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  • 刊频： Quarterly, 2011-
  • NLM标题： Ann Vasc Dis
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  • 1.

    【2hr】Is Angiosome-Guided Endovascular Therapy Worthwhile?

    包量

    机译 血管体引导的血管内治疗值得吗？
    摘要：Endovascular therapy (EVT) plays a major role in the treatment of critical limb ischemia (CLI). The latest guidelines state that the angiosome concept should be considered when performing revascularization of infrapopliteal lesions in patients with CLI. There have been several reports both of favorable and unfavorable results of angiosome-guided EVT. Based on previous reports, angiosome-guided EVT tends to improve wound healing (WH) rather than amputation-free survival and overall survival. In addition, indirect revascularization based on the angiosome concept with a good collateral flow may achieve good WH comparable to that achieved by direct revascularization. In the future, rather than just debating the effectiveness/ineffectiveness of the angiosome concept, it will be desirable to investigate the patient and lesion characteristics that may have significant influences on WH after angiosome-guided EVT and to apply the results to clinical practice.
  • 2.

    【2hr】Updates on Ultrasonography Imaging in Abdominal Aortic Aneurysm

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    机译 腹部主动脉瘤的超声检查影像学进展。
    摘要：Abdominal aortic aneurysms (AAAs) are life-threatening and are associated with >80% mortality when they rupture. Therefore, detecting these aneurysms before they rupture is critical. Ultrasonography is a non-invasive tool that is used for screening AAAs by measuring abdominal aorta diameter. A recent meta-analysis demonstrated the positive effects of ultrasonography. To date, aneurysm diameter is the most reliable predictor for aneurysm rupture and is used as a criterion for surgical intervention. However, some AAAs rupture at small diameters. Therefore, a better predictor for AAA rupture that is independent of aneurysm diameter is needed. Recently, an aortic wall strain examined using ultrasonography has been reported to have a potential in predicting AAA rupture. Since the introduction of endovascular aneurysm repair (EVAR), a paradigm shift has occurred in the management of AAAs. EVAR is broadly spread with the advantage of early favorable results but with concerning endoleak complications. At present, computed tomography angiography (CTA) is considered to be a gold standard for surveillance following EVAR, but it encounters some problems, such as contrast usage or radiation exposure. Ultrasonography offers an examination free from these problems and can this be an alternative to CTA. In this review article, current trends and new technologies regarding AAA assessment using ultrasonography are introduced.
  • 3.

    【2hr】Operative Strategy of Ruptured Abdominal Aortic Aneurysms and Management of Postoperative Complications

    包量

    机译 腹主动脉瘤破裂的手术策略及术后并发症的处理
    • 作者：Hiroyuki Ito
    • 刊名：Annals of Vascular Diseases
    • 2019年第3期
    摘要：In addition to traditional open surgical repair (OSR), endovascular aneurysm repair (EVAR) is currently another strong option to treat RAAA. All vascular surgeons who try to save RAAA patients must be deeply versed in both OSR and EVAR. In this article, current trend of RAAA treatment and abdominal compartment syndrome, which has been most important postoperative complication, are reviewed. (This is a translation of Jpn J Vasc Surg 2019; 28: 127–132.)
  • 4.

    【2hr】Anatomy and Physiology for the Abdominal Aortic Aneurysm Repair

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    机译 腹主动脉瘤修复的解剖与生理
    摘要：In 2006, commercially produced endovascular aneurysm repair (EVAR) devices were approved by the Japanese Ministry of Health, Labour and Welfare, and their cost began to be covered by Japanese medical insurance. Meanwhile, the number of juxtarenal abdominal aortic aneurysms (AAA) to need the suprarenal clamp are increasing and the number of infra-renal AAAs are decreasing for open repair. In this era when EVAR has been growing rapidly for 11 years, it is a good opportunity to learn the surgical repair of AAA. I review the basic and advanced anatomy and physiology concepts which are needed for abdominal aortic repair, which are the proximal site (exposure of the proximal site, variation of renal arteries, variation of inferior vena cava and left renal vein, arcade of visceral branches of abdominal aorta, and coeliac plexus) and distal site (iliac artery, superior hypogastric plexus, ureter, inferior mesenteric artery, and lumbar arteries) separately. (This is a translation of Jpn J Vasc Surg 2019; 28: 173–177.)
  • 5.

