Japanese Journal of Vascular Surgery
Online ISSN : 1881-767X
Print ISSN : 0918-6778
Volume 15, Issue 5
Displaying 1-11 of 11 articles from this issue
  • Toshihiro Onohara, Atsushi Guntani, Takeshi Takano, Takuya Matsumoto, ...
    2006 Volume 15 Issue 5 Pages 487-493
    Published: 2006
    Released on J-STAGE: June 08, 2007
    JOURNAL OPEN ACCESS
    Long-term results of 191 cases for unilateral iliac artery occlusive disease were retrospectively reviewed. The vascular procedures included 132 aorto- or ilio-femoral (AF) bypasses, 37 femoro-femoral crossover (FF) bypasses, and 22 unilateral axillo-femoral (AxF) bypasses. Operation was performed for claudication in 165 cases and limb salvage in 26 cases. The TASC classification of the iliac artery disease included 6 cases of type B, 17 cases of type C, and 168 cases of type D. Primary patency rates for all cases were 90% and 77% at 5 and 10 years after operation, respectively. In the AF group, there were 56 cases with occluded superficial femoral artery, of which 37 infrainguinal bypasses and 11 profundoplasties were performed simultaneously. During the follow-up periods, an additional infrainguinal bypass was required for 7 cases and repair of anastomotic pseudoaneurysm was preformed for 2 cases. Also, 11 revascularization procedures and one major amputation were performed for contralatral limb ischemia. The 5-year primary patency rate for the AF group was 92%, which was equivalent to that of the FF group (97%) and superior to the AxF group (65%). AF bypass for limb salvage had poor long-term patency. In treating unilateral iliac artery occlusive disease, attention to the ipsilateral infrainguinal artery or the contralateral lower limb artery diseases should be paid to obtain a better outcome, despite the favorable long-term patency rates for AF bypass.
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  • Nobuyuki Nakajima, Masahisa Masuda, Mizuho Imamaki, Yoko Onuki, Masaha ...
    2006 Volume 15 Issue 5 Pages 495-498
    Published: 2006
    Released on J-STAGE: June 08, 2007
    JOURNAL OPEN ACCESS
    A 62-year-old man was operated for inflammatory abdominal aortic aneurysm through a median transperitoneal approach and was discharged. He returned 3 months later with signs of graft infection. He was re-explored through a left retroperitoneal approach, the remnant of previously left aneurysmal wall was resected as much as possible with extended debridement of necrotic tissues. The wound was thoroughly irrigated, then packed by sponges soaked with 10% iodine solution. This maneuver was repeated 6 times every 8 hours. After 48 hours, the left dorsal latissimus muscle was removed with the attachment of vascular pedicles and transpositioned to the retroperitoneal space around the graft. Vascular anastomoses were made to the inferior epigastric artery and vein. The wound was closed but drainage tubes were left in place. Although prolonged periods were required for the complete healing, he was eventually discharged with “in-situ” preservation of the original graft with no infectious signs. The recurrence of infection was not observed and he is doing well at over 5 years.
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  • Kentaro Honda, Hiroyoshi Komai, Masanobu Juri
    2006 Volume 15 Issue 5 Pages 499-502
    Published: 2006
    Released on J-STAGE: June 08, 2007
    JOURNAL OPEN ACCESS
    Varicose veins and peripheral arterial disease (PAD) are common diseases of the lower extremities. However it is rare that both require surgical treatment at the same time. We report an 85-year-old woman with severe deep venous valve insufficiency and PAD in the same leg. She had had varicose veins, pigmentation and peripheral pulse attenuation of the left leg for ten years. Venogram of the left leg showed deep venous valve insufficiency (Kistner IV) and the ankle brachial pressure index (ABI) was only 0.65. External valvuloplasty of the left femoral vein with a rigid endoscope and right external ilio-left common femoral crossover bypass with an artificial graft were performed at the same time. The post operative venogram showed the improvement of the venous valve insufficiency (Kistner II), and the ABI rose to 0.85. During 15 months of follow-up, the patient has been free from symptoms.
