Annals of vascular diseases最新文献

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeons in Japan in 2018, 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 (NCD), including the number of treatments and early results such as operative and hospital mortality. Results: In total, 143,745 vascular treatments were registered by 1,090 institutions in 2018. This database comprises 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 24,495, 18,700, 4,813, 2,363, 694, 45,088, and 47,592, respectively. In the field of aneurysm treatment, 20,160 cases of abdominal aortic aneurysm (AAA), including common iliac aneurysm, were registered, and 61.6% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,794 (8.9%) cases were registered as ruptured AAA. The operative mortality rates of ruptured and unruptured AAA were 15.7% and 0.6%, respectively. Approximately 43.3% 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 14.0% and 14.6%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 8,336 cases, including 1,348 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) was performed in 9,710 cases. The EVT ratio was gradually increased at 51.9%. Varicose vein treatment was decreased in 43,133 cases (7.7% less than that in 2017), and 77.3% of the cases were treated by endovenous thermal ablation (ETA), including endovenous laser ablation (EVLA) and radiofrequency ablation (RFA). Regarding other vascular operations, 44,003 cases of vascular access operations and 1,631 lower limb amputation surgeries were included. Conclusions: The number of vascular treatments increased since 2017, and the proportion of endovascular procedures increased in almost all fields of vascular diseases, especially EVAR for AAA, EVT for chronic arterial occlusive disease, and ETA for varicose veins. (This is a translation of Jpn J Vasc Surg 2022; 31: 217-237.).

Ruptured iliac artery aneurysms are serious conditions with high mortality, occasionally perforating into the venous system. A 73-year-old male presented with left leg edema and a pulsatile left lower abdominal mass. Computed tomography revealed a ruptured left common iliac artery aneurysm with perforation into the left common iliac vein. Additionally, bilateral internal iliac veins were noted to form an anomalous common trunk draining into the left common iliac vein. Treatment involved internal iliac vein balloon occlusion under fluoroscopy followed by open surgery for artificial graft replacement and fistula repair. The patient was discharged on the 8th postoperative day.

Objectives: This study aimed to quantitatively evaluate peripheral nerve injury (PNI) after varicose vein (VV) surgery using endovenous laser ablation (EVLA). Methods: Overall, 25 cases were analyzed. All patients underwent EVLA of the great saphenous vein (GSV) with or without resection of the varix of the GSV tributaries in stab and avulsion fashion (microphlebectomy). For evaluation of PNI, the current perception threshold (CPT) was measured preoperatively at 1 week, 1 month, 3 months, and 6 months postoperatively. In each leg, CPT was measured at 6 points. PNI was defined as >40% elevation from preoperative data. Results: A significant elevation in CPT was observed at 2 points (knee joint level [P = 0.01] and upper portion of the lower leg [P = 0.008]) 1 week postoperatively. CPT decreased after 1 month and recovered to the same level after 6 months. PNI occurred in 52% and 36% of patients at the knee joint level and upper portion of the lower leg, respectively. Microphlebectomy was indicated as a factor associated with PNI (P <0.01). Conclusions: Although VV surgery using EVLA is less invasive, the occurrence of transient PNI in the early postoperative period should be noted when concomitant microphlebectomy is performed.

Superior mesenteric artery (SMA) aneurysm and their surgical interventions are rare, leading to infrequent reports of postoperative complications. This report describes 2 cases of refractory diarrhea following vascular reconstruction for infectious SMA aneurysms. Both patients underwent aneurysm resection and SMA reconstruction but experienced persistent diarrhea despite treatment with anti-diarrheal medications. Postoperative diarrhea, a complication observed after resection of the nerve plexus around the SMA in gastrointestinal surgery, may be attributed to intraoperative injury to the nerve plexus in our cases. Though palliative therapy is partially effective, more efficacious management strategies are desirable to address this persistent complication.

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.