Annals of vascular diseases最新文献

Antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) are similar to be characterized by thromboembolic events and various clinical manifestations. We experienced a 21-year-old man with acute iliocaval deep vein thrombosis (DVT). Primary APS was initially diagnosed on the criteria, and after multidisciplinary treatment, iliocaval DVT was gradually regressed. Six months later, the patient complained of acute enteritis, followed by peripheral neuropathy and butterfly lupus. SLE was diagnosed, which suggested that the onset of SLE was preceded by APS. This case raises the question of a present consensus that these two diseases are clearly different clinical entities, although these are closely related.

It is a clear fact that many complications in surgical treatment, not just in cardiovascular surgery, are caused by things related to surgical techniques. In other words, postoperative problems are already determined by preoperative surgical management and intraoperative surgical operations. This describes strategies to avoid the surgical complications of distal bypass using the autogenous veins for each item. (This is a translation of Jpn J Vasc Surg 2024; 33: 67-72).

Fibromuscular dysplasia (FMD) is an arterial disease characterized by fibrous arterial wall thickening and irregular proliferation and degeneration of smooth muscle cells in muscular arteries. Abdominal aortic aneurysms (AAA) are rare, with only a few reported cases. A characteristic feature of AAA is an aneurysm protruding forward near the terminal aorta with stenosis. Here, we report a rare case of a 66-year-old woman who underwent abdominal aortic replacement for a fusiform AAA, diagnosed with aortic FMD (without stenotic lesions) on pathological examination.

Objectives: Although direct oral anticoagulants (DOAC) have become widely used, little is known about the efficacy of DOAC for isolated distal deep vein thrombosis (DVT). Methods: In-hospitalized orthopedic patients with isolated distal DVT who were diagnosed from 2016 to 2018 were enrolled and were followed for 1 year. Embolic events included symptomatic pulmonary embolism (PE) and DVT extension above the knee. Bleeding events were determined in the presence of bleeding academic research consortium (BARC) 2, 3 or 5 bleeding. Results: Of 196 orthopedic patients, 84% of patients (n = 164) received DOAC (DOAC+ group), whereas 16% of patients (n = 32) did not (DOAC- group). Cumulative incidence of embolic events was observed in 1.5% of the DOAC+ group and none of the DOAC- group (p = 0.443). Cumulative incidence of bleeding events was observed in 5.1% of the DOAC+ group and none of the DOAC- group (p = 0.157). The majority of bleeding events (80%) occurred in patients with HAS-BLED scores of 3 or greater. Conclusions: There were no significant differences in embolic events and bleeding events in retrospective data. Balancing thrombotic risk and bleeding risk remains to be key for isolated distal DVT.

Objectives: Evidence for antithrombotic therapy after endovascular therapy (EVT) is limited. Methods: This retrospective, multicenter, observational study enrolled 732 consecutive patients with lower extremity artery disease who underwent EVT between January 2018 and December 2019. Overall, 570 patients who received single antiplatelet therapy (SAPT) and dual antiplatelet therapy (DAPT) were selected and divided into the SAPT (n = 189) and DAPT (n = 381) groups. The primary outcome was bleeding events at 24 months. The secondary outcomes were bleeding events at 30 days and 24 months after 30 days, ischemic events, and all-cause death at 24 months. Bleeding and ischemic events at 24 months were investigated in subgroups. Results: A propensity score matching yielded 164 patients in both groups. There were no significant differences in bleeding events between the SAPT and DAPT groups (14.2% and 11.3% at 24 months, p = 0.775; 2.5% and 6.1% at 30 days, p = 0.106; 11.7% and 6.7% at 24 months after 30 days, p = 0.162). Additionally, there was no significant difference in ischemic events at 24 months between the two groups (32.7% and 30.6%, p = 0.625). Bleeding and ischemic events at 24 months were similar between subgroups. Conclusions: No significant differences in bleeding or ischemic events between SAPT and DAPT were observed.

Thoracic descending aortic perforation with overlap syndrome (systemic sclerosis and dermatomyositis) is a rare, unreported vascular pathology. We describe the case of a 75-year-old woman who presented with chest tightness, back pain, and dyspnea. Computed tomography revealed a pinhole rupture in the descending aorta. The patient underwent a thoracic endovascular aortic repair and left chest drainage. Her postoperative course was uneventful.

A man in his 60s developed a pancreatic pseudocyst postoperatively after an open graft replacement for a ruptured abdominal aortic aneurysm. Endoscopic drainage was performed; however, this led to an aortic graft infection due to macroscopic communication with the perigraft cavity. Percutaneous drainage was performed to manage the pancreatic fistula and graft infection simultaneously. Although the pancreatic pseudocyst diminished, the aortic graft infection persisted. Subsequently, partial aortic graft replacement with greater omental flap coverage was performed. He was discharged with oral antibiotics, with no recurrence of infections at 10 months.

Objectives: This study aims to investigate the efficacy of thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) complicated by malperfusion. Methods: This retrospective study included patients who underwent TEVAR for the treatment of TBAD complicated by malperfusion from June 1998 to June 2022 in four institutions. In addition to the common outcomes, including short- and medium-term mortality and morbidity, the preservation of each organ was investigated. Results: A total of 23 patients were included in this analysis. The 30-day mortality was 4% (1/23) of the patients. The overall survival rate was 87% at 1 year. The preservation rate of each organ was 33% (4/12) for the visceral organs, 85% (17/20) for the kidneys, and 100% (18/18) for the legs. Fisher's exact test showed a significant difference in the preservation rate between the viscera and the other organs (P = 0.018 vs. kidneys, P = 0.0025 vs. legs). It was shown that the survival rate of patients with visceral malperfusion was significantly lower than that of patients with non-visceral malperfusion (P = 0.006). Conclusion: In terms of mortality, TEVAR showed satisfactory results. The preservation of visceral organs was still challenging even with TEVAR and adjunctive measures.

A 43-year-old man diagnosed with a giant retroperitoneal tumor with suspected invasion of the abdominal aorta and inferior vena cava underwent surgery. Complete en bloc tumor resection could be achieved by transection and reconstruction of the abdominal aorta and inferior vena cava. This case highlights the need for aggressive, complete tumor resection when major vessels are invaded. To ensure comprehensive tumor removal, especially in cases requiring manipulation of major vessels, it is imperative to increase the involvement of cardiovascular surgeons in such surgeries. Therefore, widespread promotion of the concept of oncovascular surgery is essential.