Annals of Vascular Diseases
Online ISSN : 1881-6428
Print ISSN : 1881-641X
ISSN-L : 1881-641X
Volume 12 , Issue 4
Showing 1-28 articles out of 28 articles from the selected issue
ORIGINAL ARTICLES
Selection from Japanese Journal of Vascular Surgery 2018
  • Hitoshi Kusagawa
    2019 Volume 12 Issue 4 Pages 443-448
    Published: December 25, 2019
    Released: December 25, 2019
    [Advance publication] Released: August 26, 2019
    JOURNALS FREE ACCESS

    Objective: To clarify the localization of and surgery for atypical incompetent perforating veins (IPVs) other than Dodd, Boyd, Cockett perforators, which have not been previously discussed.

    Methods: Forty-three atypical IPVs, diagnosed by venous ultrasonography and treated surgically from January 2014 to June 2018, were analyzed from the viewpoint of localization and surgical treatment.

    Results: All atypical IPVs passed through the fascia in the area between the muscle compartments in the same way as the typical IPV. The IPVs were most commonly located in the posterolateral part of the lower thigh (16), around the popliteal fossa (9), and in the posterolateral part in the lower calf (7). For 42 IPVs, surgery consisted of direct ligation and resection at the fascia level, and foam sclerotherapy was performed for 1 IPV. The blood flow of the perforating vein was blocked under the fascia in 40 IPVs, but to and fro flow at the fascia level remained in 3 IPVs.

    Conclusion: Atypical IPVs causing varicose veins were most common in the posterolateral part of the lower thigh. For treatment, it is important to ligate and cut them without leaving stumps with related branches outside the fascia under precise ultrasonic observation. (This is a translation of Jpn J Vasc Surg 2018; 27: 461–466.)

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  • Shunichiro Fujioka, Yusuke Irisawa, Tetsuya Horai, Shigeru Hosaka
    2019 Volume 12 Issue 4 Pages 449-455
    Published: December 25, 2019
    Released: December 25, 2019
    [Advance publication] Released: September 11, 2019
    JOURNALS FREE ACCESS

    Objectives: Endovascular repair of the thoracic aorta (TEVAR) represents a therapeutic option for type B aortic dissection. However, the optimal timing for TEVAR is controversial. We examined the outcomes of TEVAR for chronic type B dissection and reviewed aortic morphology using pre- and postoperative CT scan images.

    Methods: Between 2012 and 2017, 12 patients underwent TEVAR for chronic type B dissection at our institution. We retrospectively reviewed the clinical and operative data including CT scan images, comparing the values between early group (5 cases, 3 months to 1 year from initial dissection) and late group (7 cases, more than 1 year from initial dissection).

    Results: There were no paraplegia, stroke, and death in our cohort. There was no difference in degree of the aortic remodeling between two groups.

    Conclusions: Outcomes after TEVAR for chronic type B aortic dissection were favorable. Aortic remodeling could be obtained in selected patients by closing an entry with TEVAR procedure. (This is a translation of Jpn J Vasc Surg 2018; 27: 281–287.)

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Selection from the Journal of Japanese College of Angiology 2018
  • Hirono Satokawa, Shinya Takase, Hiroki Wakamatsu, Yuki Seto, Hiroyuki ...
    2019 Volume 12 Issue 4 Pages 456-459
    Published: December 25, 2019
    Released: December 25, 2019
    [Advance publication] Released: August 26, 2019
    JOURNALS FREE ACCESS

    Spontaneous isolated dissection of the superior mesenteric artery (SMAD) is not still well known. We retrospectively analyzed our 30 patients with SMAD to elucidate the treatment strategy and long-term follow-up outcomes. Due to severe abdominal symptom we performed a stents deployment and surgical reconstructive surgery for each one case. Anerysmectomy and bypass surgery was performed for a patient with aneurysmal change. Other 27 patients were managed conservatively. SMAD patients had only two vascular events (renal infarction and graft occlusion), and showed good prognosis for 6–146 (mean 69) months follow-up. We found that there is a few SMAD patients necessary of invasive management at acute phase and that most patients are safely conservatively treated with good prognosis. (This is a translation of J Jpn Coll Angiol 2018; 58: 195–199.)

