Language：Japanese   Publisher：北海道外科学会  

急速に進む高齢化により,高い致死率を示す大動脈緊急症は増加の一途であり,中でも破裂性腹部大動脈瘤の死亡率は群を抜いて高いことで知られる。2019年に循環器病対策基本法の中で国策として大動脈緊急症への医療体制への整備が推し進められている中で,ICTの果たす役割が注目されている。当教室では広域遠隔地域の破裂性腹部大動脈瘤症例において,ICTを活用した遠隔画像情報連携により,救命率向上を目指してきたが,近隣地域例においては,救急現場のプレホスピタルマネジメントにおける救急隊(EMS)との連携において地域救命率向上の糸口となる可能性がある。今後,地域を問わずICTを用いた効率的な医療の推進と地域連携体制の普及が望まれる。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J01375&link_issn=&doc_id=20240827020002&doc_link_id=10.60440%2Fhokkaidojsurg.69.1_10&url=https%3A%2F%2Fdoi.org%2F10.60440%2Fhokkaidojsurg.69.1_10&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

The Indigo Aspiration System (Penumbra Ltd., Alameda, CA, USA), a catheter-based device intended for the endovascular removal of clots from peripheral arteries and veins, was launched in Japan to treat acute limb ischemia after the cessation of urokinase sales. The initial application of this system in Japan was on a 96-year-old male patient. He was diagnosed with acute lower limb ischemia, which was caused by an embolism from a left common iliac artery aneurysm. The treatment significantly enhanced the perfusion to his left foot. This case report elaborates on the patient's treatment experience and discusses the indications for using the device.

File： 17_cr.23-00095.pdf

DOI： 10.3400/avd.cr.23-00095

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Language：English   Publisher：(NPO)日本心臓血管外科学会  

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Language：English   Publisher：(NPO)日本心臓血管外科学会  

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Language：English   Publisher：(NPO)日本心臓血管外科学会  

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Language：English   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(一社)日本フットケア・足病医学会  

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Language：Japanese   Publisher：(一社)日本フットケア・足病医学会  

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Authorship：Lead author   Language：Japanese   Publisher：血管外科症例検討会  

包括的高度慢性下肢虚血(CLTI)治療は、血行再建術による虚血の改善を主軸に、複数の補助治療によって虚血の改善、創傷治癒促進や疼痛の緩和で構成される。LDLアフェレシスは補助治療の一つのオプションとして、難治性高コレステロール血症を有する外科治療が困難な解剖学的複雑性をもつ跛行以上の下肢閉塞性動脈疾患(LEAD)患者がその適応となっている。LDLアフェレシスは全血から血球成分を分離して血漿内の浮遊粒子であるLDLコレステロールを除去することで、血液の粘稠度(レオロジー)を改善させる吸着治療法である。2021年3月に保険収載された閉塞性動脈硬化症用吸着式血液浄化用浄化器(レオカーナ)は、全血直接灌流型カラムにより血漿分離器が不要なことから高コレステロール血症を併発しない症例に適応となり、Fontaine分類IV度のLEAD患者を対象に、LDLコレステロールとフィブリノーゲン吸着による血液レオロジー改善を通じて末梢血液循環の改善と潰瘍治癒促進を図る新しい補助治療である。(著者抄録)

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：English   Publishing type：Research paper (scientific journal)  

After previous earthquakes, high prevalence of cardiovascular diseases including venous thromboembolism (VTE) has been reported. We performed venous screening at the site of Hokkaido East Iburi Earthquake which happened at 6th September 2018. VTE screening using ultrasound sonography was performed for total 7 days at Atsuma town, Mukawa town and Abira town (total 9 shelters). Deep vein thrombosis (DVT) was found in 19 of 195 evacuees (9.7%), including 8 fresh thrombus cases (4.1%). On multivariable analysis of evacuees and shelter environment factors, systolic blood pressure, use of cardboard bed and toilet environment were significant predictor of DVT. Introduction and setting-up of cardboard beds were found as an important shelter environment factor. (This is secondary publication from Jpn J Phlebol 2021; 32(1): 5-10.).

DOI： 10.3400/avd.oa.23-00046

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01122&link_issn=&doc_id=20230731170022&doc_link_id=10.4326%2Fjjcvs.52.xiii&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.52.xiii&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：北海道外科学会  

北海道における心臓血管外科救急は,都市部を除き専門医偏在や治療施設等の物理的要因と広域搬送や天候等の地理的要因により大きく制約を受ける治療環境に置かれる。広大な医療圏をカバーする当教室において,近年末梢血管疾患におけるICTを活用した医療連携を構築し診療にあたってきた。末梢血管疾患の中でも緊急度の高い腹部大動脈瘤破裂においては,ICTによる患者到着前介入と多職種連携が治療成績に寄与しており,包括的高度慢性下肢虚血においては専門医不在地域における重症化前の介入と治療後の綿密なフォローの一助としてのメリットが確認された。今後ICTを用いた効率的な医療の推進と地域連携体制の普及が望まれる。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01375&link_issn=&doc_id=20230731050003&doc_link_id=%2Fdc7hksrg%2F2023%2F006801%2F004%2F0015-0019%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdc7hksrg%2F2023%2F006801%2F004%2F0015-0019%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Malignant lymphoma rarely mimics an infected arterial aneurysm and a ruptured arterial aneurysm because of similar imaging findings, leading to misdiagnosis. The hematomas of ruptured aneurysms are radiologically difficult to distinguish from those of malignant lymphoma in emergency settings. Hence, a definitive diagnosis is crucial to avoid unnecessary surgery. CASE PRESENTATION: A man in his 80s with hematuria and shock vital had right internal iliac artery aneurysm (IIAA) and perianeurysmal fluid retention, which appeared to be a ruptured or an infected aneurysm. Treatment was initiated for infected IIAA instead of for ruptured IIAA. Systemic inflammatory response syndrome developed, and the infectious sources were assessed. Pacemaker lead and urinary tract infections were identified and treated; however, blood pressure was unstable. The aneurysm was treated with endovascular aortic aneurysm repair following antibiotic therapy; however, fluid retention increased, and inflammatory status and hematuria deteriorated. Open surgical conversion was performed to manage the infected lesions. Although an iliopsoas abscess was detected during surgery and nephrectomy and ureterectomy were performed to control the hematuria, analysis of the removed tissues led to the pathological diagnosis of diffuse large B-cell lymphoma (DLBCL). CONCLUSIONS: We encountered a case of DLBCL with imaging findings mimicking an infected internal iliac artery aneurysm, and definitive diagnosis was made more than 2 months after the initial examination. Definitively diagnosing malignant lymphoma around an iliac artery aneurysm based merely on symptoms and imaging findings is extremely difficult. Thus, histological examination should be actively performed in atypical infected aneurysms.

DOI： 10.1186/s40792-023-01665-0

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DOI： 10.5758/vsi.230020

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(一社)日本フットケア・足病医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：KOREAN SOC VASCULAR SURGERY  

Complex anatomical restrictions can lead to further interventions after the emergence of a postoperative aneurysm enlargement in thoracic endovascular aortic repair (TEVAR) for a thoracoabdominal aortic aneurysm (TAAA). A 75-year-old male underwent a TEVAR for a Crawford extent I TAAA. The main device and the distal extension were placed using a fenestrated technique, outside of the instructions for use. The aneurysm expanded because of an endoleak and stent graft migration; and was surgically repaired by fully salvaging the previous endografts 38 months after the first TEVAR. However, the distal extension, which was the proximal anastomosis site with a prosthetic graft, became completely dislocated from the main device eight months after the open surgical conversion, resulting again in the enlargement of the aneurysm. An additional TEVAR was successfully performed to correct the dislocated stent graft. An appropriate treatment strategy is crucial to prevent multiple reinterventions for TAAA with complex anatomical restrictions.

DOI： 10.5758/vsi.220049

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ANNALS VASCULAR DISEASES EDITORIAL OFFICE  

Chronic limb-threatening ischemia (CLTI) is an important issue for elderly patients with peripheral artery disease. Here, we present the case of a 91-year-old man with CLTI, residing in a rural district. The onset of CLTI rapidly deprived him of ambulation because of a foot infection. Given that he had difficulty with long-distance transportation, limb salvage for extensive tissue loss was performed at a district facility, based on his and his family's request. Finally, skin grafting on the cutting plane of the right ankle bones resulted in wound healing in six months after incomplete revascularization and multiple minor amputations.

DOI： 10.3400/avd.cr.22-00049

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Bypass to the peroneal artery has sometimes been effective for pedal gangrene. However, the difficulty of approaching the terminal segment of the peroneal artery because of its anatomic features has been a clinical issue. Surgical access to this area can be achieved via a lateral approach with fibular resection. Although severe complications associated with fibular resection have rarely been reported, a less invasive surgical procedure would enable faster postoperative recovery and reduce the incidence of wound-related complications. We have described our experience with successful terminal peroneal artery bypass via a lateral approach without fibular resection in a 38-year-old male patient with chronic limb-threatening ischemia.

DOI： 10.1016/j.jvscit.2022.05.005

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ANNALS VASCULAR DISEASES EDITORIAL OFFICE  

Post-traumatic arteriovenous fistula (AVF) is a vascular injury complication and can present with vessel dilation, forming pulsatile varices, venous hypertension, distal ischemia, and congestive heart failure. We present a case of only pulsatile mass and leg pain caused by a 60-year-old post-traumatic AVF. Computed tomography angiography showed an AVF between the superficial femoral artery and superficial femoral vein. Surgical repair with AVF ligation was successfully performed. Traumatic AVF caused vascular and heart failure in the future; therefore, post-traumatic AVF is better eliminated as soon as possible.

DOI： 10.3400/avd.cr.22-00033

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ANNALS VASCULAR DISEASES EDITORIAL OFFICE  

Stent-graft infection is a rare but potentially life-threatening complication of endovascular aortic repair. There are currently no consensus guidelines for treating stent-graft infections, but surgical treatment is generally considered preferable due to the low overall survival rate of patients receiving conservative therapy; however, the revascularization method remains controversial. We report a case in which stent-graft infection after endovascular aneurysm repair was successfully treated by stent-graft removal and extra-anatomical bypass (EAB). EAB is an effective method of revascularization for stent-graft infection.

