Browsing by Author "Chumpol Wongwanit"
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Publication Metadata only Acute arterial embolism of the lower extremities: Impact of 24-hour duration on the outcome of management(2008-09-01) Pramook Mutirangura; Chanean Ruangsetakit; Chumpol Wongwanit; Nuttawut Sermsathanasawadi; Khamin Chinsakchai; Mahidol UniversityObjective: Determine the impact of 24-hour duration of arterial embolism on the outcomes of management. Material and Method: A prospective study of 91 patients with acute arterial embolism of the lower extremities was carried out. Results: Among the 91 patients, 31(34.1%) were with early acute embolism(< 24 hours) and 60 (65.9%) were with late acute embolism (> 24 hours). Extensive limb gangrene was more common in patients with late acute embolism (26.7% versus 3.2%, p = 0.009). Subsequently, primary major amputation was higher in those patients (20% versus 3.2%, p = 0.05). In early acute embolism, surgical embolectomy was only the primary treatment of revascularization (87.1%) whereas in late acute embolism, there were varying modalities of revascularization (68.3%) in addition to surgical embolectomy. The successful revascularization after the initial surgical embolectomy was significantly higher in patients with early acute embolism (92.6% versus 43.9%, p < 0.001). Patients with late acute embolism had a higher tendency of undergoing major amputation after revascularization (24.4% versus 7.4%, p = 0.106). Successful outcome was higher in patients with early acute embolism (83.9% versus 58.3%, p = 0.014). Conclusion: The 24- hour duration of arterial embolism may be a crucial factor influencing the outcome in the management of this disease.Publication Metadata only Ascending thoracic aortobipopliteal bypass for extensive aortoiliac and femoropopliteal arterial occlusive disease(2015-01-01) Pramook Mutirangura; Teravit Phanchaipetch; Chanean Ruangsetakit; Chumpol Wongwanit; Khamin Chinsakchai; Mahidol University© 2015 The Authors. This report describes a patient with disabling intermittent claudication resulting from the complex combination of a heavily calcified abdominal aorta, extensive aortoiliac occlusion, bilateral femoropopliteal arterial occlusion, and thrombosis of a previous right axillobifemoral bypass graft, followed by revision of the graft to the left proximal popliteal artery and subsequent graft removal because of chronic infection. The patient underwent successful ascending thoracic aortobipopliteal bypass surgery and had an uneventful postoperative recovery, with ankle pulses palpable bilaterally. After6years of follow-up, he could walk unlimited distances, and computed tomography angiography showed patent grafts.Publication Metadata only Atherosclerosis obliterans of the lower extremities in Thai patients(2006-10-01) Pramook Mutirangura; Chanean Ruangsetakit; Chumpol Wongwanit; Nuttawut Sermsathanasawadi; Khamin Chinsakchai; Department of Surgery; Mahidol UniversityBackground: Major limbs loss and high mortality rate were observed in the management of Thai patients with atherosclerosis obliterans (ASO) of the lower extremities. These were the results of delayed diagnosis and treatment together with the associated morbidities. There is a lack of information of this disease resulting in a lack of knowledge and awareness of this problem among general practitioners in Thailand. Objectives: The purposes of this study were (1) to identify the prevalence of this disease in a tertiary care hospital, (2) to enumerate the risk factors and comorbidities, (3) to identify clinical characteristics of the disease and (4) to evaluate the outcomes of treatment. Material and Method: A prospective study of patients with ASO of the lower extremities was carried out between January 2000 and December 2004. Patients having clinical manifestations of chronic and acute arterial occlusion with the absence of ankle pulse were included in the present study. Evidence of atheromatous plaque by angiography, operative finding, and histopathology of arterial wall from amputated specimens were used to confirm the diagnosis. The selection of surgical treatments for this disease such as revascularization, major amputation, minor amputation and debridement depended on the severity of limb ischaemia, the status of distal artery and the patients' general condition. The risk factors, comorbidities, clinical manifestations, site of arterial occlusion, severity of ischaemia, types of surgical treatment and outcomes of management were analyzed. Results: Four hundred and fourteen consecutive patients with ASO were diagnosed in the present study with a prevalence of 1.02:1,000. Femoro-popliteal arterial segment was the most common site (221 cases, 53.4%) of the affected arteries. Diabetes mellitus (253 cases, 61. 