Annals of vascular diseases最新文献

Objectives: In Japan, radiofrequency ablation (RFA) was covered by insurance in 2014. Regarding the early results, there are many reports that it is excellent, but the long-term results are rarely shown. Therefore, the purpose of this study was to examine the results up to 5 years after RFA, which was the only means of endovascular treatment at my facility, and to evaluate recurrent varices after surgery (REVAS), reoperation, and complications.

Methods: In 2017, 275 consecutive cases (male 83, female 192, 67.5 ± 10.0 years old), involving 350 limbs (C2, 3, 4a, 4b, 5, 6 = 217, 18, 89, 18, 1, 7) and 354 veins (great saphenous vein [GSV]: 290, small saphenous vein [SSV]: 64), underwent RFA. Postoperative follow-up was usually performed at 3 days (100%), 1 week (100%), 1 month (99.4%), and 6 months (93.5%) after RFA. Of the 334 patients contacted 5 years later, 327 (92.4%), excluding deaths from other diseases, were interviewed about reoperation, recurrence, and neuropathy. Of these, 223 patients (63%, GSV: 180, SSV: 43) underwent an ultrasound examination.

Results: Endovenous heat-induced thrombosis (EHIT) of more than grade 2 occurred in 5.9% of cases (GSV: 6.6%, SSV: 3.1%) and regressed within 1 month in all cases using anticoagulant therapy. Neuropathy occurred in 6.3%, mainly in GSV full-length ablation cases, and 41% of these disappeared completely between 6 months and 5 years after RFA. The reoperation rate up to 5 years after RFA was 10.7% (GSV: 9.7, SSV: 15.6%). In the reoperation cases after the RFA of GSV, the sites of reflux were 14 incompetent perforating veins (IPVs), 7 deep venous junction-related, and 6 distal GSVs. In the reoperation cases after the RFA of SSV, there were 5 IPVs and 3 isolated branch varices. The time of diagnosis of recurrence by ultrasonography was within 6 months of regular follow-up in 61% of GSVs and 79% of SSVs. The occlusion rate after 5 years was 98.9% for GSV and 95.3% for SSV. Only 1 recanalized vein was symptomatic and underwent retreatment. After RFA of GSV, 80% of accessory saphenous veins were retained at 5 years.

Conclusions: 1) The 5-year results after RFA were generally good. 2) IPV played the most important role in reoperation cases by REVAS after RFA of the saphenous veins. 3) The majority of postoperative recurrences could be identified by follow-up up to 6 months. 4) Neuropathy after RFA disappeared completely in half of the cases within 5 years. 5) After GSV-RFA, accessory saphenous vein blood flow persisted in most cases. (This is a translation of Jpn J Phlebol 2024; 35: 403-408.).

Successful thoracic endovascular aortic repair for chronic type B aortic dissection with an enlarged false lumen depends on complete exclusion of the false lumen. Stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair (STABILISE) creates a single lumen in the dissected thoracic and abdominal aorta by disrupting the intima. We report our experience in the treatment of 3 cases of chronic dissection using the STABILISE procedure at our hospital from December 2019 to May 2022. The STABILISE technique appears to be an effective procedure; however, further evaluation of risk factors for complications such as intraoperative aortic rupture is necessary.

Endovenous surgery in the treatment of varicose veins generally consists of laser or radiofrequency ablation (RFA) as endovenous thermal ablation (ETA) with a phlebectomy or foam sclerotherapy of tributary varicose veins to improve symptomatic or cosmetic problems. Nevertheless, the efficacy of their concomitant treatments is still controversial for a decade. In the guidelines of the Japanese Society of Phlebology, concomitant phlebectomy of tributary varicose veins with ETA is described that it is not recommended officially. In our hospital, RFA without concomitant phlebectomy of tributary varicose veins accounts for 74% of the RFA cases and it shows a relatively higher percentage than other institutions in Japan. The data of RFA without concomitant phlebectomy of tributary varicose veins are evenly matched in RFA with concomitant treatments in our data concerning recurrence, remnants, endovenous heat-induced thrombosis (EHIT), and complications. This article provides the conclusion that it would be acceptable to perform isolated RFA compared to RFA with concomitant phlebectomy or foam sclerotherapy of tributary varicose veins in short- and mid-term periods. In addition, concomitant treatments might contribute to rapid improvement of the short-term and better long-term outcomes, not to mention cosmetic problems that are not identified demonstrably. (This is a translation of J Jpn Coll Angiol 2022; 62: 49-54.).

