Annals of Vascular Diseases
Online ISSN : 1881-6428
Print ISSN : 1881-641X
ISSN-L : 1881-641X
Volume 7 , Issue 1
Showing 1-18 articles out of 18 articles from the selected issue
Review Articles
  • Raffaele Pulli, Walter Dorigo, Azzurra Guidotti, Aaron Fargion, Alessa ...
    2014 Volume 7 Issue 1 Pages 7-10
    Published: 2014
    Released: March 26, 2014
    [Advance publication] Released: February 04, 2014
    JOURNALS FREE ACCESS
    The current worldwide trend in the treatment of peripheral arterial disease (PAD) is towards an increase in endovascular procedures either in the aorto-iliac area or in the infrainguinal district. However, the role of the open repair with a femoro-popliteal bypass is still debated and in our opinion there still a room for traditional surgery in the presence of complex lesions involving the superficial femoral artery and the popliteal and tibial vessels. In this field, vein bypass provides better results than prosthetic grafts, but in selected cases and not only in the absence of a suitable vein, new modified grafts may be used with satisfactory results. The choice between the two options, open and endovascular, that in some cases can be associated in hybrid procedures, depends on several factors. Only if we are able to take into account all the different preoperative issues, we could choose the right procedure in the right patient.
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  • Frederic Baumann, Ernst Groechenig, Nicolas Diehm
    2014 Volume 7 Issue 1 Pages 11-16
    Published: 2014
    Released: March 26, 2014
    [Advance publication] Released: March 15, 2014
    JOURNALS FREE ACCESS
    Restenosis is the major drawback in patients undergoing tibial angioplasty. In contrast to earlier observations, tibial patency was shown to impact on clinical outcomes in current randomized trials and is thus attributed more importance. Accordingly, intentions to reduce tibial restenosis have been intensified. Both drug-eluting balloons (DEB) and drug-eluting stents (DES) were shown to reduce tibial restenosis when compared with its plain counterparts. However, both endovascular technologies have its limitations for tibial arterial application. While DEB technology may not address elastic recoil, a pathophysiological mechanism frequently observed in tibial arteries and a significant contributor to restenosis, currently available DES do not fully address tibial arterial lesion morphology. Purpose of the present manuscript is to outline the problem and the incidence of tibial arterial restenosis, its importance on clinical outcomes and to provide an overview on technical developments aimed at its prevention.
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Original Articles
  • Naoki Hayashida, Masahisa Masuda, Yoko Pearce, Satoshi Kuwabara
    2014 Volume 7 Issue 1 Pages 17-20
    Published: 2014
    Released: March 26, 2014
    [Advance publication] Released: February 04, 2014
    JOURNALS FREE ACCESS
    Objective: To evaluate the incidence of wound complications after the retroperitoneal approach for abdominal aortic aneurysm (AAA) repair, and to ascertain the cause of abdominal bulge (AB).Subjects and Methods: Forty-three patients with AAA repair via the retroperitoneal space were retrospectively investigated. Wound complications and their incidence were studied by chart review. The thickness of the abdominal wall muscle was measured by follow-up computed tomography films. Compound muscle action potentials (CMAPs) of the abdominal rectus muscle were examined for three bulge patients and three non-bulge patients.Results: Wound hypoesthesia (30%), wound numbness (21%), AB (7%), and wound pain (2%) were found in these patients. The thickness of the abdominal wall muscle was reduced in the incision side. CMAP of abdominal rectus muscle in the incision side disappeared only in AB patients.Conclusions: (1) Wound hypoesthesia and numbness displayed a high incidence. (2) Atrophy of the abdominal wall muscle in the incision side was found in these patients. (3) The cause of AB is considered to be muscle atrophy induced by denervation injury of an 11th intercostal nerve. (4) To avoid an eleventh intercostal nerve injury must be deemed the most effective method for preventing AB.
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  • Kotaro Suehiro, Noriyasu Morikage, Masanori Murakami, Osamu Yamashita, ...