DOI： 10.3400/avd.cr.21-00106

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(一社)日本内分泌学会  

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Language：Japanese   Publisher：(一社)日本内分泌学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER  

Neurofibromatosis type 1 (NF-1) is associated with fatal vascular complications. A 40-year-old woman with NF-1 who had previously undergone left iliac artery ligation and femorofemoral bypass grafting for internal iliac artery (IIA) aneurysm rupture was transported to our hospital for the treatment of a newly developed IIA aneurysm. Although endovascular therapy was difficult owing to the previous surgery, we successfully performed embolization of the aneurysm and its feeding vessels via direct percutaneous puncture under ultrasound guidance. Aneurysm enhancement had completely disappeared at 2 months postoperatively. We have reported a novel approach of direct percutaneous puncture for IIA aneurysm embolization in a patient with NF-1.

DOI： 10.1016/j.jvscit.2021.12.005

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS  

A calcified amorphous tumor (CAT) of the heart is a rare, nonneoplastic, intracavitary cardiac mass. Histological examination shows that it contains calcified and amorphous fibrous material with underlying chronic inflammation. Surgical excision is generally recommended to avoid future embolism. The risk of embolism has been reported to be especially high in mitral-annular-calcification-related CAT, which constitutes a subgroup of CAT that is often associated with end-stage renal disease. A case of a CAT attached to the anterior annulus of the mitral valve that was easily removed with a light touch of the forceps through aortotomy is reported.

DOI： 10.1093/jscr/rjab608

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：FRONTIERS MEDIA SA  

PURPOSE: The effect of chronic limb threatening ischemia (CLTI) on advanced cardiac disease, which requires surgical treatment, has rarely been reported. The purpose of this study was to review the outcomes of cardiac surgery in patients with CLTI and determine the risk factors, with a particular focus on the severity of CLTI. PATIENTS: The baseline characteristics and outcomes of 33 patients who were treated for CLTI and underwent cardiac surgery were retrospectively analyzed. The states of CLTI were evaluated based on the Wound, Ischemia, and foot Infection (WIfI) classification system, and 33 patients were divided into the low-WIfI group (stages 1-2, n = 13) and high-WIfI group (stages 3-4, n = 20). RESULTS: The in-hospital mortality rate was 0% in low-WIfI group and 35% in high-WIfI group (p = 0.027). Postoperative complications, particularly severe infections, occurred more frequently among high-WIfI group than low-WIfI group (70.0% vs. 23.1%, p < 0.01). Multivariable analysis identified foot infection grade as a WIfI classification factor and lower albumin levels as factors significantly associated with postoperative complications. The 1-year and 2-year survival rates were 84.6% and 67.7% in low-WIfI group and 45% and 28.1% in high-WIfI group, respectively (p = 0.011). CONCLUSIONS: Cardiac surgery in patients with high WIfI stage was an extremely high-risk procedure. In such patients, lowering the WIfI stage by lower extremity revascularization and/or debridement of diseased parts prior to cardiac surgery can be considered.

DOI： 10.3389/fsurg.2022.892309

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ANNALS VASCULAR DISEASES EDITORIAL OFFICE  

Immunoglobulin G4-related disease (IgG4-RD) can affect various organs, including the cardiovascular system. In this study, we described the case of a 72-year-old man with periaortitis both in the ascending and terminal aorta related to IgG4-RD. He presented with swelling in the left leg. Computed tomography (CT) showed increased wall thickness of the ascending aorta and retroperitoneal fibrosis, which, in turn, caused deep vein thrombosis. Using positron emission tomography-computed tomography, the patient was diagnosed with IgG4-RD in the aorta. Although it was difficult to distinguish intramural hematoma (IMH) from IgG4-related periaortitis, treatment with steroids has dramatically improved his periaortitis. IgG4-related periaortitis should be differentiated from IMH due to their similar morphologies.

DOI： 10.3400/avd.cr.21-00024

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MDPI  

Nucleic acid drugs, such as siRNAs, antisense oligonucleotides, and miRNAs, exert their therapeutic effects by causing genetic changes in cells. However, there are various limitations in their delivery to target organs and cells, making their application to cancer treatment difficult. Extracellular vesicles (EVs) are lipid bilayer particles that are released from most cells, are stable in the blood, and have low immunogenicity. Methods using EVs to deliver nucleic acid drugs to target organs are rapidly being developed that take advantage of these properties. There are two main methods for loading nucleic acid drugs into EVs. One is to genetically engineer the parent cell and load the target gene into the EV, and the other is to isolate EVs and then load them with the nucleic acid drug. Target organ delivery methods include passive targeting using the enhanced permeation and retention effect of EVs and active targeting in which EVs are modified with antibodies, peptides, or aptamers to enhance their accumulation in tumors. In this review, we summarize the advantages of EVs as a drug delivery system for nucleic acid drugs, the methods of loading nucleic acid drugs into EVs, and the targeting of EVs to target organs.

DOI： 10.3390/cancers13236137

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ANNALS VASCULAR DISEASES EDITORIAL OFFICE  

A 68-year-old man with a history of superior mesenteric arterial thromboembolism due to chronic atrial fibrillation had experienced intermittent claudication (IC) of his left leg for 3 years. Computed tomography angiography showed focal occlusive lesions in the left distal popliteal artery and proximal segments of the infrapopliteal arteries. Endarterectomy was performed for these localized arterial lesions, and a drastic symptomatic improvement of IC after revascularization was achieved. The endarterectomized segments remained patent for 4 years after the surgery. Endarterectomy could be a useful alternative to bypass surgery and endovascular therapy for the treatment of localized infragenicular arterial lesions.

DOI： 10.3400/avd.cr.20-00140

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media {LLC}  

Coronary artery fistula (CAF) is a relatively rare congenital abnormality of the coronary arteries
typically, patients who undergo surgery for CAFs are relatively young because it is a congenital disease. Here we present a case of an aneurysmal coronary-to-pulmonary artery fistula rupture in a 96-year-old female. Considering her extreme high age and missing preoperative diagnostics, only local hemostasis without anatomical repair was performed but the patient is still doing well 1 year after the operation.

DOI： 10.1007/s11748-020-01488-y

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER  

A 74-year-old man with diabetes and end-stage renal failure on regular dialysis required revascularization for gangrene of multiple toes and a heel ulcer on the right foot with chronic limb-threatening ischemia. However, the anterior tibial artery, posterior tibial artery, and peroneal artery, which are the usual targets below the knee, showed obstruction or calcification and were considered inappropriate bypass targets. Instead, a collateral artery developed along the area of the posterior tibial artery, and bypass surgery was performed with this artery. This is a case report showing successful collateral artery bypass grafting in the distal infrapopliteal segment.

DOI： 10.1016/j.jvscit.2020.12.003

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

BACKGROUND: In chronic limb-threatening ischemia, maintenance or recovery of ambulatory function is an important goal of treatment. This study aimed to develop a predictive model for ambulatory ability 1 year after bypass based on preoperative risk factors, including the Wound, Ischemia, and foot Infection (WIfI) classification. METHODS: We analyzed 146 patients with chronic limb-threatening ischemia (154 limbs) who underwent bypass to below the knee arteries. The patients were classified into 2 groups based on ambulatory status 1 year postoperatively: postoperative ambulation (99 patients, 104 limbs) and postoperative nonambulation (47 patients, 50 limbs). Various factors associated with postoperative ambulation were analyzed and a predictive model of postoperative ambulation was developed. RESULTS: Multivariate logistic regression analysis detected preoperative nonambulatory status, functional nonindependence in daily living, older age, WIfI wound grade 3, chronic obstructive pulmonary disease, and hemodialysis as independent risk factors for postoperative nonambulation. The predictive scoring model (scores ranging from -5.0 to 4.4) comprising these risk factors discriminated the postoperative ambulatory status well: the probabilities of postoperative ambulatory ability were ≥85% in those with a score ≤-2, 50% in those with a score of zero, and ≤15% in those with a score ≥2. The area under the receiver operating characteristic curve was 0.898, indicating good performance of the model. CONCLUSIONS: Preoperative nonambulatory status, functional nonindependence, advanced age, high WIfI wound grade, chronic obstructive pulmonary disease, and hemodialysis were important predictors of postoperative nonambulatory status. The predictive model will help us identify patients who will benefit from bypass surgery.

DOI： 10.1016/j.avsg.2020.07.033

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：DOVE MEDICAL PRESS LTD  

BACKGROUND: The lumbar sympathetic ganglion block (LSGB) has been used as a diagnostic and therapeutic procedure for treating pain conditions such as neuropathic and ischemia-related pain, affecting the lower extremities. In general, an increase in skin temperature is useful in confirming the effectiveness of the sympathetic nerve block in clinical settings. However, the assessment of skin temperature in patients with peripheral arterial disease (PAD) occasionally provides false negatives. CASE PRESENTATION: A novel technology, laser speckle flowgraphy (LSFG) enables noninvasive quantitative and qualitative blood flow assessments. LSFG is a novel neuro-monitor for quantitative blood flow detection in the optic nerve head during cardiac surgery. Herein, we report on measuring foot blood flow using LSFG before and after LSGB in a PAD patient. This research aimed to determine whether LSFG could detect any improvement in the dynamics of foot blood flow after an LSGB in a situation where changes in skin temperature alone could not determine the procedure's outcome. CONCLUSION: LSFG can be used to assess blood flow changes in a foot with PAD, following a LSGB.

