Norio Morimoto

Treatment of Primary Varicose Veins : An Assessment of the Combination of High Saphenous Ligation and Sclerotherapy

This study was conducted to determine the optimal treatment for minimizing the recurrence of varicose veins, and to assess the value of the combined treatment of high saphenous ligation and sclerotherapy. A combined total of 967 limbs in 660 patients with primary varicose veins were treated. The treatments comprised: sclerotherapy alone in 81 limbs, high saphenous ligation alone in 3 limbs, a combination of sclerotherapy and high sephenous ligation in 843 limbs, and a combination of sclerotherapy and ligation of incompetent perforating veins in 10 limbs. Recurrent varicose veins appeared from 3 months after the initial treatment in 61 (6.3%) limbs. Saphenous-type recurrence, being the presence of saphenofemoral incompetence (SFI) and/or saphenopopliteal incompetence (SPI), was found in 20 limbs, and further treatment was given. Segmental-type recurrence, being superficial varices without SFI or SPI, was found in 41 limbs, all of which were treated with further sclerotherapy alone. To minimize the recurrence rate of varicose veins, the presence or absence of SFI, SPI, and incompetent perforating veins must be confirmed prior to the initial treatment. It was concluded that the combination of high saphenous ligation and sclerotherapy is effective for patients with SFI and/or SPI, whereas sclerotherapy alone is better for patients without SFI or SPI.

Three-dimensional computed tomographic angiography in lower extremity revascularization

To evaluate the role of three-dimensional computed tomographic angiography (3D-CT) in peripheral artery bypass surgery, 49 patients with chronic lower limb ischemia underwent 3D-CT before and after a bypass operation. 3D-CT had a sensitivity of 96.8%, a specificity of 95.0% and an overall accuracy of 96.1% for the diagnosis of arterial and graft stenosis or obstructions. The ability to observe the acquired images at any angle was very useful for assessing the implanted graft in both aortoiliac and infrainguinal bypasses. Although these images equally identified arterial stenosis, obstruction, and the anastomotic morphology of bypass grafts as well as conventional angiography, the diagnostic accuracy was not helpful in the small arteries and grafts. 3D-CT is a low-invasive imaging method that is sufficient for forming strategies for bypass operations. In aortofemoral or femoropopliteal bypass surgery, 3D-CT thus provides sufficient imaging accuracy for bypasses up to the popliteal artery below the knee in patients with chronic limb ischemia.

Combined Early Gastric Cancer with Abdominal Aortic Aneurysm: A Case Report.

症例は70歳, 男性. 早期胃癌の診断にて術前検査中に, 腹部CT, 超音波検査にて, 最大径6cmの腎動脈下腹部大動脈瘤および両側総腸骨動脈瘤を認めた. 全身状態良好で二期的, 分割手術に耐えられると判断し, 早期胃癌に対する手術を先行させ, 術後33日目に, 腹膜外経路により腹部大動脈瘤の手術 (瘤切除, 人工血管置換術) を施行し, 良好な結果を得た. 消化管悪性腫瘍と腹部大動脈瘤の合併例では, 同時手術例も報告されているが, 二度の全身麻酔に耐えられない poor risk の症例を除いては, 人工血管感染の危惧がない二期的, 分割手術がよい適応であり, また腹膜外径路による大動脈瘤手術の利点が確認された.