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19件中1~19を表示しています
Review Article
Educational Seminar of the Japanese Society for Vascular Surgery
  • Hiroyoshi Komai
    2024 年 17 巻 2 号 p. 109-113
    発行日: 2024年
    公開日: 2024/06/25
    [早期公開] 公開日: 2024/03/13
    ジャーナル オープンアクセス

    The most important vascular lesion associated with diabetes is arteriosclerosis obliterans (ASO). Differential diagnosis from diabetic foot lesions that produce neurogenic ulcers is important, and the presence of ischemia must be diagnosed as soon as possible. It has been reported that diabetes makes ASO more severe and often leads to lower extremity amputation. In addition to the need for appropriate early control of diabetes, vascular surgeons are required to perform immediate revascularization in cases of ulcer and necrosis, and to aggressively use surgical treatment with good long-term prognosis. (This is a translation of Jpn J Vasc Surg 2023; 32: 105–109.)

  • Shinya Kitayama
    2024 年 17 巻 2 号 p. 114-119
    発行日: 2024年
    公開日: 2024/06/25
    [早期公開] 公開日: 2024/03/13
    ジャーナル オープンアクセス

    Lymphedema is caused by dysfunction of the lymphatic system. It is divided into primary edema with no apparent cause and secondary edema with an exogenous cause. The main symptoms are edema and heaviness, skin changes such as skin hardening, lymphocysts, lymphorrhoea, papillomas, and recurrent cellulitis. They are often irreversible and progressive, thus greatly reducing quality of life of the patients. Diagnosis is made by image examinations that can evaluate lymphatic flow and functions such as lymphoscintigraphy and indocyanine green fluorescence lymphangiography. Linear pattern and dermal backflow are the main findings. Conservative treatment consists of four components: compression therapy with elastic garments, exercise therapy, manual lymphatic drainage, and skin care, which is called complex physical therapy (CPT). Although CPT has become the gold standard of treatment, with evidence of efficacy reported in terms of volume reduction, maintenance, and prevention of cellulitis, it is a symptomatic treatment and does not improve impaired lymphatic flow. On the other hand, surgical treatment, such as lymphaticovenous anastomosis and vascularized lymph node transplantation, can create new lymphatic flow and improve lymphatic dysfunctions. Although these techniques are expected to be effective in volume reduction, cellulitis prevention, and improving quality of life, there is a need for more studies with a higher level of evidence in the future. In Japan, lymphedema is treated with a combination of conservative and surgical therapies, but lymphedema is intractable and few cases are completely cured. Therefore, how to improve the outcome of treatment is an important issue to be addressed in the future. (This is a translation of Jpn J Vasc Surg 2023; 32: 141–146.)

  • Masaaki Kato
    2024 年 17 巻 2 号 p. 120-127
    発行日: 2024年
    公開日: 2024/06/25
    [早期公開] 公開日: 2024/03/26
    ジャーナル オープンアクセス

    The treatment strategy for acute and subacute Stanford type B aortic dissection has changed significantly since the advent of thoracic endovascular aortic repair (TEVAR). Indication for invasive treatment: In addition to the conventional complicated cases (rupture or malperfusion case), the indication for invasive treatment now includes cases with refractory hypertension, persistent or recurrent pain, large aortic diameter, and other conditions that are considered to have a poor prognosis with conservative treatment. Treatment methods: TEVAR is the first choice for acute, subacute, and early chronic-stage treatment, and when this is not possible, other techniques (fenestration and graft replacement) are chosen. Treatment timing: The timing of invasive treatment should be emergent in life-threatening conditions (for rupture or malperfusion case) and immediate in symptomatic cases, while in other cases, preemptive TEVAR is considered appropriate on a scheduled timing within 6 months of onset. (This is a translation of Jpn J Vasc Surg 2023; 32: 157–163.)

