Seiji Kamei

Mid-term results of endovascular abdominal aortic aneurysm repair: Is it possible to predict sac shrinkage?

PurposeTo evaluate the mid-term results of endovascular repair of abdominal aortic aneurysms and to predict subsequent sac shrinkage.MethodsFrom December 2006 to April 2010, 114 abdominal aortic aneurysms were treated with stent grafts. The intraoperative sac pressure was measured by a microcatheter. Correlations between the diameter change and relevant factors were determined by a logistic regression analysis.ResultsStent grafts were deployed successfully in all patients. Type-2 endoleaks were noted in 25 patients (22%); there were no type-1 or type-3 endoleaks at discharge. The clinical success rate was 99%. The diameter was reduced in 40 patients (56%) but remained unchanged in 32 (44%). There were no aneurysms that increased in diameter. At 2 years after the repair the rate of cumulative survival was 87% and freedom from secondary intervention was 95%. The sac pressure index after stent grafting with a reduced diameter was 0.56 ± 0.11 and that of patients with an unchanged diameter was 0.52 ± 0.14. There were no significant differences between the two groups. Persistent type-2 endoleaks had a slightly negative effect on sac shrinkage (P = 0.052).ConclusionsThe mid-term results of endovascular aneurysm repair were satisfactory. Although it was difficult to predict the fate of a sac after stent grafting, persistent type-2 endoleaks were observed to have a slightly negative impact on sac shrinkage.

Endovascular repair for a descending thoracic aortic aneurysm with a stent-graft covering the celiac artery: Report of two cases

An adequate landing zone for fixation and sealing is necessary for endovascular aneurysm repair (EVAR). This report presents two cases of a successful EVAR for thoracic aortic aneurysms (TAA) with a stent-graft covering the celiac artery (CA) to secure a distal landing zone. Case 1 was a 61-year-old man with a chronic traumatic descending TAA 12 mm away from the CA. Case 2 was a 79-year-old man with a descending TAA proximal to the CA. Preoperative angiography and computed tomography (CT) scan revealed a normal visceral blood flow including the peripancreatic arteries. Endovascular aneurysm repair with coverage of the CA was performed in both cases. Angiography after the EVAR demonstrated good blood flow to the CA branches via the peripancreatic arteries and a CT scan showed thrombosed aneurysms. Both patients were discharged without any abdominal symptoms. Endovascular aneurysm repair with a stent-graft covering the CA may therefore be an acceptable endovascular approach in treating selected TAA patients with a limited distal landing zone.

Emergent coil embolization for ruptured renal artery aneurysm

We report a case of ruptured renal artery aneurysm successfully treated by emergent transcatheter embolization with microcoils. A 66-year-old woman was referred for emergency treatment after presenting with sudden-onset left flank pain and vomiting. Blood examination showed anemia. Computed tomography demonstrated a partly calcified mass with massive retroperitoneal hematoma. With the diagnosis of a ruptured left renal artery aneurysm, emergency angiography was performed. Left renal arteriography demonstrated a saccular aneurysm at the lower aspect of the renal hilum. A total of five microcoils were placed at the arterial branch, including the orifice of the aneurysm. The first coil was partly lodged in a branch near the orifice of the aneurysm that was used as an “anchor” to prevent subsequent coils from migrating and effectively occluding the parent artery with a short segment. Two branches originating from the renal hilum were preserved. The postoperative course was favorable. Endovascular treatments, including coil embolization, appear to be effective, safe, and less invasive than surgery. This method should be considered as a treatment of choice for ruptured renal artery aneurysm.

Practice Guidelines for Primary Care of Acute Abdomen 2015

Since acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the Japanese Society for Abdominal Emergency Medicine, in collaboration with four other medical societies, launched the Practice Guidelines for Primary Care of Acute Abdomen that were the first English guidelines in the world for the management of acute abdomen. Here we provide the highlights of these guidelines (all clinical questions and recommendations were shown in supplementary information). A systematic and comprehensive evaluation of the evidence for epidemiology, diagnosis, differential diagnosis, and primary treatment for acute abdomen was performed to develop the Practice Guidelines for Primary Care of Acute Abdomen 2015. Because many types of pathophysiological events underlie acute abdomen, these guidelines cover the primary care of adult patients with nontraumatic acute abdomen. A total of 108 questions based on nine subject areas were used to compile 113 recommendations. The subject areas included definition, epidemiology, history taking, physical examination, laboratory test, imaging studies, differential diagnosis, initial treatment, and education. Japanese medical circumstances were considered for grading the recommendations to assure useful information. The two‐step methods for the initial management of acute abdomen were proposed. Early use of transfusion and analgesia, particularly intravenous acetaminophen, were recommended. The Practice Guidelines for Primary Care of Acute Abdomen 2015 have been prepared as the first evidence‐based guidelines for the management of acute abdomen. We hope that these guidelines contribute to clinical practice and improve the primary care and prognosis of patients with acute abdomen.