DOI： 10.2147/JPR.S305543

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(一社)日本胸部外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ACADEMIC PRESS INC ELSEVIER SCIENCE  

BACKGROUND: Proteoglycan 4 (PRG4; lubricin) is a member of two gene co-expression network modules associated with human vein graft failure. However, little is known about PRG4 and the vascular system. Therefore, we have investigated the effects of recombinant human PRG4 (rhPRG4) on cell migration and proliferation in human veins. METHODS: Effects of rhPRG4 on cell migration, proliferation, and neointima formation were determined in human venous tissue and cultured venous smooth muscle cells (SMCs), adventitial cells, and endothelial cells. Expression of PRG4 by cultured human saphenous veins, failed vein grafts, and varicose veins was determined by immunostaining or Western blotting. RESULTS: Limited expression of PRG4 in fresh saphenous veins was dramatically increased around medial SMCs after culture ex vivo. rhPRG4 inhibited the migration of cultured SMCs, adventitial cells, and endothelial cells, as well as the proliferation of endothelial cells. rhPRG4 also inhibited the migration of SMCs and adventitial cells from tissue explants, but there was no effect on cell proliferation or neointima formation in ex vivo whole veins. Finally, PRG4 was largely absent in two examples of venous pathology, that is, failed human vein grafts and varicose veins. CONCLUSIONS: Although rhPRG4 can inhibit the migration of venous SMCs, endothelial cells, and adventitial cells, and the proliferation of endothelial cells, PRG4 was only increased around medial SMCs in veins after ex vivo culture. PRG4 was not observed around medial SMCs in failed human vein grafts and varicose veins, suggesting the possibility that a failure of PRG4 upregulation may promote these pathologies.

DOI： 10.1016/j.jss.2020.03.028

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS  

The occurrence of multiple mechanical complications after myocardial infarction in the same patient may be extremely rare, and the surgical strategy may be very complex because each mechanical complication can be extremely fatal. The case of a patient who underwent repair of a ventricular septal perforation by venoarterial extracorporeal membrane oxygenation (VA-ECMO), then mitral valve replacement and VA-ECMO for papillary muscle rupture 2 weeks after the ventricular septal perforation repair, is reported. Immediate preoperative stabilization with VA-ECMO may play a crucial role in treating multiple mechanical complications after myocardial infarction.

DOI： 10.1093/jscr/rjaa188

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Language：English   Publisher：MOSBY-ELSEVIER  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPANESE CIRCULATION SOC  

BACKGROUND: NT5Egenetic mutations are known to result in calcification of joints and arteries (CALJA), and worldwide, 14 patients from 7 families have been reported.Methods and Results:A total of 5 patients from 2 independent families with CALJA were found in Japan. Of them, 3 complained of intermittent claudication (IC), and 1 suffered from bilateral chronic limb-threatening ischemia (CLTI). Whole-exome sequencing analysis revealed an identical mutation pattern (c.G3C on the exon 1 start codon) that was unique compared withNT5Emutations reported in other countries. CONCLUSIONS: Vascular specialists need to recognize CALJA as a rare cause of ischemic IC and CLTI.

DOI： 10.1253/circj.CJ-20-0153

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ANNALS VASCULAR DISEASES EDITORIAL OFFICE  

Ischemic limbs with infected heel ulcers are often difficult to salvage. We present a case of an 82-year-old woman who had bilateral heel ulcers owing to chronic limb-threatening ischemia. She underwent right femoral-terminal posterior tibial artery bypass surgery, but right calcaneus osteomyelitis occurred and inhibited wound healing. She underwent partial calcanectomy (PC), and her right heel healed six months after the bypass surgery. The ulcer on her left foot also healed after distal bypass and PC. We describe our experience with a patient who needed PC to cure her heel ulcers.

DOI： 10.3400/avd.cr.19-00122

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MOSBY-ELSEVIER  

OBJECTIVE: Intimal hyperplasia (IH) is the main cause of therapeutic failure after vascular and endovascular surgery. However, there is currently no targeted therapy for the treatment of IH. We recently reported that the inhibition of cyclic adenosine monophosphate response element (CRE) binding protein (CREB) activation is important in vein graft IH. We focused on a decoy oligodeoxynucleotide (ODN) therapeutic strategy for suppressing IH as a clinical application. The objective of this study was to confirm the therapeutic effect of a CRE decoy ODN in an animal model as a novel therapy for preventing intimal hyperplasia as the first step of the preclinical study of our strategy. METHODS: We designed two phosphorothioate CREs and two scramble decoy ODNs and screened them using a CREB transcription assay to check their ability to bind to a CRE sequence. We chose a CRE decoy ODN with high first-binding ability and transfected it into vascular smooth muscle cells (VSMCs) in vitro. Proliferation and migration were assessed using MTS (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) assays and modified Boyden chamber assays. We examined CRE activity using a luciferase reporter gene assay. We assessed the expression of messenger RNAs by quantitative real-time polymerase chain reaction. In a wire-injury mouse model (C57BL6, n = 6), CRE decoy ODN was transfected into the injured vessel wall using an ultrasound-sonoporation method in vivo. Mitogen-activated protein kinase-activated protein kinase 3 (MAPKAPK3) and four and a half LIM domains 5 (FHL5) expression of pregrafting vein remnants were assessed by immunohistologic analyses. RESULTS: Compared with scramble decoy ODN, the selected CRE decoy ODN could significantly decrease CRE activity (mean ± standard error of the mean: 0.20 ± 0.03 vs 1.00 ± 0.16, n = 6; P < .05) as shown by a luciferase reporter gene assay, VSMC proliferation (0.73 ± 0.04 vs 0.89 ± 0.02, n = 6; P < .05) and migration (96.4 ± 6.1 vs 311.4 ± 19.1 migrated VSMCs/well, n = 6; P < .05) after 24-hour transfection. The CRE decoy ODN significantly suppressed the formation of IH at injured vessel walls in an animal model, as analyzed by pathologic staining (0.20 ± 0.02 vs 0.56 ± 0.08, area of the intima/area of the artery vs the control after 21 days' transfection, n = 6; P < .05). Furthermore, MAPKAPK3 and FHL5, which are CREB activators, were significantly expressed in pregrafting vein remnants in diabetes mellitus patients. CONCLUSIONS: CREB-CRE signaling is an important mechanism of IH formation, and CRE decoy therapy can help preventing IH. This study is the first part of the preclinical study of our strategy.

DOI： 10.1016/j.jvs.2019.02.042

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：FRONTIERS MEDIA SA  

Tumor progression involves a series of biologically important steps in which the crosstalk between cancer cells and the surrounding environment is an important issue. Angiogenesis is a key tumorigenic phenomenon for cancer progression. Tumor-related extracellular vesicles (EVs) modulate the tumor microenvironment (TME) through cell-to-cell communication. Tumor cells in a hypoxic TME release more EVs than cells in a normoxic environment due to uncontrollable tumor proliferation. Tumor-derived EVs in the TME influence endothelial cells (ECs), which then play multiple roles, contributing to tumor angiogenesis, loss of the endothelial vascular barrier by binding to ECs, and subsequent endothelial-to-mesenchymal transition. In contrast, they also indirectly induce tumor angiogenesis through the phenotype switching of various cells into cancer-associated fibroblasts, the activation of tumor-associated ECs and platelets, and remodeling of the extracellular matrix. Here, we review current knowledge regarding the involvement of EVs in tumor vascular-related cancer progression.

DOI： 10.3389/fcell.2020.611039

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Language：English   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ANNALS VASCULAR DISEASES EDITORIAL OFFICE  

A 51-year-old man with severe comorbidities required redo revascularization due to left chronic limb-threatening ischemia caused by a previous vein graft occlusion. The saphenous veins were not available due to previous surgeries. Femoro-posterior tibial artery bypass surgery was successfully performed using the basilic-cephalic loop vein under peripheral nerve blockades. This anesthesia allowed a series of surgical revascularizations without general anesthesia, and the postoperative courses were uneventful. The patient survived for 4 years with ambulatory status. In conclusion, loop graft can be an alternative single vein material for distal bypass when no saphenous veins are available.

DOI： 10.3400/avd.cr.19-00091

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.ejvs.2019.06.558

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MOSBY-ELSEVIER  

OBJECTIVE: Graft flow (GF) seems to be an important prognostic predictor in distal bypass for critical limb ischemia, but previous studies have failed to clarify the association between GF and the graft prognosis. GF differs significantly among grafts, and each graft seems to have an optimal GF depending on various factors. We hypothesized that comparison between the measured GF (mGF) and optimal estimated GF (eGF) would be important in predicting graft prognosis. Herein, we aimed to develop a GF predictive equation by assessing GF determinants and to validate the equation against a clinical dataset. METHODS: A total of 198 distal bypasses with vein grafts for critical limb ischemia from 2011 to 2016 were enrolled. Of these grafts, 135 normal grafts without any abnormalities on early postoperative ultrasound examination were used to develop and validate the equation. Various anatomic and patient-related factors were analyzed to detect GF determinants with stepwise selection, and the GF predictive equation was developed with multiple linear regression analysis. After developing the equation, all 198 grafts were categorized into two groups according to the equation developed based on data from the 135 normal grafts as follows: optimal flow grafts (OFGs), in which mGF > eGF - 14.6, and suboptimal flow grafts (SFGs), in which mGF < eGF - 14.6. The cutoff value of 14.6 was determined using receiver operating characteristic curves to detect graft abnormalities. By comparing OFGs and SFGs, the efficacy of the equation in predicting bypass abnormalities and graft prognosis was assessed. RESULTS: The GF determinants were runoff, hemodialysis (HD), diabetes mellitus (DM), and graft quality (GQ). The predictive equation was estimated as follows: GF(ml/min)=(32.9×run-off)+(9.9×GQ)-(13.0×DM)-(35.1×HD)+12.1 (R2 = 0.71, coefficient: runoff and GQ, 3 [good], 2 [fair], 1 [poor]; DM and HD, 1 [yes], 0 [no]). In the efficacy assessment of the equation, SFGs showed a significantly higher rate of bypass abnormalities (64.0% vs 12.2%; P < .0001), graft intermediate stenosis (10.7% vs 1.6%; P = .0071), graft critical stenosis (28.0% vs 3.2%; P < .0001), and early graft occlusion (17.3% vs 4.3%; P = .0037) than OFGs and were associated with a higher rate of revision surgery within 2 years after surgery (50.7% vs 34.2%; P = .026). SFGs also showed significantly lower primary patency rates (P < .0001) and secondary patency rates (P = .0005). CONCLUSIONS: GF was well-estimated with runoff, GQ, and the presence of DM and HD. A comparison between mGF and eGF, calculated with the equation, will help to detect bypass abnormalities and determine the necessity of additional intraoperative procedures and, thus, achieve optimal outcomes.

