Aortic aneurysm (AA) is one of the life-threatening aortic diseases, leading to aortic rupture of any cause including atherosclerotic and non-atherosclerotic diseases. AA is diagnosed in a variable proportion of patients with dilated aorta by imaging modality. The etiopathogenesis of AA remains unclear in many aortic diseases. Furthermore, although it may be difficult to explain all phenotypes of patients even if genetic mutation could be identified in some proteins such as smooth muscle cell α-actin (ACTA2), myosin heavy chain 11 (MYH11) or SMAD3, individualized consideration of these factors in each patient is essential on the basis of clinicopathological characteristics.
Objective: We evaluated the long-term outcomes of obturator bypass.Material and Methods: A total of 16 patients (13 males and 3 females; 17 limbs) who underwent obturator bypass surgery at our department between April 1995 and March 2008 were included.Results: Their ages ranged from 50 to 90 with a mean of 74 years. Inguinal infections observed in the 16 patients consisted of vascular graft infections in 13 patients, hemostatic device infections following endovascular therapy in two patients, and femoral artery infections following coronary angiography in one patient. The cumulative patency rate was 69% for 3 years and 43% for 5 years. The cumulative survival rate was 64% for 3 years and 55% for 5 years.Conclusion: Obturator bypass surgery was successfully performed with favorable results for arterial infections and vascular graft infections in the inguinal region.
We evaluated the clinical features and the risks of 14 patients with 14 limbs affected by saphenous vein thrombophlebitis from April 2007 to May 2013 and compared the results with patients undergoing operative repair of varicose veins (127 patients, 193 limbs) during the study period. The frequency of patients with a body mass index over 25 (78.6% vs. 35.3%, p = 0.0018), varicose change in the saphenous vein (78.6% vs. 6.2%, p <0.0001), and concurrent thrombosis in another vein (50.0% vs. 7.1%, p <0.0001) were all significantly higher than those of the patients under operative repair for varicose veins. These patients with clinical features above may be at an elevated risk of thrombophlebitis of the saphenous trunk. (This article is a translation of J Jpn Coll Angiol 2014; 54: 151–157).
Our aim was to evaluate whether a Triplex vascular prosthesis could contribute to reducing postoperative inflammation after surgical abdominal aortic aneurysm (AAA) repair retrospectively. Between July 2011 and December 2013, a Triplex vascular prosthesis was used in 22 patients (group T) and a coated vascular prosthesis in 18 patients (group H) during AAA repair surgery. Body temperature (BT), white blood cell (WBC) count, and C-reactive protein (CRP) level for 5 days were assessed. There was no hospital death in both groups. During the first 2 days after surgery the BT was higher in group T than in group H reaching its maximum on POD 2. On POD 5, it was similar (p = 0.4850).The postoperative WBC count was higher in group H than in group T. It reached its maximum on POD 1 and it was similar in both groups on POD 5 (p = 0.1870). The CRP value increased postoperatively in both groups, peaking during PODs 2 or 3. On POD 5, it was lower in group H than in group T (p = 0.0415). We could not confirm the superiority of Triplex vascular prostheses to other coated vascular prostheses in inflammatory reactions.
Objective: Using a thrombus model prepared by ligation of the inferior vena cava (IVC), the influences of the glycoside, glycyrrhizin, on plasma antithrombin levels and antithrombin mRNA expression levels in the liver and IVC with the inhibition of venous thrombosis were investigated.Materials and Methods: The rat IVC was exposed and ligated for 24 h immediately after the intravenous administration of 300 mg/kg glycyrrhizin. Among antithrombotic drugs, the Xa inhibitor, fondaparinux sodium, was used as a control drug.Results: The mean thrombus weight was significantly smaller in the glycyrrhizin-treated group (18.3 mg) than in the saline-treated group (34.3 mg). In contrast, the inhibition of thrombosis was not observed in the fondaparinux-treated group. Antithrombin mRNA expression levels in the liver were significantly higher in the ligated groups than in the baseline control group. The mean plasma antithrombin level was significantly lower in the glycyrrhizin group (96.6%) than in the saline group (114.4%), but was not significantly different from that in the baseline control group (102.4%).Conclusion: The pretreatment with glycyrrhizin inhibited venous thrombosis, and antithrombin mRNA expression levels in the liver and IVC as well as plasma antithrombin levels were significantly lower than those in the saline group.
