Annals of vascular diseases最新文献

The underlying mechanisms of abdominal aortic aneurysms (AAAs) are not fully understood. Given the multifactorial nature of AAA development and progression, a comprehensive approach is essential. Throughout my academic career, I conducted various studies on AAA. To better understand this mechanism, I initially developed an elastase-infused rat AAA model and applied it to nanoparticle drug delivery systems. While open surgery has traditionally been the standard treatment for AAA, endovascular aneurysm repair (EVAR) has seen significant advancements over the past 25 years. However, insufficient evidence exists regarding this novel treatment, particularly in Japan. To address this issue, we analyzed extensive datasets on EVAR using various registries, including the Japanese Committee for Stent Graft Management. Furthermore, through medical-engineering collaboration, simulation methods were utilized to generate evidence addressing clinical questions encountered in practice.

Late postoperative type 3 endoleaks associated with the AFX (Endologix, Irvine, CA, USA) stent-graft are commonly reported. The AFX's endoskeletal design raises concerns about wire entrapment between its frame and fabric, as well as a risk of type 1a endoleak. An 84-year-old man with prior EVAR using the AFX presented with a type 3b endoleak 4 years postoperatively. He underwent relining with the TREO stent-graft (Terumo Aortic, Sunrise, FL, USA), which enabled easy contralateral gate cannulation and secured a long proximal landing zone. The TREO appears to be a viable option for relining the AFX in type 3b endoleak cases.

Objectives: Thoracic endovascular aneurysm repair (TEVAR) has revolutionized the treatment of thoracic aortic aneurysms (TAA) by providing a less invasive alternative to open surgery. This study aims to identify risk factors for early mortality following TEVAR for degenerative TAA using a machine learning-based decision tree analysis (DTA). Methods: This retrospective observational study analyzed 79 patients who underwent elective TEVAR to identify predictors of early mortality (within 2 years) using decision tree analysis. The dataset included 36 variables, covering age, sex, nutritional status, comorbidities, inflammation, immune status, and surgical details. The decision tree classifier was developed and validated using Python 3.7 with the scikit-learn toolkit. Results: DTA identified octogenarian status as the strongest predictor of early mortality, followed by poor nutritional status, debranching procedures, and compromised immunity. The model identified 7 terminal nodes, with early mortality risk ranging from 0% to 77.7%. It demonstrated moderate accuracy (65.8%) and high sensitivity (81.0%) but had relatively low specificity (60.3%), effectively identifying high-risk patients. Conclusions: Machine learning-based DTA identified key predictors of early mortality following TEVAR, including octogenarian status, poor nutritional status, compromised immunity, and debranching procedures. The model provides an interpretable risk stratification tool, but its clinical applicability requires further validation.

Diffusion-weighted whole-body imaging with background body signal suppression has been used to diagnose fever of unknown origin. An 86-year-old man who underwent bile duct jejunostomy for bile duct cancer presented with fever (body temperature, 40°C). Escherichia coli was detected in blood cultures. Diffusion-weighted whole-body imaging with background body signal suppression revealed accumulation in the aortic arch. Therefore, infectious aortitis secondary to retrograde cholangitis was diagnosed. The patient was treated with antibiotics, and the aortic arch accumulation disappeared. Diffusion-weighted whole-body imaging with background body signal suppression is a useful modality for diagnosing vasculitis and assessing treatment effectiveness.

A 59-year-old patient was undergoing careful monitoring of an isolated superior mesenteric artery dissection discovered 6 years prior. He was admitted after outpatient imaging revealed multiple visceral aneurysms including common hepatic and splenic artery aneurysms that had enlarged. Based on anatomical reasons and the past history, the splenic artery aneurysm was treated with endovascular therapy, while the common hepatic artery aneurysm was resected, and blood flow reconstruction was performed. The patient was discharged without any complications. Visceral artery aneurysms have diverse locations and morphologies, illustrating the importance of treatment strategies that consider the blood flow to the organs.

During thoracic endovascular aneurysm repair for aortic arch aneurysms, deployment of the stent graft parallel to the aortic neck is crucial to preventing a type Ia endoleak from the proximal end. We report the early tip capture release and push-up technique that comprises early release of the proximal bare stent, which is typically deployed last during stent graft deployment, followed by a push-up maneuver after landing the proximal edge, thus allowing conformation to the aortic morphology. This technique is effective even for complex aortic arch anatomy.

Spontaneous rupture of the iliac vein (SRIV) requires surgical hemostasis and venous return restoration. We herein report a case treated with initial thrombus removal and direct venous repair. Because of early occlusion, a 2nd surgery was performed for iliac vein reconstruction using a 14-mm ringed Gore-Tex graft (W. L. Gore & Associates, Newark, DE, USA), and a 4-mm Gore-Tex arteriovenous shunt was created between the femoral artery and the femoral vein to prevent reocclusion. The patient had an uneventful recovery without recurrence. A single-stage procedure including hemostasis, vein replacement, and arteriovenous bypass may be ideal for radical SRIV treatment.

Idiopathic inferior mesenteric arteriovenous fistula is an extremely rare pathology, and symptoms vary greatly depending on the shunt flow volume through the fistula. We report a case of idiopathic inferior mesenteric arteriovenous fistula in a 63-year-old man who presented with a pulsating sensation in the upper abdomen. Computed tomography revealed an inferior mesenteric arteriovenous fistula with aneurysmal dilatation and a drainage vein into the dilated marginal vein of the descending colon. Surgical resection and ligation of the fistula were successfully performed, and the postoperative course was uneventful. The patient's symptoms resolved, and no recurrence was observed during the 5-year follow-up.

A patient with complicated Stanford type B aortic dissection and a large ulcer-like projection just distal to the left subclavian artery (LSA) underwent thoracic endovascular aortic repair (TEVAR) using a physician-made 1-cm fenestration and L-shaped marker. This technique allowed accurate alignment with the LSA under fluoroscopic guidance without additional devices. Postoperative and 6-month follow-up computed tomography confirmed good outcomes. This simplified, economical Zone 2.5 TEVAR approach may be a viable treatment option for high-risk patients with anatomically challenging aortic dissections.

Intraoperative venous bleeding, particularly from deep pelvic veins, can be difficult to control with suturing or standard compression. We introduce the "French toast method," a hemostatic technique that combines Hydrofit (Terumo, Tokyo, Japan) with a gelatin sponge (Spongel; LTL Pharma, Tokyo, Japan). A small amount of Hydrofit is spread onto the sponge, which is then applied to the bleeding site. Immediately afterward, saline is poured over the area to activate Hydrofit, followed by fingertip compression. This method enables rapid and secure hemostasis without the need to remove a silicone sheet, thereby reducing the risk of rebleeding and simplifying management of difficult venous hemorrhage.