DOI： 10.1016/j.jvs.2018.12.057

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Language：Japanese   Publisher：日本下肢救済・足病学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Femoral artery and veins and axillary artery are one of the major vessels in the human body which are easily accessible to circulation. Therefore, these vessels are usually used for cardiac and aortic surgeries to establish extracorporeal circulation through surgical as well as percutaneous technique. Additionally, with increasing a minimally invasive fashion for treatment of cardiac and aortic diseases, these accessible arteries are frequently manipulated, for example transcatheter aortic valve implantation, debranching thoracic endovascular aortic repair and endovascular aneurysm repair. Thus, exposure of the vessels is a basic procedure in this field;cardiac and vascular surgeons need understanding anatomical knowledge of the arteries and the surrounding structures, such as muscles and nerves. Especially, it becomes frequent for surgeons to see a bleeding complication with the increasing endovascular therapy and a calcified and atherosclerotic artery due to peripheral artery disease;these situations increase difficulty of femoral artery exposure. Deep understanding of anatomical knowledge helps to obtain good surgical exposure. We hope that it describes some useful improvements to surgical technique and anatomical understanding of cardiac and vascular surgeons.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO LTD  

OBJECTIVES: Surgical revascularisation to accomplish limb salvage remains preferable in some patients with chronic limb threatening ischaemia (CLTI). The aim of this study was to evaluate the effectiveness and safety of ultrasound guided lower extremity nerve blockade (UGNB) in infragenicular bypass surgery (IGBS). METHODS: This was a single centre, retrospective clinical study. Fifty-nine patients with CLTI (67 limbs) who underwent IGBS under UGNB (femoral and sciatic nerve blockade) at Asahikawa Medical University between January 2012 and December 2017 were compared with patients with CLTI (137 limbs) who underwent IGBS under general anaesthesia (GA) over the same period. Propensity score matching based on pre-operative comorbidities was used to minimise background differences of the two groups. RESULTS: Fifty-six pairs of CLTIs were matched and analysed (55% dialysis dependent). Procedure duration was similar between the two groups, but intraoperative catecholamine index and intravenous fluid volume were lower with UGNB compared with GA (2.9 ± 4.6 vs. 5.9 ± 6.5; p < .01 and 1831 ± 990 vs. 2335 ± 931 mL; p < .01, respectively). The mean arterial blood pressure during induction of anaesthesia was significantly decreased with GA. Post-operatively, the time period to resume a clear liquid and solid food diet was significantly shorter with UGNB (P<0.01 for both outcome measures). Intravenous fluid volume was significanlty lower, while cardiac complications and delirium, based on the NEECHAM confusion scale, occurred significantly less often with UGNB than GA. These significant differences show advantages of UGNB compared to GA. No mortality or major amputations were observed in either group. Early graft thrombosis was observed in five limbs (8.9%) with UGNB and in four limbs with GA (7.1%) (p = .73). CONCLUSIONS: UGNB has advantages for intra- and post-operative management and could be a useful method to prevent peri-operative complications for high risk patients with CLTI. To ensure the effectiveness of UGNB for IGBS for future indications, a randomised study is required.

DOI： 10.1016/j.ejvs.2019.03.023

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：{SAGE} Publications  

Objectives Laser speckle flowgraphy is a new method that enables the rapid evaluation of foot blood flow without contact with the skin. We used laser speckle flowgraphy to evaluate foot blood flow in peripheral arterial disease patients before and after surgical revascularization. Materials and methods A prospective single-center study. Thirty-one patients with 33 limbs that underwent surgical revascularization for peripheral arterial disease were included. Pre- and postoperative foot blood flows were measured on the plantar surface via laser speckle flowgraphy and skin perfusion pressure. The laser speckle flowgraphy device was used to visualize the blood flow distribution of the target skin and processed the pulse wave velocity of synchronized heart beats. The mean blood flow, which was expressed as the area of the pulse wave as the beat strength of skin perfusion on laser speckle flowgraphy converted into a numerical value, was assessed as dynamic changes following surgery. Beat strength of skin perfusion was also investigated in non-peripheral arterial disease controls (23 patients/46 limbs). Results The suitability of beat strength of skin perfusion in non-peripheral arterial disease controls was achieved; the beat strength of skin perfusion value was significantly higher in every area of interest in non-peripheral arterial disease controls compared to that in peripheral arterial disease limbs at the preoperative stage (105.8 +/- 8.2 vs. 26.3 +/- 8.2; P < 0.01). Although the pulse wave before surgery was visually flat in peripheral arterial disease patients, the pulse wave was remarkably and immediately improved through surgical revascularization. Beat strength of skin perfusion showed a dynamic change in foot blood flow (26.3 +/- 8.2 at preoperation, 98.5 +/- 6.7 immediately after surgery, 107.6 +/- 5.7 at seven days after surgery, P < 0.01 for each compared to preoperation) that correlated with an improvement in skin perfusion pressure. Conclusions Laser speckle flowgraphy is a noninvasive, contact-free modality that is easy to implement, and beat strength of skin perfusion is a useful indicator of foot circulation during the perioperative period. Further analysis with a larger number of cases is necessary to establish appropriate clinical use.

DOI： 10.1177/1708538118810664

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：THIEME MEDICAL PUBL INC  

An arteriovenous fistula formation caused by a blunt trauma is a quite rare complication, especially in the hand. We report an extremely rare case of a traumatic arteriovenous formation in a finger that developed 5 years after the patient received a blunt trauma in conjunction with a phalangeal bone fracture. Successful management was achieved by direct surgical resection of the arteriovenous fistula without any complication.

DOI： 10.1055/s-0038-1661002

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Language：English   Publisher：MOSBY-ELSEVIER  

DOI： 10.1016/j.jvs.2019.04.040

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：{MDPI} {AG}  

The primary cause of mortality among patients with cancer is the progression of the tumor, better known as cancer invasion and metastasis. Cancer progression involves a series of biologically important steps in which the cross-talk between cancer cells and the cells in the surrounding environment is positioned as an important issue. Notably, angiogenesis is a key tumorigenic phenomenon for cancer progression. Cancer-related extracellular vesicles (EVs) commonly contribute to the modulation of a microenvironment favorable to cancer cells through their function of cell-to-cell communication. Vascular-related cells such as endothelial cells (ECs) and platelets activated by cancer cells and cancer-derived EVs develop procoagulant and proinflammatory statuses, which help excite the tumor environment, and play major roles in tumor progression, including in tumor extravasation, tumor cell microthrombi formation, platelet aggregation, and metastasis. In particular, cancer-derived EVs influence ECs, which then play multiple roles such as contributing to tumor angiogenesis, loss of endothelial vascular barrier by binding to ECs, and the subsequent endothelial-to-mesenchymal transition, i.e., extracellular matrix remodeling. Thus, cell-to-cell communication between cancer cells and ECs via EVs may be an important target for controlling cancer progression. This review describes the current knowledge regarding the involvement of EVs, especially exosomes derived from cancer cells, in EC-related cancer progression.

DOI： 10.3390/ijms20102584

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Language：English   Publisher：MOSBY-ELSEVIER  

DOI： 10.1016/j.surg.2018.12.012

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SAGE PUBLICATIONS LTD  

An emergency thoracic endovascular aortic repair (TEVAR) with zone 2 landing without revascularization of the left subclavian artery was performed due to the impending rupture of a distal arch aneurysm in an old patient presenting hemoptysis. Two months later, the patient had recurrent massive hemoptyses and continued after additional zone 0 TEVAR. The lung parenchyma was considered to be the bleeding source and transcatheter pulmonary artery embolization was performed, and the episodes of massive hemoptysis appeared to have ceased. However, the patient died of sudden recurrent massive hemoptysis 40 days later. Inflammation and/or infection of the lung parenchyma adjunct to the aortic aneurysm could be cause of fatal hemoptysis, and aggressive therapy such as lung resection should be considered in such patients.

DOI： 10.1177/1179547619896577

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MOSBY-ELSEVIER  

OBJECTIVE: When an autogenous vein is harvested and used for arterial bypass, it suffers physical and biologic injuries that may set in motion the cellular processes that lead to wall thickening, fibrosis, stenosis, and ultimately graft failure. Whereas the injurious effects of surgical preparation of the vein conduit have been extensively studied, little is known about the influence of the clinical environment of the donor leg from which the vein is obtained. METHODS: We studied the cellular responses of fresh saphenous vein samples obtained before implantation in 46 patients undergoing elective lower extremity bypass surgery. Using an ex vivo model of response to injury, we quantified the outgrowth of cells from explants of the adventitial and medial layers of the vein. We correlated this cellular outgrowth with the clinical characteristics of the patients, including the Wound, Ischemia, and foot Infection classification of the donor leg for ischemia, wounds, and infection as well as smoking and diabetes. RESULTS: Cellular outgrowth was significantly faster and more robust from the adventitial layer than from the medial layer. The factors of leg ischemia (P < .001), smoking (P = .042), and leg infection (P = .045) were associated with impaired overall outgrowth from the adventitial tissue on multivariable analysis. Only ischemia (P = .046) was associated with impaired outgrowth of smooth muscle cells (SMCs) from the medial tissue. Co-culture of adventitial cells and SMCs propagated from vein explants revealed that adventitial cells significantly inhibited the growth of SMCs, whereas SMCs promoted the growth of adventitial cells. The AA genotype of the -838C>A p27 polymorphism (previously associated with superior graft patency) enhanced these effects, whereas the factor of smoking attenuated adventitial cell inhibition of SMC growth. Comparing gene expression, the cells cultured from the media overexpress Kyoto Encyclopedia of Genes and Genomes pathways associated with inflammation and infection, whereas those from the adventitia overexpress gene families associated with development and stem/progenitor cell maintenance. CONCLUSIONS: The adverse clinical environment of the leg may influence the biologic behavior of the cells in the vein wall, especially the adventitial cells. Chronic ischemia was the most significant factor that retards adventitial cell outgrowth. The cells arising from the vein adventitia may be key players in determining a healthy adaptive or a pathologic response to the injuries associated with vein grafting.

