Yutaka Takayama

Aortobronchial fistula after an aortic operations

A 71-year-old man with a postoperative aortobronchial fistula was successfully treated. The fistula occurred between the left lower lobe and the descending thoracic aorta, to which a distal anastomosis of a temporary bypass graft had been placed during thoracic aortic aneurysmectomy 3 years before. For saving patients with this complication, early surgical treatment during episodes of intermittent hemoptysis is important. The use of an omentum pedicle flap for the isolation of the suture line is a important adjunct.

Portal vein reconstruction using an internal jugular vein as a graft: Report of a case

We report the case of a 41-year-old man with pancreatic carcinoma invading the portal vein who was successfully treated by portal vein resection combined with pancreatoduodenectomy and reconstruction using an autointernal jugular vein. The internal jugular vein is an ideal graft for portal vein replacement because it has sufficient length, a well-matched diameter, and there is no venous insufficiency after unilateral resection. Nevertheless, this is the first report of portal vein reconstruction using the internal jugular vein as a graft.

Biodegradation of glutaraldehyde-tanned human umbilical vein grafts.

A retrospective analysis of the long-term behavior of 111 glutaraldehyde-tanned human umbilical vein (HUV) grafts implanted between September 1977 and December 1993 was conducted. A total of 81 patients, with a mean age of 68.7 years, received the grafts and were followed up for between 1 and 131 months. The 5-year primary cumulative patency rate for above-knee femoropopliteal bypass was 83.1%, whereas that of other bypasses was 60.9%. An aneurysm of the graft was defined as a physically apparent localized dilatation, with diffuse ectasia being excluded. There were 11 aneurysms found in 9 grafts, 2 of which arose at the factory-made suture lines. The accumulated incidence of aneurysms had reached 21.9% by the 6th year. One aneurysm compressed the graft and resulted in limb-threatening ischemia and another resulted in frank rupture. Moreover, reinforcement of the mesh could not prevent aneurysm development, the repair of which is mandatory due to the risk of rupture and acute thrombosis. The HUV grafts showed an acceptable patency rate in the above-knee location, but the incidence of aneurysm formation after 5 years was abnormally high. Thus, both the risks and benefits of HUV grafts must be taken into account when considering their clinical application.

Nondissection method for tibial bypass surgery using Esmarch's rubber bandage or an automatic sequential pneumatic tourniquet: long-term results

It is suspected that operative injury to the native arteries during a vascular bypass procedure causes periarterial fibrosis contributing to late graft failure. A a nondissection method for tibial artery bypass has been developed using Esmarchs rubber bandage or an automatic sequential pneumatic tourniquet. This retrospective study examined patency and other late results in distal bypass operations using the nondissection method. Between June 1982 and July 1995, 78 tibial bypasses were performed using reversed autogenous saphenous vein grafts in 70 patients (57 men, 13 women; mean age 57.4 years). Graft patency was assessed angiographically. When a stenotic lesion was recognized, the graft was revised and considered an assisted primary patency. Primary patency rates at 1, 3, 5, and 10 years were 82.8%, 75.3%, 63.4% and 63.4%, respectively, by life-table analysis. Six grafts required revision for stenosis; one involved distal anastomotic stenosis. As a result, assisted primary patency rates resembled secondary patency rates of 87.7%, 84.3%, 80.3%, and 80.3% at the same respective intervals. In conclusion, the nondissection method improved long-term patency by preventing late distal anastomotic stenosis.

Use of a nondissection method in lower extremity revascularization: A report on our 12-year experience of autogenous vein bypass surgery

We report herein on our 12-year experience of performing autogenous vein grafting in the lower extremity using a nondissection method. This method involves limiting preparation for the distal anastomosis to exposure of the anterior surface of the vascular sheath, and substituting an Esmarchs rubber bandage or a pneumatic tourniquet for vascular clamps. A series of 86 consecutive patients who received 101 autogenous vein grafts employing this method were retrospectively analyzed. The causes of arterial occlusion were atherosclerosis in 55 patients, Buergers disease in 23, and other causes in 9. There was one operative death, and 12 late deaths were recorded within a follow-up period extending to 12 years. Of four early occlusions and two stenoses, three were successfully revised within 30 days of surgery. A total of 11 revision operations were required for 10 grafts during the follow-up period, and late graft closure occurred in 9 bypasses. The primary, primary revised, and secondary patency rates at 5 years for the entire series (n=101) were 65%, 85%, and 86%, respectively, with 42 bypasses to the tibial or peroneal artery having 84% primary revised and 86% secondary patency rates. These findings led us to conclude that minimization of the surgical injury at the distal anastomosis contributed to the long-term patency of the distal bypass.

Congenital arteriovenous fistula in the gluteal region —A report of five cases

Five cases of congenital arteriovenous fistula in the gluteal region have been encountered in our department in the past 20 years. In all cases, the fistulous masses were in the connective tissue between the gluteal muscles and well-localized. Preoperative angiography showed the feeding arteries to be the superior gluteal, the inferior gluteal, and/or the lateral femoral circumflex arteries, and all the arteriovenous fistulae were excised almost completely with success. In this report, we emphasize the importance of precise estimation of the feeding arteries on preoperative angiography and ligating them before excising the fistulous masses, to ensure safe surgical treatment.

Simultaneous repair of arch and abdominal aortic aneurysms. A simple new technique using a temporary bypass graft.

OBJECTIVE Atherosclerotic aneurysms in the aortic arch are associated with abdominal aortic aneurysms in up to 37% of cases. We have developed a single-stage approach to the repair of both aneurysms using a temporary bypass. SUBJECTS Since November 1996, 5 patients underwent simultaneous repair of aneurysms in the aortic arch and in the infrarenal abdominal aorta, using a new temporary bypass graft technique. Entire arch replacement with simultaneous abdominal aortic aneurysmectomy was performed in one patient. The other 4 patients underwent distal hemi-arch replacement distal from the orifice of the brachiocephalic artery with simultaneous repair of the abdominal aortic aneurysm. METHOD For the entire arch replacement procedure, blood flow to all major branches of the aortic arch was established using a bifurcated graft. This graft anastomosed to the ascending aorta was used as the proximal inflow of the temporary bypass graft. For the hemi-arch replacement procedure, the proximal inflow segment of the temporary bypass graft was anastomosed to the brachiocephalic artery. In both cases, the distal outflow segment of the temporary bypass graft was the graft used for repair of the abdominal aortic aneurysm. In order to prevent any clamp injury, Teflon felt was tightly wrapped around the aorta before the clamp was applied. RESULTS Evaluation of the hemodynamic parameters measured during cross-clamping of the aortic arch revealed stable distal perfusion to the visceral organs and no excessive increase in cardiac afterload. All patients had an uneventful postoperative course and were discharged within 1 month of surgery. CONCLUSION Our temporary bypass method is recommended for simultaneous replacement of aneurysms in the aortic arch and the abdominal aorta.