It is presumed that visceral ischemia is caused as a result of fighting between the lower limb and intraperitoneal organs to steal blood in aortoiliac occlusive disease (AIOD). Accordingly, an investigation has been made of this “aortoiliac steal” phenomenon. Out of 65 AIOD patients, the case in whom the main collateral circulation to the lower limb was found to originate in the intraperitoneal visceral arteries by angiography were only 2 (3%), both of which showed, however, no visceral ischemic symptom. Intraoperative changes in pelvic visceral hemodynamics were observed in 19 cases undergone either aorto-bifemoral or axillo-bifemoral bypass operation (AFB) using Doppler's ultrasonic trans-anal method. As a result, visceral circulation was maintained favorably even after AFB, further suggesting the possibility that not only the circulation of the inferior limb but the visceral circulation is improved directly by AFB. Visceral ischemia is considered to occur in the patient in whom concomitant stenotic lesion is present in the celiac artery or superior mesenteric artery, for which full attention should be paid to visceral circulation also in the patients with ischemia in the lower limb.

One of the complications after Dacron vascular reconstruction for both occlusive disease and aneurysmal disease is anastomotic false aneurysm. We reviewed 22 aneurysms of 13 patients who underwent aorto-femoral reconstruction in our department during the past 14 years. The indication for initial prosthetic reconstruction had been an atherosclerosis obliterans (ASO) in 12 patients and infrarenal aortic occlusion with liver abscess in 1 patient. The mean interval from initial surgery was 40.6 months (range, 2 to 142 months). Seven anastomotic pseudoaneurysms occurred within 6 months after operation and the remaining fifteen occurred in the late follow-up period (22 to 142 months). Unilateral aneurysm was found in 7, bilateral in 5 and 5 in one patient. Distal femoral anastomotic symptoms at presentation included critical limb ischemia in one, inguinal pain in three, abscess in two, mass in seven and asymptomatic in seven. Proximal aortic anastomotic symptoms included abdominal pain in one case and another case was asymptomatic. The asymptomatic aneurysm was diagnosed by routine sonographic surveillance. Surgical management in all patients included aneurysmectomy with aneurysmoplasty in 2 and prosthetic graft interposition or bypass in 11 as an elective operation, graft extirpation with extraanatomic bypass in one and graft replacement in one as an urgent operation, and thrombectomy and/or graft replacement in 6 as an emergency operation. All of the aneurysms are pseudoaneurysms were confirmed by pathological examination. Host arterial-wall degeneration was the main cause of aneurysm formation in most cases (85.7%). In our opinion, patients should be periodically studied after aortic grafting with abdominal ultrasonography for early detection of this potentially serious complication. Early diagnosis and elective repair of these aneurysms should be recommended whenever possible because of their propensity to develop serious complications.

The use of mouth guards in contact sports effectively prevents oral injuries and preserves oral structures. Many contact sports in which a high impact collision could easily cause oral injury do not require athletes to use mouth guards. We discuss the circumstance of oral injury and awareness concerning the use of mouth guards in Japanese high school soccer and rugby and basketball teams.
During an interview, each athlete was asked a series of questions concerning their history of oral injury while participating in sports and actual circumstances of using a mouth guard.
The incidence of oral injuries was 32.3% in soccer, and 56.5% in rugby, 46.6% in basketball while 0.8% of athletes possessed some type of mouth guard in soccer, 24.1% in rugby and 1.3% in basketball. Although 81.8% of soccer athletes and 81.2% of basketball athletes thought mouth guards were unnecessary, only 26.2% of rugby athletes shared this opinion. Many athletes playing soccer and basketball had insufficient knowledge about mouth guards, and were not interested in preventing oral injury. Due to the diversity of sports that can produce oral injury, it is recommended that mouth guards be worn by all individuals participating in rugby, soccer and basketball.