Keiko Miyazaki

Postoperative renal function after elective abdominal aortic aneurysm repair requiring suprarenal aortic cross-clamping.

PurposeTo examine postoperative renal function after suprarenal aortic cross-clamping performed without renal hypothermia in patients undergoing elective abdominal aortic aneurysm (AAA) surgery.MethodsBetween 1991 and 2000, 18 patients underwent surgery for a juxtarenal AAA, which required a suprarenal aortic cross-clamp. All AAAs were repaired with a proximal anastomosis just below the renal arteries. We divided the patients into two groups according to the duration of the renal ischemia: <45u2009min (n = 12) and ≥45u2009min (n = 6). The postoperative changes in renal function were analyzed.ResultsThere were no hospital deaths and none of the patients needed permanent hemodialysis. The postoperative peak in the serum creatinine level after suprarenal cross-clamping for ≥45u2009min was significantly higher than that after cross-clamping for <45u2009min. The percentage changes in serum creatinine and blood urea nitrogen were correlated positively with the duration of renal ischemia, and were significantly greater in the group with renal ischemia of <45u2009min than in the group with prolonged renal ischemia (≥45u2009min).ConclusionsSuprarenal aortic cross-clamp without performing renal hypothermia is safe and able to be tolerated well by the patient during elective AAA surgery, although careful attention must be paid to limiting the period of renal ischemia.

Use of bioresorbable membrane to prevent postoperative small bowel obstruction in transabdominal aortic aneurysm surgery.

PurposeTo evaluate the efficacy of Seprafilm (Genzyme, Cambridge, MA, USA), a bioresorbable membrane, in preventing or reducing early postoperative small bowel obstructions after transabdominal abdominal aortic aneurysm (AAA) surgery.MethodsFifty-one patients underwent aortic reconstruction via a midline transperitoneal approach for infrarenal AAAs. Twenty-one patients underwent surgery with Seprafilm (Seprafilm group) and the remaining 30 patients did not (control group). The incidence of early small bowel obstruction was examined, and the time before liquid and solid diet were resumed was also compared to assess postoperative paralytic ileus.ResultsPatients in the Seprafilm group resumed a liquid diet on postoperative day (POD) 2.4 ± 1.1 and a solid diet on POD 4.0 ± 1.3, whereas the patients in the control group resumed a liquid diet on POD 3.3 ± 1.9 and a solid diet on POD 5.4 ± 3.4. These values were not significantly different between the two groups; however, the incidence of early postoperative small bowel obstruction was significantly lower (P < 0.05) in the Seprafilm group (0/21) than in the control group (6/30).ConclusionThese findings suggest that Seprafilm may help to prevent early postoperative small bowel obstructions after transabdominal AAA surgery.

Stripping operation with preservation of the calf saphenous veins for primary varicose veins: hemodynamic evaluation.

PURPOSEnTo study early changes in venous hemodynamics in stripping operation with preservation of the calf saphenous veins.nnnPATIENTS AND METHODSnFrom October 1999 to December 2000, 110 extremities of 73 patients were treated for primary varicose veins. Based on preoperative ascending venography, 40 extremities underwent the groin-to-knee stripping of the GSV, 20 underwent the proximal division of the LSV, and 50 received combinations of both surgeries. To evaluate venous hemodynamic changes, air plethysmography was performed before operation and 7-14 days after operation.nnnRESULTSnThe venous volume, venous filling index and residual volume fraction were improved after surgery, but the ejection fraction did not change. The overall incidence of nerve injury was 4.5% (five limbs).nnnCONCLUSIONSnIn stripping operations, the preservation of the calf saphenous veins, which is shown to be advantageous in reducing saphenous or sural nerve injuries, does not adversely affect early venous hemodynamic improvement.

Successful Endovascular Stent-Graft Treatment for an Aortoesophageal Fistula Caused by a Descending Thoracic Aortic Aneurysm : Report of a Case

Conventional surgery for aortoesophageal fistula (AEF) is technically difficult, and is associated with high morbidity and mortality. We report a case of primary AEF caused by a descending thoracic aortic aneurysm, which was successfully treated with an endovascular stent-graft technique. The patient has been followed up for 3 years with no signs of infection.