DOI： 10.1016/j.jvs.2018.03.436

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS  

Since its introduction in Japan in 1980, the extracorporeal left ventricular assist device has been used as a bridge to the recovery of cardiac function or to heart transplantation by many institutions. In this case report, we describe a 23-year-old female with peripartum cardiomyopathy. She had a persistently low cardiac index despite intensive care with intravenous inotropes, intra-aortic balloon pumping and extracorporeal membrane oxygenation; thus, we implanted an extracorporeal left ventricular assist device. Thereafter, her cardiac function gradually improved; the device was removed 2 months after the implantation. She currently has good heart function.

DOI： 10.1093/jscr/rjy285

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PUBLIC LIBRARY SCIENCE  

Changes in extracellular matrix proteins may contribute significantly to the adaptation of vein grafts to the arterial circulation. We examined the production and distribution of versican and hyaluronan in intact human vein rings cultured ex vivo, veins perfused ex vivo, and cultured venous adventitial and smooth muscle cells. Immunohistochemistry revealed higher levels of versican in the intima/media compared to the adventitia, and no differences in hyaluronan. In the vasa vasorum, versican and hyaluronan associated with CD34(+) pro-genitor cells. Culturing the vein rings for 14 days revealed increased versican immunostaining of 30-40% in all layers, with no changes in hyaluronan. Changes in versican accumulation appear to result from increased synthesis in the intima/media and decreased degradation in the adventitia as versican transcripts were increased in the intima/media, but unchanged in the adventitia, and versikine (the ADAMTS-mediated cleavage product of versican) was increased in the intima/media, but decreased in the adventitia. In perfused human veins, versican was specifically increased in the intima/media in the presence of venous pressure, but not with arterial pressure. Unexpectedly, cultured adventitial cells express and accumulate more versican and hyaluronan than smooth muscle cells. These data demonstrate a differential regulation of versican and hyaluronan in human venous adventitia vs. intima/media and suggest distinct functions for these extracellular matrix macromolecules in these venous wall compartments during the adaptive response of vein grafts to the arterial circulation.

DOI： 10.1371/journal.pone.0204045

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ANNALS VASCULAR DISEASES EDITORIAL OFFICE  

A 79-year-old man with a heavy smoking history presented with threatened lower limbs due to acute exacerbation of peripheral artery disease (PAD). He underwent emergent distal bypass surgery for the right leg and external iliac stenting for the left leg. Fatal coronary artery spasm (CAS) with ST segment changes on electrocardiography was observed 28 h after the procedures, resulting in cardiac arrest. Coronary angiography showed widespread CAS with improvement after intra-arterial nitroglycerin infusion. We should keep in mind that CAS may occur more frequently than expected in PAD patients, especially those who have not stopped smoking prior to revascularization.

DOI： 10.3400/avd.cr.18-00050

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ANNALS VASCULAR DISEASES EDITORIAL OFFICE  

Acute limb ischemia (ALI) is associated with high morbidity and mortality rates, even with the advent of technical advances. Although myocardial infarction is one of the causes of ALI along with intraventricular thrombus formation and subsequent embolism, ALI with concomitant acute myocardial infarction (AMI) is extremely rare. Here, we report a complicated ALI case with concurrent AMI and prolonged limb ischemic duration. The cause may be attributed to thrombosis with atherosclerotic disease of the coronary and peripheral arteries triggered by dehydration. We successfully treated the patient using simultaneous revascularization in a hybrid operating room with the aid of intraoperative hemodialysis for preventing life-threatening reperfusion syndrome.

DOI： 10.3400/avd.cr.18-00059

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：English   Publisher：MOSBY-ELSEVIER  

DOI： 10.1016/j.jvs.2018.03.315

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DOI： 10.1016/j.jvs.2018.03.038

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

BACKGROUND: Critical limb ischemia with osteomyelitis is so difficult to treat that even appropriate revascularization and wound therapy cannot achieve limb salvage because of uncontrollable infection. It is still difficult to judge the possibility of limb salvage before revascularization. CASE PRESENTATION: A 73-year-old male complained of a small ulcer on his left toe, which was treated with multiple endovascular therapy. After failed endovascular therapy, he suffered extensive tissue loss with tibial osteomyelitis. We carried out staged surgery that was composed of dual bypass to the sural artery and posterior tibial artery. After intensive debridement and wound care, insertion of a subsequent free gracilis muscle flap to cover the exposed tibial bone was performed, achieving functional limb salvage. CONCLUSION: Even in the threatened limb with extensive tissue loss and osteomyelitis, intensive and multidisciplinary treatment with staged revascularization, muscle transfer, and appropriate wound care achieved functional limb salvage.

DOI： 10.1186/s40792-018-0449-9

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OBJECTIVE: Venous valves are essential but are prone to injury, thrombosis, and fibrosis. We compared the behavior and gene expression of smooth muscle cells (SMCs) in the valve sinus vs nonvalve sites to elucidate biologic differences associated with vein valves. METHODS: Tissue explants of fresh human saphenous veins were prepared, and the migration of SMCs from explants of valve sinus vs nonvalve sinus areas was measured. Proliferation and death of SMCs were determined by staining for Ki67 and terminal deoxynucleotidyl transferase dUTP nick end labeling. Proliferation and migration of passaged valve vs nonvalve SMCs were determined by cell counts and using microchemotaxis chambers. Global gene expression in valve vs nonvalve intima-media was determined by RNA sequencing. RESULTS: Valve SMCs demonstrated greater proliferation in tissue explants compared with nonvalve SMCs (19.3% ± 5.4% vs 6.8% ± 2.0% Ki67-positive nuclei at 4 days, respectively; mean ± standard error of the mean, five veins; P < .05). This was also true for migration (18.2 ± 2.7 vs 7.5 ± 3.0 migrated SMCs/explant at 6 days, respectively; 24 veins, 15 explants/vein; P < .0001). Cell death was not different (39.6% ± 16.1% vs 41.5% ± 16.0% terminal deoxynucleotidyl transferase dUTP nick end labeling-positive cells, respectively, at 4 days, five veins). Cultured valve SMCs also proliferated faster than nonvalve SMCs in response to platelet-derived growth factor subunit BB (2.9 ± 0.2-fold vs 2.1 ± 0.2-fold of control, respectively; P < .001; n = 5 pairs of cells). This was also true for migration (6.5 ± 1.2-fold vs 4.4 ± 0.8-fold of control, respectively; P < .001; n = 7 pairs of cells). Blockade of fibroblast growth factor 2 (FGF2) inhibited the increased responses of valve SMCs but had no effect on nonvalve SMCs. Exogenous FGF2 increased migration of valve but not of nonvalve SMCs. Unlike in the isolated, cultured cells, blockade of FGF2 in the tissue explants did not block migration of valve or nonvalve SMCs from the explants. Thirty-seven genes were differentially expressed by valve compared with nonvalve intimal-medial tissue (11 veins). Peptide-mediated inhibition of SEMA3A, one of the differentially expressed genes, increased the number of migrated SMCs of valve but not of nonvalve explants. CONCLUSIONS: Valve compared with nonvalve SMCs have greater rates of migration and proliferation, which may in part explain the propensity for pathologic lesion formation in valves. Whereas FGF2 mediates these effects in cultured SMCs, the mediators of these stimulatory effects in the valve wall tissue remain unclear but may be among the differentially expressed genes discovered in this study. One of these genes, SEMA3A, mediates a valve-specific inhibitory effect on the injury response of valve SMCs.

DOI： 10.1016/j.jvs.2017.03.447

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OBJECTIVE: The aim of this study was to elucidate the efficacy of paramalleolar or inframalleolar bypass (PIMB) in hemodialysis-dependent (HD) patients with critical limb ischemia (CLI) and nonhemodialysis-dependent (NHD) patients in terms of clinical outcomes. METHODS: Between January 2000 and December 2013, there were 333 consecutive arteriosclerosis obliterans patients with CLI who underwent 401 PIMB procedures for limb salvage (LS). Of the 333 patients, 188 (56.5%) were HD patients. Vein grafts were exclusively used, and 172 paramalleolar and 229 inframalleolar bypasses were performed. Five-year primary and secondary cumulative graft patency, LS, and amputation-free survival (AFS) rates were compared between the two groups, and the independent determinants of these outcomes were identified in each group. RESULTS: The 5-year primary and secondary cumulative graft patency rates were 53% and 82% in HD patients and 69% and 92% in NHD patients (primary cumulative graft patency, P < .05; secondary cumulative graft patency, nonsignificant), respectively. The LS rates were 87% and 99% (P < .01) in HD patients and NHD patients, respectively. Overall, 48% and 70% of HD and NHD patients were ambulatory before PIMB (P < .01), and 73% and 85% of HD and NHD patients were ambulatory 12 months after PIMB (including 1-year survivors; nonsignificant), respectively, demonstrating drastic post-PIMB improvement in HD patients. The 5-year AFS rates in the HD and NHD groups were 27% and 69% (P < .01), respectively, demonstrating very poor AFS rates in HD patients. In HD patients, factors negatively associated with AFS were female gender (hazard ratio [HR], 2.102; 95% confidence interval [CI], 1.254-3.524), history of congestive heart failure (HR, 2.075; 95% CI, 1.395-3.085), and preoperative nonambulatory status (HR, 1.974; 95% CI, 1.305-2.986), whereas older age (HR, 2.601; 95% CI, 1.372-4.931) and history of congestive heart failure (HR, 2.928; 95% CI, 1.496-5.731) were identified as independent factors negatively associated with AFS in NHD patients. CONCLUSIONS: The use of PIMB for CLI was associated with excellent LS rates in both HD and NHD patients with low operative mortality and complications. However, the AFS rate observed in HD patients was significantly lower than that observed in NHD patients, indicating the necessity of a specific management program to improve AFS after LS in HD patients.