1%) was the most common risk factor of ASO followed by hypertension (217 cases, 52.4%), smoking (195 cases, 47.1%) and hyperlipidemia (172 cases, 41.5%). Ischaemic heart disease (108 cases, 26.1%) was the most common comorbidity of ASO followed by major stroke (56 cases, 13.5%) and chronic renal failure (20 cases, 4.8%). Patients with ASO presented mostly as chronic manifestations (385 cases, 93%) or with limb-threatening condition (326 cases, 78.7%). The clinical manifestations were ischaemic ulcer and/or digital gangrene (251cases, 60.6%), rest pain (182 cases, 44.0%) incapacitating claudication (62 cases, 15.0%) and acute ischaemic pain (29 cases, 7.0%). One hundred and thirty eight (33.3%) patients had significant lower limb infection at the time of admission. One hundred and seventy one (41.3%) patients underwent revascularization procedures as the major primary treatments to salvage the limbs. The success rate of limb salvage after revascularization was 76.6% (131/171). Major amputation after revascularization was 16.9%(29/171). Perioperative mortality rate of revascularization procedure was 8.2%(14/171). Major amputation was required as the primary treatment due to infective (18.4%, 76/414) and ischaemic process (6.5%, 27/414). The mortality rate of primary major amputation for infection and ischaemia were 19.7%(15/76) and 25.9%(7/27) respectively. The total mortality rate in the present study was 11.3% (47/414). The common causes of death were sepsis and ischaemic heart disease. Conclusion: ASO of the lower extremities is one of the major problems for national health care causing major limb loss and death. Arterial bypass surgery was the most effective treatment for limb salvage. Management of this disease at the terminal stage causes high morbidity and mortality. Hence, early detection of this disease and correction of the risk factors should be the most effective strategy to improve the overall outcome of the management of this complicated problem.Publication Metadata only Balloon assisted Valsalva maneuver in the diagnosis of saphenofemoral junction incompetence(2014-01-01) Nuttawut Sermsathanasawadi; Kamolrat Pattarakittikul; Kiattisak Hongku; Chumpol Wongwanit; Chanean Ruangsetakit; Khamin Chinsakchai; Pramook Mutirangura; Mahidol University© 2014, Medical Association of Thailand. All rights reserved. Background: Conventional Valsalva maneuver (CV) is a standard procedure to exhibit reverse venous flow at saphenofemoral junction (SFJ) by duplex ultrasonography (DUS). However, some patients could not undergo CV during examination. Objective: Compare blowing party balloon assisted Valsalva (PBAV) with CV for exhibiting the reverse venous flow at SFJ incompetence. Material and Method: Forty patients who had symptoms and signs of suspected saphenofemoral junction incompetence were examined for venous reflux by DUS with two techniques of Valsalva maneuver, PBAV, and CV. The design was a 2x2 cross-over study. The patients were randomized to two sequences. The first sequence performed CV before PBAV. The second sequence performed PBAV before CV. The timing for the instruction, reflux time, and total timing of examination were compared between the two sequences. Results: There was neither period effect nor treatment-period interaction. Both PBAV and CV could equally identify SFJ reflux, but teaching time and total examination time in PBAV was shorter than CV. Conclusion: PBAV is a new option to exhibit reverse venous flow at SFJ by DUS. PBAV is easier and spend less time than CV.Publication Metadata only Case report: Successful treatment in superior mesenteric artery embolism: A case report and literature review(2010-06-01) Khamin Chinsakchai; Chumpol Wongwanit; Chanean Ruangsetakit; Pramook Mutirangura; Mahidol UniversityThe authors report a successful management of acute superior mesenteric artery embolism in a patient during the treatment of popliteal artery embolism. The diagnosis of this disease was confirmed by computerized tomographic angiography. Immediate surgical embolectomy and bowel resection were performed and postoperatively, he made an uneventful recovery except for minimal watery diarrhea for one week. In the present report the authors also review the in- patient records at Siriraj Hospital during 2005-2009 consisting of 14 cases with the claim diagnosis of this condition. Most of the patients developed peritonism on abdominal examinations showing a delay in diagnosis. The mortality rate was 86% (12 cases) which was higher than international reports. It is important to note that patients presenting with abdominal pain with underlying risk factors of arterial embolism is the clue in early diagnosis of this condition. CTA mesenteric artery is the most appropriate investigation to visualize the presence of embolism. Finally, immediate revascularization treatment is essential in the successful management of this fatal vascular problem.Publication Metadata only Catheter-directed thrombolysis for acute limb ischemia caused by native artery occlusion: An experience of a university hospital(2013-06-13) Chumpol Wongwanit; Suteekhanit Hahtapornsawan; Khamin Chinsakchai; Nuttawut Sermsathanasawadi; Kiattisak Hongku; Chanean Ruangsetakit; Pramook Mutirangura; Mahidol UniversityObjective: To evaluate the efficiency and complications of catheter-directed thrombolysis (CDT) of acute limb ischemia (ALI) resulting from thromboembolic occlusion. Material and Method: A retrospective study of CDT was carried out in patients with acute thromboembolic arterial occlusion and marginally threatened ischemia of the extremities between February 2006 and December 2011. After the tip of the angiographic catheter was placed within the blood clot, recombinant tissue plasminogen activator (rt-PA) was used for thrombolysis. The CDT procedure included an initial bolus injection of high dose rt-PA (5-15 mg) followed by a tapering of infusion rate (1-2 mg/hour) through the catheter. Primary outcome was 1-year amputation free survival rate and