Hiroyoshi Komai

Successful coil embolization for rupture of the subclavian artery associated with Ehlers-Danlos syndrome type IV

Ehlers-Danlos syndrome is a rare inherited disease of connective tissue. Patients with type IV Ehlers-Danlos syndrome are likely to present with arterial disorders such as aneurysm or dissection. We report a 20-year-old man with type IV Ehlers-Danlos syndrome in whom a subclavian arterial rupture was successfully treated with transcatheter coil embolization.

Plasma adiponectin as a predictive factor of survival after a bypass operation for peripheral arterial disease

OBJECTIVE We investigated an association between adiponectin and long-term survival in patients requiring an arterial bypass operation for peripheral arterial disease. METHODS An enzyme-linked immunosorbent assay kit was used to measure plasma adiponectin levels in 49 patients (38 men, 11 women) before they underwent an arterial bypass operation. Median patient age was 70 years (range, 49-90 years). The study excluded patients with hemodialysis requirement, heart failure, malignant neoplasm, or collagen disease. The symptoms at the first visit were severe intermittent claudication in 27 patients (55%) and critical limb ischemia with rest pain or ulcer, or both, in 22 (45%). RESULTS Plasma adiponectin levels were a mean 7.8 +/- 5.3 microg/mL (range, 1.0-25.2 microg/mL). Multiple regression analyses revealed that plasma adiponectin was positively correlated with age (r = 0.49, P = .0003) and negatively correlated with body mass index (r = -0.51, P = .0002) and systolic blood pressure (r = -0.41, P = .0059). The Cox proportional hazards model revealed that plasma adiponectin (hazard ratio, 1.30; P = .03) and critical limb ischemia (hazard ratio, 16.67; P = .047) were significant independent predictors of patient survival after a bypass operation. CONCLUSION Plasma adiponectin could be indicative of mortality after a bypass operation for patients with advanced peripheral arterial disease.

Thoracic endovascular aortic repair with aortic arch vessel revascularization

BACKGROUND Revascularization of aortic arch vessels was performed with thoracic endovascular aortic repair (TEVAR) to preserve the endoprosthesis landing zone in 19 high-risk patients. METHODS The operative procedure used was a bypass or transposition involving the common carotid and subclavian arteries. Homemade fenestrated stent-grafts, deployed in landing zone 0, were used for TEVAR. RESULTS All lesions resolved without endoleaks. No perioperative deaths occurred; seven patients had postoperative complications. One patient with acute respiratory distress syndrome required reoperation to change the bypass route and permit tracheostomy. One patient died of pneumonia 2 months after treatment, after an anastomotic pseudoaneurysm and cerebral infarction developed and an operation was performed to obtain hemostasis. The procedure-related mortality was 5.3%. CONCLUSION Aortic arch vessel revascularization before TEVAR may permit less invasive surgery, although careful patient selection is essential.

Skin perfusion pressure measurement to assess improvement in peripheral circulation after arterial reconstruction for critical limb ischemia.

AIM To assess the utility of skin perfusion pressure (SPP) measurement in evaluating the outcome of vascular constructions for critical limb ischemia (CLI) patients. METHODS We retrospectively studied 19 lower limbs in 18 patients who underwent arterial reconstruction for CLI from whom SPP measurements had been obtained pre- and postoperatively between 2008 and 2010. Six limbs whose ulcers had healed postoperatively were classified into group H, 7 limbs whose ulcers had not healed into group U, and 6 limbs without ulcers into group N. SPP values were compared among these groups. RESULTS The preoperative SPP values in all groups were <30 mmHg, without significant differences among the groups. The SPP values in groups H and N significantly improved after operation, and those in group U were significantly lower than those in the other groups. CONCLUSIONS SPP measurement before and after arterial reconstruction is useful to assess improvement in tissue circulation and to predict the likelihood of wound healing. An SPP value ≥30 mmHg was considered necessary for wound healing, supporting the findings of the few reports in the literature on the usefulness of SPP for assessing vascular reconstruction effects on ulcer wound healing.

