Annals of vascular diseases最新文献

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.

Objectives: The superficialized brachial artery (SBA) is an important alternative vascular access for hemodialysis patients when autogenous vein fistula creation is not feasible. However, repeated puncture of the SBA can lead to severe complications such as aneurysm formation, pseudoaneurysm, and infection. This study aimed to review surgical strategies for revascularization and infection control in SBA aneurysms.

Methods: We retrospectively analyzed 8 cases of SBA aneurysms treated at our institution between November 2020 and June 2025. Patient demographics, comorbidities, surgical procedures, and outcomes were evaluated based on medical records and follow-up data.

Results: Patients ranged in age from 43 to 81 years and had been on dialysis for an average of 19 years. Six aneurysms were ruptured, and 5 were associated with infection. Brachial artery bypass was the most common procedure, performed in 6 patients using autologous veins or prosthetic grafts. One patient underwent fistula closure with a bovine pericardial patch, and another received direct arterial anastomosis. In infected cases, autologous vein bypass or aneurysm resection with direct anastomosis was performed after thorough debridement. All patients maintained adequate dialysis access postoperatively.

Conclusions: Revascularization of the SBA using autologous vein bypass is effective for managing aneurysms, especially in infected cases. Careful infection control and individualized surgical planning are essential for maintaining safe dialysis access and preserving limb function.

An 82-year-old woman underwent zone 4 thoracic endovascular aortic repair (TEVAR) for a descending aortic aneurysm. Four years later, an additional TEVAR was performed for a type Ib endoleak. Preoperative computed tomography angiography (CTA) initially identified the intercostal artery branching of the Adamkiewicz artery (ICA-AKA) at the left 10th thoracic level, which was covered by a stent graft. Prior to the second TEVAR, CTA showed the ICA-AKA via the left first lumbar artery. Reevaluation of the ICA-AKA is important, particularly after coverage. Surgeons should interpret CTA findings carefully, as other arteries or veins may resemble the AKA.

Objectives: We sought to clarify the interface pressure (IP) and its variation by applying Biflex16, a calibrated bandage, to the lower leg. Methods: In Study I, 50 participants applied a bandage to the lower leg of a single subject in two ways: first, with 50% overlap, while the calibration rectangle became a square (Application 1), and then with 50% overlap without intentional stretch (Application 2) which served as a control. In Study II, another 51 participants applied the bandage to their lower leg via Application 1. The IP was measured at the level of the transposition of the medial gastrocnemius muscle into the Achilles tendon (B1). Results: In Study I, the median IP (37 mmHg) and interquartile range (IQR; 9 mmHg) in the standing position were the same for Applications 1 and 2. In Study II, the obtained IP and IQR values were 38 and 12 mmHg, respectively, in the sitting position. This IP was similar to that obtained in Study I, and no correlation was found between IP and leg circumference. Conclusions: The variation in the IP obtained by the calibrated bandage was reasonably small when applied via Application 1. The obtained IPs did not correlate with the leg circumference.

Objectives: Endovascular aortic repair (EVAR) should be performed using a less invasive procedure based on the patient's clinical condition, as many patients who undergo this procedure are elderly and have poor surgical tolerance. We report our experience and results of percutaneous EVAR under local anesthesia in order to practice minimally invasive EVAR at our hospital. Methods: In August 2019, we started percutaneous EVAR using Perclose ProGlide under local anesthesia. We compared the backgrounds and surgical outcomes of patients who underwent EVAR at our hospital before and after the introduction of percutaneous EVAR under local anesthesia. Results: We included 148 patients in this study. The age at surgery and prevalence of severe renal dysfunction were significantly higher in percutaneous EVAR under local anesthesia group. The operative time and postoperative hospital stay were significantly shorter in the percutaneous EVAR group under local anesthesia. Conclusions: The introduction of percutaneous EVAR under local anesthesia enabled minimally invasive EVAR to be performed safely even in high-risk patients. (This is a translation of J Jpn Coll Angiol 2022; 62: 1-5.).