    【2hr】Preoperative Planning for Physician-Modified Endografts Using a Three-Dimensional Printer

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    机译 使用三维打印机修改医师修改的内移植物的术前计划
    摘要：The medical uses of three-dimensional (3D) printing are evolving at a rapid pace. The current roles and the future outlooks of this technology for physician-modified endovascular graft (PMEG) in patients with juxtarenal aneurysm are discussed. Fenestrations of PMEG are designed taking into account the geometry of the stent graft. Designing of such stent grafts is extremely complicated, especially when PMEG is planned for the angulated portion of the aorta. A 3D model enables the designing of branch fenestrations, with consideration for the geometrical adaptation of the stent graft in a complex aortic anatomy. With the aid of 3D-printing technology, patients with juxtarenal aortic pathologies can be treated using fenestrated stent grafts, preserving the vital organ circulation and securing a robust length of proximal sealing zone.
  • 6.

    【2hr】Outcomes of Late Open Conversion after Endovascular Abdominal Aneurysm Repair

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    机译 血管内腹主动脉瘤修复后晚期开放转换的结果
    摘要：Objective: To review our experience with a late open conversion as a final option for an endograft infection and aneurysm expansion after endovascular aneurysm repair (EVAR), especially in endoleaks for which radiological intervention is impossible.Materials and Methods: In this retrospective study, 13 late open conversions out of 513 consecutive patients treated by EVAR were analyzed. Indications for an open conversion were aneurysm enlargement, including all endoleaks, endograft migration, and endograft infection. The patients’ data on demographics, operative details, and outcomes were reviewed.Results: Indications for a late open conversion included endoleaks, infection, and migration in 61.5%, 30.8%, and 7.7% of patients, respectively. The median interval from the initial EVAR was 32.4 months. Complete endograft explantation was performed in four patients with an endograft infection. In endoleak cases, the endograft was partially preserved and a neo-neck was used. Sacotomy and branch ligation were performed in one case. One major operative complication was an aortic injury during infrarenal aortic cross-clamping in an endograft migration case. There was no operative mortality.Conclusion: A late open conversion after EVAR is valuable as a final option. The aortic cross-clamp site, especially in endograft migration cases, should be carefully considered. To avoid aneurysm-related events, graft replacement is recommended, if possible.
  • 7.

    【2hr】Long-Term Outcomes of Acute Limb Ischemia: A Retrospective Analysis of 93 Consecutive Limbs

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    机译 急性肢体缺血的长期结果：93例连续性肢体的回顾性分析
    摘要：Objective: To examine the medium- to long-term outcomes of acute limb ischemia (ALI), which are unclear at present.Methods: We analyzed 93 consecutive limbs in 77 patients with ALI between January 2005 and December 2015 treated at our vascular center. We categorized the cases into four groups according to etiology (embolism, thrombosis, graft thrombosis, and dissection groups) to assess survival, limb salvage, and freedom from re-intervention rates.Results: The mean age at onset was 72±15 years. The median follow-up length was 2.90 years. The Rutherford categories I, IIa, IIb, and III included 1, 38, 51, and 3 cases, respectively. Thromboembolectomy was performed in all patients in the embolism and thrombosis groups. In addition, endovascular treatment was performed in 25 (37.3%) patients, especially in the thrombosis group (81.3%). A major amputation could not be avoided in 10 patients. The 5-year limb salvage rates for categories IIa and IIb were 97.1% and 83.1%, respectively. The 5-year freedom from re-intervention rate was 89.2%. The survival rates at 1, 3, and 5 years were 87.9%, 75.2%, and 60.6%, respectively.Conclusion: The 5-year survival rates of patients with ALI were equivalent to those with chronic limb threatening ischemia (CLTI). The intervention and long-term outcomes were distinguishable according to etiology.
  • 8.

    【2hr】Isolated Distal Deep Vein Thrombus Detected before Orthopedic Surgery: Is Preoperative Anticoagulation Preferable?

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    机译 骨科手术前发现远端深静脉血栓形成：术前抗凝治疗是否可取？
    摘要：Objective: We evaluate the efficacy of anticoagulant administration for isolated distal deep vein thrombus (IDDVT), detected before orthopedic surgery.Materials and Methods: The study included 32 patients diagnosed with IDDVT before orthopedic surgery in our hospital between October 2011 and October 2017. They were divided into two groups: the ‘pre- and post-operative therapy group,’ who were administered anticoagulants both pre- and post-operatively, and the ‘post-operative therapy group,’ who were administered anticoagulants only after surgery due to risk of bleeding judged by an orthopedic surgeon. We compared the primary efficacy (change in IDDVT size) between the two groups.Results: The proportion of patients with increased post-operative IDDVT sizes was significantly larger in the post-operatively treated group than in the pre- and post-operatively treated group (44.4% vs. 8.7%, p=0.026). No case demonstrated an IDDVT extension proximal to the popliteal vein or presented with symptomatic pulmonary thromboembolism in this study.Conclusion: Based on our findings, we recommend that, in patients with IDDVT detected prior to orthopedic surgery and administered anticoagulant therapy only after the procedure because of a bleeding risk, a lower limb ultrasonography to re-evaluate the existing deep vein thrombus should be conducted before beginning rehabilitation.
  • 9.