  • Hiroko Morisaki
    2024 年 17 巻 2 号 p. 128-134
    発行日: 2024年
    公開日: 2024/06/25
    [早期公開] 公開日: 2024/03/15
    ジャーナル オープンアクセス

    Hereditary aortic aneurysms and dissections, such as Marfan syndrome, differ in that they occur in younger patients without generally recognized risk factors, have a predilection for the thoracic rather than the abdominal aorta, and are at risk for dissection even at smaller aortic diameters. Early diagnosis, careful follow-up, and early intervention, such as medication to reduce aortic root growth and prophylactic aortic replacement to prevent fatal aortic dissection, are essential for a better prognosis. Molecular genetic testing is extremely useful for early diagnosis. However, in actual clinical practice, the question often arises as to when and to which patient genetic testing should be offered since the outcome of the tests can have important implications for the patient and the relatives. Pre- and post-test genetic counseling is essential for early intervention to be effective. (This article is a secondary translation of Jpn J Vasc Surg 2023; 32: 261–267.)

Original Article
  • Hisao Kumakura, Ryuichi Funada, Yae Matsuo, Toshiya Iwasaki, Kuniki Na ...
    2024 年 17 巻 2 号 p. 135-141
    発行日: 2024年
    公開日: 2024/06/25
    [早期公開] 公開日: 2024/03/08
    ジャーナル オープンアクセス

    Objectives: We examined the relationship between plasma eicosapentaenoic acid (EPA) level and long-term all-cause death (ACD) and cardiovascular or limb events in patients with peripheral arterial disease (PAD).

    Method: We performed a prospective cohort study on 637 PAD patients. The endpoints were ACD, major adverse cardiovascular events (MACEs), and lower extremity arterial events (LEAEs).

    Results: The incidences of ACD, MACEs, and LEAEs had correlation with EPA levels (p <0.05). Plasma EPA level had significant positive correlations with high-density lipoprotein cholesterol, triglyceride, and estimated glomerular filtration rate (eGFR), and negative correlation with C-reactive protein (CRP). In Cox stepwise multivariate analysis, lower EPA (hazard ratio [HR]: 0.996, 95% confidence interval [CI]: 0.993–1.000, p = 0.034), ankle brachial pressure index (ABI), body mass index, serum albumin, eGFR, age, CRP, D-dimer, critical limb ischemia, diabetes, cerebrovascular disease (CVD), and statin were related to ACD (p <0.05); lower EPA (HR: 0.997, 95% CI: 0.994–1.000, p = 0.038), ABI, serum albumin, eGFR, age, diabetes, coronary heart disease, CVD, and statin were related to MACEs (p <0.05); and lower EPA (HR: 0.988, 95% CI: 0.982–0.993, p <0.001), ABI, and low-density lipoprotein cholesterol were related to LEAEs (p <0.05).

    Conclusions: Low plasma EPA level was a significant risk factor for ACD, MACEs, and LEAEs in patients with PAD.

  • Satoshi Yamamoto, Takuya Hashimoto, Masaya Sano, Masaru Kimura, Osamu ...
    2024 年 17 巻 2 号 p. 142-149
    発行日: 2024年
    公開日: 2024/06/25
    [早期公開] 公開日: 2024/04/10
    ジャーナル オープンアクセス

    Objectives: The aim of this study was to evaluate the relationship between absolute lymphocyte count (ALC) and outcomes of infrainguinal bypass surgery for chronic limb-threatening ischemia (CLTI).

    Methods: From 2004 to 2020, 209 limbs of 189 patients who underwent infrainguinal bypass surgery for CLTI and whose ALCs were available were included. Patients with survival >2 years and limb salvage >2 years were considered discriminant groups, and an ALC cut-off value was calculated. The relationship between preoperative ALC and outcomes was evaluated.

    Results: Survivorship of the higher ALC group was significantly higher than that of the lower ALC group (cut-off value 1030/μL, p = 0.0009). The limb salvage rate of the higher ALC group was significantly higher than that of the lower ALC group (cut-off value 1260/μL, p = 0.0081). In the dialysis patient group (103 limbs), the limb salvage rate of the higher ALC group was significantly higher than that of the lower ALC group (cut-off value 1170/μL, p = 0.026). ALC was independently associated with limb loss in multivariate analysis.

    Conclusion: ALC is promising as a predictor of outcomes after bypass surgery in CLTI. In particular, ALC is expected to be useful for limb prognosis in hemodialysis patients.