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  • Ichiro Mizushima, Satomi Kasashima, Yasunari Fujinaga, Kenji Notohara, ...
    2019 Volume 12 Issue 4 Pages 460-472
    Published: December 25, 2019
    Released: December 25, 2019
    [Advance publication] Released: August 26, 2019
    JOURNALS FREE ACCESS

    IgG4-related disease is a systemic disease, characterized by elevation of serum IgG4 and, histopathologically, massive infiltration of IgG4+ lymphocyte and plasma cell infiltration, storiform fibrosis, causing enlargement, nodules or thickening. It may affect various organs simultaneously or metachronously. Here we analyzed the clinical and pathological characteristics of 99 patients diagnosed with IgG4-related periaortitis/periarteritis and retroperitoneal fibrosis. Of 99 patients (women/men, 15/84; mean age 67.3±9.5 years), 33 were diagnosed based on the histopathological findings of perivascular/retroperitoneal lesions, 50 were diagnosed based on the characteristic imaging findings of perivascular/retroperitoneal lesions and the presence of definitive IgG4-related disease in other organ(s), and the remaining 16 patients were diagnosed by experts based on the characteristic imaging findings of perivascular/retroperitoneal legions, serological findings, response to glucocorticoid treatment, and/or the presence of suspected IgG4-related disease in other organ(s). According to the new organ-specific criteria proposed by experts, 73 (73.7%) diagnoses were categorized to be definitive, and 6 (6.1%) and 17 (17.2%) diagnoses were categorized to be probable and possible, respectively. Further analyses are needed to clarify the optimal diagnostic and therapeutic strategy of IgG4-related periaortitis/periarteritis and retroperitoneal fibrosis. (This is a translation of J Jpn Coll Angiol 2018; 58: 117–129.)

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  • Yuichi Matsuzaki, Takuma Yamasaki, Yu Hohri, Takeshi Hiramatsu
    2019 Volume 12 Issue 4 Pages 473-479
    Published: December 25, 2019
    Released: December 25, 2019
    [Advance publication] Released: December 11, 2019
    JOURNALS FREE ACCESS

    The timing and choice of surgical method for type B aortic dissection, is still a topic of much debate. We performed total arch replacement using frozen elephant trunk (TAR-FET) as a means of preventing distant aortic events, such as retrograde type A aortic dissection (RTAD). We conducted analysis of 142 patients with acute type B dissection who were admitted between January of 2010 and July of 2017. Fifty-five cases required surgical intervention to treat enlargement of the false lumen diameter and ULP formation 2 weeks after the onset of symptoms. 17 TAR-FET were performed with a mean of 42±26 days period from onset to surgery. There were no complications of RTAD or paraplegic, and 90% of patient demonstrated aortic event free survival (5 years) and false lumen reduction ratio of 35%. Based on our analysis, using TAR-FET properly avoids serious complications like RTAD, and is a viable treatment option for type B dissection. (This is a translation of J Jpn Coll Angiol 2018; 58: 151–157.)

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Selection from the Japanese Journal of Phlebology 2018
  • Naoto Yamamoto, Naoki Unno, Kazunori Inuzuka, Masaki Sano, Takaaki Sai ...
    2019 Volume 12 Issue 4 Pages 480-486
    Published: December 25, 2019
    Released: December 25, 2019
    [Advance publication] Released: December 13, 2019
    JOURNALS FREE ACCESS

    Backgrounds: Pulmonary thromboembolism (PTE) is severe complication which may arise during all medical service. The purpose of this study is to evaluate inpatient symptomatic PTE.

    Materials and Methods: From 2005 to 2016, we experienced 75 symptomatic PTE patients among 600 venous thromboembolism patients. According to the place of occurrence, patients were divided to inpatient group and outpatient group. We further divided inpatient group to surgical group and non-surgical group.

    Results: Inpatients group, 38 had PTE (surgical: 23, non-surgical: 15). Outpatients group, 37 had PTE (with medical practice: 22, without medical practice: 15). Severity of PTE were follows; cardiac arrest 2, massive 13, sub-massive 18, non-massive 42. In surgical group, anticoagulation had been used in 3/23 (13.6%), intermittent pneumatic compression had been used in 16/23 (72.9%), compression stockings had been used in 20/23 (90.9%). In non-surgical group, no anticoagulation had not been used, intermittent pneumatic compression had been used in 2/15 (13.3%), compression stockings had been used in 2/15 (13.3%).

    Conclusion: As PTE prophylaxis, anticoagulation had been scarcely used in surgical group. Delayed anticoagulation may decrease symptomatic PTE in surgical patients. Despite adequate prophylaxis, PTE cannot be prevented completely. Medical staff and patients should recognize the risk of PTE together. (This is a translation of Jpn J Phlebol 2018; 29(1): 33–40.)