mortality rate. Secondary outcome included technical and clinical success rates, time to lysis, and complication rate. The complete reestablishment of the occluded arteries without major amputation and death was considered successful treatment. Results: Thirty-seven patients (30 males and 7 females) with the mean age of 55.6 years (range, 27-86 years) were enrolled in the present study. The number of acute arterial occlusion was 23 (62.2%) of acute arterial embolism and 14 (37.8%) of acute arterial thrombosis. Embolism involved two aortic bifurcations, two iliac arteries, five femoral arteries, 13 popliteal arteries, and one both popliteal arteries. The sites of thrombosis were one of aorto-iliac segment, three of iliac artery, five of femoral artery, three of popliteal artery, one of bilateral popliteal, and one of tibio-peroneal artery. The mean duration of completed infusions was 21.29 hours (range, 2-58 hours). Successful adjunctive percutaneous intervention or arterial bypass was performed in seven patients (18.9%) whose stenotic lesions were disclosed following CDT. The 30-day perioperative mortality and 30-day amputation-free survival rates of the patients treated by CDT were 10.8% (4 of 37 patients) and 86.5% (32 of 37 patients) respectively. Both 6-month and 1-year amputation free survival rate were 78.4% (29/37). Technical success rate was 75.7% (28/37) whereas clinical success was 86.5% (32/37). Technical success rate was 80.0% (28/35) if ischemic symptom onset was no longer than six weeks. The 30-day major complications included two patients (5.4%) requiring more than four units of blood transfusion for access site hematoma, two (5.4%) large fatal intracerebral hemorrhages, one (2.7%) small intracerebral hemorrhage, one (2.7%) acute embolic stroke, and one (2.7%) death of multiple organ failure following conversion to surgical revascularization. Minor complications were distal thromboembolization in one patient (2.7%), small hematoma in seven patients (18.9%), and pseudoaneurysm in one patient (2.7%). Conclusion: CDT is an effective armamentarium to salvage the ischemic limb resulting from acute embolism and acute thrombosis of native artery. However, bleeding complication is a major problem of this treatment. Although CDT is usually applied for ALI patients with ischemic symptom onset less than 14 days, it also provides technical success for those with the symptom onset between the second and the sixth weeks.Publication Metadata only Clinical differentiation between acute arterial embolism and acute arterial thrombosis of the lower extremities(2009-07-01) Pramook Mutirangura; Chanean Ruangsetakit; Chumpol Wongwanit; Nuttawut Sermsathanasawadi; Khamin Chinsakchai; Mahidol UniversityBackground: The primary treatments of acute arterial embolism and acute arterial thrombosis are different. The clinical differentiation of the two diseases at initial stage can provide the efficient treatment of acute limb ischemia. Objective: Identification of the clinical factors significant for the differentiation between acute arterial embolism and acute arterial thrombosis in acute lower extremity ischemia. Material and Method: A prospective study of the consecutive 120 patients with acute lower extremity ischemia was carried out between January 2000 and December 2004. All clinical information was compared between the proven acute arterial embolism and acute arterial thrombosis. Results: Among 120 patients, 91 (75.8%) were with acute arterial embolism and 29 (24.2%) were with acute arterial thrombosis. Normal peripheral pulse on the contralateral limb was more commonly found in patients with acute arterial embolism than in patients with acute arterial thrombosis (71.4% vs. 31.0%, p < 0.001). Atrial fibrillation was detected more in patients with acute arterial embolism than acute arterial thrombosis (31.9% vs. 3.4%, p = 0.004). Mitral valve stenosis (12.1%) and previous arterial embolism (16.5%) were only detected in patients with acute arterial embolism. On the other hand, patients with acute thrombosis had the higher comorbidities such as diabetes mellitus (44.8% vs. 19.8%, p = 0.015), hypertension (55.2% vs. 27.5%, p = 0.012), and hypercholesterolemia (37.9% vs. 6.6%, p < 0.001). Patients with acute arterial embolism had more severe clinical manifestations such as immediately threatened ischemia (56.0% vs. 13.8%, p < 0.001) and higher tendency of suffering from extensive limb gangrene (18.7% vs. 6.9%, p = 0.156). On the contrary, patients with acute arterial thrombosis had the previous symptom of intermittent claudication (51.7% vs. 3.3%, p < 0.001) more than patients with acute arterial embolism. Conclusion: The clinical factors significant for the differentiation between acute arterial embolism and acute arterial thrombosis were the status of peripheral pulse on the contralateral limb, the clinical risk factors of the two diseases, the previous arterial embolism, the clinical manifestation, and progression of ischemic status.Publication Metadata only Comparative study of the management of diabetic versus nondiabetic patients with atherosclerosis obliterans of the lower extremities(2008-12-01) Pramook Mutirangura; Chanean Ruangsetakit; Chumpol Wongwanit; Nuttawut Sermsathanasawadi; Khamin Chinsakchai; Mahidol UniversityThe aim of this study was to identify the influence of diabetes mellitus on patients with atherosclerosis obliterans (ASO) of