetes are the main co-morbid ACT Health, Garran, Australia 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 Introduction amputees. The percentage of patients receiving prosthesis has fallen from 44.8% to 33.75% with poor mobility prior to MLLA the Catheter directed thrombolysis is an established for acute lower main reason for not fitting prosthesis. The rates of wound infections extremity occlusions of native arteries and bypass grafts. Several has fallen 26.4% to 12.4% (p=0.023), rate of admission to ICU has patient-associated factors and occlusion-associated characteristics fallen 48.3% to 17.5 (p=0.001) and revision amputation to a higher have been proposed to affect outcomes of thrombolysis. 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). Purpose Mortality overall has fallen from 60.92% to 46.39% (p=0.049). 30- To evaluate our outcome for acutely thrombosed bypass grafts using day mortality fallen 10.34% to 5.15% (p=0.185), 6-month 28.76% a one-stop Urokinase thrombolysis technique, and to compare with to 16.5% (p=0.046) and 1-year 40.22% to 21.65% (p=0.006). existing standards. Over the decade, the case mix has remained similar however Methods and Materials there have been improvements in preventative health care and management of co-morbid diseases, increases in re-vascularisation We retrospectively analysed 222 consecutive patients (152 men), procedures prior to amputation, changes in anaesthetic, and median age, 74 years (range 28-99), with 183 native artery (82%), improvements in recognizing and responding to the deteriorating and 39 prosthetic bypass grafts (18%) occlusions of the lower inpatient. The rate of complications has fallen, length of stay extremity. The severity of ischaemia was classified based on the trended down and overall mortality. 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 04-09 performed using a Cox proportional hazards model. Initial and mid-term outcomes of endovascular therapy in the treatment for Leriche syndrome: Results Endovascular therapy vs Bypass surgery Complete lysis was achieved in 76% of native arteries and 82% of Osamu Yamashita1, Noriyasu Morikage1, Kotaro Suehiro1, bypass grafts. The 30-day mortality rate was 3% in native arteries Takasuke Harada1, Makoto Samura1, Yuriko Takeuchi1, Takahiro and 5% in bypass grafts, and the 30-day amputation rate was 9% Mizoguchi1, Kimikazu Hamano1 in native arteries and 26% in bypass grafts. Mean follow-up was 1 30 (3-62) months. Amputation-free survival at 1 year was 84% for Yamaguchi University Graduate School Of Medicine, Ube, Japan native arteries and 67% for bypass grafts. Background Conclusion Bypass surgery (BS) is currently the standard treatment for Leriche Acute lower extremity occlusions of native arteries and bypass syndrome (LS), endovascular therapy (EVT) has emerged as an grafts treated at one sitting using catheter-directed thrombolysis attractive alternative. demonstrate favourable outcomes compared to large published

48 Annals of Vascular Diseases 2016 Objective of AKI as per the Kidney Disease Improving Global Outcomes We investigated the efficacy of EVT for the treatment of LSby (KDIGO) criteria. Secondary endpoints included AKI stage, drop assessing the initial and mid-term outcomes. 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 Methods kidney function groups. We compared mortality. The initial and mid-term outcomes of 50 limbs from 28 patients with clinical LS treated between 2001 and 2015 were examined. Results Asymptomatic limbs and limbs for which EVT was not performed in a deliberate hybrid operation (unilateral EVT and femoro-femoral We include 385 patients except exclusion criteria (324 male, 84%; crossover bypass) were excluded. Study outcomes included the mean age:69.7±15.5years), 49(12.7%) of whom developed AKI(31 initial success rate, operative complications, postoperative ankle patients classified as stage 1, 14 as stage 2, 4 as stage 3). Within brachial pressure index (ABI), length of hospital stay, and mid- 48 hours, those with AKI dropped their eGFR from 67±25 to term patency. 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 Results within 1 week (HR 3.159 CI:1.73-5.425), no CIN prophylaxis We performed BS for 12 patients (aorto-femoral bypass=6 and (HR: 3.945 CI: 2.182-6.485) and preoperative eGFR (HR: 2.392 axillary-bilateral femoral bypass=6) and EVT for 16 (kissing CI:1.182-3.913) affected to progress to AKI after EVT. There were stents=10, unilateral stent=2, deliberate hybrid operation=3, and more mortality in AKI groups.(Log Rank=0.02) accidental hybrid operation=1). For EVT, the initial success and procedural complication rates were 90% (26/29) and 0% (0/29), Conclusions respectively. At 1, 3, and 5 years, the primary patency rates (EVT: 100%, 90%, and 90%; BS: 92%, 92%, and 92%, respectively) and The incidence of AKI after EVT for PAOD is related with CT assisted primary patency (EVT: 100%, 100%, 100%; BS: 92%, angiogram or EVT history within 1 week and no CIN prophylaxis 92%, 92%, respectively) were similar for EVT and BS (primary and preoperative eGFR. The AKI is associated with medium-term patency: p=0.96; assisted patency: p=0.15). In addition, in both mortality. 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 04-11 than after BS, except in patients with a Rutherford classification of category 5 (7 days vs. 17 days, p<0.0001). Femoral Popliteal Bypass in Octogenarians Paul Lajos1, Robert Weiss1, Alejandro Negrete, C Lutz1, A/Prof Rami Tadros1, A/Prof Ageliki Vouyouka1, Victoria Teodorescu1, Conclusion Prof Michael Marin1, Prof Peter Faries1 EVT can be executed without complications with a mid-term 1Mt Sinai, Icahn School Of Medicine, New York, United States 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. Background As the overall population ages, femoral-popliteal bypass surgery is being performed increasingly in older patients.

04-10 Objectives Occurrence and Risk Factor of Acute Kidney This study investigated whether femoral-popliteal bypass outcomes Injury after Endovascular treatment of differ in this older population. Peripheral Artery Occlusive Disease Wonpyo Cho1, MD Keun-Myoung Park1, MD Yong Sun Jeon2, Methods MD Soon Gu Cho2, MD Kee Chun Hong1 Patients over and under 80 years old who underwent femoral- 1Department of Surgery, Inha.university Hospital, JungGu, South popliteal bypass between 2009-2013 were queried using an existing Korea, 2Department of Radiology, Inha.university Hospital, hospital registry. Demographics, comorbidities, intraoperative JungGu, South Korea complications, perioperative outcomes, and 2-year patencies were collected and compared. Background Results Acute kidney injury (AKI) is an important post-operative complication that may impact on mortality and morbidity in Ninety-six patients were identified, 24 octogenarians and 72 use of contrast. The aim of this study is to assess the incidence non-octogenarians (mean age 85 ± 4 years and 62 ± 11 years, of AKI after elective EVT in PAOD and examine the impact of respectively). There was a significantly (p<0.05) lower prevalence AKI on mortality and cardiovascular morbidity using the current of smoking and higher prevalence of hypertension among universally accepted definitions. 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 Methods characteristics (CAD, conduit type, diabetes, etc.) were statistically Data have been collected and analyzed retrospectively from similar (p>0.05). elective 430 EVT for PAOD among total 584 EVT performed in our hospital from January 2010 to December 2015. Exclusion Comparing octogenarians to non-octogenarians, there were no criteria is EVT for acute limb ischemia, hybrid surgery with general statistical differences in 30-day readmissions (17% vs. 21%; anesthesia, ESRD patient. The primary endpoint was incidence p=0.59), and incidence of post-operative (25% vs. 19%; p=0.56)

Annals of Vascular Diseases 2016 49 Oral Presentation or intra-operative complications (8.3% vs. 4.2%; p=0.52). Average Conclusions length of stay (LOS) was significantly longer for octogenarians (12 Aorto-carotid bypass is effective for treating patients of Takayasu’s days vs. 7 days; p=.032) and remained significant after multivariate arteritis with cerebrovascular ischemia, but the results suggest linear regression (p=.015). Incidences of 30-day mortality and other that post-operative blood pressure should be strictly managed to perioperative outcomes were too small in both groups to statistically prevent post-operative intracranial hemorrhage. 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. 05-02 Conclusions Early Result of Directional Atherectomy using The safety and efficacy of femoral-popliteal bypass in octogenarians Silverhawk/Turbohawk System may be similar to the general population despite Length of Stay in Yoong Seok Park1, Dr. Seon-Hee Heo1, Assistant Professor octogenarians being 5.98 days longer than non-octogenarians. A Dong-Ho Hyun2, Professor Young-Soo Do2, Professor Hong-Suk larger cohort is needed, as a limitation of this study is small sample Park2, Professor Kwang-Bo Park2, Professor Young-Wook Kim1, size. 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, 05-01 Seoul, South Korea, 2Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Aorto-carotid bypass in patients with Korea, Seoul, South Korea Takayasu’s arteritis 1 2 Dr. Hong-seok Han , Kyung Won Yoon , M.D., Ph.D. Young- Objectives Wook Kim2, M.D., Ph.D. Dong-ik Kim2 Directional atherectomy (DA) was introduced for management of 1 Department of Surgery, Samsung Medical Center, Seoul, Republic infrainguinal arterial stenosis or occlusive lesions. The procedure 2 of Korea., Division of Vascular Surgery, Samsung Medical Center, success in DEFINITIVE LE study was determined using radiologic Seoul, Republic of Korea. imaging. The aim of our study was to determine the early result of DA using Silverhawk/Turbohawk System. Background Takayasu’s arteritis is considered a medically manageable disease. Methods However, when this condition results in severe cerebrovascular The patients for DA procedures using the SilverHawk/TurboHawk ischemia, radiological intervention or bypass surgery is indicated. system from January 2014 to December 2014 were reviewed retrospectively. Twenty lesions from 14 patients with femoral Objectives artery stenosis (> 70% stenosis) of short segment occlusive lesion (< 2cm length for each lesion) were treated. Seventeen lesions were We reviewed the patients with Takayasu’s arteritis who received treated with SilverHawk system, and three lesions were treated aorto-carotid bypass due to cerebrovascular ischemia. with TurboHawk system due to lesion calcification. With the TurboHawk system, a protective device was used to prevent distal Materials and Methods embolization. The percentage of stenosis during and after DA was A retrospective review was performed on 19 patients with determined with ultrasonography (USG). Takayasu’s arteritis who underwent aorto-carotid bypass from March 2002 to April 2015. The indications for bypass surgery Results included symptoms related to cerebrovascular ischemia due to The median follow-up was 5.1 months (range, 1.1-13.7). The rate occlusion of the carotid arteries or aortic arch vessels. All patients of procedure success (<30% stenosis at the end of the procedure) received surgery after normalization of ESR and CRP levels. After was 100% according to angiographic findings but 30% based on surgery, all patients were medicated with anticoagulant agents and intraoperative USG findings. According to USG evaluation, median antiplatelet agents. 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% Results (60-100) at one year. There was one dissection, but there were All patients were female and their age range was 15 to 66 years no cases of perforation, pseudoaneurysm, or thrombosis. Primary with a mean age of 40.6 ± 15.3 years (mean follow-up duration: patency defined as peak systolic velocity ratio (PSVR) ≤ 3.5 with 61.0 ± 42.4 months, range: 1~138 months). Twelve (63.2%) no reintervention for target lesions at six months was found in 18 patients underwent aorto-uni-carotid bypass and 7 (36.8%) patients lesions (90%), and 11 of 14 patients (78.6%) were free of ischemic underwent aorto-bi-carotid bypass. Sixteen (84.2%) patients had an symptoms such as claudication at six months. 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 Conclusion suffered an intracranial hemorrhage within 1 week after bypass Our findings demonstrated that DA using the SilverHawk/ surgery. Of the patients with an intracranial hemorrhage, 2 (10.5%) TurboHawk system are efficient treatment option for artery short patients expired within 30 days postoperatively, and 3 (15.8%) segment occlusive lesion of the femoral. 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.

50 Annals of Vascular Diseases 2016 05-03 institutes. The excessive fasciotomy increased risk of fasciotomy- related problem. Thus, ischemic time need to reevaluated for Factors affecting to patency of Stenting in indication of prophylaxis fasciotomy. TASC II C or D iliac lesion Wonpyo Cho1, MD Keunmyoung Park1, MD Yong Sun Jeon2, MD Patients and Methods 2 1 Soon Gu Cho , MD Kee Chun Hong All patients who underwent revascularization of lower extremity 1Department of Surgery, Inha.university Hospital, JungGu, South for non-traumatic acute ischemia were included in this study. Time Korea, 2Department of Radiology, Inha.university Hospital, from onset of symptom to revascularization (ischemic time), sign JungGu, South Korea and symptom of compartment syndrome and intra-compartment pressure (ICP) were recorded. Compartment syndrome patients were diagnosed by clinical presentation with absolute ICP > 30 Purpose mmHg afterwards emergency fasciotomy were operated. Progress 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 Results D aortoiliac lesion with stents and to identify factors affecting to Of the 22 patient revascularization for acute lower extremity maintain patency. 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 Methods syndrome patients were ischemic time exceeding 6 hours. Only 4 Stents on aortoiliac occlusive disease were performed in 218 limbs in 13 (30%) of prolonged ischemic time patients were compartment and 183 patients form Jan. 2010 to Dec 2015. We included the 98 syndrome. No significant differences in mean ischemic time limbs of TASC II C or D lesion in 83 patients reviewed preoperative between compartment syndrome and non-compartment syndrome data (sex, indication, comorbidity, ABI, TASC II classification, patients (8.5 hours and 20 hours, respectively; P = 0.484). All length of length, grade of calcification, CFA involvement) revascularization patient’s limbs were salvaged. perioperative data (stent type and number, subintimal angioplasty, concurrent treatment) and postoperative follow-up data (ABI, CT angiogram) from hospital records and radiology studies. Conclusion Ischemia time exceeding 6 hours criterion may be too easy to judge for prophylaxis fasciotomy. Particularly, patients who had no sign Results and symptom of compartment syndrome or other indication for During the follow-up (mean: 15.3 ± 3.2 months), no early prophylaxis fasciotomy. More study using analytic measures and thrombotic reocclusions occurred within 30 days, but 78 limbs well randomization patients are needed to validate the indication developed an in-stent restenosis. The primary patency rate at 12, 24 for prophylaxis fasciotomy. 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. 05-05 One-year Clinical Outcomes of Patients with Conclusion or without Critical Limb Ischemia Underwent The midterm result of stent in aortoiliac occlusive disease was Percutaneous Transluminal Angioplasty tolerable because primary patency rate at 3 years was 71% and Yoong Seok Park1, Professor Michael Lee2, Professor, MD, PhD, secondary patency rate was 80%. Reintervention after aortoiliac FACC, FAHA, FESC, FSCAI, FAPSIC Seung-Woon Rha3, Master artery stenting require the best of care, particularly in young patient Byoung Geol Choi3, Professor Seung Kyu Han4 with iliac artery of calcification and small diameter. 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 05-04 Prophylaxis fasciotomy in patients with acute Background arterial occlusion by using only “6 hours Percutaneous transluminal angioplasty (PTA) is an effective criteria”: Is it safe? treatment for patients with peripheral arterial disease (PAD). Patients with critical limb ischemia (CLI) have a poor prognosis Saritphat Orrapin1, Dr Termpong Reanpang1, Dr Saranat 1 1 1,2 including high mortality rate. There are limited data regarding Orrapin , Dr Supapong Arwon , Prof Kittipan Rerkasem the clinical outcomes comparing patients with CLI and non-CLI 1NCD Center and Department of Surgery, Faculty of Medicine, following PTA. Chiang Mai University, Chiang Mai, Thailand, 2NCD Center of Excellence, RIHES, Chiang Mai University, Chiang Mai, Thailand Method Of the 503 consecutive patients with PAD who underwent PTA Background enrolled from September 2004 to December 2013, 368 patients had Prophylaxis fasciotomy was performed to avoid compartment CLI and 135 patients did not. The primary endpoint was major syndrome-related morbidity included limb loss in acute lower adverse cardiac and cerebrovascular events (MACCE). 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

Annals of Vascular Diseases 2016 51 Oral Presentation

Results Conclusion The CLI group had a higher prevalence of diabetes and chronic Diabetic foot ulcers are one of the most common and costly diabetic renal insufficiency. The non-CLI group had a higher prevalence of complications. Means to reduce the hospitalization time of diabetic patients with dyslipidemia and history of myocardial infarction. The foot ulcer patients thus has enormous cost saving potential. Fish CLI group had a higher prevalence of diffuse long lesions, calcified skin grafts* save cost by accelerating healing of diabetic foot ulcers lesions, infra-popliteal lesions, and active wound. Procedural compared to standard of care. 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 *Kerecis Omega3 by Kerecis (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 05-07 groups. Diabetic foot limb salvage – a Singaporean experience Conclusion Dr Zhimin Lin1, Dr Zhiwen, Joseph Lo1, Dr Ruiming Teo1, Dr Despite the CLI group having more unfavorable baseline clinical Zhongkai Wang1, Dr Danson Xue Wei Yeo1, Dr Bin Chet Toh1, Dr and lesion characteristics, PTA was equally safe and effective Yiew Fah Fong1, Dr Glenn, Wei Leong Tan1, Dr Sriram Narayanan1, compared to the non-CLI group. As expected, the CLI group had Dr Sadhana Chandrasekar1, Qiantai Hong1 less limb salvage rate but MACCE rate were similar in both groups. 1Tan Tock Seng Hospital, Singapore, Singapore

Objectives 05-06 To review patient characteristics and outcomes of in-patient Cost Saving Potential of Acellular Fish Skin diabetic foot limb salvage at a tertiary Asian centre. Graft: A Cost Simulation Study on Diabetic Foot Ulcers Materials and Methods 1 3 Retrospective study of 809 limb salvage attempts between January John Lantis, Skuli Magnusson , Dr David Margolis , Dr 2014 and December 2015. Baldur Baldursson1,2, Dr Hilmar Kjartansson1,2, Gudmundur F. Sigurjonsson1 1Kerecis, Reykjavik, Iceland, 2Landspitali University Hospital Results of Iceland, Reykjavik, Iceland, 3Perelamn School of Medicine, Our study population had an average age at 65 years-old. Majority University of Pennsylvania, Philadelphia, USA 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- Introduction inguinal TASC II (trans-Atlantic inter-society consensus) patterns In 2007, cost linked to the treatment of foot ulcers in the US was type B (27%), type C (37%) and type D (27%) disease. Majority estimated be 38 billion USD with cost due to hospitalization being (96%) of patients underwent angioplasty and 32 (4%) reverse long the highest factor. Any means to reduce hospitalization by speeding saphenous vein (LSV) lower limb bypasses performed. 20 (63%) up healing of foot ulcers will contribute most to cost saving. were performed as salvage procedures for failed . 11 Intact fish skin grafts* from wild Atlantic cod are rich in naturally underwent femoral-popliteal bypass (34%), 16 underwent femoral- occurring Omega3 polyunsaturated fatty acids and are used to distal bypass (50%) and 5 underwent popliteal-distal bypass (16%). regenerate damaged human tissue. In a randomized, double-blind The average in-patient stay was 12.3 days within the angioplasty clinical trial, fish skin grafts promoted significantly faster healing group and 48.1 days within the bypass group (p<0.01). Limb compared to a porcine small intestinal submucosa product. 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% Objective within the angioplasty group and 13% within the bypass group To assess the potential cost effectiveness of using fish skin grafts on (p=0.27). The average in-patient cost for the angioplasty group was diabetic foot ulcers with a cost simulation study. SGD$5,518, as compared to SGD$15,141 (p<0.01) for patients who underwent bypass surgery. Methods The cost-simulation study was based on a prognostic model for Conclusion identifying diabetic foot ulcers that are not likely to heal. The model Within our study population, most diabetic foot peripheral arterial was generated by data from 27,630 patients with diabetic foot disease (91%) were diffuse, involved long segments with multiple ulcers. The model predicts the likelihood of a wound not healing stenotic lesions and with no distal landing zone. Coupled with the after 20 weeks based on some of all of the following parameters fact that majority of patients had multiple co-morbidities and were being met: The size of the ulcer larger than 2 sq cm; the previous poor surgical candidates, most were not suitable for bypass-first duration of wound more than 2 months and ulcer grade. Data from approach and the primary revascularisation modality was with 21 diabetic wounds treated with acellular fish skin* was inserted angioplasty. Surgical bypasses were performed mainly as salvage into the prognostic model, and compared with the actual outcome procedures for failed angioplasties. Successful limb salvage rate of the treatment. for patients admitted with diabetic foot tissue was 87%, with all cause mortality rate at 7%. Results The cost simulation study showed 49.6% cost saving potential per wound or 13235 USD in cost saved per healed wound.

52 Annals of Vascular Diseases 2016 05-08 05-09 Predictive factors to determine good The Prevalence of Asymptomatic Peripheral atherosclerotic risk factor control for diabetic Arterial Disease in Korea: Community-based patients with peripheral arterial disease Screening study Saritphat Orrapin1, Dr Natapong Kosachunhanun2, Dr Kiran Junghyun Youm1, MD, PhD Jin Hyun Joh1 4 5 6 Sony , Dr Nimit Inpankaew , Dr Piyamitr Sritara , Dr Arintaya 1Kyung Hee University Hospital At Gangdong, Seoul, South Korea Phrommintikul2, Dr Chonlisa Chariyalertsak7, Ms Antika Wongthanee3, Ms Ampica Mangklabruks2, Ms Orapin Pongtam2,3, Prof Kittipan Rerkasem2,3 Introduction 1Department of Surgery, Faculty of Medicine, Thammasat University Peripheral arterial disease (PAD) is a common vascular problem. (Rangsit Campus), Pathumthani, Thailand, 2NCD Center, Faculty PAD has a serious morbidity and mortality along with decreased of Medicine, Chiang Mai University, Maharaj Nakorn Chiang quality of life and possible major limb loss. However, the Mai Hospital, Chiang Mai, Thailand, 3NCD Center of Excellence, prevalence of asymptomatic PAD in Korea has not been reported. Research Institute of Health Science, Chiang Mai University, 4 Chiang Mai, Thailand, Department of Internal Medicine, Chiang Objectives Rai Prachanukroh Hospital, Chiang Rai, Thailand, 5Department of Internal Medicine, Lamphun Hospital, Lamphun, Thailand, The purpose of this study was to evaluate the prevalence and risk 6Department of Internal Medicine, Ramathibodi Hospital, Mahidol factors of asymptomatic PAD in Korean general population. University, Bangkok, Thailand, 7Chiang Mai Provinical Health Office, Chiang Mai, Thailand Materials and Methods The inclusion criteria for screening were men and women more Background than 50 years. The study was processed by visiting the community To assess to what extent physicians follow the standard guideline welfare centers in Korea. The screening was performed the history of atherosclerotic risk factor control in diabetic patients with taking for demographic information followed by the measurement peripheral arterial disease (PAD). 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 Objective regression were used. All statistical analyses were conducted with To assess to what extent physicians follow the standard guideline SPSS software version 22 (SPSS, Chicago, IL, USA). All P values of atherosclerotic risk factor control in diabetic patients with PAD. were considered significant if < .05.

Materials & Methods Results Between May 2014- April 2015, 168 diabetic patients who Between January 2008 and December 2012, a total of 1,987 diagnosed PAD were invited to be involved in this study. The risk participants were included with 788 (39.7%) men and 1,199 factors namely smoking, low density lipoprotein, HbA1C and (60.3%) women. PAD was detected in 97 (4.9%). The borderline systolic/diastolic blood pressure were followed up at beginning ABI (0.91-0.99) showed in 206 (10.4%). And severe decreased ABI and 12 months after diagnosed PAD. History, physical exam and < 0.5 showed in 35 (1.8%). The significant risk factors for PAD laboratory test were reviewed. Ankle brachial index ≤ 0.9 was were advanced age (OR 1.38; 95% CI, 1.06-1.78, P=.015), heart considered PAD. Then patients were evaluated the percentage of diseases (OR 2.06; 95% CI, 1.21-3.51, P=.008), cerebrovascular control in 5 risk factors according to American Heart Associated disease (OR 2.26; 95% CI, 1.23-4.15, P=.009), and smoking (OR criteria. The good control was defined that patients have adequate 2.59; 95% CI, 1.47-4.55, P=.001). risk factor control between 3-5 factors. Then multivariate analysis by using logistic regression was performed to identify the predictive Conclusions factors that were associated with good control. This study was supported by the Health Systems Research Institute and National The prevalence of PAD in the Korean general population was Research Council of Thailand. 4.9%. Advanced age, heart disease, cerebrovascular disease and smoking were significant risk factors for PAD. Further nationwide study is needed. Results 286 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 05-10 with good risk factor control criteria were primary and secondary school graduate, The non-good risk factor control criteria were Validation of WIfI classification following high body mass index and insulin user group. percutaneous angioplasty for critical limb ischemia Conclusions Uijun Park1, MD Won Hyun Cho1, MD Hyoung Tae Kim1, PhD, 2 This study concluded that the risk factor control in diabetic patients RN Min Young Kim with PAD was around half. More study is needed to confirm this 1Keimyung University, Daegu, South Korea, 2Ulsan University, finding. Ulsan, South Korea Objective The Society for Vascular Surgery Lower Extremity Guidelines Committee developed the Wound, Ischemia, foot Infection (WIfI) classification system to predict the amputation risk in patients

Annals of Vascular Diseases 2016 53 Oral Presentation with critical limb ischemia (CLI). The purpose of the study was time from first intervention to subsequent thrombosis) and post- to validate this classification system following percutaneous intervention secondary patency (SP- time from first radiological angioplasty (PTA) for CLI with diabetes. intervention to surgical declotting/revision or abandonment). The 105 native fistulas yielded SIRTAC PP, PAP and SP rates at48 months of 20%, 63% and 79%. The 39 grafts yielded SIRTAC PP, Method PAP and SP rates at 24 months of 15%, 26% and 83% respectively. From 2010 to 2015, a single center, retrospective study was NAVAC 48 month SP rates (date of fistula creation rather than first performed for the patients undergoing PTA for CLI with diabetes. intervention to date of abandonment) for native fistulas and grafts The limbs without tissue loss or missing grade in any WIfI was 82% and 80% respectively. 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, Conclusion major amputation and in-hospital mortality. Malfunctioning upper limb haemodialysis access in which thrombosis was treated at one sitting using a combination of urokinase, skin massage/balloon maceration, and aspiration Results demonstrate high patency rates compared to large published series One hundred five limbs in 100 patients underwent PTA for tissue including those in which tissue plasminogen activator and/or loss. Median follow up was 2.7(0.2-36.6) months. Limbs were mechanical thrombectomy devices were utilised. We believe that classified as very low risk in 6(6%), low risk 21(20%), moderate our results may reflect the extent of clot clearance with this method. 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 05-12 stage (n=10, P=.001). In terms of in-hospital mortality, there were Hybrid treatment for multilevel no mortality in very low risk and low risk, but 3 in moderate risk and 3 in high risk (P=.001). revascularization in PAD patients: multicenter study in Korea 1 1 1 Conclusions Prof. Hyuk Jae Jung , Dr. Yong Beum Bak , Dr Dong Hyun Kim , Sang Su Lee1 WIfI classification system was highly predictive in wound healing, 1 length of hospital stay, major amputation and in -hospital mortality Pusan National University Yangsan Hospital, Yangsan, South of the CLI patients with diabetes. Korea

Introduction Recently, endovascular treatment has been alternative first-line 05-11 modality for peripheral artery disease (PAD). Hybrid treatment also has been increasingly used for multilevel revascularization One-Stop Urokinase Thrombolysis Technique procedures as vascular surgeons have embraced endovascular for Thrombosed Dialysis Access: High Patency treatment. The goal of this study to examine the clinical and Rates after Four Year Follow up hemodynamic outcomes of hybrid treatment in patients who need multilevel revascularization Eu Jhin Loh1, Dr Robert Allen1, A Prof John Cockburn1 1ACT Health, Garran, Australia Material and Methods 9 university hospitals in Korea enrolled PAD patients who need Purpose multilevel revascularization. A retrospective multicenter study was To calculate patency rates for fistulas and grafts treated using conducted to evaluate clinical outcomes of 137 Korean PAD patient the “fast urokinase” technique and compare these results with with multilevel lesions who underwent hybrid treatment. Patients published data so as to assess efficacy. were enrolled from July 2014 to June 2015 and were follow up for 12 months. Methods and Materials Medical records of patients in whom malfunctioning fistulas and Results grafts treated within our department were reviewed, yielding 105 The mean age was 68.9±9.85 years old and 87.5% were male. fistulas and 39 grafts. An estimation of patency rates, as defined by Patients with critical limb ischemia was enrolled 41.6%. The recognised standards, was then performed using the Kaplan-Meier technical success rate was 100%. The primary patency rate at 12 and method and an assessment of predictors of patency was made 24 months were 84.4% and 77.7% respectively. The preoperative using a Cox proportional hazards model. These results were then mean ankle brachial index (ABI) of 0.55 ± 0.27 increased to 6 compared with the available published data. month postoperative mean ABI of 0.89± 0.35. The amputation free survival (AFS) rate was 97.1% and freedom from re-intervention Results rate was 83.2%. Patency was measured using the Society of Interventional Radiology Technology Assessment Committee (SIRTAC) guidelines. These Conclusions included post-intervention primary patency (PP- time from first Hybrid treatment for multilevel revascularization was feasible radiological intervention to thrombosis or second intervention alternative for treatment of multilevel PAD patients in Korea, with of any kind), post-intervention primary assisted patency (PAP- satisfactory AFS and freedom from re-intervention rates.

54 Annals of Vascular Diseases 2016 06-01 06-02 Follow up Results of Lower Extremity Arterial Aspirin and clopidogrel resistance in peripheral Bypass with Autogenous Arm Vein Grafts arterial occlusive disease. Early results of a Jihee Kang1, Dr Duk-Bee Hwang2, Dr Seon-Hee Heo1, Dr Kyung- prospective study 1 1 1 Won Yoon , Pf Yang-Jin Park , Pf Dong-Ik Kim , Pf Ynoung-Wook 1 1 1 1 Mina Guirgis , Ms Lucy Stopher , Mr Joseph Hockley , A/Prof Kim Shirley Jansen1 1 Samsung Medical Center, Sungkyunkwan University School of 1Sir Charles Gairdner Hospital, Perth, Australia Medicine, Seoul , South Korea, 21Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, South Korea Introduction Aspirin resistance (AR) and clopidogrel resistance (CR) are Background defined as lower than normal ability of these antiplatelet agents to inhibit platelet aggregation following standard dosing. Platelet Great saphenous vein (GSV) is the conduit of choice for leg bypass. function tests are required to assess antiplatelet efficacy to However, it is not always available to use due to prior use. Arm determine whether a patient is resistant to the drug’s antiplatelet vein can be used in leg artery bypass as bypass conduit for patients action. There is a sizeable body of research into the effects of who are unavailable to use GSV antiplatelet resistance in Cardiology with some studies revealing a link between resistance and major adverse cardiovascular effects Objective (MACE). There is much less data available amongst the peripheral arterial occlusive disease (PAOD) population. Among various alternative conduits for LEAB, we would like to present long-term results of arm vein grafts. Objectives Methods To measure the prevalence of aspirin and clopidogrel resistance in patients with peripheral arterial occlusive disease requiring We retrospectively reviewed database of patients who underwent revascularisation and to assess whether there is an association infrainguinal LEAB with autogenous arm vein grafts from 2003 between resistance and early MACE or target vessel thrombosis through 2016. All procedures were performed in an absence requiring reintervention. of adequate saphenous vein. Graft patency was determined by periodic examinations of duplex ultrasonography. Materials and Methods Results Prospective study in PAOD patients on aspirin or clopidogrel therapy requiring elective revascularisation procedures (endovascular Autologous arm vein grafts were implanted for 33 limbs in 32 or open surgery). Multiplate® Analyzer platelet assay was used patients (mean age, 61.6 ± 15.9 years; range, 20 - 86 years; male, to define resistance by analysing platelet reactivity prior to the 94 %; atherosclerosis 24 (75%) and non-atherosclerotic disease 8 procedure. Patients were followed up to assess for early (within one (25%) including 4 patients with Buerger’s disease. Mean number month) target vessel thrombosis requiring reintervention or MACE of prior ipsilateral leg artery interventions was 1.1±1.1 (range 0-4) (cardiovascular death, myocardial infarction, cerebrovascular either surgical or endovascular intervention. Source of arm vein accident or major amputation) or major bleeding events. 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%), Results tibio-peroneal in 24 (73%) and inframalleolar artery in 3 (9%). First cohort of 44 patients analysed. Mean duration of follow up was 52.7 ± 58.5 month(range, 1 - 229 months). Sixteen patients (50%) were available to follow up and 95% were on daily aspirin. 45% on daily clopidogrel. 43% on both. 9.4% of patients were dead due to underlying disease. Cumulative 27.5% of aspirin cohort were AR. primary patency rates at 1, 3, 5 and 10 years are 66%, 62%, 62%, 30% of clopidogrel cohort were CR. 62% and secondary patency rates at 1, 3, 5, 10 years are all 66%. 2 patients (5%) with AR experienced early stent thrombosis There was 1 limb amputation during the follow-up period. requiring revascularisation. No patient without antiplatelet resistance had early MACE. Conclusions Arm vein is an useful alternative conduit when great or short Conclusion saphenous vein is not available during LEAB. Prevalence 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.

Annals of Vascular Diseases 2016 55 Oral Presentation 06-03 Background / Objectives To review patient characteristics and outcomes of inpatient diabetic Natural History of Retrograde Pedal Access foot limb salvage at a tertiary centre and identify risk factors Site: Is it Really Safe? predicting for endovascular salvage failure. Professor Tae Seung Lee1, Daehwan Kim1 1Seoul National University Bundang Hospital, Sung-nam, South Methodology Korea Retrospective study of 809 limb salvage attempts between January 2014 and December 2015. Purpose Retrograde pedal access may be an alternative technique when Results recanalization fails via an antegrade approach in below-the-knee 68% of our study population were male and a majority had other (BTK) intervention. The aim of this study was to evaluate the cardiovascular co-morbidities. 36% of patients had previous consequences of pedal access in patients with critical limb ischemia lower limb amputations and all were of Rutherford grade 5 and who had undergone retrograde recanalization. 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 Method disease. 777 (96%) patients underwent endovascular limb salvage. 32 patients underwent surgical bypass limb salvage, with majority This was a retrospective study on patients who underwent performed as salvage procedures for failed angioplasties. Limb retrograde pedal access for revascularization of BTK chronic total salvage was successful in 88% of endovascular group, compared occlusions between 2014 and 2016. After failed antegrade access to 72% of bypass group (p=0.01). Overall survival was 93% attempts, retrograde pedal access was performed under fluoroscopy within the endovascular group and 88% within the bypass group or ultrasound guidance using a micropuncture needle. Most (p=0.27). The average in-patient cost was SGD$5,518 within the retrograde interventions were performed sheathless with 1.5-3.0 endovascular group and SGD$15,141 for bypass group (p<0.01). mm balloons. Outcomes were analyzed with special consideration Multivariate analysis showed that independent predictors for on the patency of the pedal access site after intervention. 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), Results infra-inguinal TASC II patterns C or D (OR 1.99, p=0.03) and post- A total of 18 patients (11 men, 7 women, mean age 72) underwent angioplasty below-knee single-vessel flow (OR 2.03, p=0.02). retrograde access. Among these, Rutherford grade II was present in 1 (5%) and grade III in 17 (95%) patients. The length of the target Conclusion vessel was 18.22 cm and moderate or severe calcification of the Within our study population of Asian ethnicity, most inpatient target vessel was found in 13 (72%) patients. Successful crossing diabetic foot peripheral arterial disease presented with Rutherford was achieved in 66% (12 of 18) and technical success rate was grade 6 classification, with severe TASC II patterns C orD 100% (14 of 14). There were 3 cases of pedal access site delayed disease and required infra-popliteal revascularisation. Majority wound healing (cutdown = 2, puncture = 1). Two occlusions underwent endovascular-first approach revascularisation. Most proximal to the pedal access site were found by duplex ultrasound surgical bypasses were performed as salvage procedures for the next day after the procedure. Two occlusion cases occurred in failed angioplasties, hence had significantly longer in-patient the anterior tibial artery with calcification. There was no 30-day stay, lower limb salvage success and more expensive in-patient mortality and major amputation. cost. Independent predictors of endovascular limb salvage failure include end-stage renal failure, toe pressures <50mmHg, infra- Conclusion inguinal TASC II patterns C or D and post-angioplasty infra- Retrograde pedal access is a useful technique for revascularization, popliteal single-vessel flow. 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 06-05 of successful revascularization. Use of Negative Pressure Wound Therapy in Lower Limb Bypass Incisions Kah Wei Tan1, Dr Zhiwen Joseph LO2, Dr Qiantai HONG2, Dr 06-04 Glenn Wei Leong TAN2, Dr Sadhana CHANDRASEKAR2, Dr Sriram NARAYANAN2 Diabetic foot limb salvage – A series of 809 1NUS Yong Loo Lin School of Medicine, Singapore, Singapore, attempts and predictors of endovascular 2Vascular Surgery Service, Department of General Surgery, Tan revascularisation failure Tock Seng Hospital, Singapore, Singapore Qiantai Hong1, Dr Zhiwen Joseph Lo1, Dr Zhimin Lin3, Dr Uei Pua2, Dr Lawrence Han Hwee Quek2, Dr Bien Ping Tan2, Background and objectives Dr Sundeep Punamiya2, Dr Glenn Wei Leong Tan1, Dr Sriram 1 1 The use of negative pressure wound therapy (NPWT) for post- Narayanan , Dr Sadhana Chandrasekar surgical cardiothoracic, orthopaedics, plastics, obstetrics and 1Vascular Surgery Service, Department of General Surgery, gynaecology incisions has been described. However there is no Tan Tock Seng Hospital, Singapore, Singapore, 2Vascular & data on its use in lower limb bypass wounds. We aim to investigate Interventional Radiology, Department of Diagnostic Radiology, the outcome of negative pressure wound therapy in the prevention Tan Tock Seng Hospital , Singapore, Singapore, 3University of surgical site infection for patients with lower limb arterial bypass Surgical Cluster, National University Health System , Singapore, incisions. Singapore

56 Annals of Vascular Diseases 2016 Methods surgery. In Group A QOL improved a little between 1 to 3 months A retrospective study of conventional dressing versus single-use postoperatively. But in Group B, there was significant improvement NPWT (PICO, Smith & Nephew, United Kingdom) for lower limb of postoperative QOL between 1 to 3 months. Overall, Group A bypass incisions. Comparison between the patient characteristics patients had preoperative symptoms more prominent and their and surgical site infection risk scores between the 2 groups was postoperative outcome was also poor. performed and outcomes evaluated include surgical site infection (SSI) and the need for surgical wound debridement. Conclusion Those patients who had preoperative optimum quality of life had Results better postoperative outcome. From this study it can be concluded 42 patients underwent open lower limb arterial bypasses from that quality of life can be used as a predictor of postoperative March 2014 till February 2016. 28 (67%) received bypass incision outcome in peripheral arterial disease patients. conventional dressing whilst 14 (33%) received NPWT. There was no statistical difference for patient characteristics and mean Key Words surgical site infection risk scores between the 2 groups (13.7% for conventional versus 13.4% for NPWT, p=0.831). There were a Peripheral Arterial Disease (PAD), Quality of Life (QOL), Health total of 9 SSI (32%) within the conventional dressing group while Related Quality of Life (HRQOL). there was no SSI within the NPWT group (p=0.019). 3 patients (11%) within the conventional dressing group required subsequent surgical wound debridement. 06-07 Conclusion The efficacy and safety profile of prolonged For patients with peripheral arterial disease, the use of NPWT for high pressure balloon angioplasty on below- lower limb arterial bypass incisions may help to prevent surgical the-knee lesions site infections and is superior to conventional dressing. J X Lim, D Lim, D Ho, YK Tan, Steven Kum Changi General Hospital, Singapore (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. Background and Objectives Early 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 06-06 and patency. We hypothesise that high pressure balloon (HPB) angioplasty accompanied by prolonged inflation reduces rates of Quality of Life as a Predictor of Post Operative early recoil, and thus, potentially improves vessel patency. The outcome following Revascularization of JADE non-compliant balloon (OrbusNeich Medical, HK) was Peripheral Arterial Disease utilized in this study. The primary objectives of the study were to assess the efficacy and safety profile of high pressure balloon 1 Shantonu Kumar Ghosh angioplasty (at 20-24atm), coupled with prolonged inflation 1National Institute Of Cardiovascular Diseases, Dhaka, Bangladesh times (>90s) on BTK lesions. Secondary objectives included the assessment of early recoil, rates of re-intervention and rates of wound healing. Background Peripheral arterial disease (PAD) is associated with a significant morbidity and mortality. In addition to physical factors, patient’s Methods quality of life (QOL) i.e. individual’s physical health, psychological We retrospectively reviewed the angiographic data and clinical state, level of independence and social relationships also influence outcomes of 23 consecutive patients with chronic limb ischaemia on post-operative outcome and there by long term survival after who underwent prolonged HPB angioplasty for BTK lesions in our surgery. Health related quality of life (HRQOL) is the extent to institution. 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 Their angiographic images were evaluated prior, immediately after life before and after revascularization following PAD. and 15 minutes after angioplasty with the JADE balloon. Post-op complications, re-intervention rates and wound outcomes were also reviewed. Methods Cases were divided into two groups according to presence and Results absence of ulceration in foot. Those patients having claudication with ulceration were enrolled in group A and those having Target lesions included the ATA (82.6%), PTA (21.7%) and claudication without ulceration were enrolled in group B. Data peroneal (13.0%) arteries. Mean lesion length was 198.8mm. were collected from both groups preoperatively and during follow Mean balloon diameter used was 3.02mm, and it was inflated at an up at 1 and 3 month by interviewing the patient according to SF-36. 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) Result or limb events (MALE) observed. There was a single case of Two groups with preoperative poorer HRQOL (n=25) or optimum unrelated mortality observed (4.35%), as a result of sepsis. Overall, HRQOL (n=25) were compared. Postoperative outcome was a limb salvage rate of 100% was observed at 3 months. found poor in Group A compered to Group B. In both groups, there was little improvement in quality of life after 1 month of

Annals of Vascular Diseases 2016 57 Oral Presentation Conclusions 06-09 Our findings support our hypothesis that prolonged HPB angioplasty is a safe and efficacious modality for the treatment of BTK lesions. Emergency TEVAR for Thoracic Aortic Good immediate luminal gain was observed in this study. Further Aneurysm Rupture of Blunt Thoracic Aortic long term studies can be conducted to further evaluate the direct Injuries correlation between prolonged HPB angioplasty and clinically 1, 3 1 significant restenosis. Hiroki Uchiyama Uchiyama , Dr Kiyofumi Morishita , 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 06-08 Cardiovascular Surgery, Sapporo Medical University, , Japan The Endovascular Repair of Blunt Traumatic Thoracic Aortic Injury in Asia: A Systematic Background Review Aneurysm rupture or traumatic injury of thoracic aorta confers 1 2 3,4 a significantly increased risk of adverse outcome and death. Xin Nee Ho , Lauren Wilson , Andrew MTL Choong Endovascular treatment for such critically ill patients is expected 1Department of Vascular Surgery, Guy’s and St Thomas’ NHS to decrease procedural mortality and morbidity. The aim of this Foundation Trust, London, UK, 2Department of Vascular Surgery, study was to evaluate the effect of endovascular repair on mid-term Royal Brisbane and Women’s Hospital, Queensland, Australia, survival and outcome. 3Division of Vascular Surgery, National University Heart Centre, Singapore, 4School of Medicine, Griffith University, Gold Coast, Methods Queensland, Australia From December 2007 to March 2016, 42 patients (60% men; averaged age, 74 years) underwent thoracic endovascular Background and objectives aneurysm repairs (TEVAR) urgently. Operative indications were ruptured aortic aneurysm in 30 patients, traumatic aortic injury in Management of blunt thoracic aortic injury (BTAI) has evolved 9, and ruptured anastomotic aneurysm in 3. The mean Japan score from the traditional open approach to the less invasive thoracic (mortality predicted based on Japanese data base) was 40%±23%. endovascular aortic repair (TEVAR) in recent years. As such, data on Seven patients suffered from shock. Associated procedures its effectiveness and outcomes, especially in Asia, is still emerging. included total debranching in 4 patients and surgeon-modified This systematic review aims to collate all available information fenestration in 2. about this approach in Asian countries, assessing effectiveness in this population, and identifying major discrepancies between nations. Results The 30-day mortality was 12% (5 of 42). The cause of death in Methods 4 patients was multiple organ failure. One patient in whom re- rupture occurred during balloon molding of the endograft died of All relevant literature from Asian countries (as defined by the UN) massive exsanguination. Postoperative complications included 19 on the endovascular repair of BTAI was identified through a journal respiratory failures, 3 strokes, 3 renal failures, and 2 spinal cord database and reviewed. injuries. Endgraft-related complications were endoleak in 5 patients, access trouble in 3 patients, retrograde type A aortic dissection in Results 1 patient, and graft migration in 1 patient. Of the 6 patients with 20 retrospective studies and 27 case reports from 12 countries endoleak or graft migration, 4 patients underwent re TEVAR in were identified, which reported 288 cases of BTAI managed by the follow-up period. The patient with retrograde dissection was TEVAR. Mean age of patients was 41.45 years old (range 17 - 83 treated medically because of complete thrombosis of false lumen. years old), and 60.4% were treated within 24 hours. Postoperative Technical success was achieved in 35 patients (83%). There were complications included 5 strokes, 9 endoleaks, 3 vascular access 10 late deaths. Aneurysm-related death occurred in 5 patients of injuries, 17 cases of renal failure (8 requiring continuous RRT), 1 them. aortic rupture and 1 immediate conversion to open surgery. There were no reported instances of stent migration/collapse, spinal cord Kaplan-Meier survival was 60%±8% at 1 year and 56%±8% at 5 ischaemia or aorto-esophageal fistula. Mean length of follow up years. 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). Conclusions Early and midterm outcomes of emergency TEVAR are good Conclusions when taking into account high-risk situations. However, long-term Overall, early and mid term results show that TEVAR for BTAI is surveillance will be needed because of late aortic complications. 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.

58 Annals of Vascular Diseases 2016 06-10 06-11 Comparison of long-term results of carotid Diagnostic accuracy of multiplanar reformation endarterectomys between primary closure and in computed tomography: A comparative study patch angioplasty groups to conventional angiography Young-Wook Kim1, Dr Seon-Hee Heo1, Mrs Shin-Young Woo1, Uijun Park1, RN Na Yeon Jeon1, MD Hyoung Tae Kim1, MD Won Dr Kyung-Won Yoon1, Pf Yang-Jin Park1, Pf Dong-Ik Kim1, Pf Hyun Cho1 2 2 3 Kwang-Ho Lee , Pf Gyeong-Moon Kim , Pf Keon-Ha Kim 1Keimyung University, Daegu, South Korea 1Vascular surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul , South Korea, 2Neurology, Heart Stroke and Vascular Institute, Purpose Samsung Medical Center, Sungkyunkwan University School of The purpose of the present study was to investigate the diagnostic Medicine, Seoul , South Korea, 3Interventional radiology, Samsung accuracy of mutiplanar reformation of computed tomography (CT- Medical Center, Sungkyunkwan University School of Medicine, , MPR) compared with conventional carotid angiography (CCA). South Korea Methods Background Forty carotid arteries in 21 patients who performed both image Previous multiple studies have established that patch studies were included in this study. Complete occluded carotid angioplasty(PA) following carotid endarterectomy(CEA) reduces artery was excluded. Carotid stenosis degree was measured by the risk of subsequent stroke and restenosis compared with primary NASCET method. Carotid stenosis in CT-MPR was compared closure(PC). 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 Objective diagnostic validity was assessed by kappa statistics. Intraclass We attempted to determine whether the beneficial effect of the PA correlation test was performed for evaluating reliability of stenosis works on the long-term survival of patients. measurement in CT-MPR.

Methods Results We retrospectively reviewed a database of 828 CEA which Mean age was 66.8 years (range 55-87). Male was 15 (71.4%) performed in a single institute between 2003 and 2016. and 15 (71.4%) patients were symptomatic. Spearman correlation After excluding 43 patients who underwent concomitant 42 coefficient (rho) was 0.881. In CCA, stenosis<50% was 24 (58.5%) CABG(n=42) and RND(n=1), we compared patient characteristics arteries, 50-70% stenosis was 6 (14.6%), and stenosis >70% was 11 and postoperative results including operative complications, (26.8%). In MPR, stenosis<50% was 25 (61.0%) arteries, 50-70% restenosis rate, stroke rates, long-term survival rates and stroke- stenosis was 11 (26.8%), and stenosis >70% was 5 (12.2%). Kappa related mortality rates between PC(n=332, 58%) and PA (n=453, value was 0.701 (P=0.001). Intraclass correlation coefficient was 42%) groups. To determine long-term survival rates and cause of 0.934 (95% CI; 0.880-0.964). 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 Conclusion Vascular, Inc.) and we used bovine pericardial patch for PA. Patient With improved spatial and temporal resolution, multiplanar stratification between PC and PA depended on the surgeon’s reformation in computed tomography permits the diagnosis of assertion with performing routine PC by one surgeon while routine carotid stenosis with a high degree of accuracy compared with PA by other surgeon. conventional carotid angiography

Results PA was more frequently performed for patients with coexisting coronary artery disease (43% vs 35%, p=0.019) and symptomatic 07-01 carotid stenosis (39% vs 29%, p=0.004). During follow up of mean Advancements in treating blunt thoracic aortic 43±37months (range 1-154months), carotid restenosis(>70% on injuries: Imaging evaluation and endograft 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 sizing early postoperative complications, stroke (1.2% vs 1.5%), stroke- Seiichi Yamaguchi1, Dr. Hisanori Fujita1, Dr. Shigeyasu Takeuchi1 related mortality rates(0.9% vs 0.2%) and long-term survival rates 1Chiba Emergency Medical Center, Chiba, Japan at 3, 5, 7 years (98%, 95%, and 94% vs 99%, 95%, and 91%) between PC and PA groups. Background/ Introduction Conclusion Blunt thoracic aortic injuries (BTAI) are morbid conditions that historically were difficult to manage. Though 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. Objectives The 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.

Annals of Vascular Diseases 2016 59 Oral Presentation

Materials and Methods was 17(81.0%). There was 1 mortality due to hypovolemic shock. We retrospectively evaluated all blunt thoracic trauma patients Among other 20 cases, limb salvage was achieved in 15 cases that were admitted to our hospital from January 2014 to February (75.0%). The number of the injury in upper or lower limbs was 1 and 2016 (n=201). Eighteen cases suffered blunt thoracic aortic injury, 20 respectively; 15 cases were blunt injury and 5 were penetrating representing 8.9 % (18/201). 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 Results popliteal artery stenting needed an additional superficial femoral 56 % of BTAI patients (10/18), including six out-of-hospital artery (SFA)-pedal bypass for limb salvage. Among all factors, cardiac arrest (OHCA) cases, died before reaching aortic repair. diagnosis in emergency room (ER) instead of other department in Five patients having acute BTAIs and multiple concomitant hospital is significantly related to limb salvage (11/12, 91.7% vs. injuries underwent endovascular aortic repair. But one of the five 4/8, 50.0%, p = 0.035). The presentation of class III limb ischemia cases fell into fatal ventricular fibrillation just a few minutes after is negatively correlated to limb salvage (0/3, 0% vs. 15/17, 88.2%, stent-graft placement due to rapid hemodynamic deterioration. p = 0.0011). Although the salvage rate is acceptable, only 5 cases The mean thoracic aortic diameter in these four cases was larger regained ambulation without prosthesis (5/15, 33%) at the control CT compared with the CT on admission while hemodynamically unstable. There is a very strong correlation seen Conclusion between the inverse of shock index (1/SI) and the mean thoracic aortic diameter ratio (D) to control measured on admission CT. Peripheral arterial injury with acute ischemic limb could lead to The relationship between 1/SI and D indicated very strong positive significant mortality and morbidities. Early diagnosis is very linear correlation, Pearson’s r value 0.93. D=0.2/SI + 0.7 (D =< essential to limb salvage. Extra-anatomic bypass or in-situ repair 1.0) are effective but endovascular surgery could be an alternative to selected cases. There is still significant functional loss of the limb despite salvage. 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 07-03 trauma patient at high risk due to underlying associated injuries, the acute benefits of reliable exclusion of the injury justifies the use of Outcomes of Endovascular Treatment of a stent-graft. We should know that trauma patients who admitted with hemorrhagic shock have a smaller aortic diameter compared Traumatic Aortic Transection in a Multi- with a control condition. 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 07-02 1Division of Vascular Surgery, National University Heart Centre, Surgical treatment for peripheral arterial Singapore 2Yong Loo Lin School of Medicine, National University trauma with acute ischemic limb – Experience of Singapore, Singapore, 3Department of Surgery, National University of Singapore, Singapore, 4School of Medicine, Griffith of a single vascular surgeon in ChangHua University, Gold Coast, Queensland, Australia Christian Hospital YungKun Hsieh1, Dr ChunMing Huang2, Dr ChienHui Lee1, Dr Objective YingCheng Chen1, PhD IngSh Chiu1 The aim of this study was to evaluate our experience in the acute 1Changhua Christian Hospital, Puyang St., Changhua City, treatment of traumatic aortic transection with thoracic endovascular Taiwan, 2MinShen Hospital, Taoyuan, Taiwan aortic repair (TEVAR).

