Annals of vascular diseases最新文献

A 56-year-old woman with recurrent acute pulmonary embolism was diagnosed with a left popliteal venous aneurysm (PVA) by venous echocardiography. During anticoagulation therapy with heparin for acute pulmonary embolism, she was found to be positive for heparin-induced thrombocytopenia (HIT) antibodies. Surgery was performed with argatroban for anticoagulation, removal of the thrombus in the PVA, and suturing of the vein. Postoperatively, the popliteal vein showed shrinkage, and no recurrence of thromboembolism was observed. We report a case in which a patient with a PVA positive for HIT antibodies was successfully treated with PVA resection and anticoagulation therapy with argatroban.

We report a case of an abdominal aortic rupture without aneurysm associated with giant cell arteritis. A 67-year-old woman presented with lower back pain. Contrast-enhanced computed tomography revealed a massive retroperitoneal hematoma with contrast leakage from the abdominal aorta, suggestive of abdominal aortic rupture. During emergency surgery, a rupture site was identified on the anterior wall of the abdominal aorta, while no aneurysmal changes or dilatation of the abdominal aorta were observed. Histopathological examination of the resected aortic wall revealed infiltration of giant cells positive for CD68, leading to the diagnosis of giant cell arteritis.

A single-stage extensive aortic replacement is necessary for infected stent graft explantation after thoracic endovascular aortic repair (TEVAR). However, establishing selective cerebral perfusion and antegrade myocardial protection while ensuring a clear view of the distal aorta is challenging. We adopted a semi-clamshell approach with rib cross for a case of infection following hybrid TEVAR. This approach provides visualization of the ascending aorta, aortic arch, and the descending aorta down to the diaphragm. It is a viable option for cases requiring total arch and distal descending aorta replacement, offering reliable cerebral and myocardial protection, particularly in open conversion of hybrid TEVAR.

A 74-year-old man with hypertension and hyperuricemia was incidentally diagnosed with a 39-mm brachiocephalic artery aneurysm. Because of a sufficient proximal sealing zone, a hybrid repair was performed, consisting of a right common carotid-axillary bypass with a prosthetic graft, followed by endovascular exclusion using covered stents, a vascular plug, and coils. Completion angiography confirmed complete aneurysm exclusion without endoleak and satisfactory bypass flow. The postoperative course was uneventful. Computed tomography (CT) angiography demonstrated persistent aneurysm exclusion without endoleak and a patent bypass. At 12 months, plain CT confirmed no aneurysm enlargement.

Pancreaticoduodenal aneurysms are commonly associated with narrowing of the celiac artery, although involvement of the superior mesenteric artery (SMA) is rare. A 77-year-old man presented with a 5-day history of abdominal and back pain. Contrast-enhanced computed tomography revealed hemorrhagic ascites, a pancreatic arcade aneurysm, and dissection of the SMA. Endovascular embolization was performed using metallic coils. Follow-up imaging demonstrated isolation of the aneurysm and improvement in the shrunken true lumen of the dissected SMA. This case suggests that narrowing of the SMA may alter blood flow in the pancreatic arcade and contribute to aneurysm formation.

Since 2013, the Japanese Society for Vascular Surgery has started the project of nationwide registration and tracking database for patients with critical limb ischemia (CLI) who are treated by vascular surgeons. The purpose of this project is to clarify the current status of the medical practice for patients with CLI to contribute to the improvement of the quality of medical care. This database is created on the National Clinical Database (NCD) and collects data on patients' backgrounds, therapeutic measures, early results, and long-term prognoses as long as 5 years after the initial treatment. The name of this database was changed from the JAPAN Critical Limb Ischemia Database to the JAPAN Chronic Limb Threatening Ischemia Database in 2021 because of the alteration of the definition of registered patients. The abbreviation remains JCLIMB. The limbs managed conservatively are also registered in JCLIMB, together with those treated by surgery and/or endovascular treatment (EVT). In 2021, 1338 CLTI limbs (male 916 limbs: 68%) were registered by 78 facilities. Arteriosclerosis obliterans (ASO) has accounted for 99% of the pathogenesis of these limbs. In this manuscript, the background data and the early prognosis of the registered limbs of the ASO cohort are reported. (This is a translation of Jpn J Vasc Surg 2024; 33: 229-250.).

Objectives: We report our hospital-based experience in management strategies and outcomes for pediatric extremity vascular trauma at a major trauma center. Methods: A retrospective chart review was conducted on patients under 18 with extremity vascular injuries who had surgery between May 2021 and February 2023. Results: Among 46 children, 16 (34.8%) had upper extremity injuries, while 30 (65.2%) had lower extremity injuries. Blunt trauma mechanism (82.6%) was dominant, followed by penetrating (17.4%). In all, 34 patients (73.9%) had at least 1 extremity injury, including 14 open fractures. 58.9% of patients did not present with acute ischemic syndrome. Regarding vascular repair, 16 patients (34.8%) underwent direct revascularization, 13 (28.3%) cases involved arterial dilatation using a Fogarty catheter, 9 patients (19.5%) had vascular repair using the great saphenous vein, and 1 case had cephalic and basilic venous repair using an allograft vein. Six patients had a temporary external fixation for complex lower limb fractures. One patient had a secondary amputation after a popliteal injury. One death was documented (2.7%). Conclusions: Blunt trauma poses challenges in pediatric cases. Vascular surgeons must consider children's future growth. Early diagnosis and treatment by experienced vascular surgeons at major surgical centers can lower mortality and amputation rates.

Disseminated venous thromboembolism (VTE) occurs commonly in cancer patients, who tend to have contraindications to systemic thrombolysis and require cancer surgery. Such clinical scenarios are often challenging to manage. In this case report, we illustrate an innovative, single procedural approach in such a patient to remove extensive VTE, improve symptoms, prevent hemodynamic decompensation, and allow for a minimal level of anticoagulation such that necessary cancer surgery can proceed safely.

We present a case of arterial bypass for extensive stenosis of the ulnar artery and superficial palmar arch. The ulnar artery and the superficial palmar arch were bypassed using the great saphenous vein. Postoperatively, blood flow to the affected fingers gradually improved and the pain disappeared. Contrast-enhanced CT showed good visualization of the superficial palmar arch and more distal digital arteries. Considering the slow improvement in blood flow and the dilation of the stenotic finger artery postoperatively, it appeared that there was a significant effect of spasm in addition to organic stenosis preoperatively and that revascularization was an effective treatment.

A superior mesenteric arteriovenous fistula (SMAVF) following gastrointestinal surgery represents a rare vascular complication. Enhanced computed tomography with 3-dimensional reconstruction proves to be the most efficacious modality for detecting this uncommon entity. Superior mesenteric angiography becomes imperative to accurately delineate the location and extent of mesenteric vessel involvement, which is essential for devising an optimal treatment strategy. Recently, endovascular therapy has garnered significant favor due to its less invasiveness compared to surgical interventions. Herein, we present a case of SMAVF after pancreaticoduodenectomy, manifesting with symptoms indicative of portal hypertension. Successful endovascular fistula closure using a balloon-expandable stent graft was achieved.