Seiji Onitsuka

Spontaneous Dissection of the Iliac Artery in a Patient With Fibromuscular Dysplasia

A 49-year-old man was referred to our hospital at 10 days after the onset of sudden intermittent claudication of the right lower limb and with right lower abdominal pain. Diagnosis by computed tomography scan and pelvic angiography was dissection from the common iliac artery to peripheral external iliac artery with thrombosed false lumen. Replacement of the common and external iliac artery was performed using a 10-mm Dacron prosthesis. A pathological examination of the right common iliac artery revealed an arterial disorder caused by fibromuscular dysplasia.

Perioperative Outcomes for Elective Open Abdominal Aortic Aneurysm Repair since the Adoption of Endovascular Grafting Procedures

OBJECTIVES The objective of this study was to evaluate and compare our perioperative outcomes for open abdominal aortic aneurysm (AAA) between the pre-endovascular aneurysm repair (pre-EVAR) and EVAR eras and to analyse whether the AAA that was excluded from EVAR could affect the perioperative outcome. MATERIALS AND METHODS The Kurume University Hospital vascular registry was reviewed to identify all patients undergoing an elective open AAA repair from January 2004 through November 2006 (pre-EVAR era, n = 99) and from December 2006 through June 2010 (EVAR era, n = 125). The early clinical outcomes between the two groups were compared. RESULTS In the EVAR era, the proportion of EVAR in all elective AAA repairs was 43.4%. The EVAR era had a significantly higher proportion of very elderly patients over 80 years of age (23.2% vs. 11.1%, P = 0.0391). The morbidity rates were similar between the two groups (22.3% vs. 24,8%) and the mortality rate was 0% for both. CONCLUSION Despite the increased complexity of OAR in the EVAR era, we believe that OAR remains a valid procedure for AAA repair.

Cerebral protection selection in aortic arch surgery for patients with preoperative complications of cerebrovascular disease.

OBJECTIVE Retrograde perfusion is gaining acceptance as a means of cerebral protection, but it remains unclear how long the brain is protected and whether it is effective in patients with preoperative cerebrovascular disease. METHODS From January 1989 to August 1999, 205 patients--118 male and 87 female patients who ranged 12 to 86 years old, mean: 65.5 years old--underwent surgery at our hospital for aortic arch aneurysm using cerebral protection. We focused on mortality, stroke incidence and perioperative risk factor between 2 groups--selective cerebral and retrograde cerebral perfusion--also studying patients with preoperative cerebrovascular disease that influenced postoperative stroke. RESULTS The hospital mortality was 11.7% (selective cerebral perfusion group: 12%, retrograde group: 10.9%). Stroke occurred in 11 patients (5.3%), 4.7% in the selective cerebral perfusion group and 7.3% in the retrograde group. Preoperative cerebrovascular disease does not appear to be a risk factor for postoperative brain damage in aortic arch surgery. Regarding total replacement of the aortic arch, the incidence of postoperative brain damage in the retrograde group with preoperative cerebrovascular disease was higher than that in another group (p = 0.072). Cardiopulmonary bypass time and selective cerebral perfusion time in the patients with postoperative stroke were significantly longer than that in non-stroke group. CONCLUSIONS Preoperative cerebrovascular disease did not appear to be a risk factor in postoperative neurological deficit in the selective cerebral perfusion group. Prolonged selective cerebral perfusion time and cardiopulmonary bypass time may, however, lead to brain edema and cause neurological deficit.

