Annals of Vascular Diseases
Online ISSN : 1881-6428
Print ISSN : 1881-641X
ISSN-L : 1881-641X
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Showing 1-24 articles out of 24 articles from the selected issue
Original Article
Selection from Japanese Journal of Vascular Surgery 2019
  • Daihiko Eguchi, Kenichi Honma
    2020 Volume 13 Issue 3 Pages 235-239
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: September 09, 2020
    JOURNALS FREE ACCESS

    Objectives: We aim to investigate the results of stenting for central venous occlusions and stenoses in the hemodialysis patients.

    Methods: Twenty-nine cases treated with endovascular recanalization with deployment of bare metal stent (BMS) for central venous occlusions (24 cases) and recurrent stenoses (5 cases) between 2014 and 2018 were retrospectively analyzed. Results of these procedures including success rate, operative time, estimated blood loss, morbidity, primary patency, assisted primary patency and freedom from target-lesion revascularization (TLR) were evaluated.

    Results: Nine lesions were in brachiocephalic vein (Occlusion/Stenosis: 8/1) and 20 lesions were in subclavian vein (Occlusion/Stenosis: 16/4). Procedural success was 94% (29/31 cases) and operation time/estimated blood loss was 68±39 min/28±54 g. Symptom were relieved or disappeared in all successful cases. Morbidity (extravasation of contrast medium) was 3% (1/29). During the period of observation, 1 stent fracture with occlusion and 1 stent migration to periphery were recognized. 1-year primary patency, freedom from TLR, and assisted primary patency were 40% (median patent time: 256 days), 67% (median patent time: 524 days), and 77%, respectively.

    Conclusion: Stenting for central venous occlusions and stenoses in the hemodialysis patients is safe and durable treatment option. However, considering its off-label use and potential hazard including vessel rupture, stent migration, and stent fracture, the indication for BMS deployment should be conservative, and interventionist should be well acquainted with prevention and measures to these complications. (This is a translation of Jpn J Vasc Surg 2019; 28: 193–198.)

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  • Atsushi Aoki, Kazuto Maruta, Norifumi Hosaka, Tomoaki Masuda, Tadashi ...
    2020 Volume 13 Issue 3 Pages 240-247
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: September 04, 2020
    JOURNALS FREE ACCESS

    Objective: Coil embolization of aortic side branches has been additionally performed to prevent type II endoleak during EVAR in our institute. In this study, we evaluated the predictive factors of the possibility for coil embolization of the inferior mesenteric artery (IMA) and lumbar artery (LA) during EVAR.

    Methods: Seventy-four EVAR patients during June 2015 and April 2019 were included in the study. The coil embolization procedural time for one vessel is limited to 10 min. Aortic side branches were selected with 4 Fr Shepherd hook type catheter (Medikit, Tokyo, Japan) and were embolized with Interlock (Boston Scientific, MA, USA) via microcatheter. As predictive factors, internal diameter of aortic side branches and the aortic diameter perpendicular to the origin of LA (aortic diameter) were evaluated.

    Results: Coil embolization was tried for 52 patent IMAs and all IMAs except two IMAs with ostial stenosis were successfully coil embolized (96.2%). Totally 190 LAs were patent and coil embolization was tried for 144 LAs. Among 144 LAs, 106 LAs (73.6%) were successfully coil embolized and the diameter was significantly longer (2.30±0.51 mm vs. 2.04±0.41 mm, p=0.007) and aortic dimeter was significantly shorter (30.0±8.1 mm vs. 40.5±11.6 mm, p<0.001) in successfully embolized LAs. Cut off value of successful LA coil embolization was 2.06 mm for internal diameter and 36.1 mm for aortic diameter by receiver operating characteristic curve analysis. Successful coil embolization rate for LAs with internal diameter longer than 2.0 mm and aortic diameter less than 36.2 mm was 90% (72 among 80 LAs).

    Conclusion: Coil embolization during EVAR for IMA was highly successful, if there was no calcified ostial stenosis. LA embolization was feasible especially for LAs with internal diameter ≥2.0 mm and aortic diameter ≤36.1 mm. This information would be useful to select the target vessel for aortic side branches coil embolization during EVAR. (This is a translation of Jpn J Vasc Surg 2019; 28: 389–396.)