the lower extremities. A prospective study was designed to compare differences between ASO patients with and without diabetes mellitus in regard to clinical characteristics and outcomes of management. Two hundred fifty-three consecutive (61.1%) diabetic and 161 (38.9%) nondiabetic patients were included in this study. Crural artery occlusion occurred more frequently in diabetic patients (tibioperoneal segment 26.5% vs 14.3%; p = .003). Diabetic patients had higher comorbidities, such as ischemic heart disease, disabling stroke, and renal failure. Infection requiring urgent surgical intervention was higher in diabetic patients (39.1% vs 24.2%; p = .001). This required primary major amputation in limb-threatening ischemia superimposed with infection (27.6% vs 17.7%; p = .037). The feasibility (67.2% vs 69.8%; p = .651) and success (74.4% vs 79.0%; p = .481) of revascularization between the two groups were comparable. Diabetic patients often needed more distal revascularization for limb salvage (34.4% vs 18.5%; p = .019). The mortality rate after revascularization was higher in diabetic patients (13.3% vs 2.5%; p = .009). Diabetes mellitus per se has no direct impact on limb salvageability in limb-threatening ischemia. The parity of feasibility and success in revascularization between the two groups should encourage attempts at limb salvage revascularization in diabetic patients. © BC Decker Inc. All rights reserved.Publication Metadata only Customizing elastic pressure bandages for reuse to a predetermined, sub-bandage pressure: A randomized controlled trial(2018-10-01) Nuttawut Sermsathanasawadi; Tanakorn Tarapongpun; Rattana Pianchareonsin; Nattawut Puangpunngam; Chumpol Wongwanit; Khamin Chinsakchai; Pramook Mutirangura; Chanean Ruangsetakit; Faculty of Medicine, Siriraj Hospital, Mahidol University© The Author(s) 2017. Objective: A randomized clinical trial was performed to compare the effectiveness of unmarked bandages and customized bandages with visual markers in reproducing the desired sub-bandage pressure during self-bandaging by patients. Method: Ninety patients were randomly allocated to two groups (“customized bandages” and “unmarked bandages”) and asked to perform self-bandaging three times. The achievement of a pressure between 35 and 45 mmHg in at least two of the three attempts was defined as adequate quality. Results: Adequate quality was achieved by 33.0% when applying the unmarked bandages, and 60.0% when applying the customized bandages (p = 0.02). Use of the customized bandage and previous experience of bandaging were independent predictors for the achievement of the predetermined sub-bandage pressure (p = 0.005 and p = 0.021, respectively). Conclusion: Customized bandages may achieve predetermined sub-bandage pressures more closely than standard, unmarked, compression bandages. Clinical trials registration: ClinicalTrials.gov (NCT02729688). Effectiveness of a Pressure Indicator Guided and a Conventional Bandaging in Treatment of Venous Leg Ulcer. https://clinicaltrials.gov/ct2/show/NCT02729688.Publication Metadata only Cyanoacrylate Granuloma After Cyanoacrylate Closure of Incompetent Saphenous Veins(2021-10-01) Nuttawut Sermsathanasawadi; Kanin Pruekprasert; Khamin Chinsakchai; Chumpol Wongwanit; Chanean Ruangsetakit; Siriraj HospitalBACKGROUND: Cyanoacrylate closure (CAC) is a minimally invasive surgery to treat incompetent saphenous veins. OBJECTIVE: To evaluate the incidence, the risk factors for, and the management of cyanoacrylate granuloma (CAG) after CAC of incompetent saphenous veins in patients with chronic venous disease. MATERIALS AND METHODS: Data specific to incompetent saphenous veins, including great saphenous veins, anterior accessory saphenous veins, and small saphenous veins, that were treated with CAC were retrospectively evaluated. RESULTS: A total of 126 saphenous veins from 101 patients were included. Recapture of the delivery catheter before withdrawal was not performed in all patients. Cyanoacrylate granuloma occurred in 3 of 101 (2.9%) patients, and in 3 of 126 (2.3%) treated saphenous veins. All patients with CAG presented with granuloma and abscess at the puncture site 3 to 5 months after CAC. All patients were treated with incision, drainage, and removal of the glue foreign body. No recurrent granuloma was observed during the study period. No patient or procedural predictive factor for CAG was identified. CONCLUSION: Cyanoacrylate granuloma is not a rare complication after CAC when recapture of the delivery catheter is not performed. Patients should be advised of the possibility of CAG after CAC.Publication Metadata only Early and late outcomes of endovascular aneurysm repair to treat abdominal aortic aneurysm compared between severe and non-severe infrarenal neck angulation(2020-01-01) Khamin Chinsakchai; Pichawat Suksusilp; Chumpol Wongwanit; Kiattisak Hongku; Suteekhanit Hahtapornsawan; Nattawut Puangpunngam; Frans L. Moll; Nuttawut Sermsathanasawadi; Chanean Ruangsetakit; Pramook Mutirangura; University Medical Center Utrecht; Faculty of Medicine, Siriraj Hospital, Mahidol University© The Author(s) 2020. Background: Abdominal aortic aneurysm with severe infrarenal neck angle (>60°) has long been thought to be an obstacle to endovascular aneurysm repair. However, some previous studies reported endovascular aneurysm repair to be safe and efficacious for treating abdominal aortic aneurysm