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  • Toshiyuki Kuwata, Kazumi Mizuguchi, Yoichi Kameda, Toru Mori
    2006 Volume 15 Issue 5 Pages 503-506
    Published: 2006
    Released on J-STAGE: June 08, 2007
    JOURNAL OPEN ACCESS
    A 63-year-old man was admitted with severe back pain of sudden onset. An enhanced computed tomography (ECT) revealed a Stanford type B (DeBakey IIIa) acute aortic dissection. Blood pressure was controlled satisfactorily with nicardipine hydrochloride infusion. Five days after admission, he suffered sever back pain again followed by abdominal and left leg pain, and pulselessness of the left leg and abdominal extension, which suggested an intestinal malperfusion. The ECT showed re-dissection reaching the iliac artery level. Emergency laparotomy showed small intestinal ischemia. Surgical fenestration beneath the inferior mesenteric artery, and reconstruction with a bifurcated graft were performed satisfactorily. The color of the small intestine returned to normal, and peripheral pulse in the left leg was easily palpable. The patient has been receiving care as an outpatient.
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  • Haidi Hu, Takeshi Takano, Toshihiro Onohara, Tadashi Furuyama, Yoshihi ...
    2006 Volume 15 Issue 5 Pages 507-511
    Published: 2006
    Released on J-STAGE: June 08, 2007
    JOURNAL OPEN ACCESS
    A 77-year-old woman, given a diagnosis of descending aortic aneurysm with concomitant right lung cancer, was admitted to our hospital. Preoperative enhanced computed tomography (CT) scan demonstrated a saccular aortic aneurysm, 45 mm in diameter, in the left lateral wall of the descending aorta just above the diaphragm, and an ill-defined tumor, 31 mm in diameter, in the right lower lobe of the lung. Also, CT scan showed aneurysmal dilatation of the common iliac arteries and diffuse narrowing of the external iliac arteries. These findings indicated that it would be difficult to introduce a delivery system through the femoral or iliac artery if endovascular repair were attempted. Therefore, we performed an infrarenal aortic grafting in an end-to-side manner using a synthetic tube graft, and successfully completed endovascular repair of the descending aortic aneurysm though this aortic graft access. The right lung cancer was subsequently radically resected. Our procedure offers another possible access to facilitate endovascular repair of aortic aneurysm in patients without a proper anatomic iliofemoral access.
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  • Kenji Sangawa, Atsushi Aoki
    2006 Volume 15 Issue 5 Pages 513-516
    Published: 2006
    Released on J-STAGE: June 08, 2007
    JOURNAL OPEN ACCESS
    We encounterd an abdominal aortic occlusion due to blunt trauma. The patient was a 72-year-old man who received a heavy blow to the abdomen and both legs in a traffic accident. His chief complaint was severe pain in both legs but had no bone fracture. No femoral pulse was found in either leg. Contrast-enhanced computed tomography (CE-CT) demonstrated dissection and occlusion of the infrarenal aorta. The patient was transported to our hospital for further treatment. Another CE-CT was performed and the abdominal aorta and the left iliac artery were recanalized, however the right iliac artery was still occluded. Upon surgery there was no major injury of the abdominal organs. The anterior aspect of the infrarenal aorta was dissected. The abdominal aorta was resected and reconstructed with a Y-shaped Dacron graft. The inferior mesenteric artery was re-implanted. His postoperative course was uneventful. A postoperative CE-CT revealed disappearance of the false lumen. With blunt abdominal trauma, aortic occlusion is rare, however it should be considered, because this condition becomes fatal without appropriate intervention.
