Annals of vascular diseases最新文献

Loeys-Dietz syndrome (LDS) is a genetic connective tissue disorder associated with vascular involvement and craniofacial, skeletal, and cutaneous abnormalities. Herein, we describe the case of a 28-year-old female who presented with a pulsatile mass in her abdomen. Imaging studies revealed multiple aneurysms, including a 53-mm abdominal aortic aneurysm (AAA) and tortuosity of the intracranial arterial vasculature. Genetic testing revealed a mutation in transforming growth factor beta receptor 1, leading to a diagnosis of LDS. The patient underwent open surgical repair of AAA. Other arterial lesions were carefully followed. This case demonstrates that AAA can be a primary manifestation of LDS.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeons in Japan in 2017, as analyzed by Database Management Committee (DBC) members of the Japanese Society for Vascular Surgery (JSVS). Materials and Methods: To survey the current status of vascular treatments performed by vascular surgeons in Japan, the DBC members of the JSVS analyzed the vascular treatment data provided by the National Clinical Database, including the number of treatments and early results such as operative and hospital mortality. Results: In total, 137,909 vascular treatments were registered by 1,076 institutions in 2017. This database comprised seven fields including treatment of aneurysms, chronic arterial occlusive disease, acute arterial occlusive disease, vascular injury, complication of previous vascular reconstruction, venous diseases, and other vascular treatments. The number of vascular treatments in each field was 21,680, 18,123, 4,765 2,418, 669, 48,625, and 41,629, respectively. In the aneurysm treatment, 19,982 cases of abdominal aortic aneurysm (AAA), including common iliac aneurysm, were registered, and 64.1% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,824 (9.1%) cases were registered as ruptured AAA. The operative mortality rates of ruptured and unruptured AAA were 15.0%, and 0.7%, respectively. 37.9% of ruptured AAA were treated by EVAR, and the EVAR ratio was gradually increasing, but the operative mortality rates of open repair and EVAR for ruptured AAA were 14.5%, and 12.3%, respectively. There was no statistical significance. Regarding chronic arterial occlusive disease, open repair was performed in 7,277 cases, including 1,348 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) was performed in 9,248 cases. The EVT ratio was gradually increased at 56.0%. The number of varicose vein treatments decreased to 46,754 (11.2% less than in 2016), and 73.7% of the cases were treated by endovenous laser or radiofrequency ablations. Regarding other vascular operations, 38,769 cases of vascular access operations and 1,548 lower limb amputation surgeries were included. Conclusions: The number of vascular treatments increased since 2011, and the proportion of endovascular procedures increased in almost all fields of vascular diseases, especially EVAR for AAA and EVT for chronic arterial occlusive disease. (This is a translation of Jpn J Vasc Surg 2021; 30: 359-379.).

Objectives: We evaluate the preliminary and intermediate-term results of Viet Duc modification of the frozen elephant trunk (FET) technique. Methods: During December 2019 and May 2023, 47 patients underwent surgery using our modification of the FET at Viet Duc University Hospital. The mean age of the patients was 56.8 years (±9.4, range 31-72). In all, 34 (72.3%) of the patients were men. Results: There were 5 (10.6%) perioperative deaths. The duration of cardiopulmonary bypass, cross-clamping, circulatory arrest, and total operation were 165 (±49.1 range 94-330), 100 (±37, range 46-205), 32.6 (±8, range 20-58), and 366 (±60.6, range 270-540) minutes, respectively. In complications, tracheotomy, temporal hemodialysis, cerebral shock, and type 1A endoleak were noted in 3 (6.4%), 4 (8.5%), 4 (8.5%), and 3 (6.4%) patients, respectively. The mean follow-up time was 25.8 months (±11.7, range 3-42). One case was dead in the follow-up period. Three patients (6.3%) had successful reoperation for type 1A endoleak, and 4 patients (8.5%) underwent a second intervention. One (2.1%) patient had a second intervention and an infrarenal abdominal aortic replacement. Conclusions: Our modification of the FET technique was feasible, effective, and safe, with good early and intermediate-term outcomes.

Myasthenia gravis (MG) is an autoimmune neuromuscular junction disorder that rarely coexists with infectious thoracoabdominal aortic aneurysms (TAAA) requiring open repair. A 57-year-old patient with MG underwent elective thoracoabdominal aortic replacement. He was diagnosed with MG (Osserman classification II A). Extent IV thoracoabdominal aortic repair was performed under general anesthesia and maintained by total intravenous anesthesia. The patient was withdrawn from the ventilator on postoperative day 5 without spinal cord ischemia and myasthenic crisis. The management of infectious TAAA with myasthenia gravis warrants not only the prevention of complications associated with the crisis but also multidisciplinary treatments for infection control.