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Selection from the Journal of Japanese College of Angiology 2019
  • Nobuhisa Ohno, Toshi Maeda, Otohime Kato, Hirofumi Sato, Go Ueno, Kosu ...
    2020 Volume 13 Issue 3 Pages 248-254
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: September 07, 2020
    JOURNALS FREE ACCESS

    Although numerous surgical techniques are employed to treat acute Stanford type A aortic dissection (ATAAD), controversy remains over which is the best procedure for aortic root reconstruction. Among the various techniques utilized, neomedia repair is considered to be more promising than adhesive-only repair for the treatment of a dissected aortic root. We experienced a series of neomedia sinus Valsalva repair using woven polyester fabric, and evaluated the aortic root diameter by computed tomography and severity of aortic valve insufficiency by transthoracic echocardiography. The aortic root diameter was well preserved with no progress of aortic valve insufficiency in the long-term period. Furthermore, we found that the fabric looked functioning new media in the findings obtained from the pathological examination of a neomedia repaired aortic wall sample that was obtained by chance from a patient during valve replacement surgery performed 10 years after aortic reconstruction for ATAAD. Neomedia repair using woven polyester fabric for ATAAD might facilitate the long-term durability of the surgically treated aortic root. (This is a translation of J Jpn Coll Angiol 2019; 59: 37–43.)

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Original Article
  • Turhan Yavuz, Altay Nihat Acar, Kubra Yavuz, Evren Ekingen
    2020 Volume 13 Issue 3 Pages 255-260
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: July 07, 2020
    JOURNALS FREE ACCESS

    Objective: This study aimed to evaluate the efficacy and safety of a newly developed, leak closure Internal Compression Therapy (ICT) (Invamed, Ankara, Turkey) device during a single-session procedure in a group of patients with primary deep valve incompetence.

    Methods: There were 286 patients who were diagnosed with deep venous reflux by duplex scanning. They underwent valvular leak operations to treat primary deep venous insufficiency. Follow-up visits were on the third day, first month, sixth month and twelfth month. At each visit, duplex scanning and a clinical examination were performed. Successful treatment was defined as deep vein valves without reflux. Any patency or reflux over 1 sec was considered a failure.

    Results: The study enrolled 286 patients with deep venous insufficiency. Procedural technical success was 100%. At the one-year follow-up, the overall success, among all patients, was 92%. No significant morbidity or mortality related to the procedure were observed. All patients had major improvements in venous clinical severity score (VCSS) scores postoperatively. VCSS scores at pre-intervention, and at the twelfth month, were 20.7±5.9 and 3.9±0.9, respectively (p<0.001).

    Conclusion: After the twelve-month follow-up, the postprocedural outcomes indicate the ICT device is safe and effective.

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  • Yoshimasa Seike, Tetsuya Fukuda, Koki Yokawa, Yosuke Inoue, Takayuki S ...
    2020 Volume 13 Issue 3 Pages 261-268
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: July 07, 2020
    JOURNALS FREE ACCESS
    Supplementary material

    Objective: This study aims to determine how instructions for use affect the occurrence of aneurysm sac growth and endoleaks after an endovascular aneurysm repair (EVAR).

    Materials and Methods: We reviewed 302 patients who underwent EVAR for abdominal aortic aneurysm between 2007 and 2013, and we were able to enroll 159 patients (74% men, mean age 78±7 years) with adequate data (mean follow-up; 48±20 months).

    Results: The angle of the proximal landing zone (LZ) (hazard ratio: 1.02, 95% confidence interval: 1.00–1.03, p=0.01) was recognized as an independent risk factor of sac growth (≥5 mm). The receiver operating characteristics curve (area under the curve: 0.72) showed a cutoff value of 47° of the minimum angle of the proximal LZ to predict sac growth. Freedom rates for persistent type Ia endoleaks were also found to be lower in the angulated group than those in the other groups (p=0.0095, log-rank).