Thoracic Endovascular Aortic Repair with Homemade Stent Grafts : Early and Mid-Term Outcomes

PurposeWe reviewed our experience with homemade stent grafts in the repair of a variety of thoracic aortic lesions. The objective of this study was to assess the early and mid-term outcomes of this therapy.MethodsFrom 1999 to 2007, homemade stent grafts were inserted in 88 patients with an atherosclerotic aneurysm, dissection, pseudoaneurysm, trauma, or rupture in the thoracic aorta. The endoprostheses were stainless steel Z-stents covered by a polyester graft, and were custom-designed for each patient.ResultsPlacement of stent grafts was technically successful in 81 of the 88 patients (92%). Within 30 days after treatment, 3 patients died, 3 had a cerebral infarction, and 3 had onset of paraplegia or paraparesis. Primary endoleaks were observed in 8 patients (9%). During the mean follow-up period of 32 ± 26 months, 7 patients had persistent endoleaks and 7 had stent-graft migration. The aneurysm-related mortality rate was 7%. The rate of freedom from open-surgery conversion at 32 months was 89.0%.ConclusionsOur early experience with elective and emergency thoracic endovascular aortic repair using homemade stent grafts provided therapeutic benefits to high-risk patients. Endoleaks and stent-graft migrations were the factors most commonly responsible for secondary intervention in the mid-term period. Careful follow-up of patients treated with this approach is needed to avoid major complications in the long term.

Emergent interventional approach for aortogastric tube fistula with massive gastrointestinal bleeding

This report describes the successful endovascular treatment of a rare case of aortogastric tube fistula with massive gastrointestinal haemorrhage. The patients history included oesophageal reconstruction for oesophageal carcinoma using a gastric tube. Emergent angiography revealed extravasation from the thoracic aorta into the thinner aortogastric tube fistula. A microcatheter was inserted into the aortogastric tube with the aortic approach for embolisation with a mixture of n-butyl cyanoacrylate and iodised oil to enable fluoroscopic visualisation. Aortography confirmed the complete absence of extravasation after embolisation, after which a stent graft was placed. This procedure demonstrated that transcatheter embolisation of the aortogastric tube fistula was possible, and that the technique can be used as an emergency option. CT imaging was performed 21 days after the procedure, and revealed no trace of extravasation or inflammation. There were no complications during the 14 months following the endovascular treatment; the patient remains in stable condition.

Surgical management of a graftenteric fistula: a modified method of in situ reconstruction.

Abstract Between December 1989 and May 1998, we performed a modified method of in situ reconstruction on three of seven patients with graftenteric fistulas (GEFs) at the Kurume University Hospital. The modification involved performing an anastomosis of the infrarenal abdominal aorta and running a new prosthesis through the left side of the descending colon in the retroperitoneal cavity, and wrapping the proximal anastomosis and the proximal site of the prosthesis in the greater omentum. Good results were achieved in all three patients. We describe herein this modified method of in situ reconstruction for a GEF and summarize the case reports of these three patients.

Abdominal Aortic Aneurysm Caused by Aortic Fibromuscular Dysplasia: A Case Report

Fibromuscular dysplasia (FMD) mainly develops in medium-sized arteries, including renal, extracranial, and extremity arteries, but it rarely causes abdominal aortic aneurysm (AAA). A 69-year-old woman with AAA diagnosed on ultrasonography by a home doctor visited our hospital. Contrast-enhanced computed tomography revealed a saccular aneurysm of terminal abdominal aorta. We performed abdominal aortic replacement and resected the section with aneurysm. Pathological examination of the wall tissue of the resected aneurysm revealed findings that are consistent with FMD. We report this case of AAA caused by aortic FMD because of its rarity.

Endovascular Stent-Graft Repair of a Persistent Sciatic Artery Aneurysm

Persistent sciatic artery (PSA) is a rare anomaly that may cause various symptoms, such as aneurysm, rupture, thromboembolism, and sciatica. Direct surgery can be performed to treat PSA aneurysm (PSAA), but is associated with complications; e.g., anatomical problems such as sciatic nerve injury. Herein we report a case of a 74-year-old woman with acute limb ischemia that developed from a distal embolism caused by a thrombus in the left PSAA; favorable results were obtained for her by treatment with a stent-graft after rapid anticoagulation therapy for limb salvage.