Annals of vascular diseases最新文献

Ascending aortic pseudoaneurysm is a rare but life-threatening complication after cardiac surgery, typically requiring redo open repair with substantial risk. We report a 58-year-old male with an incidental 85-mm ascending pseudoaneurysm discovered during evaluation for recurrent hepatocellular carcinoma. Due to prior sternotomy, cirrhosis, and urgent oncologic need, open surgery was deemed prohibitive. He successfully underwent thoracic endovascular repair with reverse extra-anatomical aortic arch debranching technique. He recovered uneventfully and proceeded to cancer treatment without delay. This case highlights the feasibility of hybrid endovascular strategies for ascending aortic pathology in high-risk patients.

Although both open and endovascular repair are available for hepatic artery aneurysms (HAAs), the optimal treatment strategy remains controversial, particularly in anatomically complex cases. In the present case, a large common HAA measuring 100 × 49 mm with a short proximal neck posed significant challenges for both modalities. To ensure intraoperative hemostasis, a hybrid approach was adopted: open surgical ligation combined with prophylactic balloon occlusion at the aneurysmal neck. This strategy enabled safe exclusion of the aneurysm without hepatic ischemia. The case underscores the importance of selecting open, endovascular, or hybrid techniques based on individual anatomical complexity to optimize outcomes in HAA management.

Objectives: Type II endoleaks (T2ELs) after endovascular aneurysm repair (EVAR) are associated with delayed adverse events. This study evaluated the association between changes in stent graft volume (SgV) and T2EL after EVAR.

Methods: This study included 127 patients who underwent EVAR for abdominal aortic aneurysms between 2010 and 2022. SgVs were calculated using computed tomography, and SgV ratios were calculated by dividing SgV 2 years after EVAR by SgV immediately after EVAR. The association between the SgV ratio and T2EL 2 years after EVAR was evaluated.

Results: T2ELs were detected in 62 patients (49%) 2 years after EVAR. Univariate analysis revealed that age, number of patent lumbar arteries, expanded polytetrafluoroethylene (ePTFE) stent grafts, and the SgV ratio were significantly correlated with T2EL. Multivariate analysis showed that age ≥80 years, patent lumbar arteries ≥4, ePTFE stent graft, and SgV ratio ≤1.23 were independently associated with T2EL. In both the ePTFE (80 patients) and polyester (47 patients) stent graft groups, the SgV ratio was independently associated with T2EL.

Conclusions: The SgV ratio was significantly correlated with T2EL and may improve T2EL surveillance after EVAR.

Objectives: Coronavirus disease 2019 (COVID-19) causes endothelial injury through inflammatory and hypoxic stress, leading to vascular dysfunction and immunothrombosis. The plasma level of von Willebrand factor (VWF) could serve as a biomarker of vascular injury. While elevated VWF predicts mortality in severe COVID-19, its relationship with post-discharge functional outcomes remains unclear. This study aimed to determine whether plasma VWF antigen (VWF:Ag) levels at admission predict functional status at discharge in patients hospitalized for COVID-19.

Methods: This was a single-center prospective cohort study conducted at Tokai University Hospital from July to September 2021. We evaluated the relationship between plasma VWF:Ag levels at admission and a Clinical Frailty Scale (CFS) score ≥4 at discharge using univariable and multivariable logistic regression analyses.

Results: A total of 97 patients were enrolled in the study. The median VWF:Ag level at admission was 330.0% (95% confidence interval [CI]: 273.0-391.8). Univariable analysis showed a significant association between elevated VWF:Ag levels and CFS score ≥4 at discharge. This association remained significant after adjusting for age and sex (odds ratio 1.010, 95% CI: 1.000-1.010, p = 0.005).

Conclusion: Elevated VWF:Ag levels at admission predict poor functional outcomes at discharge in COVID-19 patients, independent of age and sex.

Objectives: The objective of this study was to compare the adhesive strength and flexibility of 3 surgical sealants-synthetic (Hydrofit; Sanyo Chemical Industries, Kyoto, Japan), albumin-based (BioGlue; Artivion, Kennesaw, GA, USA), and fibrin-based (Beriplast; CSL Behring, Tokyo, Japan)-which are commonly used in cardiovascular surgery but unexplored under identical experimental conditions.

Methods: Adhesive strength was evaluated using a tensile adhesion test on collagen, polyester, and polytetrafluoroethylene substrates. Flexibility was assessed by measuring the maximum stress and elongation at failure in Hydrofit and BioGlue film samples. Beriplast was excluded as it failed to form films.

