Annals of vascular diseases最新文献

Intravenous leiomyomatosis (IVL) remains scarcely reported, and complete tumor resection is the recommended treatment. Herein, we present a comprehensive review of the case of a 52-year-old woman who suffered from recurrent syncope episodes due to IVL with intracardiac extension to the right atrium. Partial tumor resection and postoperative hormone therapy were conducted first. However, the 6-month postoperative follow-up computed tomography scan revealed a tendency for the IVL to increase in size, and complete resection was conducted. In this article, we would like to emphasize that partial resection followed by hormone therapy is insufficient for IVL, and complete resection should be chosen.

Objectives: Surgical thrombectomy has been established as an effective treatment for acute limb ischemia (ALI). Nevertheless, manipulation via the common femoral artery (CFA) to retrieve thrombus in the infra-popliteal artery sometimes proves less effective. Methods: We retrospectively reviewed patients undergoing surgical thrombectomy for infra-inguinal ALI from January 2010 to December 2022. The primary endpoint was the rate of amputation. Secondary endpoints were technical and clinical success rates, incidence of distal embolism, and freedom from reintervention. Results: A total of 35 patients underwent surgical thrombectomy where the popliteal artery or below is occluded. The CFA approach was utilized in 13, and the below-knee popliteal artery (BKPA) approach in 22. There were no differences in background between groups. The reintervention rate was lower in the BKPA group (BKPA group: 0% vs. CFA group: 30.8%; P = 0.01). The BKPA group showed a significantly lower incidence of distal embolism (BKPA group: 4.5% vs. CFA group: 38.5%; P = 0.02) and freedom from reintervention (BKPA group 100% at 12 months vs. CFA group: 68.7% at 12 months; log-rank P = 0.01). Conclusions: The BKPA approach-first strategy for surgical thrombectomy in the management of ALI is feasible with better outcomes compared with the CFA approach.

Since 2013, the Japanese Society for Vascular Surgery has started the project of nationwide registration and tracking database for patients with critical limb ischemia (CLI) who are treated by vascular surgeons. The purpose of this project is to clarify the current status of the medical practice for patients with CLI to contribute to the improvement of the quality of medical care. This database is created on the National Clinical Database (NCD) and collects data on patients' backgrounds, therapeutic measures, early results, and long-term prognoses as long as 5 years after the initial treatment. The name of this database was changed from the JAPAN Critical Limb Ischemia Database to the JAPAN Chronic Limb Threatening Ischemia Database in 2021 because of the alteration of the definition of registered patients. The abbreviation remains JCLIMB. The limbs managed conservatively are also registered in JCLIMB, together with those treated by surgery and/or endovascular treatment (EVT). In 2021, 1338 CLTI limbs (male 916 limbs: 68%) were registered by 78 facilities. Arteriosclerosis obliterans (ASO) has accounted for 99% of the pathogenesis of these limbs. In this manuscript, the background data and the early prognosis of the registered limbs of the ASO cohort are reported. (This is a translation of Jpn J Vasc Surg 2024; 33: 229-250.).

Objectives: We report our hospital-based experience in management strategies and outcomes for pediatric extremity vascular trauma at a major trauma center. Methods: A retrospective chart review was conducted on patients under 18 with extremity vascular injuries who had surgery between May 2021 and February 2023. Results: Among 46 children, 16 (34.8%) had upper extremity injuries, while 30 (65.2%) had lower extremity injuries. Blunt trauma mechanism (82.6%) was dominant, followed by penetrating (17.4%). In all, 34 patients (73.9%) had at least 1 extremity injury, including 14 open fractures. 58.9% of patients did not present with acute ischemic syndrome. Regarding vascular repair, 16 patients (34.8%) underwent direct revascularization, 13 (28.3%) cases involved arterial dilatation using a Fogarty catheter, 9 patients (19.5%) had vascular repair using the great saphenous vein, and 1 case had cephalic and basilic venous repair using an allograft vein. Six patients had a temporary external fixation for complex lower limb fractures. One patient had a secondary amputation after a popliteal injury. One death was documented (2.7%). Conclusions: Blunt trauma poses challenges in pediatric cases. Vascular surgeons must consider children's future growth. Early diagnosis and treatment by experienced vascular surgeons at major surgical centers can lower mortality and amputation rates.