DOI： 10.1016/j.jvs.2017.07.116

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BACKGROUND: Cyclin-dependent kinase inhibitor 1B (p27Kip1) is a cell-cycle inhibitor whose -838C>A single nucleotide polymorphism (rs36228499; hereafter called p27 SNP) has been associated with the clinical failure of peripheral vein grafts, but the functional effects of this SNP have not been demonstrated. METHODS: Human saphenous vein adventitial cells and intimal/medial smooth muscle cells (SMCs) were derived from explants obtained at the time of lower extremity bypass operations. We determined the following in adventitial cells and SMCs as a function of the p27 SNP genotype: (1) p27 promoter activity, (2) p27 messenger (m)RNA and protein levels, and (3) growth and collagen gel contraction. Deoxyribonuclease I footprinting was also performed in adventitial cells and SMCs. RESULTS: p27 promoter activity, deoxyribonuclease I footprinting, p27 mRNA levels, and p27 protein levels demonstrated that the p27 SNP is functional in adventitial cells and SMCs. Both cell types with the graft failure protective AA genotype had more p27 mRNA and protein. As predicted because of higher levels of p27 protein, adventitial cells with the AA genotype grew slower than those of the CC genotype. Unexpectedly, SMCs did not show this genotype-dependent growth response. CONCLUSIONS: These results support the functionality of the p27 SNP in venous SMCs and adventitial cells, but an effect of the SNP on cell proliferation is limited to only adventitial cells. These data point to a potential role for adventitial cells in human vein graft failure and also suggest that SMCs express factors that interfere with the activity of p27.

DOI： 10.1016/j.jvs.2016.12.113

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DOI： 10.1016/j.jvscit.2016.05.010

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

下腿以遠へのdistal bypassを施行した重症虚血肢94肢を対象に、graft flowに影響を及ぼす因子を検討した。Graft flowに影響を与える因子の解析はステップワイズ法を用いて行い、検討項目は性別、年齢、body mass index、糖尿病(DM)、透析(HD)、高血圧、高脂血症、喫煙、左室駆出率、run-off quality、inflow部位、graft quality、足部感染の有無とした。その結果、graft flowに影響を与える因子は、run-off quality、graft quality、HDの有無およびDMの有無であり、最も重要な因子はrun-off quality、次いでHDの有無であった。各因子間の多重共線性の有無についてVariance Inflation Factor(VIF)を用いて検討したところ、VIFはいずれも6未満と低く、多重共線性は認めなかった。更に、解析で決定された因子を用いて重回帰分析を行い、graft flow推定式を算出したところ、推定式の推定率は良好であった。本推定式は術中のバイパス異常の検出、早期グラフト閉塞の回避の一助になり得ると考えられた。

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ANNALS VASCULAR DISEASES EDITORIAL OFFICE  

According to expansion of dialysis-dependent population, more than half of patients with critical ischemic limbs are dialysis-dependent in Japan. Although patients with end-staged renal disease are well-known as poor life prognosis, well-managed dialysis patients in Japan can survive much longer compared to dialysis patients in the United States and Europe. Therefore, some dialysis patients can enjoy the long-term benefits of bypass surgery. To decide the indication of bypass surgery, patient's general condition, nutrition status, and vein availability are more important rather than arterial disease anatomy. Ultrasound guided nerve block anesthesia blocking both sciatic and femoral nerve is contributing greatly to quick postoperative recovery of high risk patients. Preoperative ultrasound examination also contribute to not only vein mapping but also find out the graftable segment of artery. The selection of distal target should be decided based on the degree of arterial disease (luminal surface as well as wall calcification), and arterial run-off. Several tips regarding anastomosis to heavily calcified artery have been established including how to create bloodless operative field without arterial clamps. Adequate wound management after bypass surgery is also important. Detection of deep infection such as osteomyelitis and the adequate treatment may avoid major amputation of salvageable limbs. In the era of endovascular treatment, the evidences guiding how to select dialysis patients suitable for bypass surgery are awaiting. (This is a translation of Jpn J Vasc Surg 2017; 26: 33-39.).

DOI： 10.3400/avd.ra.17-00076

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Language：English   Publisher：MOSBY-ELSEVIER  

DOI： 10.1016/j.jvs.2017.03.042

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DOI： 10.1016/j.jvs.2017.03.040

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MOSBY-ELSEVIER  

OBJECTIVE: Approximately 30% of autogenous vein grafts develop luminal narrowing and fail because of intimal hyperplasia or negative remodeling. We previously found that vein graft cells from patients who later develop stenosis proliferate more in vitro in response to growth factors than cells from patients who maintain patent grafts. To discover novel determinants of vein graft outcome, we have analyzed gene expression profiles of these cells using a systems biology approach to cluster the genes into modules by their coexpression patterns and to correlate the results with growth data from our prior study and with new studies of migration and matrix remodeling. METHODS: RNA from 4-hour serum- or platelet-derived growth factor (PDGF)-BB-stimulated human saphenous vein cells obtained from the outer vein wall (20 cell lines) was used for microarray analysis of gene expression, followed by weighted gene coexpression network analysis. Cell migration in microchemotaxis chambers in response to PDGF-BB and cell-mediated collagen gel contraction in response to serum were also determined. Gene function was determined using short-interfering RNA to inhibit gene expression before subjecting cells to growth or collagen gel contraction assays. These cells were derived from samples of the vein grafts obtained at surgery, and the long-term fate of these bypass grafts was known. RESULTS: Neither migration nor cell-mediated collagen gel contraction showed a correlation with graft outcome. Although 1188 and 1340 genes were differentially expressed in response to treatment with serum and PDGF, respectively, no single gene was differentially expressed in cells isolated from patients whose grafts stenosed compared with those that remained patent. Network analysis revealed four unique groups of genes, which we term modules, associated with PDGF responses, and 20 unique modules associated with serum responses. The "yellow" and "skyblue" modules, from PDGF and serum analyses, respectively, correlated with later graft stenosis (P = .005 and P = .02, respectively). In response to PDGF, yellow was also associated with increased cell growth. For serum, skyblue was also associated with inhibition of collagen gel contraction. The hub genes for yellow and skyblue (ie, the gene most connected to other genes in the module), scavenger receptor class A member 5 (SCARA5) and suprabasin (SBSN), respectively, were tested for effects on proliferation and collagen contraction. Knockdown of SCARA5 increased proliferation by 29.9% ± 7.8% (P < .01), whereas knockdown of SBSN had no effect. Knockdown of SBSN increased collagen gel contraction by 24.2% ± 8.6% (P < .05), whereas knockdown of SCARA5 had no effect. CONCLUSIONS: Using weighted gene coexpression network analysis of cultured vein graft cell gene expression, we have discovered two small gene modules, which comprise 42 genes, that are associated with vein graft failure. Further experiments are needed to delineate the venous cells that express these genes in vivo and the roles these genes play in vein graft healing, starting with the module hub genes SCARA5 and SBSN, which have been shown to have modest effects on cell proliferation or collagen gel contraction.

DOI： 10.1016/j.jvs.2014.12.052

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Language：English   Publisher：MOSBY-ELSEVIER  

DOI： 10.1016/j.jvs.2016.03.134

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MOSBY-ELSEVIER  

OBJECTIVE: Markers containing dyes such as crystal violet (CAS 548-62-9) are routinely used on the adventitia of vein bypass grafts to avoid twisting during placement. Because little is known about how these dyes affect vein graft healing and function, we determined the effect of crystal violet on cell migration and proliferation, which are responses to injury after grafting. METHODS: Fresh human saphenous veins were obtained as residual specimens from leg bypass surgeries. Portions of the vein that had been surgically marked with crystal violet were analyzed separately from those that had no dye marking. In the laboratory, they were split into easily dissected inner and outer layers after removal of endothelium. This cleavage plane was within the circular muscle layer of the media. Cell migration from explants was measured daily as either (1) percentage of migration-positive explants, which exclusively measures migration, or (2) number of cells on the plastic surrounding each explant, which measures migration plus proliferation. Cell proliferation and apoptosis (Ki67 and TUNEL staining, respectively) were determined in dye-marked and unmarked areas of cultured vein rings. The dose-dependent effects of crystal violet were measured for cell migration from explants as well as for proliferation, migration, and death of cultured outer layer cells. Dye was extracted from explants with ethanol and quantified by spectrophotometry. RESULTS: There was significantly less cell migration from visibly blue compared with unstained outer layer explants by both methods. There was no significant difference in migration from inner layer explants adjacent to blue-stained or unstained sections of vein because dye did not penetrate to the inner layer. Ki67 staining of vein in organ culture, which is a measure of proliferation, progressively increased up to 6 days in nonblue outer layer and was abolished in the blue outer layer. Evidence of apoptosis (TUNEL staining) was present throughout the wall and not different in blue-stained and unstained vein wall segments. Blue outer layer explants had 65.9 ± 8.0 ng dye/explant compared with 2.1 ± 1.3 for nonblue outer layer explants. Dye applied in vitro to either outer or inner layer explants dose dependently inhibited migration (IC50∼10 ng/explant). The IC50s of crystal violet for outer layer cell proliferation and migration were 0.1 and 1.2 μg/mL, whereas the EC50 for death was between 1 and 10 μg/mL. CONCLUSIONS: Crystal violet inhibits venous cell migration and proliferation, indicating that alternative methods should be considered for marking vein grafts.

DOI： 10.1016/j.jvs.2014.10.017

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN SOC INTERNAL MEDICINE  

Reversible posterior leukoencephalopathy syndrome (RPLS) is a clinical syndrome of varying etiologies with similar neuroimaging findings. This is a case report of a 25-year-old woman who developed typical, neurological symptoms and magnetic resonance imaging abnormalities after treatment for the acute exacerbation of ulcerative colitis (UC), which included blood transfusion, the systemic administration of prednisolone, and the administration of metronidazole. It has been reported that these treatments may contribute to the development of RPLS. RPLS should therefore be considered in the differential diagnosis of UC patients who exhibit impaired consciousness, seizures or visual deficits during treatment. We report a rare case of RPLS in a patient with UC.

DOI： 10.2169/internalmedicine.55.5250

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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DOI： 10.1016/j.jvs.2015.04.089

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Surgical treatment for popliteal artery cystic adventitial disease (PACAD) is still controversial. PACAD often occurs in young or middle-aged adults. Therefore, the maintenance of graft patency for very long periods is a concern if a prosthesis is used. Because the intima is intact in PACAD patients with popliteal artery stenosis, a treatment that preserves the healthy intima is ideal. We describe the cases of 3 patients who underwent cystic excision for PACAD with severe stenosis. No recurrence was observed for up to 11 years, and these long-term results revealed that cystic excision could be reconsidered as one of the first-line therapeutic methods.