    Conclusion: The angle of the proximal LZ was identified as an independent risk factor for sac growth post-EVAR. The incidence of persistent type Ia endoleaks was significantly higher in the angulated group.

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  • Akiyuki Kotoku, Yukihisa Ogawa, Kiyoshi Chiba, Takaaki Maruhashi, Hide ...
    2020 Volume 13 Issue 3 Pages 269-272
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: August 06, 2020
    JOURNALS FREE ACCESS

    Objective: To evaluate the clinical utility of the coil in plug (CIP) method in internal iliac artery (IIA) embolization during endovascular aortic aneurysm repair (EVAR) compared to conventional coil embolization (CCE).

    Material and Methods: From July to December 2018, 10 patients who underwent IIA embolization during EVAR were divided into CIP (n=5) and CCE (n=5) groups. In the CIP technique, the AVP-1 with a size more than 30%–50% of that of the embolized IIA diameter was used. The AVP-1 was deployed in the IIA. Before detachment of the AVP-1, a 2.2-F micro catheter was inserted through the 6-F delivery guiding sheath, and entered the plug. The AVP-1 was then packed with hydrogel micro coils.

    We compared number of coils used, embolization length, embolization time, volume embolization ratio, and embolic material cost between the groups.

    Results: The CIP method achieved shorter embolization length with fewer coils used compared to CCE. The CIP method decreased the cost of total embolic materials.

    Conclusion: The CIP method can achieve shorter embolization length with fewer coils used compared to CCE.

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  • Tsunehiro Shintani, Hiroshi Mitsuoka, Yuto Hasegawa, Masanori Hayashi, ...
    2020 Volume 13 Issue 3 Pages 273-280
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: August 12, 2020
    JOURNALS FREE ACCESS

    Objective: The purpose of this study was to evaluate the effect of atheromatous aorta on thromboembolic complications after endovascular aortic aneurysm repair (EVAR) and to assess the risk factors for these complications.

    Materials and Methods: This retrospective study included patients who underwent EVAR for an abdominal aortic aneurysm at the Shizuoka Red Cross Hospital from 2007 to 2018. We defined atheromatous aorta as a thoracic shaggy aorta or abdominal aorta with neck thrombus. The main outcome was renal dysfunction and peripheral embolization (thromboembolic complications). We compared the incidence of thromboembolic complications between patients with normal aorta and atheromatous aorta. Moreover, we assessed the risk factors associated with thromboembolic complications in patients with atheromatous aorta.

    Results: Patients with atheromatous aorta had significantly more thromboembolic complications, such as renal dysfunction (24.5% vs. 3.9%; P<0.001) and peripheral embolization (12.3% vs. 0.0%; P<0.001) than those with normal aorta, respectively. We identified no risk factors associated with thromboembolic complications in patients with atheromatous aorta.

    Conclusion: Atheromatous aorta increases the risk of thromboembolic complications after EVAR. However, there is no established therapy for these thromboembolic complications. Further studies are necessary to determine the appropriate therapy, including appropriate preoperative medication, to prevent these complications.

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  • Takumi Kawase, Yosuke Inoue, Jiro Matsuo, Atsushi Omura, Yoshimasa Sei ...
    2020 Volume 13 Issue 3 Pages 281-285
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: August 19, 2020
    JOURNALS FREE ACCESS

    Objective: Surgical indications and procedures for hilar renal artery aneurysm (HRAA) are controversial in terms of invasiveness and feasibility. Catheter treatment is minimally invasive but leads to renal dysfunction due to renal infarction. This study aims to investigate the results of surgical repair of HRAA.

    Method: Fourteen patients (58.7±11.6 years old, 7 male) who underwent surgical repair of HRAA were retrospectively reviewed. Nine patients (64%) developed HRAA in the right renal artery, and the mean maximum aneurysmal diameter was 25.9±10.3 mm. HRAA was exposed via the extraperitoneal approach. HRAA was resected completely, and reconstruction of renal arteries was performed by direct closure in two, direct anastomosis in nine, and interposition of saphenous vein graft in three patients.