One of the factors that contribute to the development of aortic aneurysms is hemodynamic factors. In this study, we analyzed the hemodynamic changes in a stented saccular abdominal aortic aneurysm model to improve hemodynamic factors. We discovered that stenting reduced wall shear stress, mean flow velocity in the aneurysm, energy loss, and pressure loss coefficient, and improved hemodynamics around the saccular abdominal aortic aneurysm. Stenting is expected to become a new treatment modality for abdominal aortic aneurysms. (This is a translation of J Jpn Coll Angiol 2022; 62: 111-119.).

Objectives: Advancements in imaging technology have led to an increase in the incidental detection of visceral artery aneurysms (VAAs), which are associated with high mortality when ruptured. In 2020, the Society for Vascular Surgery (SVS) released updated guidelines, replacing the previous 2005 ACC/AHA recommendations. This study aimed to evaluate the impact of the new guidelines through a retrospective analysis of VAA cases treated at our department. Methods: We retrospectively reviewed 43 cases of VAA treated between 2002 and 2024 at our department. Each case was re-evaluated to determine whether it met the treatment criteria defined in the 2020 SVS guidelines. Results: Of the 43 cases, 23 (53.5%) met the new guideline criteria. Notably, treatment eligibility for renal and splenic artery aneurysms decreased significantly due to the revised aneurysm size threshold, raised from 2 to 3 cm. The remaining 20 cases were considered ineligible based solely on size, with the exception of cases involving young female patients, ruptured aneurysms, symptomatic lesions, or pseudoaneurysms. Conclusions: The 2020 SVS guidelines impose stricter treatment indications for VAAs. However, clinical decisions should also consider aneurysm location, patient age, gender, symptoms, and rupture risk on an individual basis.

Objectives: Gait disturbances increase mortality rates in lower extremity artery disease. Changes in gait biomechanics after endovascular therapy for intermittent claudication associated with lower extremity artery disease remain unknown. This prospective study investigated the effect of endovascular therapy on gait biomechanics in intermittent claudication. Methods: We recruited 10 patients (14 affected limbs) with intermittent claudication caused by isolated aortoiliac artery lesions who underwent endovascular therapy, and 10 healthy controls. Using 3-dimensional motion analysis, we measured biomechanical gait parameters preoperatively and over 6 months postoperatively, comparing them with those of healthy controls. Results: One month after endovascular therapy, parameters improved significantly compared with preoperative values: step length (preoperative median 52.47 [interquartile range 47.11, 60.33]-postoperative 58.53 [54.63, 64.54] cm; P < 0.0037), walking speed (90.17 [73.98, 108.9]-103.49 [97.66, 117.94] cm/s; P = 0.0022), hip flexor moment (-0.75 [-1.04, -0.51] to -0.94 [-1.07, -0.74] Nm/kg; P = 0.04), and pull-off power generated by hip flexor muscles (H3, 0.68 [0.38, 1]-0.86 [0.72, 1.1] W/kg; P = 0.018). Preoperative joint power declined significantly compared to control parameters. However, 6 months postoperatively, no significant differences were observed. Conclusions: Endovascular therapy for isolated aortoiliac artery lesions improved biomechanical gait parameters in patients with intermittent claudication.

