The long-term efficacy of various treatments for intermittent claudication was studied to determine which regimen should be selected. Two hundred and nineteen patients with arteriosclerosis obliterans (ASO) and intermittent claudication of the extremities were divided into two groups based upon the type of treatment: 1) 170 patients who underwent arterial reconstruction and 2) 49 receiving conservative treatment. Fifty-five patients with Buerger's disease (TAO) with intermittent claudication were divided into three groups: 1) 17 patients who underwent arterial reconstruction, 2) 15 with lumbar sympathectomy, and 3) 23 receiving conservative treatment. The background factors of both disease groups were analyzed, and the changes in claudication, the quality of life, and the survival rate were followed up. Among ASO patients, the improvement of intermittent claudication was significantly better in the arterial reconstruction group (p<0.001) than in the conservative treatment group. The quality of life and 5-year surival rate were also superior in the arterial reconstruction group (p<0.01), and they were closely related to the improvement of intermittent claudication. On the other hand, there was no significant difference in any of these parameters between the three groups of TAO patients. This discrepancy in outcome was concluded to be due to differences in the background factors of the two diseases. Accordingly, the treatment for intermittent claudication should be discussed making a clear distinction between ASO and TAO. In conclusion, the treatment of choice for intermittent claudication is arterial reconstruction in ASO patients, whereas surgical treatment should only be considered for TAO patients when conservative therapy is ineffective.

A 77-year-old man with an abdominal aortic aneurysm, detected by abdominal ultrasonography, was referred to our hospital. Multi-detector computed tomography (MDCT) revealed an intrathoracic left subclavian artery aneurysm 30 mm in diameter and a small distal arch aortic aneurysm as well as an abdominal aortic aneurysm 40 mm in diameter. Surgery was indicated for the subclavian artery aneurysm considering the risks of rupture and distal embolism. Our choice for treatment was endovascular repair ; thoracic endovascular aortic repair (TEVAR) and coil embolism. The operation was performed successfully. Orifices of the left subclavian artery and the distal arch aneurysm were covered with a stent graft and the left subclavian artery was occluded with coils distal to the aneurysm. The operation time was 1 h and 44 min. He was extubated in the operation theater. A follow-up CT scan performed at 1 week showed the correct position of the TEVAR device, patency of the common trunk of the brachiocephalic and right common carotid arteries, and complete exclusion of the aneurysms. He was discharged on the 12th postoperative day without complication. Subclavian artery aneurysms, in particular in the intrathoracic location, are rare. Conventional surgery for this entity tends to require arch replacement to be unreasonably invasive as a therapy for peripheral artery disease. We believe this endovascular therapy can be a useful, less-invasive alternative to conventional open surgery.

Objective : To determine the effectiveness of acupuncture therapy on hiesho in maturate stage females.
Design : Multicenter, randomized, prospective, open blind, waiting list-controlled trial.
Setting : A clinical center attached to three universities and one vocational school.
Participants : Twenty two females between 18-39 years of age and with a level of more than four points on the “hiesho sensation scale” proposed by Kusumi et al for hiesho. Interventions : Participants were randomly assigned to receive therapies of either acupuncture or no therapy (waiting list controls). Acupuncture therapy was provided by needle retention to SP 6 and electro-acupuncture therapy to BL 32 at a frequency of 1 Hz for 20 minutes. One session per week of this therapy was provided for a total of four sessions. Method of Measurement : The primary outcome of change in hiesho intensity was measured using the visual analogue scale (VAS). Secondary changes were measured by an eight heading score and three component summaries of the standard edition SF-36 v 2.
Results : The statistical analyses used an intent-to-treat analysis that included two participants who dropped out, and the mixture of one participant targeted for exclusion who was censored from the analyses. As a result, 21 participants were classified as either in the acupuncture group (n = 12) or the control group (n = 9). Efficacy with acupuncture therapy was not found for effect size (Cohen d, point-biserial correlation r) for VAS and the scores of SF-36 between the two groups.
Conclusions : Effectiveness of the acupuncture therapy was not found, which suggests that it may be due to the smaller sample size, frequency of intervention, and symptoms associated with autonomic dysfunction.

[Objectives]We investigated the behaviour factors in Hiesho (excessive sensitivity to cold symptoms), a summary score of Health-related QOL (SF-8) and Body Mass Index (BMI) in subjects who feel Hiesho (hereinafter referred to as Hiesho Subjects), in relation to sex, and showed the future direction of acupuncture therapy on Hiesho.
[Methods]After approval by the Ethics Committee, we obtained written informed consent from the participants in this study. Participants were 753students in a vocational college. The study was performed with questionnaires, which were delivered by hand to the participants in September, 2008. We analyzed 629 subjects (538 males and 91 females, mean age of 27.4 ± 6.8) whose responses were valid. The questionnaire consisted of age, sex, height, weight, subjective Hiesho, 24 behaviour patterns of Hiesho according to a previous study, and Health-related QOL (SF-8, Japanese version). We used two summaries -physical component summary (PCS) and mental component summary (MCS) -which are derived from standard values (scores) in the nation on eight scales of SF-8 calculated using the special scoring software. Total scores of behaviour patterns of Hiesho subjects (HIE Scores) and summary scores and BMI in male and female subjects were statistically analyzed using covariance structure analysis technique in multiple populations (Amos Ver. 7).
[Results]In our model, the Comparative Fit Index (CFI), Akaike's Information Criterion (AIC) and Root Mean Squares Error of Approximation were 1.00, 75.886 and 0.00, respectively, which showed a high degree of compatibility. We found the relations from Hiesho Scores to PCS (β=-0.175, p < 0.01) and MCS (β=-0.179, p < 0.001) and from PCS to MCS (β=-0.089, p=0.038) in male Hiesho subjects. In contrast, in female Hiesho subjects, there were relations from Hiesho scores to MCS (β=-0.601, p < 0.001) and from PCS to MCS (β=-0.244, p < 0.05).
[Discussion]From the results of our investigation, Hiesho was considered not to be associated with Health-related QOL in male Hiesho subjects but to be associated with mental factors in female Hiesho subjects.
[Conclusions]It was shown that we should consider the patient's sex in acupuncture therapy on Hiesho.