Objective: The aim of this study is to investigate the positive association between the presence of renal cysts and AAA. Patients and Methods: A retrospective chart review on the clinical data of 396 consecutive patients, who underwent CT scans for preoperative evaluation of thoracic and cardiovascular surgery in Sapporo Medical University from the period of January 2007 to December 2008, was conducted. Results: When comparing patients with renal cysts (n = 164) to those without (n = 233), there was a statistically significant difference between the presence of renal cysts and male gender (p = 0.007), hypertension (p = 0.003), and AAA (p < 0.001) on univariate analysis. In addition, when comparing patients with AAA to those without, although COPD but not AAA was associated with renal cysts in less than 65 years old, the presence of renal cysts was the strongest association with AAA among patients belonging to the 65 to 74 years old group and over 75 years old group on multivariate analysis. Conclusions: There is a statistically higher incidence of renal cysts in patients with AAA compared to patients without AAA in the group of elder cardiovascular patients. It is likely that AAA and renal cysts share a common pathogenesis.
Objective: To examine the expression patterns and roles of voltage-dependent Ca2+ channels in bone marrow stromal cells (BMSCs). Materials and Methods: Ca2+ currents of BMSCs were measured by the whole-cell patch clamp method. The number and percentage of deaths of BMSCs cultured for 14 days with or without Ca2+ channel blockers were evaluated using a MTT assay and an LDH assay, respectively. Results: T-type Ca2+ channel current was recorded in 0, 2, 10, and 4% of BMSCs on days 3, 10, 17, and 24 in culture, respectively. L-type Ca2+ channel current was first recorded on day 24 in 6% of BMSCs. Addition of the T-type Ca2+ channel blocker mibefradil but not the L-type Ca2+ channel blocker nifedipine significantly increased the cell count. Immunocytochemical analysis revealed increases in the counts of smooth muscle progenitor cells (SMPCs) and endothelial progenitor cells (EPCs). Mibefradil but not nifedipine significantly decreased the rate of cell death. Conclusion: T-type Ca2+ channel blockers increased the numbers of SMPCs and EPCs in cultured BMSCs, partly through suppression of cell death. Thus, T-type Ca2+ channel blockers may have the potential to provide an increased number of both BMSC-derived SMCs and ECs of potential use in cell and gene therapy.
Objective: For the early diagnosis and therapy of peripheral thromboembolism (TE) as a complication of abdominal aortic repair (AAR), we developed and evaluated the usefulness of surgical drapes that permit observation of the lower extremities during AAR. Materials and Methods: Between January 2007 and June 2009, the handling, durability, and usefulness of new surgical drapes were evaluated during AAR in 157 patients with abdominal aortic aneurysms and 9 patients with peripheral arterial disease. The drapes are manufactured by Hogy Medical Co. Ltd. and made of a water-repellent, spun lace, non-woven fabric, including a transparent polyethylene film that covers the patients’ legs. This transparent film enables inspection and palpation of the lower extremities during surgery for early diagnosis and therapy of peripheral TE. Results: As a peripheral complication, 1 patient had right lower extremity TE. This was diagnosed immediately after anastomosis, thrombectomy was performed, and the remaining clinical course was uneventful. In all patients, the drapes permitted observation of the lower extremities , and the dorsal arteries were palpable. There were no problems with durability. Conclusions: New surgical drapes permit observation of the lower extremities during AAR for early diagnosis and treatment of peripheral TE.
