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25件中1~25を表示しています
REVIEW ARTICLES
Invited Lecture of the 46th Annual Meeting of Japanese Society for Vascular Surgery
  • Akbarshakh Akhmerov, Joseph DuBose, Ali Azizzadeh
    2019 年 12 巻 1 号 p. 1-5
    発行日: 2019/03/25
    公開日: 2019/03/25
    [早期公開] 公開日: 2019/01/22
    ジャーナル フリー

    Blunt thoracic aortic injuries are rare occurrences but carry an increased risk of mortality. Over the last two decades, however, major advances in diagnostic imaging, staging, and treatment have significantly improved outcomes. Modern imaging paved the way for a new staging system based on the anatomical layers of the aortic wall. This staging system, in turn, allowed for refinement of treatment, which now includes nonoperative management with anti-impulse therapy, endovascular intervention, and, if needed, open surgical repair. As is the case with any other rapidly evolving therapy, however, new challenges and controversies arise. The resolution of these challenges will rely on a broad, international, and multidisciplinary effort. (This is a review article based on the invited lecture of the 46th Annual Meeting of Japanese Society for Vascular Surgery.)

Educational Seminars of the Japanese Society for Vascular Surgery
  • Noriyasu Morikage, Kimikazu Hamano
    2019 年 12 巻 1 号 p. 6-13
    発行日: 2019/03/25
    公開日: 2019/03/25
    [早期公開] 公開日: 2019/02/06
    ジャーナル フリー

    Endovascular aneurysm repair (EVAR) has become the standard therapy alongside open surgery repair (OSR) for abdominal aortic aneurysm (AAA) and it is rapidly becoming prevalent. There has been substantial technical progress with respect to EVAR since its introduction. Technical contrivance can be used to manage even inappropriate EVAR cases, including those involving a hostile neck, deficient access route, or aneurysm rupture. However, there are some controversies over reinterventions in relation to long-term outcomes. Although a long-term result has not yet been analyzed in Japan a randomized controlled trial (RCT) held in the West reported that OSR is superior to EVAR for avoiding reinterventions and aneurysm-related death. The RCT involved the use of older devices and proceeded in a different way from the present study; therefore, different results may be obtained for Japanese EVAR outcomes. However, this Western RCT result should be considered as an important warning. Type II endoleak also must be managed in order to improve long term outcomes of EVAR. Efforts to improve both technical methodology and long-term outcomes are necessary to ensure EVAR as a minimally invasive therapy for patients with AAA. (This is a translation of Jpn J Vasc Surg 2018; 27: 405–411.)

  • Kiyofumi Morishita
    2019 年 12 巻 1 号 p. 14-20
    発行日: 2019/03/25
    公開日: 2019/03/25
    [早期公開] 公開日: 2019/02/26
    ジャーナル フリー

    Hybrid aortic arch repair (HAAR) consists of thoracic stent-graft repair and procedures to maintain cerebral blood flow. Several hybrid techniques have been used, including arch artery debranching, parallel graft technique, fenestration or branching of endograft, or a combination of these. We provided an overview of HAAR by presenting literature reviews as well as our clinical experience. The experience consisted of 172 patients who had undergone HAAR. The 30-day mortality was 3% (5/172). Persistent neurologic deficits occurred in 7 patients (4%), respiratory failure in 5 (3%), de novo aortic dissection in 3 and spinal cord injury in 2. 17% of the patients experienced type Ia endoleak. Seventeen patients required redo thoracic endovascular aortic repair. Fifty-six late deaths occurred during the follow-up period, including aortic-related death in 9 patients. In conclusion, hybrid arch debranching repair should be performed for elderly or high-surgical-risk patients. However, refining techniques and device technology is likely to reduce late endograft-related events. (This is a translation of Jpn J Vasc Surg 2018; 27: 385–391.)

