Eisaku Ito

Deployment Accuracy of the Conformable GORE(®) TAG(®) Thoracic Endoprosthesis in the Treatment of Zones 2 and 3 Aortic Arch Aneurysms Compared with the Previous TAG(®).

PURPOSESnWhen placing stent grafts, deployment accuracy and birdbeaking due to inadequate conformability and device apposition along the inner curvature of the arch have been encountered. The new Conformable GORE® TAG® Thoracic Endoprosthesis (CTAG) is designed to have enhanced compression resistance and improved conformability in difficult anatomy. The present study compared the deployment accuracy and conformability of the CTAG Device with TAG Device.nnnMETHODnDeployment accuracy and birdbeaking was compared of CTAG Device and TAG Device implantation for initial treatment of thoracic aortic aneurysm conducted by our department between March 2010 and March 2012. Deployment accuracy was defined as the distance between the actual and intended device implantation locations measured from DSA images.nnnRESULTSnDeployment accuracy at the time of implantation (mean ± SD) was significantly better for the CTAG Device compared to the TAG Device (2.2 ± 1.7 mm vs. 4.4 ± 3.0 mm, P <0.05). Also, while birdbeaking was seen in 8 of 20 cases (40%) for the TAG Device, it was only seen in 1 of 12 cases (8%) for the CTAG Device.nnnCONCLUSIONnThe present study found enhanced deployment accuracy and conformability along the aortic arch using the CTAG Device compared to the previous-generation TAG Device.

Fenestrated endovascular repair of aortic arch aneurysm in patients with bovine arch using the Najuta stent graft

We describe the case of a 74-year-old man with a thoracic aortic aneurysm with a bovine arch who underwent fenestrated endovascular repair of aortic arch aneurysm using the Najuta stent graft (Kawasumi Laboratories, Inc, Tokyo, Japan). He has had a previous endovascular aneurysm repair and femoropopliteal bypass for abdominal aortic aneurysm combined with peripheral arterial disease. The Najuta stent graft was inserted and deployed at zone 0 with delicate positional adjustment of the fenestration of the stent graft to the brachiocephalic trunk. There was no endoleak or complication. His postoperative course was uneventful. At 7-month follow-up, complete exclusion of the aneurysm was noted. The Najuta stent graft repair of aortic arch aneurysms is a safe and effective treatment option for patients with a bovine arch.

A case of bronchial artery aneurysm with an esophageal fistula as an extremely rare complication after bronchial arterial embolization

A bronchial artery aneurysm with an esophageal fistula (BAAEF) is an extremely rare and potentially fatal condition. Only three cases of a bronchial artery aneurysm (BAA) with hematemesis have been reported previously. Two cases of the pinhole-type were successfully treated with only coil embolization, while one case was lost due to massive bleeding (1-3). Here, we report a case of a BAAEF that developed 3 months after bronchial arterial embolization (BAE) for hemoptysis.

Aneurysm sac enlargement 16 years after endovascular aortic aneurysm repair due to late type IIIb endoleak: A case report

Highlights • We diagnosed a type IIIb endoleak and performed a secondary relining procedure with an ePTFE device.• Compared with the type IIIb endoleaks discussed in past reports, the present case occurred with a much longer delay.• Relining using an ePTFE endograft may be considered an effective for type IIIb endoleaks.

Case Series of Aortic Arch Aneurysm in Patients with Bovine Arch Treated with Proximal Scalloped and Fenestrated Stent Graft

PurposeThe bovine arch is the most common variant of the aortic arch and occurs when the innominate artery shares a common origin with the left common carotid artery. We report an endovascular repair of aortic arch aneurysm in patients with a bovine arch using the Najuta proximal scalloped and fenestrated stent graft.Materials and MethodsThoracic endovascular aneurysm repairs using the Najuta stent graft were performed at our facility. It was inserted and deployed at a zone 0 with precise positional adjustment of the scallop of the stent graft to the brachiocephalic trunk.ResultsOverall, eight patients with bovine aortic arch were treated with fenestrated endovascular aneurysm repair. Technical success was 100% with no 30-day death. The follow-up period ranged from 7 to 29 (median 12) months. None of the patients had a stroke or paraplegia, and no endoleak was observed. All brachiocephalic trunks scalloped, and the left subclavian artery fenestrated vessels remained patent during the follow-up period.ConclusionThe Najuta stent graft repair of aortic arch aneurysms in patients with a bovine arch is a safe and effective treatment option, with good immediate and short-term results.

Risk factor analyses of abdominal aortic aneurysms growth in Japanese patients

BACKGROUNDnThis study aimed to retrospectively demonstrate the growth rate (mm/year) of abdominal aortic aneurysm (AAA) diameters (ADs) and to analyze risk factors for AAA expansion.nnnMETHODSnWe retrospectively investigated the clinical data of 319 patients with AAAs who were followed up as outpatients for >2xa0years after their initial visit and who underwent computed tomography >4 times.nnnRESULTSnThe mean follow-up period was 3.7xa0±xa01.5xa0years. The annual average growth rates according to varying ADs were as follows: 1.9xa0±xa00.8 (AD 30-34xa0mm), 2.6xa0±xa01.2 (AD 35-39xa0mm), 2.8xa0±xa01.1 (AD 40-44xa0mm), 3.1xa0±xa01.3 (AD 45-49xa0mm), 3.4xa0±xa01.6 (AD 50-54xa0mm), and 3.5xa0±xa01.4xa0mm (AD ≥55 mm). Factors associated with AAA expansion were smoking (Pxa0=xa00.017), hypertension (Pxa0<xa00.001), and ADs (Pxa0<xa00.001). In the subgroup analysis, data regarding growth rates of ≥3xa0mm were extracted, and a statistically significant difference between smoking status and ADs of ≥40xa0mm was observed.nnnCONCLUSIONSnFactors associated with AAA expansion in Japanese patients included smoking, hypertension, and ADs, and a statistically significant difference was observed between smoking status and ADs of ≥40xa0mm.