in patients with severe neck angulation. The aim of this study was to investigate the early and late outcomes of endovascular aneurysm repair to treat abdominal aortic aneurysm compared between patients with severe and non-severe infrarenal neck angulation. Methods: Fifty-four severe and 144 non-severe neck angulation patients who were treated at Siriraj Hospital (Bangkok, Thailand) during January 2010–October 2013 were recruited. The primary endpoints were intraoperative neck complications (e.g., type 1A endoleak or proximal graft migration) and immediate adjunct aortic neck procedures. The secondary endpoints included perioperative mortality, overall survival, and the proportion of patients that were reintervention-free at five years compared between the severe and non-severe groups. Results: Severe angulation patients were significantly older than non-severe angulation patients (77 ± 6.3 vs. 74 ± 7.9 years; p = 0.021). The median proximal angle was significantly greater in the severe group (82° vs. 13.5°; p < 0.001). Intraoperative proximal neck complications developed in 29.6% of patients in the severe angulation group compared with 9.0% in the non-severe group (p < 0.001). Significantly more patients in the severe group required intraoperative adjunct procedures (29.6% vs. 7.6%; p < 0.001). There was no significant difference in perioperative mortality between groups. At the five-year follow-up, there was no significant difference between groups for overall survival or the proportion of patients that remained reintervention-free. Conclusions: Endovascular aneurysm repair to treat abdominal aortic aneurysm in patients with severe proximal neck angulation is technically feasible and safe Although the severe angulation group had a higher rate of intraoperative neck complications and immediate adjunct neck procedures than the non-severe group, there was no significant difference between groups for 30-day mortality, overall survival or the proportion of patients who remained reintervention-free at five years.Publication Metadata only Endovascular abdominal aortic aneurysm repair in high risk patients: Outcomes of management(2007-10-01) Pramook Mutirangura; Chutakiat Kruatrachue; Pricha Ophasanond; Walailak Chaiyasoot; Chanean Ruangsetakit; Chumpol Wongwanit; Thanongchai Siriapisith; Nuttawut Sermsathanasawadi; Khamin Chinsakchai; Orawan Phongraweewan; Mahidol UniversityBackground: The concomitant cardiopulmonary disease precluded the elective repair for abdominal aortic aneurysm (AAA) with acceptable risk. The endovascular abdominal aortic aneurysm repair (EVAR) has become an alternative method for the treatment of AAA with high-risk comorbidities. Objective: Evaluate the results of EVAR in high-risk patients with large AAA. Material and Method: A prospective study of high-risk patients with large AAA and suitable morphology who underwent EVAR between August 2003 and August 2005 was conducted. The long-term outcomes were observed up to December 2006. The comorbidities, size of aneurysm, types of procedures, operative time, amount of blood loss and transfusion, length of postoperative stay in intensive care unit and hospital, postoperative complications and mortality were analyzed. Results: Eight patients (7 males and 1 female) with the mean age of 71.4 years (range 66-83 years) were included in the present study. The comorbidities were six of compromised cardiac status, one of severe pulmonary disease and one of morbid obesity. The average size of aneurysm was 6.2 ± 0.64 centimetres. One patient also had large bilateral iliac artery aneurysms. Seven patients underwent EVAR with bifurcated aortic stent graft and one proceeded with aorto uni-iliac stent graft. Three patients underwent preoperative coil embolisation into internal iliac arteries when the distal landing zones at the external iliac arteries were considered. The mean estimated blood loss was 369cc and the mean blood transfusion was 0.88 units. There were no perioperative mortality, early graft occlusion, AAA rupture and open conversion in the present study. One patient had cardiac arrest due to upper airway obstruction but with successful treatment. Type II endoleak was observed in one patient and successfully treated by expectant management. One limb of bifurcated stent graft was occluded at the 5 th month post EVAR and was successfully treated by artery bypass surgery at both groins. The 3-year primary graft limb patency was 87.5% (7/8). The survivals of patients at 1, 2 and 3 years were 100%, 100% and 87.5% respectively. The cause of death in one patient was not related to EVAR. Conclusion: EVAR may be a safe and effective alternative to open AAA repair especially in high-risk patients.Publication Metadata only Endovascular thrombectomy versus open surgical thrombectomy for thrombosed arteriovenous hemodialysis graft(2019-01-01) Nattawut Puangpunngam; Nathakorn Supokaivanich; Chanean Ruangsetakit; Chumpol Wongwanit; Nuttawut Sermsathanasawadi; Khamin Chinsakchai; Suteekhanit Hahtapornsawan; Kiattisak Hongku; Pramook Mutirangura; Somrach Thamtorawat; Satit Rojwatcharapibarn; Walailak Chaiyasoot; Jirawadee Yodying; Trongtum Tongdee; Faculty of Medicine, Siriraj Hospital, Mahidol University© 2019, Faculty of Medicine Siriraj Hospital, Mahidol University. Objective: The aim of this study was to investigate the procedure success rate, one-year primary patency rate, one-year secondary