ORIGINAL ARTICLES
  • Kritaya Kritayakirana, Natawat Narueponjirakul, Apinan Uthaipaisanwong ...
    2019 年 12 巻 1 号 p. 21-24
    発行日: 2019/03/25
    公開日: 2019/03/25
    [早期公開] 公開日: 2019/01/10
    ジャーナル フリー

    Objective: Arteriovenous grafts (AVGs) are considered to be an alternative procedure when autogenous fistulas are not feasible. This study was conducted to establish a correlation between the inflow artery and outflow vein size and patency of AVGs.

    Materials and Methods: This was a retrospective descriptive study. Data was collected from patients who had forearm AVG performed at a university hospital from January 1, 2012, to December 31, 2016. Spearman’s rho correlation test was used to identify the correlation between the artery and vein size and patency of AVG.

    Results: A total of 34 patients were enrolled in this study. Forearm loop configuration was performed in 33 patients (97%), and straight configuration was performed in one patient (3%). The median size of the brachial artery was 3 mm (interquartile range [IQR]: 2, 4) and that of the vein was 3 mm (IQR: 2, 5). The overall primary patency was 74% at six months, 59% at one year, and 32% at two years. The analysis showed that the primary patency increased with the artery size, but there was a reverse correlation between vein sizes.

    Conclusion: Small inflow arteries may reduce the primary patency, but small veins do not result in a poor primary patency. Our method can be applied to patients with small veins, where it is still possible to perform forearm AVGs.

  • Zia Ur Rehman, Asfia Arham, Ziad Sophie
    2019 年 12 巻 1 号 p. 25-29
    発行日: 2019/03/25
    公開日: 2019/03/25
    [早期公開] 公開日: 2019/01/10
    ジャーナル フリー

    Introduction: Lower extremity hemodialysis access is offered to the patients who have severe central venous stenosis. Femoral vein transposition arteriovenous fistula (FV tAVF) is an alternative to lower leg arteriovenous prosthetic grafts. Its safety and patency is under observation.

    Materials and Methods: This is a retrospective review of patients who had FV tAVF between January 2011 and March 2016. Preoperative clinical findings, intraoperative findings, postoperative complications, and patency of the AVF were noted and analyzed.

    Results: There were 7 patients who underwent FV tAVF during this study period. Most patients were female (6 : 1), with mean age of 45.2 years (range, 33–55 years). All patients were hypertensive. Mean body mass index was 26.1 kg/m2. Patient had on average previous 6 dialysis accesses. Most patients had preoperative venograms (6/7). Mean interval between initiation of dialysis and creation of the arteriovenous fistula was 1.08 years. All procedures were done under general anesthesia. Four patients required extension of FV with either the small segment of polytetrafluorethylene or vein graft. Two patients had early postoperative complications. One patient developed hematoma, whereas other had wound dehiscence. All the accesses were utilized for dialysis after a mean interval of 6 weeks. All patients had a patent fistula on average follow-up of 2 years.

    Conclusion: Appropriate patient selection for FV tAVF can provide good patency with low incidence of complications. This can be considered for good risk individuals undergoing their first lower extremity access.

  • Hisashi Uemura, Hiroe Tanaka, Masataka Mitsuno, Mitsuhiro Yamamura, Ma ...
    2019 年 12 巻 1 号 p. 30-35
    発行日: 2019/03/25
    公開日: 2019/03/25
    [早期公開] 公開日: 2019/02/04
    ジャーナル フリー

    Objective: The usefulness of abdominal duplex ultrasound (DUS) for the detection of endoleaks after endovascular aneurysm repair (EVAR) was evaluated.

    Materials and Methods: Among 286 patients who underwent EVAR between September 2007 and July 2017, 241 patients were followed up using abdominal DUS. Endoleaks were detected in 74 patients (31%), who were divided into enlarged and nonenlarged sac groups. Endoleak velocities and widths were measured using abdominal DUS every 6 months after EVAR and were compared between the 2 groups.

