Annals of vascular diseases最新文献

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.

Cold agglutinin disease (CAD) is a rare and autoimmune hemolytic disorder caused by the presence of cold-reacting autoantibodies against red blood cells. An abdominal aortic aneurysm (AAA) is a potentially life-threatening condition. This report describes an 83-year-old man with AAA who was diagnosed with primary CAD 9 years before undergoing AAA surgery. The patient underwent successful endovascular aortic repair. Temporary hemolytic anemia and exacerbation of jaundice were observed postoperatively despite strict temperature control. Red blood cell and haptoglobin transfusions may prevent fatal hemolytic anemia, renal disorders, embolism, and systemic complications.

A 76-year-old male patient, who had undergone right axillary artery bypass and arch replacement surgery for retrograde type A aortic dissection after thoracic endovascular aortic repair 2 years ago, was referred to our department with complaints of swelling and pain in the right subclavian region. A computed tomography scan suspected an abscess around the bypass graft; however, the culture was negative. Pathological examination indicated a diffuse large B-cell lymphoma (DLBCL) diagnosis. Chemotherapy was not indicated due to the patient's condition, and he passed away after 3 months. DLBCL originating around a graft is extremely rare but crucial for differential diagnosis.

We present a case of a common femoral artery aneurysm as an extremely rare manifestation of immunoglobulin G4-related disease (IgG4-RD). A 79-year-old male, who underwent emergency abdominal aortic aneurysm repair at age 60 due to rupture, developed enlarging aneurysms of the right internal iliac artery, the right common femoral artery, and the left common femoral artery. Consequently, the right iliac artery was replaced with a graft extending to the right deep femoral artery, also reconstructing the right internal iliac artery. Histopathological examination of the resected common femoral artery wall confirmed the diagnosis of IgG4-RD.