DOI： 10.1016/j.avsg.2014.01.016

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Forced retrograde perfusion through the venous system with arterial blood can provide adequate oxygen to peripheral tissues at rest through veno-capillary networks which is the basis for surgical restoration of blood flow by distal vein arterialization (DVA). To be successful such surgery requires disruption of valve leaflets in the veins, which can be accomplished easily in the larger vessels. However, the smallest veins (venules) of less than 100 μm in diameter, also possess valves, are distributed widely throughout all tissues and are too fine for any effective surgical interference. Thus venular valves cannot be disrupted or dissected with presently available technology. Nevertheless, clinical observations suggest that retrograde peripheral blood flow is rapidly established after DVA surgery. There is as yet no rational explanation for this phenomenon. In the present study, using Laplace's law, we attempt to elucidate the mechanical properties of venules and their valves. We speculate that the remarkably thin venular walls (and especially those of the smaller vessels which have the thinnest walls), are capable of considerable, rapid distension when subjected to increased hemostatic pressure. The increase in diameter of venules in response to the increased blood pressure renders their valve leaflets incompetent, so that the valves themselves cannot close the vessel lumen. In addition, the thin bicuspid leaflets may also be forced open retrogradely by the increased blood pressure.

DOI： 10.1007/978-1-4939-0620-8_42

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

Vascular surgery for distal vein arterialization (DVA) has been adopted clinically as a strategy for saving arteriosclerotic lower limbs from amputation. To gain more detailed information on DVA, the present study investigated the procedure in hind limbs of rats under isoflurane anesthesia. Since successful DVA requires destruction of venous valves, a coronary angioplasty catheter guidewire was used to destroy valves either solely in the femoral vein or in both femoral and popliteal veins. The femoral artery was then anastomosed to the femoral vein with sutures under binocular microsopic control. Changes in the distribution of skin blood flow in the hind limbs were studied with a thermal camera. Skin temperature increased in the thigh and knee after femoral venous valve destruction, but hyperthermia was observed in the distal leg and foot only when the valves in the popliteal vein were also disrupted. These results showed that increased arterial blood flow could be established by DVA surgery in both the proximal and distal regions of the hind limbs.

DOI： 10.1007/978-1-4939-0620-8_48

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER CHEMICAL SOC  

Antibodies, with their high affinity and specificity, are widely utilized in the field of protein engineering, medicinal chemistry, and nanotechnology applications, and our recent studies have demonstrated the recognition and binding of antibody for the surface on inorganic material. In this study, we generated a high-affinity gold-binding antibody fragment by a combination of peptide-grafting and phage-display techniques and showed the availability of the material-binding fragment for one-pot functionalization of nanoparticles as interface molecules. After a gold-binding peptide sequence was grafted into one of the complementarity determining regions of a single variable domain of a heavy-chain camel antibody, a combinatorial library approach raised by 20 times the affinity of the peptide-grafted fragment. The high-affinity gold-binding fragment (E32) spontaneously adsorbed on gold nanoparticles, and consequently the nanoparticles formed a stable dispersion in a high-ionic-strength solution. Multivalent and bispecific antibodies constructed on the E32 platform by means of fusion technology functionalized gold nanoparticles in one pot, and these functionalized nanoparticles could be used to obtain surface plasmon resonance scattering images of cancer cells and to spontaneously link two different nanomaterials. Here, we propose the bispecific antibodies as convenient interface molecules in the nanosized world.

DOI： 10.1021/bc300316p

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DOI： 10.1016/j.gie.2010.03.611

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Language：Japanese   Publisher：(NPO)日本医工学治療学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J01122&link_issn=&doc_id=20240528210018&doc_link_id=10.4326%2Fjjcvs.53.3.iii&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.53.3.iii&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(株)メディカ出版  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J02115&link_issn=&doc_id=20231221050006&doc_link_id=issn%3D0914-2819%26volume%3D37%26issue%3D1%26spage%3D55&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0914-2819%26volume%3D37%26issue%3D1%26spage%3D55&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

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Language：English   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(一社)日本フットケア・足病医学会  

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Language：Japanese   Publisher：血管外科症例検討会  

フィブリノゲン(Fbg)異常症は、主に出血傾向をきたす稀な疾患であり、血栓形成を伴う下肢虚血の合併症例の報告は極めて少ない。今回われわれは低Fbg血症を背景とした重症下肢虚血に対する治療を経験したので報告する。症例:61歳男性。左下肢安静時疼痛。40年以上前に父親が低Fbg血症と診断されていた。血液検査上、血清Fbg値が51.2mg/dLと低値を示し、血流評価上、左下肢動脈に多発する慢性閉塞病変を認めていた。血行再建で虚血を解除したが、術直後に再建部位が再閉塞した。抗凝固動注療法を含めた再介入により早期再閉塞を予防し良好な経過を得た。遺伝子解析の結果、γ鎖exon7に存在する208番目アミノ酸をコードするヌクレオチドがTGG(野生型)とTTG(変異型)とのヘテロ(γTrp208Leu)であることが確認された。出血傾向が問題となる低Fbg血症を合併した症例では、血栓形成も同様に懸念され、周術期および慢性期管理に注意を要する。(著者抄録)

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(一社)日本フットケア・足病医学会  

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Language：Japanese   Publisher：(一社)日本フットケア・足病医学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：日本赤十字社医学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：The Japanese Society on Thrombosis and Hemostasis  

DOI： 10.2491/jjsth.33.661

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(一社)日本フットケア・足病医学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本フットケア・足病医学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：特定非営利活動法人 日本心臓血管外科学会  

DOI： 10.4326/jjcvs.50.5.lxxiv

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Other Link： https://search.jamas.or.jp/link/ui/2022002587

Language：Japanese   Publisher：(一社)日本救急医学会  

腹部大動脈ステントグラフト(EVAR)は腹部大動脈瘤(AAA)に対する主な治療として位置づけられ,とくに開腹歴をもつ症例群に対する加療として,低侵襲性の観点で積極的に施行されている。EVAR後に発生するエンドリークは,治療にも関わらず瘤径拡大の主原因であり,周囲臓器との瘻孔や瘤破裂の発生などEVAR関連合併症が発生しうる。EVAR後の大動脈腸管瘻(AEF)の発生は非常に稀であるが,致命的な合併症として知られる。我々は,大腸癌で開腹歴をもつ70歳代女性の拡大傾向のある嚢状AAA対してEVARを施行したが,瘤拡大が持続し十二指腸に穿破した症例を経験した。EVAR術後6ヵ月,16ヵ月後にそれぞれエンドリークによる瘤径拡大に対する追加加療を行ったが,瘤径の制御が困難であった。術後20ヵ月後に高度貧血に対する精査のために施行された上部消化管内視鏡検査の結果,AAAが十二指腸水平脚と交通し出血している所見を認め,AEFの診断となり緊急手術を行った。周術期死亡率の高い本症において,手術侵襲が大きくなることが予想される症例に対して,ステントグラフトを抜去せず瘤縫縮術を選択した1例を報告した。EVAR後の瘤拡大関連イベントに救急医が関わるケースが増えてくることが予想され,AEFの合併を念頭に置くべきである。(著者抄録)

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Language：Japanese   Publisher：Japanese College of Angiology  

Chronic limb-threatening ischemia (CLTI) is a clinical syndrome associated with increased mortality, risk of amputation, and impaired quality of life. To treat patients with CLTI appropriately, a multidisciplinary approach should be adopted. Holistic nursing, in particular, is important in the care and healing of foot wounds caused by ischemia and foot infection in these patients. In this setting, the role of specific nurses is expanded significantly to allow them to perform advanced practice under comprehensive instructions for timely wound assessment and foot care in collaboration with the nursing and medical teams. Daily practice conducted by a specific nurse, including educating and motivating patients, is subjective and should consider the patient’s own appraisal. Their perspectives contribute to multidisciplinary cooperation in CLTI treatment and help to develop ideal foot management to facilitate a smooth transition from inpatient to home care. This review provides practical content on the treatment of patients with CLTI.

DOI： 10.7133/jca.20-00037

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Other Link： https://search.jamas.or.jp/link/ui/2021269516

Language：Japanese   Publisher：Japanese College of Angiology  

We present a 50-year-old male with chronic limb-threatening ischemia, type 2 diabetes, end-stage renal failure, and ischemic heart disease. He developed an ulcer with redness and partial darkening in the sacral region 1 day after distal bypass grafting for right lower extremity. There was clinical suspicion of Deep Tissue Injury (DTI), tissue oxygen saturation (StO₂) showed 12–14% around the ulcer, suggesting ischemic ulcer. Angiography showed a proximal segment of right Internal Iliac Artery with 75% stenosis and severe calcification. A stent was placed after balloon dilation, resulting in StO₂ of 54–80% the following day. The wound was completely healed on day 50 after revascularization.

DOI： 10.7133/jca.20-00038

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Other Link： https://search.jamas.or.jp/link/ui/2021214150

Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本病理学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：Japanese Society of Phlebology  

After previous earthquakes, high prevalence of cardiovascular diseases including venous thromboembolism (VTE) has been reported. We performed venous screening at the site of Hokkaido East Iburi Earthquake which happened at 6th September 2018. VTE screening using ultrasound sonography was performed for total 7 days at Atsuma town, Mukawa town and Abira town (total 9 shelters). Deep vein thrombosis (DVT) was found in 19 of 195 evacuees (9.7%), including 8 fresh thrombus cases (4.1%). On multivariable analysis of evacuees and shelter environment factors, systolic blood pressure, use of cardboard bed and toilet environment were significant predictor of DVT. Introduction and setting-up of cardboard beds were found as an important shelter environment factor.