    2014 Volume 7 Issue 1 Pages 21-27
    Published: 2014
    Released: March 26, 2014
    [Advance publication] Released: February 04, 2014
    JOURNALS FREE ACCESS
    Objectives: To elucidate the differences in subcutaneous ultrasound findings between dependent edema (DE) and secondary lower extremity lymphedema (LE).Materials and Methods: Twenty legs in 10 patients with DE and 54 legs in 35 patients with LE, who first visited our clinic between April 2009 and December 2012, were studied retrospectively. Subcutaneous echogenicity and echo-free space (EFS) were assessed at 8 points on the thigh and leg using an 8–12 MHz ultrasound transducer.Results: In DE, echogenicity was increased most in the lower leg, without a difference between the medial and lateral side. The EFS was most remarkable in the lower leg, and the lateral side was more severe. In the early stages of LE, echogenicity was similarly increased in the medial thigh and in the leg, while remarkable EFS was observed only in the lower leg. As clinical severity progressed, echogenicity increased in all parts of the lower extremity. EFS also increased in all parts of the leg, but the lower leg was still the most severe.Conclusion: Echogenicity seemed to progress differently in DE and LE, but EFS progressed similarly and according to gravity. The current ultrasound findings may have added some diagnostic value in differentiating these conditions.
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  • Kimihiro Igari, Norihide Sugano, Toshifumi Kudo, Takahiro Toyofuku, Ma ...
    2014 Volume 7 Issue 1 Pages 28-33
    Published: 2014
    Released: March 26, 2014
    [Advance publication] Released: February 04, 2014
    JOURNALS FREE ACCESS
    Objective: To evaluate the long-term outcomes of surgical treatment for popliteal artery entrapment syndrome (PAES).Materials and Methods: This study was undertaken from a retrospective review of case notes of patients treated for PAES between August 1974 and July 2013. We examined patients’ characteristics and surgical procedures, and evaluated long-term outcomes including clinical symptoms and graft or native artery patency.Results: Twenty-nine limbs (24 patients, mean age: 32 years) underwent surgery. Popliteal arteries were occluded (n = 18) stenosed (n = 7) and normal (n = 4). Twenty-five limbs required both revasularization (interposition [n = 24] and bypass surgery [n = 1]) and myotomy. Four limbs were treated solely with myotomy. During the long-term follow-up period, three limbs required reoperation. The overall primary graft and native popliteal artery patency rates at one and 5 years were 96.3% and 91.9%, respectively.Conclusion: The treatment of PAES with myotomy and selective revascularization achieves good short- and long-term outcomes. The use of an interposition vein graft reconstruction is associated with minimal morbidity and good long-term patency.
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  • Katsuyuki Hoshina, Takuya Hashimoto, Masaaki Kato, Nobukazu Ohkubo, Ku ...
    2014 Volume 7 Issue 1 Pages 34-39
    Published: 2014
    Released: March 26, 2014
    [Advance publication] Released: February 28, 2014
    JOURNALS FREE ACCESS
    Introduction: We retrospectively analyzed outcomes of patients who had undergone endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) more than 3 years previously in a single institution. We compared outcomes between patients who underwent EVAR within and outside of the devices’ instructions for use (IFU) and examined mid-term morphological changes in AAA.Methods: A total of 275 patients who underwent EVAR for AAA were selected. IFU parameters included aneurysmal neck length, angulation and presence of massive atheroma. Patients were divided into 2 groups: the Within IFU group (W-IFU: n = 193) and the Outside of IFU group (O-IFU: n = 82).Results: Patients in the O-IFU group were older and had a larger AAA diameter. Other comorbid factors were similar between the 2 groups. There was no difference in overall survival rates and reintervention rates between the 2 groups. The most common cause for reintervention was AAA enlargement 3 years after EVAR. Irrespective of the IFU, mid-term morphological changes, including neck angulation, neck diameter, sac re-expansion, and Palmaz stent displacement, were found.Conclusion: Outcomes of EVAR were considered acceptable in the O-IFU group. Careful follow-up is necessary considering the morphological changes in AAAs after EVAR.