Deep Venous External Valvuloplasty Using a Rigid Angioscope

PurposeThe aim of this study was to evaluate the long-term results of deep venous valvuloplasty using a rigid metal angioscope.MethodsForty patients who underwent deep venous external valvuloplasty using a rigid metal angioscope for primary deep venous insufficiency were enrolled. The preoperative CEAP (Clinical/Etiology/Anatomy/Pathophysiology) classifications were class 2 in 13 patients, class 3 in 8 patients, class 4 in 12 patients, class 5 in 1 patient, and class 6 in 6 patients. In 9 legs in 6 patients, the valves were either destroyed or congenitally absent, and deep venous plication was applied instead. The long-term operative results were evaluated from clinical charts and direct telephone interviews.ResultsDuring a mean follow-up period of 5.0 years, we experienced no deep vein thromboses or other complications. In 39 of the 40 patients, the subjective symptoms improved. The improvement after successful valvuloplasty was 82% with respect to the CEAP classification. Among the 9 legs treated by deep venous plication alone, 5 had improved CEAP classifications, while 4 showed no change.ConclusionsDeep venous external valvuloplasty assisted by a rigid angioscope is a safe and effective method for severe valve insufficiency. Furthermore, the long-term results are positive. Deep venous plication may therefore represent an effective alternative for patients who cannot undergo valvuloplasty.

Successful treatment of multiple mycotic aortic aneurysms, using a hybrid procedure.

No generally accepted treatment of multiple mycotic aortic aneurysms of the thoracic and abdominal aorta has yet been established. We report a 67-year-old man with widespread mycotic aortic aneurysms previously treated for malignant lymphoma and interstitial pneumonia. He was successfully treated by a two-stage hybrid surgical procedure comprising open and endovascular methods. This is apparently the first report of repair of multiple mycotic aortic aneurysms using a hybrid procedure.

Reduced Protein C Activity Might be Associated With Progression of Peripheral Arterial Disease

We evaluated the effect of reduced activities of protein C (PC) and protein S (PS) on the progression of peripheral arterial disease (PAD). We measured PC and PS activities in 106 patients with PAD and 44 patients with abdominal aortic aneurysm (AAA) in the same period. The incidences of PC deficiency in PAD and AAA were 4.7% and 4.5%, respectively, and those of PS were 14.1% and 11.4%, respectively; these incidences were much higher than those in the normal population. The PC and PS activities were significantly lower in patients having critical limb ischemia (CLI) than in patients with intermittent claudication. In particular, lower PC activity and female gender were determinant factors of CLI in multivariate logistic regression analysis. We suggest that PC deficiency is an independent predictor for the progression of CLI.

Spontaneous Rupture of Autogenous Saphenous Vein Graft in Bypass Surgery for Peripheral Arterial Disease Possibly Associated With Collagen Disease

We encountered two cases of spontaneous rupture of a saphenous vein bypass graft for lower-leg peripheral arterial disease possibly associated with collagen disease. Rupture occurred 5 and 14 days postoperatively. Neither case had any signs of infection, graft degeneration, or evident injury, but both were associated with collagen disease diagnosed at another hospital. We believe that an association with collagen disease might have contributed to vein wall fragility in the present cases.

Long-Term Results of Crossover Bypass for Iliac Atherosclerotic Lesions in the Era of Endovascular Treatment: The Re-ACTION Study ( Re trospective A ssessment of C rossover Bypass as a T reatment for I liac Lesi ON s)

Objective: The aim of this study was to elucidate the long-term results of crossover bypass (CB) for iliac atherosclerotic lesions in the era of endovascular treatment (EVT). Methods: A retrospective multicenter cohort study was performed. CB was performed in 242 patients between 2003 and 2014 by vascular surgeons at multiple medical centers in Japan. Results: Perioperative mortality was 1.7%. Primary patency rates were 86% at 5 years and 82% at 8 years. Univariate analysis showed that critical limb ischemia (Rutherford class 4–6), vein graft, and superficial femoral artery occlusion were significantly associated with low primary patency. In multivariate analysis, only critical limb ischemia influenced primary patency. The secondary patency rate was 87% at both 5 and 8 years. The limb salvage rate was 98% at both 5 and 8 years. The overall survival rates were 71% at 5 years and 49% at 8 years. Conclusion: The long-term results of CB were good in our study, compared with previous reports. Our results suggest that CB remains an option for the arterial reconstruction in unilateral iliac occlusive disease after EVT failed.

A Case of Popliteal Artery Entrapment Syndrome with Chronic Total Occlusion

Popliteal artery entrapment syndrome (PAES) is rare congenital anomaly that occurs due to compression of the popliteal artery by adjacent musculotendinous structures. We report a 54-year-old woman with PAES of total popliteal arterial occlusion was successfully treated by release of the muscle bundle and reconstruction of the popliteal artery. Pathologic examination revealed that the extracted portion of the popliteal artery had chronic total occlusion with fibrosis and destruction of internal elastic membrane. We should deliberate whether we reconstruct the popliteal artery in addition to release of the aberrant muscle bundle due to the preoperative examination to prevent the reoperation.