Intimal hyperplasia is an impediment to patency in both arteries after percutaneous angioplasty (PTA) and veingraft. It is well known that migration and proliferation of vascular smooth muscle cells (SMCs) influence the vascular remodeling process, there are no therapies to prevent intimal hyperplasia of post-PTA arteries and vein grafts. Girdin (girders of actin filaments), also known as Gα-interacting vesicle associated protein (GIV) is a novel actin-binding Akt substrate.Girdin is highly expressed in limited types of cells such as smooth muscle cells, neuroblasts, and cancer cells. Girdin is involved in the cell migration, proliferation and remodeling of actin filaments.This study revealed that Girdin is involved with intimal hyperplasia in carotid arteries after balloon injury and vein grafts and vascular SMCs migration and proliferation. There are suggestions that Girdin has pivotal roles in migration and proliferation of vascular SMCs and that gene therapy targeting Girdin could be a novel therapeutic strategy for restenosis after PTA and vein graft failure.
Purposes: When placing stent grafts, deployment accuracy and birdbeaking due to inadequate conformability and device apposition along the inner curvature of the arch have been encountered. The new Conformable GORE® TAG® Thoracic Endoprosthesis (CTAG) is designed to have enhanced compression resistance and improved conformability in difficult anatomy. The present study compared the deployment accuracy and conformability of the CTAG Device with TAG Device.Method: Deployment accuracy and birdbeaking was compared of CTAG Device and TAG Device implantation for initial treatment of thoracic aortic aneurysm conducted by our department between March 2010 and March 2012. Deployment accuracy was defined as the distance between the actual and intended device implantation locations measured from DSA images.Results: Deployment accuracy at the time of implantation (mean ± SD) was significantly better for the CTAG Device compared to the TAG Device (2.2 ± 1.7 mm vs. 4.4 ± 3.0 mm, P <0.05). Also, while birdbeaking was seen in 8 of 20 cases (40%) for the TAG Device, it was only seen in 1 of 12 cases (8%) for the CTAG Device.Conclusion: The present study found enhanced deployment accuracy and conformability along the aortic arch using the CTAG Device compared to the previous-generation TAG Device.
Objective: To compare the clinical and angiographic outcomes after implantation of drug-eluting stents (DESs) in patients with coronary artery disease (CAD) with or without prior cerebral infarction.Materials and Methods: Ninety-eight consecutive patients (130 lesions) who underwent successful coronary DES implantation were prospectively classified into two groups: those with a clinical history of symptomatic cerebral infarction (cerebral infarction group, 49 patients, 69 lesions) and those without a clinical history of symptomatic cerebral infarction (noncerebral infarction group, 49 patients, 61 lesions). The primary endpoint was defined as death, nonfatal myocardial infarction, and cerebrovascular events.Results: The Kaplan–Meier method was used to create a primary endpoint curves to determine the time-dependent cumulative primary endpoint-free rate, which were compared using the log-rank test. The incidence of primary endpoints was higher in the cerebral infarction group than in the noncerebral infarction group (p = 0.0075). The Cox proportional hazards regression model for primary endpoint identified prior cerebral infarction (p = 0.0331, hazard ratio = 2.827) and patients with peripheral artery disease (p = 0.0271, hazard ratio = 2.757) as explanatory factors.Conclusion: The results showed that clinical outcomes were poorer in patients with CAD who had prior cerebral infarctions than in those who did not have infarction.
Objective: Conventional open repair for proximal subclavian artery aneurysms (SCAAs) requires cardiopulmonary bypass. However, patients with proximal SCAA can be treated with hybrid repair.Methods: Between 2007 and 2012, we performed hybrid repair to treat six consecutive patients with proximal SCAA (three left SCAAs, one right aberrant SCAA, two right SCAAs). Their median age was 73.5 [70–87] years, and the size of their aneurysm was 33.5 [30–45] mm. Thoracic endovascular aneurysm repair (TEVAR) only was used for one patient with left SCAA, TEVAR and supra-aortic bypass for two with left SCAA and one with right aberrant SCAA, and endovascular repair with reconstruction of the vertebral artery using the saphenous vein graft (SVG) for two with right SCAA.Results: The follow-up duration was 3.7 [0.2–6.8] years. There was no 30-day mortality and only one early complication consisting of a minor stroke after TEVAR for shaggy aorta. Two late deaths occurred, one caused by cerebral infarction due to occlusion of SVG to the dominant vertebral artery 2 months after the operation and the other by aortic dissection 5 years postoperatively.Conclusions: Hybrid repair can be a less-invasive alternative for proximal SCAA. Revascularization of neck vessels and TEVAR should be performed very carefully to prevent neurologic complications.
Purpose: To use qualitative lymphangioscintigraphy (LAS) findings to differentiate leg edema caused by high and low output lymphatic failure.Methods: LAS was performed in legs with secondary lymphedema (LE), i.e., low output failure (N = 79), and functional venous insufficiency (FVI), i.e., high output failure (N = 56), and normal legs (N = 26). Whole body images were obtained, 15, 60, and 180 min after technetium-99m injection. The rate and timing of visualization of lymphatic structures, washout out of tracer, and presence of dermal backflow were assessed.Results: The most significant finding for differentiating LE from other conditions was not the visualization of lymphatic structures, but the washout of the tracer from the leg trunk (LE 27%, FVI 100%, normal leg 100%, P <.0001). On the other hand, the most significant finding for differentiating FVI from other legs was the visualization of inguinal lymph nodes at 15 min (LE 11%, FVI 82%, normal leg 8%, P <.0001).Conclusions: We found that the lack of washout from the leg trunk was most suggestive of a low output status of the lymphatic system, while earlier visualization of inguinal lymph nodes was suggestive of a high output status.