DOI： 10.7134/phlebol.20-11

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Other Link： https://search.jamas.or.jp/link/ui/2021136170

Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(一社)日本フットケア・足病医学会  

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Language：Japanese   Publisher：(一社)日本フットケア・足病医学会  

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Language：Japanese   Publisher：(公社)日本超音波医学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：日本消化器病学会-近畿支部  

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Language：Japanese   Publisher：日本消化器病学会-近畿支部  

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Language：Japanese   Publisher：(一社)日本静脈学会  

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Language：Japanese   Publisher：Japanese College of Angiology  

Residual dissecting aneurysm of the thoracoabdominal aorta after replacement of the proximal descending aorta is difficult to treat and an open repair is considered to be very high risk. Here we report a patient underwent two staged endovascular treatment for such pathology. The early result seemed to be successful, however, further careful observation is mandatory.

DOI： 10.7133/jca.20-00027

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：全日本病院出版会  

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Other Link： https://search.jamas.or.jp/link/ui/2020308526

Language：Japanese  

type:text

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Language：Japanese  

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Language：Japanese  

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Language：Japanese  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：English   Publisher：(NPO)日本血管外科学会  

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Language：English   Publisher：(NPO)日本血管外科学会  

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Language：English   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Publisher：南江堂  

DOI： 10.15106/j_kyobu72_757

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Language：Japanese   Publisher：日本下肢救済・足病学会  

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Language：Japanese   Publisher：日本下肢救済・足病学会  

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Language：Japanese  

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Language：Japanese  

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Language：Japanese   Publisher：(一社)日本動脈硬化学会  

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Language：Japanese   Publisher：JAPANESE SOCIETY FOR VASCULAR SURGERY  

Pancreaticoduodenal artery is a branch of superior mesenteric artery (SMA). Although pancreaticoduodenal artery aneurysm (PDAA) is a rare disease, treatment is required because of the risk of rupture. A 46-year-old man has visited other hospital for type1 diabetes. He had a PDAA with a maximum minor-axis diameter of 20 mm pointed out by abdominal contract-enhanced computed tomography (CECT) and was admitted to our hospital. Preoperative CECT and angiography demonstrated severe stenosis of the celiac artery (CA) and the common hepatic artery (CHA) and the splenic artery were supplied through the PDA from SMA by collateral circulations. An open surgical repair was selected because of anatomical limitations of the aneurysm. The CA had difficulty of repair since the artery was atrophied, and the clamp test of PDA indicated beat attenuation of the CHA, resulting that we performed an abdominal aorta-CHA bypass followed by aneurysmectomy. PDAA is often caused by the development of collateral circulation route with CA stenosis. The treatment strategy of PDAA depends on several anatomical factors including relationship between aneurysm and SMA trunk, suitability of endovascular treatment in addition to involvement of CA stenosis.

DOI： 10.11401/jsvs.19-00017

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Language：Japanese   Publisher：日本下肢救済・足病学会  

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Language：Japanese   Publisher：日本下肢救済・足病学会  

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Language：Japanese   Publisher：日本下肢救済・足病学会  

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Language：Japanese   Publisher：日本下肢救済・足病学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

J-GLOBAL

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：日本消化器病学会-近畿支部  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：日本下肢救済・足病学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：特定非営利活動法人 日本心臓血管外科学会  

DOI： 10.4326/jjcvs.47.i

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Other Link： https://search.jamas.or.jp/link/ui/2018317147

Language：Japanese   Publisher：日本下肢救済・足病学会  

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Language：Japanese   Publisher：日本下肢救済・足病学会  

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Language：Japanese  

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Language：Japanese   Publisher：日本下肢救済・足病学会  

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Language：English   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：English   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：Japanese Society of Limb Salvage and Podiatric Medicine  

The diversity in the CLI population in terms of preoperative patient risk and foot condition is one of the significant factors that make treatment strategies very complex. Diversity is important for not only preoperative status but also for prognosis of limbs and survival. Therefore, the treatment goal for each individual should be set by predicting each individual’s outcome before selecting the revascularization procedure. The minimum goal of CLI treatment should be limb salvage, but higher goals, such as complete ulcer healing, recovering walking ability, or improving QOL, can be achieved by durable revascularization with high-quality multidisciplinary approaches. After revascularization, the preoperative treatment goal should be modified to reflect the residual infection, re-stenosis of the revascularized artery, and foot deformity after minor amputation. Based on the above, four important factors: foot condition（WIfI classification）, vascular condition, general condition, and functional status of limbs and brain, are key for the initial decision-making process to select bypass surgery, endovascular treatment, or primary amputation.

DOI： 10.7792/jlspm.10.56

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Other Link： https://search.jamas.or.jp/link/ui/2019334413

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Language：Japanese   Publisher：北海道外科学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Other Link： https://search.jamas.or.jp/link/ui/2018029550

Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

J-GLOBAL

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

J-GLOBAL

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Language：Japanese   Publisher：JAPANESE SOCIETY FOR VASCULAR SURGERY  

According to expansion of dialysis-dependent population, more than half of patients with critical ischemic limbs are dialysis-dependent in Japan. Although patients with end-staged renal disease are well-known as poor life prognosis, well-managed dialysis patients in Japan can survive much longer compared to dialysis patients in United States and Europe. Therefore, some dialysis patients can enjoy the long-term benefits of bypass surgery. To decide the indication of bypass surgery, patient’s general condition, nutrition status, and vein availability are more important rather than arterial disease anatomy. Ultrasound guided nerve block anesthesia blocking both sciatic and femoral nerve is contributing greatly to quick postoperative recovery of high risk patients. Preoperative ultrasound examination also contribute to not only vein mapping but also find out the graftable segment of artery. The selection of distal target should be decided based on the degree of arterial disease (luminal surface as well as wall calcification), and arterial run-off. Several tips regarding anastomosis to heavily calcified artery have been established including how to create bloodless operative field without arterial clamps. Adequate wound management after bypass surgery is also important. Detection of deep infection such as osteomyelitis and the adequate treatment may avoid major amputation of salvageable limbs. In the era of endovascular treatment, the evidences guiding how to select dialysis patients suitable for bypass surgery are awaiting.

DOI： 10.11401/jsvs.16-00086

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J02873&link_issn=&doc_id=20170608320007&doc_link_id=%2Ffj4kekka%2F2017%2F002601%2F007%2F0033-0039%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffj4kekka%2F2017%2F002601%2F007%2F0033-0039%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：日本下肢救済・足病学会  

J-GLOBAL

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

J-GLOBAL

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：日本下肢救済・足病学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Publisher：株式会社医学書院  

DOI： 10.11477/mf.1408102929

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Language：Japanese   Publisher：血管外科症例検討会  

症例は88歳、男性。81歳時にCTで最大短径30mmの孤立性右内腸骨動脈瘤を指摘された。高齢であることから降圧管理とし、定期的な経過観察を行っていた。徐々に拡大傾向を認め、7年後のCT検査で最大径42mmに達し、破裂の危険性があると判断し手術治療を行った。さらに高齢となったため血管内治療を選択し、動脈瘤末梢側をコイル塞栓し、中枢側をステントグラフトで閉鎖する方針とした。術前の3D-CT検査で、動脈瘤の中枢側がほぼ血栓閉塞となり、右第4腰動脈から右上臀動脈を介して動脈瘤の末梢側残存腔との交通があることが確認された。手術は全身麻酔下に実施した。まず左総大腿動脈より6FrBALKINシースを留置し、次いで5Fr 65cmトルコンNB血管造影カテーテル(KMPカテーテル)を右第4腰動脈から右腸腰動脈内に進め、更にマイクロカテーテルを右上臀動脈に通して起始部をコイルで閉鎖した後に、腸腰動脈側にも追加留置した。その後右鼠径部を切開、右総大腿動脈を露出して直径12mmのEXCLUDER LEGを右外腸骨動脈～総腸骨動脈間に留置し、内腸骨動脈瘤の中枢側を閉鎖した。術後経過は良好で全身状態に問題なく、術後6日目に退院した。術後CTでは瘤径の拡大を認めず、ステントグラフトの開存も保たれていた。腰動脈を介した内腸骨動脈瘤への到達は時に可能であり、塞栓療法のオプションとして知っておくべきと考える。(著者抄録)

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Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：日本下肢救済・足病学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：金原出版  

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Other Link： https://search.jamas.or.jp/link/ui/2012368935

Language：Japanese   Publisher：(一社)日本脈管学会  

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Language：Japanese   Publisher：日本下肢救済・足病学会  

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Language：Japanese   Publisher：北海道外科学会  

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Other Link： https://search.jamas.or.jp/link/ui/2012320583

Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

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Language：Japanese   Publisher：Japan Heart Foundation  

DOI： 10.11281/shinzo.44.479

DOI： 10.5833/jjgs.2018.0012_references_DOI_EuZXRqShpzsqAykJvyjDSFIww8b

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Other Link： https://search.jamas.or.jp/link/ui/2012237633

Language：Japanese   Publisher：JAPANESE SOCIETY FOR VASCULAR SURGERY  

We report the case of an 89-year-old man with a mycotic femoral artery aneurysm. He had a past history of hemiplegia and chronic renal failure secondary to pneumonia which had required hemodialysis. He presented with redness, swelling and an approximately 6-cm pulsatile mass of the right lower abdomen and groin. Computed tomography (CT) showed a ruptured right common femoral artery pseudoaneurysm. Methicillin-resistant staphylococcus aureus (MRSA) was detected by blood culture. An emergency obturator bypass, proximal anastomosis to the right external iliac artery, and a below-the-knee distal anastomosis to the right popliteal artery was performed, and the femoral artery was ligated proximally and distally. Postoperatively, the wound healed with a series of local therapy. However, at 7 months postoperatively, he demonstrated swelling in the mid-thigh, separate from the previous inguinal wound. We diagnosed a ruptured right superficial femoral artery (SFA) pseudoaneurysm by CT. Intraoperatively, a sparse zone of calcification of the SFA ruptured, and hematoma formed among his muscles. Emergency ligation of the proximal and distal femoral artery was therefore performed. Moreover, MRSA was also detected in the hematoma but the patient was discharged without severe complications. We present a case in which mycotic aneurysm ruptured metachronously, and we strongly suspected persistent MRSA infection in the throat and nasal vestibule which contributed to the aneurysms. Obturator bypass is considered one of the best options to treat critical femoral artery infection in a compromised patient.

DOI： 10.11401/jsvs.21.615

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Language：Japanese   Publisher：北海道外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会