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Annals of Vascular Diseases

Akira Murata, Koji Amaya, Kentaro Mochizuki, Masami Sotokawa, Shingo Otaka, Kazuhiro Tani, Shota Nakagaki, Tetsuyuki Ueda
We report a case of an aneurysm of the inferior pancreaticoduodenal artery (IPDA), with chronic occlusion of the celiac axis. Both surgical aneurysmectomy and endovascular coil embolization were anticipated to sacrifice IPDA, which could lead to severe acute ischemia in the celiac region. The treatment involved surgical ligation of the aneurysm after bypass grafting from the superior mesenteric artery to the anterior IPDA. A postoperative computed tomography revealed no enhancement of the aneurysm and sufficient collateral blood supply by the patent bypass graft...
March 25, 2018: Annals of Vascular Diseases
Miyako Tanaka, Fukashi Serizawa, Yohei Nagaoka, Takuya Jimbo, Kazuki Kawashima, Takeshi Asakura, Hiroshi Otomo, Kenichi Yokota
We report our experience of two cases of refractory cellulitis caused by peripheral micro-arteriovenous fistulas (AVFs) in the lower extremity. The micro-AVFs were so small that they could not be located accurately; further, the patients' symptoms differed markedly from those previously reported for AVF. AVF is known to cause ischemic symptoms. In contrast, micro-AVF causes congestive symptoms and remains undetected in the majority of patients. Identification of this pathology is crucial to enable effective treatment by the ligation of the incompetent perforator vein that increases venous hypertension, leading to congestive symptoms...
March 25, 2018: Annals of Vascular Diseases
Minami Taki, Takashi Miura, Takahiro Kobayashi, Toshio Kasai, Takahisa Maruyama, Minako Hayakawa, Yu Matsumura, Fumitaka Yamaki, Uichi Ikeda
Primary iliac venous aneurysm is an exceedingly rare abnormality that can be complicated by pulmonary embolism, thrombosis, and rupture. Here we report the case of an otherwise healthy 40-year-old man with a unilateral external iliac vein aneurysm without any evidence of an arteriovenous fistula, proximal stenosis, or obstruction, as reported on computed tomography. Pulmonary embolism was diagnosed using 99m Tc-macroaggregated albumin scintigraphy. To prevent life-threatening complications, we treated the patient with anticoagulant therapy and performed aneurysmectomy with reconstruction using a saphenous vein graft patch...
March 25, 2018: Annals of Vascular Diseases
Katsuaki Tsukioka, Tetsuya Kono, Kohei Takahashi, Hiromu Kehara, Shuichi Urashita, Kazunori Komatsu
A 75-year-old woman was involved in a traffic accident and suffered retrograde type A aortic dissection, multiple rib fractures, and grade II hepatic injury accompanied by intraperitoneal bleeding. We performed total arch replacement using an open stent graft with cardiopulmonary bypass and circulatory arrest. This procedure requires anticoagulation and hypothermia, which are principally contraindicated in severe trauma patients. However, this situation was resolved by managing the patient non-operatively for 7 days, confirming the stabilization of other injured organs, and then performing the surgery...
March 25, 2018: Annals of Vascular Diseases
Hiroshi Sato, Syuichi Naraoka
An axillary arterial aneurysm is a rare disorder, with few surgical cases reported to date. Here we report the case of a left axillary arterial aneurysm associated with Marfan syndrome. A 44-year-old female with Marfan syndrome presented with numbness of the left upper limb and a pulsatile mass on the left chest. A computed tomography scan revealed a highly enlarged and tortuous left axillary arterial aneurysm. We performed a graft replacement and resection of the aneurysm with two skin incisions. After the surgery, the blood flow to the patient's left upper limb was confirmed, and the neurological symptoms improved significantly...
March 25, 2018: Annals of Vascular Diseases
Akiko Okunaga, Yuichi Oshima, Isao Yasui, Saki Ikuma, Norifumi Higashidani, Satoshi Takashima, Hisaaki Kita, Yoshimune Hiramoto, Tadashi Kuroda, Shinji Morimoto, Shinji Sasaki, Hiroshi Takami, Masahiro Izumi
We retrospectively examined patients with ultrasonographically occlusive acute proximal deep vein thrombosis (DVT). All patients were categorized into two groups on the basis of whether great saphenous vein (GSV) flow toward the common femoral vein was detected (flow [+]; n=10) or undetected (flow [-]; n=10). We investigated the relationship between the GSV flow pattern and DVT recanalization. Thrombus recanalization, which is defined as diameter reduction to lower than 40% of the vessel diameter, was confirmed in seven of the flow (+), and none of the flow (-)...
March 25, 2018: Annals of Vascular Diseases
Kohei Hachiro, Takeshi Kinoshita, Tomoaki Suzuki, Tohru Asai
We present the case of a right internal iliac artery aneurysm with arteriovenous fistula in the posterior wall of the right common iliac vein. The fistula would have been difficult to close using endovascular treatment. We strongly anticipated difficulty in controlling bleeding; therefore, we performed cardiopulmonary bypass. Closing the fistula with suture would have been difficult, so we ligated the right common iliac artery and vein around the aneurysm. Femoro-femoral bypass was also performed to preserve blood flow in the lower right leg...