Objective: To comparatively examine in-hospital mortality between open aneurysm repair (OAR) and endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) in Japan. Methods: Using administrative data, this retrospective cohort study analyzed rAAA patients treated at 482 Japanese acute care hospitals between April 1, 2018 and March 31, 2021. Patients were assigned to an OAR group or EVAR group. The propensity score for EVAR was calculated, and logistic regression analysis using inverse probability of treatment weighting was performed with in-hospital mortality as the dependent variable and surgical procedure (EVAR vs OAR) as the main independent variable of interest. Results: The OAR group and EVAR group comprised 2650 patients from 372 hospitals and 2656 patients from 356 hospitals, respectively. In-hospital mortality was significantly higher (P <0.01) in the OAR group (11.7%) than in the EVAR group (9.4%). The logistic regression analysis calculated the odds ratio for in-hospital mortality to be 0.74 (95% confidence interval: 0.60-0.92; P <0.01) in the EVAR group (reference: OAR group). Conclusion: EVAR was significantly associated with reduced in-hospital mortality and shorter hospitalizations in patients treated for rAAA in Japan.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeons in Japan in 2018, as analyzed by database management committee (DBC) members of the Japanese Society for Vascular Surgery (JSVS). Materials and Methods: To survey the current status of vascular treatments performed by vascular surgeons in Japan, the DBC members of the JSVS analyzed the vascular treatment data provided by the National Clinical Database (NCD), including the number of treatments and early results such as operative and hospital mortality. Results: In total, 143,745 vascular treatments were registered by 1,090 institutions in 2018. This database comprises seven fields, including treatment of aneurysms, chronic arterial occlusive disease, acute arterial occlusive disease, vascular injury, complication of previous vascular reconstruction, venous diseases, and other vascular treatments. The number of vascular treatments in each field was 24,495, 18,700, 4,813, 2,363, 694, 45,088, and 47,592, respectively. In the field of aneurysm treatment, 20,160 cases of abdominal aortic aneurysm (AAA), including common iliac aneurysm, were registered, and 61.6% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,794 (8.9%) cases were registered as ruptured AAA. The operative mortality rates of ruptured and unruptured AAA were 15.7% and 0.6%, respectively. Approximately 43.3% of ruptured AAA were treated by EVAR, and the EVAR ratio was gradually increasing, but the operative mortality rates of open repair and EVAR for ruptured AAA were 14.0% and 14.6%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 8,336 cases, including 1,348 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) was performed in 9,710 cases. The EVT ratio was gradually increased at 51.9%. Varicose vein treatment was decreased in 43,133 cases (7.7% less than that in 2017), and 77.3% of the cases were treated by endovenous thermal ablation (ETA), including endovenous laser ablation (EVLA) and radiofrequency ablation (RFA). Regarding other vascular operations, 44,003 cases of vascular access operations and 1,631 lower limb amputation surgeries were included. Conclusions: The number of vascular treatments increased since 2017, and the proportion of endovascular procedures increased in almost all fields of vascular diseases, especially EVAR for AAA, EVT for chronic arterial occlusive disease, and ETA for varicose veins. (This is a translation of Jpn J Vasc Surg 2022; 31: 217-237.).

Superior mesenteric artery (SMA) aneurysm and their surgical interventions are rare, leading to infrequent reports of postoperative complications. This report describes 2 cases of refractory diarrhea following vascular reconstruction for infectious SMA aneurysms. Both patients underwent aneurysm resection and SMA reconstruction but experienced persistent diarrhea despite treatment with anti-diarrheal medications. Postoperative diarrhea, a complication observed after resection of the nerve plexus around the SMA in gastrointestinal surgery, may be attributed to intraoperative injury to the nerve plexus in our cases. Though palliative therapy is partially effective, more efficacious management strategies are desirable to address this persistent complication.

Ruptured iliac artery aneurysms are serious conditions with high mortality, occasionally perforating into the venous system. A 73-year-old male presented with left leg edema and a pulsatile left lower abdominal mass. Computed tomography revealed a ruptured left common iliac artery aneurysm with perforation into the left common iliac vein. Additionally, bilateral internal iliac veins were noted to form an anomalous common trunk draining into the left common iliac vein. Treatment involved internal iliac vein balloon occlusion under fluoroscopy followed by open surgery for artificial graft replacement and fistula repair. The patient was discharged on the 8th postoperative day.

Objectives: This study aimed to quantitatively evaluate peripheral nerve injury (PNI) after varicose vein (VV) surgery using endovenous laser ablation (EVLA). Methods: Overall, 25 cases were analyzed. All patients underwent EVLA of the great saphenous vein (GSV) with or without resection of the varix of the GSV tributaries in stab and avulsion fashion (microphlebectomy). For evaluation of PNI, the current perception threshold (CPT) was measured preoperatively at 1 week, 1 month, 3 months, and 6 months postoperatively. In each leg, CPT was measured at 6 points. PNI was defined as >40% elevation from preoperative data. Results: A significant elevation in CPT was observed at 2 points (knee joint level [P = 0.01] and upper portion of the lower leg [P = 0.008]) 1 week postoperatively. CPT decreased after 1 month and recovered to the same level after 6 months. PNI occurred in 52% and 36% of patients at the knee joint level and upper portion of the lower leg, respectively. Microphlebectomy was indicated as a factor associated with PNI (P <0.01). Conclusions: Although VV surgery using EVLA is less invasive, the occurrence of transient PNI in the early postoperative period should be noted when concomitant microphlebectomy is performed.