Background Methods Although peripheral arterial injury with acute ischemic limb A retrospective review of patients at the National University composes minority of traumatic cases, it could lead to significant Hospital, Singapore from 2002-2015 who underwent TEVAR for mortality and morbidities. traumatic aortic was conducted. The patients were studied for 30 day survival, 1 year survival, length of stay and technical details Objectives To retrospectively review our cases to identify factors affecting the Results outcome. A total of 18 patients had a TEVAR for traumatic aortic injury. Seventy-two percent (13of 18) were male. And the median age Materials and Methods was 35 years (range 23-66). Ten were Chinese, 4 were indian We retrospectively reviewed and analyzed cases of peripheral and there were 2 Malays and Indonesian. Fourteen patients were arterial injury with acute ischemic limb receiving surgery by a involved in a road traffic accident, two had industrial accidents single vascular surgeon in Chang-Hua Christian Hospital (CCH) and the remaining two fell from height. All the aortic injury was since 2011. 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 Results open vascular procedure. The median length of cover was 120mm Since 2011/01, there were 21 cases of peripheral arterial injury (range 77-150mm). No patients died during their admission. Three with acute ischemic limb receiving surgery by a single vascular patients were lost to follow up as they went home to their respective surgeon in CCH. The average age was 48.2±17.4 (15-75) and male countries for futher treatment. Of the remaining 14, all patients

60 Annals of Vascular Diseases 2016 survived past 30 days and 1 year. The median follow up for this 07-05 group was 76 months (range 14-174 months). None of these patient required reinterventions or endoleaks from this group. The relationship between nerve injury and ablated length of the vein after endovenous Conclusion thermal ablation of varicose veins Thoracic endovascular repair of traumatic aortic injuries is an Takashi Yamamoto1, Dr Nobuhisa Kurihara1, Dr Masayuki effective, rapid and safe intervention with good short and long term Hirokawa1 results. 1Ochanomizu Vascular & Vein Clinic, Chiyoda-ku, Japan

Background and objectives 07-04 Nerve injury is reported to happen in about 5% of limbs after endovenous thermal ablation of saphenous vein. The aim of this Factors related to the reflux of great saphenous study was to elucidate the relationship between the incidence of vein at thigh nerve injury and the lengths of ablated saphenous vein. Jong Kwon Park1, Dr Hyeonseung Kim1 1Inje University Haeundae Paik Hospital, Busan, South Korea Methods The clinical records of 3,989 limbs with saphenous imcompetence which were treated with endovenous laser ablation (EVLA) or Background/ Introduction radiofrequency ablation (RFA) from May 2014 to December 2015 Venous reflux can cause swelling, pain, and subsequently, varicose were reviewed retrospectively. The limbs were classified into veins or permanent cosmetic problems in lower extremities by groups according to the type of ablated vein (great saphenous vein stasis dermatitis or ulceration. (GSV) or small saphenous vein (SSV)). The incidences of nerve injury in each groups were calculated according to the ablated Objectives length of the vein (ALV) for every 10cm (≤ 10 cm, ≤ 20 cm, ≤ 30 cm, ≤ 40 cm, ≤ 50 cm and > 50 cm). The purpose of this study was to investigate the factors related to the reflux of great saphenous vein (GSV) at thigh. Results Materials and Methods In 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 The 278 legs of 139 consecutive patients with swelling and pain increased as the ALV becomes longer and significantly when the of legs were examined by Doppler Ultrasound (US). The antero- ALV was more than 30 cm. In the SSV group, the incidences of posterior diameters of GSV, common femoral (CFV), superficial nerve injury were 2.4, 2.2 and 1.6% respectively without significant femoral (SFV), profunda femoris (PFV), and popliteal (PV) veins difference between each ALV. There were no significant difference were measured. The presence of venous reflux was determined between EVLA and RFA in both groups. 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, Conclusions diameters of veins, body mass index (BMI), smoking pack•year, Nerve injury in relation to the GSV ablation was observed frequently alcohol drink days, levels of HbA1c, total cholesterol, high density as the ALV was longer as well as previous reports. However, in the lipoprotein, low density lipoprotein, triglyceride, homocysteine, SSV group, the incidences of nerve injury didn’t change with the uric acid, protein C, protein S, antithrombin III, factor VIII, ALV. This result suggests that nerve injury after thermal ablation of fibrinogen, D-dimer, and rheumatis factor. Investigated nominal the SSV may occur at the proximal portion where the tibial nerve variables were gender, diabetes mellitus, hypertension, smoking, and its branches run close to the SSV. 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 07-06 days of alcohol drink per month by 12 and by the number of years Comparison of Monopolar versus Segmental the person has drunk. Radiofrequency Ablation in Endovenous Treatment of Lower Limb Chronic Venous Results Insufficiency Logistic regression analysis showed that the independent factors 1 1 1 1 determining GSV reflux were diameter of CFV (B=0.351, p=0.017), Ryan Tan , Dr Pravin Lingam , Dr Joseph Lo , Dr Qiantai Hong , 1 1 1 BMI (B=0.237, p=0.014), alcohol drinker (B=1.375, p=0.029), and Dr Sadhana Chandrasekar , Dr Sriram Narayanan , Dr Glenn Tan antithrombin III (B=-0.001, p=0.001). 1Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore Conclusions The increased diameter of CFV, higher BMI, alcohol drinker, and Objectives lower antithrombin III level may be the risk factors of developing To compare outcomes in patients with lower limb chronic GSV reflux. venous insufficiency (CVI) who were treated with monopolar (EVRF®, F Care Systems, Belgium) versus segmental (VNUS® ClosureFastTM, Medtronic, USA) radiofrequency ablation (RFA) therapy.

Annals of Vascular Diseases 2016 61 Oral Presentation

Methods clinical and technical success. Secondary outcomes were Retrospective study of 288 limbs treated between January 2014 complications, quality of life and time to return to normal work/ and May 2015. Demographics, co-morbidities, CEAP clinical activity. Search criteria identified 31 studies, with 11 suitable for manifestation, pre-operative venous duplex, surgical procedure and inclusion. post-operative outcomes were evaluated. Results Results 1307 patients were included, 869 (66%) female and mean age 189 patients with 288 limbs were treated with RFA. 146 limbs were was 55.6 (+/-14.6) years. CEAP class 1:2-3:4-6 = 9:963:292 treated with EVRF and 142 limbs with VNUS. Both groups were respectively. 1242 great saphenous veins (GSV) and 237 small similar in demographics and co-morbidities. The average age was saphenous veins (SSV) were treated. Technical success overall = 58 years, with average BMI of 26. There were no patients with 99.9%. Anatomical success for GSV = 94.3% and for SSV 91.4% mixed arterio-venous disease. 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. Majority had long saphenous vein (LSV) reflux (99% in monopolar, There was also an improvement in quality of life (QoL) measured 97% in segmental, p=0.44) and sapheno-femoral junction (SFJ) by the AVVQ score (14.1 (+/- 2.3) to 8.3 (+/-1.6) (p=0.02)). The incompetence (88% in monopolar, 80% in segmental, p=0.07). time for patients to return to normal activity following MOCA Half had short saphenous vein (SSV) reflux (51% in monopolar, was 1.8 (+/-1.1) days and 2.4 (+/- 1.6) days for return to work. 49% in segmental, p=0.73) and a third had concomitant deep vein The most common complications were ecchymosis, induration, reflux (29% in monopolar, 34% in segmental, p=0.38). In addition hyperpigmentation and thrombophlebitis. 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 Conclusions performed to SSV in 14% of patients within the monopolar group Presenting the pooled data of MOCA to date, this study shows and 8% of patients within the segmental group (p=0.14). 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 Post-operative outcomes were similar in both groups. Transient to define the role of ClariVein™ further in relation to the ever superficial neuropathy was 8% in both groups (p=0.83), phlebitis increasing number of new technologies for endovenous ablation. occurred in 4% of monopolar group and 1% of segmental group (p=0.28). No deep vein thrombosis nor recurrences occurred within both groups. 07-08 Conclusions Both monopolar and segmental RFA are safe modalities in The results of noncomparative study of treating lower limb CVI, with similar clinical outcomes and low endovenous heat-induced thrombosis treatment complication rates. The significant advantage of monopolar is the by rivaroxaban shorter active catheter tip, which allows for treatment of shorter 1 2 vein segments such as AAGSV. Professor Alexey Fokin , Denis Borsuk 1The education department of surgery of the South Urals medical university, Chelyabinsk, Russian Federation, 2The Clinic Of Phlebology And Laser Surgery “vasculab” Ltd., Chelyabinsk, 07-07 Russian Federation

ClariVein™ - mechano-chemical ablation After using of endovenous methods of treatment of varicose veins (MOCA) for treatment of truncal venous it had been appeared a new complication such as endovenous heat- insufficiency: a systematic review induced thrombosis (EHIT). James Sun1, Mr Mohammed Chowdhury1, Mr Umar Sadat1, Professor Tjun Tang2 The aim of our work was to investigate the efficacy of rivaroxaban 1Vascular Unit, Cambridge University Hospital NHS Foundation for the treatment of EHIT after endovenous laser ablations (EVLA). Trust, Cambridge, Uk, Cambridge, United Kingdom, 2Vascular Service, Changi General Hospital, Singapore Materials and methods Prospective noncomparative study includes 1326 patients who had Background/Objectives 1514 EVLA over the period from September 2014 to February ClariVein™ or mechano-chemical ablation (MOCA) combines 2016. In 1091 (72,1%) cases the great saphenous vein (GSV) was mechanical damage to the endothelium caused by a rotating wire ablated. The anterior accessory vein (AASV) was treated in 124 with simultaneous catheter-guided infusion of a liquid sclerosant. (8,2%) cases and small saphenous vein (SSV) was treated in 299 The aim of this review was to assess the efficacy and safety of the (19,7%) cases. ClariVein™ device in the treatment of superficial venous disease. The EHIT were found out in 21 (1,4%) cases. 19 (1,7%) patients Methods 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 A comprehensive search strategy was employed of the CENTRAL, with EHIT were prescribed rivaroxaban. MEDLINE (January 1966 to April 2016), and EMBASE (January 1980 to April 2016) databases. Primary outcomes were anatomic,

62 Annals of Vascular Diseases 2016 Results 07-10 According 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 The results of endovenous laser ablation of the 2 (0,1%) cases of 3rd class EHIT. All the patients with the 1st class saphenous veins more then 2 cm of the diameter were prescribed rivaroxaban 20 mg once a day and we used 15 mg Professor Alexey Fokin1, Denis Borsuk2 twice a day for the patients of the 2nd and the 3rd classes of EHIT. 1The education department of surgery of the South Urals medical We had to stop of using rivaroxaban for 1 (4,8%) patient because of 2 dyspepsia. In this case we began to use enoxaparin in therapeutic university, Chelyabinsk, Russian Federation, The Clinic Of dosage once a day. It was a complete regress of EHIT over the Phlebology And Laser Surgery “vasculab” Ltd., Chelyabinsk, period of 6-25 days in all cases. In 1 (4,8%) case there was nose Russian Federation bleeding without major complications. This patient went on using rivaroxaban. There were no cases of pulmonary embolism. Prospective noncomparative study includes 64 patients who were operated from November 2014 until September 2015 and they Conclusions had 67 EVLA of great saphenous veins (GSV). We used 1470 Nm laser, radial fibers and special pull-back device. All veins were Rivaroxaban is an effective medicine for EHIT treatment. The treated under tumescent anesthesia. The diameter of the veins other investigations are needed to point its efficacy and safety. 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 07-09 were examined by ultrasound the next day, a week later and 2 and 6 months later. Histopathological Investigations on the Great Saphenous Vein treated with Sclerotherapy In this investigation we were interested technical result which was Harinder Singh Bedi1, Dr Nalini Calton1, Dr Kanwardeep Kwatra1 existed in occlusion of treated veins. Also we appreciated in absence 1Christian Medical College & Hospital, Ludhiana, Ludhiana, India 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 Objective 3 patients after 7 days. In 4 (6%) cases we did ultrasound-guided Sclerotherapy is a minimally invasive technique to produce foam-form sclerotherapy (UGST). Over the period of 6 months endoluminal ablation of a varicose vein. There is not much data the small stumps of GSV (mean 21 mm ± 5 mm) were found of on the histolo-pathologic effect of sclerotherapy on the human 3 (4,5%) patients. In all cases it wasn’t reflux in this stumps. Also vein. We studied in detail the histological changes in the vessel only in 1 (1,6%) case we found recanalization with pathological wall of the great saphenous vein (GSV) after it was subjected to reflux. This patient was treated by UGST. There was no necessary sclerotherapy. to retreat patients by EVLA.

Method EVLA 1470 nm by radial fibers are really effective also for the We studied the effect of sclerotherapy with sodium tetradecyl veins of the diameter more than 2 cm. We have found occlusion sulphate on 5 pieces of the human GSV. A short piece of vein was of GSV of 99,5% cases in early follow-up period. In 4,5% cases removed at the start to serve as control (labelled control 1). Another UGST has been done. 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 07-11 with warm packs at body temperature. After 1 minute the foam was gently flushed with saline-blood solution and clipped at both ends. An Old but Remarkable Instrument for After 5 minutes the clips were removed from the test and control 2 “Minimal-invasive“ Varicose Vein Surgery: and all 3 specimens were preserved in 10% buffered formaline and subsequently sectioned and stained with haemotoxylin and eosin Oesch PIN Strippers 1 and subjected to HPE. Mingli Li 1China Medical University Hospital, Taiwan, Taichung City, Republic of China Results On gross inspection there were no apparent changes. On detailed histopathology there was a loss of 63.5% of the endothelium (range Background 62.2–82.8) and an injury to the media (median depth 43.4 μm There are several varicose instruments developed (42.1–46.7) and % media injury 5.3% (3.7–6.0). 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 Conclusion familiar to most vascular surgeons. The experience of using a stick- We believe that these findings have great clinical relevance. They like Oesch PIN stripper (Credenhill, UK ) for stripping a trunk will help us to further fine tune the volume and dose of sclerosant saphenous vein is scarce in many medical centers. 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 . Objectives Comparison of cable strippers and PIN strippers used in thigh, leg and calf trunk varices

Annals of Vascular Diseases 2016 63 Oral Presentation

Materials and Methods Conclusion We use PIN strippers in patients who can’t afford the cost of PMT with AngioJet and DCAT are a safe and effective strategy for endoluminal thermal therapy or foam sclerotherapy and compare early thrombus removal of patients with acute DVT with different the post-op satisfaction with cable stripping. pitfalls. This study is limited by small number and retrospective study. Results Patients 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 08-02 and peripheral nerve injuries. We believe that the PIN stripping Correlation of obesity & chronic venous combined with hook miniphlebectomies can be done under tumescent anesthesia on outpatient basis. insufficiency with respect to Co-morbid pathologic conditions 1 1 Conclusions Sandeep Mahapatra , Professor Pinjala Ramakrishna 1 PIN stripping has many unique advantages which should be Nizam’s Institute Of Medical Sciences, Hyderabad, India popularized and inherited in medical centers and clinics. Introduction Chronic venous insufficiency symptomatology is commonly observed in obese patients 08-01 Pharmacomechanical Thrombectomy (PMT) Objectives with Angiojet Solent Omni Compared with The aim of the cross sectional observational study is to evaluate the Catheter Directed Aspiration Thrombectomy relation of morbid obesity with the severity of the venous disease and the impact of different pathological conditions on the venous (CDAT) for Treatment of Acute Deep Vein disease distribution. Thrombosis (DVT) Jang Yong Kim1, Professor In Sung Moon1, Clinical Professor Mi Method Hyeong Kim1, Professor Seung Nam Kim1, Clinical Professor Kang 200 morbid obese patients were evaluated in the outpatient Woong Jun1, Assistant Professor Jeong Kye Hwang1, Professor Ji department with respect to age, gender, lower limb affected, CEAP Il Kim1, Associate Professor Yong Sung Won1, Professor Sang (Clinical, Etiological, Anatomical, Pathological) classification, Seob Yun1, Associate Professor Sun Cheol Park1, Clinical Fellow Diabetes, Hypertension and Hypothyroidism . Obesity was defined Hyun Kyu Kim1 by Body mass index more than 30kg/m2. Clinical examination of 1The Catholic University of Korea, Seoul, South Korea the lower limb was assessed by the grades of the venous sign with documented reflex by duplex imaging. Background Conventional anticoagulation for acute DVT can cause post Results thrombotic syndrome (PTS). Therefore, early thrombus removal There is a significant association of male patients presenting with strategies for acute DVT are widely appreciated across different left leg (85.7%) high grade Chronic venous insufficiency (CVI) societies. PMT is recently-established therapy to manage acute symptoms (P value=0.05), having primary etiology of CVI in DVT, when experts and resources are available. In Korea, CDAT CEAP (p value=0.078 )classification .Superficial venous system is popular options for acute DVT because PMT devices are limited was involved in the disease pathology in 192 cases (99%) with by reimbursement issues. We compared the results of PMT with 91% of the patients having truncal valvular reflux in Duplex Angiojet with CDAT and evaluated risk factors affecting patients’ scan .High BMI is associated with higher grades of Clinical outcome. scoring ( P value0.053).The primary or the idiopathic etiology is having statistically significant association with BMI>40kg/m 2(p Materials and Method value=0.007).Duplex confirmed significant reflux is observed in patients with higher BMI(P value=0.006)).Spearman correlation This is a retrospective study from prospectively registered database showed that Age is positively correlated with Clinical score of the patients, who underwent interventional procedures due to (r=0.176 , P value =0.013).Pairwise correlation between BMI with acute DVT in Seoul St. Mary’s Hospital from 2013 to 2015. PMT clinical score and age is statistically significant (Non-Parameteric with AngioJet and Solent Omni catheter was compared to CDAT test) for acute DVT. Patients’ demographics, procedural information, their results and complications were retrieved from EMR and PACS and analyzed with SPSS 10.1. Conclusions The study confirmed that older age gentleman with high BMI Results having primary venous reflux are at increased risk of the clinical progression of CVI from varicose veins to chronic venous Fifty eight patients were enrolled. 22 patients were treated by PMT, insufficiency with trophic skin changes and venous ulcers. We and 36 by CDAT. There was no procedure or inhospital mortality could not establish primary influence of Diabetes, Hypertension or in both groups. There were 3 additional thrombolysis in PMT Hypothyroidism on the severity of CVI. 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.

64 Annals of Vascular Diseases 2016 08-03 after treatment for superficial incompetence in primary CVD is controversial. Direct interruption of ICP is often considered using Endovenous laser therapy in the treatment sclerotherapy, endovenous and surgical ablation in addition to the of great saphenous vein reflux: comparison ablation of proximal saphenous truncal reflux and simultaneous phlebectomies. This study was conducted to identify the effect on between 1470nm 2ring radial fiber and 940nm the ICP by the ablation of varicose veins using endovenous and bare tip fiber surgical procedures. Albert Ting1, Ms Grace Cheung1, Ms Silvana Lau1, Dr Yiu-che 1 1 1 1 Chan , Dr Alfred Wong , Dr Yuk Law , Prof Stephen Cheng Methods 1 Division of Vascular Surgery, Department Of Surgery, University 36 consecutive cases (45 legs, CEAP C classification; C2: 16, C3: Of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong 20, C4a: 9) with primary CVD due to GSV incompetence and varicose veins with concomitant ICPs participated in this study. In Background and objectives all affected legs, ablation of truncal and branch great saphenous vein using laser or radiofrequency with stab avulsion of varicose Endovenous laser therapy (EVLT) has emerged as a popular veins was performed. Venous reflux in the leg was examined using treatment for great saphenous vein (GSV) reflux. We performed duplex ultrasound and physical assessment was performed at pre EVLT procedures with 1470nm 2ring radial fiber (1470nm laser) and post-operative 1 month. since February 2014. The clinical outcomes and efficacy were compared with those treated with 940nm bare tip fiber (940nm laser). Results In 44 medial, 1 lateral and 5 thigh ICP detected at pre-operation, Methods 22 medial and 1 thigh ICP disappeared, 9 medial and 1 thigh IPC remained, 13 medial, 3 thigh and 1 lateral ICP became competent Eighty-eight legs with GSV reflux received EVLT using 1470nm at postoperative 1 month (Residual IPC rate: 18 %). The averaged laser under local tumescent anaesthesia as day surgery procedures diameter of ICP significantly decreased from 3.1 mm to 1.7 mm between February 2014 and May 2016. They were compared after operation. 29 % legs had residual varicose vein after operation. with another 88 legs treated with 940nm laser prior to February The rate of residual IPC in the group of residual varicose vein (60 2014. The safety and efficacy as well as the early results including %) is higher than that of non-residual varicose vein (20 %). 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 Conclusion month and one year after operation. The ablation of truncal and branch great saphenous vein with stab avulsion of varicose veins for primary varicose vein can reduce Results number of incompetent perforators without direct treatment for incompetent perforators. The 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 08-05 were comparable (Median: 6 tablets in both groups). There was significantly less bruises in 1470nm laser and the time before ClariVein(r) - One Year Results of Mechano- resuming normal activities was also significantly shorter (Median: Chemical Ablation (MOCA) for Varicose 2 days in 1470nm laser vs. 3 days in 940nm laser). VCSS showed Veins in a Multi-Ethnic Asian Population from 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 Singapore reflux noted at one year was comparable (0% in 1470nm laser vs. SN Khor2, Dr L Jiang2, Dr. S Kum1, Dr. YK Tan1, Dr TY. Tang1 5% in 940nm laser). 1Vascular Service, Department of General Surgery, Changi General Hospital, , Singapore, 2Singapore Health Services, Singapore, Singapore Conclusion Introduction Both procedures were safe and effective in ablating GSV reflux with similar recurrence rate at one year. 1470nm was associated ClariVein(r) is a novel non thermal, non-tumescent catheter with decreased pain and bruises with earlier return to normal technique, which uses mechanical and chemical ablation (MOCA) activities. to occlude the superficial vein. This study aims to assess its effectiveness and patient experience in a multi-ethnic Asian population in Singapore.

08-04 Methods Does ablation of great saphenous vein and 121 patients (141 legs; 180 procedures) underwent ClariVein(r) treatment. 49 (40.5%) for great saphenous vein (GSV) simultaneous phlebectomies of varicose veins incompetence, 16 (13.2%) bilateral GSV, 13 (10.8%) short reduce incompetent perforators in primary saphenous vein (SSV), 4 (3.3%) bilateral SSV and 39 (32.2%) chronic venous disease? combined unilateral GSV and SSV reflux. 49/180 legs (27.2%) had 1 C4 -C6 disease. Patients were reviewed at an interval of 1 week, 3, Tomohiro Ogawa 6 and 12-months post procedure and underwent Duplex ultrasound 1Fukushima Daiichi Hospital, Fukushima, Japan assessment. Post-operative complications were recorded along The role of incompetent perforators (ICP) in the recurrence with patient satisfaction. of varicose veins and the development of skin changes (C4-6)

Annals of Vascular Diseases 2016 65 Oral Presentation

Results Conclusions There was 100% technical success. 63/121 (52.1%) had concomitant This study showed the high frequency of PE in patients with phlebectomies. All procedures were very well tolerated with a symptomatic DVT, but half of PE was asymptomatic and severe mean post-op pain score of 0.8 (range 0-4). After 3 months, median symptomatic PE was rare. There was no significant difference patient satisfaction of the treatment was 9 (IQR 9-10). At 1 week, between the occurrence of PE in relation to the location and the GSV was completely occluded in 114/118 (96.6%) veins and extension of DVT. 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 08-07 SSV occlusion rates were 78/92 (84.8%) and 50/53 (94.3%). Comparative study of pain at EVLT with laser wavelength 1470nm and 1560nm in patients Conclusions with varicose veins ClariVein(r) can be used safely to ablate both long and short Dr Oleg Guzkov1, Nikita Shichkin1, Natalya Tarasova1 saphenous varicose veins in a multi ethnic Asian population. 1 Yaroslavl state medical University , Yaroslavl, Russian Federation 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 Objectives although in the majority of cases required no reintervention, are Evaluation of pain syndrome after performing EVLT of GSV in more than expected. the early postoperative period using wavelength 1470 nm and 1560 nm.

08-06 Methods 256 patients with primary varicose veins of the lower extremities. Incidence and clinical feature of pulmonary CEAP: C2 - C5. EVLT performed by diode laser 1470 nm (N=191) embolism in patients with symptomatic deep and 1560 nm (N=65). Assessment of pain was performed according to the visual analogue scale (VAS). The follow up was performed at venous thrombosis diagnosed by means of 1, 3, 5, 7, 14 and 21 days after EVLT. computed tomography 1 1 1 Uijun Park , RN Na Yeon Jeon , MD Won Hyun Cho , MD Results Hyoung Tae Kim1, PhD, RN Min Young Kim2 1 2 Comparing the two groups (1470 nm and 1560 nm), a significant Keimyung University, Daegu, South Korea, Ulsan University, difference between at various times after EVLT it was not detected. Ulsan , South Korea 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 Purpose 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 Computed tomography pulmonary angiography (CTPA) is pain was significantly lower in the 1,9 and 4,3-fold respectively. In currently the preferred imaging test for pulmonary embolism (PE). the group with the wavelength 1560 nm decreased pain syndrome This study was performed to evaluate the incidence, radiologic since postoperative days 3 to 24%. The median pain score was 2,8 and clinical severity of PE in patients with symptomatic deep vein (IQR 0-3,3, р=0,01). On the 7th and 14th day reduced pain by 41 thrombosis (DVT). and 51%, respectively. On the 21th day of the median pain score was 0 points, IQR 0-1,9, p<0,0001). Material and Methods Among the patients who took CTPA and CT of lower Conclusions extremity concomitantly due to leg swelling, the patients who In applying the wavelength of 1470 nm was a significant increase confirmed lower leg DVT with CT venography were enrolled. The in pain on the first postoperative day, while at the wavelength of incidence and clinical feature of PE was retrospectively studied. 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 Results the postoperative period, and at 1560 nm with 3 days Total 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 08-08 bilateral pulmonary artery involvement was in 39.8%. PE involving main pulmonary artery was 42.6%, lobar pulmonary artery 42.6% Endovenous laser treatment of incompetent and segmental pulmonary artery 14.8%. The frequency of PE in calf perforator veins - does the ablation method DVT was 63.6%, in popliteal DVT 73.7%, in femoral DVT 54.2%, matter? and in iliac DVT 55.1%. Forty-nine percent of PE was clinically 1 silent and 43.7% showed mild clinical symptoms, however 2.9% of Chien-Chang Chen PE showed hemodynamic unstability. 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.

66 Annals of Vascular Diseases 2016 Objectives Results In this study, we reported the clinical outcome of the patients There were 27 (15%) men and 151 (85%) women. 356 limbs were treated for IPVs with EVLT and compare the sonographic results included in this study and 346 limbs were measured the Djian- of two different ablation methods. 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 Materials and Methods in the C0-C1 group and 82 (52.5%) limbs were found in the CVD 30 IPVs in 26 patients were treated with EVLT. The surgical group. The flat foot in the CVD group were 59 (37.8%) limbs that indications were IPV diameter > 3.5mm with symptomatic varicose higher than the other groups significantly (p < 0.001). The hollow veins or dermatologic complications. The IPVs were ablated foot was no different in both groups. The mean Djian-Annonier directly if the whole routes could be cannulated (direct ablation). If angle was significantly (p < 0.001) increased when compared to the IPVs were too tortuous to be cannulated, their exits were sealed C0-C6 classification. The C5-C6 group (healed and unhealed ulcer by ablating the outflow veins (indirect ablation). The preoperative patients) had the widest of the Djian-Annonier angle. Higher of the and postoperative venous clinical severity score (VCSS) were venous clinical severity score (VCSS) was significantly related to recorded. Duplex ultrasound was used to follow up the change of wider the Djian-Annonier angle (p<0.001) when the hollow feet IPVs preoperatively, 6 weeks, 24 weeks postoperatively. were excluded.

Results Conclusions The mean age was 50.9 years (26-79 years). The mean clinical The static foot disorders are commonly found in Thai population. follow-up period was 56.8±29.5 weeks. Direct and indirect The flat foot strongly relate to more severity of chronic venous ablation was done in 15 patients (57.7%) and 11 patients (42.3%), disease. For the clinical practice, the detection of SFDs is a new key. respectively. All patients had clinical improvement after EVLT The CVD symptoms will improve when the SFDs are corrected. 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 08-10 follow-up of the mean diameters of all treated IPVs reduced Risk factors of deep venous thrombosis in a 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 cohort of Chinese patients sealing and reflux-free were found in 100% of the directly ablated Hai-Lei Li1, Dr. Yiu-Che Chan2, Dr. Ning Li1, Dr. Dong-Zhe Cui1, IPVs and 61.5% of the indirectly ablated IPVs (p< 0.05). Professor Stephen Cheng2 1Department of Surgery, The University Of Hong Kong Shenzhen Hospital, Shenzhen, China, 2Department of Surgery, University of Conclusions Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, EVLT is effective in clinical improvement of IPV-related chronic China venous disease. IPVs treated by direct ablation tend to have higher reflux-free rate than those by indirect ablation. Introduction Despite the great impact of deep venous thrombosis (DVT) on health, there are few published studies on underlying risk factors of 08-09 DVT in Chinese patients. Pulmonary embolism (PE) is frequently unsuspected or undiagnosed. Study of the relationship between static foot disorders (SFDs), clinical severity of chronic Objectives venous disease (CVD) and venous clinical To investigate the risk factors and prevalence of PE in a cohort of severity score Chinese patients with DVT at a single medical center. Termpong Reanpang1, Dr Nattaporn Ratanasoontornchai1, Dr Saranat Orrapin1, Dr Supapong Arworn1, Dr Kittipan Rerkasem1 Methods 1Department of Surgery, Faculty of Medicine, Chiang Mai A retrospective review of patients with DVT from August 2013 University, Chiang Mai, Thailand, Chiang Mai, Thailand to May 2016 was performed. Demographic data was retrieved from electronic medical record system. Risk factor of DVT and Background incidence of PE were analyzed using SPSS. To study the relationship in between static foot disorders and the CEAP clinical severity in Thai populations. Results A total of 94 patients (49 female, 52.1%) were included in this study. Material and methods 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 178 CVD patients were recorded using standardized record form the patients’ thrombosis was located at the left leg (52 patients, that includes finding from duplex ultrasound, the clinical CEAP 53.3%). The other locations including right lower limb (29 patients, classification, and the venous clinical severity score. The clinical 30.9%), bilateral lower limbs (8 patients, 8.5%) and left subclavian CEAP classification was determined in both limbs. A standardized vein (4 patients, 4.3%). Femoral vein was involved in 32 patients measurement of the Djian-Annonier angle was used to quantify and (34%), while iliac vein thrombosis was identified in 30 patients identify the presence of SFDs. The normal angle is between 119° (31.9%). Limb swelling and pain were presented in 87 (92.6%) and 128°. The angle < 119° is called hollow foot and the angle > and 83 (88.3%) patients, respectively. The most common causes 128° is called flat foot. 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,

Annals of Vascular Diseases 2016 67 Oral Presentation however, only one was symptomatic. The dosage of warfarin was 08-12 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 Incidence of chronic venous insufficiency and duplex ultrasound. post thrombotic syndrome in lower limbs DVT, a 3 years follow-up Conclusion Hossein Hemmati1 Immobility, trauma and surgery are still the most common risk 1Inflamatory lung disease research center guilan university of factors for DVT. The incidence of silent PE in patients who had medical sciences,, Rasht, Iran , 2vascular surgery and dialysis proximal DVT was high. research center guilan university of medical sciences, Rasht, Iran Hossein Hemmati, Pantea Hajireza, Kambiz Farid Marandi, Hanif Balasi 08-11 Introduction Catheter-directed thrombolysis cannot prevent DVT has been attracting many clinical attentions due to its long postthrombotic syndrome and short terms complications.can be Post-thrombotic syndrome Young Ah Kim1, Dr Woo Sung Yun1, Dr Shin Seok Yang1, Dr Bo and chronic venous insufficiencywhich occurs even after an Yang Suh1 appropriate anticoagulant therapy.The clinical evidence and evaluation of venous valves using Doppler test or Plethysmography 1Youngnam Medical Center, Daegu, South Korea can help with the diagnosis of DVT in symptomatic patients. In spite of extensive studies for the DVT’s prevention and treatment Background in the last several years,the chronic venous insufficiency has not Post-thrombotic syndrome (PTS) is a most common chronic investigated thoroughly. complication of deep vein thrombosis (DVT). Objective Objectives The purpose of the proposed study is to determine the incidence of The aims of this study are to identify risk factors and to evaluate chronic venous insufficiency,suggest optimized treatment methods an efficacy of catheter-directed thrombolysis (CDT) for preventing to reduce the patients’pain. development of PTS in patient with lower extremity DVT. Material and methods Materials and Methods DVT patients from 1389 to 1392 have been considered for the survey. From 2005 Jan to 2013 Dec, 138 limbs of 125 patients who had We chose the patients who had suffered DVT in lower limbs for the the first episode of proximal DVT at the affected limb and visited first time. Each patient went through a Photoplethysmography(PPG) our out-patient clinic to check Villalta scale were enrolled in this test and the results along with information obtained study. The PTS was defined as ≥ 5 points of the Villalta scale. We from history and physical examhave been recorded,The retrospectively reviewed medical records for possible predictors of information such as age,gender,weight,claudication,heaviness, PTS. pigmentation,telangiectasia,varicose veins, edema, pulse, venousulcers, location of DVT and underlying diseases. SPSS version21 has been employed for data analyzing with a threshold Results of p<0.05. During 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 Results years). After thrombolysis, iliac vein stent was placed in 28 limbs (20%). We achieved complete recanalization in 38 limbs (70%) In total 153 cases with an average age of 50±14 have been contributed and partial recanalization (residual thrombus < 50%) in 16 limbs in this studywith a DVT average time of 2.08±08 years.The results (30%). No differences between CDT and non-CDT group were show that in 43.1% of the cases the DVT has been involved in found in baseline characteristics, duration of symptom, use of Iliofemoral area which had not shown a significant correlation anticoagulation and recurrence of DVT. Inferior vena cava filter with PTS in our study.The evaluation of the clinical evidence in was more frequently placed in CDT group (p = 0.007). A significant the recruited DVT patients showed that 101,101,73 and 67 cases higher thrombotic burden was observed in CDT group (p = 0.013). had been suffering from edema,heaviness,Telangiectasiaand pain In multivariate analysis, patients with PTS had significantly higher respectively.The PPG results of 94.8% of the cases were positive. body mass index (BMI) (hazard ratio, 1.036; p = 0.005) and longer thrombotic burden involved in ilio-femoro-popliteal DVT (hazard Conclusion ratio, 3.722; p = 0.033). CDT did not influence the risk of PTS (p Considering the fact that the majority of the patients were > 0.05). symptomatic,a more optimized method may can be essential for future studies. Conclusions We suggest that higher BMI and longer thrombotic burden are Keywords associated with development of PTS in patients with DVT. CDT is Deep Vein Thrombosis, PostthromboticSyndrome, Venous not effective in preventing PTS in this observational study. Insufficiency.

68 Annals of Vascular Diseases 2016 09-01 Objective To study the outcome and post-operative complication of Subfascial Management of iliofemoral DVT in a single Endoscopic Perforator Surgery (SEPS) for treating complicated large tertiary hospital; a need to create greater chronic venous insufficiency. awareness Haider Bangash1, Mr Josh Cutten1, Mr Patrick Tosenovsky1, Methods 1 1 Professor Patrice Mwipatayi , Mr Nishath Altaf A total of sixty patients were included in this non randomized 1Royal Perth Hospital, Perth, Australia 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 Introduction was used for sample selection. Iliofemoral Deep Vein thrombosis (DVT) is associated with significant morbidity and long term adverse outcomes. Since the publications of numerous randomised controlled trials, several Results guidelines advocate the use of intervention in suitable patients with A total of 66 procedures were performed in 60 patients having iliofemoral DVT. With this change in recommended treatment, mean age of 41.1 years. An average of four perforators were dealt the aim of this study is to evaluate the referral patterns of patients with endoscopic surgery. Post-operative pain, hematoma 14.2%, diagnosed with iliofemoral DVT in our tertiary hospital. 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 Objective complications.Wound infection not seen in any case and there was Primary objective was to evaluate number of patients with acute no evidence of wound infection recorded during one month post- iliofemoral DVT that were referred to the vascular surgery unit. operatively. Mean hospital stay was 1.5 days. At 3 months follow Secondary objective was to evaluate the number of patients that up ulcers healing was 90% in patients with active ulcers. were not referred to vascular surgery who would have been suitable for vascular intervention based on a comprehensive selection criterion. Conclusion SEPS is a better and minimally invasive technique as compared to old Linton approach for management of venous ulcers leading to Results early patient mobility, early return to work and better ulcer healing. 114 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 09-03 treatment. Majority of referrals occurred in the year 2016 with 6 False-lumen Growth in the Abdominal Aortic patients (31.5%). 8 out of 12 patients referred underwent surgical intervention for their symptomatic iliofemoral DVT. Region after Endovascular Repair for Type-B Aortic Dissection: Computational Study of Conclusion Long-term Follow-up Jiang Xiong1, Prof. Duanduan Chen2, Mr. Huanming Xu2, Dr. There still appears to be a large proportion of patients with 1 1 symptomatic iliofemoral DVT who despite being potentially Huiwu Dong , Dr. Wei Guo suitable for intervention are not being referred to the vascular 1Dpt. Vascular And Endovascular Surgery, Beijing, China, 2Beijing services. More awareness needs to be created about the benefits of Institute of Technology, Beijing, China vascular intervention for iliofemoral DVT so that these patients can have improved short and long term outcomes Background Thoracic 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 09-02 in the infrarenal aorta, might occur. Hence, wise medical decision An Experience of Subfascial Endoscopic regarding re-intervention or surgery is required: this relies on Perforator Surgery in Complicated Chronic effective prediction of the development of the dissection. Venous Insufficiency Objective Shahzad Alam Shah1 According to the long-term follow-up CT image of post-TEVAR 1 Fatima Jinnah Medical University & Sir Ganga Ram Hospital type-B AD, using computational study to predict false-lumen Lahore, Lahore, Pakistan growth in the abdominal aortic region.

Background Methods and Results In varicose veins disease the incompetent perforators has a major Patient-specific models were established based on CTA of long-term contribution in the development of complications. Conventionally, follow-ups of type-B AD with stable (7 follow-ups in 53months) in patients that have associated incompetent perforators require and expanded (5 follow-ups in 35months) FL post-TEVAR. Doppler multiple incisions for ligation of these perforators. The advancement ultrasound velocimetry was applied to obtain individualized flow in the endoscopic techniques has permitted the use of this modality boundary conditions and to validate the computational results; for perforator surgery. 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

Annals of Vascular Diseases 2016 69 Oral Presentation longitudinal variation of local wall shear stress (WSS). The spatial- Conclusion variant pressure difference (PD) between FL and true lumen (TL) Our experienced support the safety and efficacy of TEVAR for is related to luminal remodelling. Its relative magnitude during aortic pathologies with a low morbidity and mortality rate. The use early-stage post-TEVAR may be suggestive of subsequent FL of TEVAR in young patient need a further followed up for long remodelling. In long-term follow-up, the position of the largest term outcome. 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. 09-05 Conclusions Stent graft-induced new entry (SINE) following Medical imaging techniques together with computational analyses thoracic endovascular aortic repair can quantitatively identify the FL entries and thus find the watershed Takashi Hashimoto1, Dr. Noriyuki Kato1, Dr. Takatoshi of PD. PD and WSS may predict regional luminal remodelling and Higashigawa1, Dr. Shuji Chino1 partial thrombosis establishment, which altogether assist in further 1Mie University Hospital, Tsu, Japan treatment decision-making.

Background Thoracic endovascular aortic repair (TEVAR) is now a mainstream 09-04 therapy of patients with aortic dissection (AD). Stent graft-induced new entry (SINE) has been recognized as one of important adverse Thoracic endovascular aneurysm repair events observed in them. (TEVAR) in the management of various thoracic aorta pathologies: Hosp. Kuala Objectives Lumpur experienced The objective is to report our experience of SINE. Zaharudin Ismazizi1, Dr Azizi Zainal Ariffin1 1Hospital Kuala Lumpur, Wilayah Persekutuan, Malaysia Materials and Methods Since 1997 through 2016, 141 patients with aortic dissection Purpose underwent TEVAR in our hospitals. Among them, 13 patients (9.2%) developed SINE following TEVAR. There were 10 men To present our single-center experience of endovascular and 3 women. The mean age was 63.1±9.1 years old. One of them management of various thoracic aorta pathologies had Marfan’s syndrome. Their medical records were reviewed retrospectively. Methods All patients between the period of 2006-2015 with various thoracic Results aorta pathologies who were treated with thoracic endovascular Five patients underwent TEVAR within a month from the onset repair (TEVAR) were included in the review. All data obtained of AD, 1 within 3 months, 2 within a year, and 5 beyond a year. were entered into an Excel worksheet for further analysis. Twelve patients underwent TEVAR with hand-made device and one with Talent. The mean oversizing of the device was 30±12% to Results the diameter of the true lumen. The interval between TEVAR and During the period, 69 patients with thoracic aorta pathologies SINE was 7 days in 1 patient, within 2 months in 4, and beyond a were treated with TEVAR. There were 57 males and 12 females. year in 8. All five patients who developed SINE within 2 months Patients were divided into 4 groups based on their pathologies had undergone TEVAR within a month from the onset of AD. There namely aneurysms, pseudo aneurysms, aortic dissection and were no symptoms at the onset of SINE in all patients. The interval traumatic injuries of the thoracic aorta. Median age for each group between TEVAR and SINE had a high positive correlation with the that underwent the procedure were 66.8 yrs , 67.8 yrs , 60.9 yrs interval between the onset of AD and TEVAR (Pearson correlation 22.2 yrs respectively. The number of procedures for each group coefficient = 0.817). were 29, 15, 8 and 17 respectively. Twelve patients required an additional debranching procedure. Out off twelve patients seven Conclusions were required carotid-carotid bypass, five carotid–subclavian, While SINE can develop immediately following TEVAR, it can one chimney graft to left subclavian artery and two abdominal be observed even years after TEVAR. Therefore, close follow- viscera bypass . Perioperative mortality was 8.3% (5 patients). One up should be mandatory in patients who underwent TEVAR for patient died due to rupture of the traumatic pseudoaneurysm and the treatment of aortic dissection to avoid catastrophic events four patients died because of comorbidities. Eleventh endoleaks associated with SINE. 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%).

70 Annals of Vascular Diseases 2016 09-06 09-07 Thoracic endovascular aortic repair for Results of Bentall procedure in acute type A Stanford type B aortic dissection with a disease- aortic Dissection - The single center experience specific device YungKun Hsieh1, Dr YingCheng Chen1, Dr ChunMing Huang2, Dr 1 1 Masatoshi Komooka1, Dr Shinichi Higashiue1, Dr Satoshi ChienHui Lee , PhD IngSh Chiu Kuroyanagi1, Dr Onichi Furuya1, Dr Masahide Enomoto1, Dr 1Changhua Christian Hospital, Puyang St., Changhua City, Saburou Kojima1, Dr Naohiro Wakabayashi1 Taiwan, 2MinShen Hospital, Taoyuan city, Taiwan 1Kishiwada Tokusyukai Hospital, Kishiwada, Japan Purpose Background/Introduction Anastomosis above sino-tubular junction is the standard method of In the treatment of Stanford type B aortic dissection TEVAR in proximal anastomosis of ascending aortic grafting (AsAo grafting) addition to best medical treatment is associated with improved 5 in acute type A dissection. However, in some cases, total aortic year aorta specific survival and delayed disease progression as well root replacement, i.e., Bentall procedure, is required due to root as improvement in aortic remodeling. destruction. We retrospectively reviewed the results of Bentall procedure in acute type A DAA in our hospital.

Objective Materials and Methods This study objective was to evaluate the feasibility, safety, and early technical and clinical success rate of a new endovascular device We retrospectively reviewed the patients with type A dissection specially designed for aortic dissection that has been available receiving Bentall procedure from 2011/01 to 2016/09. The results since October 2015 in Japan. are analyzed and compared to patients with ordinary AsAo grafting.

Materials and Methods Results From October 2015 to March 2016, the Zenith Dissection Since 2011/01, there are 20 cases receiving Bentall procedure in Endovascular System (Zenith TXD) was used in 6 nonconsecutive 143 type A dissection (14.0%) in our hospital. We used mechanical patients with Stanford type B aortic dissection (3 complicated valve in all cases. The age is 50.7 ± 16.3 and male are 13 cases cases; 2 bowel ischemia, 1 lower limb ischemia). Indications were (65.0%). 1 case was iatrogenic aortic root injury in coronary artery compression and collapse of the true lumen and abdominal side catheterization. 1 case was traumatic aortic root injury. 4 cases branches and/or symptomatic malperfusion. Patients were studied received pre-op CPR (20.0%). The reasons of Bental procedure for computed tomography imaging, operative complications, and including: intimal tear in Sinus Valsalva 11, intimal tear near or technical aspect of the procedure. 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 Results arch replacement + TEVAR 8. There are 6 cases with CABG and All patients were male with a median age of 63.3 years (range 31- 5 cases with Cabrol modification. ECMO was used in 5 cases. The 82 years) and were managed with conservative therapy at first of survival rate was 75.0% (15/20) and 1 late death. The freedom from admission.The median interval between the clinical presentation of stroke rate was 80.0% (12/15). 1 case received 2nd aortic cross- the aortic dissection and the endovascular procedure was 51 days clamp for bleeding from Cabrol modification and another 1 case (range 16-200 days). In 4 patients, right-to-left subclavian artery received re-sternotomy for hemostasis. There is 1 case requiring bypass was performed before device deployment to obtain adequate hemodialysis and tracheotomy. Compared with ordinary AsAo proximal landing zone. Mean operation time was 135±52 minutes grafting, the Bentall procedure has the slightly inferior survival and mean hospital stay was 22±9 days. No 30-day complication (15/20, 75% vs 104/123, 84.5%, p = 0.29), higher bleeding, stroke including spinal cord ischemia were found and preoperative rate (p = 0.33, 0.34), and significantly higher ECMO usage (5/20, symptomatic malperfusion was abolished. Postoperative imaging 25.0% vs. 12/123, 9.8%, p =0.05) prior to discharge showed that false lumen was thrombosed for the most part and the compressed true lumen enlarged without any Conclusion obstruction of the abdominal side branches. Bentall procedure is not common in type A dissection surgery. But it is required in dissection into sinus Valsalva or coronary artery Conclusions and aortic aortic ecstasia. With careful operation, it does not carry The perioperative and early follow-up results showed that the poorer outcome. But higher ECMO usage rate in Bentall procedure Zenith TXD can be safely used without affecting the patency of in our hospital. the abdominal side branches covered by the bare stent including uncomplicated cases.

Annals of Vascular Diseases 2016 71 Oral Presentation 09-08 to TEVAR is highlighted. The purpose of this study is to retrospectively evaluate our surgical strategy and outcome of these Preservation of the left subclavian artery in kinds of patients. zone 2 TEVAR using a Relay Plus thoracic stent graft with a surgeon-crafted fenestration Methods Yoshihiko Kurimoto1, Dr. Shuhei Miura1, Dr. Kosuke Ujihira1, Dr. Between November 2012 and June 2016, 103 patients with Yutaka Iba1, Dr. Ryushi Maruyama1, Dr. Eiichiro Hatta1, Dr. Akira different aortic arch pathologies underwent primary TEVAR at our Yamada1, Dr. Katsuhiko Nakanishi1 institution, 31 patients required supra-aortic debranching to obtain 1Teine Keijinkai Hospital, Sapporo, Japan adequate proximal endograft fixation.

Background Results The left subclavian artery (LSA) has been surgically reconstructed Four of 31 patients, open aortic arch reoperation had been performed or simply covered in zone 2 TEVAR. We report our clinical during mid-term follow-up. There were 3 females and 1 male, results concerning the use of the Relay Plus thoracic stent graft with the mean age of 70 years old. Three of 4 patients required system (Relay), considered a structurally suitable stent graft for secondary procedures due to stent-related complications. After physicians, to craft a fenestration in order to preserve the LSA in TEVAR complications comprised progressive type Ia endoleaks zone 2 TEAVR. (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 Methods total (N=2) or partial (N=2) arch replacement via median Those believed to be appropriate subjects for zone 2 TEVAR sternotomy. The adjunctive surgical technique included a total treatment were considered for this study. A fenestration was , moderate hypothermia, and circulatory created using a cautery on the back table during TEVAR based on a arrest with the aid of selective antegrade cerebral perfusion (ACP). configuration of the distal aortic arch around the LSA. 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 Results and Teflon strips. Distal anastomosis was completed in usual end- From November 2014 to May 2016, 13 patients underwent zone 2 to-end fashion. There was no operative death in this series. TEVAR using Relay. Etiology consisted of a type B aortic dissection in 9 patients (patent false lumen in 7, ULP in 1, thrombosed false Conclusions lumen in 1), degenerative thoracic aortic aneurysm in 2 and blunt traumatic aortic transection in 2. The mean age was 59.8±18.0 Despite the high-risk nature of the complications, secondary years old and 9 of the patients were male (69.2%). Two patients open aortic arch reconstructions after TEVAR were successfully (15.4%) – 1 from the type B aortic dissection group and 1 from performed. Our proposed technique was expected to make these the traumatic group - required emergency TEVAR. There was no complex operations safe, simple and less invasive. 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 09-10 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%) Nationwide Trends of Diagnosis, Management with a degenerative aortic aneurysm treated by non-fenestrated Strategy and Mortality Among Thoracic Aortic Relay. Disease In South Korea: From 2006-2014 Joon Hyuk Kong1 Conclusion 1Department Of Thoracic And Cardiovascular Surgery, Sejong Relay provided an excellent apposition in zone 2 TEVAR. A General Hospital, Gyeonggi-do, South Korea surgeon-crafted fenestration on Relay allowed for a less invasive preservation of the LSA. Background The Prevalence, management strategy and mortality were not elucidated in nation-wide data in South Korea. 09-09 Open Aortic Arch Surgery Following Thoracic Objective Endovascular Aortic Repair with Debranching The purpose of this study was to investigate temporal trend and management strategy of patients diagnosed with thoracic aortic 1 1 1 Tetsuro Uchida , Dr. Azumi Hamasaki , Dr. Atsushi Yamashita , disease (TAD) in Korea between 2006 and 2014. Dr. Ken Nakamura1, Dr. Jun Hayashi1, Dr. Daisuke Watanabe1, Dr. Shingo Nakai1, Dr. Kimihiro Kobayashi1, Dr. Seigo Gomi1, Prof. Mitsuaki Sadahiro1 Materials and Methods 1Yamagata University Faculty Of Medicine, Yamagata, Japan To 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 Objective O2031, O2032, O2033 for open surgical repair (OSR) and M6611 Thoracic endovascular aortic repair (TEVAR) with supra-aortic for thoracic endovascular treatment (TEVAR). To discern the debranching has been considered as therapeutic options for aortic number of TAD-related deaths in Korea, we searched the number arch disease in high-risk patients. However, with the increase of deaths from the suggested diseases counted by Korean Standard of endovascular cases, open aortic arch reoperation subsequent Classification of Disease.

72 Annals of Vascular Diseases 2016 Results Although the pre-operative statuses of the patients were extremely Between 2006 and 2014, the annual rate of aortic dissection has severe, the operative mortality and morbidity were acceptable. been increased 2.4 times. Those of Thoracic aortic aneurysm Endovascular management of acute thoracic aortic emergencies (TAA) and thoraco-abdominal aortic aneurysm (TAAA) have been was considered to improve surgical results even in high-risk increased 28 and 1.8 times, respectively. Especially, the incidences patients, but length of hospital stay tended to be prolonged in of non-ruptured TAA and TAAA significantly increased, contrary patients experiencing emergency TEVAR. 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, 09-12 proportion of TEVAR in TAD has been increased. (P for trend <0.001). Initial experience with the Najuta fenestrated stent graft for the treatment of arch aneurysm Conclusion requiring Zone 0 landing While annual rates of TAD have been increased from 2006 to 2014, Naoki Toya1, Dr Soichiro Fukushima1, Dr Eisaku Ito1, Dr Yuri the mortality has been steadily decreased but contrary in ruptured Murakami1, Dr Tadashi Akiba1, Dr Takao Ohki2 TAA or TAAA. Adoption of TEVAR for TAD has been increased. 1The Jikei University Kashiwa Hospital, Kashiwashi, Japan, 2The Jikei University School of Medicine, Minatoku, Japan

Introduction 09-11 A major issue in thoracic endovascular aneurysm repair (TEVAR) Surgical results of emergency thoracic of aortic arch aneurysm with a short proximal neck is the necessity endovascular aortic repair in patients with to cover the origin of arch branches to achieve an adequate proximal landing zone. Zone 0 TEVAR using fenestrated stent graft in the acute aortic syndrome aortic arch could achieve a better sealing zone while preserving Yoshinori Kuroda1, MD Tetsuro Uchida1, MD Azumi Hmasaki1, branch flow. MD Atsushi Yamashita1, MD Ken Nakamura1, MD Jun Hayashi1, MD Daisuke Watanabe1, MD Shingo Nakai1, MD Kimihoro Kobayashi1, MD Seigo Gomi1, MD Mitsuaki Sadahiro1 Objective 1Second Department of Surgery, Yamagata University Faculty of Here we present the initial result of zone 0 TEVAR using the Najuta Medicine, Yamagata-shi, Japan stent graft.

Background Materials and Methods Acute thoracic aortic emergencies have been particularly The Najuta thoracic stent graft is a customized fenestrated device challenging for surgeons. Thoracic endovascular aortic repair comprising of a self-expandable stainless-steel Z-stent and an (TEVAR) has been contributed to improved mortality and rapid e-PTFE graft, which was approved for use in Japan in January postoperative recovery even in high-risk patients compared with 2013. . The purpose of this study is to evaluate the clinical results of emergency TEVAR in patients with acute aortic We performed a retrospective review of patients who underwent syndrome. zone 0 TEVAR with the Najuta stent graft at Jikei University Kashiwa Hospital, Chiba, Japan during the last 18 months. Methods Between May 2010 and July 2016, 102 consecutive patients with Results various aortic pathologies involving descending aorta underwent A total of 9 patients underwent zone 0 TEVAR using the Najuta. TEVAR at our institution. Of these, 7 patients required emergency Patients were predominantly male (67 %), with a mean age of 74 TEVAR (3 men and 4 women; mean age, 74.2 ± 7 years). Three years. The mean follow-up period was 7 months. Simultaneously patients had Stanford type B acute or chronic aortic dissections, 2 performed procedures included debranching bypass (n=5; 45%) had atherosclerotic thoracic aortic aneurysms and 2 had traumatic and EVAR (n=1; 11%). In 8 cases (89%), we used additional aortic injuries. Simultaneous supra-aortic debranching was distal stent grafts to achieve secure fixation and a tight seal. One performed in 1 patient. patient (11%) who underwent Zone 0 TEVAR with concomitant endovascular repair for thoracoabdominal aorta and received Results dialysis preoperatively died within 30 days due to non-obstructive mesenteric ischemia. Postoperative stroke occurred in one patient. Emergency TEVAR was completed in all patients without open No type 1a endoleak was identified after procedure on follow-up conversion. The mean operation time was 76 min. Despite CT completion of endovascular therapy, 1 patient died of prolonged shock state due to preoperative rupture of thoracoabdominal aortic aneurysm. Respiratory failure requiring prolonged mechanical Conclusions ventilation was noted in 3 patients. One patient underwent Although adverse events were encountered in 22%, the Najuta may tracheostomy. The mean duration of intensive care unit and be a reasonable treatment option for arch aneurysms that requires postoperative hospital stay were 2 and 34 days, respectively. During Zone 0 landing and warrants further investigation. the mid-term follow-up, relevant complication was not observed.