March 25, 2018: Annals of Vascular Diseases
Koji Onoda, Yu Shomura, Takuya Komada
The combination of a double inferior vena cava (IVC), a retroaortic left renal vein, and azygos continuation of the IVC is extremely rare. Here we report the case of a 74-year-old man with this complex venous anomaly associated with a juxtarenal abdominal aortic aneurysm (AAA), who underwent a successful graft implantation with left renal artery reconstruction without injuring the retroaortic venous system. The venous anomaly was diagnosed using preoperative contrast-enhanced computed tomography (CT). Thus, contrast-enhanced CT can provide sufficient information on AAA and anomalous venous anatomy to avoid fatal complications during AAA surgery...
March 25, 2018: Annals of Vascular Diseases
Ai Tochikubo, Shinji Abe, Tomoji Yamakawa, Makoto Yoshida, Yasushige Shingu, Yoshiro Matsui
A man in his 54 was admitted to our hospital owing to progressive postprandial pain for a month. Computed tomography (CT) scan and angiography revealed severe stenosis and calcification of the celiac artery, superior mesenteric artery, and inferior mesenteric artery. Based on the findings of CT scan and angiography, abdominal angina was established and retrograde revascularization was performed only to the superior mesenteric artery using an artificial graft. After the surgery, he remains free of postprandial abdominal pain...
March 25, 2018: Annals of Vascular Diseases
Hayato Fukuda, Hiroki Aoki, Shohei Yoshida, Satoru Tobinaga, Hiroyuki Otsuka, Takahiro Shojima, Kazuyoshi Takagi, Yoshihiro Fukumoto, Hidetoshi Akashi, Seiya Kato, Hiroyuki Tanaka
Objective : Thoracic aortic aneurysm (TAA) reflects the local expansion of the thoracic aorta; the underlying causal molecular mechanism of TAA is not well understood. Recent studies have shown the importance of transforming growth factor beta (TGFβ) signaling in Marfan and Loeys-Dietz syndromes; however, its role in non-familial, non-syndromic TAA remains unclear. Materials and Methods : We performed histochemical and immunohistochemical analyses for activated (phosphorylated) SMAD2 (P-SMAD2) as an indicator of TGFβ signaling activities in the ascending TAA tissue as well as in the ascending aortic tissue with a normal diameter obtained from 7 patients without any clinical findings suggesting familial or syndromic TAA...
March 25, 2018: Annals of Vascular Diseases
Nobuhiro Hara, Takamichi Miyamoto, Junji Yamaguchi, Takamasa Iwai, Sadahiro Hijikata, Keita Watanabe, Yuichiro Sagawa, Ryo Masuda, Ryoichi Miyazaki, Naoyuki Miwa, Masahiro Sekigawa, Tetsuo Yamaguchi, Yasutoshi Nagata, Toshihiro Nozato, Orie Kobayashi, Satoshi Umezawa, Toru Obayashi
Objective : Although deep vein thrombosis (DVT) followed by pulmonary thromboembolism (PE) is a critical complication during pregnancy, there have been few reports about its intrapartum management. We evaluated intrapartum management by using a temporary inferior vena cava filter (IVCF) in pregnant women with PE/DVT. Materials and Methods : Eleven women with PE/DVT during pregnancy between January 2004 and December 2016 were included. The patients were hospitalized for intravenous unfractionated heparin infusion after acute PE/DVT onset...
March 25, 2018: Annals of Vascular Diseases
Zaiqiang Yu, Norihiro Kondo, Mari Chiyoya, Yasuyuki Suzuki, Ikuo Fukuda
Objective : This study aimed to clarify the selection and determination of appropriate treatment for acute symptomatic spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). Methods : Data from 10 consecutive patients, who were diagnosed with symptomatic SIDSMA using computed tomography angiography and were managed in our hospital from January 2010 to October 2015, were retrospectively collected and analyzed. Results : There were nine males and one female; mean patient age was 50.3 (range, 35-64) years...
March 25, 2018: Annals of Vascular Diseases
Tomoaki Iwasaki, Toshiya Nishibe, Yumiko Ohya, Shigeru Inoue, Hitoshi Ogino
Background : Recently, reduced serum levels of ω-3 polyunsaturated fatty acids (PUFAs) including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), have been focused upon as newly recognized risk factors for peripheral artery disease (PAD). The present study investigated the association between disease location and serum levels of ω-3 PUFAs in patients with PAD. Methods : We retrospectively analyzed the data of patients at Tokyo Medical University between August 2011 and November 2015. The subjects included 98 patients who were categorized into two groups: those with (n=72) and without infrainguinal lesions (n=26)...