patency rate, and complications compared between endovascular therapy and open surgical thrombectomy for treatment of thrombosed arteriovenous hemodialysis graft. Methods: This retrospective chart review included patients with thrombosed arteriovenous hemodialysis graft who were treated at the Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during January 2012 to December 2016. Demographic, graft type, time before treatment, thrombus removal technique, additional technique, procedure success rate, operative, primary and secondary patency, follow-up time, and complication data were collected. Results: Seventy-four thrombosed dialysis grafts were included. Twenty-five and 49 grafts underwent endovascular therapy and open surgical thrombectomy, respectively. There was no significant difference in demographic data, graft type, or adjunct procedure between groups. The procedure success rate was 92% and 98% in the endovascular group and thrombectomy group, respectively (p=0.262). The one-year primary patency rate was 26% in the endovascular group, and 33% in the thrombectomy group (p=0.054). One-year secondary patency rate was 82.6% in the endovascular group, and 56.3% in the thrombectomy group (p=0.122). Conclusion: No significant differences were observed between groups for procedure success rate or 1-year primary patency rate; however, the one-year secondary patency rate in the endovascular group was significantly better than in the thrombectomy group. No difference in complications was observed between groups.Publication Metadata only Epidemiologic analysis of proximal deep vein thrombosis in Thai patients: Malignancy, the predominant etiologic factor(2004-05-01) Pramook Mutirangura; Chanian Rüengsethakit; Chumpol Wongwanit; Mahidol UniversityFrom January 1995 to December 2000, 1555 patients (585 males, 970 females, with a mean age of 52.3 years) with acute limb swelling underwent diagnostic duplex venous ultrasonagraphy at the Vascular Surgery Unit, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. Of these 1555 patients, 514 (188 males, 326 females, with a mean age of 53 years) were diagnosed with deep vein thrombosis (DVT). DVT was found mainly in the lower extremities, occurring in 506 of these 514 cases (98.4%). The affected vein in the lower extremity was found more commonly in the left side (359 limbs) than in the right side (184 limbs) (p < 0.001). DVT also occurred in the upper extremities in 8 of the 514 cases (1.6%). In this study, out of 308 patients with DVT in their lower limbs, DVT was associated with malignancy in 123 cases (39.9%), with post-operation in 48 cases (15.6%), and with limb immobilization in 38 cases (12.3%). Malignancy-related DVT was found to be more extensive and virulent and was associated with high morbidity and mortality. Further study should be conducted to investigate the role of anticoagulant drugs for the prevention of DVT in cancer patients. Perhaps the spectrum of DVT as presented in this series is characteristic not only of the Thai population but also of the populations of other Asian countries.Publication Metadata only Factors that influence venous leg ulcer healing and recurrence rate after endovenous radiofrequency ablation of incompetent saphenous vein(2019-01-01) Nuttawut Sermsathanasawadi; Jarunee Jieamprasertbun; Kanin Pruekprasert; Khamin Chinsakchai; Chumpol Wongwanit; Chanean Ruangsetakit; Pramook Mutirangura; Faculty of Medicine, Siriraj Hospital, Mahidol University© 2019 Society for Vascular Surgery Objective: Endovenous radiofrequency ablation (RFA) is one of the most popular techniques for correcting superficial vein reflux. However, the effectiveness of RFA of superficial vein reflux in patients with active or healed venous leg ulcer (VLU) is unknown. Accordingly, the objective of this study was to evaluate the healing rate, the recurrence rate, and the factors significantly associated with healing and recurrence in patients with active or healed VLU who had superficial venous reflux treated with RFA. Methods: We retrospectively reviewed all healed VLU or active VLU patients treated with RFA at the Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, during January 2011 to December 2017 to evaluate the rate of VLU healing and recurrence. Time to healing and time to ulcer recurrence were determined by Kaplan-Meier survival analysis. Risk factors were assessed to determine their association with VLU healing and recurrence by Cox regression survival analysis. Results: RFA of the great saphenous vein (n = 56), anterior accessory saphenous vein (n = 5), or both (n = 1) was performed on 62 limbs with active (n = 32) or healed (n = 30) VLUs. The mean age of patients was 65.4 ± 9.8 years, and 80% were female. Deep venous insufficiency was present in 10 limbs (16%). Pathologic perforating vein was found in 17 patients (27%). Concomitant ultrasound-guided foam sclerotherapy (UGFS) of the pathologic perforating vein was performed in 12 limbs (19%). Concomitant phlebectomy was performed in 19 limbs (31%). The median follow-up time was 753 days after RFA. VLU healed in 31% of patients at 3 months, in 56% at 6 months, and in 66% at 1 year after RFA. Concomitant UGFS of the pathologic perforating vein was the only factor significantly associated with VLU healing (hazard ratio, 2.84; 95% confidence interval, 1.07-7.55; P =.037). VLU recurrence was found in 8% of patients at 1 year, in 