Annals of Vascular Diseases
Online ISSN : 1881-6428
Print ISSN : 1881-641X
ISSN-L : 1881-641X
最新号
選択された号の論文の20件中1~20を表示しています
Original Article
Selection from the Japanese Journal of Phlebology 2019
  • Shozo Tamura, Mai Yamamoto, Atsushi Kitagawa, Toshihiko Nagao
    2021 年 14 巻 2 号 p. 99-107
    発行日: 2021/06/25
    公開日: 2021/06/25
    [早期公開] 公開日: 2021/04/26
    ジャーナル フリー

    Objective: In 2017, the Medical Accident Investigation and Support center in Japan released an analysis of acute pulmonary thromboembolism (PTE) related mortality. This recommendation called for maintaining a “team in charge of PTE’s risk assessment, prevention, diagnosis and treatment” and preventing PTE through team activities. Therefore, we recommended establishing a deep vein thrombosis (DVT) prevention team. Before this recommendation, a multidisciplinary DVT prevention team was established in our hospital, with excellent outcomes. In the current study, we report the results of the DVT prevention team.

    Methods: Our multidisciplinary team consisted of several departments: Cardiovascular Surgery, ward nurses, medical safety managers, and clerks. The following themes were launched: 1) preparation of DVT prevention protocol; 2) preparation of DVT preventive manual; 3) regular round for evaluating DVT preventive measures; 4) staff education. The protocol’s strong point was that nurses evaluated patients over 16-year-old with Wells’ score for DVT on admission. We retrospectively investigated the diagnosis rate of DVT and PTE for 9 months before and after protocol operation.

    Results: The diagnosis rate of DVT was significantly improved after protocol implementation (before: 0.06% vs. after: 0.56%, p=0.0017). However, no significant difference was observed in the diagnosis rate of PTE before and after the protocol execution (before: 0.03% vs. after: 0.07%, p=0.98).

    Conclusion: Our DVT prophylactic protocol improved the diagnostic rate of DVT resulting in a decrease of PTE in our hospital. (This is a translation of Jpn J Phlebol 2019; 30(3): 285–293.)

  • Yuki Oga, Satoru Sugiyama, Susumu Matsubara, Yasuhiko Inaki, Masashi M ...
    2021 年 14 巻 2 号 p. 108-111
    発行日: 2021/06/25
    公開日: 2021/06/25
    [早期公開] 公開日: 2021/04/28
    ジャーナル フリー

    Patients with varicose veins of the lower extremities with osteoarthritis of the knee often experience improvement in knee joint symptoms after endovascular treatment. We considered that it was important to decide the operation indication of lower extremity varices, to know the correlation between the two diseases in the treatment of varicose veins. To investigate the postoperative improvement of knee symptoms related to varicose veins with knee osteoarthritis, we conducted a questionnaire survey for a total of 12 months, from December 2014 to May 2015 and from October 2018 to March 2019. The participants were 35 patients (7 men and 28 women) with varicose veins complicated with knee osteoarthritis. We classified knee osteoarthritis according to a grading scale and compared the improvement of knee symptoms after endovenous thermal ablation. The higher the knee grade, the lower the degree of improvement. However, the improvement was observed in all knee osteoarthritis grades, and as a whole, 25 patients (71.4%) have experienced improvement of subjective symptoms. For patients with knee osteoarthritis, we strongly recommend surgical treatment of the varicose veins regardless of the progression of knee grade. (This is a translation of Jpn J Phlebol 2019; 30(3): 279–283.)

  • Hitoshi Kusagawa, Yasuhisa Ozu, Kentaro Inoue, Takuya Komada, Yoshihik ...
    2021 年 14 巻 2 号 p. 112-117
    発行日: 2021/06/25
    公開日: 2021/06/25
    [早期公開] 公開日: 2021/05/08
    ジャーナル フリー

    Background: As a standard treatment for the varicose vein of the great saphenous vein (GSV) type, endovenous ablation (EVA) is the main approach. However, as a background to this, in Europe and the United States, neovascularization (Neo) following high ligation (HL) of the saphenofemoral junction (SFJ) at the time of GSV stripping has been emphasized as one of the reasons for the high rate of recurrence. However, in Japan, almost no similar mid- or long-term results of GSV stripping have been reported.