Disseminated venous thromboembolism (VTE) occurs commonly in cancer patients, who tend to have contraindications to systemic thrombolysis and require cancer surgery. Such clinical scenarios are often challenging to manage. In this case report, we illustrate an innovative, single procedural approach in such a patient to remove extensive VTE, improve symptoms, prevent hemodynamic decompensation, and allow for a minimal level of anticoagulation such that necessary cancer surgery can proceed safely.

We present a case of arterial bypass for extensive stenosis of the ulnar artery and superficial palmar arch. The ulnar artery and the superficial palmar arch were bypassed using the great saphenous vein. Postoperatively, blood flow to the affected fingers gradually improved and the pain disappeared. Contrast-enhanced CT showed good visualization of the superficial palmar arch and more distal digital arteries. Considering the slow improvement in blood flow and the dilation of the stenotic finger artery postoperatively, it appeared that there was a significant effect of spasm in addition to organic stenosis preoperatively and that revascularization was an effective treatment.

Objectives: With improved surgical outcomes for non-ruptured abdominal aortic aneurysm (AAA), the primary objective has shifted toward the detection of asymptomatic AAA. Since ultrasonographic visualization from the anterior abdominal wall is often obstructed by intestinal gas, utilizing additional bilateral posterior approaches via the retroperitoneal tissue may be beneficial. This study investigates the feasibility of assessment using three approaches through computed tomography (CT) data analyses. Methods: The study included 27 surgical patients with AAA (AAA group) and 37 patients with other atherosclerotic diseases (non-AAA group). CT data were analyzed to locate the infrarenal aorta relative to the navel, availability of acoustic window, depth of the aorta, and assessment of aneurysmal aorta using three approaches. Results: The "AAA area" for ultrasonographic screening may be set at 0-4 cm above the navel. An acoustic window was unavailable in 8.1% of AAA cases and 7.4% of non-AAA cases in the anterior approach; however, it was available in the posterior approach. Although the depth of the aorta was greater in obese patients, it remained within 20 cm. Conclusion: Ultrasonographic screening is feasible by incorporating posterior approaches in cases where anterior visualization is difficult, enhancing the detection of asymptomatic AAA.

A superior mesenteric arteriovenous fistula (SMAVF) following gastrointestinal surgery represents a rare vascular complication. Enhanced computed tomography with 3-dimensional reconstruction proves to be the most efficacious modality for detecting this uncommon entity. Superior mesenteric angiography becomes imperative to accurately delineate the location and extent of mesenteric vessel involvement, which is essential for devising an optimal treatment strategy. Recently, endovascular therapy has garnered significant favor due to its less invasiveness compared to surgical interventions. Herein, we present a case of SMAVF after pancreaticoduodenectomy, manifesting with symptoms indicative of portal hypertension. Successful endovascular fistula closure using a balloon-expandable stent graft was achieved.

Objectives: The purpose of this study is to evaluate the feasibility and clinical outcomes of vasa vasorum embolization for preventing continuous aneurysmal expansion after endovascular aneurysm repair (EVAR). Methods: We retrospectively reviewed the medical records of patients who underwent vasa vasorum embolization between August 2018 and May 2022. Vasa vasorum embolization was attempted in cases of continuous aneurysmal expansion after EVAR, where the vasa vasorum was identified through catheter angiography. The vasa vasorum was accessed and embolized with a microcatheter. The outcomes of vasa vasorum embolization were evaluated based on technical success, defined as the successful completion of the embolization procedure, and clinical success, defined as the prevention of continuous aneurysmal expansion after the embolization. Results: Seven cases of endoleak with developed vasa vasorum were confirmed by catheter angiography. The mean age was 83.7 years, and the mean aneurysmal diameter was 60.6 mm. Technical success was achieved in 6 cases, while clinical success was not achieved in any of the cases. The mean observation period was 16.5 months, and the mean increase in aneurysmal diameter was 9.7 mm. Conclusions: Although the vasa vasorum embolization is a technically feasible procedure, it is not effective in preventing continuous aneurysmal expansion.

A 19-year-old female presented with intermittent claudication without anatomical abnormality in the popliteal fossa on magnetic resonance imaging and computed tomography. However, duplex ultrasound (DUS) showed compression of the popliteal artery (PA) and vein during plantarflexion and dorsiflexion. She was diagnosed with functional PA entrapment syndrome (PAES) and underwent resection of the plantaris and gastrocnemius muscles using DUS with stress maneuvers, which relieved the symptoms. In physically active adults, functional PAES can develop without anatomical abnormality. Thus, in the field of vascular medicine, it is important to consider this underrecognized pathophysiology among young people with lower leg pain.