    Results: The average operation and renal ischemic times were 186±49 and 35±16 min, respectively. No operative death occurred, and postoperative renal function at the time of discharge had not deteriorated (creatinine, 0.74±0.15 mg/dl). During the follow-up periods (4.7±5.1 years), there was no death, no new introduction of hemodialysis, and no recurrence of renal artery aneurysm.

    Conclusion: Surgical repair of HRAA remains a valid option because of its operative safety, preservation of renal function, and long-term feasibility and patency.

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  • Yoshihiko Tsuji, Ikuro Kitano, Yoriko Tsuji
    2020 Volume 13 Issue 3 Pages 286-290
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: August 18, 2020
    JOURNALS FREE ACCESS

    Objective: In paramalleolar bypass for critical limb-threatening ischemia (CLTI), excessive skin tension may occur for the closure of surgical wounds around the ankle. Furthermore, these surgical incisions are often proximal to infectious ischemic ulcers. Wound dehiscence caused by skin tension and surgical site infection carries a risk of graft exposure, anastomotic disruption, or graft insufficiency.

    Patients and Methods: Tension-free wound management was adopted in eight patients who underwent paramalleolar bypass for CLTI. Tension-free closure was adopted for surgical incisions for distal anastomotic site of the paramalleolar bypass, whereas the incisions for saphenous vein harvest were left open. A relief incision was made as needed. The opened incisions were covered with artificial dermis.

    Results: All surgical incisions and ischemic wounds healed successfully within 1.8 months after bypass. Two postoperative graft stenoses occurred, which were rescued by additional endovascular intervention. Secondary graft patency, wound healing, and limb salvage rates were 100% during an average follow-up period of 30 months.

    Conclusion: Tension-free wound closure using artificial dermis was effective in selected cases of paramalleolar bypass for CLTI.

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  • Kenichi Yanaka, Akihide Konishi, Toshiro Shinke, Amane Kozuki, Hiroyuk ...
    2020 Volume 13 Issue 3 Pages 291-299
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: August 27, 2020
    JOURNALS FREE ACCESS

    Objectives: Balloon angioplasty for in-stent restenosis (ISR) in the superficial femoral artery (SFA) has a high recurrent restenosis rate; however, its mechanism has not been fully and precisely evaluated using high-resolution intravascular imaging. Thus, we aimed to evaluate the relationship between vascular features obtained by optical frequency domain imaging (OFDI) and recurrent restenosis at 6 months.

    Methods: This was a prospective multicenter single-arm study. OFDI was performed before and after balloon angioplasty, and vascular features were assessed. A multi-layered ISR pattern detected by OFDI was defined as several signal-poor appearances with a high-signal band adjacent to the luminal surface. The primary outcome was defined as recurrent restenosis 6 months after balloon angioplasty.

    Results: Given that this study was terminated early, only 18 patients completed the 6-month follow-up; of these, 8 developed restenosis. Recurrent restenosis at 6 months tended to be related to a multi-layered ISR pattern (odds ratio (OR), 6.67; 95% confidence interval (CI), 0.81–54.96; p=0.078) and the minimum lumen area (MLA) after balloon angioplasty (OR, 0.71; 95%CI, 0.48–1.04; p=0.077).

    Conclusion: A multi-layered ISR pattern and MLA after balloon angioplasty detected by OFDI might be risk factors for recurrent ISR in the SFA.

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  • Mitsuyoshi Takahara, Osamu Iida, Yoshimitsu Soga, Akio Kodama, Hiroto ...
    2020 Volume 13 Issue 3 Pages 300-307
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: September 14, 2020
    JOURNALS FREE ACCESS

    Aim: Critical limb ischemia (CLI) has a wide age distribution. We aimed here to reveal age-associated clinical features in CLI patients.

    Materials and Methods: We analyzed 531 Japanese CLI patients referred to vascular centers. The three-year mortality risk by age was compared to that for the Japanese nationals, derived from Japan’s national life table data. Clinical characteristics associated with age in CLI patients were also explored.