    Patients and Methods: From September 2011 to March 2014 when EVA was not my surgical option, 413 consecutive legs of patients underwent GSV stripping by myself using the same procedure. The patients were contacted by phone 5 years later, and recurrent varices after surgery (REVAS) and reoperation (REDO) were investigated. A total of 270 legs of the 391 living cases (69%) underwent venous ultrasonography (VUS). HL of the SFJ was performed via central flash ligation with towing and pulling out of the peripheral side branches containing the accessory saphenous veins. In principle, GSV stripping was performed using the invagination method in the range of the entire reflux region from the HL cut section to the confluent section of the side branch causing branch varicose veins. The range of stripping was to the upper thigh in 3 legs, to the middle thigh in 3 legs, to the lower thigh in 7 legs, to the knee in 46 legs, to the upper calve in 83 legs, to the middle calve in 52 legs, and over the full length in 76 legs. Stab avulsion was performed as much as possible for the side-branch varices. On VUS, the SFJ’s stump of GSV, the presence of side-branch remnants and their reflux, the presence or absence of Neo, and the recurrent lesions in other sites were evaluated. REVAS were classified as follows: Level 1, symptomatic recurrent lesion for which surgery is indicated; Level 2, asymptomatic recurrent lesion possibly requiring future surgery; and Level 3, asymptomatic recurrent lesion that is unlikely to require future surgery.

    Results: Of the 391 legs of patients who could be contacted, REDO was performed in 23 (6%), including 15 limbs, immediately after this investigation, and symptomatic REVAS were observed in 29 (7%). In 270 legs examined by VUS, REVAS were diagnosed as follows: 29 legs with Level 1 lesion, 40 legs with Level 2 lesion, and 27 legs with Level 3 lesion. Level 1 REVAS that occurred at the SFJ were observed only in 3 legs (1.1%), Level 1 REVAS due to incompetent perforating veins (IPVs) were observed in 14 legs (5%), and Level 1 solitary tributary varices were observed in 9 legs (3%).

    Conclusion: In this study, REVAS at the SFJ were significantly less than those in the past reports. It has been shown that REVAS due to IPVs or solitary tributary varices were more important than those at the SFJ. (This is a translation of Jpn J Phlebol 2019; 30(3): 259–265.)

Original Article
  • Zia Ur Rehman
    2021 年 14 巻 2 号 p. 118-121
    発行日: 2021/06/25
    公開日: 2021/06/25
    [早期公開] 公開日: 2021/04/08
    ジャーナル フリー

    Objective: To measure the pattern and severity of chronic venous insufficiency (CVI) in patients presenting to a vascular surgery clinic in Pakistan.

    Materials and Methods: This cross-sectional study has examined patients presenting with CVI for the first time. Patients were assessed for severity of the disease using clinical, etiological, anatomical and pathological (CEAP) score and venous clinical severity score (VCSS). Patients were then divided into two groups depending on the severity of the disease: ‘mild/moderate’ CVI if the CEAP classification was ≤C3 or VCSS was <5 and ‘severe’ if CEAP classification was >3 or VCSS was ≥5. Both groups were then compared to determine the factors associated with the more ‘severe’ form of CVI.

    Results: During the study duration, 121 patients presented with CVI with mean age of 47.83±12.02 years; 74 (61.2%) were female. Mean body mass index of the patients was 32.49±18.3 kg/m2. Mean VCSS was 5.49±3.84, indicating most patients presented with the severe form of CVI. Field workers were determined to be three to five times more likely to present with severe CVI compared to housewives and office workers.

    Conclusion: Majority of the patients who presented to a tertiary care facility had the severe form of CVI. Thus, there is a need to raise awareness on this disease at community level.

  • Shinsuke Mii, Atsushi Guntani, Ryosuke Yoshiga, Takuya Matsumoto, Eisu ...
    2021 年 14 巻 2 号 p. 122-131
    発行日: 2021/06/25
    公開日: 2021/06/25
    [早期公開] 公開日: 2021/05/18
    ジャーナル フリー

    Objective: To investigate the optimal duration of compression therapy after endovenous laser ablation (EVLA) using a 1470-nm diode dual-ring radial laser fiber for great saphenous vein (GSV) insufficiency.