The Practice Guidelines for Primary Care of Acute Abdomen 2015

BackgroundSince acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the Japanese Society for Abdominal Emergency Medicine in collaboration with four other medical societies launched the Practice Guidelines for Primary Care of Acute Abdomen that were the first English guidelines in the world for the management of acute abdomen. Here we provide the highlights of these guidelines [all clinical questions (CQs) and recommendations are shown in supplementary information].MethodsA systematic and comprehensive evaluation of the evidence for epidemiology, diagnosis, differential diagnosis, and primary treatment for acute abdomen was performed to develop the Practice Guidelines for Primary Care of Acute Abdomen 2015. Because many types of pathophysiological events underlie acute abdomen, these guidelines cover the primary care of adult patients with nontraumatic acute abdomen.ResultsA total of 108 questions based on 9 subject areas were used to compile 113 recommendations. The subject areas included definition, epidemiology, history taking, physical examination, laboratory test, imaging studies, differential diagnosis, initial treatment, and education. Japanese medical circumstances were considered for grading the recommendations to assure useful information. The two-step methods for the initial management of acute abdomen were proposed. Early use of transfusion and analgesia, particularly intravenous acetaminophen, were recommended.ConclusionsThe Practice Guidelines for Primary Care of Acute Abdomen 2015 have been prepared as the first evidence-based guidelines for the management of acute abdomen. We hope that these guidelines contribute to clinical practice and improve the primary care and prognosis of patients with acute abdomen.

Angiographic Guidewire with Measuring Markers: Design and Clinical Experience

PurposeWe have developed an angiographic guidewire with measuring markers to determine accurately how far a guidewire is inserted within a catheter. We investigated whether use of this guidewire reduces the risk of vascular injury and the fluoroscopic time during guidewire manipulations.MethodsFour markers were put on the surface of the guidewire at 80, 100, 110, and 120 cm from the tip. The actual lengths of 54 catheters from seven manufacturers were measured and compared with the nominal lengths. Sixty consecutive patients who underwent angiography were randomized into two groups: in one group guidewires with surface markers were used (marker group) and in the other group, conventional guidewires (control group). For each guidewire insertion, the fluoroscopic time before the guidewire was pushed forward into the vessel lumen was recorded. The number of occasions on which unintentionally the guidewire had already been pushed out of the catheter at the start of fluoroscopy was also evaluated.ResultsThe actual lengths of all catheters were greater than the nominal lengths by 1.0–11.0 cm. Mean fluoroscopic time for each guidewire insertion was 3.3 sec in the marker group and 5.7 sec in the control group (p < 0.05). Guidewires were unintentionally pushed out of the catheters without fluoroscopy three times (3.6%), in each case in the control group.ConclusionThe guidewire with measuring markers is effective for enhancing safety and in reducing fluoroscopic radiation during angiographic procedures. It is recommended that operators be aware that actual lengths of catheters may vary significantly from the nominal lengths listed; they should be aware of this with any guidewire, but particularly with the angiographic measuring guidewire.

Metastatic embryonal carcinoma mimicking locally advanced non-small cell lung cancer.

A 50-year-old man with a history of smoking of 45 pack-years underwent right lower lobectomy after neoadjuvant chemoradiotherapy for locally advanced non-small cell lung cancer diagnosed on a bronchial biopsy and standard imaging examinations, including chest-abdominal contrast-enhanced computed tomography (CT) and whole-body F-18 fluorodeoxyglucose positron emission tomography/CT. Left orchiectomy was performed simultaneously to treat the slightly swollen left testis, which had remained unchanged for over five years. The thoracic tumor was proven to be in pathological complete remission and the testicular lesion was pathologically diagnosed as an embryonal carcinoma. Furthermore, a pathological reevaluation of the preoperative bronchial biopsy specimen revealed the lung tumor to be a metastatic embryonal carcinoma.