Conclusions 10-01

Annals of Vascular Diseases 2016 73 Oral Presentation Surgical Outcome of Acute Type A Aortic Results Dissection in Patients Older than 80 Years old. Five of 133 patients required reoperations at long-term follow- up. An aortic root redissection with severe aortic regurgitation Reo Sakakura1, Asai Thru1 was observed in all 5 patients. All of them required surgical re- 1Shiga Medical University, Otsu, Japan intervention of aortic root. Intervals between the initial surgery and Background/Introduction re-intervention were 8, 12, 18, 20 and 108 months, respectively. In Patients with acute aortic dissection are becoming older due to all 5 cases, aortic root dissection was reached around both left and a rising proportion of elderly patients in Japan. We have been right coronary artery orifices. Broad aortic root disruption including performing aggressive emergency surgical treatment even if the both coronary arteries and commissures were characteristic in these patient is old age. patients. Furthermore, at the initial operation, the dissected aortic layers were reinforced by GRF glue in all reoperative cases. There were no operative death. Objectives To evaluate the outcome of surgical repair for acute type A aortic Conclusions dissection in patients aged 80 years or older. The excellent outcome was demonstrated in patients underwent aortic root re-interventions. Late aortic root redissection was Material and Methods considered to be associated with the broad root dissection at initial From January 2002 to December 2015, 238 patients underwent operation and the inappropriate use of GRF glue. 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. 10-03 Results Changes in and Outcomes from Surgical Range of replacement were ascending aorta n=40, hemiarch n=1 Procedures for Acute Type A Aortic Dissection and arch n=2. The hospital death was 6/43 (14.0%) and 20/195 1 1 1 (10.3%) in patients 80 years and older but 79 years or younger, Masafumi Shibata , Dr. Tetsuro Morota , Dr. Takashi Nitta respectively. Cause of death were stroke (n=2), bleeding at 1Nippon Medical School, Bunkyo-ku, Japan operative field(n=1), mediastinitis(n=1), intestinal bleeding(n=1), rupture of descending aorta(n=1). Of the deaths, one patient had Background cardiopulmonary resuscitation and two had stroke before operarion. Total arch replacement has previously been the primary procedure of choice at our department for treatment of acute type A aortic Conclusion dissection; however, from April 2013 onward, this stance was Although the hospital mortality of patients older than 80 years old changed to the use of ascending aortic replacement as a basic was slightly higher than 79 years or younger in operation acute type policy, with additional arch replacement at the arch entry. A aortic dissection, it was acceptable outcome. Objectives To investigate acute surgical outcomes of different treatment 10-02 strategies. Aortic root re-intervention in patients with Material and Methods type A acute aortic dissection The subjects comprised 44 patients who underwent emergency Ken Nakamura1, Dr Tetsuro Uchida1, Dr Azumi Hamasaki1, Dr surgery for type A aortic dissection between April 1 2011 and July Yoshinori Kuroda1, Dr Atsushi Yamashita1, Dr Jun Hayashi1, Dr 2015. We compared the 23 patients who were treated while our Daisuke Watanabe1, Dr Shingo Nakai1, Dr Kimihiro Kobayashi1, primary procedure was total arch replacement (in or before March Dr Seigo Gomi1, Dr Mitsuaki Sadahiro1 2013; early period group) with 21 patients who were treated while 1Yamagata University Faculty Of Medicine, Iidanishi, Japan 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 Objective significant differences. Duration of surgery, heart-lung machine The aortic dissection extending to the aortic root is a common time, amount of blood loss, intensive care ward stay, hospital days finding. In order to prevent late aortic root complications, precise and perioperative complications were retrospectively investigated. recognition of the proximal dissection and appropriate aortic root reconstructive procedure is important. The purpose of this study is Results to evaluate the incidence of reoperations after surgical treatment of type A aortic dissection with proximal involvement. In 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 Patients and 924±567, ICU stay (nights) was 7.7±7.1 and 5.9±2.9, hospital Between July 1997 and October 2015, 133 consecutive patients stay (days) was 36±27 and 24±11 and in-hospital mortalities underwent emergency surgery for acute type A aortic dissection amounted to 5(21.7%) and 2 (9.5%), respectively. Perioperative in our institution. Dissection reaching around the coronary artery complications were cerebral infarction in 2 and 3 cases, long-term orifice was observed in 31 patients. In 12 patients, both left and mechanical ventilation (>72h) in 8 and 5 cases, infection in 4 and 3 right coronary artery orifices were involved with extensive proximal cases and new requirement of blood purification in 6 and 2 cases, aortic dissection. Eighteen patients had dissection extended to right respectively. coronary artery orifice. In 1 patient, left coronary artery orifice was involved with root dissection.

74 Annals of Vascular Diseases 2016 Conclusions 10-05 Ascending aortic replacement, which aims at entry resection, appears to reduce invasion and thus contribute to improved surgical A 7-year History of Endovascular Treatment outcomes in the acute phase. Further follow-up is required to of Mycotic Aortic Aneurysms in a Multi-ethnic investigate long-term prognosis. Asian Population Dexter Yak Seng Chan1, Nicholas Syn2, Andrew MTL Choong1,3, Dharmaraj Rajesh Babu1, Jackie Ho Pei1,4, Peter Ashley Robless1, 10-04 Bernard Boon Kee Wee5, Dr Julian Chi Leung Wong1 Thoracic endovascular aortic repair of acute 1Division of Vascular Surgery, National University Heart Centre, Singapore, 2Yong Loo Lin School of Medicine, National University and subacute type B aortic dissection: Early of Singapore, Singapore, 3School of Medicine, Griffith University, and medium term results Gold Coast, Queensland, Australia, 4Department of Surgery, Yoshihito Irie1, Dr. Shunichi Kondo1, Dr. Yoshiaki Katada1, National University of Singapore, Singapore, 5Department of Dr. Yoshiki Endo1, Dr. Tsuyoshi Fujimiya1, Professor Hitoshi Radiology, National University Hospital, Singapore Yokoyama2 1 2 Iwaki Kyouritsu General Hospital, Iwaki, Japan, Fukushima Background and objective Medical University, Fukushima, Japan We present our single centre series from 2007 – 2016 of endovascularly (with debranching or endovascular adjuncts) Introduction treated mycotic aneurysms in a multi-ethnic Asian population. Recent data suggest that early thoracic endovascular aortic repair (TEVAR) of type B dissection lowers aortic related events and Methods improves long-term survival. A retrospective review of 22 patients with MAP treated endovascularly between 2009 and 2016 was carried out. Patients Objectives were diagnosed based on clinical imaging and/or a positive This study aimed to investigate early and medium term results of blood culture or clinical impression of infection. Patients were our aggressive management by TEVAR for acute (>2 weeks) and assessed for their 30 day mortaliy, median survival and post EVAR subacute (2 to 8 weeks) type B aortic dissection. complications.

Materials and Methods Results From January 2008 to June 2016, 49 consecutive patients Data from 22 patients were retrieved. There were more males underwent TEVAR for management of acute (n=41) and subacute (M:F=9:2). The median age was 71(range 47-84). Majority of the (n=8) type B dissection. Mean age was 65.4 years (min 41, Max patients were Chinese (81%), the others were Malays and Indo- 85) ; 39 cases (80%) were male. The mean follow-up period was Chinese. The commonest symptoms were fever and pain (68% (22 ± 18) months. 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. Results 8 patients had AAA, 11 had TAA and 3 were thoraco-abdominal There were 41 cases performed in acute phase including 31 in location. The 30 day survival rate was 95.45% (95% CI, 71.87 complicated cases of rupture in 4 (9.8%), ulcer like projection – 99.35) and the 1 year survival rate was 70.69% (95% CI, 45.75 – (ULP) expansion in 13 (31.7%), rapid dilatation of aorta in 9 85.74). The median survival is 5.3 years. 6 cases of endoleaks were (22.0%), organ malperfusion in 5 (12.2%). There were 8 cases reported, of which one was a type 1b requiring reintervention. The performed in subacute phase and all of them were complicated cases others were type 2 and resolved spontaneously. On CT follow up, with 3 (37.5%) ULP expansion, 4 (50%) rapid dilatation of aorta, 68% of the MAPs had a size reduction and 18% remained stable. and 1 (12.5%) organ malperfusion. A total of 35 (71%) devices Of the 4 cases that had ongoing sepsis, 2 passed away from an were accessed through external iliac artery and 4 (8.2%) case aorto-esophageal fistula. There was 1 NSTEMI and 2 acute kidney were performed under local anesthesia. There were 2 Zone-1, 14 injuries post EVAR. Zone-2, 30 Zone-3, 1 Zone-4 and 2 previous total arch replacement grafts selected as landing zone. There were no complications occur Conclusions regarding to the procedure and 30 days mortality was 4% (two rupture cases) ; three cases (6.1%) needed additional therapies Endovascular stenting is a feasible and minimally-invasive option included 2 TEVARs and 1 total arch replacement. 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 Conclusion antibiotics requires further investigation. Although 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.

Annals of Vascular Diseases 2016 75 Oral Presentation 10-06 surgery (OS) has an advantage of less reintervention after initial operation compared to endovascular aneurysm repair. Suppression Chronic obstructive pulmonary disease effect of hospitalization costs of OS can provide socioeconomic benefit. on the prevalence and postoperative outcome of abdominal aortic aneurysms: A meta-analysis Objective Jiang Xiong1, Dr. Zhongyin Wu1, Dr. Chen Chen2, Dr. Wei Guo1 To determine the factors to increase the hospitalization costs of OS 1Dpt. Vascular And Endovascular Surgery, The Chinese PLA for AAA. General Hospital, Beijing, China, 2Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Methods Georgia Southern University, Statesboro, USA A total of 607 consecutive patients who underwent OS for intact AAA and survived between 1998 and 2015 at Asahi General Background Hospital in Japan were included in the analysis. Patients’ Epidemiologic evidence suggested chronic obstructive pulmonary characteristics, morphology of aneurysm, operative procedures, disease (COPD) might increase risk for abdominal aortic aneurysm postoperative complications and postoperative courses were (AAA). However, the association between COPD and AAA analyzed in relation to the hospitalization costs. remains inconclusive. Results Objective Mean age was 74.7 ± 7.9 years old, and 517 patients (85.2%) To access the effect of COPD on prevalence and clinical outcome were male, with mean aortic diameter of 57 ± 11mm. Operation of AAA. 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 Methods were 1.4 ± 0.8 and 3.7 ± 1.3, respectively. Embolic complications A systematic literature search in PubMed and Cochrane databases occurred in 33 patients (5.4%), additional bypasses were required was conducted. Studies reporting AAA prevalence and AAA in 18 (3.0%) patients, and redo surgery in 20 patients (3.3%). Five clinical outcomes among COPD patients were identified. Meta- hundred ninety five patients (98.0%) were discharged home. The analysis was performed using the generic inverse variance method. 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 Results operation time ≥ 3.5 hours, estimated blood loss ≥ 400 grams, Forty-eight articles were included for meta-analysis. COPD was additional bypass, redo surgery, postoperative fasting ≥ 5 days, found to be positively associated with AAA, regardless of study length of hospitalization ≥ 8 days and failure to discharge home. design and smoking status. AAA postoperative mortality is higher among COPD patients compared with non-COPD patients (short- Conclusions 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- High-quality operations with short time, less blood loss and term mortality and COPD was not found to be significant in patients fewer complications, combined with enhanced recovery (early underwent endovascular aneurysm repair (mixed OR 2.53; 95% CI mobilization and enteral feeding) can reduce the total hospitalization 0.70-9.18). Rupture AAA may increase the postoperative mortality costs. 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). 10-08 Increased COPD severity may increase the long-term postoperative mortality (medical versus oxygen dependent: [OR 1.26; 95% CI Open and endovascular techniques to overcome 1.07-1.49] versus [OR 2.79; 95% CI 2.24-3.49]). unfavorable iliac anatomy during endovascular aneurysm repair Conclusion Jaepak Yi1, MD, PhD Jin Hyun Joh1 As COPD may increase the risk of AAA, AAA postoperative 1Kyung Hee University Hospital At Gangdong, Seoul, South Korea morbidity and mortality, for COPD patients, vascular specialists should pay more attention on AAA prevention and make low-risk AAA treatment. Introduction Iliac 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. 10-07 Surgical quality and enhanced recovery after Objectives surgery suppresses hospitalization costs of open The purpose of our study is to evaluate types of unfavorable iliac anatomy and its management. repair for abdominal aortic aneurysm Takuro Shirasu1, Dr. Takatoshi Furuya1, Dr. Yukihiro Nomura1, Materials and methods Dr. Nobutaka Tanaka1 From 2009 to February 2016, patients who underwent EVAR were 1Asahi General Hospital, Asahi City, Japan consecutively included in the study. Unfavorable iliac anatomy was defined as iliac artery diameter < 7mm, iliac tortuosity index ≥ 1, Background iliac neck length < 15 mm, and concomitant internal iliac artery Among the treatment of abdominal aortic aneurysm (AAA), open (IIA) aneurysm. Operation results of patients with additional

76 Annals of Vascular Diseases 2016 procedure due to unfavorable iliac anatomy were compared with GA group. There were also 2 cases of postoperative arrhythmia the patients with routine procedure. For statistical analysis, data (no cases in the TLA group). Transfusion was not performed either were analyzed using SPSS 22.0 software (IBM Corp, Chicago, Ill). during or after the operation in all cases. All P values were considered significant if <0.05. Conclusions Results EVAR can thus be performed without any adverse events in high We included 127 iliac arteries in 70 patients with a mean age of risk cases under iliohypogastric nerve block, femoral nerve block 73.5±9.4 years (range, 51-98 years). Iliac tortuosity was the most and local anesthesia by tumescent local anesthesia. 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 10-10 dealt with external iliac to internal iliac bypass in 2 patients, use Association Between MTHFR C677T of custom-made iliac branched device in one patient. Concomitant Polymorphism and Abdominal Aortic IIA aneurysm was overcome with iliac sandwich technique in one patient and hybrid surgery in one patient. The operation time was Aneurysm Risk: A Comprehensive Meta- significantly longer in patients with additional procedure than one Analysis with 10,123 Participants Involved with the routine procedure (347 min vs. 154 min, P<.001) Jie Liu1, Xin Jia1, Senhao Jia1, Wei Guo1 1Department of Vascular and Endovascular Surgery, Chinese PLA Conclusions General Hospital, Beijing, China Unfavorable iliac artery anatomy is not an obstacle for successful EVAR. However, we should consider the longer operation time in Background patients with additional procedure. 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 10-09 were observed and the strength of the association remains unclear. Comparison of local anesthesia and general anesthesia for performing endovascular aortic Objectives aneurysm repair (EVAR) The aim of the study was to investigate the aforementioned association in the overall population and different subgroups. Naoya Matsumoto1, Dr Osanori Sogabe1 1Mitoyo General Hospital, Kanonji, Japan Materials and Methods PUBMED and EMBASE databases were searched until March Background 2016 to identify eligible studies, restricted in humans and articles There are some reports of comparisons between general anesthesia published in English. Summary odds ratios (ORs) and 95% and local anesthesia for endovascular aortic aneurysm repair confidence intervals (CIs) were used to evaluate the susceptibility (EVAR). These reports showed that cardiac events, pulmonary to AAA. Subgroup meta-analyses were conducted on features of morbidity and the length of stay are occur less frequently when the population such as ethnicity, sex of participants, study design using local anesthesia than when using general anesthesia for (source of control), and so on. EVAR. Results Objectives A total of 12 case-control studies on MTHFR C677T polymorphism We currently perform EVAR under iliohypogastric nerve block, and AAA risk, including 3,555 cases and 6,568 case-free controls femoral nerve block and local anesthesia using tumescent were identified. The results revealed no significant association local anesthesia (TLA) with intravenous anesthesia with either between the MTHFR C677T polymorphism and AAA risk in the dexmedetomidine or propofol. In this study, we compared the overall population and within Caucasian or Asian subpopulations use of iliohypogastric nerve block, femoral nerve block and local in all five genetic models. Following further subgroup meta- anesthesia by TLA with intravenous anesthesia (TLA group) and analysis, significantly increased risks were observed among cases general anesthesia (GA group) for EVAR. 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, Materials and Methods 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 Twenty-three successive cases of EVAR were compared (TLA the dominant genetic model. No publication bias was found in the group: 9 cases, GA group: 14 cases) regarding age, gender, present study. 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. Conclusions Our comprehensive meta-analysis suggests that the MTHFR C677T Results polymorphism may play an important role in AAA susceptibility, especially in younger, non-smoking, and larger-AAA-diameter The usage rate of vasopressors was significantly higher in the GA subgroups. 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

Annals of Vascular Diseases 2016 77 Oral Presentation 10-11 Methods We retrospectively reviewed database of patients who had suffered Comparison of percutaneous access versus from EPD after OSR of AAA during the period between January open femoral exposure for endovascular aortic 2011 and May 2016. EPD was defined as loose form bowel aneurysm repair in single center movements > 3 times a day during early (< 2 weeks) postoperative period. To identify causes of EPD, we investigated past history of JungSik Choi1, MD Keunmyoung Park1, MD Yong Sun Jeon2, MD 2 1 colonic disease of the patients and performed Clostridium difficile Soon Gu Cho , MD Kee Chun Hong (CD) toxin assay/culture and/or colonoscopic examination. 1Department of Surgery, Inha.university Hospital, JungGu, South Korea, 2Department of Radiology, Inha.university Hospital, JungGu, South Korea Results Among 262 OSRs of AAA (213 infrarenal, 33 juxtarenal, 16 suprarenal AAAs; 229 elective and 33 emergent OSRs), 57 Introduction (21.8%) patients developed EPD. The frequencies of EPD was not Due to the utility of vascular closure devices, their use has been different between elective and emergent OSR (22.3% vs 18.2%, adapted to common femoral artery closure as percutaneous p=.595). EPD developed at mean 5.16±1.96 days after surgery. We endovascular aortic aneurysm repair (PEVAR). We evaluate the performed CD test in patients with EPD persist for 2 days or longer effectiveness and safety of PEVAR on comparison of standard and colonoscopic examinations for patients showing left abdominal femoral exposure (SEVAR) because there were no data that PEVAR pain or tenderness, leukocytosis and/or metabolic acidosis. Among compare with SEVAR in Korea. 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 Method and patients examinations, eight (32.0%) patients showed positive on CD test We reviewed 68 patients that underwent EVAR between January and three (23.1%) patients showed left colon ischemia including 2012 and July 2015. During this period, 32 patients were performed 2 mucosal and 1 mural types. During the study period, two more by percutaneous femoral artery access and closure and 36 patients patients were identified as colon gangrene without performing were performed by open femoral exposure. PEVAR procedure colonoscopic examination. were performed the 8F Perclose Proglide closure device. We compared procedural technical success, characteristics, clinical result and vascular complication between PEVAR and EVAR Conclusion groups. Procedural time, blood laboratory analyses and hospital EPD was not uncommon after OSR of AAA. Among patients with stay time were also evaluated. EPD, 14% of EPD was caused by CD–related diarrhea and 5.3% of EPD was associated with left colon ischemia. Result There 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). 11-02 There were three complications in PEVAR group (Bleeding [n=1], Comparable Mid-term results of Elective Dissection [n=2]) although there were 3 complications in SEVAR group (Lymphorrhea [n=1], Hematoma [n=2]). There was 1 open Endovascular and Open Aortic Aneurysm conversion in PEVAR group due to retroperitoneal bleeding. But, Repair in Young Patients postoperative pain score of PEVAR was less than that of SEVAR Yang-Jin Park1, KW Yoon1, SH Heo1, SY Woo1, JG Kim1, DI (4.5 vs 6.4 p<0.03). There were no difference in ICU stay and Kim1, YW Kim1 hospital stay. 1Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea, Seoul, South Korea Conclusion PEVAR is relatively safe and effective comparing standard Objectives open femoral exposure with less pain. But, for success without To compare the mid-term outcomes and re-intervention rates vascular complication careful patients selection and sufficient following elective open (OAR) and endovascular (EVAR) repair comprehension of procedure is important. of infrarenal aortic aneurysms in patients aged 65 years or younger.

Methods 11-01 A retrospective review of a prospectively collected vascular surgery database was performed to identify all patients aged 65 years or Clinical significance of early postoperative younger at the time of repair who underwent elective repair of an diarrhea after open surgical repair of abdominal abdominal aortic aneurysm (AAA) between September 2003 and aortic aneurysm June 2016. Kyoung Won Yoon1, Seon-Hee Heo1, Yang-Jin Park1, Dong-Ik Kim1, Young-Wook Kim1 Results 1Samsung Medical Center, Sungkyunkwan university, Seoul, South The study cohort comprised 173 patients 65 years of age or Korea 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) Purpose had died at a median follow-up of 40.8 months (interquartile range, To determine frequency of early postoperative diarrhea (EPD) after 30.1–85 months) and no aneurysm-related deaths or late aneurysm open surgical repair (OSR) of abdominal aortic aneurysm (AAA) ruptures were observed. There was no significant difference of and its clinical significance.

78 Annals of Vascular Diseases 2016 long-term survival (10 years, 81.4% OAR, 97% EVAR, P=0.559), 11-04 but re-intervention rates (0.9% OAR, 8.5% EVAR, P=0.018) had significant differences. The most common cause of long-term Endovascular repair of abdominal aortic mortality was malignancy and comorbidities. Re-interventions aneurysm with severely angulated proximal in OAR were exclusively laparotomy-related (adhesive ileus), whereas all re-interventions in EVAR were aneurysm-or graft- neck: Comparison between Excluder vs Aorfix related. stent graft Eisaku Ito1, MD and PhD Naoki Toya1, MD Soichiro Fukushima1, 1 1 Conclusions MD Yuri Murakami , MD and PhD Tadashi Akiba , MD and PhD Takao Ohki2 After elective aneurysm repair, EVAR offered comparable 1 2 durability and long-term survival compared to OAR in young Jikei University Kashiwa Hospital, Kashiwa-shi, Japan, Jikei patients and improving results with EVAR over time may increase University Hospital, Minato-ku, Japan the role of EVAR in these patients group as long as aneurysm anatomy is adhere to. Introduction Anatomical characteristics of an infrarenal abdominal aortic aneurysm (AAA) are important factors to consider in planning an endovascular abdominal aneurysm repair (EVAR). Notably, 11-03 severe proximal aortic neck angulation increases the risk of type Is conventional open repair for abdominal I endoleaks. aortic aneurysm feasible in nonagenarians? Objectives Kyokun Uehara1, Dr Kenji Minatoya1, Dr Jiro Matsuo1, Dr Teppei Toya1, Dr Yosuke Inoue1, Dr Atsushi Omura1, Dr Yoshimasa Seike1, To evaluate the safety and early outcomes of various grafts in Dr Hiroaki Sasaki1, Dr Junjiro Kobayashi1 patients with AAA with severely angulated neck (> 90°). 1National Cerebral And Cardiovascular Center, Suita, Japan Materials and Methods Objectives This was a retrospective non-randomized observational study. Between July 2011 and June 2016, 296 patients underwent EVAR Although endovascular repair for abdominal aortic aneurysm has for AAA at our hospital. Thirty six (12%) had AAA with severely been considered beneficial procedure for very elderly patients, the angulated neck. Mean age and mean neck angle of these 36 results of open repair for nonagenarians are unclear. The purpose patients were 79 and 103°, respectively. Mean follow-up period of this study was to compare the early and mid-term outcomes of was 16 months. open repair and endovascular repair for abdominal aortic aneurysm in the nonagenarian patients. Results Methods The Excluder™ graft was used in 28 cases and the Aorfix™ graft in 8. No aneurysm-related ruptures or deaths occurred. Two endograft This study included 14 and 24 nonagenarians patients (mean occlusions were observed. Snorkel EVAR was performed in 4 age 92.2±1.9 years) who underwent open surgical repair and patients. At 1 month, type Ia endoleak was observed in six cases endovascular repair for abdominal aortic aneurysm, respectively, (21.4%) with Excluder™ grafts and none with Aorfix™ grafts. from 2005 to 2015. Of those, 5 and 4 patients with ruptured or Aneurysm sac size decreased in five cases (17.8%) with Excluder™ impending ruptured aneurysm required emergency surgeries grafts and in three (37.5%) with Aorfix™ grafts. (35.7% vs 16.7% , P=0.11).

Conclusions Results The results of this study supports EVAR for the treatment of AAAs There was no significant difference in early mortality between with severely angulated neck. Although the number of cases was the open and endovascular groups (0 vs 4.1%, P = 0.16). Early small, the Aorfix™ graft appeared to be the best graft for such morbidity was equivalent in both groups (P=0.11), but hospital cases. 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 11-05 reintervention at 1 year were 88.9 % in the open group and 95.2% in the endovascular group (P =0.91). Outcomes of elective endovascular aortic aneurysm repair: A case series in Asian Conclusions octogenarians 1 1 Although endovascular repair was superior in recovery after the Mabel Shu Fen Yip , Dr Joseph, Zhiwen Lo , Dr Sadhana Chandrasekar1, Adjunct Assistant Professor Sriram Narayanan, procedure, the results of conventional open repair were acceptable 1 even in nonagenarian patients. Open repair for abdominal aortic Adjunct Assistant Professor Glenn, Wei Leong Tan aneurysm would remain a good option even in emergency cases for 1Tan Tock Seng Hospital, Singapore, Singapore very elderly patients. 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

Annals of Vascular Diseases 2016 79 Oral Presentation elderly patients due to its association with lower morbidity and Results mortality compared to open aortic repair. From the study population, 10 patients were male (71%), with the average age of study population at 62 years-old. 10 patients Objective (71%) had decreased immunity from illnesses such as HIV (21%), steroid use (14%) and type 2 diabetes mellitus (T2DM) To evaluate the outcomes of elective endovascular repair of aortic (36%). 64% (9/14) of the patients had positive blood cultures, of aneurysms in Asian octogenarians in our centre. which 67% (6/9) grew Salmonella Enteritidis. On average, patients received 19 days of pre-operative antibiotics prior to stenting. Methods All patients received post-op life-long antibiotics therapy. Retrospective review of medical records was performed on Prior to surgery, 8 patients (57%) had raised white cell count octogenarians who underwent elective endovascular aneurysm (>10x10^9/L). 7 patients (50%) had low haemoglobin (<10g/dL) repair (EVAR) or thoracic endovascular aneurysm repair (TEVAR) while 13 patients (93%) had raised C-reactive protein (>5mg/L). between May 2008 to December 2015 in Tan Tock Seng Hospital All patients had low albumin prior to surgery (<35g/L). 2 (TTSH). Factors evaluated include population demographics, pre- patients (14%) had thoracic aneurysm and 11 patients (79%) operative risks and functional status. Outcomes of endovascular had infra-renal aneurysm. 1 patient (7%) had both thoracic intervention such as complication rates, length of hospital stay, 30- and abdominal aneurysm. The average size of the aneurysms was day re-admission rates and mortality were also analysed. Survival 3.8cm (range 1.1–6.8). 3 patients (21%) presented with a ruptured probability was illustrated using the Kaplan-Meier curve. 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 Results average length of hospital stay was 29 days. 1 patient suffered from Out of 271 endovascular aortic aneurysm repairs identified, 172 aneurysm-related mortality (aorto-oesophageal fistula). were elective cases and 45 were performed on octogenarians. The mean age was 84.3yrs (80-91yrs). Common comorbidities include Conclusion hypertension (83.3%, n=35), hyperlipidaemia (78.6%, n=33), ischaemic heart disease (33.3%, n=14), stroke (26.2%, n=11) and Endovascular stent grafting is a feasible and invaluable diabetes mellitus (21.4%, n=9). The average size of AAA and TAA tool in the management of mycotic aortic aneurysms. However, was 6.1cm (3.8- 9.3cm) and 7.5cm (6.1- 9.8cm) respectively. There this does not address the issue of sepsis hence pre-operative were 38 (84.4%) EVARs and 5 (11.1%) TEVARs. There was 100% antibiotics treatment and life-long antibiotics therapy is technical success. Main post-operative complications include imperative. There are satisfactory outcomes in this limited series nosocomial infections (28.9%, n=12), myocardial infarction (6.7%, and further follow-up is required to evaluate long term outcomes n=3) and wound infection (4.4%, n=2). There were 5 (11.1%) of the procedure. 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. 11-07 The early mid-term results of EVAR in patients Conclusion with proximal hostile neck This study supports that in carefully selected patients, elective Yasutoshi Tsuda1, Dr. Takahito Yokoyama, Dr. Hiroo Kinami, EVAR in octogenarians is associated with low mortality and Dr. Yujirou Kawai, Dr. Hirokazu Niitsu, Dr. Gentaku Hama, Dr. morbidity and a 3-year survival rate of 55%. Yasuyuki Toyoda, Dr. Kazuaki Shiratori, Dr. Takahiro Takemura 1Saku Central Hospital Advanced Care Center, Saku-city, Japan

11-06 Background Endo-vascular aortic repair (EVAR) must be performed even for Outcomes of EVAR repairs in a series of 14 patients with a hostile neck(HN) by increasing numbers of elderly mycotic aortic aneurysms and high-risk patients. Dr Wee Ming Tay, Dr Jospeh Zhi Wen Lo, Adjunct Assistant Professor Glenn Wei Leong Tan, Adjunct Assistant Professor Objective Sriram Narayanan, Senior Consultant Sadhana Chandrasekar, Wei- En Wong To evaluate the early and mid-term results of EVAR in patients with HN primarily in terms of type Ia endoleaks (EL) 1Tan Tock Seng Hospital, Singapore, Singapore

Subjects Aim 289 patients underwent EVAR for abdominal aortic aneurysms To evaluate characteristics and outcomes of patients with mycotic (AAA ) between May 2009 and April 2016, we selected 69 patients aortic aneurysms who underwent endovascular aortic repair with HN .((HN was defined as AAA with proximal neck length ≤15 (EVAR). mm, proximal neck diameter ≥29 mm, or angulated neck (degree of neck angulation ≥60° or degree of infrarenal angulation ≥45°)). Methodology Retrospective study of 14 patients who underwent EVAR for Results aortic mycotic aneurysms between January 2008 and August 2015. Short 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

80 Annals of Vascular Diseases 2016 procedures (proximal cuff insertion for 17 patients, the chimney Conclusion technique for 1 patients, and repeated only balloon molding The study showed differences in overall mortality of octogenarian for 2 patients); in final intraoperative imaging, type Ia EL had Abdominal Aortic Aneurysm patients, but no different in aneurysm disappeared in 13 , had markedly decreased in 2 , and remained in related dead between operated and non- operated group. That mean 2 patients, while confirmation could not be obtained in 1 patients. patient might had morbidity and mortality by their underlying Reintervention for type Ia EL was performed for three patients with condition than by AAA. From our study may conclude that AAA a highly angulated neck, but none of them with a short neck or operative intervention in octogenarian might be less benefit to enlarged neck. No patient with type Ia EL in final intraoperative patient overall survival. 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. 11-09 Carbon dioxide angiography as an adjunct for Conclusion endovascular aortic aneurysm repair; how does Early outcomes in EVAR for AAA with HN were relatively it compare to traditional contrast? favorable. However, in the long term, morphological changes in Kalpa Perera1, Mr. Kishore Sieunarine1 aneurysms are considered to recurrence of type I EL, therefore 1 requiring careful selection of patients and follow-up. Royal Perth Hospital, Perth, Australia

Background/Introduction Renal impairment can be a significant impediment to endovascular 11-08 aortic aneurysm repair (EVAR). Carbon dioxide (CO2) is a non- Survival of octogenarian Abdominal Aortic nephrotoxic agent that has been suggested as an alternative. Aneurysm patients in Chiang Mai University Hospital Objectives 1 1 We describe our series using CO2 for effective aortic stent-graft Saranat Orrapin , Professor Kamphol Laohapensang , Professor deployment using a historical control for comparison. Kittipan Rerkasem1, Supapong Arworn1, Termpong Reanpang1 1Chiang Mai University, Chiang Mai, Thailand Materials and Methods We performed a retrospective analysis of all EVARs using CO2 Background contrast in our institution over the past 12 months. We compared Management of Abdominal aortic aneurysm (AAA) operation in a historical control using standard iodinated contrast EVARs over octogenarian has high mortality and morbidity due to underlying the preceding 12 months. Both standard and fenestrated EVARs diseases and co-morbidities and they themselves might had severe (FEVAR) were included. Screening time, radiation dose, CO2 underlying disease that cause dead at anytime. An octogenarian and iodinated contrast volume, and pre and post-operative renal AAA in our institute is 14.9%. In this study, we compared patient’s function was assessed. Data was collected using the Western survival between the operated group and non-operated group. Australian Electronic Bookings System (EBS) database, patient files and documented radiography notes. Research methodology This study is a retrospective review study of octogenarian Results Abdominal Aortic Aneurysm patients in our institution between Eighteen patients (11 EVAR, 7 FEVAR) had CO2 angiography January 2006 and December 2015. All patients whose age over and twelve (10 EVAR, 2 FEVAR) were performed with iodinated 80 year old with surgical indicated AAA were included. Ruptured contrast only. All grafts were deployed successfully, with no AAA patients were excluded. leak evident on the final run. Five cases (all EVAR) utilised CO2 angiography only, without iodinated contrast. Mean screening Result time and radiation dose were lower in the CO2 compared to the contrast EVAR population (1375.7 sec & 182.4 Gy/cm2 vs. 1486 & 148 patients were enrolled to this study, 73 patient was operated 220.8), but markedly higher in the FEVAR cases (6448.1 & 751.1 by both open surgical repair (OSR) and endovascular aneurysm vs. 4718.5 & 435). At two days post-op, renal function (Cr) was repair (EVAR) and 78 remain was refuse for operative treatment. preserved at baseline for EVAR CO2 cases, compared to a mean There was no difference in demographic study between two groups 17.0% increase in iodinated contrast procedures (p=0.78). Mean except underlying disease of cancer was significant higher in non- pre-operative creatinine was higher in the contrast cohort (99.67 operated group. Overall mortality of operated group was significant µmol/L vs. 90.29; p=0.163). 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 Conclusion no significant different in aneurysm related dead ( 30 mortality Using CO2 angiography results in better renal function in EVAR in operated group vs Ruptured AAA in non-operated group , p cases. Yet, no prospective randomised trial exists to provide high = 0.792) Subgroup analysis of operated group shown that there quality evidence for this benefit. Based on our initial study, we were no significant different in morbidity and mortality outcome have designed a prospective randomised trial comparing CO2 to between EVAR and OSR. iodinated contrast in endovascular aortic stent-grafts.

Annals of Vascular Diseases 2016 81 Oral Presentation 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

Background Ruptured 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.

Methods We 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.

Results Group 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 typeⅡ endoleak and two of them required the additional treatment of coil embolization.

Conclusions Considering 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.

82 Annals of Vascular Diseases 2016 Prize Oral Presentation

PO-01 PO-02 Hybrid aortic arch repairs: a 9-year single- Anatomical endovascular aortic arch repair institutional experience of 150 patients. with custom-made fenestrated endograft and Kiyofumi Morishita, Dr Masami Shingaki, Dr Tuyoshi Shibata, branch grafts via neck vessels Dr Kouhei Narayama, Dr Toshio Baba, Dr Tohru Mawatari Masaki Saso1, Dr Takashi AzumaDr1, Dr Junko Katagiri1, 1 1 1 1Hakodate Municipal Hospital, Hakodate, Japan Dr Kei Kobayashi , Dr Masashi Hattori , Dr Yoshihiko Yokoi , Dr Hideyuki Tomioka1, Dr Shigeyuki Aomi1, Dr Kenji Yamazaki1 1Tokyo Women’s Medical University, Tokyo, Japan Objectives Despite the evolution of technology, aortic arch aneurysm repairs remain challenging in high-surgical-risk patients. Recently, hybrid Objectives arch repair has emerged as a potentially less invasive treatment. Thoracic endovascular repair (TEVAR) is increasingly applied The aim of this study was to analyze our results of hybrid aortic for thoracic aortic aneurysm. In most cases of arch aneurysm, arch repairs. precurved fenestrated endograft provides adequate sealing zone. But There are some extended aneurys cases more suitable for branched graft. Methods From June 2007 to March 2016, 150 patients underwent hybrid arch repairs. Indications included degenerative aneurysm (119 Otherwise there are no available manufactured branched graft patients), dissection (21), and stent-graft failure (5). Thirteen for Aortic aneurysm in our country. Therefore we used to use the patients underwent emergency repairs due to rupture. fenestrated Najuta endograft and some debranching technique in cases of aortic aneurysm extended zone 2.

The techniques of incorporating arch vessels into the repair have evolved over time. Initially, we created oval or scallope-shaped Methods fenestrations in hand-made endografts (n=20). Subsequently, We used the precurved fenestrated Najuta endograft. The custom- debranching and revascularization was performed using made fenestrations are about the same size as the orifices of neck commercially available endografts (n=110). Recently, we have vessels and can be modified as ring ports for branches as needed. used surgeon-modified fenestration combined with debranching in The ring port was made of a long platinum coil sutured cylindrically 40% of candidates for hybrid aortic arch repairs (n=20). JapanScore around the fenestration. For branches, we used the Aorfix AAA (mortality predicted from the Japanese database) was 16%±17%. Stent Graft Plug-in Leg, which has a ring stent structure and connects well with the ring port. Results The 30-day mortality was 1.3% (2/150 patients). Persistent Results neurologic deficits occurred in 3 patients and spinal cord injury in We underwent this technique for ten cases of arch aneurysms since 4. 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. Three patients experienced bypass graft occlusion without neurologic complications. Respiratory complications occurred in 6 patients. Aortic dissection was observed in 3 patients. Type Ia The technical success rate was 100%. There was no endoleak seen endoleak occurred in 55%(11/20) of patients with fenestrated hand- on Postoperative computed tomography in this series. Perioperative made devices, 20%(22/110) of patients undergoing debranching, cerebral infarction occurred in 1case. and zero of patients undergoing surgeon-modified fenestration combined with debranching (p≤0.01). Fifteen patients required Conclusions re-TEVAR because of progressive dilatation (11 patients), stent failure (2), another lesion (1), and rupture (1). A 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 Ten aneurysm-related deaths occurred during follow-up period. procedure has moderate potential risk of a cerebrovascular accident. 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. PO-03 Conclusions Comparing the outcomes using propensity score Hybrid arch repairs can successfully reduce postoperative mortality in high-surgical-risk patients. However, these procedures matching analysis in carotid endarterectomy are associated with late aneurysm-related complication rates. The versus carotid artery stenting: Single-center evolving technology of preserving cerebral circulation has led to a data decrease in incidence of type Ia endoleak. Kyoung Won Yoon1, Shin-Young Woo1, Yangjin Park1, Young- Wook Kim1, Dong-Ik Kim1 1Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea

Background Despite of many reports, there continues to be debate in efficacy between carotid endarterectomy (CEA) and (CAS).

Annals of Vascular Diseases 2016 83 Prize Oral Presentation

One of the major advantages of propensity score matching (PSM) Method methods is making possible observational studies to be designed 54 non healing wounds were treated with fish skin grafts* for a similar to randomized controlled trials (RCTs). In this study, we period of four weeks and 2 applications on average. Improvement used PSM as statistical technique to balance the covariates and is defined as >20% reduction of wound area. Data was extracted mimic randomization. from the patient records database at the Landspitali University Hospital in Reykjavik, Iceland. Study was approved by the National Objectives Bioethics Committee of Iceland (VSN-15-137). To compare early outcomes of CEA and CAS procedure for carotid artery stenosis revascularization with single-center data and PSM Results methods. Venous, arterial or mixed venous/arterial ulcers: 7 (20,6%) healed, 24 (70,6%) improved and 4 (11,8%) did not respond. Surgical and Materials and Methods trauma wounds: 5 (41,7%) healed, 5 (41,7%) improved, and 2 (16,7%) did not respond. Diabetic foot ulcers: 4 (50%%) healed, From January 2002 to December 2015, 1403 cases of CEA (n=793) 3 (37,5%) improved and 1 (12,5%) did not respond. Additionally or CAS (n=610) with embolic protection device were performed treatment with the fish skin graft* showed a 38% reduction in in our institute. Primary endpoint was defined as any clinical antibiotics at the end of the trial. Antibiotics therapy was not a stroke, transient ischemic attack, myocardial infarction and death predetermined endpoint since this was a retrospective study. within postoperative 30 days. Secondary endpoint was defined as restenosis rates after postoperative 30 days. Conclusion Results This study shows that treatment with fish skin grafts* is effective on a range of different types of non healing wounds. The fish skin 197 pairs of asymptomatic (n=394) and 152 pairs of symptomatic graft* also reduces the need for antibiotics, potentially due to its cases (n=304) able to match between CEA and CAS procedure. In omega-3 content. PSM cohort, CAS was associated with a higher risk for the all of the items of primary endpoints in both asymptomatic group (odds *Kerecis™ Omega3 by Kerecis 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. PO-06 Suggestion of Treatment Strategy Based on Conclusions its Natural Course for Patients with Isolated In this study with propensity score matching analysis, CEA showed better 30 days outcome than CAS for revascularization of carotid Spontaneous Abdominal Aortic Dissection artery stenosis. (ISAAD) Jihee Kang1, Young-Wook Kim, Seon-Hee Heo 1Samsung Medical Center, Seoul, South Korea PO-04 Background/introduction Acellular Fish Skin Graft for Surgical, Trauma, Isolated abdominal AD is rare and has not been well known in its Venous, Arterial and Diabetic Wounds: A etiology, natural course, or an optimal management. Retrospective Clinical Study John Lantis, Dr Baldur T. Baldursson1,2, Skuli Magnusson1, Dr Objectives Hilmar Kjartansson1,2, G. Fertram Sigurjonsson1 To establish indications for treatment by reviewing the clinical 1Kerecis, Reykjavik, Iceland, 2Landspitali University Hospital of features and natural course of isolated spontaneous abdominal Iceland, Reykjavik, Iceland aortic dissection (ISAAD).

Introduction Materials and Methods Acellular Fish skin* grafts that contain natural antibacterial A retrospective review of ISAAD patients from a single institution. and anti-inflammatory omega-3 polyunsaturated fatty acids are Patient searching from interpretation reports of abdominal or fundamentally different from other advanced tissue based products thoraco-abdominal CTs from 2003 to 2015 with key words of from mammalian sources. Mammalian products carry the risk “aortic dissection” or “dissection AND aorta”. ISAAD defined as of disease transmission to humans that is nonexistent from the a spontaneous aortic dissection confined to the abdominal aorta Atlantic cod (Gadus morhua) to humans. Mammalian tissues are regardless of its extension to the iliac or visceral branches. ADs subjected to viral inactivation methods involving detergents that involving thoracic aorta, or by traumatic or iatrogenic causes remove lipids from the tissues and denature the native structure excluded. Demographic and clinical features, coexisting diseases, leaving behind only insoluble collagens. A randomized double aorta-related events and morphologic changes were investigated. blind clinical trial demonstrated significantly faster wound healing with fish skin* compared to a mammalian matrix product.

Objectives Evaluate the clinical efficacy of a fish skin graft* on non healing surgical-, trauma-, venous- and arterial wounds.

84 Annals of Vascular Diseases 2016 Results During 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.

Conclusions Progression 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.

Annals of Vascular Diseases 2016 85 Prize Poster Presentation

Introduction P01 Gastric or pancreaticoduodenal artery aneurysms are associated Gene therapy using hepatocyte growth factor with median arcuate ligament syndrome (MALS) because plasmid DNA ameliorates lymphedema hemodynamic change plays an important role in their development. However the necessity of the revascularization of the celiac artery via promotion of lymphangiogenesis and remains unclear. lymphatic-vessels remodeling. 1 Yukihiro Saito Method 1 Div. of Vascular Surgery, Asahikawa Medical University, We reviewed a case of right gastric artery (RGA) aneurysm with Asahikawa, Japan MALS.

Background and Objectives Result Lymphedema is an intractable disease caused by anatomic or This is a case report of a 51-year old man who presented with functional obstruction of the lymphatic system. There is no cure a sudden epigastric pain. Contrast-enhanced abdominal CT for lymphedema at this time. The goal of the present study was demonstrated a ruptured RGA aneurysm in moderately dilated to investigate the novel gene therapy for lymphedema using RGA. Replaced common hepatic artery branched from superior hepatocyte growth factor (HGF) plasmid DNA. mesenteric artery (SMA) and lead to RGA. In addition, the celiac axis was severely stenosed, and dorsal pancreatic artery Methods communicated from SMA to splenic artery. We diagnosed that MALS caused RGA aneurysm. We performed laparotomy, resected Human lymphatic endothelial cells (LECs) were treated with the aneurysm and transected the median arcuate ligament. In the several dose of HGF protein (0-100 ng/ml) or transfected with intraoperative aortogram, we confirmed the revascularization of HGF plasmid, and examined MTS assay, Boyden chamber method, the celiac artery. As a result, blood flowed from the celiac artery Western blot, immunoassays, and qPCR. All animal protocols were to the splenic artery and the dorsal pancreatic artery narrowed. He approved by the Animal Ethics Committee of Asahikawa Medical was discharged on postoperative day 9 without any sign of organ University. Lymphedema was induced by dissection of lymphatic ischemia. The follow-up CT at 6 month after surgery showed; tissue at tail or forelimb in SD rat. Lymphatic flow was observed enlarged diameter of the celiac artery, narrowed SMA and dorsal directly with a fluorescent lymphography system in vivo. pancreatic artery. This suggests that the transection of the median arcuate ligament decreases the shear stress on the dorsal pancreatic Results artery and prevents the formation of an aneurysm in the collateral vessels. There was no other de-novo aneurysm. 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 Conclusion after HGF is added to LECs. Furthermore, weekly HGF gene While there is a discussion on the necessity of the celiac artery transfer into rats with lymphedema results in amelioration of the revascularization, the present case supports the hemodynamic lymphedema by tail thickness or forelimb volume, and expression benefit of the MALS transection. 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- P03 injected) site, and these vessels were connected with the existing Late surgical open conversion for endoleaks lymphatic vessels. HGF plasmid significantly ameliorated the lymphedema via lymphangiogenesis and lymphatic-vessels after endovascular abdominal aortic aneurysm remodeling in the rats. repair Yusuke Takei1, Takayuki Hori Hori1, Toshiyuki Kuwata1, Yasuyuki Conclusions Kanno1, Yuta Kanazawa1, Hironaga Ogawa1, Koji Ogata, Ikuko Shibasaki1, Hirotsugu Fukuda1 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 1Dokkyo Medical University, Mibu, Shimotugagun, Japan of benefit to patients with lymphedema, and hope to overcome the lymphedema. Background Endovascular 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 P02 conversion is Endoleak (EL). Morbidity and mortality rates with Hemodynamic benefit of the release of the that can be high. We review our experience with emphasis on the surgical management and clinical course. celiac artery in ruptured right gastric artery aneurysm associated with the median acurate Objective ligament syndrome To evaluate operative methods of late open surgical conversion for Tetsuro Toriumi1, Dr Yuichi Ohashi2, Dr Atushi Akai2, Dr Takuro EL following EVAR. Shirasu1, Dr Takatoshi Furuya1, Dr Yukihiro Nomura1, Dr Nobutaka Tanaka1 Methods 1Asahi General Hospital, Asahishi, Japan, 2The University of Tokyo, Bunkyoku, Japan Between Jun 2008 and May 2016, 339 EVARs were performed. 13 patients required late open surgical conversion because of sac

86 Annals of Vascular Diseases 2016 expansion due to EL. Our operative methods are preparing for P05 endovascular surgery: transperitoneal approach, femoral cut down for wire access or endovascular occlusion balloon (EOB) prior to Clinical Outcomes of Endovenous Laser open the sac. Ablation for the Treatment of Varicose Veins Atsushi Tabuchi1, Dr. Hisao Masaki1, Dr. Yasuhiro Yunoki1, Results Dr. Yoshiko Watababe1, Dr. Kazuo Tanemoto1 Data was reviewed for 13 patients with a mean age of 79±8 years 1Kawasaki Medical School, Kurashiki, Japan old .The median interval from the initial implantation was 3.8 years. Three patients were presented with type Ⅰa EL, 8 patients were type Ⅱ EL and 2 patients were type Ⅲb EL. Four patients required Background and Objectives an endovascular procedure：three for EOB and one for EVAR. In We evaluated the surgical outcomes, improvements in subjective Type Ⅰa EL, a stent graft was partially explanted in one patient and objective symptoms of varicose veins, and changes in venous and proximal neck banding was performed on 2 patients. A stent function after endovenous laser ablation (EVLA) using a 980-nm graft was preservation in all cases of typeⅡand type Ⅲ EL. The 30- diode laser. day mortality rate was 7.6%. There was no aneurysm–related death during median follow up period of 21months. Methods Between October 2011 and September 2015, 704 limbs (525 Conclusion patients) were treated for incompetent saphenous veins at our Our operative methods of late open conversion are of safety and institution. We studied the operative complications, venous clinical efficacy. 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 P04 postoperatively. Technical tip to overcome a tortuous aortic arch during TEVAR using a snare Results Hyung Sub Park1, Dr. Yoon Hyun Lee1, Dr. Dae Hwan Kim1, Prof. Twenty-four months after surgery, the technical success rate Taeseung Lee1 (cumulative occlusion rate) was 99.2%. Although EHIT occurred 1Seoul National University Bundang Hospital, Seongnam, South in 8.3% of limbs, class 3 EHIT occurred in only 0.9%. Severe Korea 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 Challenging aortic arch anatomy during thoracic endovascular 24 months postoperatively. The mean preoperative VFI was 6.0 ± aneurysm repair (TEVAR) can be troublesome and can seriously 3.4 mL/s, and this value improved to 2.2 ± 1.4 mL/s at 1 month, influence the outcomes of treatment. We herein present a case of 2.3 ± 1.7 mL/s at 12 months, and 2.5 ± 1.9 mL/s at 24 months a patient with an aortic aneurysm just distal to the origin of the postoperatively. At 24 months after EVLA, the mean VCSS and left subclavian artery, in which passage of the endovascular device VFI values were significantly lower than the preoperative values. 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 Conclusions with an increasing 5.6 cm descending thoracic aortic aneurysm. EVLA did not cause severe complications, and good surgical The patient had a type 3 aortic arch with severe angulation in both outcomes were obtained. VCSS and venous function were cranio-caudal and anterior-posterior aspects. A TEVAR procedure significantly improved at 24 months postoperatively. EVLA isa was planned with proximal landing in zone 2 and carotid-subclavian safe and effective treatment for incompetent saphenous veins. 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. P06 Combined superficial femoral endovascular Therefore a snare system was used which was placed in the proximal treatment and popliteal-to-distal bypass for part of the device and pulled firmly to physically bend the delivery critical limb ischemia system, allowing for advancement into the aortic arch. The device Yoshihiko Tsuji1, Dr Ikuro Kitano1 was placed just distal to the left carotid artery origin and deployed, 1 but due to the severe angulation, the device migrated distally. Shinsuma General Hospital, Kobe, Japan Therefore an extender graft was introduced and the procedure was finished with coil embolization of the left subclavian artery origin. Objectives 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 The aim of this study was to evaluate graft patency and limb salvage which passage of the device is hindered. 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 Methods Between 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.

Annals of Vascular Diseases 2016 87 Prize Poster Presentation

In this study, we reviewed 14 cases (16%) who were treated by Results combined EVT for the SFA lesions and popliteal-to-distal bypass. EVAR was performed in these five patients first and then followed There were 10 men and 4 women and the mean age was 72 years by laparoscopic retroperitoneal debridement later (one or two days (58-81), and all of them had ischemic forefoot or toe wound after EVAR). All patients were successfully discharged in two to 6 (Rutherford 5: 10 cases, Rutherford 6: 4 cases). All of them had weeks with oral antibiotics control in OPD. No recurrent infection hypertension and diabetes mellitus, and 6 (43%) of them received was noted during the follow-up. 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 Conclusion saphenous vein graft was used in all of popliteal-to-distal bypass, Endovascular treatment is now considered a durable option for and the target arteries were posterior tibial artery in 2 and dorsalis mycotic aortic aneurysm. Recurrent infection is still a problem pedis artery in 12. since the infective aneurysm is not excised and deployment of a stent graft can aggravate the infection. Laparoscopic retroperitoneal Results approach can provide adequate drainage and debridment for these patients and the result is good. Initial 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- P08 up period, and all of them were successfully revised by additional Cilostazol improves wound healing and freedom EVT. from major amputation after infrainguinal bypass for ischemic tissue loss Conclusions Shinsuke Mii1, MD, PhD Atsushi Guntani1, MD Aisuke Kawakubo1 Combined endovascular treatment for the SFA lesions and 1 popliteal-to-distal bypass were considered to be useful procedures Saiseikai Yahata General Hospital, Kitakyushu-city, Japan for appropriately selected patients with critical limb ischemia. Careful follow-up for endovascular treated lesions and vein graft Background and purpose is necessary. Some 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. P07 Endovascular treatment for mycotic abdominal Patients and methods aneurysm with laparoscopic debridement: case From December 2010 to December 2015, a total of 145 consecutive report and systemic review patients underwent infrainguinal bypass for tissue loss due to 1 arteriosclerosis obliterans (ASO). Excluding 6 patients who died Chai Hock Chua and 3 patients who lost the legs within 30 days after surgery, 136 1Shin Kong Wu Ho-Su Memorial Hospital Taipei, Taiwan, Taipei, patients divided into 2 groups by postoperative use of cilostazol Taiwan (cilostazol group: 42 and non-cilostazol group: 94). Wound healing (WH) was defined as the primary endpoint and freedom from major Background amputation (ffMA) was defined as the secondary endpoints. The clinical outcomes of the 2 groups were compared using the Kaplan- Mycotic aortic aneurysm remains a rare but life-threatening disease. Meier method and the significant predictors of each outcome were Among of these, infrarenal abdominal mycotic aneurysm is the determined by a Cox proportional hazards analysis. 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 Results treatment after endovascular treatment is warranted to prevent The Kaplan-Meier survival curves demonstrated that WH and ffMA recurrent infection. Laparoscopic debridement via retroperitoneal of the cilostazol group was superior to that of the non-cilostazol approach is considered a promising method to control the infection group ([cilostazol vs. non-cilostazol] one-year WH rate. 100% vs. after the endovascular treatment. 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 Objectives hazards regression analysis showed that cilostazol use, direct angiosome, no diabetes mellitus, no coronary artery disease, and In our experience, there are total five cases of mycotic abdominal no wound infection were positive predictors of WH, and cilostazol aortic aneurysm, in which EVAR was performed and then followed use and male were positive predictors of ffMA. by laparoscopic retroperitoneal debridement. No recurrent infection was found during the follow-up. Conclusions Methods Postoperative use of cilostazol may improve WH and ffMA after infrainguinal bypass for tissue loss due to ASO. There were total 5 cases of mycotic abdominal aortic aneurysm, treated in this method, during these 3 years.

88 Annals of Vascular Diseases 2016 P09 P10 Acellular Fish Skin as a Bone and Tendon Angioscope assisted retrograde in-situ branched Covering: Case Report stentgraft (RIBS) for the treatment of an John Lantis, Baldur T. Baldursson1, 2, Gudbjorg Palsdottir2, Dr. C endoleak following custom-made fenestrated Winters3, Skuli Magnusson1, Dr. Hilmar Kjartansson1,2, Dr. Gunnar 1 1 stent graft: a case report Johannsson , G Sigurjonsson 1 1 1 1 2 Soichiro Fukushima , Dr. Naoki Toya , Dr. Eisaku Ito , Dr. Yuri Kerecis, Reykjavik, Iceland, Landspitali University Hospital 1 1 2 3 Murakami , Dr. Tadashi Akiba , Dr. Takao Ohki of Iceland, Reykjavik, Iceland, American Health Network, 1 2 Indianapolis, USA Jikei University Kashiwa Hospital, Kashiwa-Si, Japan, Jikei University School of Medicine, Minato-ku, Nishi-shinbashi, Japan Background Introduction and Objective Retrograde in-situ fenestration is one of a less invasive method for The aim of this case report was to evaluate fish skin grafts* for the branch reconstruction during thoracic endovascular aneurysm wounds with exposed bone or tendon. repair（TEVAR） for high risk aortic arch disease. However, we sometimes experience a difficult case for the in-situ fenestration Methods because of their anatomical background. Here we report a case of a patient who underwent retrograde in-situ fenestration using Data was gathered from patient database in Landspitali University angioscpe for aortic arch aneurysm with an endoleak after TEVAR Hospital of Iceland and the American Health Network Indianapolis. by the Najuta® custom-made thoracic fenestrated stentgraft（SG）. The fish skin graft was used in complicated cases where standard of care had failed after at least 4 weeks of treatment. Case presentation Results An 83-year old man underwent endovascular aortic arch aneurysm with the Najuta® custom-made 3-fenestrated SG in 2011 at another 1: 69 y.o. male with 64 week old necrotic surgical wound with institution. He was referred to our institution after complaining of exposed achilles tendon. Healed in 10 weeks with 6 applications hoarseness, and computed thomography (CT）imaging showed of fish skin *. an endoleak through the SG fenestrations with aneurysm sac 2: a 48 y.o. female with iatrogen wound on forearm with exposed enlargement. Because of the presence of pre-existing fenestrations, tendons, deteriorating for 8 weeks. Healed in 6 weeks with 6 fish we decided to perform additional TEVAR with retrograde in-situ skin applications*. fenestration for the carotid artery using an angioscope. During 3: 63 y.o. female with >4 week with exposed bone on elbow and the fenestration for the left common carotid artery, we observed puncture through the bursa olecranii. Healed in 3 weeks with 2 fish both the SG and the puncture needle through an angioscope which skin applications*. enabled us to avoid double puncture of the SGs, which may lead to 4: 60 y.o. male with >4 weeks old DFU with exposed caput of the the inability of puncture site expansion. Postoperative CT imaging 5th metatarsal. Healed in 14 weeks with 5 fish skin applications*. confirmed the resolution of the endoleak, and the patient was discharged without complications. 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*. Conclusions 6: 53 y.o. female with wound on to dorsal surface of the 5th MTP Retrograde in-situ fenestration is a less invasive option for branch joint with exposed tendon. Healed in 4 weeks with 3 fish skin reconstruction during TEVAR for high risk aortic arch disease. applications*. Angioscope may be a useful tool in performing redo in-situ 7: 55 y.o. male with DFU after partial 5th ray amputation due to fenestration. 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*.