    Results: The aneurysm diameter in the nonenlarged sac group was 54.4±8.7 mm in the final follow-up. None of the patients in the nonenlarged sac group were subjected to reintervention, whereas all patients in the enlarged sac group were subjected to reintervention. The aneurysm diameter in the enlarged sac group was 62.8±8.8 mm at the time of reintervention, and the maximum endoleak flow velocities and endoleak widths were significantly higher in the enlarged sac group than in the nonenlarged sac group (p<0.05). The cutoff values on receiver operating characteristics curves for endoleak velocity and width were 83.4 cm/s and 4.0 mm, respectively.

    Conclusion: Follow-ups using abdominal DUS are useful after EVAR. Endoleak velocity and width measurements are important, and reintervention may be needed when these measurements exceed their cutoff values.

  • Tatsuro Yata, Masaki Sano, Takafumi Kayama, Ena Naruse, Naoto Yamamoto ...
    2019 年 12 巻 1 号 p. 36-43
    発行日: 2019/03/25
    公開日: 2019/03/25
    [早期公開] 公開日: 2019/02/19
    ジャーナル フリー

    Objective: To investigate whether a finger-mounted tissue oximeter is useful in evaluating limb blood flow in patients with peripheral arterial disease (PAD).

    Materials and Methods: Seventy-two patients with PAD were included, and the ankle-brachial index (ABI), transcutaneous oxygen pressure (TcPO2), and skin perfusion pressure (SPP) were measured. The regional tissue oxygenation saturation (rSO2) was measured using a finger-mounted tissue oximeter at the ankle, dorsal foot, and each dorsal and plantar toe. Correlations between rSO2 and ABI and between TcPO2 and SPP were analyzed. The patients were divided into three groups: Fontaine IIa (F-IIa), IIb (F-IIb), and III and IV (F-III/IV) groups. The difference in rSO2 between each group was analyzed.

    Results: Significant correlations were observed between rSO2 and TcPO2 and between rSO2 and SPP. TcPO2 and SPP in the F-III/IV group were significantly lower than those in the F-IIa group. rSO2 in the F-IIb and F-III/IV groups was significantly lower than that in the F-IIa group.

    Conclusion: The measurement of rSO2 using finger-mounted tissue oximetry is quick, simple, and painless. It can be used on any skin area and is useful to evaluate limb circulation in patients with PAD.

  • Ali Kordzadeh, Shabnam Sadeghi Esfahlani
    2019 年 12 巻 1 号 p. 44-49
    発行日: 2019/03/25
    公開日: 2019/03/25
    [早期公開] 公開日: 2019/03/05
    ジャーナル フリー

    Objective: The aim of this study is to examine the application of virtual artificial intelligence (AI) in the prediction of functional maturation (FM) and pattern recognition of factors in autogenous radiocephalic arteriovenous fistula (RCAVF) formation.

    Materials and Methods: A prospective database of 266 individuals over a four-year period with n=10 variables were used to train, validate and test an artificial neural network (ANN). The ANN was constructed to create a predictive model and evaluate the impact of variables on the endpoint of FM.

    Results: The overall accuracy of the training, validation, testing and all data on each output matrix at detecting FM was 86.4%, 82.5%, 77.5% and 84.5%, respectively. The results corresponded with their area under the curve for each output matrix at best sensitivity and at 1-specificity with the log-rank test p<0.01. ANN classification identified age, artery and vein diameter to influence FM with an accuracy of (>89%). AI has the ability of predicting with a high grade of accuracy FM and recognising patterns that influence it.

    Conclusion: AI is a replicable tool that could remain up to date and flexible to ongoing deep learning with further data feed ensuring substantial enhancement in its accuracy. AI could serve as a clinical decision-making tool and its application in vascular access requires further evaluation.

  • Jiro Matsuo, Yosuke Inoue, Atsushi Omura, Yoshimasa Seike, Kyokun Ueha ...
    2019 年 12 巻 1 号 p. 50-54
    発行日: 2019/03/25
    公開日: 2019/03/25
    [早期公開] 公開日: 2019/02/27
    ジャーナル フリー

    Objectives: Abdominal aortic aneurysm (AAA) in patients <30 years old is relatively rare. We retrospectively analyzed patients <30 years who received an AAA replacement.