14% at 2 years, and in 23% at 3 years after RFA. Deep vein reflux was the only identified risk factor for VLU recurrence (hazard ratio, 3.72; 95% confidence interval, 1.05-13.21; P =.042). Conclusions: UGFS of the pathologic perforating vein at the time of RFA of saphenous vein reflux improved VLU healing. VLU recurrence was more frequent in patients with concomitant deep vein reflux. The authors suggest performing UGFS of the pathologic perforating vein at the time of RFA to improve VLU healing and monitoring of patients with associated deep vein reflux for ulcer recurrence.Publication Metadata only Hypersensitivity reaction after cyanoacrylate closure of incompetent saphenous veins in patients with chronic venous disease: A retrospective study(2021-07-01) Nuttawut Sermsathanasawadi; Pak Hanaroonsomboon; Kanin Pruekprasert; Tossapol Prapassaro; Nattawut Puangpunngam; Kiattisak Hongku; Suteekhanit Hahtapornsawan; Khamin Chinsakchai; Chumpol Wongwanit; Chanean Ruangsetakit; Siriraj HospitalPurpose: The objective of this study was to evaluate the incidence of, the risk factors for, the nature of the disease, and the management of hypersensitivity reaction (HSR) after cyanoacrylate closure (CAC) of incompetent saphenous veins in patients with chronic venous disease. Methods: Data consisting of all incompetent saphenous veins, including great saphenous veins, anterior accessory saphenous veins, and small saphenous veins, treated with CAC at Siriraj Hospital (Bangkok, Thailand) from January 2017 to December 2018 were retrospectively evaluated. Results: A total of 126 saphenous veins, including 106 great saphenous veins (84.1%), 7 anterior accessory saphenous veins (5.6%), and 13 small saphenous veins (10.3%) of 126 limbs from 101 patients were included. A HSR occurred in 16 of 101 patients (15.8%), in 19 of 126 limbs (15.0%), and in 19 of 126 treated saphenous veins (15.0%). HSR-related erythema, itching, swelling, and pain occurred in 100.0%, 95.0%, 68.4%, and 52.6%, of HSR patients, respectively. HSR occurred 1 week after CAC. All HSR symptoms were mild, could be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and antihistamine, and were resolved within 1 week. The risk factors for HSR were suprafascial saphenous vein with a depth <1 cm from the skin, and saphenous vein diameter of ≥8 mm. Conclusions: A HSR occurred in 15.8% of patients and in 15.0% of limbs after CAC. Risk factors for HSR were a suprafascial saphenous vein located close to the skin and a large saphenous vein. All HSR symptoms were mild in severity, occurred at 1 week after CAC, and were resolved within 1 week after treatment with nonsteroidal anti-inflammatory drugs and antihistamines. To prevent HSR, CAC should be avoided in suprafascial saphenous veins that are located close to the skin, and CAC in saphenous veins with a size of ≥8 mm should be performed with caution.Publication Metadata only Incidence, Risk Factors, Progression, and Treatment of Endovenous Heat-Induced Thrombosis Class 2 or Greater After Endovenous Radiofrequency Ablation(2019-04-01) Nuttawut Sermsathanasawadi; Wacharaphong Pitaksantayothin; Nattawut Puangpunngam; Khamin Chinsakchai; Chumpol Wongwanit; Pramook Mutirangura; Chanean Ruangsetakit; Faculty of Medicine, Siriraj Hospital, Mahidol UniversityBACKGROUND: Endovenous heat-induced thrombosis (EHIT) is a thrombus that extends from an ablated saphenous vein into the common femoral vein after endovenous radiofrequency ablation (RFA). OBJECTIVE: To investigate the incidence, progression, treatment, and risk factors associated with EHIT-2 or greater after RFA. MATERIALS AND METHODS: This retrospective study included patients diagnosed with symptomatic superficial venous incompetence that were treated by RFA of the great saphenous vein or anterior accessory saphenous vein during the July 2012 to December 2016 study period. Duplex ultrasound scanning was performed at 1 week, 1 month, 3 months, and every year after RFA to detect EHIT. RESULTS: A total of 317 legs from 274 patients were included. The incidence of EHIT-2 or greater was 7.0%, including 5.4% EHIT-2, 1.3% EHIT-3, and 0.3% EHIT-4. No symptomatic pulmonary embolism was found. The independent risk factors for EHIT-2 or greater were vein diameter (p = .027) and concomitant sclerotherapy (p = .037). CONCLUSION: The risk factors found to be independently associated with EHIT-2 or greater were large vein size and concomitant sclerotherapy. Screening for EHIT should be performed in patients with one or both of these risk factors within 1 week after RFA and in patients with postoperative symptoms suggestive of venous thromboembolism.Publication Metadata only The influence of VKORC1 polymorphisms on warfarin doses in thai patients with deep vein thrombosis(2015-01-01) Nuttawut Sermsathanasawadi; Chukij Sritongsathian; Nunthapol Pongrattanaman; Banjerd Praditsuktavorn; Kiattisak Hongku; Chumpol Wongwanit; Chanean Ruangsetakit; Khamin Chinsakchai; Pramook Mutirangura; Naravat Poungvarin; Mahidol University© 2015, Medical Association of Thailand. All rights reserved. Background: Polymorphisms in cytochrome P450 2C9 and vitamin K epoxide reductase complex, subunit 1 genes (CYP2C9 and VKORC1, respectively) were previously shown to affect the warfarin dose required in anticoagulant therapy of deep vein thrombosis (DVT). However, little is known about the role of these genetic variants in the Thai population. Objective: To identify the effect of CYP2C9 and VKORC1 genetic variants on warfarin dosage in the Thai population with DVT. Material and Method: Genotyping of CYP2C9 (*2 and *3) and VKORC1 promoter (-1639G>A) variants were carried out in 97 Thai DVT patients receiving constant warfarin therapy and with a stable international normalized ratio using real-time PCR assays. Results: VKORC1 AA, GA, and GG genotype frequencies were found to be 49.5%, 46.4%, and 4.1%, respectively, while those of CYP2C9 genotypes were 88.7% for *1/*1 and 11.3% for *1/*3. The CYP2C9*2 variant was not present in the patients studied. The mean daily warfarin dose required to maintain a therapeutic INR differed significantly according to VKORC1 genotype, with 3.6 mg/day required for AA, 4.7 mg/day for GA, and 7.4 mg/day for GG (p-value <0.001). The CYP2C9 genotype did not significantly affect the warfarin dosage requirement (p-value = 0.29). Conclusion: These findings underline the impact of VKORC1 genotypes on the wide variation in warfarin maintenance dosing in Thai patients with DVT.Publication Metadata only Malignant carcinoid tumor of the appendix with liver and lung metastasis : Report of a case with a high level of serum carcinoembryonic antigen(2000-01-01) Plernpit Panomreongsak; Sanya Sukpanichnant; Yudhtana Sattawatthamrong; Chumpol Wongwanit; Chalengpoj Sthapanachai; Kleophant Thakerngpol; Phunsup Wongsurakiat; Prasert Seesillapachai; Mahidol UniversityWe report elevated serum carcinoembryonic antigen (CEA) in a case of malignant carcinoid tumor of the appendix with liver and lung metastasis. A 55-year-old Thai man was found to have multiple nodules in the liver by ultrasonography. Serum CEA was 7,387.9 ng/mL (normal 0 - 4.1 ng/mL) leading to a clinical impression of colonic carcinoma with liver metastasis. During the investigation, he developed acute abdomen caused by ruptured acute appendicitis. Malignant carcinoid tumor of the appendix, 1 cm in diameter and located proximal to the ruptured acute appendicitis, was identified. The tumor cells showed trabecular or insular growth pattern, some nuclear pleomorphism but typically fine nuclear chromatin, frequent mitoses and focal necrosis. They were immunoreactive for antibody to chromogranin, neuron-specific enolase, CEA, and cytokeratin. Tumor metastases were discovered in the liver, right lung, mediastinal and right supraclavicular lymph nodes. Electron microscopic study demonstrated pleomorphic neurosecretory granules of the midgut type of carcinoid tumor.Publication Metadata only Novel culture media enhances mononuclear cells from patients with chronic limb-threatening ischemia to increase vasculogenesis and anti-inflammatory effect(2021-12-01) Nuttapol Chruewkamlow; Kanin Pruekprasert; Phakawan Phutthakunphithak; Onchira Acharayothin; Tossapol Prapassaro; Kiattisak Hongku; Suteekhanit Hahtapornsawan; Nattawut Puangpunngam; Khamin Chinsakchai; Chumpol Wongwanit; Chanean Ruangsetakit; Nuttawut Sermsathanasawadi; Siriraj HospitalBackground: Quality and Quantity culture media (QQ culture media) was reported to enhance vasculogenesis and angiogenesis function of mononuclear cells (MNCs) from healthy volunteers. In this study, MNCs from chronic limb-threatening ischemia (CLTI) patients were cultured in QQ culture media, and then investigated for angiogenesis-related phenotype and function. Methods: Patients aged ≥ 18 years with CLTI caused by atherosclerosis of the lower extremities were prospectively recruited at Siriraj Hospital (Bangkok, Thailand) during July 2017–December 2018. Peripheral blood mononuclear cells (PBMNCs) were isolated from peripheral blood. PBMNCs were cultured in either QQ culture media or standard culture media. The number of CD34+CD133+ cells, CD206+ cells, CD4+CD25+CD127+ cells, colony formation assay, and human umbilical vein endothelial cell (HUVEC) tube formation assay in MNCs were compared between those cultured in QQ culture media and those cultured in standard culture media. Results: Thirty-nine patients were included with a mean age of 69 ± 11 years. Diabetes mellitus was found in 25 (64%) patients. The percentage of CD34+CD133+ progenitor cells in MNCs cultured in QQ culture media and in MNCs cultured in standard culture media was 4.91 ± 5.30% and 0.40 ± 0.46%, respectively (p < 0.0001). The percentage of CD206+ cells in MNCs cultured in QQ culture media and in MNCs cultured in standard culture media was 19.31 ± 11.42% and 4.40 ± 2.54%, respectively (p < 0.0001). The percentage of inactive population of T regulatory cells (CD4+CD25+CD127+ cells) in MNCs cultured in standard culture media and in MNCs cultured in QQ culture media was 14.5 ± 10.68% and 1.84 ± 1.37%, respectively (p < 0.0001). The total number of colony-forming units from MNCs cultured in QQ culture media and in MNCs cultured in standard culture media was 8.86 ± 8.35 of 2 × 105 cells/dish, and 0.58 ± 1.05 of 2 × 105 cells/dish, respectively (p < 0.0001). The mean intensity of Dil-Ac-LDL uptake that incorporated into the HUVEC forming tube was 1.37 ± 0.88 in MNCs cultured in QQ culture media, and 0.78 ± 0.41 in MNCs cultured in standard culture media. (p < 0.0003). Conclusions: MNCs from CLTI patients that were cultured in QQ culture media had a significantly higher number of CD34+CD133+ cells and anti-inflammatory cells, and higher angiogenesis-related function compared to MNCs cultured in standard culture media.