Conclusion Fish skin* with facilitates granulation and tissue mass creation over exposed bone and tendons where other treatments faile. *Kerecis™ Omega3 by Kerecis #Primatrix by Integra

Annals of Vascular Diseases 2016 89 Prize Poster Presentation P11 P12 A Successful Staged Hybrid Repair of a Fibrinogen replacement therapy guided Ruptured Type V Thoracoabdominal Mycotic by coagulation management reduces blood Aneurysm By Visceral Debranching and transfusion in thoracic aortic surgery: a Completion Endovascular Stent Grafting retrospective observational study 1 1 1 1 1,2 Kazuhiro Takatoku , Dr Junichiro Nishizawa , Dr Motoyuki Julian ZY Hong , Raj K Menon , Andrew MTL Choong Kumagai1, Dr Masahiro Uraoka2, Dr Mutsuhito Kikura2 1 Division of Vascular Surgery, National University Heart Centre, 1Department of Cardiovascular Surgery, Hamamatsu Rosai 2 Singapore, School of Medicine, Griffith University, Gold Coast, Hospital, Hamamatsu, Japan, 2Department of Anesthesiology, Queensland, Australia Hamamatsu Rosai Hospital, Hamamatsu, Japan

Introduction Background and Objectives Surgical management of type V thoracoabdominal aneurysms Coagulation management is important for perioperative hemostasis (TAAA) remains a surgical challenge, especially in an emergency in cardiovascular surgery. We evaluated the effects of fibrinogen setting. We report the successful staged hybrid repair of a leaking replacement therapy guided by coagulation management for mycotic TAAA repair, with Salmonella Enteritidis as the offending thoracic aortic surgery. We studied 53 consecutive patients who organism. underwent thoracic aortic surgery with cardiopulmonary bypass (CPB) between January 2009 and July 2016. We excluded Results cases of descending thoracic aortic surgery, aortic rupture, re-do cardiovascular surgery, and those requiring additional surgery A 69-year-old lady presented with worsening low back pain, during the postoperative 24 hours. We compared the transfusion dysphagia and an acute drop in haemoglobin levels from 10.4 outcomes between 31 patients (control group) who underwent to 7.0 g/dL. Bedside ultrasound revealed an abdominal aortic conventional management before December 2012, and 22 patients aneurysm (AAA) which was further delineated by a Computerised (algorithm-guided group) who received fibrinogen replacement Tomography (CT) scan of her Aorta revealing a 7.2cm saccular therapy guided by coagulation management after January 2013. 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. Methods In the algorithm-guided group, fibrinogen level and fibrin She was admitted to the high dependency unit for preoperative polymerization (FIBTEM) were measured by the Clauss method optimization for surgery as a planned semi elective open TAAA and thromboelastometry (ROTEM®), respectively, during the repair. However an interval CT Aortogram revealed an interval re-warming phase of CPB and stratified the starting fresh-frozen increase in aneurysm size to 7.8cm with associated pleural effusion plasma (FFP) volume according to the 4-group classification suggesting a contained leak. 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 An emergency partial visceral hybrid repair of her type V presumed postoperative bleeding and blood transfusion volumes within the mycotic TAAA was performed. Exploratory laparotomy, retrograde first postoperative 24 hours between the groups. bypass from right iliac to superior mesenteric artery, jump graft from bypass graft to coeliac trunk and completion thoracic endovascular stent grafting. Results There were no significant differences between the control group and the algorithm-guided group in age (65±12 vs. 64±14 years; Interval CT Aortogram 1 week later depicted a rebound increase in p=0.87), CPB time (230±65 vs. 226±47 min; p=0.76), operation aneurysm size. Decision to return to operating theatre was made. time (509±140 vs. 523±103 min; p=0.69), postoperative chest- Further debranching was performed of both renal arteries onto tube drainage (676±410 vs. 584±289 mL; p=0.34), intra-and the previous right ilial-superior mesenteric artery graft. Previous postoperative FFP (1827±1261 vs. 1341±1020 mL; p=0.12), stent graft was lengthened with additional stents beyond the renal or platelet concentrate volume (522±192 vs. 490±274 mL; arteries, and stents ballooned in place. p=0.64). Compared with the control group, the algorithm-guided group required a lower red blood cell volume (2831±1354 vs. The patient was discharged well on post-operative day 41 2036±860mL; p=0.01) and a lower total blood transfusion volume (5181±2495 vs. 3869±1996mL; p=0.03).

Conclusions Conclusions The visceral hybrid repair of visceral debranching and completion endovascular stent grafting is a robust and useful tool in the Fibrinogen replacement therapy guided by fibrinogen level and armamentarium of vascular surgeon. A staged approach to may fibrin polymerization reduces blood transfusion in thoracic aortic be of benefit in complex aortic aneurysm repair particularly in an surgery. emergency setting.

Key words: Mycotic, Thoracoabdominal Aneurysm, Leaking

90 Annals of Vascular Diseases 2016 Poster Presentation

Objectives P01-01 To evaluate the feasibility and usefulness of placing an IVC filter Deep Vein Thrombosis after Abdominal through the same popliteal vein access site used for PEVI in Surgery in Korean Patients patients with extensive lower extremity DVT; Fahed Aljaber1, Prof. Dong-ik Kim1 1Samsung Medical Center, South Korea, Seoul, South Korea Materials and Methods During a 3 years, a total of 21 patients undergoing IVC filter insertion through the popliteal vein. In all patients, a popliteal vein Introduction approach in the leg with the venous thrombosis was attempted. A Deep vein thrombosis (DVT) is a postoperative complication and double-basket shaped retrievable IVC filter equipped with a 90 cm may manifest as pulmonary embolism, which causes 300,000 length introducer set (OptEase filter; Cordis, Warren, NJ, USA) was deaths annually in the United States alone. The incidence of DVT deployed in the infra-renal IVC under fluoroscopic guidance. After after abdominal surgery has been reported in the literature to be IVC filter insertion, endovascular treatment, including aspiration lower in Asian countries, particularly in countries farther to the east. thrombectomy or thrombolysis, was performed for iliofemoral vein Although the relationship between thrombosis and malignancy is thromboses to prevent thrombus migration into the IVC well known, little information is available regarding the incidence. Results Objective Prophylactic infra-renal IVC filter insertion were successfully The purpose of this study was to prospectively investigate the deployed in all patients. In all patients, recanalization procedures incidence of deep vein thrombosis (DVT) after abdominal surgery were preformed: Aspiration thrombectomy (n=21), Catheter in Korean patients. 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 Materials and Methods plane. (*P= 0.238, paired t-test) Significant filter tilt (filter tilt ≥ Two hundred and two patients who underwent surgery for 15°)= 3 patients (14.3%)- maximum filter tilt= 18°. Filter retrieval pancreaticobiliary, lower gastrointestinal or stomach disease were was attempted in 17/21 patients. Persistent DVT (n=3), Patient enrolled. Duplex scanning for diagnosis of DVT was performed refusal of the retrieval procedure (n=1). Filter was successfully one day preoperatively and on postoperative day 7. removed in 16/17 (94.1%). Mean filter dwell time (20.13 days).

Results Conclusions Patients were divided into two groups, those who received Transpopliteal IVC filter insertion is enable a single session mechanical thromboprophylaxis (n = 50) and those who did not procedure using a single venous access and site for filter insertion (n = 152). There was no statistically significant difference in and PEVI. PEVI is feasible and useful theraphy that results in low demographics between the two groups. Soleal vein thrombosis rates of significant filter tilt. 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 P01-03 (6 months postoperative). Recurent acute venous thrombosis of left lower extremity in a patient with hyperlipidemia Conclusions Kazim Ergunes1, Dr Ihsan Peker1, Dr Ismail Yurekli1, Dr Tayfun This study demonstrated a low incidence of DVT after abdominal Goktogan1, Dr Mehmet Balkanay1, Dr Orhan Gokalp1, Prof Levent surgery in Korean patients. A large, randomized, multi-center Yilik1, Prof Ali Gurbuz1 study is needed to establish guidelines for DVT prevention and 1Izmir Katip Celeby University Atatürk Training and Research management after surgery in Hospital, Izmir, Turkey

Objective P01-02 Venous thrombosis is important factor affecting morbidity and mortality. We presented a patient with hyperlipidemia having Inferior vena cava filter insertion through recurrent acute venous thrombosis of the left lower extremity. the popliteal vein: enabling the percutaneous endovenous intervention (PEVI) of deep vein Methods thrombosis with a single venous approach in a A 62-year old woman admitted to the outpatient clinic of our single session hospital in November, 2015. She had pain and edema in the left lower extremity. She had hyperlipidemia. MD Sang Young Chung1, Hong Sung Chung1, MD Ho Kyun Lee1, MD Soo Jin Na Choi1 1Chonnam National University Hospital, Gwangju, South Korea Results Venous Doppler ulrasonography detected thrombosis in the deep venous system of left lower extremity. She used warfarin Background/ Introduction due to venous thrombosis of the left lower extremity five years Retrievable inferior vena cava (IVC) filters and prophylactic IVC ago. Anticoagulant therapy with low-molecular-weight heparin filter insertion is approached two venous access sites. (LMWH) was immediately started. The patient!s symptoms,

Annals of Vascular Diseases 2016 91 Poster Presentation particularly pain and edema continued to improve in left lower The current recommendations range from watchful waiting to full- extremity. She was discharged after seven days with warfarin dose anticoagulation. treatment. Objectives Conclusions The purpose of the present study was to investigate the progression Low-molecular-weight heparin and warfarin are important in and regression of thrombi and to identify the patterns of serial treatment of acute recurrent deep venous thrombosis of the lower changes in patients with ICDVT during a 1-year follow-up. extremity in patients with hyperlipidemia. Methods A retrospective chart review was performed for patients with ICDVT in a single institution between 2013 and 2014. Diagnosis P01-04 was established with duplex ultrasound (DUS) examination. All A case with recurrent acute left lower deep deep veins in the calf, excluding the anterior tibial vein, were imaged. We evaluated patients who were followed up clinically and venous thrombosis having pulmonary who underwent DUS at 1, 3, and 6 months, and up to 12 months. thromboembolism and deep venous thrombosis Additionally, the rate of anticoagulant therapy and compression operated due to genital and colon cancer one were investigated. year ago Kazim Ergunes1, Dr Erturk Karaagac1, Dr Yuksel Besir1, Dr Ismail Results Yurekli1, Dr Bortecin Eygi1, Dr Banu Lafci1, Dr Koksal Donmez1, The study included 218 patients (163 women and 55 men). The Prof Ali Gurbuz1 mean age of the patients was 73.9 ± 11.0 years (range, 39-93 years). 1Izmir Katip Celeby University Atatürk Training and Research The majority of the patients were asymptomatic (167 patients, Hospital, Izmir, Turkey 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 Objective therapy, and 211 (96%) received compression therapy. Complete Venous thromboembolism has multiple risk factors and tends recanalization of ICDVT was observed in 66 patients (30%), while to recur. We reported a case with acute left lower deep venous 102 patients (47%) showed residual thrombosis, and 40 patients thrombosis having pulmonary thromboembolism and deep venous (18%) showed recurrence in the calf. Proximal vein propagation thrombosis operated due to genital and colon cancer one year ago 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 Methods sufficient anticoagulant therapy. A 44-year old woman admitted to emergency department of our hospital on November, 2015. She had pain and edema in the left lower extremity. Conclusions Although most of the patients in our study were asymptomatic, there was a substantial risk for PE and proximal vein propagation. Results Sufficient anticoagulant therapy is necessary in such a high-risk Venous Doppler ulrasonography detected thrombosis in the deep group of patients. 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 P01-06 medication. Total endovascular treatment for acute deep venous thrombosis by catheter-directed Conclusions thrombolysis Pulmonary thromboembolism and deep venous thrombosis, genital Kimihiro Igari1, Dr Toshifumi Kudo1, Dr Takahiro Toyofuku1, and colon cancer operations are important factors in the recurrent Dr Yoshinori Inoue1 lower extremity venous thrombosis. 1Tokyo Medical And Dental University, Bunkyo-ku, Japan

Objectives P01-05 The present study aimed to investigate our treatment for acute deep venous thrombosis (DVT) by endovascular procedure, and to Progression and regression of isolated calf deep evaluate the treatment outcomes. vein thrombosis during a 1-year follow-up 1 1 1 1 Makoto Haga , Yutaka Hosoi , Tooru Ikezoe , Masao Nunokawa , Methods Hiroshi Kubota1 We retrospectively reviewed the charts of patients who underwent 1 Kyorin University School Of Medicine, Mitaka, Japan endopvascular treatment (EVT) for acute DVT between January 2015 and June 2016. For the EVT procedure, we inserted a 4 or Background 5 Fr sheath through popliteal or short saphenous vein under the local anesthesia. The infusion catheter for thrombolysis was Isolated calf deep vein thrombosis (ICDVT) is common in clinical positined between iliac vein and femoral vein, and thrombolysis practice; however, the treatment of ICDVT remains controversial. with urokinase was done. After the operation, we performed

92 Annals of Vascular Diseases 2016 thrombolysis with urokinase through the infusion catheter which to this population. The results of the sub analysis of the Hokusai- was posintined intraoperatively. Furthermore, we conducted the VTE trial revealed that edoxaban was associated with significantly ballon dilatation for the stenotic segment of iliac vein. less clinically relevant bleeding than warfarin. Our clinical outcome showed remarkable efficacy of initial treatment with edoxaban in patients with VTE. Results Three patients (one male, and 2 female) were included in this study. In all patients, the EVT procedure was successful in achieving re- Conclusion canalisation of the iliofemoral veins at the end of the intraoperative In the future, large-scale and precise investigation for use of thrombolysis with urokinase (median dose of 360,000 unit). We edoxaban in the real world are required to validate the efficacy and peformed the postoperative thrombolysis with urokinase (dose safety for treatment of VTE. 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. P01-08

Conclusion Clinical characteristics of May-Thurner’s Our treatment with EVT procedure might be a safe and feasible syndrome with thrombus extension to IVC treatment for acute DVT. Heungman Jun1, Dr. Cheol Woong Jung1, Dr. Sung Bum Cho1 1Korea University Anam Hospital, Seoul, South Korea

Introduction P01-07 With an increase in lower extremity deep vein thrombosis (DVT), Clinical outcome of edoxaban for treatment interest in May-Thurner’s syndrome (MTS) accompanying iliac of venous thromboembolism in Japanese vein compression is also on the rise. In particular, it is observed that some patients with MTS have IVC thrombosis. And if IVC population thrombosis is present, mortality as well as significant complications Shinichi Imai1, Medical Doctor Shinichi Hiromatsu1, Medical including postthrombotic syndrome (PTS) and pulmonary Doctor Kanako Sakurai1, Medical Doctor Ryou Kanamoto1, thromboembolism (PTE) will rise. Medical Doctor Shohei Yoshida1, Medical Doctor Mau Amako1, Medical Doctor Hiroyuki Otsuka1, Medical Doctor Satoru Objectives Tobinaga1, Medical Doctor Seiji Onitsuka1, Professor Hiroyuki Tanaka1 To find the different characteristics of MTS with thrombosis extending stenotic lesion of iliac vein into IVC, compared to MTS 1 Kurume University Surgery, Kurume, Japan without IVC thrombosis.

Objectives Method The purpose of this study is to evaluate our recent clinical experience A total of 35 patients with MTS were treated with many with edoxaban for treatment of venous thromboembolism (VTE). interventional modalities including catheter directed thrombolysis, percutaneous mechanical thrombectomy and iliac vein stent from Patients January 2012 to December 2015. The data on the current history, We retrospectively reviewed 39 patients(pts) (12 men and 27women, the stenotic feature (stenotic size, stenotic ratio compared form the mean age 62.6± 19.7 years) to whom edoxaban was administrated other side) and clinical outcomes (PTE, PTS) were retrospectively for treatment of VTE from January 2015 until December 2015. reviewed by dividing into groups with IVC thrombosis and without. The patency in the two groups was compared with log-rank test.

Results Results The 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 Eight patients (22.85%) had thrombus extension to IVC (TEIVC) pts (53.8%) were DVT with proximal type and 12 pts (30.7%) DVT in 35 patients of MTS. The group with TEIVC showed higher with distal type. The cause of VTE included the following: 2 pts measurement in stenotic size and ratio, which was statistically who had previous VTE, 12 pts (30.8%) who had cancer, 25 pts significant (P<0.001, P=0.001). The group with TEIVC presented (64.1%) who had temporary risk factor. Daily dose of edoxaban more with PTE compared to the group without, which was for these pts was 60mg (20.5%), 30mg (53.8%) and 15mg (25.6%). statistically significant (P=0.007). But there were no statistical The mean follow-up period was 103±87 days. The plasma D-dimer differences of PTS. In follow-up of mean 11 months, there were level were 6.6μg/ml (range 0.8 to 39.2) before receiving edoxaban. no statistical differences of patency in the two groups (P=0.501). 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 Conclusions to edoxaban. Clinically relevant nonmajor bleeding occurred in 6 In MTS, TEIVC is likely to develop in cases where the iliac patients. Liver dysfunction was observed in 2 patients. Paradoxical venous size of stenotic lesion and the stenotic ratio compared from cerebral infarction occurred in one patient. the other side is shown to be greater. Also, PTE occurred more frequently in MTS with TEIVC. Thus, patients with MTS require Discussion thorough inspection on TEIVC, and large scale research with long East Asian pts tend to have bleeding complications for receiving term results is also necessary. warfarin as compared with non East Asian pts. For this reasons, treatment alternatives to warfarin might be of particular relevance

Annals of Vascular Diseases 2016 93 Poster Presentation P01-09 We report a case of 69 year old man with a subclavian artery pseudoaneurym following a closed fracture of a clavicle. Vascular Patients with epithelial ovarian cancer and DVT can be treated surgery intervention was indicated as he presented with an acute safely with standard DVT treatment. upper limb from distal embolisation into his brachial artery, with a Jang Yong Kim1, Clinical Professor Eun Young Ki1, Professor surgical thromboembolectomy performed followed by stenting of Jong Sup Park1, Professor Young Ju Suh2, Professor Soo Young the pseudoaneurysm with a self expanding covered stent. Hur1, Professor Seung Nam Kim1, Professor In Sung Moon1 1The Catholic University of Korea, College of Medicine, Seoul, 2 While he recovered well from the procedure, there remained South Korea, Inha University, College of Medicine, Incheon, concerns about stent deformation or perforation from the pointed South Korea fracture edge that remained unfixed. Discussions with the Objective orthopaedic team and our investigations to rule out risk of stent The aim of this study was to evaluate the prevalence of deep vein damage will feature in our poster presentation. thrombosis (DVT) and the influence of DVT on patients’ survival with epithelial ovarian cancer with standard DVT treatment.

Methods P02-02 This is a retrospective study from prospectively registered data Vascular Complications Related to Lumbar base of patients who underwent cytoreductive surgery and adjuvant Disc Surgery chemotherapy from January 2010 to December 2014 at Seoul St. 1 1 Mary’s Hospital. Electronic medical records(EMR) and picture Sang Young Chung , MD Soo Jin NA Choi archiving and communication system(PACS) was used to evaluate 1Chonnam National University Hospital, Gwangju, South Korea patient’s clinical characteristics, treatment results and the influence of DVT. Background/ Introduction Vascular complications related to lumbar disc operation are rare Results but extremely fatal conditions. The vascular related symptoms that Two hundred eighty four patients were identified. There were 260 warn the surgeon may be late to appear: they usually turn out to be patients without DVT and 24 patients with DVT. Among 24 patients, mortal. 9 patients had pulmonary embolism. All patients with DVT were treated with anticoagulation. Patients with DVT were older (61.0 vs Objectives 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 The hypotension during the operation, tachycardia and pulsatile those without. The overall survival was not significantly different unstoppable hemorrhage observed in the disc space are major between two groups (P=0.14) by using the log rank test. The stage findings, urgent detection of this complication and the repair of the was associated with shorter overall survival (for stage IV: hazard vascular injury prevent the case from turning out to be fatal. 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, Materials and Methods 0.1.0-1.06, P=0.61). We report our experience 4 cases with vascular complications that occurred during lumbar disc operations performed. Conclusion The incidence of DVT was 8.5% in patients with epithelial ovarian Results cancer. DVT can cause a fatal complication. However, Patients with epithelial ovarian cancer and DVT can be safely treated with One patient underwent an L5-S1 procedure and the remaining standard treatment of DVT. 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 artery In two cases shock or pre-shock due to hemorrhage developed P02-01 during the early phase. 3cases the lesion was repaired using primer Endovascular treatment considerations for suture techniques and the other case performed endovascular graft an acute subclavian pseudoaneurysm after insertion. There was no surgery-related death and none of the patients fracture of the clavicle suffered any problem related to vascular injury Ching Siang Cheng1 1The Royal Brisbane And Women’s Hospital, Herston, Australia Conclusions Despite its low incidence, iatrogenic vascular injury related to Pseudoaneurysm of the subclavian artery is an uncommon lumbar disc surgery is a possible complication. During lumbar complication following fracture of the clavicle. Reports of disc operation early diagnosis of vascular injuries and urgent endovascular repair have been published since 2003, but discussions transperitoneal surgery can save patients’ lives. concerning implications of the remaining orthopaedic injury on the stented area were not often detailed.

94 Annals of Vascular Diseases 2016 P02-03 Methods 19 Patients who were undergone TEVAR for BAI since 2012 to Cardiopulmonary Arrest Due to Rupture of 2016 in King Chulalongkorn Memorial Hospital were analyzed for Pseudo-Aneurysm of Superior Mesenteric demographic data, technique of TEVAR and early complication. Artery Caused by Blunt Trauma: Case Report Baku Takahashi1, Dr. Yoshihiro Nakayama1, Dr. Shinyu Shiroma2 Results 1Department of Cardiovascular Surgery, Osumikanoya Hospital, Among 19 patients, Most of cases were male (75%) in mean aged Kanoya, Kagoshima, Japan, Kanoya, Japan, 2Department 38.5 years (range : 21-70 years) with injury from traffic with injury of General Surgery, Uwajima Tokushukai Hospital, Kanoya, from traffic accident (73%). Most associated injuries were chest Kagoshima, Japan , Uwajima, Japan 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 Pseudo-aneurysm of the superior mesenteric artery is rare distant from left subclavain artery to it was 14.14 mm (range : condition, however, potentially life-threatening complication after 0-20 mm). Proximal landing zone diameter was 23.9 mm (range abdominal trauma. : 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% A 61-year-old man was admitted to the emergency department of Valiant Thoracic and 32% Zeninth TX2. Technical success was another hospital for complaining of severe back pain because an achieved in 100% of cases. No case was required left subclavain epigastric region was pushed away by a cow. Laboratory tests were artery coverage. Only 1 case (5%) ,the injury was pseudoaneurysm unremarkable. Contrast-enhanced computed tomography (CT) at aortic arch between innominate artery and left subclavain artery. detected the pseudo-aneurysm of superior mesenteric artery (SMA) In this case, we performed chimney TEVAR at innominate artery, that placed at the about 3cm from the origin of the SMA. The patient carotid-carotid bypass and left carotid to left subclavain bypass with was treated by conservative treatment with blood pressure (BP) proximal landing zone at zone 0. No early endoleak was occurred control because his vital signs was stable, and the pain disappeared. after procedures. No other perioperative complication such as However, his back pain developed again and follow-up CT revealed transient or permanent paraplegia, or cerebral complication. Mean enlargement of SMA pseudo-aneurysm. The patient was conveyed ISS score was 36±20.3. to our hospital. His back pain persisted and BP fell, therefore we diagnosed with impending rupture and decided to perform Conclusion urgent surgery. During the anesthesia introduction, the patient fell into shock and cardiopulmonary arrest. With cardiopulmonary Most common location of BAI was distal to left subclavian artery. resuscitation, we performed urgent laparotomy and clamped In our study, without left subclavain artery coverage, TEVAR abdominal aorta above the celiac artery, recovery of spontaneous was done successfully without endoleak and other perioperative circulation was obtained in several minutes. Laparotomy revealed complications. 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, P02-05 we performed laparotomy on the same day. We detected bleeding from SMV and ischemic ascending colon, therefore we repaired Stages of an emergency surgical procedure of SMV and resected the colon. 2 days later, we performed second a 4-year-old patient with post-traumatic 90º look operation, and we confirmed non-bleeding and anastomosed angulation of left brachial artery the appendix and transverse colon. His postoperative course was Assist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, uneventful and the patient was discharged on foot on postoperative 2 3 day 30. Specialist Köksal Dönmez , Assist.Prof. Özhan Pazarcı , Prof.Dr. Öcal Berkan1, Ufuk Yetkin1 1Cumhuriyet University Medical Faculty, SİVAS, Turkey, 2Katip The SMA pseudo-aneurysm is fatal disease when it ruptures. Celebi University Izmir Ataturk Training and Research Hospital, Before rupture, endovascular treatment may be available, however, Izmir, Turkey, 3Cumhuriyet University, Dept. of Medical Faculty, emergency laparotomy is mandatory when rupture is suspected. SİVAS, Turkey

Objective P02-04 In daily vascular surgery practice, emergency interventions to pediatric patient group have great variety and severe difficulties. TEVAR for Blunt Thoracic Aortic injury without left subclavain artery coverage Method Dr. Kritaya Kritayakirana1, Dr. Natawat Narueponjirakul1, Apinan 1 A 4-year-old girl patient admitted to our emergency department. Uthaipaisanwong She fell from her bicycle one hour before admitting. She had an 1King Chulalongkorn Memorial Hospital, , Thailand open-fracture at her left upper extremity. Patient was examined by Orthopedic surgeons first. Direct radiographies revealed a Background left open supracondylar fracture. Amplitude of radial and ulnar pulses and temperature of left hand were lesser than right. Further Endovascular treatment for blunt traumatic aortic injury (BAI) investigations were planned. Duplex ultrasonography was achieved was standard treatment but coverage of left subclavian artery was firstly. CT angiography was planned afterwards. questionable.

Annals of Vascular Diseases 2016 95 Poster Presentation

Results Results About a 6 cm part of left brachial artery was not visualized at Compartment syndrome occurred in postoperative period of both investigations. Patient underwent emergent reduction by three (8.8%) patients. Two of these patients had popliteal artery orthopedic surgeons. As vascular surgery team, we attended to injury. Compartment syndrome occurred after 6th to 12th hours operation. Under general anesthesia, we used a standard S incision of revascularization and a fasciotomy was performed. Remaining for left brachial artery. Area had severe hematoma. Proximal patient had a brachial artery injury with extensive tissue damage. dislocation of fracture caused a 90 º angulation distal brachial Fasciotomy was performed after 8th hour of revascularization artery. Pulsation was very weak after this point. Neural and venous for compartment syndrome. One patient had below-knee and structures were suspended and checked for their integrity. After one patient had forearm amputation. None of the remaining 32 vascular exploration, orthopedic surgeons fixated and repositioned patients had a complication causing amputation. There was not any the bones with instrumentation. Distal pulses were absent with mortality in our series. 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 Conclusion extracted and artery was released from adjacent tissues with Amputation may be inevitable in trauma patients with vascular sharp dissection. Distal pulses were achieved. Re-reduction was injury, bone fracture, nerve damage and extensive tissue damage. completed. 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 Distal pulses were palpable in control examination. Addition to vein. Other patient (2.9%) had amputation after bypass grafting to other medications, iloprost and pentoxifylline treatment were brachial artery with saphenous vein. Amputation rates in our series initiated with appropriate dosage according to patient’s weight. are significantly lower than literature. Patient recovered uneventfully.

Conclusion In vascular surgery practice, treating pediatric patients requires P02-07 more experience. Multiple episodes may be required and multidisciplinary approach may be necessary due to accompanying Hybrid approach to a work-related accident pathologies. 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 P02-06 1Cumhuriyet University Medical Faculty, Department of Fasciotomy Due to Compartment Syndrome Cardiovascular Surgery, SİVAS, Turkey, 2Katip Celebi University Izmir Ataturk Training and Research Hospital, Izmir, Turkey and Amputation Rates of Our Post-traumatic Extremity Vascular Injury Series Objective Assist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, Ufuk Yetkin1, Specialist Köksal Dönmez2, Prof.Dr. Öcal Berkan1 Metallic objects penetrating to especially upper part of body due to work-related accidents may cause to various vascular trauma and 1 Cumhuriyet University Medical Faculty, Department of complications.Emergency interventions for these pathologies are 2 Cardiovascular Surgery, SİVAS, Turkey, Katip Celebi University rare but important in daily vascular surgery practice. Izmir Ataturk Training and Research Hospital, Izmir, Turkey

Method Objective Our case was a 49-year-old male patient.In his medical history,he Compartment syndrome may occur after revascularization. If had a penetrating trauma four hours ago with an approximately ischemia period of extremity exceeds 6 hours, compartment 10mm long piece of iron from an instrument he was working syndrome is more common and patients may undergo prophylactic with,fromright anterolateral part of his neck.An entry site of 1 cm fasciotomy. We aimed to present fasciotomy due to compartment long was visualized at anterolateral–supraclavicular right neck. syndrome and amputation rates in patients with vascular injuries Minimal edema and hematoma was available around the tissue of extremities from admittance to Emergency Department to of entry site.There was not any active bleeding.Contrasted thorax diagnosis and treatment between dates January 2013 and December CT revealed a hyper dense object with metallic artefact and a size 2015. We retrospectively investigated our modalities and assessed of 1,5cm localized at right clavicular,anterior of superior jugular with up-to-date literature. vein.There was hematoma at surrounding muscles.Due to foreign body at vascular site and hematoma,an emergency exploration was Method planned. Between dates January 2013 and December 2015, thirty-four patients who were treated surgically for peripheral vascular injury Results by the same surgical team were investigated retrospectively. Patient underwent emergent operation.Under general anesthesia Twenty-nine patients were male (85.3%) and 5 patients were female and laryngeal intubation,we preferred a transvers incision at right (14.7%). Mean age of patients were 32.00±14.67 (between 10 to medial supraclavicular area.Dermis and subdermal tissues were 68 years). According to trauma site, patients were examined with passed.By using a right-angle forceps,muscles were separated with a multidisciplinary approach including cardiovascular surgeon, blunt dissection at their anatomic plans.Objects localization was orthopedic surgeon and/or plastic surgeon. 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

96 Annals of Vascular Diseases 2016 from the area.After optimal bleeding control and hemostasis,tissues dosage of low molecular weight heparin was administered.At were restored at their anatomic planes.Patient was extubated and postoperative 6th day,Clopidogrel (75 mg)was added to treatment. transferred to intensive care unit.Patient recovered uneventfully Low molecular weight heparin therapy was maintained for ten days and discharged at postoperative 4th day.He is still followed-up by after discharged.Each patient was invited to our outpatient clinic our outpatient clinic. for control ten days after discharge.

Conclusion Conclusion Penetrating trauma of upper body with metallic objects and In peripheral vascular injuries, early diagnosis and urgent initiation suspicion of vascular injury is an absolute surgical indication. of treatment reduces extremity loss and mortality significantly. 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. P03-01 Heparin bonding improves early primary patency of arteriovenous graft for hemodialysis access P02-08 Kenji Aoki1, Norihito Nakamura1, Akihiro Nakamura1, Takeshi Our Principles At Post-traumatic Extremity Okamoto1, Yuka Okubo1, Osamu Namura1, Kazuhiko Hanzawa1, Vascular Injuries: Operation Steps And Early Masanori Tsuchida1 Post-operative Period 1Niigata University, Niigata, Japan Assist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, Ufuk Yetkin1, Specialist Köksal Dönmez2, Prof.Dr. Öcal Berkan2 Background 1Cumhuriyet University Medical Faculty, SİVAS, Turkey, 2Katip Efficacy of heparin bonding is still controversial in arteriovenous Celebi University Izmir Ataturk Training and Research Hospital, graft (AVG) for hemodialysis access. Izmir, Turkey Objective Objectives We compared the patency of heparin-bonded grafts (Gore Propaten) We performed a retrospective investigation for operation steps with standard expanded polytetrafluoroethylene (ePTFE) grafts. and treatment principles in early postoperative period on patients with vascular injury of extremity between dates January 2013 and Methods December 2015. Forty patients underwent forearm loop AVG creation using 4- to 6-mm tapered ePTFE graft. During the first period (October 2012 Methods to March 2014), standard ePTFE grafts were used in 17 patients. Thirty-four patients who were treated surgically for peripheral During the latter period (April 2014 to July 2016), Propaten grafts vascular injury.Twenty-nine of these patients were male (85.3%) were used in 23 patients. The patency of Propaten grafts was and 5 patients were female (14.7%).Mean age of patients were compared with standard grafts. 32.00±14.67. Results Results Mean follow-up period was 12.3 ± 9.4 months in the Propaten Anesthesia type (local/general)was selected according to wound group and 33.1 ± 14.9 months in the standard graft group. Primary type,simultaneous operations and patient’s general status.Unless patency was 90.0％ and 90.0% in the Propaten group, and 70.6％ there is a life threatening condition, all other operations including and 51.3% in the standard graft group at 6 months and 12 months, orthopedic interventions were performed after revascularization respectively. Propaten demonstrated significantly improved or vessel repair.Incisions were performed at projection of trauma primary patency, compared to the standard grafts (P = 0.0204). site.Bleeding artery and/or vein was suspended from proximal part. There was a trend to reduction of early occlusion during the first Intravenous 100 IU/Kg heparin was administered.If it was necessary 6 months in the Propaten group (8.7% versus 23.5%). Secondary distal and proximal embolectomy was performed to artery and was patency was 94.4％ and 94.4% in the Propaten group, and 88.2% irrigated with heparinized saline.If damaged segment was longer and 81.9% in the standard graft group at 12 months and 24 months, than two centimeters or there is tension at end-to-end anastomosis respectively. There was a trend to improved secondary patency in site,saphenous vein graft was preferred for interpositioning. the Propaten group, but no statistical difference was found in both Polytetrafluoroethylene (PTFE) or Dacrongraft was used in patients groups. without appropriate saphenous veins.If there is not a possibility for primary repair in venous injuries,vein was ligated or repaired by Conclusions using saphenous vein graft.Bone stabilization,tendon and nerve repairs were performed after vascular repair.Anastomosis and/ Heparin bonding reduced incidence of early occlusion after AVG or repair sites were checked again before suturation of wound. creation. This advantage may improve long-term patency of ePTFE Each patient was followed up in intensive care unit for vascular grafts and become a great benefit to hemodialysis patients. 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

Annals of Vascular Diseases 2016 97 Poster Presentation P03-02 P03-03 Cannulation of arterio-venous fistula after Percutaneous transluminal angioplasty for ultrasound evaluation - National Kidney and central vein stenosis in adults with chronic Transplant Institute experience kidney disease at the National Kidney and Dr. Benito Purugganan Jr1, Rophel Miguel1, Dr. Adolfo Parayno1, Transplant Institute 1 1 Dr. Ricardo Jose Quintos , Dr. Arwin Ronan Ronsayro Alexander Kent Achurra1, Dr. Benito Purugganan Jr.1 1 Philippine Society For Vascular Surgery, Inc, Quezon City, 1Philippine Society For Vascular Surgery, Inc, Quezon City, Philippines Philippines

Background Background and Objective Initiation of hemodialysis for end stage renal disease patients Central vein stenosis is a common cause of venous hypertension (ESRD) usually starts with non-tunneled temporary catheters after a successful peripheral access creation. Percutaneous insertions and creation of permanent accesses weeks to months intervention with transluminal angioplasty is the preferred treatment later. Arteriovenous fistula (AVF), requires a period of maturation. for central vein stenosis. Literature states that initial success Patients are at risk of developing catheter related complications. rates for angioplasty alone ranges from 70-100%, and a 6 month Ultrasonography with Doppler study (DUS) offers a means to patency drop to between 13-86%. There is no local experience on evaluate AVF maturation earlier than 6 weeks allowing earlier use efficacy and safety of percutaneous transluminal angioplasty in the of these AV fistulas. treatment of central vein stenosis.

Methodology Methods A chart review was conducted involving patients who underwent Records of patients managed with percutaneous transluminal AVF creation and ultrasound assessed clearance to determine angioplasty from catheterization laboratory is documented. The whether there are significant cannulation injury attributable to early success rate of percutaneous transluminal angioplasty to salvage cannulation and to determine what factors may have contributed a failing hemodialysis fistula was documented. Estimates of to this. central tendency for continuous variables, and frequency tables for categorical variables were used to present data. SPSS version 20 Results was used for cross tabulations. A total of 73 patients were included in the study. There were 24 documented injuries.Injury between groups at different maturation Results period with respect to length of maturation period, outflow Only 22 patients were included in the study. Chronic vein diameter and compliance to the K/DOQI guidelines were Glomerulonephritis (50%), hypertensive nephrosclerosis (22.8%), determined to be not significantly different statistically. With and diabetes mellitus nephropathy (18.2%) were the predominant regards to the outflow vein wall thickness, all complied with the cause of their chronic kidney disease. These patients consulted late ≥0.6mm but development of injury across both groups was not in the course of their disease, presenting with Grade 2 (36.4%) to decreased even if the wall thickness was increased to 0.07mm or Grade 3 (63.3%) venous hypertension, and severe stenosis (>75%) ≥0.8mm. on venogram. Venography showed the brachiocephalic vein to be the most common area involved (81.82%). Statistical analysis Conclusion showed that only the residual lumen post venoplasty significantly influenced the primary patency rate (p value = .006). The 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 Conclusion DUS evaluation was done, suggests that the cannulation of the This observation is supportive to the recommendation that a former does not result into major injury that can compromise the primary stent insertion is indicated for significant recoil (>30%). AVF function. Length of maturation period, anatomical factor The grade of venous hypertension, location and stenosis severity, particularly vein diameter and compliance to K/DOQI guidelines balloon size used for venoplasty, were not statistically proven to have not been shown to independently increase risk of injury. significantly affect the immediate resolution of arm swelling and patency after 6 months. The safety profile of the procedure is (Keywords: AV fistula maturation, vein diameter, cannulation acceptable with no perioperative morbidity or mortality noted. The injury, AVF intima-media thickness, AVF ultrasound evaluation) primary patency rate of 68% at 6 months in our institution is at par NKF-KDOQI standards.

98 Annals of Vascular Diseases 2016 P03-04 Objective To determine and describe the profile of hemodialysis patients Movement of intravascular catheters in a with arteriovenous fistula presenting with venous hypertension at simulated hemodialysis environment the National Kidney and Transplant Institute and to determine the Dr. Benito Purugganan Jr1, Joy Gali1, Dr. Ricardo Jose Quintos1 significant factors related to its occurrence. 1Philippine Society For Vascular Surgery, Inc, Quezon City, Philippines Methods The profiles of end stage renal disease patients on hemodialysis Introduction with arteriovenous fistula presenting with peripheral venous hypertension who consulted at the outpatient vascular clinic, This experimental study was the first of the many studies that emergency room, vascular laboratory and in-patient referrals were will explore the possibility of the movement of the catheter as the collected and tabulated. The charts and records of the patients at the cause for the development of central venous occlusive disease. No medical records were reviewed. 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 Results hemodialysis environment. A total of 45 ESRD patients presented with venous hypertension at the National Kidney and Transplant Institute from January 1, Objectives 2011 to July 30, 2013. All patients presented with arm edema. The most common location of catheterization was the internal The study documented the changes of catheter movement (in jugular vein. Total duration (for both single catheterization and mm) in relation to different flow rates using the four (4) different multiple catheterizations) of catheters for 16 patients was all more catheters during the 1st, 2nd, 3rd, 4th and 5th minute of the than 1 month before these were removed. Of the 42 patients who experiment. It also described of the movement of catheter during underwent venogram, the most common site of both occlusion and simulated dialysis using the different flow rates. It also determined stenosis was the brachiocephalic vein. 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. Conclusions A larger number of study population or at least 30 patients with Methods complete data will be needed to be able to make an inference/ generalization, with level of significance between risk factors and The four catheters were subjected to different flow rates, starting the occurrence of venous hypertension secondary to central vein at 100 ml/ min up to 440ml/min. The treatment per catheter was occlusion or stenosis. 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. P03-06 Conclusion There indeed displacement or movement of catheter in a simulated Long Term Monitoring of Arteriovenous Graft dialysis environment. Displacement of catheter becomes constant for Hemodialysis by Radionuclid Methods for at a certain period. Displacement between the tunneled catheter Early Detection of Graft Infection and non – tunneled catheter is significantly different. Displacement 1 1 1 1 of catheter is highly related to the flow rate. Petr Bachleda , Petr Utíkal , Jana Janečková , Monika Váchalová 1LF UP Olomouc, Cz, Olomouc, Czech Republic Keywords: Catheters, Catheters – Indwelling, Movement, MVascular Access Device, Background and Objectives The 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 P03-05 ultrasound or by MRA. Early detection of AVG infection is still complicated. Radionuclide methods are emerging as a promising Profile of hemodialysis patients with tool to detect infection of AVG. The aim of our study was to arteriovenous fistula presenting with venous evaluate the options and benefits of PET/CT and labeled leukocytes hypertension at the National Kidney and scintigraphy (LLS) in early detection of AVG infection. Transplant Institute Methods Dr. Benito Purugganan Jr1, Eduardo Aro Jr.1, Dr. Ricardo Jose Quintos1 Between 1/2009-12/2014 were 80 AVG inserted in 65 patients. 1 During the 70 weeks since the insertion of AVG patients were Philippine Society For Vascular Surgery, Inc, Quezon City, monitored by protocol - clinical, bacteriological and laboratory. Philippines PET/CT and LLS were performed after 10, 30, 50 and 70 weeks from the insertion of AVG. Background Venous hypertension secondary to central vein stenosis or occlusion Results is a complication of an arteriovenous fistula affecting the quality of From the group of 80 AVGs, the 70-week monitoring was closed an already miserable life of a chronic kidney disease patient. This only in 25 AVGs; 5 had to be excluded for non-compliance, in commonly occurs after cannulation of major thoracic veins. 38 patients there were repeated graft closures, in 2 patients we had to remove the prosthesis due to infection progresion and 11

Annals of Vascular Diseases 2016 99 Poster Presentation patients died. PET/CT and LLS showed infection in 13 AVGs. Conclusion All these patients were given antibiotic treatment according to BBTAVFs had superior primary and functional patency, and microbiological findings. Clinical manifestations of developed required lesser salvage interventions than forearm AVG. The infection occured in 3 AVGs, both grafts had to be removed. In 10 forearm AVG might have a role in patients who require early patients AVG infection was treated successfully and access to HD vascular access due to complications from central venous catheters rescued. or with limited life expectancy.

Conclusions Evaluation with PET/CT and LLS seems to be sensitive for the detection of early AVG infection with poor or no clinical signs. For P03-08 practical use, it is necessary to specify the frequency and timing of radionuclide controls. We estimate that 20, 40 and 70 weeks from Feasibility of Basilic Vein Transposition AVF the insertion of AVG is the best timing for radionuclid control. after side to side Brachiocephalic AVF Jungkee Chung1, prof inmok jung1 1Boramae Hospital Seoul National Unversity Medical College, Seoul, South Korea P03-07 Comprehensive comparison of the performance Background/ Introduction of autogenous brachial-basilic transposition Basilic Vein Transposition AVF(BVT AVF) was considered 3rd optional procedure and its efficiency was well accepted in spite of arteriovenous fistula (BBTAVF) and prosthetic high operative morbidity. forearm loop arteriovenous graft (AVG) in a multi-ethnic hemodialysis Asian population Objectives Koy Min Chue1, Dr Kyi Zin Thant1, Dr Hai Dong Luo1, Dr Yu 2 1 Upper arm brachio-cephalic AVF(B-C AVF) was 2ndary optional Hang Rodney Soh , Associate Professor Pei Ho procedure and sometimes by using perforating branches side to 1National University Health System, Singapore, Singapore, 2Yong side (S-S) B-C AVF would be made to maintain high basilic vein Loo Lin School of Medicine, National University of Singapore, fistula flow. Under the background of S-S B-C AVF, later BVT AVF Singapore, Singapore could be more easily performed and better results were expected.

Aim Materials and Methods Maintaining a working vascular access is a major problem facing We made BVT AVF 16 cases since 2002 and previous S-S BC patients on dialysis. For patients who have exhausted cephalic vein AVF group (SS group) and other procedures (such as S-E B-C arteriovenous fistulas (AVF) options, controversy exists on whether AVF or GraftAVF) group (OT group) were separated and clinical brachial-basilic AVF with transposition (BBTAVF) or a forearm parameters were compared to evaluate the advantage of side to side arteriovenous graft (AVG) should be the next vascular access of anastomosis. choice. This study compared the clinical outcomes of these two modalities. Results 6 cases of SS group and 9 cases of OT group were compared as Methods below (SS group/OT group) A retrospective study of 122 Asian multi-ethnic patients who i) age distributions (years) were 61.1±10.7/63.0+12.0 underwent either a BBTAVF (81) or a forearm AVG (41) procedure in a tertiary referral centre. Maturation rate, maturation time, and ii) M:F ratio were 5:2/7:2 intervention rates were analyzed. Functional primary, secondary iii) Intervals between previous operations and BVT AVF (months) and overall patency rates were evaluated using the Kaplan-Meier were 51.2±13.3/47.6±12.4 analysis. 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 Results vi) Maturation periods (wks) were 4.7±1.8/4.6±1.2 The maturation rate of AVGs was higher than BBTAVFs though vii) 1 year primary & secondary patency rates were not reaching a statistical significance. The maturation time for 100%,100%/88.9%,88.9% and 3years P& S PR were 87%, BBTAVFs was significantly longer than AVGs. There was also a 87%/78.8%,88.9% (p>0.05) 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 Conclusions 1-year follow-up: 73.2% vs 34.1% (p<0.001) and 71.8% vs 54.3% i) Both groups had nodifference in age, sex, complications, (p=0.022) respectively. AVGs also required more interventions maturation periods and waiting periods. to maintain patency. When maturation rate were considered, the ii) In SS group preop basilic vein diameters were slightly enlarged overall patency of AVGs were initially superior to the BBTAVFs in (p>0.05) and 1,3 year patency rates were slightly better but not the first 25 weeks post-creation, then became inferior afterwards. 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.

100 Annals of Vascular Diseases 2016 P03-09 venous aneurysm reconstruction that was developed for relieving the patients from pain and other complication. Percutaneous transluminal angioplasty in the treatment of stenosis of arteriovenous fistulae Methods for hemodialysis Eleven patients with giant venous aneurysm of the AVF underwent Igab Krisna Wibawa1, MD Hilman Ibrahim1 surgical procedure at our hospital from August 2015 to May 2016. 1Indonesian Society For Vascular And Endovascular Surgery, The diagnoses were made by physical examination and Color Central Jakarta, Indonesia Doppler Ultrasonography. The aneurysm was repair under local anesthesia.

Background Results Thrombosis following stenosis of arteriovenous fistulae resulting in the loss of vascular access for hemodialysis is an important There were 6 male and 5 female patients ranging in age from 33 to complication in patients with chronic renal failure. Percutaneous 66 years with a mean age of 48,73 ±9,81. Plication of the aneurysmal transluminal angioplasty is being used more frequently in was performed in 6 patients,and 1 patient was venoplasty to repair the treatment of stenosis aiming at increasing the patency of central vein stenosis. Five patients were resected and repair by end arteriovenous fistulae. to end anastomosis. There were no vascular complications during the follow up period. All patients are relieved from pain, distanded mass effect, and dyspnea. Case Report Reporting a case,man 65 years old,who has undergone rutine Conclusions hemodialysis since 7 month ago. A month later,the patient underwent left radiocephlic fistulae operation and the fistulae has Surgical reconstruction of the arteriovenous fistula aneurysm been used for the least 5 month. Two week before admission,patient can be safely and effective in controlling venous dilatation and complain swollen at the left hand. The angiography resulted as achieving patency. We have 2 modality that used to repair giant direct puncture at the left cephalic vein with stenosis present > 70%, venous aneurysm, there are plication and resection anastomosis 3 cm proximal to the anastomosis. Angioplasty was performed with with or without graft. HP balloon catheter size 50 x 80. The balloon was inflated with 8 atm pressure for 2 minutes. Stenotic lesion recoil > 50 % was profounded. P03-11 Discussion Impacts of Arteriovenous Hemodialysis Shunt In recent years, several studies have demonstrated that angioplasty Location and Type in Patients having coronary is efficacious with some advantages compared to the conventional surgical treatment such as a shorter time needed to perform the Artery Bypass Graft with In Situ Left Internal procedure and shorter hospitalization, less discomfort for the Thoracic Artery patient, and lower infection rates. Complications of angioplasty Youngjin Han1 have been reported in about 2 to 16% of cases, with the most 1Division Of Vascular Surgery, Department Of Surgery, Asan common being immediate venous rupture during the procedure, Medical Center, University Of Ulsan College Of Medicine, Seoul, the formation of pseudoaneurysms, acute thrombosis and South Korea 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 Background days after angioplasty. The coronary steal in having coronary artery bypass graft (CABG) with in situ internal thoracic artery (ITA) and ipsilateral upper Conclusion extremity arteriovenous (AV) hemodialysis shunt has been reported in some cases. But the long-term clinical effect in this phenomenon Percutaneous transluminal angioplasty is an efficacious method for is not clear. the correction of stenosis of arteriovenous fistulae for hemodialysis, prolonging the patency of the fistula and enabling new interventions Objective The aim of this study was to determine the impact of upper extremity AV hemodialysis shunt location and type in patients P03-10 having CABG with in situ ITA. Management of giant venous aneurysms of arteriovenous fistula in hemodialysis patients Methods Between January 2001 and December 2014, 111 patients received [serial case] upper extremity AV hemodialysis shunt creation after CABG using Romzi Karim1, PhD Akhmadu Muradi1 in situ TIA were analyzed retrospectively in this study. All patients 1Indonesian Society For Vascular And Endovascular Surgery, underwent CABG using in situ left ITA (LITA) to revascularize the Central Jakarta, Indonesia 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 Objective characteristics and outcomes. The primary end point was defined An aneurysm draining vein formation may occur because of the adverse cardiac events. repeating puncture that can weaken the wall and it can became complication. This study shows the efficacy and results of giant

Annals of Vascular Diseases 2016 101 Poster Presentation Results P03-13 The mean interval periods of AV hemodialysis shunt creation after CABG were 34months. After AV shunt creation, the mean follow- Comparison of 4 weeks and 8 weeks AV up periods were 39 months. Kaplan-Meier analysis showed that the two groups had no significant difference in the primary end point (P Fistulae Maturation = 0.257) and the overall survival (P = 0.167) during follow-up. In Muhammad Fauzi, Raden Suhartono multivariate logistic regression analysis, previous cerebrovascular 1Cipto Mangunkusumo Hospital Indonesia, Central Jakarta, disease (harzard ratio, 2.686 [95% CI, 1.16 to 6.16], P = 0.020) and Indonesia 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. 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 Conclusion and treatment causing of stage V CKD patients. Couple studies The ipsilateral AV hemodialysis shunt creation is not associated showed that artery-vena fistulae (AV Fistulae) decreased morbidity with the adverse cardiac events in patients having CABG with in and mortality of CKD patients. After AV Fistulae creation, it needs situ LITA during follow-up. But AV shunt using the prosthetics time for maturating so that it has adequate for vascular access graft can increase the risk of late cardiac adverse events. 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.

P03-12 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. 6 Weeks Maturity Rate of Arteriovenous Fistula Design of this study is prospective observational of all patient who and the Affecting Factor were undergone AV Fistulae creation at Cipto Mangunkusumo Wahyu Wardhana, MD Dedy Pratama hospital from March to June 2015. Patients were assessed using USG Doppler before operation, 4 weeks, and 8 weeks. 1Vascular Indonesia, Central Jakarta, Indonesia

Result showed that maturity of 4 and 8 weeks AV Fistulae was Introduction 27.69% and 58.46% respectively. There was no different maturity Guideline of KDOQI defines as the “rule of 6s” for the criteria of 4 and 8 week AV Fistulae. 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 P03-14 avshunt reached 62%. Correlation Tip Position of Catheter Double Lumen with Hemodialysis Continuity and Objective Comfort of Long Term CDL Using To determine the outcome of the arteriovenous fistula (AVF) created Oky Noviandry Nasir, Dedy Pratama in our centre and the other hospital in Jakarta, Indonesia. Mainly to 1Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia study asses 6 weeks maturity rate of AVF. And the affecting factor. Hemodialysis is the most common procedure of renal replacement in patients with stage 5 chronic renal failure, vascular access Methodology complications and morbidity as a result of access is a major cause of Prospective observational study of all patients who underwent AVF hospitalization. In 1989 to the present position of the tip of double creation at Ciptomangunkusumo hospital and the other hospital in lumen catheter is still no uniformity. The core of this difference is jakarta form march 2015 to may 2015, Assesment of patient, clinical of interest to patient safety and the desire for optimal performance and ultrasound done at pre op, 4 weeks, 6 weeks and 8 weeks. At in terms of catheters for hemodialysis access adequate. The study 6 weeks assesment for maturity Data on patients demographic, pre design was a prospective cross-sectional study of patients with morbid disease, operation procedure were analyzed. 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 Results pull quick CDL and force of blood when hemodialysis. Result 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. The results obtained CAJ thorax X-ray positioning more To create the av fistula in the elbow area, preoperative brachial comfortable for patients compared to the SVC. Statistical test artery diameter of less than 3 mm 75% have a tendency not to be shows that there is a significant relationship between Ro Thorax mature. While in the wrist area of the radial artery diameter less with comfort (p <0.05). Position tip at SVC have blood flow <300 than 2.5 mm have a tendency to not mature 41.4%. In this study mL. whereas in patients with tip position in the CAJ have blood found no association between comorbid age, sex, blood pressure, flow> 300 mL. Statistical tests showed no significant association smoking habits and weight at maturity av fistula 6 weeks. between ro thorax with blood flow (p> 0.05).

Conclusion 6 Maturity av fistula 6 weeks comorbidities not related to age, sex, blood pressure, smoking habits and weight.

102 Annals of Vascular Diseases 2016 P03-15 P03-16 Vascular Access Failure with Vertebral Vascular access surgery for elderly hemodialysis Subclavian Steal due to Subclavian Artery patients Stenosis and Myocardial Ischemia in a Jinichi Iwase1, Dr Hirohisa Yoshitomi1 Hemodialysis Patient with a Left Internal 1Narita Memorial Hospital, Toyohashi, Japan Thoracic Artery Coronary Bypass Graft Yuichi Ito1, Dr. Akihito Tanaka2, Dr. Takeshi Hattori3 Objectives 1Nagoya Ekisaikai Hospital, Nagoya, Japan, 2Japanese Red Cross The purpose of this study is to assess the outcome of surgically Nagoya Daini Hospital, Nagoya, Japan, 3Kyoto Katsura Hospital, created vascular access and clarify what factors affect the vascular Kyoto, Japan access conduits patency in the elderly.

