Osamu Suzuki

Rupture of an Isolated Internal Iliac Artery Aneurysm into the Rectum : Report of a Case

Aneurysmal rupture into the intestinal tract is a rare but disastrous complication of an internal iliac artery aneurysm. We report herein the successful surgical repair of a fistula between a huge aneurysm of the right internal iliac artery and the rectum in an 81-year-old man. After a femoro-femoral cross-over bypass had been performed, the aneurysm was opened and its patent arterial branches were ligated with sutures. The fistula was then intra-aneurysmally sutured and covered with an omental flap. The diagnostic and therapeutic approaches to this severe complication are discussed with a review of the literature following the presentation of this case.

Abdominal Aortic Aneurysm Repair with Arterial Branch Reconstruction: Utility of the Temporary Bypass Technique

Between June 1992 and May 1996, five patients underwent an abdominal aortic aneurysm (AAA) repair with concomitant arterial branch reconstruction. All of the patients were males ranging in age from 55 to 66 years (mean: 61.6 years). The operations were performed for a localized abdominal aortic dissection, a pseudoaneurysm after patch angioplasty of a supraceliac AAA, a pararenal AAA, a total AAA with retrograde descending thoracic aortic dissection, and a supraceliac AAA after an infrarenal AAA repair. All patients underwent bilateral renal artery (RA) reconstruction. Three patients also had a concomitant reconstruction of the superior mesenteric artery ad celiac axis. The renal arteries were preferentially reconstructed. Visceral circulation during aortic cross-clamping was maintained via a temporary bypass circuit. A temporary division of the left renal vein was necessary in two patients. Overall, the mean renal ischemia time was 17.2min (range: 10 to 32 min). There was one perioperative death due to sepsis from a graft infection. Another patient died 6 months postoperatively due to pyothorax. One patient required postoperative hemodialysis for 1 month. Based on the above findings, the temporary bypass technique is thus considered to be useful for maintaining physiologic organ perfusion during aortic clamping without the need to use any complicated devices.

Mediastinal vagal neurilemmoma causing tracheal stenosis

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Delayed Manifestation of Aortic Stenosis After Blunt Abdominal Trauma: Report of a Case

Delayed manifestation of aortic stenosis caused by abdominal blunt trauma is rare. We report herein the case of a 67-year-old man who was taken to a nearby hospital after being crushed between a heavy truck and a wall. An emergency laparotomy was performed, revealing only a mesenteric tear which was repaired. He was discharged after an uneventful postoperative course; however, 1 month later he began to experience intermittent claudication, and presented to our hospital in December 1994, 1 year after the first operation. Angiography and enhanced computed tomography (CT) demonstrated infrarenal abdominal aortic dilatation with distal stenosis. Both the dilated and stenotic lesions were resected and bypass surgery was performed. Pathologic examination demonstrated that the intima had been lacerated circumferentially and everted distally, causing the aortic stenosis. To our knowledge, this is the first case of the delayed manifestation of traumatic aortic stenosis to be documented in Japan. The etiology of this rare complication of blunt trauma is described in this report.

Collateral artery bypass in buerger's disease: Report of a novel procedure

A 25-year-old man was admitted to our hospital for treatment of a painful ulcer on his left fourth toe, 9 years after undergoing lumbar sympathectomy and 4 years after undergoing bypass, both of which had been unsuccessful. Angiography demonstrated diffuse arterial occlusion in the lower extremities except for a persistent sciatic artery and a sural artery, which was the main collateral. Thus, reversed bifurcated saphenous vein bypass from the sciatic artery to the sural artery and the posterior tibial artery was performed utilizing Esmarchs rubber bandage as a substitute for a vascular clamp to control bleeding intraoperatively. The ulcer healed promptly and the patient was discharged symptom-free 1 month postoperatively. This case report dmonstrates the advantage of performing collateral arterial bypass and illustrates some of the technical challenges associated with this procedure.

Distal arterial reconstruction using Esmarch's bandage technique to salvage upper extremity function in thoracic outlet syndrome caused by cervical ribs: A report of two cases

We present herein the cases of two patients with thoracic outlet syndrome (TOS) who required arterial reconstruction due to gangrene of the fingers and/or hand. In both patients, the cervical ribs had produced intimal injury of the subclavian arteries, and the successive distal arterial embolism brought about severe ischemia of the affected upper extremity. To treat the TOS, the cervical ribs were resected through a supraclavicular incision. In the first patient, arterial reconstruction was performed from the subclavian artery to the radial collateral artery, a branch of the deep brachial artery, which resulted in minimizing amputation of the gangrenous hand. In the second patient, resection and direct anastomosis of the injured subclavian artery were performed, and bypass surgery from a brachial artery to an interosseous artery was carried out, preserving finger function. Reversed saphenous vein grafts were utilized and Esmarchs bandage technique was applied as a substitute for a vascular clamp in both patients. Following these case reports, we discuss the technique of performing distal bypass in the upper extremities and comment on the usefulness of Esmarchs bandage technique for preserving upper extremity function.

Radial Artery Reconstruction at the Wrist for Hand Claudication Using the Nondissection Method A Case Report

Arterial reconstructions in the upper extremity are reported less frequently than those in the lower extremity. In most cases, the operative indications are to save the hand that has severe ischemia. The authors present a case of radial artery reconstruction performed for hand claudication that was disturbing the patients work as a carpenter. By using the nondissection method, the anastomotic procedure of the small artery was easily performed. The successful result highlights a flexible determination of operative indication for the arterial reconstruction in the upper extremity.

Fate of the Communicated False Lumen Following Surgical Treatment for Aortic Dissection.

大動脈解離術後偽腔血流残存19例で, 術後CTの経時的変化, 術後大動脈造影所見および遠隔予後の関連について検討した. Stanford A型では大動脈径拡大は平均5.1mm/年 (平均観察期間3年5か月) で, 上行4.8mm/年, 弓部5.4mm/年, 下行中枢4.3mm/年, 下行末梢2.7mm/年, 腹部2.4mm/年と中枢側大動脈の拡大が大きく, 全例に major communication を認めた. 大動脈中枢に major communication を伴わないB型 (平均観察期間3年8か月) では, 偽腔は血栓閉鎖傾向にあり大動脈拡大は認めなかった. 遠隔期解離関連事故は, 開窓術や double barrel 吻合を施行した4例および大動脈縫合部に major leakage を認めた2例の計6例 (32%) に, 破裂による突然死 (4例) および解離進展による腸管壊死 (1例) や脳梗塞 (1例) を認めた. 大動脈解離術後偽腔血流残存例においては, CTでの偽腔瘤化の厳重な経過観察と瘤破裂予防の積極的な再手術が重要と考える.