Shuji Chino

Adipose Tissue Detected by Multislice Computed Tomography in Patients After Myocardial Infarction

OBJECTIVES Our aim was to investigate the frequency of left ventricular (LV) and right ventricular adipose tissue on multislice computed tomography (CT) in patients with a history of myocardial infarction (MI) and to determine correlations with infarct age. BACKGROUND Fat deposition in the ventricular wall has frequently been observed in post-infarct myocardial tissue. However, the in vivo relevance of adipose tissue in MI on CT and correlations with infarct age have not been determined. METHODS Fifty-three patients with a history of MI (mean age 66 +/- 10 years; 38 men, 15 women) and 63 subjects with no history of MI or coronary revascularization (mean age 65 +/- 12 years; 37 men, 26 women) were retrospectively studied for intramyocardial fat on 64-slice cardiac CT. Presence or absence, distribution, and correlations with infarct age of LV adipose tissue were evaluated. RESULTS Compared with noninfarct control subjects, the MI group showed a significantly higher prevalence of fat deposition within LV myocardium on CT (MI group, 62% [33 of 53] vs. control group, 3% [2 of 63]; p < 0.0001). In 32 of 33 patients (97%) with MI and LV fat deposition on CT, adipose tissue was observed in the region perfused by the infarct-related artery and was located in the subendocardium in 30 patients (94%), the middle layer in 1 patient (3%), and the subepicardium in 1 patient (3%). Mean infarct age was significantly higher in patients with LV adipose tissue (8.2 +/- 4.4 years) than in those without adipose tissue (2.2 +/- 2.6 years, p < 0.001). Thirty of 35 patients (89%) with infarct age >or=3 years showed adipose tissue in MI. Conversely, none of 9 patients with infarct age <10 months showed fatty replacement. CONCLUSIONS Myocardial adipose tissue is common in patients with infarct age >or=3 years. CT evaluation of myocardial adipose tissue may be important for accurate interpretation of CT perfusion and infarct imaging of the heart.

Intimal Tear After Endovascular Repair of Chronic Type B Aortic Dissection

Two patients with chronic type B aortic dissection underwent endovascular repair. The interval between the onset of aortic dissection and stent grafting was 1 year, 7 months in both patients. The entry closure was successful and postoperative course was uneventful for each patient. However, intimal injury developed at the bottom end of the stent graft 6 years after endovascular repair in 1 patient, and at 2 years in the other patient. The former patient underwent graft replacement of the descending thoracic aorta, and the latter underwent placement of additional stent grafts.

Upside down use of Gore Excluder or Cook Zenith Legs

PurposeEndovascular aneurysm repair is becoming increasingly popular. This technical note describes the usefulness of the upside-down technique of Gore Excluder or Cook Zenith legs.MethodsFour patients with iliac or abdominal aortic aneurysms were treated. Three patients with isolated iliac artery aneurysms and one patient with an abdominal aortic aneurysm, in which the neck diameters were unfit for commercially available stent-grafts, were treated using an Excluder or a Zenith leg in an upside-down technique.ResultsThe aneurysms were completely excluded and no endoleak occurred. There were no serious adverse events.ConclusionsThe upside-down technique using an Excluder leg or a Zenith leg is both feasible and effective.

Treatment of Infected Aneurysms of the Abdominal Aorta and Iliac Artery with Endovascular Aneurysm Repair and Percutaneous Drainage

Infected aneurysm remains one of the most challenging diseases for vascular surgeons. We describe the successful treatment of 2 cases of infected aneurysms with endovascular aneurysm repair and percutaneous computed tomography-guided drainage. This strategy may be an effective alternative to open surgical repair in selected patients.

Splenic Artery Aneurysm Treated With Endovascular Stent Grafting: A Case Report and Review of Literature.