Background: Sac behavior after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) is considered as a surrogate for the risk of late rupture. The purpose of the study is to assess the sac behavior of AAAs after EVAR.Methods and Results: Late sac enlargement (LSE) (≥5 mm) and late sac shrinkage (LSS) (≥5 mm) were analyzed in 589 consecutive patients who were registered at 14 national centers in Japan. The proportions of patients who had LSE at 1, 3 and 5 years were 2.6% ± 0.7%, 10.0% ± 1.6% and 19.0% ± 2.9%. The proportions of patients who had LSS at 1, 3 and 5 years were 50.1% ± 0.7%, 59.2% ± 2.3% and 61.7% ± 2.7%. Multiple logistic regression analysis identified two variables as a risk factor for LSE; persistent endoleak (Odds ratio 9.56 (4.84–19.49), P <0.001) and low platelet count (Odds ratio 0.92 (0.86–0.99), P = 0.0224). The leading cause of endoleak in patients with LSE was type II.Conclusions: The incidence of LSE is not negligible over 5 year period. Patients with persistent endoleak and/or low platelet count should carefully be observed for LSE.Clinical Trial Registration: UMIN-CTR (UMIN000008345).
Ultrasound-guided thrombin injection has been well described as a safe and effective treatment for pseudoaneurysms of the femoral artery. However, cases for subclavian artery pseudoaneurysm are rare. An 82-year-old man developed an iatrogenic right subclavian artery pseudoaneurysm. The pseudoaneurysm, which was partially thrombosed, was successfully treated by ultrasound-guided percutaneous thrombin injection. A trial injection with saline under color Doppler ultrasonography was helpful for confirming that the tip of the needle was in the sac with blood flow in the partially thrombosed pseudoaneurysm. Ultrasound-guided thrombin injection can be the first treatment of choice to treat subclavian artery pseudoaneurysm.
We report a case of chronic aortic dissection in a patient with Marfan syndrome in which we performed thoracic endovascular repair after aortic root replacement, total arch replacement with open stent grafting and thoracoabdominal aortic repair. We consider that endovascular repair of the dissected descending aorta in a patient with Marfan syndrome can be effective when graft-to-graft bridging is performed as the “finishing procedure”.
A 64-year-old female patient with aortitis syndrome presented with progressive intermittent claudication for 6 months. Her medical history was notable for living-donor liver transplantation for primary biliary cirrhosis 4-years prior and chronic immunosuppressive therapy. Evaluation included normal laboratory examination, and contrast-enhanced computed tomography angiography which demonstrated severely calcified descending aorta with high-grade stenosis below the diaphragm. The patient was treated by axillobifemoral bypass using an 8-mm ringed expanded polytetrafluoroethylene graft under general anesthesia. Medical management included decreased preoperative doses of immunosuppressants and predonisolone, which were resumed after the operation, and chronic anticoagulation. There were no postoperative complications.
We report the case of a 59-year-old male presenting with dissection and rupture of the innominate artery with acute type A aortic dissection. We performed total arch replacement via median sternotomy with extension into the right side of the neck. The innominate artery was reconstructed just proximal to the bifurcation of the right subclavian artery and common carotid artery using the 1st limb of a 4-branched graft. This case illustrates an unusual aspect of an isolated innominate artery rupture in the absence of aortic rupture in acute type A aortic dissection.
Endovascular aortic aneurysm repair (EVAR) has revolutionized the management of abdominal aortic aneurysms (AAAs), with lower perioperative morbidity and mortality compared to conventional surgical repair. However, late secondary re-interventions after EVAR are still needed before aneurysm rupture in many cases. A patient with impending rupture of an AAA associated with a type I endoleak 7 years after EVAR who was successfully treated with a unique technique of fixation of the proximal aortic neck taking into account the structure of the stent graft is reported. This technique offers a safe solution to late open conversion after failed EVAR.
Postoperative celiac artery stenosis (CAS) rarely occurs in the absence of vascular injury or pseudoaneurysm after pancreatoduodenectomy (PD). Because of its low incidence, the optimal treatment for non-traumatic postoperative CAS is unknown. Here, we show a case of CAS possibly due to exacerbated median arcuate ligament compression after PD. The purpose of this report is to describe this rare complication and its successful endovascular treatment with review of literatures.
We present a 77-year-old female with heavily calcified chronic total occlusions (CTO) in a superficial femoral artery treated by endovascular therapy using a Wingman crossing catheter, which is an over-the-wire catheter with a metallic blade, controlled manually. The blade could probe and track the calcified cap of CTO, wherein any hydrophilic guidewires or looped wires could not penetrate. Moreover, the Wingman could proceed through the occlusion and introduce a guidewire into distal intramedial lumen as a support catheter. Finally, wire crossing was achieved using a bi-directional approach. The Wingman can be a simple solution for crossing calcified peripheral CTO.