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  • Nobuhiro Shimabukuro, Makoto Mo, Naoki Hashiyama, Shinobu Matsubara, H ...
    2019 Volume 12 Issue 4 Pages 487-492
    Published: December 25, 2019
    Released: December 25, 2019
    [Advance publication] Released: December 12, 2019
    JOURNALS FREE ACCESS

    Background: The natural history of asymptomatic isolated distal deep vein thrombosis (DVT) of the leg is unclear. This study aimed to describe a 3-month and 1-year clinical course after diagnosis of asymptomatic isolated distal DVT of the leg.

    Methods: This study included 127 patients with asymptomatic, sonographically proven isolated distal DVT who did not receive anticoagulant therapy and were retrospectively evaluated at our hospital between May 2014 and September 2016. After 3 months and 1 year, the presence or absence of venous thromboembolism recurrence and extension of DVT toward proximal veins was sonographically confirmed.

    Results: At 3-month and 1-year follow-ups, 125 and 109 patients were observed, respectively. All patients showed no symptoms or findings suspecting venous thromboembolism recurrence during the observation period. However, 43 patients underwent repeat ultrasonic examination, and thrombus extension was confirmed in 2 patients.

    Conclusions: Asymptomatic isolated distal DVT of the leg showed good prognosis, and thus uniform anticoagulation therapy was considered unnecessary. (This is a translation of Jpn J Phlebol 2018; 29(3): 309–314.)

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ORIGINAL ARTICLES
  • Yuthapong Wongmahisorn
    2019 Volume 12 Issue 4 Pages 493-499
    Published: December 25, 2019
    Released: December 25, 2019
    [Advance publication] Released: August 30, 2019
    JOURNALS FREE ACCESS

    Objectives: This study aims to evaluate the survival and prognostic predictors of arteriovenous fistulas (AVFs) among patients undergoing AVF creation. The significant predictors were incorporated into a prognostic model to determine its prognostic performance for five-year AVF survival.

    Materials and Methods: Data on 290 patients who underwent first-time AVF creation and who had been followed up for at least 5 years or until AVF failure were reviewed. The Kaplan–Meier survival curves and Cox proportional hazards model were generated to determine the AVF survival and associated prognostic predictors. Significant predictors were used to derive a prognostic model.

    Results: The mean age of the patients was 59.7±14.6 years, and the 5-year AVF survival rate was 34.5%. Three features were found to be independent prognostic factors for the five-year AVF survival: old age, diabetes mellitus, and prior central venous catheter placement. These three significant factors were integrated into a prognostic scoring model that ranged from zero to five points. According to this model, the patients whose scores were 0, 1, 2, 3 and 4 or more had five-year AVF survival rates of 60.0%, 45.3%, 36.6%, 15.0%, and 2.9%, respectively.

    Conclusion: The five-year survival rate of AVFs was modest, and a prognostic model could excellently estimate the five-year AVF survival.

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  • Daijiro Hori, Koichi Yuri, Sho Kusadokoro, Hiroyasu Katayama, Naoyuki ...
    2019 Volume 12 Issue 4 Pages 500-506
    Published: December 25, 2019
    Released: December 25, 2019
    [Advance publication] Released: September 04, 2019
    JOURNALS FREE ACCESS

    Objective: The purpose of this study was to compare the long-term outcomes of open surgery and thoracic endovascular aortic repair (TEVAR) in patients undergoing repeat thoracic aortic repair from previous anastomosis site.

    Methods: From January 2009 to December 2017, 68 patients needed repeat aortic surgery from previous anastomosis site. Twenty-three patients had dissected distal aorta and 45 patients had non-dissected distal aorta. Early and long-term outcomes of open surgery and TEVAR were compared in both groups.

    Results: There were no significant differences in patient background between the two treatments in both groups. Open surgery was associated with longer intensive care unit stay, but there was no significant difference in in-hospital mortality in both groups. In patients with dissected distal aorta, there was no significant difference in long-term mortality (p=0.73). However, TEVAR was associated with higher risk of reintervention (p=0.038). In non-dissected distal aorta patients, acute kidney injury (p=0.002) and prolonged ventilation (p=0.032) were more often observed in open surgery. However, there were no significant differences in long-term mortality (p=0.23) and freedom from reintervention (p=0.13).

    Conclusions: Long-term outcomes were similar between open surgery and TEVAR in both groups. However, TEVAR in patients with dissected distal aorta was associated with higher risk, for reintervention.

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  • Kentaro Tamura, Genta Chikazawa, Arudo Hiraoka, Toshinori Totsugawa, H ...
    2019 Volume 12 Issue 4 Pages 507-513
    Published: December 25, 2019
    Released: December 25, 2019
    [Advance publication] Released: October 07, 2019
    JOURNALS FREE ACCESS

    Objectives: The aim of this study is to investigate the characteristics and surgical outcomes of acute type A aortic dissection (AAAD) in patients younger than 50 years of age.

