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26. Predictive preoperative factors of long-term survival rate after open surgery for abdominal aortic aneurysm

Author

Furuie, Wakaba, Nagai, Saya, Kudo, Toshifumi, Inoue, Yoshinori, Akaza, Miho, Sasano, Tetsuo, and Sumi, Yuki

Subjects
open surgery, abdominal aortic aneurysm, hypertension, anemia, mortality
Abstract

Objective: We aimed to examine long-term survival rate andthe risk factors of poor prognosis in patients whounderwent open surgery (OS) for abdominal aorticaneurysm (AAA).Materials and Methods: We performed a retrospective analysis of thepatients who underwent elective OS for AAAbetween 2005 and 2011 at Tokyo Medical andDental University Hospital. The relations betweenmortality rate and preoperative clinical factorswere examined.Results: For this study 195 patients were identified. Themortality was significantly related to size ofaneurysm, type of aneurysm, massive bleedingduring operation, age, anemia, uncontrolledhypertension, and comorbid chronic kidneydisease. No specific leading causes of death wereidentified for these increases in the mortalityrate. Cox proportional hazard model revealed thatanemia, hypertension, and chronic kidney disease(CKD) were independent predictive factors ofhigher mortality in the patients who underwent OSfor AAA.Discussion: In our previous study, high preoperative CRPlevel was correlated to long-term death rate afterendovascular aortic aneurysm repair (EVAR) forAAA. The difference might be attributed to the factthat OS relieves the aortic wall tension and reducesthe aortic inflammation, whereas EVAR does not,because of endoleak or endotension.

Published
2019

28. Development of a Non-Invasive Local Heating Load Test to Detect Severe Limb Ischemia Within 200 seconds.

Author

Katsui, Sotaro, Yamamoto, Yohei, and Kudo, Toshifumi

Subjects
ISCHEMIA diagnosis, ISCHEMIA, ANKLE brachial index, HEATING, PERIPHERAL vascular diseases, PATIENTS, REGRESSION analysis, SEVERITY of illness index, LEG, HOSPITAL admission & discharge, COMPARATIVE studies, BLOOD circulation, DESCRIPTIVE statistics, RECEIVER operating characteristic curves, SENSITIVITY & specificity (Statistics), PERFUSION
Abstract

Purpose: To establish a non-invasive test method for the rapid detection of severe ischemia (SI) in the limbs in patients with peripheral arterial disease (PAD). Methods: Between November 2019 and May 2021, 22 patients admitted for PAD to 2 hospitals agreed to participate in the study. All patients underwent a local heating load (LHL) test. SI was defined as at least 1 ankle-brachial index value of <.4 and/or transcutaneous oximetry value of <30 mmHg. The other cases were classified as mild-to-moderate ischemia (MMI). The LHL test was performed simultaneously with 15 minutes of heating and measurement by attaching a blood flow meter measuring probe combined with a warmer to the patient's dorsal foot. Evaluation consisted of 200-s periods from the start of heating to 800 seconds. For each period, perfusion value (PV) was evaluated, and slope was calculated graphically based on linear regression as PV fluctuation per minute. Test accuracy was calculated using a receiver operating characteristic curve. Results: Twenty-four limbs of 18 patients were finally evaluated; 4 patients (2 with missing data, 1 with collagen disease, and 1 with embolism) were excluded, with 13 and 11 limbs in the SI and MMI groups, respectively. The SI group showed a significantly lower slope value in the first 200 seconds and lower PV at 200 seconds and thereafter. From the slope value, it was possible to detect SI with 85% sensitivity and 73% specificity at 200 seconds. PV could be determined with higher accuracy in periods after 200 seconds, with 85% sensitivity and 82% specificity at 800 seconds. Conclusions: Our non-invasive LHL test could be used as a rapid screening test to detect SI in limbs within 200 seconds, as well as a more accurate test to detect ischemia within 800 seconds. [ABSTRACT FROM AUTHOR]

Published
2023
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36. Safety and Ease of Sheath Insertion During Endovascular Treatment Via the Common Femoral Artery After Endarterectomy With Autologous Repair: A Retrospective Cohort Study.

Author

Katsui, Sotaro, Igari, Kimihiro, Nishizawa, Masato, and Kudo, Toshifumi

Subjects
RETROSPECTIVE studies, HEMOSTASIS, FEMORAL artery, ENDARTERECTOMY, AUTOGRAFTS, DESCRIPTIVE statistics, ENDOVASCULAR surgery, PATIENT safety, LONGITUDINAL method
Abstract

