Pub Date : 2025-01-01Epub Date: 2025-12-17DOI: 10.3400/avd.oa.25-00093
Shunichiro Fujioka, Kenjiro Sakaki
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.
{"title":"Revascularization of the Superficialized Brachial Artery.","authors":"Shunichiro Fujioka, Kenjiro Sakaki","doi":"10.3400/avd.oa.25-00093","DOIUrl":"10.3400/avd.oa.25-00093","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":7995,"journal":{"name":"Annals of vascular diseases","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145817460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Challenges in Identifying and Interpreting Intercostal Branches of the Adamkiewicz Artery.","authors":"Satoru Tomita, Yoshimasa Seike, Tatsuya Nishii, Kazufumi Yoshida, Yojiro Koda, Takayuki Shijo, Yosuke Inoue, Tetsuya Fukuda, Hitoshi Matsuda","doi":"10.3400/avd.cr.25-00092","DOIUrl":"10.3400/avd.cr.25-00092","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":7995,"journal":{"name":"Annals of vascular diseases","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Interface Pressures Derived from a Calibrated Bandage Applied for Compression Therapy.","authors":"Kotaro Suehiro, Hitoshi Sakuda, Takasuke Harada, Yuriko Takeuchi, Takahiro Mizoguchi, Ryunosuke Sakamoto, Hiroshi Kurazumi, Ryo Suzuki, Kimikazu Hamano","doi":"10.3400/avd.oa.24-00103","DOIUrl":"10.3400/avd.oa.24-00103","url":null,"abstract":"<p><p><b>Objectives:</b> We sought to clarify the interface pressure (IP) and its variation by applying Biflex16, a calibrated bandage, to the lower leg. <b>Methods:</b> 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). <b>Results:</b> 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. <b>Conclusions:</b> 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.</p>","PeriodicalId":7995,"journal":{"name":"Annals of vascular diseases","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.).
目的:血管内主动脉修复(EVAR)应根据患者的临床情况采用微创手术,因为许多接受该手术的患者是老年人,手术耐受性差。为了在我院实施微创EVAR,我们报告局麻下经皮EVAR的经验和结果。方法:2019年8月,我们在局麻醉下使用Perclose ProGlide进行经皮EVAR。我们比较了局麻下经皮EVAR术前后在我院行EVAR术患者的背景和手术结果。结果:我们纳入了148例患者。局麻组经皮EVAR患者手术年龄和严重肾功能不全发生率明显增高。局麻下经皮EVAR组的手术时间和术后住院时间均明显缩短。结论:局麻下经皮EVAR的引入使微创EVAR即使在高危患者中也能安全进行。(这是j.jpn Coll angol 2022的翻译;62: 1 - 5)。
{"title":"The Practice of Percutaneous EVAR under Local Anesthesia.","authors":"Yuika Kameda, Naohiko Nemoto, Bon Inoue, Satoru Takaesu, Hiroki Takenaka, Yoshinori Nagashima, Hitoshi Anzai","doi":"10.3400/avd.oa.24-00129","DOIUrl":"10.3400/avd.oa.24-00129","url":null,"abstract":"<p><p><b>Objectives:</b> 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. <b>Methods:</b> 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. <b>Results:</b> 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. <b>Conclusions:</b> 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.).</p>","PeriodicalId":7995,"journal":{"name":"Annals of vascular diseases","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2025-06-14DOI: 10.3400/avd.oa.25-00027
Nikolaos Kontopodis, Michalis Pesmatzoglou, Ifigeneia Tzartzalou, Konstantinos Litinas, George Tzouliadakis, Nikolaos Galanakis, Elias Kehagias, Christos Ioannou
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.
{"title":"Comparative Study of Endovascular Aneurysm Repair in Patients with Narrow Aortic Bifurcation Using the Unibody AFX2 vs the Bifurcated ALTO Endoluminal System.","authors":"Nikolaos Kontopodis, Michalis Pesmatzoglou, Ifigeneia Tzartzalou, Konstantinos Litinas, George Tzouliadakis, Nikolaos Galanakis, Elias Kehagias, Christos Ioannou","doi":"10.3400/avd.oa.25-00027","DOIUrl":"10.3400/avd.oa.25-00027","url":null,"abstract":"<p><p><b>Objectives:</b> 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. <b>Methods:</b> 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. <b>Results:</b> 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. <b>Conclusions:</b> 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.</p>","PeriodicalId":7995,"journal":{"name":"Annals of vascular diseases","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2025-03-25DOI: 10.3400/avd.cr.24-00118
Masato Hayama, Kayo Wakamatsu, Yuko Teratani, Yuki Kunitomo, Chihaya Ito, Masayuki Shimizu, Hiromitsu Teratani, Yuta Sukehiro, Masato Furui, Mizuki Sumi, Mau Amako, Yoshio Hayashida, Go Kuwahara, Hideichi Wada
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.