Background and Objective Methods The cause of subclavian steal syndrome are subclavian artery A retrospective study was made of patients with end stage renal stenosis or arteriovenous hemodialysis fistula. Inadequate disease required hemodialysis from 2011 to 2014 at our vascular retrograde blood flow of vertebral subclavian steal can lead access referral institutes. All vascular access surgeries were vascular access failure and myocardial ischemia in hemodialysis performed in patients forearm with autologous vessels (AVF) patients with left internal thoracic artery (LITA) coronary artery or prosthetic grafts(AVG) when inadequate for AVF. Among the bypass Graft (CABG). 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 Methods were allocated to group B (21 AVFs and 1 AVG). Elderly patients We report on a 76-year-old chronic hemodialyzed female with end- demographics such as gender, maturation time, diabetes mellitus stage renal disease (ESRD) who underwent CABG surgery using (DM), and intervention were statistically analyzed between group LITA previously. She had vascular access failure due to reduction of A and B. 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 Results myocardial ischemia. Of 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 Results non-elderly patients were 25% vs 45% (p= .003). The secondary Angiographic left subclavian stenosis was defined as 90% stenosis patency rates at 2 years were 44% vs 67% (P= .017). Significant and 50mmHg pressure difference across the lesion. Angiography difference were not found regarding gender (6 males and 3 femal in revealed slow and low flow to LITA and laminar flow of left group A, 10 males and 10 females in group B, p= 0.83), maturation vertebral artery (VA) on origin. Magnetic Resonance Angiography time (33.5 days vs 41 days, p= 0.71), DM (42% vs 37%, p=0.23), (MRA) revealed bilateral intracranial VA. The diagnosis of vertebral and intervention (42% vs 45%, p=0.83). subclavian steal syndrome was made. There are no neurological symptoms associated with the vertebral subclavian steal. Conclusions This study revealed surgically created vascular access conduits The cause of vascular access failure was inadequate retrograde in the elderly have significant lower patency rate compared with flow of vertebral subclavian steal due to left subclavian stenosis the non-elderly. In the elderly, intervention had little correlation in and maintaining blood flow to LITA. However, the flow of LITA maintaining patency due to poor vessel quality. The number were was reduced, therefore inadequate flow of LITA caused myocardial limited and randomized controlled study will be needed to confirm ischemia. Percutaneous stenting of the left subclavian artery via this results. left brachial artery was performed successfully. After stenting, angiography revealed adequate flow of LITA and left subclavian artery, and antegrade flow of left VA. P03-17 Conclusion This is the first case that the subclavian artery stenosis caused Hemodialysis associated carpal tunnel vascular access failure and myocardial ischemia in spite of the syndrome; single center experience presence of subclavian steal in hemodialyzed patients with CABG Jae Young Park1, Dr Chang Hyun Yoo1 surgery. Percutaneous stenting for stenosis is very effective to 1Busan Vascular Clinic, Busan, South Korea improve subclavian steal, myocardial ischemia, and vascular access failure in hemodialyzed patients with CABG surgery using LITA. Background and objectives Carpal 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.

Methods From 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.

Annals of Vascular Diseases 2016 103 Poster Presentation

Results Keywords: Arteriovenous fistula (AVF); Hemodynamics; Micro- Total 73 carpal tunnel surgeries were performed for 63 patients in particle image velocimetry (μ-PIV); 3D printing technology; Wall our vascular center. Median age was 61.0 years, and there were shear stress (WSS) 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 P03-19 in 10 patients (10/63, 15.9%), Median follow-up period was 6 month. Hand paresthesia was disappeared within 2 weeks in most The unusual causes of central venous stenosis cases (65/73, 89.0%) after CTS surgery. In 5 cases (5/73, 6.8%), in patients with arteriovenous access paresthesia was slowly improved and disappeared in 3 months. But, Dr. Kittisak Thanu1, Dr. Tanop Srisuwan1,2, Kittipan Rerkasem1,3 in 3 patients (3/73, 4.2%), there was no clinical response after CTS 1 surgery. And 1 of these 3 patients, steal syndrome was diagnosed NCD Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Chiang and hand paresthesia was improved after arteriovenous fistula 2 ligation. There was no significant postoperative complication. Mai, Thailand, Interventional radiology unit, Department of Radiology Faculty of medicine, Chiang Mai University, Chiang Mai, Thailand, 3NCD Center of Excellence, Research Institute of Conclusion Health Sciences, Chiang Mai University, Chiang Mai, Thailand In our experience, HD-associated CTS can be improved with simple CTS surgery without significant complication. Vascular Background surgeons should consider CTS surgery for HD-associated CTS during regular HD access surveillance. Central 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 P03-18 patients without history of central venous catheter insertion. Fabrication of Artificial Arteriovenous Fistula and its Flow Field and Shear Stress Analysis Objectives using u-PIV Technology To evaluate the causes of CVS in patients without a history of previous catheter insertion 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 Methods We retrospectively review patients in our hospital. We collected data from computed tomographic venography (CTV) result Introduction between January 2010-December 2012. Patients who was Radio-cephalic arteriovenous fistula (RC-AVF) is an operation performed CTV due to CVS were include in our study. Clinical performed to achieve vascular access for hemodialysis. Although picture, history of hemodialysis catheter placement and CTV it is a very reliable and well-known method, RC-AVF still has high findings were recorded and analyzed. This study was supported by rates of early failure depending on the vessel condition. Health Systems Research Institute of Thailand

Objectives Results The blood shear stress around the anastomosis site and the 76 patients was enrolled in this study and we distributed CVS vascular access failure caused by thrombosis secondary to by side to study the effect of catheter insertion. In 152 sides of stenosis formation, as well as vascular access re-occlusion after central vein were assessed by taking into account the presence of percutaneous interventions contributes to failures. the history of central vein catheter insertion. Patients with history of central vein catheter insertion had 6.93 times higher chance to Materials and Methods develop CVS than those without such history (p <0.0001). 22 CVS (14.5%) was occurred in patients without history of hemodialysis We fabricate in-vitro 3D RC-AVF using poly (dimethylsiloxane) catheter insertion (in that side) previously. External compression (PDMS) and 3D printing technology to understand this mechanism by aortic branch or aortic dissection was found in 10 patients. 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. Conclusion Major cause of CVS was still associated with the history of Results hemodialysis catheter insertion. However, CVS can occur in patients who did not have a history of catheter placement and The results are confirmed by a numerical simulation. Accordingly, one of common cause is due to the external compression of aortic the in-vitro AVF model agrees well with the simulations. branches.

Conclusions This research would provide the future possibility of using the proposed method to reduce in-vivo AVF failure for various conditions in each patient.

104 Annals of Vascular Diseases 2016 P03-20 Objectives We aimed to investigate the results of vascular access formation Nutritional Status among End Stage Renal and the risk factors associated with early dialysis suitability failure Disease Patients with arteriovenous access in patients older than 70 years old. at Maharaj Nakorn Chiang Mai Hospital, Thailand Materials and Method Dr. Jukkrit Wungrath1, Ms. Orapin Pongtam1,2, Ms. Paweena Vascular access creation procedures that were performed in Thongkham1,2, Ms. Waranporn Na Chiangmai1, Ms. Nipaporn elderly patients (≥70 years old) at a tertiary medical center by Pinmars1, Kittipan Rerkasem1,2 single surgeon between March 2012 and November 2015 were 1NCD Center of Excellence, Research Institute of Health Science, retrospectively reviewed. “Early dialysis suitability failure” was Chiang Mai University, Chiang Mai, Thailand, 2NCD Center & defined as an access that cannot be used successfully for dialysis Division of Vascular and Endovascular Surgery, Department of by the third month following its creation despite radiological or Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, surgical intervention. Thailand Results Background During the study period, 53 patients had 58 new accesses. There Diet plays a critical role in the care of patients with renal failure. were 29 autogenous accesses (4 forearm, 25 upper arm) and 29 A well-planned diet can replace lost protein and ensure efficient prosthetic accesses (24 forearm, 5 upper arm). 23 patients (40%) utilization of ingested proteins through provision of adequate needed central venous catheter for urgent hemodialysis, and 22 calories. 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 Objective patients was 80% (46/58), and immediate occlusion rate happened To investigate nutrition status among end stage renal disease in 4 (7%) patients. In risk factor analysis for early dialysis suitability patients with hemodialysis in Maharaj Nakorn Chiangmai Hospital. failure, the presence of peripheral vascular disease is independent risk factor (p=0.013). Method Conclusions The researcher collected patient’s biochemical data from medical record of hemodialysis unit during November 2014 to January The 70 years and older patients who need vascular access surgery 2015. The instruments used in the research was Modified from have poor prognosis and it reinforces the need of careful selection Bhumibol Adulyadej Hospital Nutrition Triage, which is the and evaluation prior referral. In these patients, the need of artificial established method in Thailand. This study was supported by the graft was high, and the existence of peripheral vascular disease was Health Systems Research Institute, Thailand. independent risk factor for early dialysis suitability failure.

Results 120 random subjects had body mass index (BMI) less than 18.5 kg/ P03-22 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 Primary Patency Rates of Arteriovenous Fistula pressure before dialysis was 133.80 ± 27.42/70.50 ± 12.75 mmHg, for Haemodialysis: A Retrospective Analysis blood urea nitrogen and serum creatinine before dialysis was 49.28 1 2 3 ± 27.28 mg/dl and 7.26 ± 3.00 mg/dl, respectively, serum albumin Charley Simanjuntak , Dr. Dedy Pratama , Dr. Aria Kekalih 4.00 ± 0.50 mg/dl potassium 4.56 ± 0.87 mEq/l phosphorus 3.99 1Department Of Surgery Cipto Mangunkusumo Hospital Indonesia, ± 1.89 mg/dl, Dietary energy and protein intake was 19.55 ± 6.75 Jakarta, Indonesia, 2Vascular and endovascular surgery division, kcal/kg/day and 0.82 ± 0.60 g/kg/day, respectively. The percentage Cipto Mangunkusumo hospital, Jakarta, Indonesia, 3Community of mild, moderate and severe malnutrition was 70.67, 24.89 and health department, Cipto Mangunkusumo hospital, Jakarta, 4.44 respectively. Indonesia

Conclusion Background and objectives Hemodialysis patients had a risk of malnutrition, a multidisciplinary The success of haemodialysis relies on the success of the vascular team approach to the nutrition care planning and monitoring access, whether achieved with an arteriovenous fistula (AVF), an nutrition status of patients. 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, P03-21 the largest tertiary referral hospital in Indonesia, lacks data on AVF Short-term results of vascular access surgery patency rates. This study is aimed to determine the primary patency for hemodialysis in patients older than 70 years rates of AVF in Cipto Mangunkusumo Hospital. Young-nam Roh1 Methods 1Korean Society For Vascular Surgery, Goyang, South Korea A single-centre retrospective study was performed in all patients who had primary arteriovenous fistulas created at Cipto Background/Introduction Mangunkusumo Hospital during the period between January 2011 In elderly patients, creating a successful arteriovenous fistula is and December 2013. challenging because of their comorbidities and the presence of age- associated changes in vascular biology.

Annals of Vascular Diseases 2016 105 Poster Presentation Results P04-02 Of 269 patients (mean age 53.1 ± 13.9), 190 (70.6%) patients underwent brachiocephalic fistula creation, 71 (26.4%) patients Selection criteria of endovenous ablation and underwent radiocephalic fistula creation, and 7 (2.6%) patients stripping and its performing rate in our hospital underwent other fistula types creation during the two-year study Takahiro Imai1 period. The first year patency rate was 71.4%. 1Department Of Vascular Surgery Nishinokyo Hospital, Nara, Japan Conclusions In this setting, the rate of AVF creation for end-stage renal disease Background and objectives patients meets the standard of the target goals set forward by the National Kidney Foundation published updated Dialysis Outcomes In 2011 Endovenous ablation for varicose vein was covered by Quality Initiative (NKF/DOQI) Guidelines. Our study suggested national insurance and after that endovenous ablation are becoming that venous diameter was significantly correlated with primary increasingly popular in Japan. We started Endovenous ablation patency rates of AVF. Other factors were not associated with treatment using ELVeS laser 980nm in 2013 and we changed primary patency. 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%. P04-01 Methods Early experience of endovenous laser ablation Endovenous ablation is a minimally invasive treatment and suitable with single radial 1470-nm diode laser for for day surgery, but not applicable to all cases. We examined the primary varicose veins factors affecting selection of operative method in our hospital. Hitoshi Endo1, Dr. Kazumi Nakamura1, Dr. Takaya Murayama1 1Kannai clinic, Yokohama, Japan Result According to the package insert provided with the ELVeS Laser device, blood vessel diameter must be less than 20mm. [Superficial Background/Introduction varicose veins] Endovenous ablation is chosen, because we can Endovenous laser ablation (EVLA) using the 980nm diode laser secure distance between fiber and the skin surface by giving TLA. and a bare- tip fiber has been covered by Japanese National Health For young woman, we make a difficult choice considering a risk system since 2011.Various laser fibers and radiofrequency ablation of pigmentation. [Growth of saphenofemoral junction tributaries] (RFA) had reported. Endovenous Ablation is usually chosen. When the tributaries are not presumed to be completely occluded according to their Objectives locations on ultrasonography, stripping is chosen. [Patients on oral anticoagulants and antiplatelet drug] We perform Endovenous To assess the results of the treatment with a single radial 1470-nm ablation with less bleeding during surgery. [Highly meandering diode laser for the primary varicose vein, we investigate the early blood vessel] Endovenous ablation is chosen because the guidewire experience of endovenous laser ablation (EVLA) with a single is more likely to pass through the vein than stripper. [Varicose veins radial 1470-nm diode laser. complicated by thrombophlebitis] Stripping was chosen before, now Endovenous ablation is mostly chosen. [Recurrent case] We Materials and Methods decide method considering the last operative method. [Operation invasion] In stripping, the surgical wound is small and the day From January to June 2016, about 100 patients who underwent EVLA surgery is possible, therefore operative method is not judged based with a single radial 1470-nm diode laser, ENDOTHERMELASER™ on the patient wishes to have the day surgery or their cosmetic 1470(LSO Medical) for primary varicose veins were studied. aspects. 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 Conclusions percutaneous puncture method. Laser energy was administered at Here we report examination results of the factors affecting selection 10W of power with constant pullback of the laser fiber from 2cm of operative method. distal SFJ and SPJ under the tumescent local anesthesia.

Results All treated veins were occluded and major complications such as P04-03 deep vein thrombosis and skin burns were not seen. Improvements of deep vein reflux following radiofrequency ablation for saphenous vein Conclusions incompetence EVLA using a single radial 1470-nm laser is an efficient and safe 1 2 1 treatment for primary varicose vein. In Mok Jung , Dr. Suh Min Kim , Dr. Jung Kee Chung 1SMG-SNU Boramae Medical Center, Seoul, South Korea, 2Dongguk University Hospital, Ilsan, Gyeongkee --Do, South Korea

Objectives The aim of this study was to describe the changes of deep vein reflux after radiofrequency ablation for great saphenous vein incompetence.

106 Annals of Vascular Diseases 2016 Materials and Methods Conclusions The data on 139 limbs which were treated with radiofrequency We have results that this new approach for superficial varicose ablation for great saphenous vein incompetence were prospectively veins is going well. collected and reviewed.

Results Deep vein reflux was present in 43 of 139 limbs (30.9%). There P04-05 were no significant differences in the rate of successful closure, Relationship between the right heart function the incidence of procedure-related complications, and the improvements of symptoms and quality of life between the limbs and varicose veins of the lower limbs in patients with or without deep vein reflux. With a mean follow-up of 5.9 undergoing hemodialysis months, the peak reflux velocity and duration of reflux were Yasuhiro Ozeki1, Ph.D. Kazuo Tsuyuki1, Ph.D. Shinich Watanabe2, improved in all limbs with deep vein reflux and it was completely Yuki Ishida1, M.D., Ph.D. Kunio Ebine1, M.D., Ph.D. Susumu corrected in 13 limbs (30.2%) after radiofrequency ablation. 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., 1 1 Conclusions Ph.D. Kenji Yamazaki , M.D. Satoru Toi 1 2 The presence of deep vein reflux does not affect the treatment Odawara Cardiovascular Hospital, Odawara, Japan, Kanagawa outcomes of radiofrequency ablation for great saphenous vein Institute of Technology, Atsugi, Japan incompetence and is improved in all patients. Deep vein reflux is not a barrier to performing radiofrequency ablation. Background and Objectives We 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 P04-04 blood flow velocity of lower limb veins in hemodialysis patients was significantly higher than in healthy adults. In our previous Examination of the treatment for surgical study, pulse Doppler waveforms of the common femoral vein were varicose veins - Stab Avulsion vs. Varices pulsatile and synchronized with the heart rate in dialysis patients, Ablation whereas they were constant in healthy adults, suggesting that the 1 1 1 right ventricle is involved in an increase in the velocity of lower Kazumi Nakamura , Takaya Murayama , Hitoshi Endoh limb venous blood flow and beats in the former. In this study, 1Kannnai Medical Clinic, Yokohama, Japan we examined the relationship between the right heart function in dialysis patients or healthy adults. Introduction FDA approved Diomed 810nm system (Angio Dynamics, Methods Queensbury, NY, USA) as a brand-new treatment for saphenous The subjects consisted of 8 patients (hemodialysis group), type varicose veins in 2002. In next 10years, we put some devices undergoing dialysis, with sinus rhythm and a left ventricular into practical use, for example 980nm and 1470nm Endovenous ejection fraction (LVEF) of ≥50% in the absence of valvular Laser Ablation (EVLA) and Radio Frequency Ablation (RFA). disease, such as tricuspid valve insufficiency, and 8 healthy adults Now in Japan these have been recognized as major method of (non-hemodialysis group). The right heart function was measured, treatment for truncal varicose veins. and the results were compared using the Mann-Whitney U-test. As parameters of the right heart function, we used the tricuspid annular On the other hand, what should we do for superficial varicose plane systolic excursion (TAPSE) and fractional area change (FAC) veins? I guess many surgeons do phlebectomy like Stab Avulsion, on echocardiography. and other surgeons do sclerotherapy or nothing. Which way to take depends on surgeon. In our clinic, we have done“Varices Results Ablation”for superficial varicose veins since September 2014. The mean TAPSE (mean_standard deviation)(paired test) in the It is laser ablation using bare-tip fiber under the tumescent local hemodialysis and non-hemodialysis groups was 23.5_5.5 and anesthesia. 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 Materials and Methods the former (p<0.001). First, you puncture superficial varicose veins with a long type indwelling needle, like barbecue. And then, you replace bare-tip Conclusions fiber with the indwelling needle under local anesthesia. After that, The right heart function of the hemodialysis patients was you can do laser ablation. This time, we use the 810nm or 1470nm significantly higher than in the healthy adults. It may have advanced diode laser (Endovenous Laser Treatment DT-810 / Venocure through continuous internal shunt venous return loading, increasing 1470nm, DIOTECH, Korea). We named this method as“Varices the lower limb venous blood flow velocity and contributing to a Ablation”. decrease in the incidence of lower limb varices.

Results We 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.

Annals of Vascular Diseases 2016 107 Poster Presentation P04-06 Objective Our aim was to determine whether GSV measurements from Comparison of Radiofrequency Ablation computed tomography angiography (CTA) of lower limbs closely and 1470nm Endovenous Laser Ablation for correlated with duplex ultrasonography (US), and if it could be Treating Varicose Veins used as primary mode of assessment. Yuka Sakurai1, Dr Hiroyuki Abe2, Dr Shota Kita1, Dr Hirotoshi Suzuki1, Dr Daijyun Ro1, Dr Kiyoshi Chiba1, Dr Hirokuni Ono1, Dr Methods 1 1 1 Makoto Ono , Dr Yousuke Kitanaka , Dr Masahide Chikada , Dr Patients from January 2010 to Feburary 2016, who underwent both 1 1 Hiroshi Nishimaki , Dr Takeshi Miyairi CTA of their lower limbs and US vein-mapping within 3 months 1St.marianna University School Of Medicine, Kawasaki, Japan, were included. Measurements were taken at 5 levels: proximal 2Keiai clinic, Yokohama, Japan thigh, mid-thigh, knee, calf and ankle. CTA measurements were Background taken both anteroposteriorly (AP) and laterally. US measurements were perpendicular to skin surface. Pearson correlation coefficient Endovenous thermal ablation is one of the most accepted treatment was calculated at each level. options for varicose veins

Results Objective 472 CTA points from 25 patients were collected (82 proximal To compare the efficacy of radiofrequency ablation (RFA) and thigh, 140 mid-thigh, 75 knee, 129 calf, 46 ankle). 282 US points 1470 nm endovenous laser ablation (EVLA) in the treatment of were obtained (65 proximal thigh, 72 mid-thigh, 50 knee, 67 calf, patients with varicose veins. 28 ankle). Overall correlation was moderately positive(r=0.48 laterally; 0.46 AP). At both proximal and mid-thigh, moderate Methods positive association was found (rproximal thigh=0.57 laterally and 0.50 AP; rmid-thigh= 0.58 laterally; 0.47 AP). Very strong positive We shared with the crowd RFA to the varicose vein and EVLA correlation was found at the knee AP(r=0.84) and laterally(r=0.81). from July, 2015 to May, 2016. The age before the way, the sex Strong positive correlation was found at the calf laterally(r=0.68) ratio, CEAP classification, cauterization time during an operation, and a moderately positive one AP(r=0.41). Very strong positive the cauterization distance and a sharp pain after an operation sell at correlation was found at the ankle laterally(r=0.92) and a strong a sacrifice price subcutaneously, and relational item is endothermal positive one AP(r=0.63). heat-induced thrombosis (EHIT).

Conclusion Results CTA measurements are moderately positively correlated with US. A total of 57 patients (76 limbs) and 32 patients (41 limbs) were Lateral CTA measurements provide better correlation than AP. included in the RFA and EVLA groups, respectively. No significant CTA measurements at knee and ankle levels showed the strongest differences were observed in the age, sex, and CEAP classification correlation. Pre-operative US vein mapping is necessary to provide between the two groups. Occlusion rates at one month were 100% more accurate assessment of GSV suitability as a bypass conduit. 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 P05-02 the RFA group. No procedure-related major complications (DVT, pulmonary embolism, or skin burns) occurred in this study. Transdermal Nitroglycerin for Peripheral Arterial Disease 1 1 1 Conclusion Koksal Donmez , Dr. Bortecin Eygi , Dr. Sahin Iscan , Dr. Habib Cakir1, Dr. Ismail Yurekli1, Dr. Nihan Karakas Yesilkaya1, Dr. Mert We suggest that RFA and EVLA have similar success rates and are Kestelli1 better suited for the short-term treatment of patients with varicose 1 veins. Results of longer-term clinical studies are awaited for further Department Of Cardiovascular Surgery, Katip Celebi University evidence. Izmir Ataturk Training And Research Hospital, Izmir,turkey, Izmir, Turkey

Introduction P05-01 Local treatment of peripheral arterial disease should be considered Computed Tomography angiography alone is as an alternative to oral treatment in elder patients. inadequate for evaluation of the great saphenous vein conduit for infrainguinal bypass Objectives 1 1 1 We aimed to present a case who is treated with transdermal Cassandra Hidajat , Dr Hansraj Bookun , Dr Daniel Nour , Ms nitroglycerin for peripheral arterial disease. Kai Leong1 1The Royal Melbourne Hospital, Melbourne Health, Parkville, Australia Method A eighty-three year old male patient was followed-up by our outpatient clinic for peripheral arterial disease. He had a Background femoropopliteal bypass grafting operation for his right lower The great saphenous vein (GSV) is a common conduit for extremity before and graft was already occluded. Measuring blood infrainguinal bypass, with vein mapping performed to assess its flow volume at ankle level was shown as an important method for suitability.

108 Annals of Vascular Diseases 2016 this disease. Blood flow was measured as 15 ml/min at posterior P05-04 tibial artery. Transdermal 5 mg nitroglycerin patch/daily was initiated. Patch was localized at dorsum of foot. Acute arterial thromboembolism of left lower extremity in a patient with hypertension Results and diabetes receiving warfarin due to atrial Patient was controlled a week later. Pulses of popliteal, dorsalis fibrillation pedis artery and posterior tibial artery very still absent. Blood flow Kazim Ergunes1, Dr Hasan Iner1, Dr Erturk Karaagac1, Dr Ismail was measured as 100 ml/min at posterior tibial artery (almost five Yurekli1, Dr Sahin Iscan1, Dr Yuksel Besir1, Dr Bortecin Eygi1, Prof times of normal flow). Varicosities appeared at leg and they were Ali Gurbuz1 similar to ones in arteriovenous fistula. 1Izmir Katip Celeby University Atatürk Training and Research Hospital, Izmir, Turkey 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. Background Acute ischemia resulting from embolic or thrombotic arterial occlusion is associated with morbidity and mortality. We presented Discussion a patient with hypertension and diabetes receiving warfarin due to We believe that local treatment of peripheral arterial disease may atrial fibrillation. be a strong alternative of common oral treatment, in especially elder patients. Method

A 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. P05-03 Pulses of the popliteal, tibialis anterior and tibialis posterior arteries Our surgical strategy in a smoker patient with were nonpalpable. The hand-held Doppler found no audible signals hypertension, diabetes and hyperlipidemia in the the popliteal, tibialis anterior and tibialis posterior arteries. The Doppler ultrasonography showed occlusion in the popliteal, having right femoral artery stenosis tibialis anterior and tibialis posterior arteries. Kazim Ergunes1, Dr Erturk Karaagac1, Dr Ismail Yurekli1, Dr Ihsan Peker1, Dr Koksal Donmez1, Dr Tayfun Goktogan1, Prof Results Levent Yilik1, Prof Ali Gurbuz1 Thromboembolectomy was performed to the femoral, popliteal, 1Izmir Katip Celeby University Atatürk Training and Research tibialis anterior and tibialis posterior arteries. Abundant thrombus Hospital, Izmir, Turkey was thrown out from femoral, popliteal, tibialis anterior and tibialis posterior arteries. Pulses of these arteries recovered postoperatively. Objectives Low-molecular-weight heparin was given postoperatively. The Peripheral arterial disease is a worldwide problem that has patient was discharged five days after operation with warfarin significant impact on quality of life and can also lead to mortality. treatment. We presented a case with right femoral artery stenosis. Conclusions Methods Acute arterial thromboembolism is important complication in A 65-year old man was hospitalized in our clinic in April , 2016. patients with hypertension, diabetes and atrial fibrillation. The He had hypertension, diabetes and hyperlipidemia. The right lower thromboembolectomy is effective and safe treatment method. extremity distal pulses were non-palpable. The digital substraction angiography showed stenosis of right superficial femoral artery stenosis. P05-05 Results Hybrid surgical and endovascular intervention Operation was performed with general anesthesia. The right to management of complex iliofemoral disease femoro-popliteal bypass was performed with reversed right great Jun Hayashi1, Dr Ushida Tetsuro1, Dr Azumi Hamasaki1, Dr saphenous vein graft. The right tibialis anterior and posterior pulses Yoshinori Kuroda1, Dr Atsushi Yamashita1, Dr Ken Nakamura1, Dr recovered postoperatively. The patient was discharged 7 days after Daisuke Watanabe1, Dr Shingo Nakai1, Dr Kimihiro Kobayashi1, operation with antiplatelet and antiaggregant drugs. Dr Seigo Gomi1, Professor Mitsuaki Sadahiro1 1Second department of surgery, Yamagata University, Yamagata Conclusions City, Japan Autogenous great saphenous vein is the conduit of choice for infra- inguinal bypass. Background Endovascular 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.

Annals of Vascular Diseases 2016 109 Poster Presentation

Case reports Discussion A 75-year-old male presented with left calf claudication. An ankle- Cuff–combined PTFE grafts had been developed to prevent intimal brachial index (ABI) was 0.46 (left). Computed tomographic hyperplasia on the anastomosis site due to wall shear stress. Some (CT) scan revealed a long segment of total occlusion from the left previous report described higher patency rates in cuff-combined external iliac artery (EIA) to the middle superficial femoral artery PTFE grafts than no cuff-combined PTFE grafts. However, it is (SFA). One stage hybrid therapy was performed by cardiologist and still controvertial. In addition, recent development of heparin- vascular surgeon at hybrid operating theater. At first, the anterior bonding PTFE grafts was expected to imporove lomg term patency aspect of CFA was incised longitudinally and endarterectomy was in ATKFPB. 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 Conclusion procedure, EVT was performed for SFA. Postoperative course was On the basis of our outcomes, cuff-combined PTFE grafts did uneventful. The patient is asymptomatic with an improved ankle- not contributed to higher patency rates as compared to no cuff- brachial index of 1.02. Another patient was a 71-year-old male combined PTFE grafts. In the future, PTFE grafts in ATKFPB will with complains left calf claudication. On CT, he had total occlusion be replaced by heparin-bonding PTFE grafts. 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. P05-07 Inconsistent Result of Target Lesions between Conclusions Completion Angiography and Duplex Follow- The surgical results of hybrid therapy were excellent. This attractive procedure was expected to be effective, safe and less-invasive up Study alternative to conventional approach for patients with complex Prof Taeseung Lee1, Daehwan Kim1 iliofemoral disease. 1Seoul National University Bundang Hospital, Sung-nam, South Korea

P05-06 Purpose Percutaneous transluminal angioplasty (PTA) is widely being used Comparison of mid-term results of femoro- for femoropopliteal artery (FP) lesions and immediate technical popliteal bypass with no cuff-combined PTFE success is usually defined as a residual stenosis of less than 30% on final angiography. However, final angiography may not truly reflect grafts and cuff-combined PTFE grafts the real outcome of the procedure since it is mostly performed at Ryo Kanamoto1, Dr. Shinichi Hiromatsu1, Dr. Kanako Sakurai1, a time point before elastic recoil occurs. Therefore we compared Dr. Shinichi Imai1, Dr. Shohei Yoshida1, Dr. Mau Amako1, Dr. the results of final angiography with duplex ultrasound (DUS) Hiroyuki Otsuka1, Dr. Satoru Tobinaga1, Dr. Seiji Onitsuka1, Prof. performed within 48 hours after the procedure to assess whether Hiroyuki Tanaka1 final angiography accurately reflects the technical success of PTA. 1Department Surgery Of Kurume University, Kurume City, Japan Methods Objective The data of 152 atherosclerotic lesions (116 patients) of the FP The purpose of this study is to compare mid-term results between between March 2013 and February 2016 were retrospectively no cuff-combined PTFE grafts (Advanta VS) and cuff-combined reviewed. All lesions were treated primarily with balloon PTFE grafts (Flared-end Advanta VXT and Distaflow) in above- angioplasty with or without selective spot stenting. Final the-knee femoro-popliteal bypass (ATKFPB). 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. Methods We retrospectively reviewed 67 patients who underwent 79 ATKFPB between April 2003 and March 2014. No cuff-combined Results PTFE grafts were used for 37 limbs (29 men and 2 women, mean FP total occlusion in 51 limbs (33%). The length of the target vessel age 73.1 years) ATKFPB. The cuff-combined PTFE grafts were was 15±8.2cm. Technical success was achieved in 149 of 152 limbs used for 42 limbs (24 men and 12 women, mean age 73.8years) on final angiography. On follow-up DUS, 7 limbs showed moderate ATKFPB. We compared the mid-term clinical outcomes between residual stenosis and 7 cases showed occlusion. Seven thrombotic 2 groups. 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. Results There were no significantly differences between the two groups regarding to characteristics demography. The primary patency Conclusions rates were not significantly different between no cuff-combined Our results suggest that there is a discrepancy between final PTFE grafts and cuff combined PTFE grafts at 5 years after angiography and follow-up DUS in up to 9% of FP PTA cases. The surgery (87.5% vs. 78.6%). The secondary patency rates were timing of final angiography does not allow for accurate evaluation also no significantly different between two groups at 5 years after of elastic recoil or thromboembolic lesion by local thrombus after surgery (97.2% vs. 83.3%). There were no statistically significant PTA. Therefore the definition of technical success rate as measured differences between the two groups. However no cuff-combined by final angiography should be used with caution since it may PTFE grafts tended to show higher patency rate compared to cuff underestimate the “true” procedural technical success. combined PTFE graft.

110 Annals of Vascular Diseases 2016 P05-08 approach offers an additional option to a vascular surgeon for successful recanalization. Our case report highlights 3 cases where Prevalence and Risk Factors for the Peripheral successful hybrid open retrograde approach was able to achieve Neuropathy in Patients with Peripheral Arterial recanalization of long chronic total occlusion. Occlusive Disease Se Young Kim1, Dr Ho Kyeong Hwang1, Dr Kyung Bok Lee1, Dr Presentation of cases Sol Lee1, Dr Ji Woong Jung1, Dr Yu Jin Kwon1, Dr Dong Hui Cho1, The three cases in our series presented with critical limb ischaemia. Dr Sang Su Park1, Dr Jin Yoon1, Dr Yong Seog Jang1 All three cases had undergone duplex imaging of the affected 1Seoul Medical Center, Seoul, South Korea 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 Background/Introdection fluoroscopy failed we proceeded with a cutdown or open approach. Peripheral neuropathy (PN) is known as a major contributor of the worsening of ischemic symptoms and the foot ulceration in patients Discussion with peripheral arterial occlusive disease (PAOD). However, there are few studies reporting the prevalence and risk factors for PN in Retrograde approach usually offers a better chance of successfully PAOD. 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 Objectives additional pathway for puncturing the target vessel when duplex This study aimed to evaluate these issues for PN and to establish imaging or fluoroscopic guidance fails. the importance of screening as additional treatment target for PN in PAOD. Conclusion Open approach is usually attempted as a last resort by many Materials and Methods endovascular surgeons. However procedural time, contrast and A total of 52 limbs with PAOD were enrolled from January 2011 radiation usage could have been cut short in cases where the to December 2012. PN was divided into radiculopathy, ischemic distal target vessels pose a technical challenge for approach via a PN (IPN), and diabetic PN (DPN), based on electromyographic percutaneous method. findings. We investigated the prevalence of overall PN and subtypes of PN and then analyzed the risk factors.

Results P05-10 The prevalence of overall PN in PAOD was 43 of 52 limbs (82.7%). Endovascular Treatment of extensive Aortoiliac In terms of subtypes of PN, the prevalence rate of radiculopathy Occlusive Lesions: Single-Center Experiences and IPN was 30.8% and 23.1%, respectively. DPN showed in 22 HaengJin Ohe1, Dr. Hyun Kyu KIM2, Dr. Mi Hyeong KIM2, Dr. limbs (73.3%) among 30 diabetic limbs. There was no significant 2 2 correlation between each type of PN and ischemic symptoms. Kang Woong JUN , Dr. Jeong Kye HWANG , Dr. Jang Yong KIM2, Dr. Sun Cheol PARK2, Dr. Ji Il KIM2, Dr. Yong Sung WON2, Our analysis showed that coronary artery disease (CAD) was a 2 2 significant risk factor (P=0.01) for IPN, however, did not identify Dr. Sang Seob YUN , Dr. In Sung MOON any significant risk factors for DPN. 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 Conclusion Surgery, The Catholic University of Korea College of Medicine, This present study indicated that most patients with PAOD had Seoul, South Korea 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 Background and objectives treatment target in patients with PAOD. 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. P05-09 The Open Retrograde Approach as an Methods Retrospective study was done from prospectively registered data Alternative for Failed Percutaneous Access for the patient with aortoiliac occlusive disease(AIOD) treated for Difficult Below the Knee Chronic Total by endovascular means in vascular and transplantation surgery in Occlusions - A Case Series Seoul St. Mary’s hospital from May 2012 to May 2016. Patient’s 1 clinical characteristics, procedure in details and post operative Saravana Kumar record were summarized. 1Dr Saravana Kumar, Kuala Lumpur General Hospital, Jalan Pahang, Malaysia Results Nine patients was enrolled. The mean age was 55.5 years (range, Abstract 43-67 years). The indication of the treatment was 6 acute attack on Retrograde puncture via patent pedal vessels can be attempted chronic AIODS, 1 chronic limb threatening Ischemia and 2 chronic in failed antegrade approach for infrapopliteal long chronic total short distance claudication. Thrombectomy was done in 6 cases : occlusion. However in cases where the pedal vessels are unable to 5 open thrombectomy and 1 AngioJet thrombectomy. Stents was be visualized via duplex ultrasonography or fluoroscopy an open used in all cases including 1 covered stent. The median procedure

Annals of Vascular Diseases 2016 111 Poster Presentation time was 251 minutes (range, 115-395 minutes). The 30-day post P05-12 procedural mortality and morbidity rate was 0%. Three patients had compartment syndrome and fasciotomy. Two of 3 patients Can postoperative ST-segment change and had a skin graft. With a mean follow-up of 574 days), 100% of blood pressure variability predict short term reperfusion is valid. mortality in patients following major vascular surgery? Conclusions Dr. Aekapej Liwatthanakun A1, Associated professor Arintaya Endovascular treatment for AIOD showed the feasibility as Phrommintikul2,3, Ms Orapin Pongtam3,4, Kittipan Rerkasem1,3,4 alternative procedure for open surgical treatment. Long-term 1Department of Surgery, Faculty of Medicine, Chiang Mai results and further graft improvements will define their role in the 2 treatment of patients with aortoiliac occlusive disease. University, Chiang Mai, Thailand, Department 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 P05-11 Sciences, Chiang Mai University, , Chiang Mai, Thailand Drug-coated balloon for femoropopliteal Background disease: early clinical experience in real world Patients with peripheral arterial disease carried a very high risk of KW Yoon1, YJ Park1, SH Heo1, DI Kim1, YS Do2, SH Choi3, YW cardiovascular morbidity and mortality after operation. Therefore Kim1 we tried to identify predictive factors for these event. 1Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, 2Intervention Objective Radiology, Samsung Medical Center, Sungkyunkwan University 3 To evaluate the association between the ST-segment abnormality, School of Medicine, Seoul, South Korea, Intervention Cardiology, blood pressure variability, and short term mortality in patients who Samsung Medical Center, Sungkyunkwan University School of have undergone major vascular surgery. Medicine, Seoul, South Korea

Materials and Methods Purpose A prospective cohort study of 71 patients underwent major vascular To assess the clinical outcomes of Drug-coated balloon (DCB) for surgery between June 2011 and May 2013 at Maharaj Nakorn femoropopliteal (FP) disease Chiang Mai Hospital. Blood pressure was recorded for the first week after surgery, as well as electrocardiograms at baseline for the Methods first 4 postoperative days. The association between abnormality This retrospective, single-center study analyzed 31 patients (median of ST-segment, blood pressure variability (BPV), and short-term age of 75 years old, 28 male) with 40 FP lesions in 34 limbs, mortality were analysed. who underwent angioplasty with 62 DCBs (IN.PACT Admiral, Medtronic) for symptomatic FP disease (Rutherford classification Results 2-5) from April 2013 to January 2016. The primary endpoint was 9 (13%) patients had ST-segment change and were identified as primary patency, defined as freedom from restenosis (PSVR>2.4) having postoperative myocardial ischemia. 18 (25%) patients or clinically driven (CD)-target lesion revascularization (TLR). had blood pressure variability the first week of post operation. The second-endpoint was 30-day or late freedom from procedure- The median follow-up was 11 months. 13 (18%) patients died or device-related death and target limb major amputation. during follow up. Postoperative ST-change was associated with a significant increased risk of short-term mortality (hazard ratio (HR) Results 24.74%, 95% confidence interval (95% CI) 6.23-98.27). BPV was Median cumulative lesion length and diameter stenosis was 90 also associated with short-term mortality (HR 4.65, 95%CI 1.31- mm (10-360) and 90% (70-100) including 17.5% of chronic total 16.49). Also the risk of stroke in patients with BPV was 20.6 times occlusion, respectively. 42.5% of lesions involved popliteal artery higher than those without BPV. and 25% showed severe calcification. Provisional stent was used in 9 (22.5%) lesions of which major cause was post-ballooning Conclusion dissection (n=7). Primary patency at 6 months and 12 months was ST-change and blood pressure variability after major vascular 91.1% and 86.8%, respectively as Figure. The CD-TLR performed surgery are associated with a significantly increased risk of short- only in 2 patients during the follow-up (median 9.6 months, term mortality. 1-35.5). There was no procedure- or device-related death and no major amputation.

Conclusions DCB had a favorable safety and promising clinical outcomes for the treatment of patients with symptomatic FP disease.

112 Annals of Vascular Diseases 2016 P05-13 P05-14 The prevalence and risk factors of PAD in 893 Risk of Peripheral Artery Disease among elders HIV infected patients living with HIV, age and gender matched with Associate Professor Romanee Chaiwarith1, Dr. Thananchai non-HIV, as determined by Ankle Brachial Kampee3, Dr. Parichat Salee1, Dr. Nontakan Nuntachit1, Dr. 1 2,3 Index Khuanchai Supparatpinyo , Ms. Orapin Pongtam , Ms. Paweena 1 2,3 2 Associated professor Kriengkrai Srithanaviboonchai , Ms Thongkham , Dr. Patcharaphan Sugandhavesa , Dr. Taweewat 1 1 2 2 2,3 Wathee Sitthi , Dr. Arunrat Tangmunkongvorakul , Ms Chonlisa Supindham , Dr Natthapol Kosashunhanan , Kittipan Rerkasem 2 1,3 1 Chariyalertsak , Kittipan Rerkasem Division of Infectious Disease, Department of Internal Medicine, 1 Chiang Mai University, Chiang Mai, Thailand, 2NCD Center for NCD Center of Excellence and Center for AIDS and STDs, RIHES, Chiang Mai University, Chiang Mai, Thailand, 2Chiang Mai Excellence and Center for AIDS and STDs, Research Institute of 3 Health Sciences, Chiang Mai University, Chiang Mai, Thailand, Provinical Health Office, Chiang Mai, Thailand, NCD Center, 3NCD Center & Department of Surgery, Faculty of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Chiang Mai University, Chiang Mai, Thailand Introduction Background Highly active antiretroviral therapy (HARRT) has helped reduce HIV infected patients seems to be at high risk of cardiovascular death and increase life expectancy of PLHIV. Majority of PLHIV disease (CVD). Peripheral arterial disease (PAD) has been a major in Thailand will approach elderly age faster and at larger number problem in CVD because it is associated with myocardial infarction than other developing countries due to severe AIDS epidemic in and stroke. Nevertheless the incidence of PAD is still unknown in the past and better coverage of high quality HAART program. HIV infected patients. 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- Objective infected elders compared to their un-infected counterparts. To identify the prevalence and risk factors for PAD in HIV infected patients Method This comparative survey study was conducted at 12 community Method hospitals in Chiang Mai, Northern Thailand in 2015. The 30 oldest Authors prospectively recruited HIV infected patients from our HIV patients of each hospital were invited to participate in the outpatient clinic at Department of Internal Medicine, Faculty of study. The comparative group were HIV-negative or HIV status Medicine, Chiang Mai University, Chiang Mai, Thailand. Authors not-knowns who came for OPD cares at the days of the survey, assessed ankle brachial index (ABI), cardiovascular index and matched to the recruited HIV patients by age and gender. The ABI carotid intimal medial thickness (CIMT). ABI less than 0.9 was of both sides of the body were measures using the automatic ABI considered PAD. This project was supported by National Research measuring machine (VS-1500N; Fukuda Denshi, Japan). The lower University Project, Chiang Mai University under the Office of the of the two ABIs (left or right) was used to represent each person Higher Education Commission. ABI. The ABI of ≤ 0.9 was considered abnormal and higher risk of PAD. Result Result 867 patients were recruited. The mean age is 42.84 years ± 0.33 (standard error of the mean). There were 459 males (51.4%). 39 The number of participants (364), the median age (57 years old) patients had PAD. The prevalence is 4.37% (95% confidence and the proportion of female (57%) were the same for both groups. interval (3.02-5.71). Female, higher education, history of The prevalence of higher risk of PAD among elderly HIV patients arrthymia, diastolic pressure less than 80 mmHg and duration on was 4.95% (18/364) and among the comparison group was 6.87% antiretrovirus less than 1 year were associated with PAD. (25/364). The difference was not statistically significance (p value = 0.27) Conclusion Conclusion The prevalence of PAD in HIV infected Thais was 4.37%. The risk factors appeared poor correlation with traditional risk factor of In our study, the prevalence of risk of PAD as measured by ABI atherosclerosis, perhaps the pathology of vascular disease in HIV were not different between the elders living with HIV and the infected patients is mainly not atherosclerosis. HIV-negative out-patient age and gender matched. Further study is needed to confirmed this finding and gain more insight into the issue.

Annals of Vascular Diseases 2016 113 Poster Presentation P05-15 Objective This pilot study was aimed to assess the eating habits of patients Predictive factors to determine post-operative with leg ischemia-peripheral arterial disease (PAD) in our hospital. mortality in patients with peripheral arterial disease Method 1 1 Rungrujee Kaweewan , Dr. Saritphat Orrapin , Ms Antika This study included 30 consecutive patients in our OPD. Patients 2 1,2 Wongthanee , Kittipan Rerkasem were interviewed using a Food Frequency Questionnaire (FFQ) for 1NCD Center, Department of Surgery, Faculty of Medicine, Chiang the last 30 days, and a 24 hours recall record. The data were analyzed Mai University, Chiang Mai, Thailand, 2NCD Center of Excellence, and presented in percentage, mean, and standard deviation. This Reserach Institute of Health Sciences, Chiang Mai University, assessment included the frequency of food intake, ingredients, Chiang Mai, Thailand processed food, cooking method, and alcohol consumption. This study was supported by Health Systems Research Institute of Thailand Background Major vascular surgery of peripheral arterial disease (PAD) is a high post-operative mortality procedure. Studies in predictive Results factors for post-operative mortality in Asian populations are few. This 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 Objective PAD (Rutherford stage 1-3) (group 2), and 12 cases of severe PAD To assess the predictive factors preoperatively determine mortality (Rutherford stage 4-6 ) (group 3). The baseline characteristic was in patients undergoing vascular surgery. 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 Material and Methods in group 3 consumed carbohydrates more frequently, but fat less The prospective study included patients with PAD who had frequently than other groups, There was no significant difference major vascular surgery from December 2002 to December 2005 between the three groups in terms of the amount of trace elements. at Maharaj Nakorn Chiang Mai Hospital. Survival status and It is important to note that patients in group 2 cooked food by predictive factors of mortality were contemplated. streaming, frying and stir, whereas patients in group 3 cooked their food by boiling, grilling and soup. Results 101 patients were included in the study. 53 patients died Conclusion (62.3%) with 4.19 years of median survival time; 5 year survival Patients in group 3 who mainly needed high protein to heal the was 47.28%. The predictive factors effecting mortality were wound, but this group had low BMI and high level of carbohydrate hyponatremia (Hazard ratio (HR) 17.69; 95% confidence interval taking. Better nutritional policy is needed in place. (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). P05-17 Value of multimodal anesthesia in peripheral Conclusion artery revascularization procedure Serum hyponatremia, shortness of breath, atrial fibrillation, Osanori Sogabe1, Dr Naoya Matsumoto1 abnormal plasma potassium level, and hypertension were the 1Mitoyo General Hospital, Kanonji, Japan predictive factor for high mortality in patients with PAD. Title: Value of multimodal anesthesia in peripheral artery revascularization procedure

P05-16 Purpose The advantages of peripheral nerve block over general anesthesia Dietary Consumption in Patients with include earlier postoperative recovery, lower morbidity, and a shorter Peripheral Artery Disease in Maharaj Nakorn hospital stay. In several reports on nerve block use in peripheral Chiang Mai Hospital artery bypasses, patients required the maximum (and potentially toxic) doses of local anesthetics, which were administered without Ms. Orapin Pongtam1,2, Dr. Sakda Pruenglampoo2, Kittipan ultrasonography. Solutions of lidocaine 0.1% with epinephrine Rerkasem1,2 1:100,000 are safely used in the treatment of varicose veins. The 1NCD Center, Faculty of Medicine, Chiang Mai University, ultrasound-guided method is associated with a higher success rate Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, and lower morbidity than previous nerve block techniques. 2NCD Center of Excellence, Research Institute of Health Science, Chiang Mai University, Chiang Mai, Thailand Method For peripheral artery bypasses, we performed ultrasound-guided Background blocks on the transversus abdominis plane and on the femoral and Nutrition is an important factor for healing in chronic foot ulcer. sciatic nerves. We also administered solutions of lidocaine 0.1% However such data is shortage in literature especially ischemic foot plus epinephrine 1:100,000 as infiltrative anesthetics. Patients ulcer. 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.

114 Annals of Vascular Diseases 2016 Results P05-19 Forty-nine peripheral artery revascularization procedure were performed; these include 7 lower limb artery and 13 femoropopliteal Development of the gene therapy with CRE artery bypasses. There were no cardiovascular or respiratory decoy ODN to prevent vascular intimal complications and no postoperative declines in swallowing or hyperplasia motor function. There was no shift to general anesthesia, and only 1 1 1 9 of 49 patients intraoperatively needed dopamine (maximum 5ɤ). Daiki Uchida , Dr Yukihiro Saito , Prof Nobuyoshi Azuma 5 patients were categorized as ASA III and 2 as ASA IV in the 1Asahikawa Medical University Vascular Surgery, Asahikawa, American Society of Anesthesiologists (ASA) Classification and Japan the average Rutherford’s classification score was 5.6 in patients undergoing lower limb artery bypass. Objective Intimal hyperplasia (IH) is the main cause of vein graft stenosis or Conclusion failure after bypass surgery. However, in the previous study derived A combination of ultrasound-guided nerve blocks; local infiltration from an animal model, no therapeutic targets for the treatment of with lidocaine 0.1% plus epinephrine 1:100,000; and intravenous IH have been identified. Our recent research using human vein graft dexmedetomidine could provide successful peripheral artery samples have been reported that the inhibition of Cyclic adenosine revascularization, even in patients in poor condition. Furthermore, monophosphate response-element (CRE) binding protein (CREB) this less invasive method could result in fewer postoperative activation is a key role for suppressing IH. We focused on decoy complications and less expensive peripheral artery bypasses. 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.

P05-18 Methods and Results Review of Transmetatarsal Amputations in the We designed and synthesized phosphorothioated CRE decoy ODN and checked binding capacity to CRE sequence of CREB management of Peripheral Vascular Disease cis-element. Transfer of the CRE decoy ODN to vascular smooth Ming Ngan Aloysius Tan1, Dr 2hiwen Joseph Lo1, Dr Rui Ming muscle cells (VSMCs) strongly repressed CRE activity and Teo1, Mr Soon Hong Lee2 decreased proliferation and migration in vitro. Now we check the 1NHG - TTSH, Singapore, Singapore, 2NTU - LKC School of therapeutic efficacy of the decoy therapy on mouse model. Medicine, Singapore, Singapore Conclusions Background The present result suggested that CRE decoy ODN provide an Despite advancements in revascularisation techniques, amputation effective therapeutic approach to suppressing IH. still plays a key role in the management of Peripheral Vascular Disease(PVD).

Objectives P05-20 The study objective was to evaluate transmetatarsal Local difference of skin perfusion pressure in amputation(TMA) as a viable treatment option for PVD and lower extremity identify risk factors associated with failure of treatment. Yoshiko Watanabe1, Dr Hisao Masaki1, Dr Taishi Tamura1, Dr Hiroki Takiuchi1, Dr Takahiko Yamasawa1, Dr Hiroshi Furukawa1, Materials and Methods Dr Yasuhiro Yunoki1, Dr Atsushi Tabuchi1, Dr Kazuo Tanemoto1 The retrospective study was conducted in a large tertiary hospital, 1Kawasaki Medical School, Kurashiki, Japan reviewing 147 patients with PVD who had undergone TMA between 2008 and 2014. Background and objectives

As well as transcutaneous oxygen tension (tcPO2), skin perfusion Results pressure (SPP) is useful in the evaluation of limb ischemia. The 54 patients (36.7%) required a subsequent major amputation, and SPP >30 or 40 mmHg is supposed to indicate adequate perfusion Type 2 Diabetes Mellitus was the only risk factor shown to be for wound healing, however, almost based on the experiments significantly associated (p value<0.05) with these patients. Patients at dorsum of the feet. TcPO2 appears similar in any body area who subsequently needed major amputations were also more likely according to the previous reports, whereas SPP may differ. We to develop nosocomial infections during their stay, and have a investigated the local difference of SPP in the lower extremity. 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 Methods crural vessels did not significantly affect the outcomes of patients. We 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 Conclusions metatarsal heads), and at two points in other 50 legs ([3] shin, [4] TMA is a viable option for the treatment of PVD, but diabetic calf). Similarly, we also measured SPP using a thermostatic heating patients should be considered for upfront major amputation. probe that heats up to 44℃ as same as tcPO2 probes.

Results

Both SPP and tcPO2 values at shins and calves were lower than those values at dorsum of the feet (p <0.001, respectively). The

Annals of Vascular Diseases 2016 115 Poster Presentation mean values of SPP measured using a plain probe were [1] 57.2 P05-22 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 Endovascular approach to elder patients (70 mmHg, and [4] 45.5 mmHg. At the lower leg areas, SPP values and older) treated with femoral embolectomy measured using a plain probe were similarly low regardless of the for acute arterial obstruction and essentials for tcPO2 values. When measured using a thermostatic probe, the SPP values increased with closing the gap from the tcPO2 values. using fractioned heparin Assist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, 1 2 Conclusions Ufuk Yetkin , Specialist Köksal Dönmez , Assist. Prof. Osman Beton3, Prof. Dr. Öcal Berkan1 When evaluating the SKIN PERFUSION PRESSURE values, the 1Cumhuriyet University Medical Faculty ,Department of characteristics of the measurement site might have to be considered. 2 Local temperature can affect SPP measurements more at the lower Cardiovascular Surgery, SİVAS, Turkey, Katip Celebi University Izmir Ataturk Training and Research Hospital, Izmir, Turkey, leg than at dorsum of the foot. Careful examinations and total 3 assessment should be required for assessment of limb ischemia. Cumhuriyet University, Dept. of Medical Faculty,Department of Cardiology, SİVAS, Turkey

Objective P05-21 In acute leg ischemia,hemodynamic balance and status of organs may detorioriate in patients who lately admitted to hospital or Outcomes of Bio-absorbable stent for Below treatment is delayed.In endovascular approach,thrombolytic agents Knee Critical Limb Ischaemia are applied to obstructed vessels which are targeted angiographically. Derek Ho, Dr Jemima Xue This method helps to create passage in smaller distal vessels but 1Changi General Hospital, Singapore , Singapore 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 Background not possible.In addition, it may be preferred to prevent secondary Stenting of infrapopliteal lesions are often limited by a relatively embolic events after embolectomy or thrombectomy. high restenosis rate and subsequent late in-stent thrombosis. The bioabsorbable stent is a novel development that provides initial Method scaffolding support, elutes anti-proliferative drugs to prevent vessel restenosis and reabsorbs subsequently to reduce risk of in stent Forty-five patients, who were 70 years old or over admitted thrombosis. It hopes to address issues with pre-existing stents and to our emergency department or out-patient clinic with acute promises to be the next frontier in endovascular revascularisation. 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 Aims 78.53±5.85. Thirty-one patients were male (68.9%) and fourteen The study aims to investigate the early outcomes, efficacy and were female (31.1%). safety of a bioabsorbable stent (BVS) in patients with below knee critical limb ischaemia. Results We excluded endovascular interventions because our patient Methods population was elder and had additional comorbidities(hypertension, A case series of 13 patients with median age 67 (range 46-89) diabetes mellitus etc.)which may easily deteriorate renal functions. who underwent stenting of below knee arterial diseases with Our stages of heparin use in and after conventional embolectomy Bioabsorbable Everolimus Eluting Bioresorbable Vascular were:common femoral artery was explored from appropriate Scaffold System developed by Abbott Vascular (Abbott, Illinois, incision and 100 IU/kg intravenous heparin was administered before USA). The primary outcomes measured were stent patency, target femoral .After extraction of thrombus material, distal lesion revascularization (TLR) and limb salvage rates. segments of artery were irrigated with heparinized physiologic saline solution.Heparin was administered intravenously after operation.Continuous infusion was preferred by perfusor with an Results ACT value of 220±20seconds.At fifth postoperative day, heparin 30 BVS were inserted for 14 below knee lesions. The median infusion was stopped.Low molecular weight heparin was used with length of the lesions was 25mm (range10-70). Majority of patients appropriate posology and combined with 5 mg oral warfarin.Both has significant critical limb ischemia (Rutherford 5-6). Technical drugs were used together for 4 days. success was 100%. 6 months vessel patency, TLR and limb salvage rates were 75%, 8.3% and 91.7% respectively. There were no Conclusion procedure related complications or deaths. We suggest conventional surgery in elder patients with acute arterial obstruction and require emergent femoral embolectomy. Conclusions Also we recommend heparin at each stage of surgery because it has Our study shows that BVS for below knee diseases have fairly good anti-inflammatory features by inhibiting cell adhesion molecules early outcomes, is safe and technically feasible. Longer follow-up and providing protective effects on tissue reperfusion damage.We and more rigorous clinical trials for BVS are required to determine administered heparin intra and perioperative period. its clinical benefits over pre-existing stents.

