Katsuhiko Oda

Endovascular flexible stent grafting with arch vessel bypass for a case of aortic arch aneurysm

The Matsui-Kitamura (MK) stent graft (Kitagawa, Kanazawa, Japan) is designed to fit the curvy portions of the aorta because first-generation rigid skeleton–type stent grafts potentially cause kinking and endoleak as a result of limited flexibility. The MK stent graft consists of a custom-made, self-expandable spiral mesh of a single nitinol wire and thin-walled polyester fabric. We report the first surgical case of aortic arch aneurysm treated with this flexible and curved stent graft after extra-anatomic bypass of the arch vessels to prepare a landing zone for the stent graft.

Use of cuffed anastomosis in total aortic arch replacement.

The distal aortic anastomosis portion of the total arch surgery remains technically complex especially in cases in which an aortic arch aneurysm extends below level of carina. We present the cuffed anastomosis that overcomes this difficulty. We applied this technique in 49 patients of elective total aortic arch aneurysm repair using selective cerebral perfusion from 1996 to 2001. Hospital mortality was 2%.

Successful Management of Esophagoparaprosthetic Fistula After Aortic Surgery

Aortoesophageal fistula is a relatively rare but highly fatal condition, especially in the case of secondary aortoesophageal fistulas after previous thoracic aortic surgery in which the aortic prosthetic graft itself may be involved in the infection, resulting in an esophagoparaprosthetic fistula. In this report, we describe a complicated case of esophagoparaprosthetic fistula arising after descending thoracic aortic replacement and endovascular pseudoaneurysm repair that was successfully treated by surgical resection and in situ aortic graft replacement using a homograft completely covered with an omental flap, combined with subtotal esophagectomy and staged reconstruction of the alimentary tract. The patient has been doing well for 24 months without signs of recurrent infection.

Results of Aortic Surgery in Patients with Marfan Syndrome

PurposeWe reviewed the outcome of aortic operations in patients with Marfan syndrome to evaluate the immediate and long-term results of surgical treatment.MethodsBetween January 1985 and June 2002, 22 patients with Marfan syndrome underwent surgical treatment for aortic diseases at our hospital. Eight patients had Stanford type A aortic dissection and ten patients had aortic root aneurysm with aortic regurgitation. We performed aortic root replacement in 21 patients. Subsequent aortic operations were done in 11 patients, 6 of whom required a third operation. Five patients underwent repeat surgery of the previously operated aortic segment. A collective a total of 42 aortic operations were performed in the 22 patients. Seven patients underwent total aortic replacement.ResultsThe in-hospital mortality rate was 4.5%, and there were three late deaths: two caused by rupture of the dissected aorta, 17 months and 24 months after the last surgical intervention, respectively, and one caused by heart failure 27 months after a total aortic replacement. The overall actuarial survival was 90.2% at 5 years and 74.4% at 10 years.ConclusionsSurgical treatment of patients with Marfan syndrome can be accomplished with low mortality; however, new aortic lesions should be promptly explored, and appropriately timed surgical treatment can substantially improve the prognosis of patients with Marfan syndrome.

Successful treatment of intraoperative heart failure caused by ampulla cardiomyopathy by intra-aortic balloon pumping and percutaneous cardiopulmonary support : Report of a case

An 82-year-old woman underwent total gastrectomy for advanced gastric cancer with invasion to the lower esophagus. Her blood pressure dropped alarmingly during the operation, which was performed via the transabdominal and left-side transthoracic approach. Using echocardiography, we diagnosed intraoperative-oneset reversible heart failure caused by ampulla cardiomyopathy. Because the infusion of catecholamines is associated with secondary heart failure, we gave her calcium antagonists and nicorandil, then started intra-aortic balloon pumping (IABP) and the percutaneous cardiopulmonary support system (PCPS). On postoperative day (POD) 7, the IABP and PCPS were removed and on POD 12, she was extubated successfully. The patient was discharged on POD 54 and has remained well. The factors predisposing her to ampulla cardiomyopathy were left-side thoracotomy, hypoxia caused by one-lung ventilation, and the infusion of high-dose catecholamines. Prompt diagnosis and timely treatment of the heart failure with IABP and PCPS prevented any further complications.

Ascending aortic replacement through right thoracotomy.

A 62-year-old woman with a history of esophageal resection and colon interposition with anterosternal subcutaneous tunnel required replacement of the ascending aorta due to dissecting aortic aneurysm. Preoperative three-dimensional computed tomography enabled us to reveal that right thoracotomy could offer an ascending aortic operation. The patient underwent successful operation under hypothermic circulatory arrest and the right anterolateral thoracotomy provided safe exposure of the diseased ascending aorta even when the suprasternal tunnel precluded conventional median sternotomy.

Modified cuffed anastomosis technique to treat pseudoaneurysms following thoracic endovascular aortic repair

Pseudoaneurysm after thoracic endovascular aortic repair (TEVAR) is very rare. We report a case of thoracic aortic pseudoaneurysms due to flares at the proximal end of a stent graft after TEVAR for ductal aneurysm. We describe a total aortic arch replacement in this case using a modified cuffed anastomosis technique with an elephant trunk procedure leaving the partial stent graft in situ.

Modifying Anastomotic Site in Thoracic Aortic Surgery by Using Biodegradable Felt Strips With or Without Basic Fibroblast Growth Factor

Results: The medial thickness in the PTFE group was significantly lower than that of the PGA with bFGF group (66±5% versus 90±4% of control, < 0.05). The adventitial layer in the PTFE group significantly decreased in thickness compared to control (42±8% of control, < 0.05), whereas those in the PGA and PGA with bFGF groups significantly thickened (117±11 and 134±14% of control, respectively, < 0.05), which was associated with increased vessel number. The failure force measured at anastomotic sites did not show statistical difference between the four groups.

A Case of Inflammatory Aneurysm of the Distal Aortic Arch with Coronary Artery Disease.

炎症性大動脈瘤が胸部大動脈に発生することはきわめて希である.症例は58歳男性で,労作時の胸痛を主訴に精査目的で入院した.心臓カテーテル検査とCT検査から,冠状動脈#6:99%,#9:90%の狭窄病変と,径55mmの真性遠位弓部大動脈瘤と診断され,冠状動脈バイパス手術と弓部大動脈人工血管置換の合併手術を施行された.術中所見で,弓部大動脈瘤壁は高度に肥厚,石灰化し周囲組織と強固に癒着していたため,遠位吻合は最小限の剥離で可能なinclusion法で行った.術後経過は良好で,第35病日に退院した.病理組織学的検査では,著明な繊維化肥厚とりンパ球,プラズマ細胞,マクロファージの浸潤が認められ,炎症性弓部大動脈瘤と診断された.

Successful surgical treatment for impending rupture in acute type a dissecting aneurysm complicated with a thoracoabdominal aortic aneurysm in an octogenarian

Emergency or urgent thoracoabdominal aortic replacement in octogenarians has high morbidity and mortality rates due to decrease in the potential of other organs because of their age and the high invasiveness. Here, report a case of an 81-year-old woman who was diagnosed as having an impending rupture in an acute type A dissecting aneurysm complicated with a thoracoabdominal aortic aneurysm, who was rescued successfully by replacement of the thoracoabdominal aorta, under epidural perfusion cooling.