    【2hr】Pressure- and Velocity-Based Physiological Assessment of Stenotic Lesions at Hyperemia in Superficial Femoral Artery Disease: Importance of Hyperemic Stenosis Resistance

    包量

    机译 浅层股动脉疾病充血时基于压力和速度的狭窄病变的生理评估：耐高狭窄性的重要性
    摘要：Background: In superficial femoral artery (SFA) stenosis, stenosis resistance may increase, but the relationship between stenosis resistance and stenotic severity remains to be seen. This study aimed to investigate the physiological response, through a hyperemic condition, and the pathophysiological significance of Doppler flow and stenosis resistance in SFA.Methods: Twenty-four limbs with focal stenosis of the SFA were analyzed. We assessed the fractional flow reserve (FFR), hyperemic stenosis resistance (h-SR), and vascular flow reserve (VFR) of the SFA with a pressure/Doppler flow sensor-tipped combination guidewire before and after endovascular therapy (EVT).Results: FFR, h-SR, and VFR changed significantly after EVT. h-SR was more strongly correlated with % area stenosis, measured by intravascular ultrasound than FFR (FFR: r=−0.716, h-SR: r=0.741, p<0.0001, respectively). However, VFR was not associated with % area stenosis. A receiver operating characteristic curve showed cut-offs h-SR >0.36 mmHg·sec/cm, and FFR <0.88 predicted >75% area stenosis with area under curves of 0.883 and 0.828, respectively.Conclusion: h-SR can indicate stenotic severity in an SFA focal lesion more prominently than FFR and may be a new physiological index to determine indication for EVT. VFR was not feasible for assessment in SFA focal stenosis.
  • 10.

    【2hr】Appropriate Surgical Treatment of Symptomatic Primary Varicose Veins Decreases Systemic Inflammatory Biomarkers

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    机译 有症状的原发性静脉曲张的适当手术治疗可减少全身炎症生物标志物
    摘要：Objective: To evaluate the relationship between systemic inflammatory biomarkers and efficacy of surgical treatment of primary varicose veins of the lower extremities.Methods: Total 12 patients who underwent endovenous laser ablation or stripping of varicose veins and six healthy subjects were enrolled. Structural and molecular changes of varices were assessed by immunohistochemical staining with anti-monocyte chemotactic protein-1 (MCP-1). MCP-1 and interleukin-6 (IL-6) levels in systemic antecubital blood were measured before and at 12 weeks after treatment.Results: Immunohistochemical staining revealed prominent manifestation of MCP-1-positive endothelial cells in the walls of varices. Preoperative serum MCP-1 and IL-6 levels in the patients were significantly higher than those in the control (166±12 pg/mL vs 99±10 pg/mL, p=0.003; 5.1±0.95 pg/mL vs 0.0±0.0 pg/mL, p=0.001, respectively). The values were significantly correlated with the severity of chronic venous insufficiency (CVI). Postoperative serum MCP-1 level significantly decreased compared with the preoperative level (152±10 pg/mL vs 166±12 pg/mL, p=0.048). The values after endovenous laser ablation did not significantly decrease compared with those after stripping.Conclusion: Varicose veins with CVI increase inflammatory biomarker levels in the local tissue and systemic blood. Appropriate treatment of symptomatic varicose veins decreases inflammatory biomarker levels.
  • 11.

    【2hr】Deep Vein Thrombosis in Severe Motor and Intellectual Disabilities Patients and Its Treatment by Anticoagulants of Warfarin Versus Edoxaban