116 Annals of Vascular Diseases 2016 P05-23 P06-01 Peripheral arterial disease, comorbidities and A Case of Superficial Femoral Artery Aneurysm level of obstruction in elder patients (70 and detected with intermittent claudication older) treated with femoral embolectomy for Norimasa Haijima1, Dr Ichiro Hayashi, Dr Hirofumi Kasahara acute arterial obstruction 1National Hospital Organization Saitama National Hospital, Assist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, Wako-shi Suwa, Japan Ufuk Yetkin1, Specialist Köksal Dönmez2, Assist. Prof. Osman Beton3, Prof. Dr. Öcal Berkan1 We experienced one case of a rare superficial femoral artery 1Cumhuriyet University Medical Faculty,Department of aneurysm in peripheral aneurysms, we report it including some Cardiovascular Surgery, SİVAS, Turkey, 2Katip Celebi University discussion from literatures. Izmir Ataturk Training and Research Hospital, Izmir, Turkey, 3Cumhuriyet University, Dept. of Medical Faculty,Department of The case is a 67 years old man. There is no medical history. He Cardiology, SİVAS, Turkey had intermittent claudication at 1km from one year ago. He had intermittent claudication at 300m for half a year from before and Objective was introduced this hospital.It is aneurysms of 42mm in the distal Acute atherosclerotic thrombus is the underlying cause of majority superficial femoral artery by CT of patients with acute peripheral arterial obstruction and it’s caused by atherosclerotic changes in arterial structure of lower extremities. The high-grade stenosis that there are aneurysms with the mural thrombosis in to a popliteal artery. Methods We performed graft replacement for a superficial femoral artery Between January2007 and December2015,forty-five patients,who aneurysm were 70years old or over admitted to our emergency department We performed the superficial femoral artery - posterior tibial artery or out-patient clinic with partial functional loss,coldness,pain bypass operation using SVG graft for the arteriosclerosis obliterans and discoloration.After confirmation of acute femoral artery that was lower than popliteal artery aneurysms. obstruction,all of these patients were treated with emergent A postoperative course is good 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%). P06-02 Results Successful endovascular repair of a recurrent Twenty-four(54,3%)patients had prior diagnosis and treatment for femoral artery pseudo-aneurysm using a peripheral arterial disease.Male gender was significantly higher coronary covered stent in this group(p: 0,025).When we consider the time passed before Yukio Muromachi1, Shigeki Ito1, Masafumi Hashimoto1, Tadashi admitting to hospital,12 patients(50%)admitted to hospital after Amemiya1, Yasuyuki Hatano1, Michihiko Morisaki1, Hitoshi 48 hours or more(late term).Our series consists of elder patients Ogino2 and 44.4%(20 patients)had chronic obstructive pulmonary 1 2 disease,51%(23 patients)had smoking habit,44.4%(20 patients)had Nishitokyo Chuo General Hospital, Nisitokyo-shi, Japan, Tokyo diabetes and 15.6%had cerebrovascular event.Although 24 patients Medical University, Shinjuku-ku, Japan had peripheral arterial disease diagnosis,high incidence of risk factors in our series made us thought that real peripheral arterial We report on a case having a recurrent femoral artery (FA) pseudo- disease rate with undiagnosed patients is much higher.Chronic aneurysm treated successfully with a coronary stent covered with obstructive pulmonary disease(p: 0,037),history of smoking a great saphenous vein (GSV). The patient was a 74-year-old habit(p: 0,001)and diagnosed peripheral arterial disease(p: 0,025) gentleman who had undergone a right femoro-popliteal artery were significantly higher in male patients.Diabetes(p: 0,001)and bypass due to peripheral artery disease one year before. Six months atrial fibrillation(p: 0,020)were significantly higher in female after surgery, a pseudo-aneurysm developed on the proximal patients.According to the site of occlusion,common femoral anastomosis site of femoro-popliteal bypass on the right common artery(37.7%,17 patients),superficial femoral artery(46,7%,21 FA with complete occlusion of the prosthetic bypass graft. An open patients)and both superficial and profound femoral arteries(15.6%,7 repair of the pseudo-aneurysm with direct aneurysmorrhaphy was patients)were obstructed. performed. In another six months, the patient was again suffered from a recurrent pseudo-aneurysm on the same site. The patient Conclusion and his family consistently refused its redo open repair, although the pseudo-aneurysm was gradually enlarged. It was also expected Most common cause of acute arterial thrombosis is atherosclerosis that its direct repair would be extremely difficult because of dense obliterans.Fast-progressing thrombosis may have a similar clinic adhesion due to the several-times previous surgeries. Consequently, with embolic events but with lesser complaints.Many patients an endovascular repair using a coronary covered stent (TERUMO may not have any specific finding accept claudication.This is Ultimaster 3.5/38 mm) with GSV was attempted. We approached caused by creation of collateral vasculature while progression of the right common FA through the left common FA. The GSV atherosclerosis.Progression of ischemia is much slower and daily covered coronary stent was placed from the right common FA to the activities of these patients are not enough to cause ischemia in deep FA. The postoperative course was uneventful with remarkable muscular tissue.This situation causes delays of hospital admission reduction of the size of pseudo-aneurysm. and may be responsible for limb-loss and life-threatening post- ischemic syndrome. 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

Annals of Vascular Diseases 2016 117 Poster Presentation with covered stents would be useful alternative treatments. P06-04 In particular, for the peripheral arteries with small diameters, percutaneous trans-catheter repairs with coronary covered stents Non-traumatic brachial artery aneurysm would be good options with less-invasiveness. Shuhei Suzuki1, Dr Norihito Nakamura, Dr Kenji Aoki 1Niigata Prefectural Central Hospital, Jyoetsu City, Japan

P06-03 Background Upper extremity artery aneurysms are uncommon. Most of them The cyst evacuation with the removal of the are pseudo-aneurysms and caused by trauma or iatrogenic injury. cystic wall for Popliteal Adventitial Cystic Non-traumatic cases are extremely rare and their clinical features Disease are unclear. Takashi Shintani1, Hironobu Fujimura1, Takuma Iida2, Takashi Shibuya3 Methods 1Toyonaka Municipal Hospital, Toyonaka, Japan, 2Toyonaka We experienced a case of brachial artery aneurysm of unknown Municipal Hospital, Toyonaka, Japan, 3Osaka University Graduate cause. School of Medicine, Suita, Japan Results Introduction Case Adventitial Cystic Disease (ACD) is an uncommon non- A 79-year-old woman noticed a pulsatile mass in the left arm. She atherosclerotic condition in which a cystic collection of mucinous had no history of trauma or medical treatment to the arm. Computed material accumulates in the adventitial layer of the vessel. This tomography showed a saccular aneurysm of 15 mm in diameter cystic formation is predominantly located in the popliteal artery in the brachial artery. She underwent aneurysmectomy. The artery (85%). Some case reports have been published, but the management was segmentally resected and reconstructed with end-to-end and operative procedure of ACD is still remains unclear. anastomosis. Postoperative course was uneventful. Pathological examination revealed absence of arterial layers in the aneurysmal Case wall; the most compatible diagnosis was pseudo-aneurysm. A 67-year-old woman presented with intermittent claudication in the left calf. The right and left ankle brachial pressure indexes (ABI) Conclusions were 1.20 and 0.55, respectively. Duplex ultrasound scanning and Non-traumatic pseudo-aneurysm of the brachial artery was computed tomography angiogram (CTA) and angiography were successfully repaired. Surgical treatment is recommended because performed. From the above, we diagnosed ACD of the popliteal pseudo-aneurysm has a potential risk of rupture or thrombosis. artery and performed cyst evacuation with the removal of the cystic Etiology, symptoms, imaging characteristics and surgical options wall through the posterior approach. Among the surgical findings, including vascular reconstruction are reviewed and discussed. 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. P06-05 Discussion A Case of Femoropopliteal Bypass and The etiology of ACD is still under debate. Trauma, ganglion, Transcatheter Artery Embolization for systemic disorder, embryonic development have been proposed. Ruptured Persistent Sciatic Artery Aneurysm The management of ACD varies depending on the condition of the Koichi Tamai1, Dr. Kei Kazuno3, Dr. Yasushi Tashima2, Dr. affected vessels. Cyst aspiration and Endovascular treatment are Toshiyuki Kobinata1, Dr. Harunobu Matsumoto2 less invasive, but it is associated with a high rate of recurrence. 1 2 Resection of the affected segment of the vessel and interposing a Kasukabe Chuo General Hospital, Kasukabe , Japan, Jichi Medical University Saitama Medical center, Saitama, Japan, vein graft or prosthesis is promising, but it is more invasive and has 3 the risk of graft occlusion. Removal of the cyst content (evacuation) Itabashi chuo general hospital, Itabashi, Japan while preserving the involved artery can be effective. Background Conclusion Persistent sciatic artery aneurysm is a rare congenital vascular We performed the procedure with the cyst evacuation and cystic anomaly. When the femoral artery is formed during early wall excision. The patient remained free of symptoms after the embryogenesis, the sciatic artery basically regresses. Most cases procedure, and postoperative CTA showed good patency. Long- of the persistent sciatic artery can be detected by the symptoms of term follow up is mandatory because of the potential for recurrence. occlusion and aneurysm.

Objectives A 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.

118 Annals of Vascular Diseases 2016 Materials Case CT showed right persistent sciatic artery aneurysm was an The patient was an about-70-year-old woman. She underwent incomplete type. And the patient state was end-stage breast cancer. total aortic arch replacement for the dissecting thoracic aortic Thus femoropopliteal bypass and transcatheter embolization of aneurysm in January 2014. After the operation, aneurysms of the right internal artery by using an Amplatzer Vascular Plug was descending aorta (60 mm in diameter) and the abdominal aorta performed because we intended to treat her less invasive. (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 Results area was observed. The hematoma was increasing in size and CT Her postoperative course was uneventful and ABI has improved to angiography revealed a pseudoaneurysm under inguinal ligament, 1.04/1.17. CT after surgery has showed sciatic artery was occluded which was then confirmed to be arisen from the distal lumbar and femoropopliteal bypass was patent. And her right buttock pain arterial branch by angiography. The cause of the pseudoaneurysm has resolved after surgery. was unknown but we supposed that muscle retractors used during the surgery had injured the small artery. Conclusions We experienced a case of ruptured persistent sciatic artery Because the size was increasing, we performed percutaneous aneurysm and successfully treated by femoropopliteal bypass and embolization for this aneurysm by direct puncture. We punctured transcatheter embolization. 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 P06-06 pseudoaneurysm was disappeared without any complication.

Ruptured aneurysm of the external iliac vein Conclusion 1 1 Yong Sung Won , Emeritus Professor Jang Sang Part , Associate We experienced an inguinal pseudoaneurysm from distal lumbar Professor Jang Yong Kim1, Assistant Professor Mihyeong Kim1, 1 artery caused by open femoral access trouble for endovascular Associate Professor Sun Cheoll Park repair. Direct puncture embolization is safe, convenient, and 1The Catholic University Of Korea, Seoul, South Korea effective treatment compared with catheter embolization especially for superficial pseudoaneurysms like this case. 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- P07-01 old woman who was admitted to the emergency department and diagnosed by computed tomography. Protective effects of remote pre- and postconditioning on ischemia-reperfusion Computed tomography indicated a 4 3 5-cm ruptured aneurysm in induced hepatic injury the right external iliac vein that was surrounded by hematoma in Hyung Joon Ahn1, M.D. Min Su Park1, M.D. Sun Hyung Joo1 the right side of the pelvis. The aneurysm was successfully treated 1Kyung Hee University, Seoul, South Korea by tangential aneurysmectomy and lateral venorrhaphy. Purpose Hepatic ischemia-reperfusion injury (IRI) is considered a major P06-07 cause of hepatic damage in liver surgery. The aim of this study was to investigate the effect of the remote ischemic perconditioning A case of right inguinal pseudoaneurysm after method on hepatic IRI in a rat model. the simultaneous endovascular aortic repair for the thoracic and abdominal aortic aneurysms Methods Shinji Yamazoe1, Dr Yasuhito Sekimoto1, Dr Hirohisa Harada1, Dr Seventeen rats underwent hepatic IRI for 30 minutes followed Yohei Munetomo1, Dr Akira Baba1, Dr Yuko Kobashi1, Dr Takuji by reperfusion, and were divided into three groups: group I, the Mogami1 only hepatic IRI (n=5); group II, the hepatic IRI with remote 1Tokyo Dental College Ichikawa General Hospital, Ichikawa, perconditioning (n=7); and group III, the hepatic IRI with remote Japan postconditioning (n=5).

Background Results Pseudoaneurysm formation at the access site is one of the For Bax/β-actin, mean values of the three groups (± SD) were 1.29 complications after endovascular aortic repair for aneurysms. ± 0.26 (I), 0.89 ± 0.15 (II), and 1.02 ± 0.23 (III). The level of Bax/β- The reported frequency of the access site complications after actin in group II was significantly lower than in group I (P <0.01). endovascular aortic repair is 4.4%. Although the major complication The cleaved Caspase-3/β-actin ratio for groups I, II, and III were of the access site is known to be the femoral arterial trouble, we 0.93 ± 0.22, 0.46 ± 0.16, and 0.63 ± 0.22, respectively. The level recently experienced an inguinal pseudoaneurysm that had arisen of cleaved Caspase-3/β-actin in groups II and III were significantly from the distal lumbar artery. Here we present the case that we lower than in group I (P <0.01 and P <0.05, respectively) The Bcl- could treat with the direct embolization by needle puncture. 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.

Annals of Vascular Diseases 2016 119 Poster Presentation

Conclusion with major risk factors for open surgery, such as Behçet disease. The remote perconditioning on rat hepatic IRI downregulated the However, using stent grafts for patients with metallic allergy Bax and cleaved Caspase-3 expression. remains controversial.

Keywords: remote perconditioning, ischemia-reperfusion injury, We encountered a 29-year-old man with metallic allergy who had liver 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 P07-03 considered to be at high risk of recurrence or allergic shock due Case Presentation of Isolated Celiac Artery to the stent components. Even though he was allergic to metals, the emergency nature of the case was considered to warrant Mycotic Aneurysm endovascular treatment. We describe herein the endovascular Dr Sungjae An1, A/Prof Vikram Vijayan Sannasi1 treatment of this case. 1Ng Teng Fong General Hospital, Jurong, Singapore

Background/ Introduction P07-05 Isolated celiac artery mycotic aneurysm is extremely rare, with few reported cases until yet. And there is no randomized trials to guide Comparison Between Radiocephalic and the management of mycotic aneurysm. Brachiocephalic AV Fistula Maturity at 6 Weeks Post-Surgery Objectives Ramzi Asrial1 To share this rare case of isolated celiac artery mycotic aneurysm 1dr. Ramzi Asrial, Sp.B(K)V, Bangkinang General Hospital, of clinicaly presentation, relavent investigations, our management, Pekanbaru, Indonesia and progress.

Background Materials and Methods Autogen AV fistula is currently the best hemodialysis access choice 73 year old man presented with lower abdominal pain due to for stage 5 chronic kidney disease (CKD) patients. AV fistulas can recurrent diverticulitis exacerbation. CT-abdomen/pelvis to be made at the radiocephalic (wrist) and brachiocephalic (cubiti examine the extent of diverticulitis revealed celiac artery lesion, fossa). Comparison between radiocephalic and brachiocephalic AV and further imaging of CT mesenteric angiogram showed isolated fistula maturity at 6 weeks post-surgery according to KDOQI has celiac artery aneurysm measuring 1.7 x 1.5 x 0.9cm. Patient was not yet been made. treated with antibiotics and endovascular intervention.

Method Results This study is a prospective cohort study on stage 5 CKD patients Follow-up CT mesenteric artery showed successful placement of who underwent either brachiocephalic (FAVBC) or radiocephalic celiac artery endovascular stent. (FAVRC) AV fistula surgery, which are evaluated via USG before and 6 weeks after surgery. Data are collected and, if fulfilling Conclusions inclusion criterias and n1=n2, analyzed statistically with Mann- Whitney U test. Isolated 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 Results management strategies. The 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 P07-04 with a volume flow ≥ 600 dL/minutes of 66,7% and 33,3% on FAVBC and FAVRC respectively. Fistule-skin distance are < 6 mm Endovascular treatment of subclavian aortic on both procedures. aneurysm rupture in a Behcet disease patient with metallic allergy Conclusion Mizuki Ando1, MD., PhD. Yuya Kise1, MD Tatsuya Maeda1, MD There is a significant difference between FAVBC and FAVRC Takaaki Nagano1, MD., PhD Yukio Kuniyoshi1 maturity with a p value < 0,05 according to Mann-Whitney U and 1Dept. Of Thoracic And Cardiovascular Surgery, University Of The Wilcoxon W tests. FAVBC 6 weeks post-surgery maturity reaches Ryukyus, Nishihara-city, Japan 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/ Open surgical treatment is recommended for most patients minutes are 66,7% and 33,3% on FAVBC and FAVRC respectively with Behçet disease, but postoperative complications such as with a p value < 0,05. Fistule-skin distance of < 6 mm are 100% on graft occlusion or anastomotic pseudo-aneurysm formation are both procedures. frequently reported. Endovascular treatment is a recent innovation that may provide an alternative treatment of choice in patients

120 Annals of Vascular Diseases 2016 Key words: Brachiocephalic AV fistule, radiocephalic AV fistule, P07-07 AV fistule maturity, chronic kidney disease, draining vein, volume flow. The Endovascular Treatment of a Ruptured Aneurysm of the Middle Colic Artery Combined With an Isolated Dissection of P07-06 Superior Mesenteric Artery: Report of a Case 1 2 A Novel Approach For Femoral Artery Access: Byung Sun Cho , Prof. Hye Young Ahn 1Eulji University Hospital, Daejeon, South Korea, 2Eulji University Purse Suture Technique College of Nursing, Daejeon, South Korea 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 Background/ Introduction 1Ankara University Medicine School, Ankara, Turkey Ruptured 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. Introduction Femoral artery (FA) is the main access route in patients who Objectives underwent minimally invasive cardiac (MICS) and endovascular aortic surgery. Different techniques have been reported for the We would like to know the feasibility of endovascular treatment exploration and repair of FA after surgical procedure. In our clinic, for a ruptured middle colic artery aneurysm with a concomitantly a modified approach (group PT) to the conventional technique detected isolated SMAD. (group CT), was the method of choice since May 2013; which specifies a shorter groin incision and diamond shaped hemostatic Materials and Methods suture for arteriotomy closure without a need for cross-clamping. A previously well 56-year-old man was referred to our hospital with acute-onset pain throughout the entire abdomen. A ruptured Objectives aneurysm of the middle colic artery and isolated SMAD were We aimed to evaluate early outcomes and the complication profiles revealed using a computed tomography (CT) scan. of two techniques for femoral access. Results Materials and Methods Coil embolization was successfully performed for a ruptured In our clinic, between May 2011 and December 2015, we evaluated aneurysm of the middle colic artery. During the immediate 476 FA cannulations in 325 patients who underwent MICS postprocedural period, the patient had ischemic colitis, but he (n:105;mean age:44.4±18.8;F/M:70/35), endovascular aneurysm recovered in a few days with conservative treatment. Close repair (EVAR) (n:151;mean age:72.5±9.35;F/M:15/136), observation was elected to address the SMAD because the thoracic endovascular aneurysm repair (TEVAR) (n:45;mean condition was not thought to be responsible for any symptoms. The age:64.9±15.6;F/M:12/33) and trans-femoral aortic valve CT scan followed after 2 years showed no change in SMAD. 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 Conclusions closure, wound infection, vascular complications including We successfully performed endovascular treatment for a ruptured bleeding-hematoma, thromboembolic and ischemic events, aneurysm of the middle colic artery. For the incidentally detected pseudoaneurysm, seroma, surgical reintervention rates, delayed SMAD, close observational management was chosen. hospital stay for groin complications and existence of postoperative local narrowing of FA over 25 % for both groups.

Results P07-08 Duration of femoral closure, frequency of bleeding-hematoma and Selective Angioembolization of Renal prolonged hospital stay for groin complications were significantly Angiomiolipoma lower in PT group. There were no differences in terms of ischemic 1 1 events, wound infection rates, development of pseudoaneurysm Igab Krisna Wibawa , MD Patrianef Patrianef and seroma, surgical reintervention rates and local narrowing of FA 1Indonesian Society For Vascular And Endovascular Surgery, over %25 during 54 months follow up. Central Jakarta, Indonesia

Conclusion Backgroud We suggest performing a smaller skin incision for FA access and AMLs ( angiomyolipoma ) are benign mesenchymal tumors, utilizing purse sutures that allow completing the procedure without composed of blood vessels, smooth muscle, and mature adipose cross-clamping, thus providing a favorable approach and excellent tissue, that arise primarily in the kidneys. Angiomyolipomas comfort for the surgeon especially in cases of calcific vessels which (AMLs) are the most common benign renal neoplasm and are often are prone to complications. 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.

Annals of Vascular Diseases 2016 121 Poster Presentation Case Report P07-10 The 53-year-old Man with history of abdominal dyscomfort was admitted due to left flank pain, abdominal fullness and urine Variations of Circle of Willis retention. However, abdominal CT and MRI revealed enlarged Dr. Sahin Iscan1, Dr. Habib Cakir1, Dr. Ismail Yurekli1, Dr. Mert lesions and dystrophic calcification within a mass in left kidney Kestelli1, Köksal Dönmez1, Dr. Börtecin Eygi1, Dr. Nihan Karakaş ( Calcified Angiomyolipoma ). The patient was sent to vascular Yeşilkaya1, Dr. Hasan Iner1 surgery for embolization. This patient good candidate for 1Department Of Cardiovascular Surgery, Katip Celebi University embolization, an effective treatment modality, useful to control Izmir Ataturk Training And Research Hospital, Izmir, Izmir, Turkey active bleeding and for management of symptomatic AMLs. Introduction Results There are several papers on hypoplasia and incompleteness of The patient tolerated the procedure well and selective Circle of Willis. We decided to explain the general opinion. Brain angioembolization was performed. tissue, with over 100.000 axons and dendrites at each millimeter, is indispensable. Conclusion Angioembolization an effective treatment modality for symptomatic Objectives Angiomyolipoma (AMLs) This situation suggests that cerebral perfusion is extremely important at carotid interventions and management of carotid artery disease.

P07-09 Materials and Methods Medical Treatment of Internal Carotid Agenesis We examined two important anatomy textbooks for Circle of Willis. Dr. Banu Yürekli1, Dr. Ismail Yürekli2, Dr. Habib Cakir2, Dr. Mert 1-Vankov’s anatomy. Central nervous system. Steno publishing Kestelli2, Köksal Dönmez2, Dr. Börtecin Eygi2, Dr. Sahin Iscan2, house. M Vankova page:88 3 Dr. Mehmet Engin Uluc 2-Sobotta Atlas of Human Anatomy. Elsevier Urban&Fisher 1Department Of Endocrinology, Ege University Training And !4th edition Edited by Putz and R. Pabst 2009 Munich page:705 Research Hospital, Izmir, Turkey, 2Department Of Cardiovascular fig:1269 a-g Surgery, Katip Celebi University Izmir Ataturk Training And Research Hospital, Izmir, Turkey, 3Department Of Radiology, Katip Celebi University Izmir Ataturk Training And Research Hospital, Results Izmir, Turkey Both textbooks considered hypoplasia and/or incompleteness of arteries building Circle of Willis as variations. Introduction Internal carotid artery artery is a rare pathology in our daily practice. Conclusion We do believe that hypoplasia and/or incompleteness of arteries building Circle of Willis should not be considered as variations. Objectives Because: We aimed to present a case with internal carotid artery agenesis. 1) Surgical interventions would not be necessary in Due to complications of this anomaly, these patients need a serious subclavian steal syndrome follow-up. 2) Shunt usage at carotid endarterectomy would be unnecessary Materails and Methods 3) Cilostazol and anti-aggregation drugs would be A thirty-three year old female patient admitted to our outpatient unnecessary in internal carotid artery agenesis. 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 P07-11 were normal. Internal Carotid artery was reported as occluded in Combined ultrasound and electric field duplex ultrasonography. Her LDL level was 173 mg/dl. We initiated stimulation treatment of chronic wounds: her medical treatment with Clopidogrel (75 mg/day), Atorvastatin (20 mg/day), pentoxifylline (2x600 mg/day) and trimetazidine Complementary therapies in wound care (2x35 mg/day). Diane Eng1, Sriram Narayanan1, Jonathan Rosenblum, DPM2 1Tan Tock Seng Hospital, Singapore, 2 Shaarei Zedek MedicalCenter, Results , Israel Patient’s vertigo did not regress with this therapy. Trimetazidine was Chronic wounds are increasing rapidly owing to increasing stopped and Cilostazol (2x100 mg/day) was initiated. Her vertigo healthcare costs, an aging population, and increasing co morbidities. and symptoms regressed gradually after this revised therapy. 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 Conclusion to expedite healing by addressing the principles of wound bed We believe that Cilostazol is an essential medication in treatment of preparation as well as managing cytokines and proteases and by agenesis of internal carotid artery. stimulating expression of growth factors. To address these and

122 Annals of Vascular Diseases 2016 other needs of chronic wounds, frequently standard wound care is P07-13 employed alone or in combination with adjunctive wound therapies that deliver several types of biophysical energy to further enhance “Wii thumb”: Case report of symptomatic healing. peripheral arteriovenous malformation from gaming and systematic review of vascular The effectiveness of ultrasound (US) as a non-invasive diagnostic injuries from gaming tool has led to investigation into its potential benefits for wound 1 1 1 healing. Although there appears to be considerable laboratory Mina Guirgis , A/Prof Kishore Sieunarine , Dr Ruben Rajan evidence that US leads to faster and/or improved wound healing, 1Joondalup Health Campus, Perth, Australia the clinical evidence has been less convincing. Electric Stimulation (ES) has likewise been used for more than a century in the treatment Introduction 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 A 28 year old patient presented to the vascular service with an biologic basis for both individual modalities and their combined exquisitely tender lump on his right thumb. He played Nintendo effect on the wounds in both gross and histological terms as well as Wii daily for extended periods. Sudden pain occurred after playing to examine the clinical effectiveness of the device as an adjunctive a thumb driven console for 14 continuous hours. Examination therapy in treating chronic leg ulcers. 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 P07-12 of capillaries and venous structures consistent with an arterio- Extreme Fistula Salvage: The Promotion venous malformation (AVM). The only activity attributed to the symptomatic AVM of his thumb was trauma from prolonged of Ulno-cephalic Fistulae Development via periods of video gaming using a hand held console. This lead to the Palmar Arch Angioplasty Following Occlusion development of a painful traumatic AVM which was refractory to multimodal analgesia and eventually required surgery. of Radio-cephalic Fistulae Inflow Caesar Lopez Gimao1, Raj K Menon1, Andrew MTL Choong1,2 Objectives 1 Division of Vascular Surgery, National University Heart Centre, A 2016 systematic review of all reported vascular injuries caused 2 Singapore, School of Medicine, Griffith University, Gold Coast, by video games. Queensland, Australia Methods Radio-cephalic arteriovenous fistulae has a higher failure rate as Medline and Pubmed searches including the following keywords: compared to the other autologous limb vascular accesses. Factors “Thrombosis” or “Artery” or “Vascular” or “ethrombosis” AND such as distal vessel size, patient age, peripheral vascular disease “Video game” or “Wii” or Nintendo” or “Wiiitis” or “Computer and other medical comorbidities all contribute to this failure. game”. Salvage for failing radio-cephalic fistulae are challenging and therefore, frequently abandoned for more proximal vascular access options. Results A total of 11 case reports reporting 12 vascular injuries related to Palmar arch angioplasty has been utilized as a method to treat video gaming. Nine vascular injuries from gaming were associated critical hand ischemia but there few description of it as a means of with venous thromboembolism (VTE). 67% of cases resulted improving arteriovenous fistula inflow. We present two recent cases in major pulmonary emboli, one fatal. In the majority of VTE of patients with primary radio-cephalic fistulae who developed cases, the only risk factor known was prolonged immobility, an radial artery inflow occlusions. We were able to salvage them by unusual finding with regards to the multi-factorial nature of VTE palmar arch angioplasty allowing the ulnar to become the dominant pathogenesis. All cases had negative thrombophilia screens or inflow vessel, via the palmar arch and then through the collaterals no history of thrombophilia. Two injuries occurred from intense that had developed. physical activity on Nintendo Wii causing internal carotid artery dissection and permanent disability. The first case has a severely stenosed left distal radial artery that compromised fistula inflow. Arteriotomy, thrombectomy and Conclusion bovine patch repair were undertaken restoring borderline flow to Most vascular injuries from gaming are VTE related. We report the fistula. Palmar arch angioplasty was done to improve flow and the first known case of gaming associated symptomatic peripheral allow formation of ulnar-cephalic fistula. The second case has a AVM. 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.

Annals of Vascular Diseases 2016 123 Poster Presentation P07-14 2009 to December 2015.We analyzed the patient’s baseline characteristics, postoperative renal function, blood pressure Management of symptomatic isolated evolution, and the number of antihypertensive drugs pre- and spontaneous dissection of superior mesenteric postprocedure. artery Tohru Ishimine1, Dr Hiroshi Yasumoto1, Dr Toshiho Tengan1, Dr Result Hidemitsu Mototake1 A total 21 patients(M:15, F: 6) were treated with endovascular 1Okinawa Prefectural Chubu Hospital, Miyazato Uruma, Japan 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 Objective hemodynamic kinking were located at the anastomosis 7(33.3%), Isolated spontaneous dissection of superior mesenteric artery proximal 13(61,9%), distal 1(4.8%). Number of donor renal artery (SMA) is extremely rare, and treatment of it is not established. was single in 11(52.4%), multiple in 10(47.6%;double 8, triple In this study, we present our experience in the treatment of 2). The PTA without stent placement was performed in 7(33.3%), symptomatic isolated spontaneous dissection of SMA. 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- Methods 3.08mg/dl) at discharge(p=.33).The glomerular filtration rate(GFR) Between 2005 and 2016, 15 consecutive patients (12 men; mean also showed no difference between preprocedure and discharge age, 49 ± 6.5 years) with symptomatic isolated spontaneous day(53.6 ml/min(22.4-145.7 ml/min) to 57.0 ml/min(17.56 -145 dissection of SMA were retrospectively reviewed. The mean ml/min) (p=.084). Systolic and diastolic blood pressure varied follow-up period was 20.9 ± 28.9 months. 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 Results antihypertensive medication was significantly decreased from All patients had acute-onset abdominal pain. Three patients (20%) 1.5(0-6) to 0.5(0-2)(p=.023).In our study, there was no technical had hypertension, 4 (26.7%) had hyperlipidemia, and 11 (73.3%) failure and no procedure related complication or mortality.During were smokers. All cases were diagnosed by computed tomography follow up period free from reintervention rate was 100%, graft (CT) angiography. Twelve patients were treated conservatively failure was occurred in 2(9.5%) due to rejection. (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 Conclusion saphenous vein in two and exploratory laparotomy in one patient) Endovascular procedure in TRAS shows high technical success as a primary treatment. Iliomesenteric bypass was additionally rate with favorable result and low morbidity.In our experience, its performed in one patient in whom initial conservative treatment impact on serum creatinine levels and GFR do not seem to improve, failed (reappearance of abdominal pain after resuming diet and however, number of antihypertensive drug could be reduce after progression of the false lumen on CT angiography). During the procedure. follow-up period, all patients were free from aneurysmal formation of SMA or chronic intestinal ischemia.

Conclusions P07-16 Most patients with Isolated spontaneous dissection of SMA can Reduction of totally implantable central venous be treated conservatively. However, surgical treatment should be considered if there is suspicion of intestinal ischemia. port system complication Yong Beum Bak1, Prof. Hyuk Jae Jung1, Dr. Dong Hyun Kim1, Prof. Sang Su Lee1 1Pusan National University Yangsan Hospital, Yangsan, South P07-15 Korea Endovascular Treatment of Transplant Renal Purpose Artery Stenosis The aim of this study is to describe our procedure of totally 1 1 1 Kang Woong Jun , Mi Hyeong Kim , Hyun Kyu Kim , Jeong Kye implantable central venous port system (TICVPS) insertions and to 1 1 1 1 Hwang , Sang Dong Kim , JangYong Kim , Sun Cheol Park , Ji Il investigate TICVPS complications. Kim1, Yong Sung Wong1, Sang Sup Yun1, In Sung Moon1 1The Catholic University of Korea, Soeul , South Korea Methods We retrospectively investigated 827 patients who underwent a Purpose single-type TICVPS from January 2013 to July 2015. The length of Transplant renal artery stenosis(TRAS) is most common(1-23%) the procedure, long-term device function, angle (chamber-to-tip), vascular complication following kidney transplantation, which and complications of TICVPS, such as infections, skin erosion, most clinicians regard percutaneous transluminal angioplasty(PTA) occlusions, dislocations, and thrombosis, were analyzed from with/without stent placement to be the treatment of choice for medical records. TRAS.The aim of this study was to review our experience with an endovascular approach to TRAS. Results A total of 843 TICVPS insertions were performed in 827 patients. Methods The TICVPS implantation was successful in all cases (100%). The We retrospectively reviewed the kidney transplant recipients those mean indwelling time was 275.4 days per patient (range 1-782 days), who underwent PTA due to TRAS in our institute from January and 325 (38.6%) patients had more than 300 days of indwelling

124 Annals of Vascular Diseases 2016 time. The mean catheter angle was 72.5°. Among the patients, 766 No progression of the false lumen or newly developed organ (90.8%), 71 (8.4%), and 6 (0.7%) had solid tumors, hematologic/ ischemia was observed. 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 Conclusions were recorded. Chamber insertion site complications occurred in 11 Isolated visceral artery dissection with a completely thrombosed patients (5 infection and 6 erosion cases). All patients with chamber false lumen disappeared rapidly, while only one-third of dissections insertion site infection were treated with antibiotic administration disappeared in case with a patent false lumen or thrombosed false and dressing. Two patients with chamber insertion site erosion were lumen with ULP. 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, P07-18 and 2 patients had catheter-related infection, catheter migration confirmed by chest radiography, catheter-related thrombosis, and Prevalence of lower extremity ulcer in Maharaj chamber malposition, respectively. Nakorn Chiang Mai hospital Rungrujee Kaweewan1, Dr Christine Rojawat1, Professor Kittipan Conclusion Rerkasem1,2 Our large retrospective study of TICVPS revealed a low 1NCD Center of Excellence, RIHES, Chiang Mai University, Chiang complication rate (4.0%) compared with literature (5%-20%). Mai, Thailand, 2NCD Center & Department of Surgery, Faculty of Well-designed procedure, experienced vascular surgeons, aseptic Medicine, Chiang Mai University, Chiang Mai, Thailand operating room environment, ultrasound-guided puncture, wide angle (chamber-to-tip), and using fluoroscopy with contrast can Background help in reducing the complication rate of TICVPS insertion. Patients 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 P07-17 controversial. Prognosis of isolated visceral artery dissection after conservative treatment Objective Tatsuya Kaneshiro1, Dr Toshimi Yonaha1, Dr Hideyoshi Henzan1 To find out the causes of lower extremity ulcer in patients of 1Nakagami General Hospital, Okinawa-city, Japan Maharaj Nakorn Chiang Mai Hospital, Thailand.

Background Method Isolated visceral artery dissections not associated with aortic Data collection was carried out in consecutive patients who came to dissection are relatively rare. Recently, these have been diagnosed vascular clinic from March 2014 to March 2016 with the problem more frequently due to advances in diagnostic imaging technology. of lower extremity wounds. This included demographic data, There is no consensus on optimal management or prognosis. Here, etiology, location. we report the short- to mid-term prognosis of isolated visceral artery dissection after conservative treatment. Results There were 321 patients in this study. There were 173 men and 148 Methods women. The average ages were 62.51 years old. The cause of lower A total of 22 consecutive patients with isolated visceral artery extremity ulcer was Ischemic ulcer 116 patients (36.13%) , venous dissection were seen between October 2006 and May 2016. ulcer 72 patients ( 22.4%), Neuropathic ulcer 60 patients (18.69%), All patients received conservative management, including Infected ulcer 59 patients (18.38%) and other cause 14 patients antihypertensive or anticoagulant therapy. The locations of (4.36%). Venous ulcer was seen commonly above medial malleolus dissection were the celiac artery (CA) in 8 patients; superior 62 out of 72 patients (86.11%) and 23 (31.94%) patients had ulcer mesenteric artery (SMA) in 10; and 1 each involving both CA, both legs. All 116 patients with Ischemic ulcer, ulcer commonly SMA and bilateral renal arteries (RA), both CA and left RA, located at foot, in 59 patients (64.66%), toe 26(22.41%) patients. inferior mesenteric artery (IMA), and left RA. The mean age was Besides infection was also present in these patients or wet gangrene 54 years. There were 18 men and 4 women. we found in 20 (17.2%) patients.

Results Conclusion The mean follow-up duration was 33 months (range: 3 to 117 The most common cause of lower extremity ulcer in our center was months). Four patents (7 arteries) had patent false lumens, 8 had ischemic ulcer which differ from previous Western studies .Further thrombosed false lumens with ulcer-like projection (ULP), and 10 study are needed to clarify the difference. 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.

Annals of Vascular Diseases 2016 125 Poster Presentation P07-19 P07-20 3D Printing in Vascular Surgery: A Systematic A Novel use of the Clarivein Catheter for Review Pharmaco-Mechanical Thrombolysis of a Teck Ee Reyor Ko1, Yeong Xue Lun2, Andrew MTL Choong3,4 Thrombosed Arteriovenous Graft 1Yong Loo Lin School of Medicine, National University of D Lim, D Ho, Y K Tan, Dr Steven Kum Singapore, Singapore, 2Faculty of Medicine, University of New Changi General Hospital, Singapore South Wales, New South Wales, Australia, 3Division of Vascular Surgery, National University Heart Centre, Singapore, 4School of Introduction and Background Medicine, Griffith University, Gold Coast, Queensland, Australia Arteriovenous grafts (AVG) for dialysis access are commonly required in patients with poor quality veins for autogenous Background arteriovenous fistulas (AVF). However, the primary patency 3D printing technology is an exciting technology that has made of these AVGs are as low as 42% at 1 year. Percutaneous rapid progress since its first introduction. There are now multiple interventions are commonly used to restore patency of the access applications within medicine. We systematically review the circuit. Phamacomechanical Thrombolysis (PMT) is one of several published literature and report on the myriad of roles 3D printing techniques to restore flow. We describe a technique of using the plays within the domain of cardiovascular surgery. Clarivein catheter (Vascular Insights, Madison CT) to successfully perform PMT in a thrombosed AVG.

Methods Methods and Description of Procedure A systematic review of 5 electronic databases (Cochrane, PubMed, Ovid, Scopus, Google Scholar) was performed as per the Preferred A 65 year old male was admitted for a thrombosed AVG. Under Reporting Items for Systematic Reviews and Meta-Analyses local anaesthetic, the AVG accessed and pharmacomechanical guidelines. We included studies reporting on any use of 3D thrombolysis of the AVG was done with 120,000 units of technology in cardiovascular surgery. 3D printing in neurosurgery Urokinase delivered via the Clarivein device. Angiogram revealed (defined as being intracranial) were excluded. 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 Results endoprostheis was performed. Simultaneous balloon angioplasty A total of 289 articles were identified but only 18 studies met our of the graft-artery anastomosis was performed resulting in a good search criteria including twelve case reports, four case series and angiographic result with no residual stenosis or clot in the AVG. two comparative studies. Time to successful thrombolysis was 10 minutes and time for the entire intervention was 65 min. We encountered no procedural complications. 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 Conclusion reported excellent outcomes in guiding therapeutic decisions in the Off-label use of the Clarivein catheter for PMT to restore flow in pre-operative phrase. an AVG is safe and technically feasible. It allows rapid restoration of flow to the access circuit with a low dose of thrombolytic agent. 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. P07-21 Novel use of Drug Eluting Balloon 6 studies assessed the value of 3D printed models in aiding the Assisted Maturation (DEBAM) in Primary training of surgical trainees. All 6 studies showed varying degree of educational benefits of trainees. Arteriovenous Fistula Creation J X Lim, D Lim, D Ho, YK Tan, Steven Kum Changi General Hospital, Singapore Conclusions 3D printing has the potential to significantly advance both patient care and training in cardiovascular surgery. Further studies Background and Objectives regarding the long-term benefits of 3D printing are warranted. Arteriovenous 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

126 Annals of Vascular Diseases 2016 the inhibition of smooth muscle proliferation and neointimal Overall procedures through the RA were successful in 96,2% of the hyperplasia. Medtronic received the CE Mark this year for usage lesions. RAO clearly reduced in better trained doctors. Length of of its IN.PACT DEBs in the maintenance of hemodialysis access. hospitalization within the iliac interventions was 2,75 (95%CI 95% ;1,4 and 4) days. 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 Conclusion calibre vein, to assist in the subsequent maturation of the fistula. Transradial access for peripheral endovascular interventions is safe and feasible with potentially lower complication rates than Methods traditional TF access. More studies are required and training in appropriate methods is essential if this is to be reproduced more Technical note describing the usage of DEB at the time of primary widely. TR interventions seem to be saver than TF interventions AVF creation in a patient with a 1.5mm scarred cephalic vein, who and hospitalization is shorter. would otherwise not be a candidate for autogenous AVF creation.

Conclusions We propose that DEBAM is a viable option in patients with small P07-23 veins, who would otherwise be deemed unsuitable for AVF creation. The long term clinical outcomes, however, are not established and Successful endovascular treatment for rectal we propose future prospective studies to investigate this. arteriovenous fistula after pelvic trauma Yohei Munetomo, Shinji Yamazoe, Akira Baba, Yuko Kobashi, Takuji Mogami 0Department of Radiology, Tokyo Dental College Ichikawa General P07-22 Hospital, Japan Transradial Non-coronary Peripheral Endovascular Interventions: A Systematic Background Arterial trauma may lead to the development of arteriovenous Review fistula (AVF). In previous literature, about 1 % of acquired AVF Max Meertens1, Eugene Ng2, Andrew MTL Choong3,4 were due to blunt trauma, while penetrating trauma, stab wounds, 1Faculty of Health, Medicine and Life Sciences, Maastricht and gunshot wounds accounted for the vast majority of these lesions. And there are few reports of acquired rectal AVF after University, Köln, Germany, 2Westmead Hospital, Sydney, trauma. Australia, 3Division of Vascular Surgery, National University Heart Centre, Singapore, 4School of Medicine, Griffith University, Gold Coast, Queensland, Australia We present a successful case in that we treated lower gastrointestinal bleeding caused by rectal AVF after pelvic trauma. Objective Case The transradial (TR) approach has been proven to be safer than transfemoral (TF) access in coronary interventions. The Patient was an about-80-year-old man. He fell down at home chance for major hemorrhage is decreased and also for other two months ago, and he had back pain from 1 month ago. Three major complications. Furthermore is the mortality is reduced. weeks ago he was diagnosed as sacral fracture by previous doctor. Nevertheless, percutaneous TR access remains underused in other On February 25 2016, he was admitted to our emergency room endovascular procedures. because of massive melena and hemorrhagic shock. Dynamic CT showed high enhancement lesions and extravasation in rectum. Colonoscopic examination showed elevated lesions with bleeding Methods in the lower rectum. We suspected acute rectal variceal hemorrhage We performed a systematic literature review according to the and performed endoscopic variceal ligation (EVL) . However 6 days PRISMA guidelines looking at TR access for non-coronary after EVL, lower gastrointestinal bleeding occurred again. So we peripheral endovascular interventions. We excluded all articles performed angiography for localization and evaluation of bleeding. which focused coronary treatment, AV shunts or non endovascular The angiography including pelvic vessels demonstrated rectal AVF procedures. 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% Results ethanolamine oleate under balloon occlusion without complication. We included 18 articles which looked at iliac/femoral, popliteal, After the embolization, melena and rectal varices were disappeared renal, carotid, tibial, axilary, subclavian, vertebral artery, peripheral by enhanced CT and colonoscopy. interventions and endoleak or peripheral artery embolization representing 1985 patients and 2639 lesions. Conclusion We experienced a case of rectal AVF after pelvic trauma. There are We found access problems in 79 patients (3,9%), major few reports of acquired rectal AVF after trauma, but it is necessary complications (MI, bleeding, stroke) in 11 patients (0,42%), 31 to consider AVF as the cause of lower gastrointestinal bleeding patients (1,2%) with minor (small hemorrhage, TVI) complications after brunt pelvic trauma. 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.

Annals of Vascular Diseases 2016 127 Poster Presentation P07-24 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 40 Hours with a Traumatic Carotid side of calf; then we selected conservative management. After the treatment, his clinical symptoms were relieved, and no further Transection hematoma appeared. Eugene Ng1, Ian Campbell1, Andrew Choong1,2,3, Allan Kruger1, Philip J Walker1,2 These three cases presented with thin skin and hyperextensibility of 1Royal Brisbane and Women’s Hospital, Queensland, Australia, skin, and arterial fragility or rupture. These findings suggested the 2Discipline of Surgery, School of Medicine, University of vascular type EDS. Queensland, Queensland, Australia, 3School of Medicine, Griffith University, Gold Coast, Queensland, Australia Patients with vascular type EDS should be promptly evaluated, and we should select the treatment, especially with conservative Background management, by taking into account the fragility of skin and blood Although penetrating neck trauma is uncommon, it is associated vessels. 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. P07-28 The effect of rifampicin bonded graft for A 22 year old male was assaulted with a screw driver and sustained bacterial infection multiple penetrating neck injuries. A contrast computed tomographic 1 1 scan revealed a focal pseudoaneurysm in the left common carotid Shinnosuke Okuma , PhD Takeshiro Fujii , PhD Tomoyuki 1 1 1 artery bulb. There was no active bleeding or any other vascular Katayanagi , MD Yoshio Nunoi , MD Toru Kameda , MD Kota 1 1 1 injuries and the patient remained hemodynamically stable. In view Kawada , MD Tatsuaki Hosaka , MD Takahide Yao , PhD Hiroshi 1 1 1 of these findings, he was initially managed conservatively without Masuhara , MD Yuzo Katayama , PhD Tsukasa Ozawa , PhD 1 1 open surgical exploration. However, repeat radiological via Noritsugu Shiono , PhD Yoshinori Watanabe catheter directed angiography raised further concern for vascular 1Toho University, Ota-ku, Japan 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. Objective A percutaneous drain was inserted in the carotid triangle and a The infection in vascular prosthetic conduits is one of the most course of intravenous antibiotics for 5 days was commenced. The threatening complication of cardiovascular surgery. It has been patient recovered well from his operation with no complications reported that rifampicin bonded graft (RBG) is effective for the and remained asymptomatic on followup at 5 months. prosthetic graft infection. We investigated about the effect of RBG.

Methods Study 1: Gelatin-coated Dacron vascular grafts were cut into 6cm P07-27 segment. Two RBG grafts and two saline bonded grafts were placed Three Cases of Vascular Ehlers-Danlos U-shaped configuration on culture plate. The saline was added into the inside of four grafts and 106CFU/ml and 108CFU/ml suspended Syndrome Pseudomonas aeruginosa were added to the outside each by two Masato Nishizawa1, Dr Toshifumi Kudo1, Dr Kimihiro Igari1, Dr grafts. Samples taken from inside and outside the grafts every six Takahiro Toyofuku1, Dr Yoshinori Inoue1 hours by twenty-four hours were spread on LB agars. 1Tokyo Medical And Dental University, Division Of Vascular And Endovascular Surgery, Department Of Surgery, Bunkyo-ku, Japan 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 Ehlers-Danlos syndrome (EDS) is a rare connective tissue disorder, CFU/ml, 106 CFU/ml and 108 CFU/ml suspended Pseudomonas which is characterized by fragility of the skin, blood vessels, and aeruginosa were added to the outside each by these grafts. Samples joints. Arterial rupture is one of the most severe complications in were taken. patients with vascular type EDS. We herein report three cases with vascular type EDS. Result Study1: We did not detect the bacteria inside the rifampicin bonded First case was a 27-year-old male with swelling of the left calf. graft spread 106CFU/ml suspended Pseudomonas aeruginosa. The His brother had a history of carotid artery aneurysm. Computed bacteria have decreased outside of the graft. On the other hand, tomography (CT) showed bilateral posterior tibial artery the sample inside the rifampicin bonded graft spread 108CFU/ml aneurysms, sized 10 mm, and a left aneurysm ruptured. We selected suspended Pseudomonas aeruginosa were the same concentration conservative management. His clinical symptoms were relieved, of saline bonded graft after a period of 24 hours. and no further rupture of the aneurysms occurred. Study2: The sample inside the rifampicin bonded graft spread Second case was a 34-year-old female with the swelling and pain 106CFU/ml and 108CFU/ml suspended Pseudomonas aeruginosa of the left calf. CT showed a rupture of popliteal arterial aneurysm increased the rapidly after a period of 24 hours. 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. Conclusion RBG 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

128 Annals of Vascular Diseases 2016 vascular prosthetic conduit infection using RBG, because the P07-30 rifampicin is not effective after 24 hours in this study. Intra-luminal thrombus bleeding in abdominal aortic aneurysm as an indicator for acute or impending rupture: A case series P07-29 Abdul Rahman M N A1, Razali MR2, Faidzal Othman1 A case of rupture was saved splenic artery 1Vascular Unit, Department of Surgery, Kulliyah(Faculty) aneurysm due to Segmental Arterial of Medicine, International Islamic University Malaysia, Kuanta, Malaysia, 2Department of Radiology, Kulliyah(Faculty)Of Modiolysis(SAM) after 7days of surgery of Medicine, International Islamic University Malaysia, Kuantan, ascending aortic aneurysm ruptured Malaysia Hirokuni Ono1, Shota Kita1, Hirotoshi Suzuki1, Yuka Sakurai1, 1 1 1 Ro Daijyun , Tokuichirou Nagata , Kiyoshi Chiba , Makoto Keywords: Hyper attenuating crescent sign Aneurysm rupture Ono1, Yosuke Kitanaka1, Masahide Chikada1, Hiroshi Nishimaki1, Takeshi Miyairi1 1St.marianna Univercity Of Medicine, kawasaki , Japan 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 Background aortic aneurysm (AAA). We present two cases of patients presenting Segmental arterial mediolysis (SAM) is a rare noninflammatory, to our centre with a finding as described above. The importance of nonatherosclerotic disease of unknown etiology typically affecting these finding correlating with intra-operative findings and review medium-sized abdominal arteries. It is characterized histologically of relevant literatures will be highlighted. 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 P07-31 at the fifth and sixth decades. There is a slight male predominance. Endovascular Management of peripheral Patient date: 79 years old,female. Medical history:hypertension. AVM (Arteriovenous malformation) & AVF (arteriovenous fistula) at Nepal 1 Clinical course & Results Sandeep raj Pandey 1 Because of the patient occurred severe acute chest and back pain, Annapurna Neuro Hospital, Kathmandu, Nepal transported to the Emergency center. We diagnosed an ascending aortic aneurysm rupture. The patient was underwent the urgent Background/ Introduction surgery. Peripheral AVM & AVF are rare congenital lesions. Complete eradication of the nidus of an AVM is the only potential cure. At postoperative day 7, the patient occurred severe acute abdominal However, surgical resection is often difficult, and recurrence of pain and fell into a state of really shock vital. We admitted the AVM is common with incomplete resection.Transcatheter Intraperitoneal hemorrhage in emergency CTA examination, embolisation now plays a significant role in the treatment of AVM confirmed the blood vessel leakage of the contrast agent from the & AVF. splenic artery aneurysm. Objective: We performed selectively embolization of splenic artery and To assess the treatment results of coils & glue embolization of hemostasis in emergency catheter intervention. peripheral AVM & AVF at Nepal.

In catheter angiography showed a severe stenosis and Materials & methods: pseudoaneurysm in the splenic artery distal portion. Left gastric artery and left hepatic artery was recognized beaded aneurysm. Case of AVM:A 20 yr old male found a painful pulsatile nodules on the right gastroepiploic artery showed saccular aneurysm,spindle- his left lower thigh which was progressively enlarging for several shaped extension and spasm.Diagnosis was strongly suspected the months. CT-angio showed AVMs draining from SFA with multiple SAM. 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. Discussion Originally described as “segmental mediolytic arteritis” by Slavin Case of AVF:A 60 yr old female c/o pain & pulsation in lt buttock and Gonzales-Vitale in 1976, this disease has been renamed post fall.Ct-angio showed very high flow AV fistula from inferior “segmental arterial mediolysis” due to lack of inflammatory gluteal artery with large venous varix of draining vein.She changes. It is the most of a abdominal branch of the aneurysm. underwent coil embolisation of feeding artery followed by glue embolisation via right femoral approach.It was followed by percut A mortality rate of 50% has been attributed to the acute presentation lipidurol injection. with aneurysm rupture necessitating urgent surgical or endovascular treatments. Results: Both of patient got relieved of pain & significantly decreased mass Conclusions n pulsation. The outcome was satisfactory without complication. It will be necessary to long-term follow-up.

Annals of Vascular Diseases 2016 129 Poster Presentation

Conclusion: technically challenging. Via an endovascular route, a balloon Treatment for peripheral AVM & AVF is a challenge because of angioplasty catheter was passed into the IJV and inflated to their unpredictable behaviour. There is a wide plethora of embolic achieve proximal and distal control of the haemorrhage as well as agents, each with its own particular characteristics that makes it identifying the anatomical position of the vein in the wound. This ideal for certain situations. Familiarity with these and their modes allowed controlled dissection and facilitated definitive surgical of use and action can help in selecting the correct agent depending intervention with minimal blood loss. There were no neurological on the goal of embolization or aero-digestive tract injuries and the patient was subsequently discharged well 5 days after the initial injury.

