A 60 year old man presented with a history of right leg claudication which occurred after walking a distance of 200 m. He had no history of cardiovascular risk factors or trauma in the lower extremities. Palpation disclosed no right popliteal or pedal pulse. Ankle-brachial pressure index (ABI) was 0.60 on the affected side. Computed tomography (CT) demonstrated the presence of a highly stenotic lesion in the right popliteal artery due to compression from periarterial polycystic masses. Magnetic resonance imaging (MRI) revealed no communication to the knee joint bursa. Further, angiography showed a beak-like severe stenosis on the knee of the right popliteal artery. Based on the results of these three imaging techniques we confirmed the diagnosis of cystic adventitial disease (CAD). The patient underwent a surgical exploration of his popliteal artery through a posterior approach. Evacuation of all cysts by longitudinal incision of his adventitia yielded yellow mucoid gelatinous material. The popliteal artery was replaced using the great saphenous vein because the previous imaging showed thrombus formation at the cyst site. He had an uneventful postoperative recovery with ABI of 1.10.

Recently, with the advent of medical devices and minimally invasive operations, endoscopic saphenous vein harvesting (EVH) in coronary artery bypass grafting has been widely accepted. Although EVH has short-term advantages of less wound morbidity and better cosmetic results compared with open vein harvesting (OVH), several studies have demonstrated that the mid- and long-term patency rate of EVH veins is significantly lower than that of OVH veins, therefore the role of EVH is currently controversial. The purpose of this study was to investigate the early results of EVH compared with the OVH group. Between April 2011 and December 2012, 115 consecutive patients underwent coronary artery bypass grafting (CABG) in our institution. Of these, EVH was performed in 62 patients and OVH in 53. In EVH groups, all 50 patients were men, and mean age was 71.3±7.8 years. A total of 211 coronary anastomoses, 109 SVGs anastomoses were assessed for patency postoperatively by angiography or enhanced computed tomography before discharge. The mean vein harvesting time was 26.0±8.1 min, and the mean number of ostial branch tear was 0.34±0.59. The overall SVG patency rates at discharge were 95.4% in EVH and 92% in OVH, respectively (p=0.24). There was a significant reduction in the incidence of leg wound complications in the EVH group (EVH : 1.6% ; OVH : 13.2% ; p=0.038). In conclusion, the short-term result of EVH was satisfactory. EVH reduces leg wound complications compared with OVH.

A study was designed to examine the effects of exercise intensity on renal clearance parameters. Five healthy male subjects underwent exercise tests on an bicycle ergometer at 4 different work loads for 15 min. The indicators of exercise intensity employed were the percentage of maximal oxygen uptake (%VO₂max), heart rate (HR) and blood lactate level (La) . As parameters of renal clearance, para-aminohippurate clearance (CPAH), thiosulfate clearance (C_thio) and creatinine clearance (C_cr) were measured by the continuous infusion technique during the exercise.
1) The renal clearance parameters during exercise decreased linearly as the exercise intensity increased. The percentage of maximal oxygen uptake at the onset of the decreases in %C_PAH, %C_chiu and %C_cr were 36, 45 and 47%VO₂max, respectively.
2) Among the indicators of exercise intensity, the decrease in La showed the closest correlation with renal clearance during the exercise.
3) The renal plasma flow, which was measured as C_PAH, began to decrease linearly at a significantly lower exercise intensity than the glomerular filtration rate, which was measured as both C_thio and C_cr.
The above results suggest that renal clearance parameters begin to decrease at the threshold as exercise intensity increases.

Aerobic exercise is known to reduce pulse wave velocity (PWV), which reflects arterial stiffness. However, aerobic exercise has a depressor effect, and PWV strongly depends on blood pressure (BP). Therefore, improvement of PWV with aerobic exercise may have an indirect effect on reducing BP. In this study, the relationship between changes in BP and regional PWV measured by oscillometric and tonometry sensors before and after exercise therapy emphasizing aerobic exercise was evaluated in 46 elderly people receiving outpatient treatment for lifestyle-related diseases (7 males and 39 females, mean age : 68 years). In all subjects, BP and PWV measurements were performed before and after exercise therapy. PWV was measured between the brachium and ankle (baPWV), between the heart and femoral artery (hfPWV), and between the femoral artery and ankle (faPWV). During 6 months of exercise therapy, BP, baPWV, hfPWV and faPWV decreased significantly. By multiple regression analysis, the changes in systolic BP were extracted as factors correlated with changes in baPWV and faPWV. The changes in baPWV (r=0.639, p<0.01) and faPWV (r=0.649, p<0.01) correlated significantly with changes in systolic BP. However, changes in hfPWV were not extracted as a factor correlated with changes in systolic BP (r=0.228, p=n. s). In conclusion, exercise therapy emphasizing aerobic exercise was suggested to reduce the stiffness of both the lower limb artery (peripheral artery) and the aorta (central artery). Peripheral arterial stiffness improved concurrently with a reduction in BP as a result of exercise therapy ; but there is a possibility that the improvement of central arterial stiffness is not dependent on reducing BP.

We report a case of successful anatomical reconstruction with omentopexy of an infected abdominal aortic aneurysm (AAA) in a patient with a previous history of coronary artery bypass grafting with the right gastroepiploic artery. A 60-year-old man was referred to our institute because of fever and abdominal pain during hemodialysis for chronic renal failure. Antibiotic therapy was started after computed tomography revealed an infected abdominal aortic aneurysm. After infection control, surgical treatment was scheduled. At surgery, left axillo-bifemoral bypass was performed first, because it was unclear whether the omentum was large enough for omentopexy. At laparotomy, adequate omentum and infective AAA were confirmed. AAA repair using a rifampicin-soaked graft, and omentopexy were performed. Enterobacter aerogenes was detected from the resected aortic wall. After the operation, intravenous antibiotic was used for 25 days until CRP was normalized. One year follow-up showed no sign of re-infection.

Mitral valve surgeries for cases with mitral annular calcification (MAC) are challenging because of the operative complications. For a case of MS with MAC, we achieved mitral valve plasty by ultrasonic decalcification alone. An 82-year-old male with edema and dyspnea was diagnosed with AS and MS with MAC. MAC was so severe that MVR was challenging. There were calcifications at the anterior commissure and the anterior mitral leaflet (AML), and removal of them was expected to improve the valve function. Therefore, anterior commissurotomy and ultrasonic decalcification of the anterior commissural annulus was performed using cavitron ultrasonic surgical aspiration (CUSA). Following the resection of the aortic valve, we carried out decalcification of the AML through the aortic valve orifice. After AVR, a trans-esophageal echocardiogram showed MS was ameliorated. Two years after surgery, recurrence of MS was not recognized. Some mitral cases with MAC can be treated by only decalcification to avoid risky valve replacement.