In this report there are three cases of abdominal aortic aneurysm (AAA). These patients underwent preoperative evaluation with real-time virtual sonography (RVS), which can synchronize US image and CT image. Case 1: 72-year-old male. Maximum diameter of AAA: 55 mm. Indication for graft replacement (Y-graft). Preoperative RSV indicated that US and CT showed the same findings, such as characteristics of the wall from renal artery to aneurysm. Case 2: 63-year-old male. Maximum diameter of AAA: 52 mm, kinking. Indication for graft replacement (Y-graft) Preoperative RSV indicated that US and CT showed the same findings, such as mural thrombus, characteristics of the wall, and plaque on the posterior wall of infrarenal artery. Plaque on the proximal left CIA seen in CT image is unclear in US image, and this suggests the presence of a hypoechoic unstable plaque. Case 3: 79-year-old female. Maximum diameter of AAA: 44 mm, mild kinking. We considered an indication for stent grafting, but did not employ it because preoperative RSV indicated that US recognized a mobile plaque. This plaque is likely to move due to pulsation in the Stent-Graft landing zone which could be a source for an embolism. We consider the US preoperative evaluation, utilizing RVS, as an extremely useful diagnostic technique.
Objectives: This study compared and contrasted the wave propagation patterns of the main pulmonary trunk with those of the ascending aorta in the same subjects using WI analysis. Methods: Flow velocity (V) and pressure (P) at the same site in the main pulmonary trunk and ascending aorta were recorded using a multisensor catheter in 5 control subjects without hypertension and evidence of pulmonary disease and in one patient with mild pulmonary hypertension (PH) with mitral regurgitation. WI was calculated from the following equation. WI=(dP/dt)(dV/dt), where dP/dt and dV/dt are the derivatives of blood pressure and velocity with respect to time. To determine the nature and direction of waves during the cardiac cycle, data were analyzed by calculating the following parameters. Positive peak WI (W1) in early systole, positive peak WI (W2) in late systole, W1/W2, negative peak WI (NW) in midsystole and ∫PW/∫NW (area ratio of positive and negative WI waveform in systole). Results: All parameters, especially NW and ∫PW/∫NW reflecting the amount of reflection, in aorta of control subjects were significantly higher than those in main pulmonary artery (p<0.05) except for peak W2. NW was observed in aorta of all subjects except for one juvenile control subject. But no NW was observed in main pulmonary artery of all control subjects. NW was only observed in main pulmonary trunk in the patient with mild PH. Conclusions: The differences in the physical characteristics between the aorta as a resistance vessel and the main pulmonary trunk as a capacitance vessel can be illustrated by WI analysis. WI analysis may offer further detailed insight into the understanding of pulmonary diseases such as mild PH, in which initial minimum changes in peripheral resistance could alter the amount of reflection significantly because of its physical characteristics of negligible development of wave reflection in normal pulmonary artery.
We assessed whether sarpogrelate hydrochloride improves the microcirculation in patients with peripheral artery disease, by measuring the transcutaneous oxygen tension (tcPO2). The tcPO2 was measured in the dorsum pedis of 13 patients before and after 2 weeks of sarpogrelate hyrochloride treatment (300 mg/day). The 26 legs were classified into 2 groups: those with a tcPO2 (A) <50 mmHg and those >50 mmHg (B). There were significant difference in the findings noted before administration and those between the first treatment and 2 weeks into therapy. There were significant differences in the findings between before and after administration in the first treatment. These findings suggest that sarpogrelate hydrochloride improves the microcirculation in legs with a tcPO2 <50 mmHg.
Endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm has been performed more safely, but we must use iodine contrast media. So we hesitate to perform EVAR for renal insufficiency patients. We have tried to use carbon dioxide to decrease the volume of iodine contrast media. We experienced 115 EVAR cases from May 2007 to May 2011. We divided two groups by preoperative eGFR (estimated glomerular filtration rate). 111 patients were into group IC that preoperative eGFR was over 30 ml/min were performed EVAR using only carbon dioxide. 4 patients were group CD that eGFR was blow 30 ml/min were performed EVAR with iodine contrast media and carbon dioxide. Median volume of iodine contrast media was 193 ml in group IC and 48.5 ml in group CD. We had 4 operation related death but no dialysis case were detected in group CD. And no carbon dioxide related complications were detected too. Any patients did not treat dialysis after EVAR in group CD. We think using carbon dioxide in EVAR for renal insufficiency patients are useful for avoid dialysis.
We reviewed the outcome of 126 patients between 1981 and 2010 who required emergency surgery for a ruptured abdominal aortic aneurysm. Since 2008, we applied a proactive strategy to abdominal compartment syndrome after abdominal aortic repair. When primary abdominal closure seemed to increase intra-abdominal pressure, patients underwent open abdominal management using a vacuum-assisted closure technique. One hundred one patients underwent aortic repair before 2008 (group A) and 25 patients after 2008 (group B). In the group B delayed abdominal closure was performed in 11 patients. Operative mortality was significantly lower in group B (8% vs 31%, p=0.02). Postoperative bowel ischemia or necrosis was remarkably decreased in group B (4% vs 24%, p=0.001). On multivariate logistic regression, the current proactive strategy to abdominal compartment syndrome was associated with prevention of bowel ischemia or infarction. In conclusion, open abdominal management for selected patients with ruptured abdominal aortic aneurysm may prevent bowel ischemia and confer a survival benefit.
Carotid ultrasonography revealed circumferential wall thickening (so-called macaroni sign) of the common carotid artery (CCA) in two patients with temporal arteritis (TA). Few reports describe details of the CCA of TA determined using carotid ultrasonography. A combination of Takayasu’s arteritis in our patients was difficult to justify according to the criteria of American College of Rheumatology. Thus we considered that the macaroni signs in these patients were not due to a type of polyangiitis overlap syndrome but were rather associated with TA. Because the TA might cause macaroni signs on the CCA, the influence of inflammation on the CCA should be examined.