Introduction: Although endovascular therapy is becoming an alternative to open surgical repair of splenic artery aneurysms (SAAs), reports on the use of stent grafts for SAA repair are limited. We present our experience of endovascular therapy using a stent graft for the treatment of an SAA that had ruptured into the gastric lumen. We also reviewed 18 cases of stent graft repair for SAAs, including the present case. Case Report: A 43-year-old man was admitted due to hematemesis. Endoscopic examination and contrast-enhanced computed tomography (CT) revealed a dissecting SAA that had ruptured into the stomach. Two 10 × 100 mm Viabahn (W.L. Gore, Flagstaff, Arizona) stent grafts were used to exclude the aneurysm. No complications occurred during the procedure. Although postoperative CT showed complete exclusion of the aneurysm, endoscopic examination showed a discharge of purulent matter from the aneurysm. Therefore, surgical debridement and omental implantation were added to avoid stent graft infection. Follow-up CT obtained 1 year later showed the residual aneurysm almost disappeared without any evidence of infection. Literature Review: A literature search in the PubMed database returned 17 cases with sufficient data. Review of these cases, together with the present case, revealed a 100% technical success rate, 11% splenic infarction rate, 94% graft patency rate, and 0% reintervention rate. Conclusion: Endovascular repair of SAAs using stent grafts appears to be safe and effective. In terms of preserving the blood flow and avoiding splenic infarction, it may be superior to coil embolization. Even in a case with aneurysm infection, stent graft repair may be an acceptable method to minimize invasion of concomitant surgical intervention.

Treatment of a Ruptured Chronic Aortic Dissection Using Stent-Graft Placement and Coil Embolization

Editor: Efficacy of thoracic endovascular aortic repair (TEVAR) in the treatment of ruptured acute type B aortic dissection has been reported previously (1). However, there still remains some controversy with the use of this strategy. We describe a case with ruptured chronic type B aortic dissection treated with TEVAR and coil embolization of the false lumen. Institutional review board approval was not required for a retrospective case report. A 52-year-old man was admitted to our hospital as a result of sudden onset of severe chest pain. During transfer to the hospital in an ambulance, his vital signs were stable. Seventeen years previously, he had developed an acute type B aortic dissection. After conservative therapy for 3 years, he underwent TEVAR with the use of a noncommercial custom-made stent-graft to close entry tears. His postoperative course was uneventful until he underwent a Ygraft replacement for the treatment of a dissecting abdominal aortic aneurysm 5 years before the current admission. During the latter operation, the intimal flap at the proximal anastomotic site was resected because it was impossible to reapproximate the intimal flap and the adventitia. Emergent contrast-enhanced computed tomography (CT) obtained immediately after the current admission revealed a massive hematoma in the left thorax (Fig 1). The maximum diameter of the descending thoracic aorta was 47 mm. CT also revealed a few small entry tears in the distal descending aorta below the previously placed handmade device and a large reentry at the flap-resected segment just above the proximal anastomotic site of the Y-graft. In addition, there was a site at which the border between the adventitia and the surrounding hematoma was unclear; this was deemed to be the rupture site. Rupture of the descending thoracic aorta was assumed, and endovascular repair was selected as the treatment. Only an oral informed consent was obtained from the patient before the procedure because this was an emergent case. Under general anesthesia, stent-grafts (TX2; Cook, Bloomington, Indiana) were placed to cover the true lumen of the whole descending thoracic aorta to close the small entry tears (Fig 2). To isolate the ruptured false lumen from the systemic perfusion, coil embolization was implemented by using a catheter inserted into the false lumen via the reentry just above the proximal anastomotic site of the Y-graft. Ten 15-mm-diameter coils, six 12-mm-diameter coils, and three 10-mmdiameter coils (MReye; Cook) were placed in the false lumen spanning across the presumed ruptured site of the adventitia. The postoperative CT scan obtained 2 weeks after the procedure showed complete thrombosis of the false lumen of the descending thoracic aorta (Fig 3). There were two procedural complications. One was groin infection, which was finally controlled with antibiotics. The other was paraparesis limited to the left leg treated by immediate