Conclusion P07-32 A multi-disciplinary approach with the incorporation of endovascular techniques are good adjuncts to surgical intervention Acute lower limb ischemia in a case of ischemic and should be considered for complicated penetrating neck trauma & valvular heart disease patient: A case report with vascular injuries. Mokhlesur Rahman 1National Institute of Cardiovascular Diseases, , Bangladesh

Abstract: P07-34 A female patient with valvular heart disease and atrial fibrillation Endovascular embolization of iatrogenic presenting with acute both lower limb ischemia, successful superior mesenteric arteriovenous fistula embolectomy was performed through bi-femoral approach 16 hours Jun Yamao1, MD Hiroyoshi Komai2, MD Masashi Okuno1 after onset of symptoms. After operation patient was recovered well 1 2 and patient’s both lower limbs were saved. Patient was discharged Yoshida Hospital, Hirakata City, Japan, Department of Vascular from hospital on 10th postoperative day. Coronary artery bypass Surgery, Medical Center, Kansai Medical University, Moriguchi graft and double valve replacement operation of same patient was City, Japan done successfully after two months of embolectomy. Iatrogenic arteriovenous fistula between the superior mesenteric Keywords: artery and vein is extremely rare. We herein report a case of an 85-year-old male with an iatrogenic superior mesenteric Valvular heart disease, saddle thrombus, aortic occlusion, acute arteriovenous fistula that developed after a small bowel resection. lower limb ischemia, embolectomy. 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 P07-33 the right upper quadrant. An abdominal ultrasound examination demonstrated an arteriovenous fistula between the super mesenteric A Multi-Discliplinary Approach to the artery and vein without any sign of hepato-splenomegaly. The Management of Penetrating Neck Trauma findings were also confirmed with volume-rendered computed Ian J. Tan1, Lowell Leow1, Harvinder S. Raj1, Dr K.Y. Seto2, tomography and superior mesenteric angiogram. The fistula showed Vikram Vijayan1 a U shape and was about 1.3 mm in diameter. The patient suffered from ascites, pleural effusion and hypotension caused by high flow 1Department of Surgery, Ng Teng Fong General Hospital, , congestive heart failure. Because the shunt flow was predicted to be Singapore, 2Department of Radiology, Ng Teng Fong General high and coil embolization seemed to be unsuitable, endovascular Hospital, , Singapore embolization of the fistula was performed with embolic agent: AMPLATZER™ Vascular Plug 4 (AVP 4) at the arterial side Introduction of the fistula, resulted in reducing the sign of congestive heart Penetrating neck injuries have traditionally been managed by the failure and stabilizing the blood pressure. However, five days after trauma surgeon. We present a case of a man who sustained an the endovascular treatment the patient was died of pneumonia. internal jugular vein (IJV) tear due to a penetrating neck injury Endovascular embolization with AVP 4 is expected to be one of the who underwent surgical management by a multi-disciplinary team feasible treatment choices for arteriovenous fistula in severe cases. involving a vascular surgeon and an interventional radiologist.

Case Description P07-35 A 44 year old Chinese man presented to the emergency department with a zone 2 penetrating neck injury secondary to an industrial- Totally implanted venous access ports at upper related high velocity shrapnel injury. He presented with a arm in patients with female breast cancer: early large, bleeding but initially non-expanding neck hematoma. At presentation, there was no evidence of compression of the aero- experience in comparison with trans-jugular digestive track but as time progressed he developed some tracheal chest port shift to the contralateral side. Shin-Seok Yang1, Prof Bo-Yang Suh1, Dr Young-A Kim1 1Yeungnam Universtiy Hospital, Namgu, South Korea A multi-disciplinary (vascular surgeon and interventional radiologist) surgical approach was adopted and a neck exploration Background was performed in a hybrid operating theatre. Due to the tissue damage along the path of the penetrating projectile and a Totally implantable venous access ports (TIVAPs) are widely used continually expanding and profusly bleeding hematoma from for chemotherapy in patients with breast cancer. a torn IJV, there was severe anatomical distortion which proved

130 Annals of Vascular Diseases 2016 Objectives Results The purpose of this study is to retrospectively analyze the safety, Port catheters were placed to all patients for chemotherapy due to technical feasibility and complication of TIVAPs at the upper arm malignancy. Mean follow-up term for ports was 386.46±268.713 and to compare with trans-jugular chest port in patients with breast days and mean stay length of port was 553.29±234.051days. cancer. 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. Materials and Methods Between July 2014 and February 2016, 223 consecutive female breast cancer patients who underwent a TIVAP at the upper Conclusion arm or the chest were included. All procedures were performed Maintenance and usage of port catheters must be performed with with sonogrpahic and fluroscopic-guided approach under local a strict protocol. Maximal care should be taken when inserting anesthesia. We reviewed medical records for technical success, and extracting the needle. Especially blunt-tipped needles (ports pain scale, early (≤30day) and late (>30day) complication. 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 Results post catheters. Maintenance of catheter is directly involved with A total of 231 devices were implanted at the upper arm (n=176, efficient usage period. Every step of usage must be handled with 76%; 159 basilic veins and 17 brachial veins) and the chest (n=55, extreme caution. 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- P07-37 days). There was no significant difference in complication-free En-bloc resection of tumors with infrahepatic survival of patients with upper arm and trans-jugular chest TIVAPs. Mean amount of 2% lidocaine for local anesthesia was 3.3±1.7 vena cava ml at the upper arm and 14.5±4.1 ml at the chest, respectively Chun Ling Patricia Yih1, Dr Yuk Hoi Lam1, Prof Yun Wong James (p<0.001). High body mass index was significant risk factor of Lau1 catheter-related infection. 1Prince Of Wales Hospital, Hong Kong, Hong Kong

Conclusions Background and objectives Implantation of TIVAPs at upper arm is a safe procedure with low Involvement of inferior vena cava (IVC) by tumors was thought to rates of complications in patients with breast cancer. High body be a contraindication to resection. In many such patients, en bloc mass index is associated with a higher risk of catheter-related tumor resection with IVC is the only option. We report a series of infection. This method can be performed less painful compared patients who underwent such a resection. with trans-jugular chest TIVAPs. Methods All patients who underwent en-bloc resection of infrahepatic IVC with tumours at a tertiary referral centre. Baseline, operative and P07-36 postoperative data were analyzed. Discussion of factors effecting the stay length of venous port catheter for chemotherapy Results Assist. Prof. Özge Korkmaz1, Assist. Prof. Sabahattin Göksel1, There were nine patients (M:F 3:6), at a median age of 58 at Ufuk Yetkin1, Specialist Köksal Dönmez2, Prof.Dr. Öcal Berkan1 operation (range, 27-73). Median OT time was 480 minutes 1Cumhuriyet University Medical Faculty, SİVAS, Turkey, 2Katip (range, 300-720), with a median transfusion requirement of 6 units Celebi University Izmir Ataturk Training and Research Hospital, (range, 2-16). Median size of tumour was 9cm (range, 3.5-19). Izmir, Turkey 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 Objective each). Seven (78%) of the patients required concomitant visceral Oncologic patients are subject to many venous interventions resection in addition to the caval resection (5 right nephrectomies, because of long therapy term and vein wall injury caused by 2 duodenal resections). Complex vascular resection was performed chemotherapeutic agents. This situation resulted with preferring in 2 patients (one aortocaval resection in para-ganglioneuroma, one central venous lines for longer periods. Insertable port catheter is IVC and right common iliac artery resection in chondrosarcoma). closed system which is located under the skin as a central venous In all cases, the resected segment of IVC was reconstructed using line. This system is safer for chemotherapy, especially in patients prosthetic graft. Two patients had complications in the early with problematic peripheral veins. Also, with low infection rates, postoperative period (1 duodenojejunostomy leakage, 1 subphrenic easy-to-use for longer periods, less reduction of patient’s daily collection). There were no 30-day mortalities. The median follow- activities, this system is more suitable and more generally used for up was 57 months (range, 4-73), with 5 long-term survivors past daily and weekly chemotherapies at out-patient clinics. 50 months.

Methods Conclusions Between January 2013 and December 2015, 109 permanent En-bloc resection of the infrahepatic IVC with tumours is a safe port catheters for chemotherapy were placed to 98 patients with procedure with an acceptable risk of postoperative complications. malignancy in our clinic. Mean age of patients were 51.63±11.45. Concomitant multi-visceral resections are often required. After a Between these patients 57 of them were male (58,1%) and 41 of margin-free resection, long term survival is possible. them were female (48,9%).

Annals of Vascular Diseases 2016 131 Poster Presentation P07-38 Conclusion This case illustrates the potential durability of endovascular A Rare Case of Clostridium Perfringes Causing repair with carotid-carotid crossover bypass of innominate artery an Abdominal Aortic Graft Infection lesions and highlights the potential role of this minimally invasive Ismazizi Zaharudin, Zainal Ariffin Azizi alternative to surgery in these clinical situations. 1Vascular unit, Department of General Surgery, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia Key words: Pseudoaneurysm, endovascular, bypass, hybrid procedure 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 P07-40 the literature disclosed only one case of Clostridium perfringes A Case Report of Thrombotic May-Thurner aortic graft infection1. There are infrequent reports of aortic graft infection by anaerobic organism. The infection are closely related Syndrome with Concomitant Extrinsic to large bowel pathologies. Compression - Multidisciplinary Hybrid Management Case report Szymon Mikulski, D Lim, D Ho, YK Tan, S Kum We are presenting a case report of a patient that was admitted under our care with an infected aortic graft following an emergency Introduction/Background repair of a ruptured abdominal aortic aneurysm with underlying May-Thurner syndrome (MTS) occurs when the left common iliac diverticular disease. vein is compressed against the lower lumbar vertebrae by the right common iliac artery. It remains an underdiagnosed cause of uni- Conclusion lateral left lower limb deep vein thrombosis (DVT). Treatment of Aortic graft infection with anaerobic bacteria represents a thrombotic MTS is targeted at pre-vention of pulmonary embolism clinical entity distinct from infection with enteric bacteria and and of post-thrombotic syndrome (PTS) and is accomplished by Staphylococcus. Isolation of clostridia sp is closely related with ear-ly thrombus removal and iliac vein angioplasty with stent large bowel pathologies. Optimal treatment and the natural history implantation. of anaerobic graft infection are still in the evolutionary stage. Methods/Results Key words: aneurysm, diverticular disease, anaerobic organism We 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 P07-39 thrombolysis, followed by intravenous ultrasound and stenting of Traumatic Right Proximal Subclavian Artery her left common iliac vein. To improve inflow and maintain stent patency, a common femoral artery to com-mon femoral vein loop Pseudoaneurysm Treated with Hybrid arteriovenous graft (AVG) was created. The patient recovered well Procedure post-op and showed almost complete clinical resolution of her Ismazizi Zaharudin, Zainal Ariffin Azizi symptoms at two-week follow-up. 1Vascular Unit, Department of General Surgery, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur ,Malaysia , , Conclusion Malaysia This report elucidates the successful use of a novel hybrid technique to treat extensive and symp-tomatic left lower limb DVT in the Introduction setting of MTS. Blunt trauma to the right proximal subclavian artery is quite rare and tends to be associated with pseudoaneurysme formation post trauma . P08-01 Case Report Endovascular Revascularization and Free Flap A 53 years old patient was admitted following a major road accident. Reconstruction for Lower Limb Salvage Computed tomography (CT) and on admission Chianan Hsieh1, Honda Hsu2, Chien-Hwa Chang3 disclosed an right proximal subclavian artery pseudoaneurysm. The 1 lesion was stable, so an elective endoluminal repair and carotid- Department Of Nursing, Dalin Tzu Chi General Hospital, Dalin, 2 carotid crossover bypass was undertaken as hybrid procedure once Taiwan , Division of Plastic Surgery, Dalin Tzu Chi General the patient was treated for his other injuries. The carotid-carotid Hospital, School of Medicine, Tzu Chi University, Dalin, Taiwan, 3 crossover bypass was performed followed by the aneurysm was Division of Cardiovascular Surgery, Dalin Tzu Chi General excluded by transluminal implantation of a balloon-expandable Hospital, Dalin, Taiwan Atrium V12 covered stent-graft. A CT scan at 1 month and duplex scans at 6-month intervals documented good stent-graft positioning Objective and aneurysm exclusion over a period of 12 months. Combined 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.

132 Annals of Vascular Diseases 2016 Methods Conclusions Retrospective review of all patients who had undergone Although routine replacement of albumin is not warranted in all endovascular revascularization followed by reconstruction with a patients, but there is a demonstrating outcome benefit. This study free flap for lower limb salvage at Dalin Tzu Chi General Hospital could provide some suggestions and guidance for albumin use between April 2008 and April 2013 were included in the study. 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. Results Total 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 P08-03 but partial flap necrosis was seen in 4 patients. A high rate of wound Predictive factor to determine the 12 months infection was seen in 10 patients. One patient died during the perioperative period. In one patient further limb amputation was risk of major cardiovascular events after required 6 months later due to acute thrombosis of her lower leg treatment for peripheral artery disease vessels. One patient underwent below knee amputation, 21 months Kittipan Rerkasem1,2, Dr. Supapong Arworn1, Dr. Pornchanok later due to deep-seated foot infection. The overall limb salvage Jumroenketpratheep1, Associate professor Natapong rate among 1-year survivors was 96%, and was 92% among the Kosachunhanu1, associate professor Arintaya Phrommintikul1, Dr. 2-year survivors. Kiran Sony3, Dr. Nimit Inpankaew4, Ms Antika Wongthanee2, Dr Saranat Orrapin1, Dr. Termpong Reanpang1 Conclusions 1NCD Center, Faculty of Medicine, Chiang Mai University, The success rate of lower limb salvage using a combination Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, 2NCD Center of Excellence, Research Institute of Health Science, of endovascular revascularization together with free tissue 3 reconstruction is acceptable with a high limb salvage rate, but Chiang Mai University, Chiang Mai, Thailand, Department of Internal Medicine, Chiangrai Prachanukroh Hospital, Chiangrai requires team work between the vascular and the reconstructive 4 surgeon , Thailand, Department of Internal Medicine, Lamphun Hospital, Lamphun, Thailand

Background P08-02 Peripheral arterial disease (PAD) in diabetic patients is associated with high morbidity and mortality. Prognosis after treatment for Can albumin level be a predictor of healing in PAD is mainly determined by the occurrence of major adverse patients with diabetic foot ulcers? cardiovascular events (MACE). Therefore the predictive factor of Yin-Tso Liu1, Yi-Teen Wang1 this MACE is important, but the study for such predictive factors are scarce in Asia. 1Asia University Hospital, Taiwan, Taichung City, Taiwan

Objective Background To identify the predictive factors determine MACE in diabetic Albumin has always been used worldwide for improving wound patients with PAD 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 Method well established that low serum albumin levels are associated with The prediction model was developed in a consecutive cohort of worse outcomes in ill patients. However, there is no good rationale 500 diabetic patients in the Northern part of Thailand who were for use of albumin in diabetic foot ulcers for wound healing. The diagnosed as PAD between 2014 and 2015. Primary end point was purpose of this study is to try to find the relationship between serum MACE and encompassed non fatal myocardial infarction, non fatal albumin levels and wound healing. stroke, worsening PAD and death. 16 potential clinical predictors were entered into a Cox proportional hazard model with backward Methods stepwise regression was performed. This study was supported by Health Systems Research Institute (HSR) Thailand. We 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’ Result albumin level were equal or greater than 3g/dl. The others’ albumin During a mean follow-up of 12 months period, 55 events occurred, were below 3 g/dl. The primary outcome was the length of wound corresponding to a cumulative incidence of 15.4%. The number healing time. Secondary outcome was the length of hospital stay. of death was 34 patients. Clinical predictors in the final model were history of gangrene or chronic ulcer (harzard ratio (HR) Results 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 There was a significant increase in granulation formation in the 13.90, 95%CI 2.92-66.18), history of amputation of ischemic limb wound of elevated albumin group within the first month of treatment (HR 2.69(1.34-5.41), BMI<19 (HR2.62, 95%CI1.29-5.30) patients (P<0.05). Mean wound healing time in the elevated serum albumin with history of taking warfarin (HR3.63,95%CI1.52-8.67), patients group was 54.12 ±5.81 days. Those patients in the other group was with history of taking sulfonylureas (HR0.32,95%CI0.14-0.70). 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.

Annals of Vascular Diseases 2016 133 Poster Presentation Conclusion P09-01 The clinical prediction model for MACE in the first 12 months after detection of PAD in diabetic patients may be used to identify high- Guidelines for Carotid Artery Interventions risk patients to assist optimize medical treatment and risk factor Must Be Revised control as part of secondary prevention to increase life expectancy Koksal Donmez1, Dr. Habib Cakir1, Dr. İsmail Yurekli1, Dr. Mert free from MACE. 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 P08-04 Training And Research Hospital, Izmir, Turkey, 3Department Of Cardiovascular Surgery, Afyonkarahisar State Hospital, Negative Pressure Wound Therapy Instillation Afyonkarahisar,Turkey, Afyonkarahisar, Turkey in Foot Ulcers Sivagame Maniya, Esther Sheau Lan Loh Introduction 1Singapore General Hospital, Singapore We investigated studies to explain cerebral perfusion and perfusion pattern after carotid artery occlusion and clamping at surgery. Circle Background of Willis acts as a safety switch for brain tissue. Incompleteness of Negative pressure wound therapy utilisation in wound care has circle of Willis or hypoplasia of arteries building the circle is very been established over the years. Topical antiseptics have been important. proven useful to combat microbes in wounds. Biofilms Poly- microbial burdened wound beds are common in postoperative Objectives vascular wound beds. Biofilms are known to be present in chronic Due to two important articles, we aimed to present this paper. 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. Method Two recent studies (1,2) were examined. These studies represented Aim a very important anatomic variation. This paper reports the preliminary findings of the combination of [1] BioMed Chuanya Qiu, Yong Zhang, Caixia Xue, Shanshan NPWT and antiseptics instillation use in postoperative wounds in Jiang, and Wei Zhang. “MRA study on variation of the circle of diabetic patients with peripheral vascular disease. willis in healthy Chinese male adults”. Research International, Volume 2015, Article ID 976340 Non-integrity of posterior circulation rate was found as 83,9%. Methods [2] Naveen SR, Bhat V, Karthik GA. “Magnetic resonance The three case studies reported here, underwent revascularization angiographic evaluation of circle of Willis: A morphologic study in (angioplasty) and were treated with appropriate antibiotics a tertiary hospital set up. “ Ann Indian Acad Neurol 2015;18:391-7 accordingly. Patients who had positive postoperative tissue cultures in their wounds were initiated with NPWT instillation. The Completeness of anterior circulation was found as 77,3%, decision for the type of antiseptic use was decided based on the completeness of posterior circulation was found as 33%. Isolated culture result. The amount of solution was dependent on the size posterior circulation was found in 32,6% of the patients. of the wound bed and the frequency of the intermittent irrigation Isolated hypoplasia of arteries of anterior circle of Willis was ranged between 4-6 hourly. 11,6%. Hypoplastic arteries accompanying incomplete circle of Willis is 15,6%. Results NPWT instillation was discontinued in patients when surface Results granulation was achieved and subsequently appropriate dressing As vascular surgeons, we ignore incompleteness of Circle of Willis. products was applied for the patients. Patients 1 and 2 achieved This variation is more common than we thought. wound closure. Patient 3 Lisfranc amputation wound was noted to be progressing on last follow-up visit. Conclusion We believe that due to high incompleteness rates, Circle of Willis Considerations must be evaluated in all patients who are candidates for carotid The amount of solution instillation and frequency has to be assessed interventions or surgery. Carotid angiography is essential for with each dressing change. Periwound protection is imperative evaluating intracranial arteries. with NPWT instillation dressings.

Conclusion Negative Pressure Wound Therapy instillation with antiseptics may be beneficial in controlling bacterial burden and promoting granulation in postoperative vascular wounds.

134 Annals of Vascular Diseases 2016 P09-02 resonance imaging. The microinfarcts-positive and -negative groups were compared for delayed postoperative infarction. Our surgical strategy in a smoker patient with severe left internal carotid artery stenosis Results 1 1 1 Kazim Ergunes , Dr Orhan Gokalp , Dr Ihsan Peker , Dr Habib A total of 76 (13.86%) patients were diagnosed with microinfarcts. 1 1 1 1 Cakır , Dr Yasar Gokkurt , Dr Banu Lafci , Prof Levent Yilik , Prof Preoperative neurological symptoms were significantly related 1 Ali Gurbuz to the incidence of microinfarcts [odds ratio (OR), 2.93; 95% 1Izmir Katip Celeby University Atatürk Training and Research confidence interval (CI), 1.72–5.00; p < 0.001]. Shunt insertion Hospital, Izmir, Turkey 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 Background postoperative infarction (p = 0.204). The carotid artery stenosis is associated with severe morbidity and mortality .We presented a smoker patient with severe left internal carotid artery stenosis . Conclusions In the present study, risk factors for microinfarcts after CEA included preoperative symptoms and intraoperative shunt insertion. Method Microinfarcts was not associated with delayed postoperative A 70-year-old woman was hospitalized in ourclinic on February infarction. 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). P09-04

Results Clinical value (or utility) of preoperative Carotid endarterectomy was performed with regional anesthesia. carotid ultrasonography prior to operation An arteriotomy was made on the anterior wall of the left common for abdominal aorta aneurysm and peripheral and internal carotid arteries extending to the region not including artery disease plaque. The left internal carotid endarterectomy was performed Prof. Hyuk Jae Jung1, Yong Beum Bak1, Dr. Dong Hyun Kim1, without using shunt. Arteriotomy was closed with Dacron patch. 1 The patient was discharged after three days with clopidogrel and Prof. Sang Su Lee aspirin. 1Pusan National University Yangsan Hospital, Yangsan, South Korea Conclusion Carotid endarterectomy is effective and safe method in appropriate Background patients. Careful and appropriate dissection of carotid artery is Carotid ultrasonography (CUS) is one of useful screening modality important to decrease morbidity. 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). P09-03 Analysis of Risk Factors for Cerebral Material and Methods From 2011 to 2015, we retrospectively evaluated 341 patients who Microinfarcts After Carotid Endarterectomy underwent preoperative CDS for vascular surgery. Radiologist and the Relevance of Delayed Cerebral estimated degree of ICAS using ECST. We compared the prevalence Infarction of severe ICAS between abdominal aortic aneurysm (AAA) and 1 PAD, and evaluated risk factors of ICAS in PAD patients. For Jun Gyo Gwon statistical analysis, data were tested by multiple logistic regression 1University Of Ulsan College Of Medicine, Asan Medical Center, analysis and Chi-square test. Seoul, South Korea Results Background Prevalence of severe ICAS was significantly higher in PAD Carotid endarterectomy (CEA) is performed to prevent cerebral compared to AAA (15.2% vs. 7.3% ; P = 0.041). Among 231 PAD infarction; however, cerebral microinfarcts are a common side patients, multi-level lesion revealed significantly higher incidence effect of CEA. 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% Objectives 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 This study aimed to analyze the variables related to microinfarcts factors of severe ICAS in multivariate analysis. Prevalence of during CEA as well as to determine their association with delayed severe ICAS according to ABI in PAD was not significant. postoperative infarction.

Conclusions Materials and Methods CUS can be a useful non invasive preoperative screening imaging This was a retrospective review of prospectively collected data from tool for PAD patients with multi-level lesion, CKD, and CVA 548 patients who underwent CEA. Patient clinical characteristics, incidence rates, and microinfarcts causes were analyzed. Microinfarcts were diagnosed by diffusion-weighted magnetic

Annals of Vascular Diseases 2016 135 Poster Presentation P09-05 P09-06 Impact of subclinical coronary artery disease on Review of 99 consecutive carotid the clinical outcomes of carotid endarterectomy endarterectomies in a moderate volume centre Minsu Noh1 Yongxian Thng1, Joel Lee1, Dr Julian Wong1 1Asan Medical Center, Seoul, South Korea 1Nuh, Singpore, Singapore

Introduction Introduction Controversy persists regarding the optimal management of Carotid endarterectomy has been established by 2 randomised subclinical coronary artery disease (CAD) prior to carotid controlled trials ECST ( European carotid surgery trial ) and endarterectomy (CEA) and the impact of CAD on clinical outcomes NASCET ( North American Symptomatic Carotid Endarterectomy after CEA. 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 Objectives centres. This study aimed to evaluate the short-term surgical risks and long- term outcomes of patients with subclinical CAD who underwent CEA. Aim To review the outcome of a consecutive series of patients undergoing carotid endarterectomies in a moderate volume setting. Materials and Methods The authors performed a retrospective study of data from a prospective CEA registry. They analyzed a total of 702 cases Methods involving patients without a history of CAD who received A retrospective case review was performed from 2005 to 2015. preoperative cardiac risk assessment by radionuclide myocardial During which we performed 99 elective carotid endarterectomies perfusion imaging (MPI) and underwent CEA over a 10-year on patients with severe carotid stenosis. Follow-up data was mostly period. The management strategy was determined according to the attained from the outpatient setting. 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 Results defined on the basis of postoperative elevation of the blood level The mean age was 69 with the age range from (41 to 86). 85% of of cardiac troponin I (0.05–0.5 ng/ml) in the absence of myocardial the patients were Chinese, 10 % were Malays and 5% were Indians. ischemia. The primary endpoint was the composite of any stroke, There were no deaths in this series of 99 cases. All our patients myocardial infarction, or death during the perioperative period came through surgery without major neurologic deficit. One patient and all-cause mortality within 4 years of CEA. The associations had a peri-operative TIA and two other patients developed neck between clinical outcomes after CEA and subclinical CAD were hematomas. analyzed. Conclusion Results Carotid endarterectomies can be safely performed in moderate Concomitant subclinical CAD was observed in 81 patients (11.5%). volume hospitals with excellent outcomes. 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 P10-01 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 Endovascular aortic aneurysm repair (EVAR): similar rates of overall survival (p = 0.75). the National Kidney and Transplant Institute (NKTI) experience from 2013 to 2014 Conclusions Dr Benito Purugganan Jr1, Edgar Macaraeg1, Dr. Ricardo Jose Patients with subclinical CAD can undergo CEA with acceptable Quintos1, Dr. Leo Carlo Baloloy1, Dr. Marc Anter Mejes1 short- and long-term outcomes provided they receive selective 1Philippine Society For Vascular Surgery, Inc, Quezon City, coronary revascularization and optimal perioperative medical Philippines treatment.

Background Endovascular 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.

Objectives To show the clinical results, perioperative complications and parameters of patients at NKTI who underwent EVAR from 2013 to 2014.

136 Annals of Vascular Diseases 2016 Materials and Methods femoral vein cannulation and clamping aorta,aneurysmal sac was This is a retrospective descriptive study of EVAR cases at NKTI excised,dissection extending from aortic bulb was visualised. from 2013 to 2014. 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 A chart review was done wherein significant data were obtained performed.Patient was discharged in good condition. needed for the study. Conclusion Results Management and outcomes differ about types.Type B IMH has There were ten cases of EVAR done at NKTI from 2013 to 2014. favorable outcomes in comparison with type A IMH and type B Eight of these cases were abdominal aneurysms while two of the AD.These don’t mean type B IMH is benign.Rates to progression cases involved the thoracic aorta. to AD are variable both in frequency and time.11% progressing from IMH to AD is described in among published series.Treatment The average duration of procedure is 4 hours and 22 minutes. selection is challenging and should be based on comprehensive In terms of blood loss, the mean blood loss is 415ml. Out of 10 evaluation. 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 P10-03 average hospital stay for all 10 cases is 8 days. Anatomical characteristics of an infra-renal abdominal aortic aneurysm: Can an aneurysm In terms of morbidity, none of the cases had surgically related that is prone to enlargement after endovascular morbidities. One of the ten cases died due to a complicated case of suprarenal aneurysm with concomitant lower gastrointestinal aneurysmal repair be predicted? bleeding and pneumonia. MD Sang Young Chung1, MD Ho Kyun Lee1, Soo Jin Na Choi1 1Chonnam National University Hospital, Gwangju, South Korea Conclusion The experience of NKTI on EVAR is still limited but it continues to Background/ Introduction grow and expand. Despite the limited number of cases, data shows An attempt was made to identify the morphological determinants better outcome. of an infra-renal AAA, which could result in aneurysmal sac expansion after EVAR. Keywords: Aortic Aneurysm, Endoleak, length of stay, Intensive Care Unit (ICU), Hypertension Objectives This 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). P10-02 Horns of a dilemma: Follow-up or surgery for Materials and Methods aortic intramural hematoma? The datasets of 60 patients were retrospectively analyzed. All the Nur Dikmen Yaman1, Mehmet Cakici1, Evren Ozcinar1, Cagdas patients were underwent EVAR for an infra-renal AAA, followed by Baran1, Levent Yazicioglu1, Bulent Kaya1 computed tomography angiography (CTA), at a routine schedule of more than a year. With the final follow-up CTA findings, the EVAR 1Ankara University Medicine School, Ankara, Turkey results were classified into three groups [Group I that showed a more than 10% aneurysm shrinkage, Group II that showed minimal Introduction (less than 10%) or no aneurysmal area change; and Group III that Management of aortic intramural hematoma remains controversial. showed a more than 10% post-EVAR aneurysmal expansion] and Most surgeons advocate emergency surgery in manner similar to then re-classified into two groups (Group A that showed no post- frank to acute aortic dissection. EVAR aneurysmal expansion and Group B that showed post-EVAR aneurysmal expansion).

Methods Results A 63-year-old female with hypertension and recent coronary artery bypass was admitted complaining of angina.Initial troponin was The proximal neck length was significantly shorter in Group I than normal.Patient was transferred to cardiovascular intensive care in Group II and Group III (p = 0.016). Moreover, the AAA in Group unit where echocardiogram showed normal function,no significant I showed a much larger maximum aneurysm lumen diameter (p valvular abnormalities,suspected intramural hematoma,aortic = 0.017) and area (p = 0.009) than that in the other groups. The wall thickening.Shortly thereafter,CT revealed ascending aortic proximal neck length of Group A was significantly shorter than that aneurysm of 50 mm in arch,heterogeneous aortic wall was of Group B (p = 0.004). In the binary regression test, the shorter visualised-12 mm hyperdense area most likely resulting from proximal aortic neck length was the only statistically significant IMH at ascending aorta,extending down to descending.Maximal difference, with an odds ratio of 0.436. medications was given,CT was performed serially,demonstrated stable hematoma.Patient was discharged with optimal medications. Conclusions On follow-up,15 days after discharge,she had similar complaints. An AAA with a shorter proximal aortic neck and a larger lumen CT showed intimal tear,dissection flap at ascending aorta on diameter/area could result in AAA sac expansion after EVAR. 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

Annals of Vascular Diseases 2016 137 Poster Presentation P10-04 Materials and Methods Stent assisted coil embolization is a novel approach in the Can EVAR replace open repair as primary management of complex, life threatening abdominal aortic disease treatment for abdominal aortic aneurysm? such as this case. Professor Sung Woon Chung1, Associate professor Chung Won 1 1 1 Lee , Fellow Up Huh , Resident Joohyung Son Results 1 Pusan National University School Of Medicine, Pusan National On follow-up, patient remains asymptomatic with evidence of University Hospital, Busan, South Korea sac thrombus on follow-up CT Angiogram of the abdomen, two months after the procedure. Background With significant reduction in the number of open aneurysm Conclusions repairs, endovascular aneurysm repair (EVAR) has dramatically Stent assisted coil embolization of saccular, suprarenal aortic transformed the management of abdominal aortic aneurysm aneurysm is a promising technique of abdominal aneurysm repair (AAA). This paper compares the demographics, operative for patients with difficult and complex surgical anatomy. The long- data, complications, and mortalities associated with AAA after term impact will be defined via serial CT-scan follow-up. 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 P10-06 period of eight years Hybrid Operation for Juxta-renal Aortic Results Aneurysm with Fragile Neck Ida Bagus Budiarta1, MD Djony Edward Tjandra1 Mean age in the EVAR group was higher than that in the open repair group (p = 0.001). Hospital mortality showed no significant 1Indonesian Society For Vascular And Endovascular Surgery, difference between the groups (p = 0.360). However, the overall Central Jakarta, Indonesia survival rate was significantly lower in the EVAR group (p= 0.033). In 21 cases of ruptured AAA, two patients underwent Backgroud EVAR and 19 patients underwent open repair. The two patients who underwent EVAR are still alive (follow-up duration, 49 months and The proximal aortic neck is one of the limiting factors for 24 months). Mortality rate associated with open repair in ruptured endovascular aneurysm repair (EVAR) and represents a crucial AAA was 52.6%. 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 Conclusion aortic segment for the treatment endoleak type 1. The EVAR of It would be ideal to set stricter criteria for EVAR, particularly for juxtarenal aneurysms could be performed through fenestrated younger patients. EVAR seems to be more advantageous in cases endovascular repair or “chimney or snorkel” technique. of emergency ruptured AAA rather than as an elective procedure. Case Report A 70-years-old male with hypertention due to pulsatile abdominal P10-05 mass since 2 years ago. Stent assisted Coil Embolization of a Large, From Physical examination there was palpable pulsatile mass, at the Saccular, Suprarenal Aortic Aneurysm with 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 Walled off Rupture: A Case Report largest diameter 60,7 - 60,9 mm, from renal artery to bifurcatio 1 1 Alinaya Cordero , Dr Fabio Enrique Posas aorta 157,8 mm, diameter of bifurcatio 28,6 mm, calsification of 1Heart Institute, St. Luke’s Medical Center, Global City, Taguig RCIA and LCIA, diameter of RCIA 10,2-11,3 mm and LCIA City, Philippines 10,1-10,8 mm.

Background/ Introduction We did the procedure with local anaesthesia. We started EVAR Suprarenal and thoracoabdominal aortic aneurysms portray procedure from the right femoral artery, we use main body and significant surgical challenges given their anatomical locations extention for the right leg and left leg. A hybrid procedure was and associated difficulties with surgical procedure. In patients chosen: juxtarenal aortic banding and one-stage EVAR. with suitable anatomy, or prohibitive surgical risk, endovascular aneurysm repair offers a less invasive alternative. Special strategies Result are needed to attain favorable repair outcome. The patient tolerated the procedure well and was discharged home on day 7. Subsquent postoperative CTA will be heald after 3 month Objectives as a first evaluation. We report a case of a 59 year old male with a large, suprarenal, saccular aortic aneurysm with probable walled off rupture who Conclusion underwent aneurysm repair with stent assisted coil embolization EVAR combined with juxtarenal aortic banding is the ideal technique. Surgical repair in this case otherwise required modalities procedure which minimally invasive for the treatment thoracoabdominal incisions, intensive dissection and cross-clamp of AAA with endoleak type 1. above the celiac trunk.

138 Annals of Vascular Diseases 2016 P10-07 multiple comorbidities. However, the technique is challenging when encountering concomitant iliofemoral occlusive diasease. Aortoiliac Unigraft with Femoro-femoral Bypass Graft on Case Abdominal Aortic Case Report Aneurysm with Ruptured Right Common Iliac We report a 75-years-old man who had asymptomatic infrarenal Aneurysm – Case Report AAA.The patient had history of smoking, COPD, hypertension, Kemas Dahlan1, MD Raden Suhartono1 and previous CABG.Physical examination revealed pulsatile 1 abdominal mass, diminished pulse of the left femoral and popliteal Indonesian Society For Vascular And Endovascular Surgery, arteries and non-palpable pulse of the pedal arteries. The CTA Central Jakarta, Indonesia showed infrarenal AAA with largest diameter of 60 mm, 20 mm proximal neck length, but has small terminal aorta (15 mm), total Background occlusion of the left CIA and stenotic lesion of the right CIA (5.4 mm). 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 Under local anaesthesia, multiple attempts to pass the left CIA multiple comorbidities. However, the technique is challenging occlusion through the left and right femoral accesses using 0.035” when encountering concomitant iliofemoral occlusive diasease. 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 Case Report using bifurcated endograft was successfully performed. Control We report a 75-years-old man who had asymptomatic infrarenal angiography shows limiting flow dissection in the left EIA that was AAA.The patient had history of smoking, COPD, hypertension, treated by stent placement. 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 Result showed infrarenal AAA with largest diameter of 60 mm, 20 mm After the procedure, the left pedal arteries were normally palpable. proximal neck length, but has small terminal aorta (15 mm), total The patient was discharged uneventfully at post-operative day 4. occlusion of the left CIA and stenotic lesion of the right CIA (5.4 No complications were observed at 1 month follow-up. mm). Conclusion Under local anaesthesia, multiple attempts to pass the left CIA Even though complicated, difficult, required skill-full vascular occlusion through the left and right femoral accesses using 0.035” surgeons and resources,bifurcated endograft placement could avoid angled guidewire failed to enter the true lumen of the aorta. several complications associated with femoro-femoral bypass graft. 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. P10-09 Our surgical strategy in a patient with Result hypertension having acute Type A aortic After the procedure, the left pedal arteries were normally palpable. dissection The patient was discharged uneventfully at post-operative day 4. Dr Kazim Ergunes1, Prof. Levent Yilik1, Dr Ismail Yurekli1, Dr No complications were observed at 1 month follow-up. Banu Lafci1, Dr Habib Cakir1, Dr Hasan Iner1, Dr Yasar Gokkurt1, Prof Ali Gurbuz1 Conclusion 1Izmir Katip Celeby University Atatürk Training and Research Even though complicated, difficult, required skill-full vascular Hospital, Izmir, Turkey surgeons and resources,bifurcated endograft placement could avoid several complications associated with femoro-femoral bypass graft. Objective Type 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 P10-08 patient with hypertension having an acute Type A aortic. Endovascular Repair Using Bifurcated Endograft for Abdominal Aortic Aneurysm Methods with Concomitant Total Occlusion of the A 40-year-old female was hospitalized in our clinic in January, Common Iliac Artery 2016. She had hypertension and chest pain. Echocardiography showed dissection flap in ascending aorta. CT-Scan revealed type 1 1 Kemas Dahlan , MD Raden Suhartono A aortic dissection. 1Indonesian Society For Vascular And Endovascular Surgery, Central Jakarta, Indonesia Results She had Type A aortic dissection with intimal tear at proximal region Background of the ascending aorta. Native aortic valve was normal in function. Endovascular aortic aneurysm repair (EVAR) for abdominal aortic Arterial cannulasyon was performed via right axillary artery. The aneurysm (AAA) is a minimally invasive, an alternative approach right atrium is cannulated with a standard two-staged venous to major open repair, and the preferred choice for those with cannula. Ascending aorta was replaced by 26 mm Dacron tube

Annals of Vascular Diseases 2016 139 Poster Presentation graft between supracoronary and distal ascending aorta by using P10-11 hypothermic circulatory arrest and antegrade selective cerebral perfusion. Postoperative period was event-free. The patient was Endovascular repair of an isolated common discharged on 12th postoperative day with acetilsalicylicasit and iliac aneurysm in 70 patients metoprolol treatment. Soichiro Hase1, MD., Ph. D. Tassei Nakagawa1, MD., Ph. D. Motoshige Yamasaki1, MD. Yumi Kando2, MD., Ph. D. Mutsumu Conclusions Fukata2, MD., Ph. D. Professor Hiroshi Nishimaki3 Dacron tube graft replacement between supracoronary and distal 1Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, ascending aorta by using hypothermic circulatory arrest and Japan, 2Numazu City Hospital, Numazu, Japan, 3St.Marianna antegrade selective cerebral perfusion can be performed without University School of Medicine , Kawasaki, Japan morbidity and mortality. Introduction Isolated common iliac artery aneurysms (CIAAs) occurring in the absence of abdominal aortic aneurysm are rare, and potentially P10-10 lethal if they rupture. Recently, endovascular aneurysmal repair Emergent debranching TEVAR to treat (EVAR) of CIAAs has emerged as an alternative to open repair. ruptured Stanford type B acute aortic dissection Onichi Furuya1, Shinnichi Higashiue1, Satoshi Kuroyanagi1, Objectives Masatoshi Komooka1, Masahide Enomoto1, Saburo Kojima1, To evaluate the clinical results in EVAR of CIAAs retrospectively. 1 Naohiro Wakabayashi 1 Kishiwada Tokusyukai Hospital, Kishiwada, Japan Materials and Methods Between June 2009 and April 2016, 70 patients (56 males) Introduction underwent EVAR for isolated CIAAs. The age ranged from 52 A mortality of emergency surgery for ruptured Stanford type B to 90 years (mean, 73.2 years). Unilateral involvement of CIAA acute aortic dissection is generally sever, lifesaving cases with was seen in 48 patients (69%), with bilateral involvement in the thoracic endovascular aortic repair (TEVAR) have been reported. remaining 22 patients (31%). Internal iliac artery involvement was However, in emergent TEVAR, the order and whether or not seen in 37 patients (39%). The maximum diameter of aneurysm to perform debranching methods for aortic arch branches is a ranged from 23 to 55 mm (mean, 35 mm). The bifurcated endograft problem. We report two cases of ruptured Stanford type B acute in 46 (66%), iliac stent-graft deployment in 18 (26%), and others aortic dissection that could be treated by emergent TEVAR with in 5 patients (9%) were used. The follow-up CT was performed at left subclavian artery reconstruction. discharge, 3, 6, and 12 months and annually thereafter.

Cases Results Case 1. A 79-year-old man was transferred with chest discomfort. The mean follow-up period was 634 days (range, 30-2496). A computed tomography (CT) scan showed a patent false lumen Technical success was achieved in all 70 patients (100%). in the descending aorta with a mediastinum hematoma and in Aneurysm related death and aneurysmal enlargement (>5 mm) both sided hemothorax. We performed TEVAR (Zenith TX2 were not observed during follow-up. In 29 CIAAs (33%), shrinkage endovascular graft / COOK medical, Inc.) with left subclavian of aneurysmal sac was observed. CT endoleaks emerged in one at artery reconstruction by right-to-left axillary artery bypass and coil discharge, and three patients at follow-up. embolization of left subclavian artery. The vital signs ware stable, we performed left subclavian artery reconstruction before the stent- Conclusions graft deployment. Operation time was 213 minutes. After surgery without complications, in good course. He was safely discharged. Endovascular repair of an isolated common iliac aneurysm is safe Case 2. A 71-year-old man was transferred with back pain and shock. and effective with a favorable mid-term result. 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 P10-12 embolization of left subclavian artery. The body pressure was able to be maintained by blood transfusion and catecholamine use, we Successful thoracic endovascular aortic repair performed left subclavian artery reconstruction before the stent- for acute type B aortic dissection complicating graft deployment. Operation time was 233 minutes. After surgery critical lower limb ischemia without complications, in good course. He was safely discharged. Yutaka Hasegawa1, Ezure Masahiko1, Yasuyuki Yamada1, Syuichi Okada1, Shuichi Okonogi1, Hiroyuki Morishita1, Yuriko Kiriya1, Conclusion Tatsuo Kaneko1, Ren Kawaguchi1 Debranching TEVAR for ruptured Stanford type B aortic dissection 1Gunma Prefectural Cardiovascular Center, Maebashi, Japan was able to be a life-saving alternative without complications in comparison with conventional open surgery. Case Report A 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 catheter was introduced by percutaneous

140 Annals of Vascular Diseases 2016 puncture of his right femoral artery, and the true lumen of the cross-clamp time was 34±10 minutes. Renal artery reconstruction aorta was confirmed. Then his proximal entry tear was covered were needed 5 patients (7%) and renal artery bypass underwent by a Gore TAG stent graft, subsequently two self-expanding 2 patients (3%). In-hospital mortality was 0% and all patients noncovered Zenith Dissection endovascular stents were placed into didn’t need CHDF or HD during perioperative period. Mean serum the descending to the abdominal aorta to extend his true lumen. creatinine was 0.95mg/dl at pre-operative, 1.24mg/dl at maximum Seven hours after the onset, the blood flow of his lower limb and level during post-operative, and 0.97mg/dl. Serum creatinine levels his symptoms were dramatically improved though he required among each CKD group were no significant difference between complementary stenting to the left external iliac artery for persistent at preopearive and at discharge(Severe CKD:1.5mg/dl - 1.5mg/ static malperfusion, Immediately after the operation, continuous dl; p=0.39, Moderate CKD:1.1mg/dl - 1.1mg/dl; p=1.0, Mild-non hemodiafiltration (CHDF) was introduced for the treatment of CKD:0.7mg/dl - 0.7mg/dl; p=0.92). Mean follow-up period was 54 reperfusion injury. The serum creatinine phosphokinase level months. Three years survival was 86%, and six years survival was elevated to 42,319 IU/L on postoperative day (POD) 1, and 71%. Freedom from denovo HD was 100%. 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 Conclusions the true lumen and both iliac arteries was improved. The patient Early and late outcomes of open surgery in patients with pararenal had uneventful postoperative course without myonephropathic abdominal aneurysms were acceptable. Clamping renal artery metabolic syndrome and the limbs were salvaged. His state was around 35 minutes was not adverse effect on renl function after still stable six months later, and remodelling of the thoracic to open surgery. abdominal false lumen was obtained.

Conclusion TEVAR with Zenith Dissection endovascular stent can become one P10-14 of the effective treatments for complicated acute B-AD. Facilitation of Approach to the Arch Vessels in Aortic Arch Translocation Key words: acute aortic dissection, limb ischemia, thoracic Mitsuharu Hosono1 endovascular aortic repair, Zenith Dissection endovascular stent 1Kansai Medical University Medical Center, Moriguchi, Japan

Background and Objective P10-13 The strategy for treatment of thoracic aortic aneurysms has recently changed in association with widespread use of the stent graft. In Outcomes of abdominal aortic aneurysms our institute, we sometimes adopt aortic arch translocation using an surgery requiring suprarenal aortic cross- elephant trunk or open-stent-graft for aortic arch disease. In such operations, however, it is difficult to secure the operative field for clamping and their effect of postoperative renal the arch vessels in some cases because the aortic arch and aneurysm function have not been incised open. We herein report how to facilitate the Soichiro Henmi1, Hitoshi Matsuda1, Hidekazu Nakai1, So Izumi1, approach to the arch vessels in aortic arch translocation. Masamichi Matsumori1, Hirohisa Murakami1, Masato Yoshida1, Nobuhiko Mukohara1 Patients and Methods 1Hyogo Brain And Heart Center At Himeji, Himeji-shi, Japan We reviewed seven patients who underwent aortic arch translocation using an elephant trunk or open-stent-graft. Five patients had Background a distal aortic arch aneurysm and three had an aortic dissection. Few large series document surgical outcomes for patients with Concomitant coronary artery bypass grafting was performed in two pararenal abdominal aortic aneurysms (PAAAs) that require patients. All operations were performed via a median sternotomy suprarenal aortic clamping. 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 Objectives open-stent-graft was inserted and fixed. Three- and two-arch-vessel We assessed early and long-term surgical outcomes of open repair reconstruction was performed in five and two patients, respectively. in patients with pararenal abdominal aortic aneurysms and their The skin incision was extended by 2 or 3 cm toward the left upper postoperative renal function. 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 Methods secured with these procedures. A retrospective review was performed of all patients underwent open replacement of abdominal aortic aneurysm required suprarenal Results aortic clamping between 2007 and 2015. The mean operation time was 380.1 minutes, mean cardiopulmonary bypass time was 198.0 minutes, and selective antegrade cerebral Results perfusion time was 127.4 minutes. No hospital deaths occurred. Seventy six patients were identified (men, n=62) with a mean age Recurrent nerve palsy was observed in one patient. Neither cerebral was 74years old. Mean aneurysm size was 54.5mm. 6 patients infarction nor respiratory complications were observed. (8%) underwent hemodialysis (HD). Severe CKD (eGFR40) was 10 patients (14%), moderate CKD (40eGFR60) was 22 patients Conclusion (31%), and Mild-non CKD (eGFR60) was 38 patients (54%). 31 patients(41%) required supra bilateral renal artery clamping and 45 Our technique to secure the operative field for the arch vessels patients(59%) required supra lateral renal artery clamping. Mean during aortic arch translocation was easy and effective.

Annals of Vascular Diseases 2016 141 Poster Presentation P10-15 Methods In 32 patients, TEVAR was performed in subacute phase (15 to Case report: Successful medical treatment 180 days) in 11 patients and chronic phase (>181 days) in 21. False in a case of aortic infection after thoracic lumen (FL) was not thrombosed only limited area near the entry in endovascular aortic repair (TEVAR) 8 (ULP type) and patent or partially thrombosed in 24 (pFL type). Supra-aortic bypass was performed concomitantly in 13; zone 1 in Yung-Kun Hsieh1, Dr Chun-Ming Huang2, Dr Chien-Hui Lee1, Dr 1 1 5, zone 2 in 14. Devices selected were Zenith TX2 in 15, cTAG in Ying-Cheng Chen , PhD Ing-Sh Chiu 11, VALIANT in 5, and Excluder in 1. To adjust the difference of 1Changhua Christian Hospital, Puyang St., Changhua City, Taiwan proximal aortic diameter and distal diameter of true lumen, tapered , 2MinShen Hospital, Taoyuan, Taiwan stentgraft were used in 14.

Case Profiles Results A 76-year-old Malaysian man presented to our emergency unit No 30-day mortality was encountered and two died for non- with acute severe back pain. Chest CT showed a penetrating aortic events. Minor stroke and paraparesis was observed in one aortic ulcer (PAU) over proximal descending aorta while other respectively. Procedural success was achieved in 27. Type Ia laboratory studies were unremarkable. He received emergent endoleak was residual in 5, but disappeared within 6 months in 4. thoracic endovascular aortic repair (TEVAR) and was discharged Complete thrombosis of FL and aortic remodeling were observed at 5 days after the operation. Post-operative course was uneventful, the level of stentgrafts in all patients except for one patient in pFL complete obliteration of PAU was demonstrated in post-operative group with type Ia endoleak. However, at the level of celiac artery, CT image . However, spiking fever occurred 1 month later. Blood FL remained patent in 21 patients whose re-entry was residual culture revealed Group D Salmonella. Under the impression of in pFL group. Re-interventions were required in 3 patients for infected aortic aneurysm with PAU status post TEVAR, we chose retrograde dissection, stentgraft infection and expansion of thoracic intravenous Ceftrixone for 6weeks followed by oral Ciprofloxacin FL. 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 Conclusions (6months post-op). The antibiotic was discontinued after the TEVAR for uncomplicated TBAD could be performed safely. treatment course. There was no sign of relapse for 1 year after the Tapered stentgraft was useful to adjust the size difference. Close operation. observation of residual FL is critical and the procedure to reduce the patency of FL is the most demand. Conclusions Infected 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% ; P10-17 17/30). The standard treatment included aortic stenting to prevent Staged open surgery for aorto-esophageal rupture and adequate antibiotics to eradicate the pathogens. Although life-long oral antibiotic after operation is generally fistula after TEVAR for infected thoracic aortic accepted, we found that the majority of our cases (13/17) can even aneurysm discontinue antibiotic treatment possibly because the infection MD, PhD Toru Iwahashi1, MD, PhD Nobusato Koizumi1, MD, due to low pathogenicity can be completely eliminated. In this PhD Kentaro Kamiya1, MD Masaki Kano1, Keita Maruno1, MD case, no persistent stent infection or other complications occurred, Toshiki Fujiyoshi1, MD Shun Suzuki1, MD Takashi Ino1, MD antibiotic treatment alone seems successful even the pathogen was Satoshi Takahashi1, MD Kayo Sugiyama1, MD, PhD Shinobu found after aortic stenting without coverage of antibiotics initially. Matsubara1, MD, PhD Toshiya Nishibe1, MD, PhD Hitoshi Ogino1 1Tokyo Medical University, Shinjuku-ku, Japan

P10-16 Background Aorto-esophageal fistula (AEF) is one of fatal complication after TEVAR for uncomplicated type B aortic TEVAR. In-situ graft replacement of descending aorta, esophageal dissection resection and omental implantation is one of common surgical Takahiro Ishigaki1, Hitoshi Matsuda1, Ryuta Kawasaki1, Yojiro treatment for AEF after TEVAR. But, sometime, it is difficult to Koda1, Naoki Tateishi1, Soichiro Henmi1, Megumi Kinoshita1, do it depend on a condition of patient. We report on staged open Hidekazu Nakai1, Masamichi Matsumori1, Hirohisa Murakami1, surgery for AEF after TEVAR for infected thoracic aortic aneurysm Masato Yoshida1, Nobuhiko Mukohara1 (TAA), the patient who underwent total gastrectomy for gastric cancer. 1Hyogo Brain And Heart Center At Himeji, Himeji, Japan

Case Report Background A 67-year-old male presented with back pain and a high fever. TEVAR for uncomplicated type B aortic dissection (TBAD) to 4 months ago, he underwent TEVAR for infected TAA due to close entry has been widely performed to prevent aneurysmal anastmotic leak after total gastrectomy for gastric cancer. The degeneration. However, there were few reports about its details, preoperative CT and esophagogastroduodenoscopy found an AEF such as the usage of tapered stentgraft or the combination with in the middle thoracic esophagus. Acute hematemesis occurred just supra-aortic bypass. after he transferred our institution. Then, emergency TEVAR and embolization of the bronchial artery were carried out. After recovery Objective of general condition and antibiotics treatment, we performed extra- anatomical bypass (ascending aorta-abdominal aorta) via right To investigate early and midterm outcomes of TEVAR for retoroperitoneal space using 16mm of J-graft. Secondary, removal uncomplicated TBAD.

142 Annals of Vascular Diseases 2016 of stent graft, stump formation and esophageal repair and drainage Conclusions of the perigraft abscess was carried out. These operations were No significant difference in 30-day mortality rate was seen between performed without cardiopulmonary bypass. Finally, we covered elderly and young patients, but poor prognosis and a higher AEF with the latissimus dorsi myocutaneous flap. complication rate were seen among elderly survivors.