    Materials: Among 3,003 patients who received an AAA replacement during the last 40 years, 10 patients <30 years old were retrospectively reviewed. All patients suffered from a connective tissue disease: eight from Marfan syndrome and two from Loeys–Dietz syndrome. Five patients had a history of cardiovascular surgery. Aortic pathologies were a dissection type in eight patients and a non-dissection type in two. All patients received a graft replacement of infrarenal AAA, with a bifurcated graft in six patients and a straight graft in four.

    Results: Except for cases that were urgent and emergent, rapid aneurysm expansion was noted in all cases. Mean AAA diameter at surgery was 46.7±9.2 mm. No hospital mortality was recorded. Eight patients required 10 additional cardiovascular surgeries: two root replacements, two total arch replacements, two descending aortic replacements, and four thoracoabdominal replacements.

    Conclusion: AAA replacement in patients <30 years is safe. In younger patients with a connective tissue disease, AAA should be included in the routine medical check-up, and earlier surgical indication should be considered for its rapid expansion.

  • Zia Ur Rehman, M Hammad Ather, Wajahat Aziz
    2019 年 12 巻 1 号 p. 55-59
    発行日: 2019/03/25
    公開日: 2019/03/25
    [早期公開] 公開日: 2019/03/04
    ジャーナル フリー

    Objective: To assess surgical strategies and the impact of a multidisciplinary approach on patients undergoing inferior vena caval thrombectomy for renal cell carcinoma and to evaluate perioperative morbidity and mortality associated with these procedures.

    Methodology: A retrospective audit for all adults who underwent nephrectomy and inferior vena caval thrombectomy from January 2008 till November 2018 at a University hospital. Patients with incomplete records were excluded from the study.

    Results: During the study period, 21 patients underwent inferior vena caval thrombectomy as a completion of radical nephrectomy. Most were males (19 : 2) with a mean age of 54±11.3 years. The most common surgical approach was the 11th rib flank approach (n=8) followed by midline abdominal (n=6) and Mercedes-Benz (n=5). Eight patients had level 1, 10 patients had level 2, and three patients had level 3 tumour thrombus. The cavotomy was closed primarily in 20 patients; one required inferior vena cava (IVC) reconstruction with a pericardial patch. The proximal clamp was applied below the hepatic veins for most patients. Two patients required suprahepatic clamping before thrombectomy. There was no intraoperative mortality. Five patients (24%) developed complications: two required cardiopulmonary resuscitation due to severe hypotension and were revived; one developed acute renal failure; and one patient required a damage control laparotomy for excessive oozing. There was no thirty-day mortality.

    Conclusion: The IVC thrombectomy, along with radical nephrectomy for renal cell carcinoma for 1–3 level thrombus, can be performed with acceptable morbidity in a multidisciplinary team approach.

CASE REPORTS
ANNUAL REPORT
  • The Japanese Society for Vascular Surgery JCLIMB Committee, NCD JCLIMB ...
    2019 年 12 巻 1 号 p. 109-135
    発行日: 2019/03/25
    公開日: 2019/03/25
    [早期公開] 公開日: 2019/03/05
    ジャーナル フリー

    Since 2013, the Japanese Society for Vascular Surgery has started the project of nationwide registration and tracking database for patients with critical limb ischemia (CLI) who are treated by vascular surgeons. The purpose of this project is to clarify the current status of the medical practice for the patients with CLI to contribute to the improvement of the quality of medical care. This database, called JAPAN Critical Limb Ischemia Database (JCLIMB), is created on the National Clinical Database (NCD) and collects data of patients’ background, therapeutic measures, early results, and long term prognosis as long as five years after the initial treatment. The limbs managed conservatively are also registered in JCLIMB, together with those treated by surgery and/or EVT. In 2016, 1,092 CLI limbs (male 755 limbs: 70%) were registered by 91 facilities. ASO has accounted for 98% of the pathogenesis of these limbs. In this manuscript, the background data, the early prognosis, and 6-months’ prognosis of the registered limbs are reported. (This is a translation of Jpn J Vasc Surg 2019; 28: 1–27.)

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