Intravenous leiomyomatosis with intracardiac extension is a rare benign tumor originating from uterine smooth muscle. A 50-year-old woman presented with a cardiac mass 3 years after hysterectomy. Imaging revealed a tumor extending from the right internal iliac vein to the right atrium. Complete resection was achieved via a 2-stage surgery. In the 1st stage, median sternotomy and a retroperitoneal approach were performed, and the intracardiac tumor was excised under deep hypothermic circulatory arrest with cardiopulmonary bypass. Postoperatively, gonadotropin-releasing hormone (GnRH) agonist therapy was administered, followed by a 2nd-stage resection of the residual pelvic tumor and right ovary. The patient remained recurrence-free for 15 months.

Objectives: This study aimed to investigate the actual detection process and diagnostic methods for asymptomatic abdominal aortic aneurysm (AAA) in a multicenter setting, and to plan an effective screening strategy for asymptomatic AAA. Methods: The subjects of this multicenter study were collected in a retrospective manner at 7 facilities. A total of 1894 patients with AAA, including iliac artery aneurysms, who were considered asymptomatic with a confirmed initial diagnosis from January 2018 to December 2022, were collected and reviewed. Results: A total of 1666 patients who were diagnosed with asymptomatic AAA were included [83.9% males, median age of 75 (69-81) years]. Asymptomatic AAAs were frequently diagnosed during examinations for other diseases in 1339 patients (80.4%), whereas health screenings accounted for only 313 (18.8%). Computed tomography (CT) was the most commonly used diagnostic method (n = 1352, 81.2%) compared to abdominal ultrasonography (n = 252, 15.2%). Conclusions: Asymptomatic AAAs are detected incidentally during examinations for other diseases, and there is an urgent need to promote health screening. Most AAAs are diagnosed by CT; nevertheless, we consider that abdominal ultrasonography would be the most appropriate modality for AAA screening because of its reasonable accuracy, noninvasiveness, and low cost.

Objectives: Acute hemorrhagic rectal ulcer (AHRU) occurs with a sudden onset of painless bloody stools and is caused by impaired blood flow in the rectal mucosa due to arteriosclerosis or prolonged bedridden status. Little information is available about AHRU in patients with chronic limb-threatening ischemia (CLTI). This study aimed to identify factors related to AHRU among CLTI patients after bypass surgery. Methods: Between 2019 and 2023, we enrolled 80 CLTI patients at our institution who underwent bypass surgery using autogenous veins. Data were collected prospectively and supplemented with retrospective medical record reviews. Information regarding demographic and clinical characteristics was collected. The outcomes of patients without AHRU (non-AHRU group) and those with AHRU (AHRU group) were compared. Logistic regression analysis was used to assess factors associated with AHRU after bypass surgery. Results: During the study period, 6 of the 80 patients (7.5%) experienced AHRU after bypass surgery. There was no significant difference in the global limb anatomic staging system (GLASS) or wound ischemia and foot infection (WIfI) stage between the 2 groups. The percentage of patients taking oral steroids was significantly greater in the AHRU group. In addition, the AHRU group had a significantly greater percentage of postoperative ambulatory failure and a longer hospital stay. In the univariate analysis of factors associated with the incidence of AHRU after bypass surgery, steroid use (odds ratio [OR], 13.8; 95% confidence interval [CI], 2.19-86.9; P = 0.005) and nonambulatory status after surgery (OR, 7.22; 95% CI, 1.26-41.4; P = 0.026) were significant factors. Conclusions: Steroid use and postoperative nonambulatory status were associated with AHRU after bypass surgery for CLTI.

A 52-year-old man with scoliosis and psoriasis vulgaris, treated with infliximab, presented with a large right gastroepiploic artery aneurysm (GEAA). Following surgical resection, additional aneurysms of the anterior communicating artery and abdominal aorta were identified. Histopathological examination revealed a pseudoaneurysm with organizing thrombus and marked acute inflammation, including neutrophilic infiltration of the medial wall. Despite negative cultures, an infection-related vascular insult could not be excluded. This case highlights a rare immune-mediated vascular pathology in the context of chronic inflammatory disease, emphasizing the potential role of acute inflammation and psoriasis-associated immune dysregulation in visceral artery aneurysm formation.