Endovascular Aneurysm Repair–First Strategy for Ruptured Aneurysm Focuses on Fitzgerald Classification and Vein Thrombosis

BACKGROUNDnRecent study have demonstrated the good results of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysms (RAAAs). We report on the results of our EVAR-first strategy for RAAAs focuses on Fitzgerald (F) classification and vein thrombosis.nnnMATERIALS AND METHODSnFrom 2011 to 2017, 31 patients with RAAA underwent EVAR at our hospital. We compared F-1 patients (group A) with F-2 to F-4 patients with obvious retroperitoneal hematoma (group B).nnnRESULTSnThe baseline characteristics in group A (nxa0=xa09) and group B (nxa0=xa022) were similar. In group B, there were 8 cases of F-2, 10 cases of F-3, and 4 cases of F-4. Of the 22 cases in group B, 16 (73%) cases involved preoperative shock. Operation time was not significantly different (group A: 147xa0min and group B: 131xa0min, Pxa0=xa00.48). The total mortality rate of group A and group B combined was 77.4%. The 30-day mortality was 0% for group A and 23.8% for group B, in which there were 2 F-4 cases and 3 F-3 cases. In group B, hematoma-related complications developed in 6 cases (deep vein thrombosis: 4 cases, abdominal compartment syndrome: 1 case, and hematoma infection: 1 case), and 1 case with deep vein thrombosis developed a pulmonary embolism that resulted in cardiac arrest. The 3-year survival rate was significantly higher for group A (100% vs. 52.3%, Pxa0=xa00.016), but the freedom from aortic death rate was not significantly different (100% vs. 66.7%, Pxa0=xa00.056).nnnCONCLUSIONSnUsing EVAR for RAAA is a valid strategy. Certain complications that are associated with peritoneal hematoma, especially venous thrombosis, should receive particular attention.

Prophylactic accessory renal artery coil embolization for prevention of type II endoleak following endovascular aneurysm repair: a case report

BackgroundPrior reports indicate that intentional coverage of the accessory renal arteries (ARAs) with a diameter larger than 3xa0mm during endovascular aneurysm repair (EVAR) increases risk of additional treatment for type II endoleak. Here, we report a case of prophylactic coil embolization for a 4xa0mm ARA originating from an abdominal aortic aneurysm.Case presentationA 76-year-old woman was admitted to our hospital after noticing an abdominal pulsatile mass. Computed tomography (CT) imaging revealed an abdominal aortic aneurysm (AAA) with a maximum diameter of 53xa0mm. Preoperative CT scan showed a right ARA, 4xa0mm in diameter, which was considered likely to lead to type II endoleak following EVAR. ARA coil embolization was performed at the time of EVAR. We observed no endoleaks and no infarct of the inferior pole of the right kidney on completion angiography. The postoperative course was uneventful, and the patient was discharged 7xa0days later. Postoperative eGFR (58.4xa0ml/min) was not significantly different from preoperative level (56.7xa0ml/min). After EVAR, blood pressure was under control, and no additional anti-hypertensive medicines were required. Postoperative enhanced CT image showed that the distal portion of the ARA was well perfused without type II endoleak from ARA.ConclusionsProphylactic coil embolization for a large ARA originating from an abdominal aortic aneurysm appears to be safe and effective in preventing type II endoleak following EVAR.

Ascending aorta-common hepatic artery bypass for mesenteric revascularization

Highlights • We report the case of a patient who underwent hemodialysis because of a bilateral renal occlusion.• He also had occlusion of the superior mesenteric artery and stenosis of the celiac artery.• We performed antegrade bypass using great saphenous vein from the ascending aorta to the common hepatic artery.• The bypass remained patent 20 months after the procedure, and the patient was asymptomatic.• There is no report using the common hepatic artery as a revascularization outflow in patients with CMI.

Aneurysm Wall Enhancement Detected by Contrast Computed Tomography Scan Is Associated With Aneurysm Shrinkage After Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm

BACKGROUNDnAneurysm expansion, and consequent endoleaks, after endovascular aneurysm repair (EVAR) is a major problem. Accurate prediction of aneurysm expansion is demanding for surgeons and remains difficult.Methodsu2004andu2004Results:We retrospectively analyzed 157 cases of EVAR for abdominal aortic aneurysm (AAA) using a bifurcated main-body stent-graft. There were 62 cases of aneurysm shrinkage after EVAR, 63 cases of stable aneurysm, and 32 cases of aneurysm expansion. Type I endoleaks were significantly increased in the aneurysm expansion group (EXP) compared with the stable (STB) and shrinkage (SHR) groups (EXP: 15.6% vs. STB: 4.8% vs. SHR: 0%, P=0.005). Type II endoleaks were also significantly increased in EXP (EXP: 65.6% vs. STB: 36.5% vs. SHR: 6.5%, P<0.001). Aneurysm wall enhancement (AWE) on imaging, however, was significantly decreased in the EXP group (EXP: 18.8% vs. STB: 23.8% vs. SHR: 53.2%, P<0.001). In multivariate analysis, the occurrence of type II endoleaks significantly decreased (P<0.001) and that of AWE significantly increased the likelihood of aneurysm shrinkage (P=0.032).nnnCONCLUSIONSnAWE following EVAR may be associated with aneurysm shrinkage.