Background Endovascular treatment (EVT) using the common femoral artery (CFA) for access after endarterectomy (EA) may result in sheath insertion difficulties because of subcutaneous scar tissue, as well as difficulties with hemostasis. We evaluated the safety of CFA access and the ease of sheath insertion over time after EA. Method We included 19 patients (21 limbs, 40 cases) in whom the CFA was used after EA with autologous repair as an access route in EVT for peripheral arterial disease in our institution from January 2013 to December 2020. Nine limbs underwent simple closure repair and 12 underwent autologous patch repair. Difficult sheath insertions were defined as those in which additional devices (stiff guidewire or a smaller diameter sheath for dilation) were used for scheduled sheath insertion. The inability to insert a sheath with the scheduled diameter was defined as a failed sheath insertion. We evaluated the EVT timing after EA for difficult sheath insertions, and whether the CFA was repaired with simple closure or autologous patch repair during EA surgery. Results There were 10 (25%) difficult sheath insertions, with one (2.5%) failure. The rate of difficult sheath insertions peaked from 6 months to 1 year after EA and gradually decreased (47% from 6 months to 3 years, 14% thereafter). There were more statistically significant difficult sheath insertions with simple closure repair (50%) than with autologous patch repair (12%) (P = 0.018). Hemostasis devices were used in 90% of EVT cases. The median maximum sheath diameter was 6 Fr (mean = 5.8 Fr). None of the cases required surgical procedures to achieve hemostasis after EVT. Conclusion EVT may be performed safely using the CFA after EA. The difficulty of sheath insertion may differ depending on the EVT timing after EA; it was more difficult with simple closure than with autologous patch repair, possibly related to scar formation. [ABSTRACT FROM AUTHOR]

Published
2022
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44. Upper limb gangrene due to a subclavian arterial thrombosis associated with thoracic outlet syndrome following cervical spondylotic amyotrophy.

Author

Yamada, Tsuyoshi, Kudo, Toshifumi, Kawabata, Atsuyuki, and Yoshii, Toshitaka

Subjects
*THORACIC outlet syndrome, *MUSCULAR atrophy, *GANGRENE, *THROMBOSIS, *BRACHIAL plexus, *CERVICAL vertebrae
Abstract

Thoracic outlet syndrome (TOS) refers to an abnormal compression of the subclavian vessels and the brachial plexus at the base of the neck or thoracic outlet. The authors described a novel case of a 66-year-old male with arterial TOS and unilateral upper rib dysplasia following cervical spine disease. Owing to the comorbidity of cervical spondylotic amyotrophy and a history of sloping shoulder due to rib dysplasia, TOS occurred, which subsequently led to subclavian arterial thrombosis and eventually resulted in the gangrene of the hand. Thrombectomy and surgical resection of the first and second ribs avoided the progression of further neurovascular disorder. When treating a cervical spondylotic patient, concurrent TOS can be obscured by symptoms caused by cervical lesions, leading to difficulty in identifying the origin of these neurovascular findings. The possibility of subsequent thromboembolic events based on TOS should be considered, especially in cases with dysplasia of the upper ribs. [ABSTRACT FROM AUTHOR]

Published
2021
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47. A Case of Successful Coil Embolization for a Late-Onset Type Ia Endoleak after Endovascular Aneurysm Repair with the Chimney Technique

Author

Igari, Kimihiro, Kudo, Toshifumi, Toyofuku, Takahiro, and Inoue, Yoshinori

Subjects
Article Subject, cardiovascular system
Abstract

Juxtarenal aortic aneurysms (JRAAs) are challenging to treat by endovascular aneurysm repair (EVAR) procedures. The chimney technique with EVAR (Ch-EVAR) is one of the feasible and less invasive treatments for JRAAs. However, the main concern of Ch-EVAR is the potential risk of “gutters,” which can lead to type Ia endoleak (EL). Most type Ia ELs after Ch-EVAR procedures occurred intraoperatively, and these ELs could be treated using an endovascular technique. However, late-onset type Ia ELs could be extremely rare, which might have a fear of conservative treatment. Type Ia ELs are associated with an increased risk of aneurysm rupture; therefore reintervention is recommended as soon as possible, and we should be aware of the occurrence of type Ia ELs after the Ch-EVAR procedure.

Published
2016
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49. Surgical Treatment for Profunda Femoris Artery Aneurysms: Five Case Reports

Author

Igari, Kimihiro, Kudo, Toshifumi, Toyofuku, Takahiro, and Inoue, Yoshinori

Subjects
Article Subject
Abstract

Profunda femoris artery aneurysm (PFAA) is an extremely rare entity, with most cases being asymptomatic, which makes obtaining an early diagnosis difficult. We herein report a case series of PFAA, in which more than half of the PFAAs, which presented with no clinical symptoms, were discovered incidentally. All PFAAs were treated surgically with aneurysmectomy with or without vascular reconstruction. In cases involving a patent superficial femoral artery (SFA), graft replacement of the profunda femoris artery (PFA) is not mandatory; however, preserving the blood flow of the PFA is necessary to maintain lower extremity perfusion in patients with occlusion of the SFA. Therefore, the treatment of PFAAs should include appropriate management of both the aneurysmectomy and graft replacement, if possible.

Published
2015
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