The functional and imaging diagnostic method were performed for intermittent claudicants. FormPWV/ABI® was used with a treadmill test for 341 patients. The treadmill test was performed with a 12% slope at a speed of 2.4 km/hr for three minutes. The time until the ABI returned to pre-exercise values (recovery time; RT) was measured. Walking exercise therapy including pharmacotherapy was effective for 26 of 29 cases with an RT of less than 10 minutes. In conclusion, we believe that walking exercise therapy should be selected for cases with an RT of less than 10 minutes, followed by endovascular surgery and that the surgical arterial reconstruction should follow such therapy for cases with an RT of more than 10 minutes.
Lymphaticovenular anastomosis (LVA) is a minimally invasive surgical treatment which can be performed under local anesthesia and is effective for compression-refractory lymphedema. LVA, however, requires experience and supermicrosurgical technique to detect and anastomose lymphatic vessels through a small skin incision. Recently, ICG lymphography was developed and considered useful for LVA surgery with visualization of superficial lymph flows. We report a safer and a more secure LVA with guidance of ICG lymphography.
A 61-year-old man was urgently referred to our hospital with complaints of nausea and abdominal discomfort which started a few days before. Palpation of the abdomen revealed a pulsatile mass and upon auscultation, there was note of a systolic bruit. The abdominal enhanced computed tomography scan showed the presence of an abdominal aortic aneurysm (AAA) which ruptured into the inferior vena cava (IVC). Replacement of the AAA with a gelatin-coated Y-graft was performed.
A 69-year-old woman with chronic renal failure was referred to our department because of repeated problems with her arteriovenous access. She had no suitable veins for creating a new areteriovenous fistula in either of her upper limbs. She had congestive heart failure (CHF) due to valvular heart disease and myocardial ischemia. Therefore, there was a strong possibility that creating a conventional areteriovenous fistula with a prosthetic graft would worsen her condition due to volume overload. There was also a possibility that general anesthesia would cause cardiogenic shock. Accordingly, we inserted an arterioarterial prosthetic loop (AAPL) into the left superficial femoral artery (SFA) under local anesthesia. There were no procedural complications, and she continued to undergo hemodialysis until she died from cardiopulmonary arrest 173 days after the operation. Use of an AAPL in the SFA for hemodialysis access is a worthwhile option in patients with CHF.