  • Fukashi Serizawa, Yoshiyuki Nakano, Munetaka Hashimoto, Yoshihisa Tama ...
    2024 年 17 巻 2 号 p. 150-156
    発行日: 2024年
    公開日: 2024/06/25
    [早期公開] 公開日: 2024/04/10
    ジャーナル オープンアクセス

    Objectives: Distal bypass surgery’s effect on tissue blood pressure beyond a focal angiosome remains debated. This study assessed tissue blood pressure in both direct revascularized angiosome (DRA) and indirect revascularized angiosome (IRA) after bypass surgery, utilizing repeated skin perfusion pressure (SPP) measurements.

    Methods: Twenty-nine limbs in 27 chronic limb-threatening ischemia (CLTI) patients (22 males and five females, age: 70.2 ± 9.3 years) who received distal bypass surgery were enrolled. SPP measurements were conducted for the DRA and IRA at 10 time intervals, encompassing both preoperative and postoperative periods of every 3–5 days until 30 days.

    Results: In total, 486 SPP measurements were collected from 58 measurement sites, and the transition of the SPP at the DRA was 35.4–62.5–59.5–70.2–58.2–62.2–63.1–63.6–63.8–73.4 mmHg and IRA was 29.4–53.4–53.7–58.8–51.3–63.1–47.9–62.1–57.6–61.0 mmHg. No significant differences were observed between SPP at the DRA and IRA. Fifteen wounds on the DRA (63%) and five on the IRA (100%) healed.

    Conclusion: Distal bypass improves SPP in both direct and IRAs of CLTI patients. These data indicated distal bypass improves tissue blood flow at entire foot regardless of angiosomes.

  • Yasuharu Funamizu, Hitoshi Goto, Ayaka Oda, Takashi Miki, Yoshifumi Sa ...
    2024 年 17 巻 2 号 p. 157-163
    発行日: 2024年
    公開日: 2024/06/25
    [早期公開] 公開日: 2024/04/10
    ジャーナル オープンアクセス

    Objective: In patients with abdominal aortic aneurysm (AAA), early detection and optimal elective treatment before rupture are desirable. In the absence of an established public screening system, opportunistic screening during ultrasound examination for another purpose might be efficacious. The aim of this study was to evaluate the efficacy of opportunistic screening for AAA.

    Methods: This prospective multicenter observational study enrolled patients who were scheduled to undergo ultrasound for reasons other than AAA. After the ultrasound for the original purpose, evaluation of the abdominal aorta was added. If the abdominal aorta was clear enough for measurement, its diameter and shape were recorded. Furthermore, information on comorbidities was collected for each patient.

    Results: A total of 10325 patients (echocardiography: 6150; abdominal ultrasound: 4162) from 16 institutions were enrolled. The abdominal aorta was well visualized in 92.9% of patients who underwent echocardiography. Among 9791 patients, AAA was diagnosed in 122 (1.3%) (107 fusiform and 15 saccular), with a diameter range of 30–63 mm. The diagnostic rate increased with age. On multivariate analysis, older age, male sex, coronary artery disease, peripheral arterial disease, and smoking habituation were the risk factors for AAA.

    Conclusion: Opportunistic screening for AAA was efficacious.

  • Yasushi Shiraishi, Naomi Kinoto, Atsuko Miyoshi, Kyoko Ishii, Mika Oga ...
    2024 年 17 巻 2 号 p. 164-170
    発行日: 2024年
    公開日: 2024/06/25
    [早期公開] 公開日: 2024/04/18
    ジャーナル オープンアクセス

    Objectives: To assess the physical features and compression characteristics of a newly developed adjustable compression garment, McBoooon (Mc).

    Methods: Twelve healthy volunteers were recruited to assess the compression characteristics. The interface pressure (IP) was continuously measured to calculate the static (SSI) and dynamic stiffness indices (DSI). Additionally, the peak flow velocity (PV) of the popliteal vein during ankle dorsiflexion was measured using ultrasonography. Each parameter was compared between ASHIKA stockings (AS), Mc applied at the same resting pressure as AS (Mc1), and Mc applied at a resting pressure approximately twice that of Mc1 (Mc2).

    Results: SSI and DSI were significantly different, increasing in the order AS < Mc1 < Mc2 (p <0.01). Although the PV was significantly higher in the compression group than in the control group (p <0.05), no significant differences were found among the three groups.

    Conclusion: The physical features and compression characteristics of Mc were clarified. The high stiffness of this garment improves the adherence to compression therapy and contributes to the treatment of chronic venous insufficiency.

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