Annals of Vascular Diseases

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Volume 6 (2013) Issue 4 Pages 687-693

Visceral Artery Aneurysms and Pseudoaneurysms—Should They All be Managed by Endovascular Techniques?

Alfredo C. Cordova, Bauer E. Sumpio

Visceral artery aneurysms (VAA) and pseudoaneurysms (VAPA) can be life-threatening conditions with high incidence of rupture and hemorrhage. Greater availability and increased use of advanced imaging technology has led to the increased incidental detection of asymptomatic visceral aneurysms. In addition, increased percutaneous endovascular interventions have raised the incidence of iatrogenic pseudoaneurysms. Due to this, both VAA and VAPA have become an increasingly frequent diagnosis confronting the vascular surgeon. Over the past decade, there has been steady increase in the utilization of minimally invasive, non-operative interventions, for vascular occlusive and aneurysmal disease. All VAA and VAPA can technically be fixed by endovascular techniques but that does not mean they should. These catheter-based techniques constitute an excellent approach in the elective setting, particularly in patients who are poor surgical candidates due to their comorbidities or who present a hostile abdomen. However, in the emergent setting it may carry a higher morbidity and mortality. We review the literature about open and endovascular approach for the treatment of VAA and VAPA both in the elective and emergent setting.

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Volume 5 (2012) Issue 4 Pages 416-422

Compression Therapy: Clinical and Experimental Evidence

Hugo Partsch

Aim: A review is given on the different tools of compression therapy and their mode of action.Methods: Interface pressure and stiffness of compression devices, alone or in combination can be measured in vivo. Hemodynamic effects have been demonstrated by measuring venous volume and flow velocity using MRI, Duplex and radioisotopes, venous reflux and venous pumping function using plethysmography and phlebodynamometry. Oedema reduction can be measured by limb volumetry.Results: Compression stockings exerting a pressure of ~20 mmHg on the distal leg are able to increase venous blood flow velocity in the supine position and to prevent leg swelling after prolonged sitting and standing. In the upright position, an interface pressure of more than 50 mmHg is needed for intermittent occlusion of incompetent veins and for a reduction of ambulatory venous hypertension during walking. Such high intermittent interface pressure peaks exerting a “massaging effect” may rather be achieved by short stretch multilayer bandages than by elastic stockings.Conclusion: Compression is a cornerstone in the management of venous and lymphatic insufficiency. However, this treatment modality is still underestimated and deserves better understanding and improved educational programs, both for patients and medical staff.

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Volume 5 (2012) Issue 4 Pages 409-415

Recent Advancement on Surgical Treatments for Lymphedema

Isao Koshima, Mitsunaga Narushima, Yusuke Yamamoto, Makoto Mihara, Takuya Iida

Treatment for limb lymphedema is challenging. The recent development of the super-microsurgical technique has made lymphaticovenular (LV) anastomosis an easier and more accurate surgical method for lymphedema. A summary of our experience as well as recent developments in surgical treatments for lymphedema are described.Methods and Results: Ultra-microstructural analysis demonstrated that dysfunction of the lymphatics in lymphedema was caused by the degeneration and incomplete regeneration of smooth muscle cells and valve insufficiency in the lymphatic channel. ICG and infrared ray examinations have been proposed as new means of assessment of lymphatic function. LV anastomosis is suitable for genital edema, arm edema with severe phlegmone with leg edema, and early stage leg edema. Although pre- and postoperative compression therapy is generally required for limb edema, some cases do not require postoperative compression due to remaining or regenerated smooth muscle cells. As new methods of treatment, the vascularized lymphadiposal flap has been effective for progressive cases with LV anastomosis. LV anastomosis is also effective for congenital chyloabdomen. (*English Translation of J Jpn Coll Angiol 2008; 48: 173-178.)

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Volume 11 (2018) Issue 3 Pages 398-426

2015 JAPAN Critical Limb Ischemia Database (JCLIMB) Annual Report

The Japanese Society for Vascular Surgery JCLIMB Committee, NCD JCLIMB Analytical Team

Since 2013, the Japanese Society for Vascular Surgery has started the project of nationwide registration and tracking database for patients with critical limb ischemia (CLI) who are treated by vascular surgeons. The purpose of this project is to clarify the current status of the medical practice for the patients with CLI to contribute to the improvement of the quality of medical care. This database, called JAPAN Critical Limb Ischemia Database (JCLIMB), was created on the National Clinical Database and collects data of patients’ background, therapeutic measures, early results, and long term prognosis as long as five years after the initial treatment. The limbs managed conservatively are also registered in JCLIMB, together with those treated by surgery and/or endovascular treatment. In 2015, 1138 CLI limbs (male, 796 limbs [70%]) were registered by 92 facilities. Arteriosclerosis obliterans has accounted for 98% of the pathogenesis of these limbs. In this manuscript, the background data and the early prognosis of the registered limbs are reported. (This is a translation of Jpn J Vasc Surg 2018; 27: 155–185.)

Volume 9 (2016) Issue 4 Pages 374-391

2014 JAPAN Critical Limb Ischemia Database (JCLIMB) Annual Report

The Japanese Society for Vascular Surgery JCLIMB Committee, NCD JCLIMB Analytical Team

Since 2013, the Japanese Society for Vascular Surgery (JSVS) has started the project of nationwide registration and a tracking database for patients with critical limb ischemia (CLI) who are treated by vascular surgeons. The purpose of this project is to clarify the current status of the medical practice for patients with CLI to contribute to the improvement of the quality of medical care. This database, called JAPAN Critical Limb Ischemia Database (JCLIMB), is created on the National Clinical Database (NCD) and collects data of patients’ background, therapeutic measures, early results, and long-term prognosis as long as 5 years after the initial treatment. The limbs managed conservatively are also registered in JCLIMB, together with those treated by surgery and/or endovascular treatment (EVT). In 2014, 1347 CLI limbs (male 936 limbs: 69%) were registered by 95 facilities. Arteriosclerosis obliterans (ASO) has accounted for 97% of the pathogenesis of these limbs. In this manuscript, the background data and the early prognosis of the registered limbs are reported. (This is a translation of Jpn J Vasc Surg 2016;25:293–310.)

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2018 Volume 11 Issue 4

Update on Cardiovascular Echo in Aortic Aneurysm and Dissection Kazuhiro Nishigami
Modified Total Arch Debranching TEVAR with Aberrant Left Vertebral Artery Yusuke Takei, Takayuki Hori, Yasuyuki Kanno, Ikuko Shibasaki, Hirotsugu Fukuda
Thoracic Endovascular Aortic Repair for Pseudoaneurysm after Interrupted Aortic Arch Repair Kanako Hayashi, Naritaka Kimura, Masatoshi Ohno, Kentaro Yamashita, Hiroaki Izumida, Yu Inaba, Tatsuo Takahashi, Masataka Yamazaki, Tsutomu Ito, Hideyuki Shimizu
The Diagnostic Classification of Critical Limb Ischemia Nobuyoshi Azuma

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