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    机译 重度运动和智力障碍患者的深静脉血栓形成及其华法林抗凝治疗与依多沙班抗凝治疗
    摘要：Objective: Patients with severe motor and intellectual disabilities (SMID) often develop complications, including paralysis of the extremities due to abnormal muscular tonicity. Furthermore, the incidence of sudden death, which may be caused by pulmonary thromboembolism (PTE), is approximately 4.2%. Deep vein thrombosis (DVT) is attracting attention as an embolic source. In this study, DVT was confirmed in SMID patients by lower extremity venous ultrasound. The oral anticoagulant, warfarin, and novel oral anticoagulant, edoxaban tosilate hydrate, were administered, and their efficacies and safeties were evaluated.Materials and Methods: DVT patients were randomly allocated to warfarin and edoxaban groups. The frequency of hemorrhagic events and incidence of adverse events were investigated to evaluate efficacy and safety.Results: DVT was detected in 14 (8.4%) out of 167 patients. Four (0.067/person-month) hemorrhagic events occurred in the warfarin group from subcutaneous hemorrhage due to bruises caused by postural changes. Three (0.042/person-month) events occurred in the edoxaban group due to nasal hemorrhage caused by tracheal aspiration. There was no significant difference (p=0.5383) between groups.Conclusion: No significant differences were observed in hemorrhagic events between SMID patients with DVT treated with warfarin and edoxaban.
  • 12.

    【2hr】Changes in Aortic Wall Thickness at a Site of Entry Tear on Computed Tomography before Development of Acute Aortic Dissection

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    机译 急性主动脉夹层发生前在计算机断层扫描上进入撕裂部位的主动脉壁厚度的变化
    摘要：Objective: To determine if there are changes in the aortic wall before acute aortic dissection (AD) that can be observed on contrast-enhanced computed tomography (CECT).Materials and Methods: Twenty-two patients with AD who underwent CECT before developing AD were retrospectively identified and enrolled as the AD group. Twenty-five consecutive patients who underwent CECT and did not develop AD were enrolled as the control group. In the AD group, the site of entry tear was detected on CECT images; the aortic wall thickness at this site, defined as the dissection-related wall thickness (D-T), was then measured on CECT images acquired before AD. Moreover, the mean thickness of the ascending, thoracic descending, and abdominal aortic walls before AD was defined as the non-dissection-related wall thickness (non-D-T). In the control group, the aortic wall thickness was measured similarly and defined as the control wall thickness (C-T). The D-T, non-D-T, and C-T values were compared using one-way analysis of variance with the Games–Howell pairwise comparison test.Results: The D-T (2.17±0.75 mm) was significantly greater than the non-D-T (1.58±0.22 mm; P<.01) and C-T (1.53±0.15 mm; P<.01).Conclusion: The aortic wall may have become thicker prior to the onset of AD.
  • 13.

    【2hr】Left Subclavian-Bilateral External Carotid Artery Bypass for Symptomatic Carotid Artery Dissection Secondary to Open Repair of Type A Aortic Dissection

    包量

    机译 左锁骨下-双侧颈外动脉旁路术用于继发于A型主动脉夹层修复的症状性颈动脉夹层
    摘要：Symptomatic carotid dissection, secondary to surgical repair of Stanford type A acute aortic dissection (AAD), requires prompt intervention. A 56-year-old man who underwent total arch replacement with frozen elephant trunk for AAD presented with left hemiplegia and unilateral spatial neglect 16 h after the surgery. Cerebral computed tomography (CT) revealed no fresh lesions, and CT angiography showed severe bilateral carotid dissection. The patient’s neurological symptoms improved soon after left subclavian-bilateral external carotid artery bypass to correct symptomatic severe right cerebral ischemia. Therefore, this technique can be a good option for symptomatic carotid dissection in selected patients.
  • 14.

    【2hr】Inferior Vena Cava Occlusion and Ilio-Iliac Arteriovenous Fistula Caused by Tumor Invasion: A Case Report

    包量

    机译 下腔静脉闭塞和肿瘤侵袭引起的I-lio动静脉瘘：一例报告
    摘要：An 80-year-old woman presented with general fatigue and leg edema for several months. Ultrasonography and contrast-enhanced computed tomographic angiography revealed inferior vena cava thrombosis, ilio-iliac arteriovenous fistula (AVF), and iliac artery pseudoaneurysm. Furthermore, malignant cells were observed in the aspirated thrombus. Although thrombus aspiration and anticoagulant therapy were unsuccessful in reducing the thrombotic mass and alleviating her symptoms, endovascular therapy for AVF and pseudoaneurysm improved her leg edema without recurrence or any endoleak. These findings highlight that endovascular therapy can be effective in older adults with cancer because of its low invasiveness.
  • 15.