March 25, 2018: Annals of Vascular Diseases
Kunihiro Yagihashi, Hiroshi Nishimaki, Yukihisa Ogawa, Kiyoshi Chiba, Kenji Murakami, Daijun Ro, Hirokuni Ono, Yuka Sakurai, Takeshi Miyairi, Yasuo Nakajima
Objective : We evaluated early and mid-term results of endovascular aortic repair (EVAR) using crossed-limb and non-crossed-limb techniques. Material and Methods : From December 2011 to October 2013, 37 patients (31 men; mean age 75.4 years) were treated with EVAR (crossed-limb, 21 and non-crossed-limb, 16). We compared technical success, maximum short-axis diameter of abdominal aortic aneurysm, iliac angulation, time for catheterization of the short contralateral limb gate of the main body (SCT), and complications between the groups...
March 25, 2018: Annals of Vascular Diseases
Tomokazu Ohno, Hiroki Aoki, Satoko Ohno, Michihide Nishihara, Aya Furusho, Shinichi Hiromatsu, Hidetoshi Akashi, Yoshihiro Fukumoto, Hiroyuki Tanaka
Objective : Abdominal aortic aneurysm (AAA) is characterized by inflammation and destruction of normal tissue architecture. The present study aimed to evaluate the inflammatory signaling cascade by analyzing the cytokines of AAA tissue. Materials and Methods : We analyzed the comprehensive cytokine secretion profiles of 52 cytokines from human AAA in four patients with AAA using fluorescent beads-based multiplex assay. Further, the effect of janus kinase (JAK) inhibition by pyridone 6 on cytokine profiles was also evaluated...
March 25, 2018: Annals of Vascular Diseases
Nikolaos Kontopodis, Konstantinos Tzirakis, Christos V Ioannou
Although the therapeutic management of abdominal aortic aneurysms (AAAs) is currently based on the maximum diameter criterion, this has often proved inaccurate and misleading. Conversely, the biomechanical approach, which takes into account the pressure-induced wall stress exerted at every point throughout the aneurysmal surface, has been proven superior in predicting the rupture risk of AAAs, and its value is being increasingly recognized among physicians. More recently, hemodynamic indices, such as flow-induced wall shear stresses, have been indicated as potentially significant determinants of AAA natural history...
March 25, 2018: Annals of Vascular Diseases
Fuminori Kasashima, Kengo Kawakami, Yasushi Matsumoto, Masamitsu Endo, Satomi Kasashima, Atsuhiro Kawashima
Immunoglobulin G4-related diseases (IgG4-RD) are systemic inflammatory conditions, characterized by high serum IgG4 concentrations, and pathologically IgG4-positive plasmacytes infiltrations and storiform fibrosis. We described IgG4-related inflammatory abdominal aortic aneurysm in 2008, and revealed the existence of vascular lesions. IgG4-related vascular lesions frequently occur in the aorta and branching medium-sized arteries with or without aneurysmal change. The inflammatory lesion mainly involves in the adventitia, indicating remarkable adventitial fibrous thickening with infiltration of inflammatory cells...
March 25, 2018: Annals of Vascular Diseases
Naoki Haruta
There were three epoch making events in therapy of varicose veins. The first one is that the endovascular heat ablation (EVHA) using diode laser was authorized by the Ministry of Health Labor and Welfare in January 2011. The second one is that Subfascial Endoscopic Perforator Surgery (SEPS) was also authorized in April 2014. All of the therapies which were covered by the national insurance system had been the procedures for superficial veins but the SEPS is procedure for the perforating veins. The third one is that the foam usage of Polidocasklerol was listed formally at the medical package insert in September 2016...
March 25, 2018: Annals of Vascular Diseases
Atsubumi Murakami
In this seminar, I would like to discuss the recent hybrid operations in patients with peripheral arterial diseases. Hybrid is generally defined as combinations of different types of things. In the surgical community, it is loosely defined as therapy combining open surgery (OS) and endovascular therapy (EVT). In practice, combination surgery of diseased inflow vessels by EVT and outflow vessels by OS is a typical example, namely, the combination therapy of thromboendarterectomy (TEA) for common femoral artery and EVT (PTA and stenting) for iliac artery in patients with PAD (ilio-femoral lesions)...
March 25, 2018: Annals of Vascular Diseases
Hiroyuki Ishibashi
Vascular Behçet's disease (BD) would keep risk of anastomotic pseudoaneurysm due to deterioration of the disease even after vascular surgery was successfully done. Therefore, it is one of the least-welcome diseases for vascular surgeons. There still exist several points on a concept and criteria of the vascular BD which not only general practitioners but also the vascular surgeons do not understand. Clinical findings strongly suspecting vascular BD are follows; saccular aneurysms without atherosclerosis developed in younger than 50-year-old patients, superior vena cava syndrome or deep vein thrombosis in bilateral legs without apparent causes, and multiple superficial thrombophlebitis, etc...
March 25, 2018: Annals of Vascular Diseases
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