The iliopsoas bursa is the largest bursa in the region of hip joint. It is unusual that these bursa become symptomatic. However the bursa can compress femoral vein, leading to lower extremity edema. A 58-year-old man was referred to our department for his unilateral leg edema which had been treated as deep vein thrombosis without any favorable response. Magnetic resonance angiography was performed, which demonstrated enlarged iliopsoas bursa compressing his femoral vein. Surgical removal of the bursa was performed. The postoperative course was uneventful, and the patient is free from symptoms with no evidence of recurrence.
Carotid endarterectomy is a standard vascular surgical procedure performed worldwide and encompasses multiple risks including cerebral hyperperfusion syndrome, stroke, carotid dissection and aneurysmal formation, all of which are well documented in the literature. However, neovascular glaucoma manifesting post carotid endarterectomy, is extremely rare and can have disastrous consequences if left undiagnosed. In this article, we present one such case of neovascular glaucoma manifesting post carotid endarterectomy and review the available literature on this uncommon entity.
A 67-year-old man complicated with back pain. The computed tomography (CT) scan showed an extended thoracoabdominal aneurysm. We successfully performed a three-stage hybrid repair using the visceral-renal debranching technique. For the first stage operation we performed Y-grafting with the debranching technique to create a distal landing zone. Then, for the second stage operation, we performed the hybrid procedure including total arch replacement (TAR) and antegrade stent graft deployment to create a proximal landing zone. Finally, additional thoracic endovascular aortic repair (TEVAR) between the distal and proximal landing zones was successfully accomplished as the third stage operation.
Chylothorax is a rare but serious complication of thoracic aortic surgery, leading to malnutrition, respiratory insufficiency, and prolonged hospital stay. In this article, we describe the successful treatment of a case of intractable chylothorax by lipiodol lymphography. The patient was a 39-year-old man who underwent descending aortic replacement for a remaining dissected aneurysm after total arch replacement. Chylothorax developed postoperatively. After complete oral intake cessation, total parenteral nutrition, and plasmatic factor XIII administration, lipiodol lymphography detected the chyle leakage location and subsequently decreased pleural effusion. The patient recovered uneventfully and was discharged on postoperative day 30 without any complications.
A 63-year-old Caucasian male presented with a 4-month history of low back pain associated with bilateral intermittent claudication. A contrast enhanced CT scan demonstrated a 4 cm abdominal aortic aneurysm (AAA), along with severe bilateral aorto-iliac disease, a right psoas collection, and extensive vertebral erosion. An MRI of the lumbar spine suggested spondylodiscitis at L4–L5. After an unsuccessful and prolonged course of antibiotics, a decision was ultimately made to repair the aneurysm and bypass the aorto-iliac disease. Intra-operatively, a chronic contained rupture (CCR) involving the posterior aortic wall was encountered and repaired with an aorto- bifemoral bypass graft.
We report a case of deep femoral artery (DFA) aneurysm associated with pre-vasculo-Behcet status. A 34-year-old man with a history of recurring oral and genital ulcers was admitted complaining of worsening left thigh pain over the previous 30 days. Computed tomography showed a left DFA aneurysm (60 mm × 70 mm), concomitant aneurysms in the popliteal and carotid arteries, and deep vein thrombosis. Active pre-vasculo-Behcet status was diagnosed, and DFA ligation was performed urgently. Remission was achieved with postoperative prednisolone and colchicine without vascular complications. DFA aneurysm and vascular pathologies were successfully managed by ligation surgery and medical therapy.
Spontaneous isolated dissection of the superior mesenteric artery (SID-SMA) is a rare condition, and there is still no consensus on optimal management. Here, we present three cases of SID-SMA, that were treated by surgical revascularization with urgent iliomesenteric bypass surgery without intestine resection, endovascular therapy with stent placement, and conservative management. The purpose of this study is to review these three cases and propose an algorithm for optimal management of SID-SMA.
Takayasu’s arteritis affects most commonly young women, often causing stenotic and occasionally dilated lesions of the medium-to-large-sized arteries with an acute inflammatory signs and symptoms. Here, we report a rare case of Takayasu’s arteritis with total occlusion of the abdominal aorta, which was successfully treated with medication alone and asymptomatic over 40 years. Magnetic resonance imaging revealed total occlusion of the abdominal aorta and stenosis of the right carotid artery. This is the first report of a very rare case of Takayasu’s arteritis, in which medical treatment only was successful against total occlusion of the abdominal aorta.
Pseudocoarctation of the aorta is a rare anomaly and considered a benign condition. Pseudocoarctation of the aorta has been associated with aneurysm formation in the thoracic aorta, which may cause sudden rupture or dissection. Thus, the presence of an aneurysm in combination with pseudocoarctation of the aorta is thought to be an indication for surgery. We present a case of pseudocoarctation of the aorta associated with thoracic aortic aneurysm and severe aortic valve stenosis with a bicuspid aortic valve. In our case, single-stage repair was performed through a median sternotomy using our “pleural-window approach.”
A man in his 80s underwent urgent endovascular aortic repair (EVAR) for a ruptured abdominal aortic aneurysm (RAAA). Surgery was completed without apparent complications, and the patient was returned to the Cardiac Care Unit. Two hours later, he again developed shock, and contrast-enhanced Computed Tomography showed extravasation from a type II endoleak (T2EL) involving the IMA. Transcatheter arterial embolization (TAE) was immediately performed, and the patient’s vital signs stabilized soon after embolization. Abdominal compartment syndrome was suspected during the procedure, so a retroperitoneal hematoma evacuation was performed. The patient’s postoperative course was satisfactory, and he transferred to another hospital.EVAR for RAAA would be useful, but it is necessary to be considered that T2EL can cause the aggravation of unstable circulation.