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  • Masamichi Hoshino, Satoshi Ohki, Toru Takahashi, Yasuo Morishita
    2006 Volume 15 Issue 5 Pages 517-519
    Published: 2006
    Released on J-STAGE: June 08, 2007
    JOURNAL OPEN ACCESS
    True aneurysm of the inferior thyroid artery is extremely rare. A 52-year-old man complained of a pulsatile mass in the left side of the neck. A preoperative computed tomography (CT) showed an aneurysm (6.5 cm×4.5 cm) in the left side of the neck and 3 dimensional-CT revealed an inferior thyroid artery aneurysm. His postoperative course after an aneurysmectomy was uneventful. Pathological findings showed atherosclerotic changes. Inferior thyroid artery aneurysm should be considered in the differential diagnosis of pulsatile masses in the neck.
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  • Hiroo Shikata, Katsuto Miyazawa, Yoshimichi Ueda, Takashi Kobata, Kenj ...
    2006 Volume 15 Issue 5 Pages 521-524
    Published: 2006
    Released on J-STAGE: June 08, 2007
    JOURNAL OPEN ACCESS
    A 73-year-old man consulted our cardiology department for hypertension and post-myocardial infarction angina pectoris. After the examination, early gastric cancer was discovered at the lower gastric confines. Preoperative examination (abdominal CT scan) revealed an abdominal aortic aneurysm 7 cm in diameter and a left renal tumor. Simultaneous nephrectomy and repair of the abdominal aortic aneurysm were performed with a median retroperitoneal approach. Immediately after the operation, the white blood cell count increased transiently. At that time, the level of granulocyte colony stimulating factor (G-CSF) in the blood was high (81 pg/ml). The histopathological diagnosis of the tumor was renal cell carcinoma and immunohistochemical staining with an anti G-CSF antibody demonstrated cancer cells producing G-CSF. The postoperative course was uneventful. The patient underwent endoscopic resection of the gastric cancer 38 days after the first operation.
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  • Mitsuaki Matsumoto, Mikizo Nakai, Kotaro Suehiro, Hiroshi Kubo
    2006 Volume 15 Issue 5 Pages 525-528
    Published: 2006
    Released on J-STAGE: June 08, 2007
    JOURNAL OPEN ACCESS
    We encountered a case who escaped ischemic spinal cord injury following stentgrafting of the lower thoracic descending aorta, though the Adamkiewicz artery and its feeding intercostal arteries were confirmed preoperatively by a multi-detector row computed tomography (MDCT) and these were completely blocked by the stent graft. Postoperative MDCT demonstrated clear evidence of collateral supply to the Adamkiewicz artery which might have helped this patient avoid serious complications.
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  • Atsushi Kambara, Katsushi Ueyama, Yuko Tsuda, Takeshi Ueyama
    2006 Volume 15 Issue 5 Pages 529-532
    Published: 2006
    Released on J-STAGE: June 08, 2007
    JOURNAL OPEN ACCESS
    A 49-year-old man was admitted with sudden onset of epigastralgia, lumbar pain, and pain in his legs. Computed tomography (CT) revealed type A aortic dissection with narrowing of the true lumen, which was compressed by a false lumen at the level of the descending and abdominal aorta. Pulsation in either leg was not palpable as the site of femoral arteries, but aortic branches to visceral organs, including renal arteries, and those of lower extremities were all equally enhanced by contrast medium on CT films. Emergency operation to replace the ascending aorta was performed under hypothermic circulatory arrest and retrograde cerebral perfusion. Postoperatively, the pulse in the lower extremities improved to some extent but was still weak, and malperfusion in kidneys and other visceral organs was suggested by anuria and by changes in the results of blood analysis. On the day after the primary surgery, left axillo-left femoral bypass was performed. After this additional procedure, the pulse in the lower limbs became similar to those of upper limbs, and the anuria disappeared. The recovery of the patient was uneventful thereafter. In this case, it seemed that this additional minor procedure worked effectively to treat the potentially life-threatening ischemic complications of acute aortic dissection.
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