Results: Hydrofit and BioGlue showed similar collagen-collagen adhesion strengths (p = 0.11), while Beriplast was significantly weaker (p <0.01). Hydrofit outperformed both BioGlue and Beriplast (p <0.01) in collagen-polyester and collagen-expanded polytetrafluoroethylene (ePTFE) adhesions. Hydrofit also demonstrated a significantly higher elongation rate, strength, and maximum stress before rupture than BioGlue.

Conclusions: These surgical sealants possess distinct adhesive and mechanical characteristics. Hydrofit showed stable adhesion across various substrates, with notable flexibility. BioGlue displayed adequate adhesion on collagen surfaces but had restricted flexibility. Beriplast demonstrated reduced adhesion. Although only adhesive strength and flexibility were evaluated, such properties may offer valuable insights into sealant traits contextually. These potentially aid in the selection of appropriate sealants for cardiovascular procedures that require both durable adhesion and tissue compliance. Further in vivo validation is warranted.

We report a rare case of a radial artery aneurysm associated with ulnar artery occlusion in an 80-year-old female. Preoperative imaging showed poor visualization of the palmar arch and absent ulnar flow, prompting aneurysmectomy and radial artery reconstruction using a vein graft. Intraoperative findings revealed good retrograde flow, suggesting preserved distal perfusion. This case highlights the importance of accurate preoperative assessment of hand arterial anatomy, particularly the palmar arch, in determining the need for revascularization in radial artery aneurysms with compromised collateral circulation.

A female in her early 40s with no skeletal abnormalities was incidentally found to have a 45-mm saccular aneurysm at the aortic isthmus during evaluation for pharyngitis. She had sustained blunt trauma 20 years earlier, resulting in multiple fractures and pneumothorax. Her family history included premature vascular or sudden death and scoliosis. Imaging showed no arterial tortuosity. She underwent successful open surgical repair. Histologic examination revealed disorganized elastic fibers with irregular thickening and partial loss of lamellar architecture. Postoperative genetic testing identified a heterozygous missense variant in SLC2A10, suggesting a possible association between monoallelic variants and vascular fragility.

This case report presents a case of lower extremity peripheral arterial disease (PAD) with severe calcified lesions extending from the external iliac artery to the bifurcation of the superficial femoral artery, involving the groin region. Owing to the complexity and risk of complications, such as infections and delayed wound healing, revascularization was performed with extensive endarterectomy. The inguinal-lifting technique (ILT) was used to provide safe surgical access and minimize complications. The procedure resulted in successful revascularization with no major wound-related issues. The ILT proved to be an effective approach for safe, extensive endarterectomy in complex PAD cases.

Objectives: We conducted a detailed comparison of inpatient medical costs between endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) for abdominal aortic aneurysms.

Methods: We evaluated 312 EVAR and 205 OAR cases performed at our institution between January 2007 and December 2017. Patient background characteristics were adjusted between the EVAR and OAR groups using propensity score matching (PSM). Surgical outcomes and inpatient medical costs were compared.

Results: After PSM, 161 cases were included in each group for comparison. Operative time, blood loss, intensive care unit (ICU) stay, and hospital stay were significantly lower in the EVAR group than in the OAR group. Total inpatient medical costs were significantly higher in the EVAR group (3111× 10³ vs. 2156 × 10³ JPY [Japanese yen], p <0.01). The surgical material costs in the EVAR group were significantly higher than those in the OAR group, accounting for 58% of total medical expenses. Other costs (diagnosis procedure combination, ICU management, surgical procedure, transfusion, intraoperative injection, and room) were all lower in the EVAR group than in the OAR group.

Conclusions: The cost-saving effects of EVAR, such as reduced transfusion costs and ICU stay fees, were offset by the significantly higher cost of surgical materials.

Objectives: We aimed to elucidate the long-term outcomes of acute symptomatic spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) to inform optimal decision-making during the acute phase.

Methods: We retrospectively collected and analyzed data from 14 consecutive patients diagnosed with SIDSMA by using computed tomography angiography (CTA) between January 2010 and August 2024.

Results: The cohort comprised 13 males and 1 female, with a mean age of 59.36 ± 14.90 years. All patients presented with acute abdominal pain, and some experienced vomiting. Thirteen patients received conservative treatment, while only 1 patient underwent open surgery with extra-anatomical bypass; this patient required no further intervention 10 years postoperatively. One of the patients, whose abdominal pain worsened with food intake, showed SMA stenosis and decreased intestinal blood flow. His symptoms improved after heparin anticoagulation therapy followed by direct oral anticoagulant therapy. Over a follow-up period of 7.20 ± 3.21 years, none of the patients experienced recurrent SIDSMA-related abdominal pain, and all survived without the need for additional invasive treatment.

Conclusions: Conservative treatment effectively manages SIDSMA over the long term without reintervention. Early diagnosis and management of intestinal ischemia are essential for optimal treatment outcomes.