Left renal vein anomaly associated with abdominal aortic aneurysm surgery: Report of a case

Retroaortic left renal vein occurs infrequently and poses potential hazards to the surgeon during abdominal aortic surgery. We herein report the case of a 77-year-old man with a retroaortic left renal vein who underwent an abdominal aortic aneurysm (AAA) repair. The retroaortic left renal vein was diagnosed preoperatively by contrast-enhanced computed tomography (CT). The patient underwent a successful abdominal aortic replacement with an uneventful postoperative course without any renal complications. The CT scan was useful for both evaluating the AAA and for establishing the presence of the venous anomaly. Major venous anomalies (retroaortic left renal vein, left renal vein collar, left-sided inferior vena cava, and caval duplication) should thus be taken into consideration in AAA operations.

Cilostazol suppresses neointimal hyperplasia in canine vein grafts

PurposeTo investigate whether cilostazol, a cyclic adenosine monophosphate (cAMP) phosphodiesterase inhibitor, suppresses intimal hyperplasia in canine vein grafts, and to elucidate its mechanisms in terms of cell proliferation and apoptosis.MethodsBilateral reversed jugular vein interposition grafts of the common carotid artery were performed in 12 beagle dogs. Starting from 7 days before surgery, either cilostazol (30 mg/day; n = 6) or a placebo (n = 6) was given orally twice daily. Vein grafts were harvested at 1 or 4 weeks, and fixed under pressure for histological examination.ResultsBy 1 week after implantation, the cilostazol group showed significantly less cell proliferation than the placebo group. By 4 weeks after implantation, intimal and medial thickness was significantly thinner in the cilostazol group than in the placebo group. There was significantly more apoptosis in the placebo group than in the cilostazol group at both time points.ConclusionCilostazol suppressed the development of intimal hyperplasia in canine autogenous vein grafts. Thus, it may be associated with the modulation of cell proliferation and apoptosis.

Dissecting Aneurysm of the Infrarenal Abdominal Aorta : Report of a Case

A primary abdominal aortic dissection is exceedingly rare, especially in the absence of blunt abdominal trauma. We herein report a case of aortic dissection with aneurysmal dilatation (dissecting aneurysm) of the infrarenal abdominal aorta in a 61-year-old female patient, and discuss the diagnostic and therapeutic management of this rare disorder.

Stripping Operation with Sclerotherapy for Primary Varicose Veins Due to Greater Saphenous Vein Reflux: Three-year Results

The purpose of this study was to compare the recurrence-free rates of stripping with varicectomy and stripping with sclerotherapy for the treatment of primary varicose veins due to greater saphenous vein insufficiency. This is a multicenter retrospective analysis of 186 patients and 220 limbs treated for primary varicose veins due to greater saphenous vein reflux from January 1996 to December 1997. The difference between the two groups was evaluated by the Χ2 test or t-test. The recurrence-free rates were estimated by the Kaplan-Meier life-table method. The mean follow-up period was 3.2 ± 1.1 years. The clinical backgrounds of patients with varicectomy stripping and sclerotherapy stripping were not significantly different between the two groups. The overall recurrence-free rates at 1 and 3 years were 97.0% and 91.4%, respectively. The recurrence-free rates at 3 years were 93.5% for stripping with varicectomy and 88.6% for stripping with sclerotherapy. No statistical difference was found between the two groups. The recurrence rate after stripping with sclerotherapy was equivalent to that after stripping with varicectomy. Thus concurrent varicectomy can be replaced with sclerotherapy.

Venous Stasis Ulcers Due to Primary, Isolated Deep Venous Insufficiency in a Patient with Systemic Lupus Erythematosus: Report of a Case

Abstract.Primary, isolated deep venous incompetence is rare, difficult to diagnose, and can lead to the development of venous stasis ulcers. We herein report a case demonstrating chronic venous stasis ulcers due to primary, isolated deep venous incompetence, which was misdiagnosed as vasculitis ulcers associated with systemic lupus erythematosus (SLE). Although primary, isolated deep venous incompetence is rare, it is important to bear this possibility in mind when a patient presents with leg ulcers.

Successful Arterial Reconstruction with Collateral Artery Bypass for a Femoral Artery Aneurysm: Report of a Case

The outcome of surgery for femoral artery aneurysms is dependent on the preoperative status of the runoff vessels. We report a case of a femoral artery aneurysm complicated by thromboembolic obstruction of the distal superficial femoral and profunda femoris arteries. Fortunately, the collateral arteries were viable runoff vessels for restoring adequate blood flow to the limb.