    Methods: We retrospectively evaluated 307 patients who consecutively underwent surgical treatment for AAAD in our institute from January 2007 to June 2017. Patients were classified into two groups: the young group with 31 patients aged younger than 50 and the old group with 276 patients aged 50 years or older.

    Results: In-hospital mortality was similar in both groups (3.2% vs. 9.4%, p=0.19). Overall survival at 5 years was higher in the young group than that in the old group (97% vs. 71%, p=0.017). No significant differences were observed in freedom from aorta-related death and distal aortic reoperation at 5 years (97% vs. 87%, p=0.26; 86% vs. 92%, p=0.093). The percentage of young patients with postoperative patent false lumen at the descending aorta was significantly higher than that of old patients (76% vs. 30%, p<0.001) in spite of primary entry resection.

    Conclusion: Early and mid-term outcomes for AAAD in young patients were satisfactory. However, future follow-up is important because postoperative patent false lumen is at a high rate in young patients in spite of entry resection.

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  • Masaya Nakashima, Masayoshi Kobayashi
    2019 Volume 12 Issue 4 Pages 514-518
    Published: December 25, 2019
    Released: December 25, 2019
    [Advance publication] Released: October 01, 2019
    JOURNALS FREE ACCESS

    Objective: Saphenous varicose veins can be accomplished by various operative techniques that result in stripping, ablation, or ligation of the venous reflux section. Great saphenous vein (GSV) stripping is one of the standard operations for varicose veins to eliminate reflux of the sapheno-femoral junction. The goal of any treatment regimen is to eliminate the junctional varicose reflux to control congestive dysfunction. Endovenous laser ablation (EVLA) is safe and effective with less postoperative pain, bleeding, and peripheral nerve damage than open surgery. In this study, a patient with severe progression of primary saphenous varicose veins is presented. We report the outcome of combined surgical strategy and perioperative treatment for extremely swollen varicose veins of the lower limbs to improve leg symptoms and congestion and/or promote skin ulcer healing.

    Materials and Methods: The subjects included 42 patients (51 limbs) who underwent EVLA with stripping. The patients comprised 24 males and 18 females, who presented a maximum GSV diameter >15 mm. The Clinical-Etiological-Anatomic-Pathophysiologic classification identified 9, 20, 9, 2, 6, and 5 limbs with C2, C3, C4a, C4b, C5, and C6, respectively, among the 42 patients.

    Results: EVLA was used to treat GSV with a mean length of 16.1±2.8 cm. The mean of the maximum GSV diameter was 16.8±3.2 mm (14.6–21.8 mm). The preoperative visual analog scale (VAS) score was 82.1±12.1. After operation, the VAS gradually deteriorated to 31.3±17.9 (p<0.0001), 2.8±3.6 (p<0.0001), and 1.2±1.8 (p<0.0001) in 7 days, 1 month, and 3 months, respectively.

    Conclusion: We obtained a satisfactory outcome from our combined strategy and perioperative treatment for extremely swollen saphenous varicose veins. This approach may show the possibility that lower saphenous varicose veins can induce cosmetic and minimally invasive ameliorated intervention to avoid late-phase incompetent perforating veins.

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  • Yu Inaba, Akihiro Yoshitake, Kanako Hayashi, Tsutomu Ito, Takashi Hach ...
    2019 Volume 12 Issue 4 Pages 519-523
    Published: December 25, 2019
    Released: December 25, 2019
    [Advance publication] Released: November 25, 2019
    JOURNALS FREE ACCESS
    Supplementary material

    Objective: Endograft limb occlusion (ELO) is a complication of endovascular aneurysm repair (EVAR). In this study, we investigated the mechanism and anatomical features of ELO.

    Materials and Methods: We retrospectively reviewed 227 consecutive patients with abdominal aortic aneurysm who underwent EVAR between 2007 and 2017. We then analyzed the preoperative risk factors and anatomical features of patients with ELO.

    Results: A total of nine patients had ELO (4.0%). The diameter of the terminal aorta was significantly smaller in patients with ELO than in patients without ELO (18.0 mm vs. 22.3 mm, p=0.039). We measured the diameter of each limb near the terminal aorta. The smaller limb (SL) was occluded in all patients with occlusion. The difference between the larger limb (LL) and the SL (LL-SL) was significantly larger in patients with ELO than in patients without ELO (4.0 mm vs. 1.7 mm, p<0.001). The following were considered risk factors for ELO: younger age, narrow terminal aorta, severe calcification at the terminal aorta, and use of an Endurant device.

