Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by pulmonary hypertension caused by nonresolving thromboemboli of the pulmonary artery. However, up to 40% of CTEPH patients have had no clinically apparent acute pulmonary embolic episodes. In addition, both a female predominance and an association of HLA with CTEPH unrelated to deep vein thrombosis are observed in Japan, thus suggesting this condition to be a type of pulmonary vasculopathy. The key for making an accurate diagnosis is to consider CTEPH in any patients with dyspnea on exertion. Perfusion scans provide an excellent noninvasive tool for distinguishing between pulmonary arterial hypertension (PAH) and CTEPH, while CT angiography is useful for differentiating arteritis, tumor, and a congenital anomaly of the pulmonary artery from CTEPH. Pulmonary angiography (PAG) is still considered the gold standard for evaluating CTEPH. No subpleural perfusion in any segments by PAG with high pulmonary vascular resistance is might be related to small vessel disease, thus resulting in a poor outcome after surgery. Recent data suggest a potential therapeutic benefit of antiproliferative therapy for cells isolated from endarterectomized tissue.
Objective: For new evidence of treatment with statins in Japanese hypercholesterolemic patients, we performed an open-label, randomized, parallel-group comparative study to assess the effect of rosuvastatin 2.5 mg and pravastatin 10 mg on plasma lipids. Methods: A total of 100 patients in whom the target control levels of LDL-cholesterol (LDL-C) set by the Japan Atherosclerosis Society Guidelines (JASGL2007) had not been achieved were randomly assigned to receive rosuvastatin 2.5 mg / day or pravastatin 10 mg / day for 8 weeks. The primary endpoint was the percent change of LDL-C at week 8. Results: LDL-C was lowered by -40.3% (from 160.3 to 95.1 mg / dL) in the rosuvastatin group and -22.9% (from 162.9 to 126.0 mg / dL) in the pravastatin group, at week 8 (P < 0.001 vs. pravastatin). LDL-C / HDL-C ratio was lowered by -41.3% (from 2.85 to 1.69) and -20.6% (from 2.81 to 2.24), respectively (P < 0.001 vs. pravastatin). The rate of achievement of the target LDL-C control level at week 8 was significantly higher in the rosuvastatin group (98.0%) than in the pravastain group (78.7%) (P = 0.003). Both drugs were well tolerated. Conclusion: Rosuvastatin 2.5 mg produced significantly greater reduction in LDL-C and beneficial effect on other lipid parameters than pravastatin 10 mg, and its safety profile is similar to pravastatin 10 mg.
Objective: For new evidence of aggressive lipid lowering treatment with statins in Japanese hypercholesterolemic patients, we performed an open-label, randomized, parallel-group comparative study to assess the effect of rosuvastatin 5 mg and atorvastatin 10 mg on plasma lipids. Methods: A total of 900 patients in whom the target control levels of LDL-cholesterol (LDL-C) set by the Japan Atherosclerosis Society Guidelines (JASGL2007) had not been achieved were randomly assigned to receive rosuvastatin 5 mg / day (n = 450) or atorvastatin 10 mg / day (n = 450) for 8 weeks. The primary endpoint was the percent change of LDL-C at week 8. Results: LDL-C was lowered by -44.5% (from 170.2 to 93.3 mg / dL) in the rosuvastatin group and -41.6% (from 169.5 to 97.9 mg / dL) in the atorvastatin group, at week 8 (P = 0.002 vs. atorvastatin). LDL-C / HDL-C ratio was lowered by -47.6% (from 3.01 to 1.56) and -43.5 % (from 2.96 to 1.66), respectively, at week 8 (P < 0.001 vs. atorvastatin). The changes in HDL-C, ApoB, ApoA-1, and ApoB / ApoA-1 ratio showed significant improvement in the rosuvastatin group than in the atorvastatin group. Adverse events were observed comparably between the rosuvastatin group (121 events) and the atorvastatin group (104 events). None of these events had adverse clinical consequence. Both drugs were well tolerated. Conclusion: Rosuvastatin 5 mg produced significantly greater reduction in LDL-C and beneficial effect on other lipid parameters than atorvastatin 10 mg, and was also well tolerated.
We report a case of atypical aortic coarctation with severe calcification of the proximal aorta treated by a new extra-anatomical bypass. This 58-year-old woman with coarctation of the infrarenal aorta had thick circular calcifications of the thoracic aorta and stenosis of the subclavian arteries. To control the progressive claudication, we performed a bypass with an externally supported PTFE graft 6mm in diameter between the right renal artery and the right common iliac artery. Postoperative ankle pressure rose to 84 mmHg (right) and 89 mmHg (left) from zero, and she could walk without pain. Renal function was preserved. Using the proximal anastomosis from the non-diseased aortic branch to avoid the calcified aorta, reno-iliac arterial bypass is a useful alternative for control of ischemic lower limbs.
The predisposing condition of deep vein thrombosis (DVT) is venous stasis or hypercoagulable state. Impaired venous blood flow caused by extrinsic compression is relatively rare situation. Only 3 cases of deep vein thrombosis due to osteochondroma have previously been reported in English literature. We report a case of a 21-year-old man, who presented with left lower leg pain and swelling due to extrinsic compression of femoral vein by an osteochondroma. In the case of vascular complications due to an osteochondroma, prompt surgical intervention should be made to avoid irreversible vein wall damages.
Acute pulmonary embolism following varicose vein surgery is reported in a patient receiving hormonal replacement therapy. A 45-year-old woman underwent partial stripping of the greater saphenous vein of her bilateral legs and division of the lesser saphenous vein of her left legs under spinal anesthesia. On the first postoperative day, she complained of severe chest discomfort and collapsed suddenly while walking to the toilet. Emergency spiral computed tomography and perfusion scintigraphy demonstrated multiple defects in the bilateral lower lobes. She recovered after aggressive anticoagulant therapy. Although acute pulmonary embolism occurs only rarely after varicose vein surgery, it is important to remember its possibility especially when a patient has known risk factors predisposing venous thromboembolism, such as hormone replacement therapy.
We describe the first Marfan syndrome case of non-traumatic bilateral radial artery aneurysms in the anatomical snuff box. A 74-year-old woman with Marfan syndrome had a pulsatile mass in her bilateral anatomical snuff box. The color Doppler ultrasonography showed an aneurysm of radial artery located in the bilateral anatomical snuff box. Resection of the right radial artery aneurysm was completed without complications. Histopathological analysis showed a true aneurysm with atherosclerotic changes in the arterial wall. We review the literature on non-traumatic or bilateral radial artery aneurysm in the anatomical snuff box, and discuss the clinical presentation and surgical management.
Emergency conventional surgical repair of the descending thoracic aorta remains a therapeutic challenge and is associated with a high risk of mortality. We describe a case of ruptured descending thoracic aortic aneurysm in an 87-year-old man who presented with chest and back pain. The patient underwent successful endovascular repair of the lesion with the use of Gore TAG thoracic endoprosthesis. Post-procedure computed tomography showed complete exclusion of the aneurysm without endoleaks. Endovascular repair is feasible and can be effective in such cases.