{"title":"A Case of Surgery for Myxoma in the Inferior Vena Cava Using Deep Hypothermic Circulatory Arrest.","authors":"Masato Hayama, Kayo Wakamatsu, Yuko Teratani, Yuki Kunitomo, Chihaya Ito, Masayuki Shimizu, Hiromitsu Teratani, Yuta Sukehiro, Masato Furui, Mizuki Sumi, Mau Amako, Yoshio Hayashida, Go Kuwahara, Hideichi Wada","doi":"10.3400/avd.cr.24-00118","DOIUrl":"10.3400/avd.cr.24-00118","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":7995,"journal":{"name":"Annals of vascular diseases","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
目的:探讨腹主动脉瘤(AAA)动脉瘤囊内脉波速度(PWV)与动脉僵硬度和扩张度的关系。方法:回顾性分析2020年6月至2022年11月东京医科大学医院49例AAA患者的资料。通过自动示波法获得肱-踝关节PWV (cm/s)。采用二维自动组织跟踪(2DTT)超声评估区域动脉刚度和扩张参数,如刚度参数(β)、压力-应变弹性模量(Ep, kPa)、一点PWV (PWV β, m/s)和动脉顺应性(AC, mm2/kPa-1)。患者分为高PWV组(≥1800)和低PWV组(结果:高PWV组患者β和PWV β显著升高(30.6±10.1∶25.2±6.3,p = 0.047;(11.6±2.3 vs. 10.5±1.5,p = 0.048),与低PWV组相比,动脉瘤囊AC明显降低(10.6±5.3 vs. 14.7±8.1,p = 0.045)。AC与PWV呈负相关(r = -0.361, p = 0.011)。结论:2DTT超声测量肱踝PWV能反映AAA动脉瘤囊内动脉僵硬度和扩张度,提示其可作为评估AAA局部动脉僵硬度和扩张度的弹性指标。
{"title":"Brachial-Ankle Pulse Wave Velocity Reflects Regional Arterial Stiffness and Distensibility in Patients with Abdominal Aortic Aneurysm.","authors":"Toshiya Nishibe, Shinobu Akiyama, Masaki Kano, Shoji Fukuda, Fumio Chiba, Jun Koizumi, Masayasu Nishibe","doi":"10.3400/avd.oa.24-00097","DOIUrl":"10.3400/avd.oa.24-00097","url":null,"abstract":"<p><p><b>Objectives:</b> 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). <b>Methods:</b> 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, mm<sup>2</sup>/kPa<sup>-1</sup>), were assessed using 2-dimensional automated tissue tracking (2DTT) ultrasonography. Patients were divided into two groups: high PWV (≥1800) and low PWV (<1800). <b>Results:</b> 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). <b>Conclusions:</b> 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.</p>","PeriodicalId":7995,"journal":{"name":"Annals of vascular diseases","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2025-01-20DOI: 10.3400/avd.ra.24-00135
Akio Kodama
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.
{"title":"Clinical Outcomes after Revascularization in Patients with Chronic Limb-Threatening Ischemia.","authors":"Akio Kodama","doi":"10.3400/avd.ra.24-00135","DOIUrl":"10.3400/avd.ra.24-00135","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":7995,"journal":{"name":"Annals of vascular diseases","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: The pathophysiological mechanism of abdominal aortic aneurysm (AAA) remains unclear. We previously reported that Bifidobacterium adolescentis levels were reduced in the feces of patients with AAA by 16S ribosomal ribonucleic acid (RNA) gene sequencing. In this study, we increased the number of cases and conducted metagenomic analyses to examine bacterial genes associated with the pathophysiology of AAA. Methods: For gut microbiota data, feces from 55 patients with AAA and 52 patients with no history of AAA, lower extremity artery disease, or coronary artery disease (control group) were collected. Metagenomic analysis was performed by collecting raw stool samples from patients. For intestinal microbiota analysis, metagenomic analysis of the fecal samples was performed. Results: Oral bacteria, including Actinomyces oris (p <0.0001), Streptococcus salivarius (p <0.001), Lactobacillus salivarius (p <0.001), and Streptococcus sp. (p <0.001), were increased in the feces of patients with AAA. In addition, bacterial genes related to alpha lipoic acid (ALA) biosynthesis (M00882, M00883, and M00884, p <0.0001) were decreased in patients with AAA. Conclusions: In the feces of patients with AAA, there was an increase in oral bacteria, and the expression of bacterial genes related to ALA biosynthesis was reduced. The results suggest the possibility of developing gut microbial drug treatments for AAA.