    Methods: Patients undergoing EVLA of GSV for varicose vein disease were divided into two groups based on the duration of subsequent compression after the procedure: short duration group (S group; 0–2 days) and long duration group (L group; 1–4 weeks). Patient-reported outcomes (pain and quality of life [QOL]) were set as the primary outcomes, and objective findings (venous clinical severity score [VCSS], leg circumference, and duplex ultrasound [DUS] findings) were set as the secondary outcomes. A follow-up examination was performed at 1 week and 1 and 6 months. Each variable between the groups was compared after a propensity score matching using the age, sex, Clinical–Etiological–Anatomical–Pathophysiological (CEAP) clinical class, job type, and target variable as covariates. A per-protocol analysis was performed.

    Results: The S and L groups included 98 and 99 patients, respectively. A propensity score matching analysis showed no significant differences between the groups in any outcomes at any follow-up intervals.

    Conclusion: Long-term compression showed little benefit; therefore, the prescription of compression stocking beyond 2 days after EVLA is unnecessary.

  • Shobhit Sharma, Sudipta Bera, Vikas Deep Goyal, Vivek Gupta, Navneeta ...
    2021 年 14 巻 2 号 p. 132-138
    発行日: 2021/06/25
    公開日: 2021/06/25
    [早期公開] 公開日: 2021/04/08
    ジャーナル フリー

    Objectives: As per standard guidelines, the recommended order of arteriovenous fistula (AVF) creation for hemodialysis (HD) access is radiocephalic (RC), followed by proximal elbow fistulas and arteriovenous graft. Although ulnar-basilic (UB) fistula has been an alternative to RC-AVF, still this procedure searches clear recommendations. We present here our experience on UB-AVF as the preferred “second procedure” instead of proximal fistula after the RC-AVF.

    Methods: Forty-two UB-AVF were created in nonfeasible and failed RC-AVF cases between 2016 and 2018. They were reviewed retrospectively and outcomes were compared with 480 RC-AVF constructed within the same period.

    Results: The primary patency at 18 months was 73.8%, 69.6% and mean maturation time was 33.7±6.6 days, 32.1±4.7 days for UB-AVF and RC-AVF respectively (p>0.05).

    Conclusion: Our altered order of preference enabled us to create all the first-time fistula in the distal forearm, providing all the advantages of distal fistula like RC-AVF and avoiding proximal fistula, improved patient convenience and short-term benefit. In an inference that may be used for references and needs support from a larger sample and longer duration study from other centers, UB-AVF may be considered as the second option after RC-AVF depending on the clinical scenario.

  • Yukihisa Ogawa, Hiroshi Nishimaki, Kiyoshi Chiba, Tomotaka Iraha, Taka ...
    2021 年 14 巻 2 号 p. 139-145
    発行日: 2021/06/25
    公開日: 2021/06/25
    [早期公開] 公開日: 2021/06/04
    ジャーナル フリー

    Objective: To describe the clinical utility and technical aspects of the candy-plug technique using an Excluder aortic extender (Ex-cuff) for false lumen (FL) occlusion in chronic aortic dissection.

    Materials and Methods: This is a retrospective study analyzing seven consecutive patients (mean age, 63 years; range, 44–78 years; 6 men) with aneurysmal dilatation or rupture in chronic aortic dissection. All patients had undergone thoracic endovascular aortic repair with FL occlusion using this technique. We assessed technical (deployment accuracy) and clinical (no FL backflow on the latest contrast-enhanced computed tomography) success.

    Results: Technical success was obtained in six patients (86%). Technical failure was caused by the malposition of the candy-plug. The mean follow-up period was 593 days (range, 222–1225 days). Clinical success was obtained in four (57%), and incomplete Amplatzer Vascular Plug (AVP) embolization was seen in two. There was no enlarged FL after the procedure, and all patients are alive during the follow-up periods.

    Conclusion: The candy-plug technique using an Ex-cuff may be a feasible option; however, it takes time to achieve complete AVP embolization. Therefore, using additional embolic materials should be considered when we use it for the rupture case. (This is a translation of Jpn J Endovasc Interv 2018; 19: 29–35.)