Objectives: A narrow aortic bifurcation poses technical challenges during endovascular aneurysm repair (EVAR). We aim to compare the unibody AFX2 (Endologix, Irvine, CA, USA) vs the bifurcated ALTO (Endologix) system in EVAR patients with a narrow bifurcation. Methods: Retrospective single-center study, including patients undergoing standard EVAR over 3 years. Patients with a bifurcation diameter <20 mm were identified, and outcomes were compared between the AFX2 and ALTO groups. Primary endpoints were primary and overall technical success, primary and overall clinical success, rate of adverse limb events, rate of limb occlusion, and need for secondary interventions. The analysis was repeated using a diameter threshold of <18 mm. Results: Among 151 cases, 26 presented with bifurcations <20 mm and 12 with <18 mm. In the primary analysis, 15 patients were treated with the AFX2 and 11 with the ALTO endograft. Both groups achieved 100% technical and clinical success. No limb occlusions occurred, and no reinterventions were recorded. Preoperative anatomy was suitable for ALTO in all cases, while eligibility for AFX2 was 15 out of 26 cases. Secondary analysis displayed similar results. Conclusions: In patients with narrow aortic bifurcation, the AFX2 endograft can be safely used when appropriate anatomic conditions are met. If the AFX2 system is unsuitable due to other anatomic restrictions, the ALTO endograft is a viable alternative.

We experienced a case in which a myxoma in the inferior vena cava (IVC) was surgically removed along with the IVC using deep hypothermic circulatory arrest. A 42-year-old female with no subjective symptoms was incidentally found to have a mass in the IVC at the junction of the hepatic veins on contrast-enhanced computed tomography. Ultrasonography revealed a mobile tumor attached to the junction of the hepatic veins. Surgery was performed via median sternotomy and laparotomy. Cardiopulmonary bypass and deep hypothermic circulatory arrest were utilized to safely operate.

Objectives: We investigated the association between brachial-ankle pulse wave velocity (PWV) and arterial stiffness and distensibility in the aneurysmal sac of abdominal aortic aneurysm (AAA). Methods: Data from 49 patients with AAA from June 2020 to November 2022 at Tokyo Medical University Hospital were retrospectively analyzed. Brachial-ankle PWV (cm/s) was obtained via an automated oscillometric method. Regional arterial stiffness and distensibility parameters, such as stiffness parameter (β), pressure-strain elasticity modulus (Ep, kPa), one-point PWV (PWV β, m/s), and arterial compliance (AC, mm²/kPa^-1), were assessed using 2-dimensional automated tissue tracking (2DTT) ultrasonography. Patients were divided into two groups: high PWV (≥1800) and low PWV (<1800). Results: Patients with high PWV showed significantly higher β and PWV β (30.6 ± 10.1 vs. 25.2 ± 6.3, p = 0.047; 11.6 ± 2.3 vs. 10.5 ± 1.5, p = 0.048) and significantly lower AC in the aneurysmal sac (10.6 ± 5.3 vs. 14.7 ± 8.1, p = 0.045) than those with low PWV. AC was negatively correlated with PWV (r = -0.361, p = 0.011). Conclusions: Brachial-ankle PWV can reflect arterial stiffness and distensibility, as measured by 2DTT ultrasonography, in the aneurysmal sac of AAA, suggesting its potential as an elasticity index for assessing regional arterial stiffness and distensibility in AAA.

Chronic limb-threatening ischemia (CLTI) occurs in the advanced stage of peripheral artery disease and is associated with high risks of mortality and amputation. Universal management strategies are not always applicable, owing to population diversity, and the Western trials may not be applicable to Japanese patients, owing to differences in demographics and clinical profiles. This paper examines the outcomes of revascularization in Japanese CLTI patients and emphasizes the benefits of tailored management. Post-hoc analysis of the bypass versus angioplasty in severe ischemia of the leg (BASIL)-1 trial validated the use of the Global Limb Anatomic Staging System for predicting the outcomes of endovascular therapy (EVT) but not bypass surgery (BS). The SPINACH (surgical reconstruction versus peripheral intervention in patients with critical limb ischemia) registry revealed comparable 3-year amputation-free survival rates between patients who underwent EVT and those who underwent BS, with patient-specific factors such as limb status and general health influencing its success. Revascularization improved the quality of life, but benefits declined over time, especially in non-ambulatory and older patients on dialysis. Surgical reconstruction is better for preserving ambulation. Retrospective studies revealed pedal branch artery bypass as a viable option, functional independence as a predictor of survival, and zinc supplementation as promising for wound healing. Future research should focus on refining these strategies and exploring innovative approaches to overcome persistent challenges in CLTI care.