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. P10-19 Our experience of treatment for symptomatic Conclusion superior mesenteric artery dissection Extra-anatomical bypass and staged esophageal repair / resection Yasuhiko Kawaguchi1, Dr Hiroshi Mitsuoka1, Dr Masanao Nakai1, and resection of descending aorta is one of option for AEF Dr Yujiro Miura1, Dr Shinnosuke Goto1, Dr Yasuhiko Terai1, Dr after TEVAR, especially patient’s condition does not allow Yuta Miyano1, Dr Shinji Kawaguchi1, Dr Fumio Yamazaki1 cardiopulmonary bypass. 1Shizuoka City Shizuoka Hospital, Shizuoka City, Japan

Background P10-18 Superior mesenteric artery (SMA) dissection can occur either as Long-term Outcomes of Ruptured Abdominal spontaneously isolated dissection (SISMAD) or as a part of an extension of aortic dissection (ADSMAD). Endovascular therapy Aortic Aneurysm in an Aging Society for the SMA dissection with acute abdomen has been currently in Akihito Kagoshima1, Dr. Hirono Satokawa1, Dr. Hiroki an era of intense investigation. Wakamatsu1, Dr. Tomohiro Takano1 1 Department of Cardiovascular Surgery, Fukushima Medical Objectives University, Fukushima City, Japan To share our experience of endovascular stenting in two SISMAD and two ADSMAD cases. Highlighted are the importance of Background pathophysiological understanding of the lesions, and a feasibility Repair of a ruptured abdominal aortic aneurysm (rAAA) remains of retrograde open mesenteric stenting (ROMS). challenging despite the advent of endovascular aortic repair (EVAR). Elderly patients requiring surgery for rAAA may increase Cases as society ages. Consideration of the prognosis after emergency surgery from the perspectives of cost and care is important, Case1; A 60-year-old man presented with severe chest and back particularly for elderly patients. pain. CT revealed Stanford type B aortic dissection involving the SMA. Aortic stenting and primary entry closure resolved the mesenteric ischemia. Objectives Case2; A 60-year-old man presented with a severe back pain. CT This study aimed to compare long-term outcomes of rAAA between showed Stanford type A aortic dissection involving the SMA and elderly and young patients and to clarify the impact of age. the left renal artery. Renal and SMA stenting through via the right femoral artery restored the mesenteric blood flow. Materials and Methods Case3; A 64-year-old man presented with a sudden abdominal pain. CT showed SISMAD. Percutaneous SMA stenting via the right A total of fifty patients with rAAA were admitted to Fukushima brachial artery avoided intestinal necrosis. Medical University between July 2004 and September 2015. Of these, 32 patients underwent emergency surgery and 18 did not Case4; A 45-year-old man presented with an aggravating abdominal (11 died before operation, 7 refused operation due to fragility). We pain. CT showed a truncal occlusion of the SMA. Gastrointestinal retrospectively analyzed outcomes for elderly (≥76 years old) and interventionist failed in endovascular procedure via the right young (<76 years old) surgical patients. femoral artery. ROMS was performed in midline laparotomy. The recovery from mesenteric ischemia could be confirmed under direct vision. Results All 7 patients who refused operation died (mean age, 86 years; Discussion median time, 4 h after admission). The elderly surgical group comprised 8 men and 2 women (mean age, 82 years; range, 76-89 In ADSMAD cases, it is important to understand the years). The young surgical group comprised 19 men and 3 women pathophysiological condition for the successful endovascular (mean age, 70 years; range, 62-75 years). EVAR was performed for 1 treatment. In SISMAD cases, ROMS seems feasible especially patient in each group. No significant differences between the elderly when percutaneous endovascular procedures failed. The superior and young groups were evident in preoperative state (hemoglobin, control of a guide-wire achieved by direct access would increase the creatinine, loss of consciousness, electrocardiographic ischemia, technical success rate. ROMS also allows direct observation of the hemodynamics, time from onset to operation, and Fitzgerald small intestinal damage. ROMS provides an efficient endovascular classification) or 30-day mortality. Among survivors, the elderly approach, while not compromising important surgical principles to group showed lower 5-year survival (33% vs. 92%; P<0.01) and deal with the mesenteric ischemia. a higher complication rate (83% vs. 40%; P=0.149). Fitzgerald classification type IV was associated with a high mortality rate in elderly cases.

Annals of Vascular Diseases 2016 143 Poster Presentation P10-20 absence of tenderness, pulse and bruit. Contrast enhanced computed tomography(CT) showed huge peri-graft seroma measuring The results of in situ prosthetic graft approximately 111-mm in diameter. The patient underwent replacement for an infected endograft after endovascular relining of PTFE graft with Aortic extender, Excluder and 10-mm-10-cm sized stent-grafts, Viabahn. At 9-month and endovascular repair for infrarenal abdominal one year follow-up, CT revealed that there was no evidence flow aortic aneurysms disturbance with a decreased seroma size to 70mm in diameter. Hakyoung Kim1, Dr Youngjin Han1 1Asan Medical Center, SongPaGu, South Korea Conclusion Objective Endovascular Relining of perigraft seroma can be considered after Infected endograft after endovascular aneurysm repair (EVAR) for open repair of abdominal aortic aneurism with PTFE graft if it is abdominal aortic aneurysms (AAAs) is rare but life-threatening not infected. conditions. The aim of this study was to review the outcomes of in situ graft replacement of infected endografts.

Methods P10-22 A total of 6 consecutive patients who underwent in situ graft Surgical outcome for aorta and iliac artery replacement of infected endografts at our center from January with infection 2001 to December 2014 were retrospectively evaluated. Treatment Yojiro Koda1, Takahiro Ishigaki1, Naoki Tateishi1, Soichiro involved removal of all infected tissue, including the infected aortic 1 1 1 1 tissue and endograft, in situ prosthetic graft reconstruction, and Henmi , Hidekazu Nakai , So Izumi , Masamiti Matsumori , Hirohisa Murakami1, Tasuku Honda1, Hitoshi Matsuda1, Masato wrapping of the graft with retrocolically transposed great omentum. 1 1 Sensitive antibiotics were administered pre- and postoperatively. Yoshida , Nobuniko Mukohara 1Department Of Cardiovascular Surgery, Hyogo Brain And Heart Center, Himeji, Hyogo, Japan, Himeji, Japan Results 333 patients with infrarenal AAA were treated with EVAR. The infection rates of our institution after EVAR of infrarenal AAA were Objective 1.2% (4 patients of 333) and 2 patients with an infected endograft To describe surgical outcome for aorta and iliac artery with were transferred from other institutions. Patients with an infected infection in our institution. aortic endograft had a mean interval of 29.1 months (range, 1–88 months) from the primary aortic procedure. The 30-day mortality Patients and Methods 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 Between January 2000 and July 2016, we treated 43 patients endograft. The reinfection rate was 0% (0 of 6) and there are no late diagnosed with infectious aneurysm (for the thoracic aorta in 17, complications during a mean follow-up of 16 months. thoracoabdominal aorta in 7, abdominal aorta in 14, iliac artery in 5).

Conclusion Mean age was 69 (46- 88) years old. 8 patients (19%) was female. In situ graft replacements of infected endografts have acceptable 39 patients (91%) presented fever (> 38℃) or local pain. Mean outcomes if removal of all infected tissue, including the infected aneurysmal size was 49.6 (23- 72) mm. Mean WBC was 11200 aortic tissue and endografts. (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, P10-21 3 salmonella, 9 othes, 4 negative and 4 unknown were detected. Sac regression after endovascular relining of We perfomed radical debridement, in situ anatomic replacement using standard prosthesis (no antibiotics bonded) as principle. In perigraft seroma after open repair of abdominal 24 patients (56%), wrapping with omental pedicles were perfomed. aortic aneurism with PTFE graft Recently, wrapping with omental pedicle was performed secondary Sang Seop Yun1, Associate Professor Jang Yong Kim1, Associate by design. Post operative antibiotics was continued for 6- 8 weeks Professor Sun Cheol Park1, Associate Professor Yong Sung Won1, by drip. Professor In Sung Moon1, Professor Ji Il Kim1 1The Catholic University of Korea, Seoul, South Korea Results Intubation time was 39.4 (0- 144) hours. ICU stay was 6.9 (2- 37) Background 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 Perigraft seroma is sterile, serous fluid collection confined around survival at 5 years was 54%. The cause of death included 4 sepsis, the prosthetic vascular graft. Authors experienced successful 3 pneumonia, 2 heart failure, 1 cerebral hemorrhage, 1 rupture of endovascular treatment of perigraft seroma, which was developed proximal anastomosis, , 1 rupture of descending aorta, 1 traffic after open surgical repair of abdominal aortic aneurysm(AAA). accident, 1 lung cancer, 1 liver failure, 1 pulmonary embolism and 5 unknown. The death of aortic events were 2 cases. Case Report The 75-year-old man presented with growing aneurysm after open Conclusion surgical repair of AAA with PTFE bifurcated graft six years ago. Our surgical outcome for aorta and iliac artery with infection was He complained of abdominal discomfort and palpable mass in the acceptable.

144 Annals of Vascular Diseases 2016 P10-23 Objective We report easy technique of IMA occlusion using the aortic cuff Emergent Surgical Conversion during during EVAR to prevent the development of T2EL. endovascular Procedure for Leriche’s disease 1 Joon Hyuk Kong Method 1 Department Of Thoracic And Cardiovascular Surgery, Sejong Between June 2015 and May 2016, 8 patients underwent occlusion General Hospital, Gyeonggi-do, , South Korea of IMA with EXCLUDER aortic cuffs during EVAR. All patients underwent Computed tomography angiography (CTA) to confirm A 45-year old- male patient visited to our hospital for complaining the anatomical factors of the IMA such as diameter, location and of aggravated both limb claudication. Preoperative CT angiogram the aortic diameter at the ostium. The patent IMA with the diameter showed mild stenosis at celiac artery, severe focal stenosis greater than 2.5mm was considered for embolization. The aortic at superior mesenteric artery ostium, near total occlusion at diameter less than 35mm at the IMA ostium was covered with the both renal artery, severe atherosclerotic obstruction at distal aortic cuff. The cuff diameter was 5-10 % larger than the aortic abdominal aorta and total occlusion of right ilio-femoral arteries diameter. All of the procedures were performed via 18-F femoral up to femoral artery bifurcation (Fig. 1). Endovascular procedures sheath. The aortic cuff was introduced to the aorta, and deployed were done before massive retroperitoneal bleeding at right to cover the ostium. After the deployment, EVAR was performed EIA: Seal bifurcated stent graft extension (12mmx80mm) and as usual. CTA was performed postoperatively to confirm successful Seal Hercules vascular(14mmx100mm) at infra-renal aorta, EVAR and endoleaks. Absolute pro stent(8x100mm) at left iliac artery, Viabahn stent grafts(10mmx100mm and 7mmx100mm) at right iliac artery(Fig.2). Result Surgical conversion was decided due to these problems: 1st problem was that left renal artery was occluded due to thromboembolism The number of the aortic cuff was one in all cases. The technical and fragile floating thrombosis at infra-renal aorta, 2nd problem success rate was 100%, with no procedurally related complications. was uncontrolled active bleeding at right iliac artery although Postoperative CTA revealed no T2EL with patent IMA in all Viabahn stent-grafts were deployed(Fig.3). To solve 1st problem, patients. left renal artery was dilated by 4mm stenting and 16mm stent was deployed to put the floating thrombosis up against aortic wall by Conclusion periscope manner(Fig.4). To solve 2nd problem, retroperitoneal Although it is unavailable for IMA occlusion with large aortic bleeding was well controlled by Medtronic distal stent graft 13- diameter at the ostium, the use of the aortic cuff during EVAR is 13mm insertion(Fig.5). After these procedures, we could find 3rd easy and feasible option that prevents T2EL from the IMA. 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). P10-25 There was no perioperative complications. Postoperative CT Endovascular Treatment of Type III Endoleak angiogram showed patent left renal artery stent, no interval change after EVAR of the SMA stenosis, good blood flow in aorta to left femoral Yujin Kwon1, Dr Kyoung Bok Lee1 artery stent without luminal stenosis and patent femoral artery to femoral artery bypass graft with good distal right femoral arterial 1Seoul Medical Center, Seoul, South Korea flow(Fig.7). Introduction Endovascular aneurysm repair (EVAR) allowed the minimally invasive treatment of aortic aneurysm. However, there is high P10-24 percentage of unique complication after EVAR called endoleaks. Prevention of type II endoleak using the aortic We present minimally treated Type III endoleak. cuff during endovascular aneurysm repair Shinsuke Kotani1, Takumi Ishikawa1, Tadahiro Murakami1, Materials and Methods Hirokazu Minamimura1 A 70-year-old male patient was diagnosed to have type III 1Bellland General Hospital, Sakai, Osaka , Japan 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 Background extravasation was observed from right external iliac artery (EIA) Type II endoleak (T2EL) is common complication after and internal iliac artery (IIA) bifurcation which should be covered endovascular aneurysm repair (EVAR) for abdominal aortic by the stent graft. Also, increase in size of right CIA aneurysm was aneurysm. Persistent T2EL has shown to be associated with a observed. higher incidence of adverse outcomes. Prophylactic embolization of inferior mesenteric artery (IMA) may be associated with a lower Results incidence of T2EL, and various preoperative or intraoperative methods have been reported. However, the procedure is sometimes After introducing 6Fr long sheath by open method, angiography complex and time consuming. We report easy technique of IMA was done. Fiber covering (IIA) stent graft was injured by the wire occlusion using the aortic cuff during EVAR to prevent the structure of EIA stent graft and coil embolization of Rt. IIA was development of a T2EL. done. No more endoleak was observed after the coil embolization.

Conclusions Type III endoleak was successfully treated with minimally invasive method.

Annals of Vascular Diseases 2016 145 Poster Presentation P10-26 Conclusions Neck angle, length and thrombus changed significantly immediately Successful Endovascular Treatment of Mycotic after EVAR and the greater the preoperative their values were, Thoracic Aneurysm with Spinal Osteomyelitis, the greater their differences were immediately. Aneurysm sac A Case Report regression occurred at 6months after EVAR. There were statistically 1 significant correlations among the size of aneurysm, neck angle, Chon Wa Lam neck length and thrombus of aneurysm. 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 P10-28 with spinal osteomyelitis. We had prescribed high dose of antibiotic Infra-renal Abdominal Aortic Aneurysm treatment initially but aneurysm was enlarged after 2 weeks of treatment. Then we prescribed thoracic endovascular aortic repair Repair for the Severely Angulated Neck: (TEVAR) technique to that aortic aneurysm with prolong oral The Usefulness of Precuff Kilt Technique of antibiotics treatment. Postoperative course was uneventful and he Endovascular Aneurysm Repair (EVAR) was in good condition. Postoperative PET/CT scan at 4 months 1 1 later that didn’t show obvious residue infection over the thoracic Samuel Lee , MD Young Kwon Cho aorta and spine. 1Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea

Background P10-27 Abdominal aortic aneurysms and difficult infra-renal necks are The structural changes of aneurysm after regarded as very challenging when performing endovascular repair. Although fenestrated and branched endografts may be the main endovascular aneurysm repair method of repair for these patients, their current limited availability Jae Hoon Lee1, Dr Ki Hyuk Park1 has prompted the use of alternative endovascular techniques to 1Daegu Catholic University Hospital, Daegu, South Korea enhance success of endovascular aortic aneurysm repair in patients with severely angulated neck. Background Methods Several studies showed the change of neck and aneurysmal sac after endovascular aneurysm repair (EVAR), but they included the A retrospective review of all patients who underwent endovascular fragmentary contents of single topic. abdominal aneurysm repair with a predeployed aortic cuff (Kilt) at Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Objectives Korea between January 2015 and April 2016 was performed. We 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 Case 1. relationship between neck changes and type Ia endoleak. 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 Materials and Methods infra-renal type with severely angulated neck(98°). He underwent From January 2010 to February 2015, 108 patients with AAA EVAR using predeployed aortic cuff(Kilt). underwent EVAR in our institution. Among them, 90 patients CT angiography revealed the type II endoleak which was decided evaluable by computer tomography (CT) were included this study. to be followed up without any management. 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. Case 2. Forty five years old male patient was incidentally found to have infra- Results renal AAA, measured 8x5cm with severely angulated neck(80°). He underwent EVAR using predeployed aortic cuff(Kilt). Follow- Mean last CT follow-up period was 30.02 ± 145.06 months. A up CT angiography showed no abnormal finding. 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 Conclusion volume in aneurysm sac increased on immediate postoperative Short-term follow-up suggests that the Kilt technique may be useful study (P=0.008) and decreased after 6 months. The greater the in patients with traditionally unfavorable anatomy for endovascular preoperative values of neck angle, length and thrombus were, the abdominal aortic aneurysm repair. 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). Anatomic features most amenable to this technique include Thrombus volume was great in the aneurysms with great neck severely angulated infrarenal necks. angle, short neck length, great diameter and great area (P=0.002, 0.013, <0.001 and <0.001).

146 Annals of Vascular Diseases 2016 P10-29 Methods A 68-year-old man was admitted to our hospital with a diagnosis A New Type of Endoleak After EVAR Induced of TAA and moderate aortic valve stenosis and regurgitation due by Stanford B Aortic Dissection and its to a bicuspid aortic valve. Computed tomography (CT) revealed Treatment pseudocoarctation of the aorta and dilatation of the thoracic aorta 1 1 1 1 from the sinus of Valsalva to the descending aorta. Diameters of Jie Liu , Dr. Xin Jia , Dr. Senhao Jia , Dr. Wei Guo Valsalva sinus, ascending aorta, descending aorta, and narrowed 1Chinese PLA General Hospital, Beijing, China segment of the arch were 46, 48, 52, and 26 mm, respectively.

Background and objective Results EVAR aims at prevention of aneurysm rupture. However, endoleaks As a first-stage operation, aortic root replacement with composite are the Achilles heel of EVAR. Endoleaks have been categorized graft (CEP Magna Ease and Gelweave Valsalva) and total arch and subcategorized according to the location of the inflow into replacement (Triplex four-branched arch graft ø24 mm) with five types, but there may be other types of endoleak. We aimed to frozen elephant trunk (J-Graft Open Stent Graft ø23 mm) were describe a case of a new type of endoleak after EVAR induced by performed via median sternotomy. Anastomosis of the arch graft Stanford B aortic dissection and its treatment. 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 Methods operation was >1. Nineteen days after the first operation, second- An 80-year-old man was admitted to the emergency room with stage thoracic endovascular aortic repair (TEVAR) was performed. abdominal and lumbar pain. The patient’s history included The postoperative course was uneventful. Postoperative chest CT cardiopathy, hypertension, dyslipidemia, and chronic renal revealed no evidence of endoleak or other complications. 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 Conclusion maximum diameter of AAA was 59.5 millimeter, which was 5.5 Two-stage repair using frozen elephant trunk followed by TEVAR millimeter larger than 3 months ago. The DSA showed the distal represents a reasonable option for extensive TAA associated with tear of Stanford B aortic dissection was located near the right renal pseudocoarctation of the aorta if the narrowed segment of the arch artery and the false lumen running into the sac of AAA was the can be used as an anastomotic site for the frozen elephant trunk. 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). P10-31

Results Extension of frozen stent graft for the treatment Follow-up after 6 months, the CTA showed endoleak had of multiple thoracic aneurysms disappeared and the max diameter of AAA was smaller. Hideki Mishima1, M.D. Susumu Ishikawa1, M.D. Hiroki Matsunaga1, M.D. Akira Oshima1 1 Conclusions Tokyo Metropolitan Bokuto Hospital, Sumidaku, Japan The endoleak induced by Stanford B aortic dissection is different from the other five types of endoleak and it might be a new type Introduction of endoleak. GPS stent and coil might be a good choice for the For multiple aortic aneurysms, endovascular treatments and treatment. More studies are warranted. 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. P10-30 Two-stage repair of extensive thoracic aortic Cases aneurysm and aortic valve lesion associated Case 1; 67 -year-old female was pointed out aortic arch saccular aneurysm of 60mm and descending aortic aneurysm of 70mm in with pseudocoarctation of the aorta diameter. Emergency surgery was performed because of back pain. Saito Masahito1, Asano Naoki1, Ohta Kazunori1, Niimi Kazuho1, Cardio pulmonary bypass with hypothermia was used through Tanaka Kouyu1, Gon Shigeyoshi1, Takano Hiroshi1 median sternotomy. Through the incision of anterior wall of aortic 1Dokkyo Medical University Koshigaya Hospital, Koshigaya-shi, arch just distal of left subclavian artery, the frozen stent graft Japan 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 Background and objective level of aortic incinsion. Pseudocoarctation of the aorta, which involves elongation and kinking of the aortic arch without a pressure gradient across Case 2; 82-year-old male was pointed out the distal aortic arch the lesion, is a rare anomaly. Although it is considered a benign aneurysm 60mm and descending aortic aneurysm 56mm in diameter condition, association with an aortic aneurysm is an indication for growing rapidly during last half a year. He had the past histories of surgery. We present a patient with extensive thoracic aortic aneurysm type B aortic dissection and Y-shaped graft (16 × 8mm) replacement (TAA) and aortic valve lesion associated with pseudocoarctation of for abdominal aortic aneurysm. Endovascular treatment was the aorta who underwent two-stage repair of this disorder. 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.

Annals of Vascular Diseases 2016 147 Poster Presentation Through the left thoracotomy, half incision of anterior wall of P10-33 descending aorta was made. The frozen stent graft was inserted to enclose the distal aneurysm. After distal aortic arch aneurysm was Secondary aortoduodenal fistula following dissected, Another graft was anastmosed to the proxymal aorta just abdominal aortic reconstruction distal of the left subclavian artery. Finally, the second Dacron graft 1 1 1 and frozen stent-graft were anastomosed. Shingo Nakai , Dr. Tetsuro Uchida , Dr. Azumi Hamasaki , Dr. Yoshinori Kuroda1, Dr. Atsushi Yamashita1, Dr. Ken Nakamura1, Dr. Jun Hayashi1, Dr. Daisuke Watanabe1, Dr. Kimihiro Kobayashi1, Conclusion Dr. Seigo Gomi1, Prof. Mitsuaki Sadahiro1 Hybrid surgery using the extended frozen stent graft was useful 1Yamagata University, Yamagata, Japan for multiple aortic aneurysms. Postoperative hemodinamic maintainance and prophylactic CSF drainage were effective for the prevention of the spinal code ischemia. Background Secondary 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 P10-32 circumstance. Although bleeding control and management of Postoperative venous thromboembolism infection are major concerns, optimal therapeutic strategy remained controversial. We report two cases of secondary aortoduodenal after EVAR for ruptured abdominal aortic fistula subsequent to graft replacement of abdominal aortic aneurysm: report of two cases aneurysm (AAA). Yuri Murakami1, Dr. Naoki Toya1, Dr. Soichiro Fukushima1, 1 2 3 Dr. Eisaku Ito , Dr. Tadashi Akiba , Dr. Takao Ohki Case reports 1The Jikei University Kashiwa Hospital Department of Surgery, 2 A 69-year-old man was admitted to neighboring hospital with Division of Vascular Surgery, Kashiwa City, Japan, The Jikei complains of abdominal pain and large amount of blood in the University Kashiwa Hospital Department of Surgery, Kashiwa 3 stool. He had a history of graft replacement of AAA via laparotomy. City, Japan, The Jikei University School of Medicine Department Computed tomographic (CT) scan showed a pseudoaneurysmal of Surgery, Division of Vascular Surgery, Minatoku, Japan formation at proximal anastomotic site of the graft. Upper gastrointestinal endoscopy revealed duodenal ulceration an Background and Objectives adjacent blood clot with active bleeding. He was diagnosed with Endovascular aneurysm repair (EVAR) has been successfully used aortoduodenal fistula, and emergent endovascular abdominal aortic to treat ruptured abdominal aortic aneurysm (rAAA). However, repair (EVAR) was performed. One month following EVAR, he postoperative venous thromboembolism (VTE) is an occasional presented with recurrent abdominal pain and high-grade fever. An complication after EVAR for rAAA due to prolonged bed rest endograft infection was highly suspected and he was referred to and venous compression secondary to abdominal hematoma. We our institution for surgical treatment. At laparotomy, aortoduodenal reported two cases of postoperative VTE after emergency EVAR fistula was not identified. Infected endograft was pulled outand for rAAA. 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 Material and Methods because of an uncontrolled leak from the fistula. Another patient Case 1: A 65-year old man underwent an emergency EVAR is a 64-year-old man previously underwent graft replacement for rAAA. Initially, postoperative course was unremarkable, of AAA. He was admitted to our institution with complains of but he complained of chest pain and cardiopulmonary arrest severe abdominal pain and hematemesis. With the diagnosis of on postoperative day 5 when he began standing and walking. aortoduodenal fistula, emergent EVAR was successfully performed. CT revealed massive pulmonary embolism (PE). Although Two months after EVAR, he received repair of duodenal fistula, re- cardiopulmonary resuscitation was successful, agnosia remained graft replacement and omentopexy. Postoperative course of both as post resuscitation hypoxic encephalopathy. patients was uneventful.

Case 2: A 72-year old man underwent an emergency EVAR for Conclusion rAAA. He had a tracheotomy because of prolonged intubation after Early surgical intervention was expected to improve the chances of surgery. On day 33, post-operative CT scan revealed VTE extending successfully managing this rare but lethal complication. 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 Conclusion Patient who had emergency EVAR for rAAA should have a contrast enhanced CT taken before ambulating in order to rule out VTE.

148 Annals of Vascular Diseases 2016 P10-34 Material and Methods The study group comprised 11 patients (10 men and 1 woman) who A Case of a Right Common Iliac Artery underwent EVAR in 2015. The mean age was 74.6 ± 11.0 years, Aneurysm Complicate the Arteriovenous and the aneurysm diameter was 74.3 ± 19.4 mm. The Fitzgerald Fistula and the Common Iliac Vein Occlusion classification was type I in 3 patients, type II in 1, type III in 7, 1 1 and type IV in 0. Four patients had shock before surgery, and 3 Shinsuke Nishimura , Dr Takashi Murakami , Dr Hiromichi patients had impaired consciousness. EVAR was performed with Fujii1, Dr Masanori Sakaguchi1, Dr Yosuke Takahashi1, Dr Daisuke 1 1 1 the use of a Gore C3 Excluder stent-graft. In patients with unstable Yasumizu , Dr Yoshito Sakon , Dr Toshihiko Shibata vital signs during surgery, an aortic occlusion balloon catheter was 1Department of Cardio Vascular Surgery, Osaka City University used to stabilize vital signs and thereby safely perform surgery. In Graduate School of Medicine, Osaka City, Japan patients with disturbed hemodynamics associated with abdominal compartment syndrome accompanied by a postoperative intravesical pressure exceeding 20 mm Hg, open abdominal Arteriovenous fistula (AVF) is a rare complication of abdominal management was performed. 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) Results aneurysm. Mortality at 30 days was 0%. All patents were ambulatory and discharged. The operation time was 132 ± 51 min. The intraoperative An 86-year-old man, who suffered from a swollen left leg and transfusion volume was 1232 ± 1450 mL, and the duration of lower limb ulcer with lymphorrhea for three months, was referred mechanical ventilation was 3.4 ± 4.4 days. The intensive care unit to our hospital. However he didn’t develop congestive heart failure. 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. 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 Conclusions veins of left side lower extremity and pelvis were enhanced in the EVAR for ruptured abdominal aortic aneurysms had good outcomes early phase, suggesting an arteriovenous shunt, however inferior in our center. Further studies of a larger numbers of patients are vena cava was not enhanced in the phase. needed to confirm our results.

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 P10-36 with a bovine pericardial patch. Floating thrombus causing systemic embolization in the ascending aorta in the Post operative enhanced CT showed occlusion of the left CIV as previously. However the left lower limb swelling subsided absence of any coagulation abnormality gradually with compression therapy. Shunsuke Ohori1 1Hokkaido Ohno Hospital, Sapporo, Japan AVF located in the distal part from the iliac vein compressed by aneurysm was thought to be the reason of this rare presentation of Floating thrombus causing systemic embolization in the ascending aneurysm as lymphedema, instead of congestive heart failure. High aorta is very rare especially in the absence of any co-existing alert for pelvic evaluation would be the key to find the cause of coagulation abnormality. We report a case of the floating thrombus unilateral lymphedema. 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 P10-35 no evidence of atherosclerosis. He was in sinus rhythm and heart sounds were normal. TTE did not show any intracardiac thrombus Initial Outcomes of Endovascular Stent- or any structural and functional cardiac abnormality. Because of graft Repair of Ruptured Abdominal Aortic the high risk of recurrent embolization, the patient underwent the replacement of ascending aorta with hypothermic circulatory Aneurysms: A single-center experience arrest. Intraoperative TEE showed several mobile thrombuses in 1 1 1 Hirotoki Ohkubo , Tadashi Kitamura , Toshiaki Mishima , Koichi the ascending aorta. Aortotomy revealed several mobile chronic 1 1 1 1 Sughimoto , Tetsuya Horai , Mitsuhiro Hirata , Shinzou Torii , thrombuses with the atherosclerotic plaque of the ascending aorta. 1 Kagami Miyaji The postoperative course was uneventful and the patient was 1Department of Cardiovascular Surgery, Kitasato University discharged on 17th postoperative day with anticoagulation and School Of Medicine, Sagamihara, Japan 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 Background atherosclerotic plaque to prevent further thromboembolic event. Open 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.

Annals of Vascular Diseases 2016 149 Poster Presentation P10-37 P10-38 Vascular Caliber Changes Post PEVAR versus Combined Proximal Stent-Grafting with Distal SEVAR in the Asian Context Bare Stenting for Management of Three- Daniel Ong1, Prof Uei Pua2 Channeled Type B Aortic Dissection with 1Yong Loo Lin School of Medicine, Singapore, Singapore, 2Tan Malperfusion Syndrome Tock Seng Hospital, Singapore, Singapore Kimimasa Sakata1, MD,PhD Saori Nagura1, MD,PhD Toshio Doi2, MD,PhD Akio Yamashita2, MD,PhD Katsunori Takeuchi2, Background/ Introduction Prof Naoki Yoshimura2 Endovascular aneurysmal repair has been gaining popularity 1Shinonoi General Hospital, Nagano, Japan, 2Toyama University over the years, with percutaneous access (PEVAR) becoming Hospital, Toyama, Japan increasingly preferred over the conventional cut-down technique (SEVAR). Background Three-channeled aortic dissection is relatively rare case. Because Objectives it is easy to cause expansion of the false lumen and explosion Existing studies of the Western population showed varying degrees compared with normally dissection, surgical treatment may be of accessed common femoral artery (CFA) diameter changes necessary in early phase post-EVAR. Aorto-iliac anatomy in Western population differ significantly from that of the Asian population. In this study, we Case aim to evaluate postoperative vascular caliber changes in the Asian context. A 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 Materials and Methods at descending thoracic aorta, and distal aortic arch was expanded A retrospective study is conducted, identifying EVAR patients from to 66mm in diameter. Descending Aorta was dissected three 2011 to 2016 from our Electronic Medical Records (EMR). 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 Patients with complete preoperative and postoperative computed Aorta. At this point, because there are no chief complaint that tomography (CT) aortograms were included. Demographic malperfusion is suspected in, the patient was treated using strict parameters were collected. The CFA inner diameter (ID) is measures to control the blood pressure and heart rate.However, the measured at 3 levels distinguished by bony landmarks. Per groin patients came to gradually complained of postprandial abdominal analysis is then carried out after division into PEVAR and SEVAR pain from the onset seventh day .Also, a blood test showed the groups. increase of the hepatobiliary enzyme. Because malperfusion syndrome was suspected in, a thoracic endovascular aortic repair Independent sample t-test is used for comparing differences in CFA was performed urgently. In a postoperative course, abdominal ID change in PEVAR versus SEVAR groups. Paired sample t-test pain after eating and the biochemistry findings with suspected is used for evaluating CFA ID change in each group. P-value of less malperfusion were improved immediately. The patient was than 0.05 is considered statistically significant. discharged with uneventful.

Results Conclusion The PEVAR and SEVAR groups have no significant differences Combined proximal stent-grafting with distal bare stenting is demographically, except in sheath sizing used and duration of CT considered an effective method for three-channeled Type B Aortic follow-up post-procedure. A total of 120 patients were included, of Dissection with malperfusion syndrome 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 P10-39 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). Thrombosis of inferior vena cava caused by large left iliac artery aneurysm 1 1 Conclusions Yasuhito Sekimoto , Dr Hirohisa Harada 1 Within the limitations of our study, there are no significant vascular Tokyo Dental College Ichikawa General Hospital, Ichikawa, caliber changes post-EVAR in the Asian population. Japan

Background Venous 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.

150 Annals of Vascular Diseases 2016 Case Report P10-41 A 66-year-old male was sent to our emergency department with sudden onset of the left lower extremity swelling, pain, and Prevention of renal infarction for abdominal gait disturbance. Computed tomography showed a 5cm non- aortic aneurysm with mural thrombus at the inflammatory left common iliac artery aneurysm (CIAA) and DVT proximal clamp site in the left lower extremity extended to the IVC. Left iliac vein 1 1 1 compression by the left CIAA was considered to provoke DVT. Nobuoki Tabayashi , Dr Takehisa Abe , Dr Tomoaki Hirose , Dr Yoshihiro Hayata1, Dr Keigo Yamashita1, Dr Yoshio Kaniwa1, Dr IVC filter placement was firstly performed for thrombosis of IVC, 1 and anticoagulation therapy was introduced. As treatment for the Rei Tonomura , Dr Shigeki Taniguchi left CIAA, open surgical repair and reconstruction was performed. 1Nara Medical University, Kashihara, Japan Open aneurysmectomy is considered to achieve decompression of iliac vein quickly, on the other hand, it is impossible to achieve Purpose decompression of iliac vein quickly by endovascular repair. The post-operative course was uneventful. Oral anticoagulation and Proximal aortic clamping during abdominal aortic aneurysm compression therapy by using elastic stocking was continued, and (AAA) repair seems to be a risk factor of renal infarction in the he was discharged 10 days after the operation. 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 P10-40 AAA with proximal mural thrombus. Late open conversion after endovascular aortic Patients and Methods aneurysm repair From October 2007 to Jun 2016, seven patients were operated Riha Shimizu1, Takayuki Hori2, Yasushi Matsushita1, Hirotsugu on for AAA with proximal mural thrombus. We used renal artery Fukuda2 perfusion with 4℃crystalloid solution after supra renal clamping at 1Dokkyo Medical University Nikko Medical Center, Nikko, Japan, the healthy aorta. 2Dokkyo Medical University, Mibu, Japan Results Objective There was no 30-day mortality, nor in-hospital death. There was Endovascular aortic aneurysm repair is used for the treatment of no postoperative renal infarction. Serum creatinine level was not abdominal aortic aneurysm. Usually, complications secondary to changed postoperatively (pre 0.96±0.33, post 1.00±0.47, P=0.546). EVAR are treated with endovascular technique. However, open surgical repair can be required in 0-9% of cases of EVAR. This Conclusion study aims to present our experience in open conversion after It seems that supra-renal aortic clamping followed by renal artery EVAR. perfusion for AAA with proximal mural thrombus may prevent renal infarction. Methods Between 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 P10-42 between EVAR and open conversion was 35.3 month (range, 9-51 months). Does post-implantation syndrome affect perioperative and long-term outcome? 1 1 Results Tomohiro Takano , Dr Akihito Kagoshima 1 The indications for open conversion included typeⅠb endoleak Fukushima Medical University, Fukushima, Japan (n=1), typeⅡ endoleak (n=5), typeⅢ endoleak (n=1) with sac enlargement, stentgraft infection (n=2), and stentgraft thrombosis Background (n=1). All underwent elective conversion. 5 (50%) patients with typeⅡ endoleak were treated with simple ligation of the culprit Cryptogenic fever, also known as post-implantation syndrome vessels, without aortic clamping and stent graft explantation. 4 (PIS), can be experienced by patients following aortic endovascular (40%) patients were complete removal of the stent graft. 2 (20%) therapy (EVT). We aimed to evaluate whether PIS affects patients inserted endovascular balloon occlusion to prepare perioperative and long-term outcome. conversion to endovascular repair. The mean duration of hospital stay was 25.7±24.9 days (range 12-85 days). Operative mortality Methods and mortality rate was 0% as well as that of first open AAA repair. PIS was defined as the presence of fever >38℃ lasting over 2 days post-operation and leukocytosis (white blood cell count>12000/μl) Conclusion or CRP>10mg/dl despite antibiotic therapy and negative culture Late open conversion after EVAR can be performed safety results. Infectious, inflammatory and ruptured aneurysms were and successfully. For the success of operation, it is necessary excluded. This study retrospectively included 98 patients treated preoperative planning tailored to approach. 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.

Annals of Vascular Diseases 2016 151 Poster Presentation

Results Conclusion There were 48 thoracic aortic endovascular repair cases for thoracic Proximal TEVAR of chronic type B dissection is a relatively aortic aneurysm and chronic aortic dissection and 50 abdominal safe and effective therapy. However rapid false lumen expansion aortic endovascular repair cases for abdominal aortic aneurysm. occurred in several cases during early follow up period. Further PIS was diagnosed in 27 (28%) patients. There was no hospital studies are needed to evaluate this procedure. 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 P10-44 (11%) and non-PIS group (7%), respectively. Additionally, there Large false lumen occlusion using Candy-plug was no statistical significance of adverse event-free rate between technique in ruptured chronic type B dissecting the two groups (p=0.87). aortic aneurysm: a case report Katsunori Takeuchi1, Dr. Akio Yamashita1, Dr. Kanetsugu Nagao1, Conclusions prof. Naoki Yoshimura1 We did not find any correlation between PIS and occurrence of 1Graduate School Of Medicine, University Of Toyama, Toyama, long-term complications. However, PIS can lead to extended Japan hospitalization and higher costs.

Introduction In recent years, Thoracic Endovascular aortic repair (TEVAR) P10-43 came to be performed as treatment of complicated type B acute aortic dissection. However, TEVAR is not recommended in the Thoracic Endovascular Repair in Chronic Type chronic state because the treatment often fails due to persistent B Aortic Dissection retrograde false lumen perfusion. Consequently the Candy-plug Takahiro Takemura1, Dr Takahito Yokoyama1, Dr Yuujirou technique is used for distal occlusion of a false lumen aneurysm in Kawai1, Dr Hirokazu Niitsu1, Dr Gentaku Hama1, Dr Yasuyuki chronic aortic dissection. Toyota1, Dr Yasutoshi Tsuda1 1Saku Central Hospital Advanced Care Center, Saku, Japan Case A 73-year-old male patient with hypertension and chronic arterial Background fibrillation and cerebral infarction treated by apixaban. He had a history of chronic type B dissecting aortic aneurysm with onset The optimal management strategy for chronic type B aortic 16 years ago. He confirmed sudden chest and back pain and a dissection, whether open or endovascular is controversial. The aim diagnosis of a ruptured dissecting aortic aneurysm by Computed of this study is the evaluation of thoracic endovascular aortic repair Tomography (CT) was made. Emergency TEVAR was performed (TEVAR) for chronic type B dissection. that covered the entry at the level of distal arch with left common carotid artery to left subclavian artery bypass. Retrograde perfusion Methods into the false lumen from re-entry was utilized at the level of the superior mesenteric artery and terminal aorta. Furthermore, we Fourteen patients (average age 65 years) were initially treated performed embolization of false lumen by Candy-plug technique TEVAR for closing the primary entry between April 2009 and after TEVAR. Candy-plug technique was modified to 36×40mm. December 2015. All patients had patent false lumen and dilatation Excluder aortic extender was deployed proximal of the reentry of descending thoracic aorta. The median time from onset to in the false lumen, and a 16mm Amplatzer Vascular Plug II was TEVAR was 12 month. deployed in the waist of the modified Excluder aortic extender for complete occlusion. Results There was no hospital death. No patient had stroke, paraplegia, Conclusion paralysis or renal failure. Clinical and radiological follow up was Candy-plug technique is recommended as a good treatment for complete in all patients. Mean follow up was 23 ± 18 months. chronic aortic dissection. 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 P10-45 decreased in 8 patients. However four patients required further intervention because false lumen was dilated. 3 patients underwent Unexpected finding of single coronary artery hybrid TEVAR within 6 months after first TEVAR. In such cases during an emergent surgery of type A aortic we performed graft replacement for abdominal aorta and made dissection bypasses between graft and visceral arteries. TEVAR performed Kazuhito Tatsu1, Toru Uezu1, Norio Mouri1, Moriichi Sugama1 about 1 week after open surgery. One of those patients who was 1 treated hemodialysis died due to brain hemorrhage at 6 month Makiminato Chuo Hospital, Urasoe, Japan after second TEVAR. 1 patients underwent endovascular repair to abdominal aorta for closing re-entry. 1 patients underwent Introduction adjunctive false lumen embolization using covered stent graft devices for impending rupture. Single 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

152 Annals of Vascular Diseases 2016 diagnosed incidentally during conventional angiography. If SCA is normal(especially back to office!) after operation is more rapid in not recognized preoperatively, it can lead to serious complications Group E. So EVAR treatment is thought to have benefits in younger during cardiac surgery because of inappropriate myocardial and lower risk patients. Conclusion Assessment of postoperative protection or iatrogenic injury. recovery of QOL was thought to be effective. Especially to enlarge the indication of EVAR to younger and lower risk patients. Case In group E, preoperative status was relatively poor, so we need more data, and match the preoperative status for precise analysis. 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 P10-47 pericardial effusion. Moreover her chest pain was persisting. So we performed an emergent operation. After cannulation of right Repair of thoracoabdominal dissection femoral artery and vein, median sternotomy was done. Blood aneurysm with Zenith® t-Branch™ pericardial effusion was revealed. In addition of SVC drainage, Thoracoabdominal Endovascular Graft cardiopulmonary bypass (CPB) was established , and core cooling Yew Toh Wong1 was started. Following hypothermic circulatory arrest at core 1 temperature of 21 ℃, the dissected ascending aorta was incised. The Flinders Medical Centre, Bedford Park, Australia entry of aortic dissection was identified at the anterior wall of the ascending aorta, therefore,we decided to replace ascending aorta Background only. For selective administration of , we carefully observed the aortic root from the inside and recognized a solitary Open repair of thoracoabdominal aneurysm (TAA) post aortic left coronary ostium. We could not find the right coronary ostium, dissection is associated with major morbidity. Fenestrated and so we administered first cardioplegia through left coronary ostium multibranched endografting (FEVAR/BEVAR) has enabled repair alone. Although cardiac arrest was obtained, we added retrograde with lower morbidity and paraplegia risk. We described a case of administration of cardioplegia for secure myocardial protection. large TAA after type B aortic dissection repaired with Zenith® We completed ascending aortic replacement using Hemashield t-Branch™ Device (T-branch). prosthetic graft. Weaning of CPB was smooth. Postoperative course was uneventful. We diagnosed SCA by postoperative MDCT. The Methods & results type of SCA was L1. A 65 years old man with a 6.5cm TAA extending from just beyond the left subclavian artery (LSCA) to just below the renal arteries. Conclusion The intima flap extended from LSCA to the right common iliac In an emergent case, it is difficult to recognize SCA preoperatively. artery with long standing occlusion of the true lumen (TL) at the Retrograde myocardial protection and careful dissection avoiding level of infrarenal aorta. Coeliac artery (CA), superior mesenteric iatrogenic injury are thought to be essential. 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 P10-46 and stented with covered stent (Fluency) and reinforced with non- covered balloon expandable stent (BES). LRA was accessed from Introduction of less invasive treatment for the FL using OUTBACK Re-Entry Catheter. LRA was similarly Abdominal Aortic Aneurysm - Introduction stented. Standard thoracic stent graft was deployed just beyond of Endovascular treatment, inspection of the the left common carotid artery (TL) across a large fenestration into the FL to mate with the T-branch. Abdominal aorta and iliac results for future development analysis of arteries were repaired using standard distal extensions. Completion postoperative Quality of life using SF-36 angiogram showed successful exclusion of the aneurysm with Takayuki Uchida1 patent branches to all visceral arteries. Postoperative recovery was 1Iizuka Hospital, Iizuka, Japan complicated by paraparesis requiring four weeks of rehabilitation to enable independent walking.

The invasiveness of operation has been compared by a mortality , hospitalization period and perioperative event rate. But in JAPAN, Conclusions at AAA surgical treatment, even in open graft repair, mortality is FEVAR/BEVAR repair of post aortic dissection aneurysm is very low(<1%). And we can’t find significant difference in mortality feasible. Consideration should be given to stage covered stenting and morbidity between open graft replacement and EVAR. So to for one of the visceral branches to reduce spinal cord ischaemia and compare the invasiveness of EVAR and open repai of AAA, we to allow rapid exclusion of the aneurysm in the event of interval analyze recovery of ADL or QOL after operation. rupture.

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

Annals of Vascular Diseases 2016 153 Poster Presentation P10-48 P10-49 Diabetic effect on prevalence and growth rate of Unruptured left sinus of Valsalva aneurysm abdominal aortic aneurysms: Systemic review with fistulous track complicated by aortic and meta-analysis regurgitation Dr. Jiang Xiong1, Dr. Zhongyin Wu1, Dr. Chen Chen2, Dr. Yingqi Satoshi Yamashiro1, Professor Yukio Kuniyoshi1, Dr Ryoko Wei 3, Dr. Wei Guo1 Arakaki1, Dr Hitoshi Inafuku1, Dr Yuya Kise1 1Dpt. Vascular And Endovascular Surgery, The Chinese PLA 1Department of Thoracic And Cardiovascular Surgery, University General Hospital, Beijing, China, 2Department of Health Policy Of The Ryukyus, Nishihara-cho, Nakagami-gun, Japan and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, USA, 3Beijing Center for Diseases Prevention and Control, Beijing, China Introduction Sinus of Valsalva aneurysms are relatively uncommon, while unruptured sinus of Valsalva aneurysm in the left coronary sinus Background is rare. Epidemiologic studies revealed that the prevalence of abdominal aortic aneurysm (AAA) might be lower in diabetic patients. However, the relationship between diabetes and AAA formation Case presentation and enlargement remains unclear. A 54-year-old female was admitted for palpitations and general fatigue. Transthoracic echocardiogram revealed severe aortic regurgitation and Valsalva aneurysm of the left coronary Objective sinus. Multi-slice computed tomography demonstrated diffuse To examine the effect of diabetes on prevalence and growth rate aneurysmal dilatation of the left sinus of Valsalva without rupture. (GR) of AAA through a systematic review and meta-analysis. 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 Methods a modified Bentall procedure using 23mm Carbo-Seal Valsalva A comprehensive systematic literature search (from January 1, graft. Left coronary artery reconstruction was performed using the 1982 to October 1, 2015) was conducted using PubMed, Web of Piehler technique with a saphenous vein graft. The right coronary Science, Scopus and Cochrane databases. Articles reporting the artery was reconstructed using the usual Carrel’s button technique. AAA prevalence in diabetic patients and diabetic effects in GR of We left an aneurysmal sac, because no bleeding from aneurysm AAA were included. was seen (indicating no communication with cardiac and vascular structures). Results Forty-nine studies on AAA prevalence in diabetics were included for The patient’s postoperative course was uneventful, and she was meta-analysis by study type, geography and time of data collection. discharged 21 days after this procedure. Thirteen studies were included for meta-analysis of diabetic effect on AAA growth. A strong negative association was found between Conclusions diabetes and AAA in population based screening (adjusted odds ratio [OR]: 0.66; 95% confidence interval [CI]: 0.58-0.75) and The optimal management of an asymptomatic, unruptured sinus of prospective studies (adjusted OR: 0.52; 95%CI: 0.43-0.63), but Valsalva aneurysm is not known, because the precise natural history not in case-control studies (adjusted OR: 0.48; 95%CI: 0.20-1.15). of this phenomenon has not been well characterized. However, Similar association was found in North American (adjusted OR early surgery is recommended, because it provides excellent 0.62; 95% CI 0.54-0.71) and European (adjusted OR 0.45; 95% outcomes in such cases. CI 0.33-0.62) studies. The strong negative association remained to be consistent when stratified by time of data collection (-1995 The precise repair technique is dependent on the number of dilated [adjusted OR: 0.65; 95%CI: 0.53-0.80], 1996-2005 [adjusted OR: sinuses, whether the aneurysm has ruptured, and whether the 0.61; 95%CI: 0.47-0.78], 2006- [adjusted OR: 0.67; 95%CI: 0.53- aneurysm has an orifice. 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). P10-50 Conclusion The strongly negative association between diabetes and AAA Surgical, endoscopic and radiological was independent of study type (screening and prospective study), management of infected graft and geography (America and Europe) and time period. The negative aortoduodenal fistula after EVAR impact of diabetes on GR of AAA has been strengthened. Chun Ling Patricia Yih1, Dr Yuk Hoi Lam1, Prof Yun Wong James Lau1 1Prince Of Wales Hospital, Hong Kong, Hong Kong

Background and objectives Aortoenteric 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.

154 Annals of Vascular Diseases 2016 Methods Intentional endograft coverage of the LSA was initially without We report a case of graft infection, paraaortic abscess and revascurization portends significantly increased risk of subclavian subsequent secondary aortoduodenal fistula developing more than steal syndrome, arm ischemia, vertebral territory stroke and spinal 2 years post-EVAR as a result of salmonella bacteremia, and its cord ischemia. multidisciplinary treatment. Although several options have been reported that allow patency of Results the LSA to be maintained, including elective debranching before TEVAR, the chimney technique, prefabricated branched endograft The patient is a 66-year-old man who had a 6.2cm infrarenal deployment, surgeon-modified endografts, the most simple method AAA and underwent successful EVAR in 05/2012. Surveillance is fenestrating the endograft to revascularize the LSA duaring ultrasound showed suspected type II endoleak with static sac size. TEVAR. 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 We report the cases of simple LSA revascularization with percutaneously under image guidance. He was treated with a fenestration of the endograft. prolonged course of intravenous antibiotics and subsequently long term oral antibiotics. P10-52 However the inflammatory process persisted with increasing CRP. Follow up CT showed gas densities in the aortic sac. OGD Aortoesophageal fistula secondary to thoracic in 06/2015 (37 months post-EVAR) showed a nodule at D3, with endovascular aortic repair of an acute type B fistulation to the aortic sac confirmed on contrast injection. The fistula opening was endoscopically clipped (Ovesco OTSC®). aortic dissection Weimin Zhou1 1 He remained well despite follow up CT showing persistence of gas the 2nd affiliated hospital of Nanchang University, Nanchang, density inside the sac. He had an episode of diarrhea and recurrent China anaemia in 04/2016 (47 months post-EVAR). Repeated OGD showed persistent fistulation with friable tissue not suitable for Introduction further clipping. Laparotomy with division and repair of the fistula Thoracic endovascular aortic repair (TEVAR) is increasingly was performed in 07/2015 (50 months post-EVAR) in which the applied in clinical practice as a novel, less invasive treatment previous graft was not explanted. Recovery was uneventful and he for patients with aortic aneurysms and dissections. Secondary was discharged with antibiotics. aortoesophageal fistula(AEF) is a relatively rare but very often lethal complication that may develop after TEVAR. The clinical Conclusions syndrome is well explained by the Chiari triad and sentinel minor Secondary infection and aortoenteric fistula development is rare hematemesis followed by massive hematemesis. The incidence of in the current era of EVAR. A high index of suspicion, prompt this serious complication has increased with the growing number diagnosis and appropriate multidisciplinary treatment should of patients undergoing TEVAR. This case report describes a be instituted. Depending on the clinical status and severity of patient who was admitted in our center because of fever, sepsis inflammation, explantation may not be necessary. 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.

P10-51 Objective We present the case of a patient who developed an AEF 10 months Left subclavian artery revascularization during after TEVAR of an acute type B aortic dissection. thoracic endovascular aortic aneurysm repair with simple fenestrated technique Materials and Methods Hiroaki Yusa1, Dr Tomoaki Tanabe1, Dr. Makoto Taoka1, Dr Shou 1 1 2 2 A 62-year-old male Chinese patient underwent emergency stent Tatebe , Dr Imun Tei , Dr Takashi Azuma , Dr Yoshihiko Yokoi graft placement in January 2013 because of an acute type B aortic 1Ayase Heart Hospital, Adachi-ku, Japan, 2Tokyo Women Medical dissection aneurysm. The patient was discharged uneventfully. college, Shinjuku-ku, Japan 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 Thoracic endovascular aortic repair（TEVAR) has a rule in the examination revealed an AEF located at the midportion of the treatment of many pathologies of the descending thoracic aorta and esophagus and at the caudal end of the stent graft. An emergency aortic arch. stent graft placement was performed in the distal of the previous stent graft. Especially, treating aortic arch pathology, maintaining perfusion of the innominate artery and the left common carotid artery is Results mandated to prevent major stroke. Hematemesis was stopped, but the patient died due to mediastinitis six months later after the second stent-graft implantation. But the necessity of maintaing blood flow to the left subclavian artery(LSA) remains controversial.

Annals of Vascular Diseases 2016 155 Poster Presentation Conclusions P11-02 AEF is a catastrophic complication of TEVAR. Conservative treatment is often associated with fatal results. If possible, Trans-radial Access for Iliac Intervention: A these patients should be treated with secondary major surgical Systematic Review procedures. Stent graft re-implant into the previous stent graft can 1 2,3 only stop hematemesis, and prolong the lifetime. Eugene Ng , Andrew MTL Choong 1Westmead Hospital, Sydney, Australia, 2Division of Vascular Surgery, National University Heart Centre, Singapore, 3School of Medicine, Griffith University, Gold Coast, Queensland, Australia P11-01 Symptomatic carotid artery stenosis: literature Aim review of current standards of timing and The radial artery is well established as a feasible and safe access site for coronary angiography and intervention. As the use of radial factors to improve access for endovascular intervention has increased, so have the Kalpa Perera1, Mr. Kishore Sieunarine1 indications. It is now technically possible to intervene on the iliac 1Royal Perth Hospital, Perth, Australia artery via a radial artery approach.

Background/Introduction Methods In symptomatic carotid artery disease, established guidelines Our review was carried out as per the Preferred Reporting recommend intervention within two weeks of the index event. Instructions for Systematic Reviews and Meta-analyses (PRISMA) Studies reporting on timing to intervention have consistently found guidelines. An electronic search of the public domain databases inherent delays in achieving optimal results. 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 Objectives for further references. Primary outcomes wereangiographic The aim of this literature review was to clarify the extent of the success at completion of intervention, clinical improvement in delay in the reported literature and to identify factors and suggest patient symptoms as determined by ankle-brachial index (ABI) mechanisms to reduce this. 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 Materials and Methods and overall length of follow up. Generic terms including carotid surgery, carotid endarterectomy, carotid stenting and delay to intervention/treatment were used to systematically search online, English-language, databases (e.g Results MEDLINE, etc.) from 1990-2016. Studies were selected according A total of 13 studies were included in the systematic review. These to certain inclusion and exclusion criteria. Primary outcome comprised of 1 prospective multicenter cohort study, 2 prospective measure was proportion of symptomatic carotid interventions cohort studies, 1 retrospective cohort study, 2 case control studies, performed within two weeks of index event (SVS guidelines). The 3 case series and 4 case reports. A total of 388 patients underwent time from symptoms to intervention and factors that influenced this transradial access for revascularization of iliac arteries, of which time in the studies were recorded. 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. Results Procedural success defined as angiographic stenosis of less than Seventy-eight papers were identified. Only 18 studies were eligible 30% after intervention ranged from 87.9 to 100%. Access and for review. These included 17 carotid endarterectomy (CEA) and procedural related complications occurred in 30 patients (7.7%). one carotid artery stenting (CAS) paper. A total of 10,023 carotid The total length of stay in hospital ranged from 0 to 4 days post interventions were performed amongst the included studies, with intervention. Radial artery patency post intervention was assessed 2,763 (27.6%) within the recommended two-week guideline. in 5 studies comprising 170 patients and was patent in 123 patients Specific factors affecting delays included time to initial primary care (72.4%) post intervention. Follow up period was variable across or emergency department presentation, time to vascular surgical studies and ranged from 0.75 month to 23 months. 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 Conclusion FTP cases, 305 (65%) were treated within the guideline timeframe The results of this systematic review suggest that iliac of two-weeks. 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 Conclusion route. Current treatment is limited by availability of interventional Institutions are failing to perform symptomatic carotid artery sheath, angioplasty balloon and stent delivery systems. Larger intervention within the recommended timeframe. Certain factors randomised controlled trials assessing safety, efficacy and cost are associated with such delays and, when addressed, it is feasible effectiveness are required to further elucidate the use of this to expedite treatment appropriately. A multidisciplinary fast track modality in the management of iliac arterial disease. protocol has been proven to reduce delay.

156 Annals of Vascular Diseases 2016 NOTES

Annals of Vascular Diseases 2016 157 NOTES

158 Annals of Vascular Diseases 2016 NOTES

Annals of Vascular Diseases 2016 159 ANNALSAVD OF VASCULAR DISEASES http://www.avd.umin.jp/