    Results: Mean age was 73±10 years. Whereas 27.9% were aged ≥80 years, 19.2% were aged <65 years. Mortality risk was increased with age, but its risk ratio relative to the same-aged nationals was higher in younger patients. Incidence of major amputation was higher in a younger population. Receiving welfare, smoking, increased body mass index, diabetes with hemoglobin A1c ≥7.0%, non-high density lipoprotein cholesterol ≥190 mg/dL, renal failure, and the Wound, Ischemia, and foot Infection classification stage 4 were associated with younger age, whereas non-ambulation and institutionalization were associated with older age.

    Conclusion: Patients aged <65 years, belonging to the working-age population, reached almost one fifth of the CLI population. Younger patients had a lower mortality risk in the population, but had a higher risk ratio relative to the same-aged nationals. Socioeconomic disadvantage, poor cardiovascular risk control, and wound severity were associated with younger age.

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Case Report
  • Yusuke Motoji, Takayoshi Kato, Jun Seki, Kosuke Tsumura, Shinji Tomita ...
    2020 Volume 13 Issue 3 Pages 308-311
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: July 06, 2020
    JOURNALS FREE ACCESS

    We report a case of stent graft occlusion, severe lower extremity ischemia, and ruptured abdominal aortic aneurysm due to type B acute aortic dissection 3 years after endovascular aneurysm repair. He admitted our hospital because of abrupt back pain and dysesthesia of bilateral lower limb. Contrast-enhanced computed tomography (CT) scan showed type B acute aortic dissection and occlusion of the stent graft due to dynamic compression by the false lumen. Emergent right axillo-bifemoral bypass operation was done for his critical limb ischemia. Immediately after the successful operation, he fell into shock vital and dissecting abdominal aortic aneurysm rupture was revealed by CT scan. We performed the stump occlusion of the infrarenal abdominal aorta and the bilateral common iliac arteries by abdominal midline incision. Postoperative myonephropathicmetabolic syndrome due to the left ischemia resulted in amputation of his left lower leg for lifesaving. While EVAR cases are increasing, various its complications come to be reported. We consider that this case report might be cautious about the indication of EVAR for the younger generation. (This is a translation of Jpn J Vasc Surg 2019; 28: 367–371.)

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  • Yuki Imamura, Norihiro Kondo, Yoshiaki Saito, Kaoru Ogawa, Mari Chiyoy ...
    2020 Volume 13 Issue 3 Pages 312-315
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: July 10, 2020
    JOURNALS FREE ACCESS

    We report a case of periaortic lymphoma mimicking Stanford type B acute aortic dissection treated for impending rupture by thoracic endovascular aortic repair. Although no endoleak was detected, the aneurysm enlarged continuously. Repeat computed tomography scans showed that an aortic aneurysm-like structure around the stent graft had enlarged irregularly. Histopathological examination revealed diffuse large B-cell malignant lymphoma. Post-chemotherapy, the aneurysm-like structure disappeared without any fistula or rupture. In open surgery, differentiating between aneurysms and malignancy is easy under direct vision; however, in the endovascular surgery era, this is a pitfall because no surgical specimen of the lesion can be obtained.

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  • Soichiro Henmi, Hidekazu Nakai, Katsuhiro Yamanaka, Atsushi Omura, Tak ...
    2020 Volume 13 Issue 3 Pages 316-318
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: June 26, 2020
    JOURNALS FREE ACCESS

    Aneurysmal change of reconstructed intercostal arteries is believed to be a rare complication after thoracoabdominal aortic repair. To our knowledge, there is no guideline or randomized controlled trials regarding intercostal patch aneurysm management. Therefore, the optimal treatment is still controversial. We describe a successful case of emergent thoracic endovascular aortic repair for ruptured intercostal patch aneurysm in an 83-year-old man following thoracoabdominal aortic aneurysm repair. Our experience illustrated that gradual expansion of large blocks of aortic wall reconstruction should be closely monitored after primary thoracoabdominal aortic replacement.

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  • Hiroaki Kato, Noriyuki Kato, Ken Nakajima, Takatoshi Higashigawa, Taka ...
    2020 Volume 13 Issue 3 Pages 319-321
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: July 16, 2020
    JOURNALS FREE ACCESS

    The effectiveness of endovascular aneurysm repair (EVAR) has been proven, but anatomical limitations, including narrow access route, may obstruct procedure of EVAR and cause serious complications. Parallel placement of Excluder legs (W. L. Gore & Associates, Inc., Newark, DE, USA) was established to treat patients with type IIIb endoleak or those with a narrow aorta, who could not be treated using a standard main body. In this report, we applied this technique in two patients with aortoiliac aneurysms with occlusive lesion.