    【2hr】Acute Type B Aortic Dissection Associated with Acute Pancreatitis, Pancreatic Pseudocysts, and Acalculous Cholecystitis

    包量

    机译 急性胰腺炎，胰腺假性囊肿和无结石性胆囊炎相关的急性B型主动脉夹层
    摘要：Acute aortic dissection can result in fatal conditions when associated with organ malperfusion. A rare complication of aortic dissection with organ malperfusion is ischemic pancreatitis with cholecystitis. Here, we present the case of acute type B aortic dissection complicated by concurrent acute ischemic pancreatitis and acalculous cholecystitis. Prompt diagnosis and specific multidisciplinary treatment are crucial to improving patient outcomes in cases of visceral ischemia.
  • 16.

    【2hr】Redo Descending Aortic Replacement via Direct Anastomosis to J Graft Open Stent Graft

    包量

    机译 通过直接吻合将重做降主动脉置换为J移植物开放支架移植物
    摘要：A 64-year-old man with prior history of total arch replacement with frozen elephant trunk was admitted for an enlarging descending thoracic aortic aneurysm. Preoperative computed tomography revealed previously implanted J graft open stent graft, a frozen elephant trunk device approved in Japan, with enlarged dissected aortic aneurysm from distal anastomosis site to the level of the diaphragm. The patient underwent descending aortic replacement. Proximal anastomosis was directly performed at the distal end of the previously implanted J graft open stent graft. Hemostasis at the anastomosis site was uneventful and the patient was discharged from the hospital without any aneurysm-related complication.
  • 17.

    【2hr】Aorto–Esophageal Fistula Caused by Distal Stent Graft-Induced New Entry after Frozen Elephant Trunk Technique for Chronic Aortic Dissection

    包量

    机译 冷冻大象躯干技术行主动脉夹层分离术后远端支架移植引起的新进入导致主动脉-食管瘘
    摘要：We present a case of aorto–esophageal fistula (AEF) caused by distal stent graft-induced new entry (dSINE) after the frozen elephant trunk (FET) technique for chronic aortic dissection. We propose that the combination of the spring-back force and the radial force of the FET may play a role in the occurrence of dSINE, leading to AEF. In this case, we successfully performed a three-stage surgery, including esophagectomy, descending aortic replacement, and esophageal reconstruction. To prevent this critical complication, additional endovascular aortic repair should be performed if the FET is not positioned at the straight portion of the descending aorta.
  • 18.

    【2hr】Ruptured Abdominal Aortic Aneurysm with a Duplicated Inferior Vena Cava

    包量

    机译 腹主动脉瘤破裂，下腔静脉重复
    摘要：We report a very rare case of a ruptured abdominal aortic aneurysm (AAA) with an anomaly of the inferior vena cava (IVC). The AAA was covered with a large hematoma and an expanded vein was on its left side. It was not until we could not locate the IVC on the right side of AAA that we recognized the anomaly during the operation. Although we reviewed the findings on enhanced computed tomography, we were confused whether the case was a duplicated or left-sided IVC. Subsequently, a bifurcated vascular prosthesis was implanted without ligation of the left renal vein to join the left-sided IVC.
  • 19.

    【2hr】Critical Malperfusion Caused by Central Aortic Repair for Acute Aortic Dissection: A Case Report

    包量

    机译 中央主动脉修复引起的急性主动脉夹层严重灌注不良：一例报告
    摘要：We encountered a case of hepatic malperfusion resulting from central repair for Stanford type A acute aortic dissection (AAD). A 78-year-old woman had AAD, for which ascending aortic repair was performed. Hepatic malperfusion developed 3 days postoperatively. The superior mesenteric and celiac arteries were occluded by a false lumen (FL). We believed that the surgery caused a change in the blood flow in FL. Percutaneous transluminal angioplasty and stenting of the superior mesenteric artery were performed, and the patient’s condition improved. Thus, intervention for the branched artery should be performed prior to central repair, depending on the type of malperfusion.
  • 20.

    【2hr】One Technique to Modulate a Device Implantation Path in a Short Treatment Length Using the Gore IBE Device

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    机译 一种使用戈尔IBE装置在较短治疗长度内调节装置植入路径的技术
    摘要：The GORE EXCLUDER Iliac Branch Endoprosthesis (IBE; W. L. Gore and Associates, Flagstaff, AZ, USA) applicability is limited by the aorto-iliac length (AOL). The shortage may be a major exclusion criterion. An 85-year-old male presented with an abdominal aortic and left common iliac arterial aneurysm. The left-side AOL was 146-mm, which was deemed 19-mm too short for IBE usage. To increase implantation length, the contra-lateral connection stent graft was deployed along the implantation line, wound half-circumferentially around the ipsilateral limb. Any form of endoleak, limb occlusion, and device migration has not been observed for twelve months.
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