Annals of vascular diseases最新文献

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.

Objectives: The purpose of this study is to evaluate the feasibility and clinical outcomes of vasa vasorum embolization for preventing continuous aneurysmal expansion after endovascular aneurysm repair (EVAR). Methods: We retrospectively reviewed the medical records of patients who underwent vasa vasorum embolization between August 2018 and May 2022. Vasa vasorum embolization was attempted in cases of continuous aneurysmal expansion after EVAR, where the vasa vasorum was identified through catheter angiography. The vasa vasorum was accessed and embolized with a microcatheter. The outcomes of vasa vasorum embolization were evaluated based on technical success, defined as the successful completion of the embolization procedure, and clinical success, defined as the prevention of continuous aneurysmal expansion after the embolization. Results: Seven cases of endoleak with developed vasa vasorum were confirmed by catheter angiography. The mean age was 83.7 years, and the mean aneurysmal diameter was 60.6 mm. Technical success was achieved in 6 cases, while clinical success was not achieved in any of the cases. The mean observation period was 16.5 months, and the mean increase in aneurysmal diameter was 9.7 mm. Conclusions: Although the vasa vasorum embolization is a technically feasible procedure, it is not effective in preventing continuous aneurysmal expansion.

Objectives: With improved surgical outcomes for non-ruptured abdominal aortic aneurysm (AAA), the primary objective has shifted toward the detection of asymptomatic AAA. Since ultrasonographic visualization from the anterior abdominal wall is often obstructed by intestinal gas, utilizing additional bilateral posterior approaches via the retroperitoneal tissue may be beneficial. This study investigates the feasibility of assessment using three approaches through computed tomography (CT) data analyses. Methods: The study included 27 surgical patients with AAA (AAA group) and 37 patients with other atherosclerotic diseases (non-AAA group). CT data were analyzed to locate the infrarenal aorta relative to the navel, availability of acoustic window, depth of the aorta, and assessment of aneurysmal aorta using three approaches. Results: The "AAA area" for ultrasonographic screening may be set at 0-4 cm above the navel. An acoustic window was unavailable in 8.1% of AAA cases and 7.4% of non-AAA cases in the anterior approach; however, it was available in the posterior approach. Although the depth of the aorta was greater in obese patients, it remained within 20 cm. Conclusion: Ultrasonographic screening is feasible by incorporating posterior approaches in cases where anterior visualization is difficult, enhancing the detection of asymptomatic AAA.

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.

A 19-year-old female presented with intermittent claudication without anatomical abnormality in the popliteal fossa on magnetic resonance imaging and computed tomography. However, duplex ultrasound (DUS) showed compression of the popliteal artery (PA) and vein during plantarflexion and dorsiflexion. She was diagnosed with functional PA entrapment syndrome (PAES) and underwent resection of the plantaris and gastrocnemius muscles using DUS with stress maneuvers, which relieved the symptoms. In physically active adults, functional PAES can develop without anatomical abnormality. Thus, in the field of vascular medicine, it is important to consider this underrecognized pathophysiology among young people with lower leg pain.

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.