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  • Masato Nishizawa, Kimihiro Igari, Masayuki Hirokawa, Nobuhisa Kurihara ...
    2020 Volume 13 Issue 3 Pages 322-325
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: July 07, 2020
    JOURNALS FREE ACCESS

    Venous aneurysm (VA) is an uncommon vascular disease; however, VA, especially in the lower extremities, can lead to critical complications, such as pulmonary embolism (PE). We report a case with a VA located in the sural vein (SV), which did not lead to PE; however, it had the potential to cause PE. Therefore, we treated this VA by total excision. The popliteal vein (PV) is the most common VA location in the lower extremities, but SV is extremely rare. We should always be aware that, in addition to the PV, VAs may also occur in the SV.

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  • Satoshi Okugi, Takashi Azuma, Yoshihiko Yokoi, Satoru Domoto, Hiroshi ...
    2020 Volume 13 Issue 3 Pages 326-329
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: July 28, 2020
    JOURNALS FREE ACCESS

    Recently, it has been reported that a fenestrated stent graft is an effective option in the treatment of pararenal artery abdominal aortic aneurysm. We report the case of a 72-year-old male patient with multiple aortic aneurysms in the distal arch, thoracoabdominal aorta, right common iliac artery, as well as a pararenal abdominal aortic aneurysm. The patient was found to have a mass with a tendency of rapid expansion within a month from its discovery. Because it was a saccular aneurysm with a tendency of rapid expansion and wide spread, the risk of rupture was judged to be high, and surgical treatment became necessary. One-stage treatment was desirable; therefore, endovascular treatment with a fenestrated stent graft was selected. Four fenestrations were made to a stent graft for the celiac artery, superior mesenteric artery, and bilateral renal arteries. The postoperative computed tomography (CT) showed no branch occlusion or endoleak, and the 2-year postoperative CT showed the shrinkage and subsequent disappearance of the aortic aneurysm at the treatment site. For extensive aortic aneurysm, including pararenal artery abdominal aortic aneurysms, one-stage treatment with fenestrated stent graft was considered to be effective as a treatment strategy. (This is a translation of Jpn J Vasc Surg 2020; 29: 9–13.)

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  • Koji Hirano, Toshiya Tokui, Bun Nakamura, Ryosai Inoue, Reina Hirano, ...
    2020 Volume 13 Issue 3 Pages 330-334
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: July 28, 2020
    JOURNALS FREE ACCESS

    Pancreaticoduodenal artery aneurysm (PDAA) is a rare disease without treatment guidelines. We present two patients with PDAA. The first patient was a 70-year-old man with a pseudoaneurysm in the anterior superior pancreaticoduodenal artery (ASPDA), for which we achieved exclusion by endovascular coil embolization. The second patient was a 63-year-old woman with a PDAA in the ASPDA with celiac axis obstruction. Endovascular coil embolization of the aneurysm and the ASPDA was successful without visceral organ ischemia. Endovascular treatment is effective for PDAAs, but careful evaluation of collateral circulation is vital in PDAAs with celiac axis obstruction.

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  • Shingo Nakai, Tetsuro Uchida, Yoshinori Kuroda, Atsushi Yamashita, Eii ...
    2020 Volume 13 Issue 3 Pages 335-338
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: August 11, 2020
    JOURNALS FREE ACCESS

    Spinal cord injury (SCI) following endovascular aortic repair (EVAR) for an abdominal aortic aneurysm (AAA) is a rare but serious complication. Case 1 presented with ruptured AAA and shock and underwent emergency EVAR. The patient developed incomplete paraplegia 2 days following EVAR. Case 2, diagnosed with impending rupture of AAA with extremely shaggy aorta, was treated with emergency EVAR. The patient was diagnosed with complete paraplegia soon after EVAR. Case 3 underwent elective EVAR and developed delayed paraplegia 2 weeks later. In EVAR, the etiology of SCI leading to paraplegia is often multifactorial. Surgeons must consider the possibility of SCI-induced paraplegia.