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  • Surajit Awsakulsutthi, Kwanjit Punpho, Jinpitcha Mamom, Pairat Baikrut ...
    2014 Volume 7 Issue 1 Pages 40-45
    Published: 2014
    Released: March 26, 2014
    [Advance publication] Released: February 28, 2014
    JOURNALS FREE ACCESS
    Background: Chronic diabetic foot ulcer has a high rate of healing failure. Beraprost sodium, oral form of prostaglandin I2 analogue, maybe used for increasing wound healing.Objective: To compare the healing rate of chronic diabetic foot ulcer between Beraprost sodium and control groups.Design: A single blind randomized trial.Materials and Methods: Fifty non-healed chronic diabetic foot ulcer patients were randomized to be the study and control groups. Beraprost sodium was prescribed in the study group according to protocol.Results: At 6th week follow up, median wound healing rate in the study group was significantly higher than in the control group with the rate of 88.1% and 33.3%, respectively. Complete wound healing in the study group was also significantly higher than in the control group (48%:8%). In the study group, 9 patients (37.5%) could be administered with recommended dose. Side effects were headache in 14 patients (58.3%) and palpitation in one patient (4.2%). One patient was discontinued for severe headache.Conclusions: The use of Beraprost sodium in chronic diabetic foot ulcer patients significantly increases the wound healing rate. Headache was the common side effect.
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  • Kimihiro Igari, Toshifumi Kudo, Hidetoshi Uchiyama, Takahiro Toyofuku, ...
    2014 Volume 7 Issue 1 Pages 46-51
    Published: 2014
    Released: March 26, 2014
    [Advance publication] Released: February 28, 2014
    JOURNALS FREE ACCESS
    Objectives: This study was evaluating the outcomes of endovascular aneurysm repair (EVAR) using the endowedge technique (EnT) and/or snorkel technique (SnT) for abdominal aortic aneurysms (AAAs).Materials and Methods: The patients treated with EnT and/or SnT were retrospectively reviewed between January 2010 and June 2013. All patients underwent EVAR under general anesthesia. Bilateral femoral arterial access was obtained through bilateral femoral cut-down to place the stent graft mainbody, and brachial arterial access was obtained percutaneously to perform the EnT and/or SnT.Results: Three patients were treated with unilateral EnT, 1 with unilateral SnT, two with bilateral SnT, and two with combined EnT/SnT. A total of 12 renal arteries was attempted to preserve, and could be successfully performed by these techniques in 11 renal arteries. After complete deployment of the endograft, intraoperative angiography showed no type Ia EL. During the median follow-up of 11 months (range: 2–22 months), no deaths nor aneurysm enlargement occurred, and all treated renal arteries were patent without further intervention.Conclusions: Our findings suggest that the management of AAAs by EVAR with EnT and/or SnT could achieve an adequate proximal seal, and preserve renal artery perfusion in patients with unfavorable neck anatomy.
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  • Nuttawut Sermsathanasawadi, Kiattisak Hongku, Chumpol Wongwanit, Chane ...
    2014 Volume 7 Issue 1 Pages 52-55
    Published: 2014
    Released: March 26, 2014
    [Advance publication] Released: March 15, 2014
    JOURNALS FREE ACCESS
    Introduction: Klippel-Trenaunay syndrome is composed of port-wine stain, limb hypertrophy and varicose veins.Methods: The two patients with Klippel-Trenaunay syndrome treated by endovenous radiofrequency thermal ablation and ultrasound-guided foam sclerotherapy of the abnormal veins was conducted.Results: Radiofrequency thermal ablation resulted in successful occlusion of the incompetent anterior accessory great saphenous vein. Moreover, ultrasound-guided foam sclerotherapy showed complete occlusion of the residual veins. At 6 month follow-up, both patients markedly decreased leg symptoms including pain, cramping, limb swelling, and bulging of veins.Conclusion: Radiofrequency thermal ablation combined with foam sclerotherapy is a minimally invasive procedure alternative to the standard invasive surgery and can be the option for saphenous ablation in Klippel-Trenaunay syndrome patients.
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Case Reports
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