{"title":"Metagenomic Analysis of Gut Microbiota for Abdominal Aortic Aneurysm.","authors":"Eisaku Ito, Takao Ohki, Naoki Toya, Takuo Emoto, Tomoya Yamashita, Tomomi Sugiyama, Takuji Yamada, Hiroshi Mori, Atsushi Toyoda, Ken-Ichi Hirata","doi":"10.3400/avd.oa.24-00105","DOIUrl":"10.3400/avd.oa.24-00105","url":null,"abstract":"<p><p><b>Objectives:</b> The pathophysiological mechanism of abdominal aortic aneurysm (AAA) remains unclear. We previously reported that <i>Bifidobacterium adolescentis</i> levels were reduced in the feces of patients with AAA by 16S ribosomal ribonucleic acid (RNA) gene sequencing. In this study, we increased the number of cases and conducted metagenomic analyses to examine bacterial genes associated with the pathophysiology of AAA. <b>Methods:</b> For gut microbiota data, feces from 55 patients with AAA and 52 patients with no history of AAA, lower extremity artery disease, or coronary artery disease (control group) were collected. Metagenomic analysis was performed by collecting raw stool samples from patients. For intestinal microbiota analysis, metagenomic analysis of the fecal samples was performed. <b>Results:</b> Oral bacteria, including <i>Actinomyces oris</i> (<i>p</i> <0.0001), <i>Streptococcus salivarius</i> (<i>p</i> <0.001), <i>Lactobacillus salivarius</i> (<i>p</i> <0.001), and <i>Streptococcus</i> sp. (<i>p</i> <0.001), were increased in the feces of patients with AAA. In addition, bacterial genes related to alpha lipoic acid (ALA) biosynthesis (M00882, M00883, and M00884, <i>p</i> <0.0001) were decreased in patients with AAA. <b>Conclusions:</b> In the feces of patients with AAA, there was an increase in oral bacteria, and the expression of bacterial genes related to ALA biosynthesis was reduced. The results suggest the possibility of developing gut microbial drug treatments for AAA.</p>","PeriodicalId":7995,"journal":{"name":"Annals of vascular diseases","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: The venous cuff technique has been used primarily for arterial bypass using artificial grafts to the lower extremities. The boat-form vein cuff was designed to allow adjustment of the size and angle of the anastomosis at any anatomic site. We report our experience and outcomes of the original vein cuff technique in various peripheral artery bypass grafting procedures. Methods: A total of 10 patients underwent arterial bypass grafting using a polytetrafluoroethylene (PTFE) graft with a boat-form venous cuff. The indications for the surgery consisted of peripheral artery disease (n = 4), acute limb ischemia (n = 4), chronic mesenteric ischemia (n = 1), and traumatic upper limb ischemia (n = 1). Five patients required emergency surgery. Surgical outcomes, such as mortality and morbidity, limb salvage rate, and graft patency, were examined using perioperative and postoperative follow-up data. Results: There were no operative deaths or serious complications, including amputation of the lower extremity. During the follow-up period (44 ± 36.9 months), the PTFE graft remained patent in 9 patients (90%). In 1 patient, occlusion of the femoropopliteal bypass graft was observed 3 months after surgery. Conclusions: The simple design and creation of the boat-form vein cuff are useful at any anatomical site in peripheral artery bypass grafting with a PTFE graft.
{"title":"Surgical Outcomes of the Boat-Form Vein Cuff Technique in Peripheral Artery Bypass Grafting.","authors":"Shun-Ichiro Sakamoto, Anna Tsuji, Motohiro Maeda, Atsushi Hiromoto, Kenji Suzuki, Jiro Honda, Yosuke Ishii","doi":"10.3400/avd.oa.24-00134","DOIUrl":"10.3400/avd.oa.24-00134","url":null,"abstract":"<p><p><b>Objectives:</b> The venous cuff technique has been used primarily for arterial bypass using artificial grafts to the lower extremities. The boat-form vein cuff was designed to allow adjustment of the size and angle of the anastomosis at any anatomic site. We report our experience and outcomes of the original vein cuff technique in various peripheral artery bypass grafting procedures. <b>Methods:</b> A total of 10 patients underwent arterial bypass grafting using a polytetrafluoroethylene (PTFE) graft with a boat-form venous cuff. The indications for the surgery consisted of peripheral artery disease (n = 4), acute limb ischemia (n = 4), chronic mesenteric ischemia (n = 1), and traumatic upper limb ischemia (n = 1). Five patients required emergency surgery. Surgical outcomes, such as mortality and morbidity, limb salvage rate, and graft patency, were examined using perioperative and postoperative follow-up data. <b>Results:</b> There were no operative deaths or serious complications, including amputation of the lower extremity. During the follow-up period (44 ± 36.9 months), the PTFE graft remained patent in 9 patients (90%). In 1 patient, occlusion of the femoropopliteal bypass graft was observed 3 months after surgery. <b>Conclusions:</b> The simple design and creation of the boat-form vein cuff are useful at any anatomical site in peripheral artery bypass grafting with a PTFE graft.</p>","PeriodicalId":7995,"journal":{"name":"Annals of vascular diseases","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}