Gut barrier failure and the resultant translocation of luminal bacteria and bacterial products into the systemic circulation have been proposed as pathogenic mechanisms of multiorgan dysfunction syndrome (MODS) in open repair of abdominal aortic aneurysm (AAA). Our study aimed to demonstrate the direct release of gut-derived inflammatory mediators via the trans-serosal route in humans. Fifteen patients who underwent elective infrarenal open repair of AAA were randomized into two groups. In Group I patients (n = 10), the small intestine was exteriorized into a bowel bag. In Group II patients (n = 5), the small intestine was packed within the peritoneal cavity using large gauzes. We collected the bowel bag fluid in Group I and the ascites fluid, squeezed out from the gauzes at the end of surgery, in Group II. Leukocytes were collected from patients’ blood samples. Incubation with the bowel bag fluid and ascites fluid caused a significant increase in both granulocyte pseudopod formation and CD11b expression compared to that with control fluid (p < 0.01). The addition of phospholipase A2 (PLA2) inhibitor quinacrine abolished leukocyte activation by the bowel bag fluid. Based on these results, we consider that trasns-serosal leakage of gut-derived mediators occurred during the open repair of AAA; further, sPLA2 may be the most potent mediator in the activation of leukocytes among such gut-derived mediators in AAA surgery.
Popliteal artery entrapment (PAE) is an uncommon syndrome. Although this phenomenon can cause claudication in younger populations, other clinical features may vary. The present report describes a case of a 48-year-old woman who was referred for treatment of a pulsatile mass in the right popliteal fossa. Computed tomography scan and magnetic resonance imaging demonstrated popliteal aneurysm associated with PAE. Resection of abnormal musculotendinous structures, aneurysmectomy and subsequent revascularization were successfully performed. Although PAE may lead to poststenotic dilatation and aneurysm formation, huge aneurysm without clinical signs of ischemia in a patient with PAE is extremely rare.
The Angio-Seal arterial closure device consists of several bioabsorbable components and is used for hemostasis of arterial puncture sites. We report 3 cases of hemorrhagic and ischemic complications related to Angio-Seal use. Two cases were treated successfully by surgical removal of the device. In the third case surgical removal of the device failed and additional intervention was necessary. The unique structure of the Angio-Seal and the most likely cause of failure should be considered when treating device-related complications.
Disseminated intravascular coagulation (DIC) is an extremely rare complication of acute thrombosis in popliteal aneurysms and makes it difficult to restore the blood flow with thrombolytic therapy or surgical repair. A 75-year-old man with a history of hypertension presented to the emergency department with complaints of right leg pain and bleeding tendency over a 5-day period. The laboratory findings and multislice computed tomography were suggestive of overt DIC caused by acute thrombosis in the right popliteal aneurysm. Successfully treated with medication, he could discharge without surgical or thrombolytic recanalization of the aneurysm.
Fibromuscular dysplasia (FMD), a disease process which leads to arterial stenosis and aneurysm formation, has been reported to occur in almost every arterial bed in the body. However, multivisceral FMD is rare, and we report a 43-year-old woman with hypertension who had incidental finding of FMD of both renal arteries and the superior mesenteric artery (SMA). The left renal aneurysms and right renal stenosis were successfully treated by aneurysm resection and aortorenal bypass and percutaneous transluminal angioplasty, respectively. The asymptomatic FMD of the SMA was treated conservatively. The indications for intervention in patients with asymptomatic FMD have not been clarified till date, and we therefore advise a close surveillance program.
Popliteal artery entrapment syndrome (PAES) is rare congenital anomaly that occurs due to compression of the popliteal artery by adjacent musculotendinous structures. We report a 54-year-old woman with PAES of total popliteal arterial occlusion was successfully treated by release of the muscle bundle and reconstruction of the popliteal artery. Pathologic examination revealed that the extracted portion of the popliteal artery had chronic total occlusion with fibrosis and destruction of internal elastic membrane. We should deliberate whether we reconstruct the popliteal artery in addition to release of the aberrant muscle bundle due to the preoperative examination to prevent the reoperation.
A 72 year-old man was referred to our hospital for treatment of a gradually expanding inferior mesenteric artery (IMA) aneurysm associated with an occluded superior mesenteric artery (SMA) and a severely stenosed celiac artery (CA). Using 64-slice computer tomography (CT), we were able to accurately define a precise collateral visceral circulation from the IMA to the SMA and the CA, greatly clarifying preoperative strategy. The aneurysm was subsequently removed, with revascularization of the SMA and the CA accomplished through grafts from the abdominal aorta using 6 mm polytetrafluoroethylene (PTFE) grafts.