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  • Yohei Kawatani, Motoshige Yamasaki, Atsushi Oguri
    2020 Volume 13 Issue 3 Pages 339-342
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: August 18, 2020
    JOURNALS FREE ACCESS

    Aortic stenosis is a serious valvular disease that increases the risk of cardiac arrest and/or cardiogenic shock during noncardiac surgery. A 93-year-old woman with an abdominal aortic aneurysm impending rupture and aortic stenosis underwent endovascular abdominal aortic aneurysm repair. During surgery, the patient presented with ventricular tachycardia. Due to on-going cardiogenic shock, we did a direct cannulation into the right axillary artery for the immediate establishment of venoarterial extracorporeal membrane oxygenation. The endovascular treatment of the abdominal aortic aneurysm was completed according to the standard procedure. The patient recovered without any complications, including heart failure or neurological dysfunction.

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  • Masami Takagaki, Hirofumi Midorikawa, Hiroki Yamaguchi, Hiromasa Nakam ...
    2020 Volume 13 Issue 3 Pages 343-346
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: August 19, 2020
    JOURNALS FREE ACCESS

    The J Graft Open Stent Graft (JOSG) is used for the frozen elephant trunk procedure in Japan. We report a 70-year-old male who developed a rapidly progressing distal arch aneurysm caused by a distal stent graft-induced new entry (DSINE) 7 months after the procedure. The JOSG was originally implanted at the curved part of the distal arch. It created its initial DSINE on the greater curve and rapidly “sprang” back in 2 months. Urgent thoracic endovascular aortic repair fixed this serious complication. We should remember such rapid progression of DSINE by JOSG and treat its initial sign earlier.

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  • Benjamin Dak Keung Leong, Feona Sibangun Joseph
    2020 Volume 13 Issue 3 Pages 347-350
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: August 28, 2020
    JOURNALS FREE ACCESS

    Thoracoabdominal aortic aneurysm (TAAA) is a challenging vascular condition to manage. Traditionally, open surgical repair has been the standard of treatment. Endovascular repair for TAAA has gained much popularity because it is a minimally invasive approach that results in better mortality and morbidity profiles. We report a case of TAAA successfully treated with a custom-made multi-branch device through a total femoral approach with the use of a steerable sheath for branch cannulation and deployment of bridging stents to targeted visceral vessels. This approach avoided complications related to upper extremity access, such as stroke, and allowed shorter operative time with better workstation ergonomics.

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  • Masahiro Aiba, Ikutaro Kigawa
    2020 Volume 13 Issue 3 Pages 351-354
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: August 27, 2020
    JOURNALS FREE ACCESS

    Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignancy, but has been found more frequently with recent advances in diagnostic imaging. Local recurrence and metastases are frequent with this pathology, and prognosis is poor. We report a case of a patient with leiomyosarcoma of the IVC surviving for >10 years after the first resection despite local recurrence and two metastatic recurrences to the pancreas and liver, with successful excisions following early detection on positron emission tomography-computed tomography.

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  • Shingo Kunioka, Hiroto Kitahara, Seima Ohira, Yuki Tada, Nobuyuki Akas ...
    2020 Volume 13 Issue 3 Pages 355-357
    Published: September 25, 2020
    Released: September 25, 2020
    [Advance publication] Released: August 25, 2020
    JOURNALS FREE ACCESS

    Secondary aortoenteric fistula or erosion (SAEFE), an abnormal connection between the aorta and gastrointestinal tract, is a rare but critical complication after abdominal aortic aneurysm repair. Most SAEFEs occur between the aorta or proximal graft anastomosis and the duodenum, and occurrence between the iliac graft and small intestine is rare. Standard SAEFE management involves graft removal and extra-anatomical bypass. However, this is extremely invasive and has a high mortality rate. We encountered a rare case of SAEFE with no sign of infection, which was successfully treated by ligating the iliac graft to reduce mechanical pulsatile stress and bleeding following the retroperitoneal approach.

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