    Conclusion: ELO occurs when the diameter of one side of the stent graft limb is small compared with the diameter of the other side owing to the narrow terminal aorta and calcification.

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  • Munetaka Hashimoto, Hitoshi Goto, Daijirou Akamatsu, Takuya Shimizu, K ...
    2019 Volume 12 Issue 4 Pages 524-529
    Published: December 25, 2019
    Released: December 25, 2019
    [Advance publication] Released: December 04, 2019
    JOURNALS FREE ACCESS

    Objectives: The optimal surgical management for primary infected abdominal aortic aneurysm (IAAA) is controversial. Here, we report the early and long-term results of surgical treatments with the resection of the IAAA and in situ graft reconstruction with pedicled omental coverage that was performed at out hospital.

    Methods: Between 2010 and 2017, 27 consecutive patients (26 males, 1 female, median age 69 years) with IAAA were surgically treated with the resection of the IAAA, in situ graft reconstruction and covered with a pedicled omental flap. Perioperative and long-term outcomes were reviewed retrospectively by medical records.

    Results: Clinical manifestations, including pyrexia, fever and abdominal pain, were observed during the treatment of the patients. Aneurysm excision and in situ graft reconstruction with omental coverage were performed for all cases. In 13 cases (48.1%), tissue culture was positive. The antibiotic was administered intravenously for 9 to 47 days (median 18 days) postoperatively, and after confirming the reduction of the inflammatory response, it was administered as oral agents for 24 to 443 days (median 169 days).There was no perioperative death or re-infection. Perioperative complications were found in 8 cases (29.6%) of minor spinal cord infarction, ileus, chylous ascites, and cholangitis due to choledochlithiasis. During the observation period of median 1,147 days, there was no recurrence of infection, graft infection, or disease-related death. There were six deaths due to other diseases. And the overall survival rate was 76.2%.

    Conclusion: According to our study, the long-term outcomes of surgical treatment with in situ graft reconstruction for IAAA were considered satisfactory. (This is a translation of Jpn J Vasc Surg 2019; 28: 35–40.)

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CASE REPORTS
ANNUAL REPORT
  • The Japanese Society for Vascular Surgery Database Management Committe ...
    2019 Volume 12 Issue 4 Pages 566-586
    Published: December 25, 2019
    Released: December 25, 2019
    [Advance publication] Released: December 12, 2019
    JOURNALS FREE ACCESS

    Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeon in Japan in 2013, as analyzed by database management committee (DBC) members of the JSVS.

    Materials and Methods: To survey the current status of vascular treatments performed by vascular surgeons in Japan, the DBC members of the JSVS analyzed the vascular treatment data provided by the National Clinical Database (NCD), including the number of treatments and early results such as operative and in-hospital mortality.

    Results: In total 100,470 vascular treatments were registered by 1,045 institutions in 2013. This database is composed of 7 fields including treatment of aneurysms, chronic arterial occlusive disease, acute arterial occlusive disease, vascular injury, complication of previous vascular reconstruction, venous diseases, and other vascular treatments. The number of vascular treatments in each field was 19,439, 13,276, 4,688, 1,563, 1,777, 37,643, and 23,971, respectively. In the field of aneurysm treatment, 16,694 cases of abdominal aortic aneurysm (AAA) including common iliac aneurysm were registered, and 52.9% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,598 (9.6%) cases were registered as ruptured AAA. The operative mortality of ruptured and un-ruptured AAA was 17.9%, and 1.0%, respectively. 25.5% of ruptured AAA were treated by EVAR, and the EVAR ratio was gradually increasing, but the operative mortality of open repair and EVAR for ruptured AAA was 16.1%, and 15.8%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 7,437 cases, including 1,121 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) were performed in 5,839 cases. The EVT ratio was gradually increased at 44.0%. Venous treatment including 35,986 cases with varicose vein treatments and 506 cases with lower limb deep vein thrombosis were registered. Regarding other vascular operations, 22,572 cases of vascular access operations and 1,185 amputation surgeries were included.

    Conclusions: The number of vascular treatments increased since 2011, and the proportion of endovascular procedures increased in almost all field of vascular diseases, especially EVAR for AAA, EVT for chronic arterial occlusive disease, and endovenous laser ablation (EVLA) for varicose veins. (This is a translation of Jpn J Vasc Surg 2019; 28: 273–292.)

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Reviewers Index
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Contents of Volume 12, 2019
Best Cited Articles 2019
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