  • Nobuhiro Hara, Tetsumin Lee, Kentaro Mitsui, Masashi Nagase, Shinichir ...
    2021 年 14 巻 2 号 p. 146-152
    発行日: 2021/06/25
    公開日: 2021/06/25
    [早期公開] 公開日: 2021/05/21
    ジャーナル フリー

    Objectives: To examine the outcomes of anticoagulant therapy for patients with venous thromboembolism (VTE) with active cancer and the outcomes after cancer remission with and without anticoagulant therapy.

    Materials and Methods: Of the 338 patients with cancer-associated VTE who received anticoagulant therapy, we evaluated therapeutic outcomes over 1 year for 112 patients whose cancers were in remission (cancer remission group) and 226 patients who continued cancer treatment (continued cancer treatment group). Further, the cancer remission group was divided into 89 and 23 patients who completed (completion of anticoagulation group) and continued (continued anticoagulation group) anticoagulant therapy, respectively. Treatment outcomes after completing anticoagulant therapy were compared between these two groups. The follow-up period was 1 year, and the endpoints were all-cause death, VTE recurrence, and bleeding events.

    Results: The event-free survival rates were 99.1% and 42.9% in the cancer remission and continued cancer treatment groups, respectively. For treatment outcomes after the completion of anticoagulant therapy, the event-free survival rates were 98.9% and 87% in the completion of anticoagulation and continued anticoagulation groups, respectively (log rank, P=0.005).

    Conclusion: When cancer is in remission, recurrence is low even if anticoagulant therapy is terminated after a certain period.

  • Ryuta Seguchi, Ryuta Kiuchi, Takafumi Horikawa, Tatsuya Tarui, Junichi ...
    2021 年 14 巻 2 号 p. 153-158
    発行日: 2021/06/25
    公開日: 2021/06/25
    [早期公開] 公開日: 2021/06/04
    ジャーナル フリー

    Objective: Zone 0 thoracic endovascular aortic repair (TEVAR) is associated with a high incidence of cerebral infarction mostly due to the embolic shower of a plaque from the aortic arch when the stent graft brushes against the aortic wall. Thus, it is important to develop a method for protecting the brain from such embolism. We report the outcomes of Zone 0 TEVAR with a novel brain protection method using selective cerebral perfusion under extracorporeal membrane oxygenation (ECMO).

    Materials and Methods: Two T-shaped grafts with ringed expanded polytetrafluoroethylene (ePTFE) were created using an 8-mm-ringed ePTFE anastomosed end-to-side with a 7-mm-ringed ePTFE. Carotid–carotid bypass and axillo-axillary bypass were established using these grafts. ECMO was connected to the grafts and the femoral vein. Bilateral carotid and axillary arteries were blocked, and cerebral perfusion was selectively maintained using ECMO. Total endovascular Zone 0 TEVAR was performed. The patency of brachiocephalic artery was maintained using the chimney or in situ fenestration technique.

    Results: Since August 2016, seven patients with aortic arch aneurysms underwent the procedure. The mortality rate was 0%. No neurological complications developed.

    Conclusion: This brain protection method using selective cerebral perfusion under ECMO is a safe method for Zone 0 TEVAR.

Case Report
Annual Report
  • The Japanese Society for Vascular Surgery JCLIMB Committee
    2021 年 14 巻 2 号 p. 202-230
    発行日: 2021/06/25
    公開日: 2021/06/25
    [早期公開] 公開日: 2021/06/14
    ジャーナル フリー

    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 patients with CLI to contribute to the improvement of the quality of medical care. This database, called JAPAN CLI Database (JCLIMB), is created on the National Clinical Database 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 the JCLIMB, together with those treated by surgery and/or endovascular treatment. In 2018, 1,145 CLI limbs (male 758 limbs, 66%) were registered by 90 facilities. Arteriosclerosis obliterans has accounted for 97% of the pathogenesis of these limbs. In this manuscript, the background data, ischemic status, treatment, and the early prognosis (within 1 month) of the registered limbs are reported. (This is a translation of Jpn J Vasc Surg 2020; 29: 365–393.)

feedback
Top