Inferior mesenteric artery aneurysm (IMAA) is a rare disease among visceral aneurysms. We encountered an open repair of IMAA in association with arteriosclerosis obliterans (ASO). The case was 74-year-old man who had progressive intermittent claudication for 10 years. Preoperative enhanced CT demonstrated IMAA and ASO due to the occlusion of right common iliac artery, the coil embolization was initially considered as a therapeutic option. However, since CT also revealed the occlusion of superior mesenteric artery, the open repair of the aneurysmal resection and subsequent IMA reconstruction were performed in order to avoid mesenteric necrosis. During the procedure, we confirmed bilateral arterial flow of the lower extremities and the good color of the small intestine before closing the abdomen. The patient was started on food intake on postoperative day (POD) 3, and CT showed intact arterial flow of the inferior mesentery. Postoperative course was uneventful and the patient was discharged on POD 16.

We describe the case of an 80-year-old man who underwent surgical repair for abdominal aortic aneurysm with horseshoe kidney. We performed open surgery by a transperitoneal approach via a standard median laparotomy, and noted that the right accessory renal artery had 1 branch and the left accessory renal artery had 2. We safely dissected these arteries using a Harmonic scalpel. The aneurysm was successfully replaced using a Dacron straight graft, and all renal arteries were preserved. Renal infarction and renal dysfunction did not occur during the uneventful postoperative course.

Congenital factor XI deficiency is a rare intrinsic coagulation factor. We treated a 67-year-old man with abdominal aortic aneurysm, in whom activated partial thromboplastin time (APTT) found to be prolonged preoperatively. After fresh frozen plasma (FFP) was given before surgery, aneurysm was successfully replaced by a woven Dacron graft. No bleeding tendency was noted during the operation and FFP was also administered during and after surgery. The patient recovered without incident and left the hospital 13 days after the operation. Since several days are required to determine factor XI activity, APTT is useful as a parameter of coagulation factor activity in the perioperative period.

Cystic adventitial disease of the popliteal artery is a rare cause of lower extremity occlusive disease. We report 2 cases of this disease. Two male patients aged 27 and 59 year old complaining of intermittent claudication visited our vascular service. Angiography showed a smooth sharp defect of the popliteal artery. Postcontrast computed tomography (CT) scanning and magnetic resonance image (MRI) showed a cystic lesion around the popliteal artery. One patient underwent resection of the cyst, which in the other patient endscopic surgery was performed with the aid of intravascular ultrasonograpy and intravascular endscope. Fifty three cases of this disease have been reported in Japan so far. These patients included 45 men and 8 women with a mean age of 47.7, ranging from 19 to 76 years old. Chief complaints were commonly intermittent claudication and sensory disturbance. In all cases, angiography revealed a smooth sharp defect. Recently 3D-CT scan, ultrasonography and magnetic resonance angiography (MRA) also are accurate for cystic lesions around the popliteal artery and these new technologies easily distinguish such cases from arteriosclerosis obliterans, Buerger disease and popliteal entrapment syndrome. Treatment consist resection of the cyst, in 27 cases reconstruction of the popliteal artery using a saphenous vein graft or artificial graft in 19 cases, percutaneus aspiration under the guide of CT and endscopy in 2 cases and 1 with spontaneous resolution, was seen in 1 case. In conclusion, we encountered 2 cases of cystic adventitial disease of the popliteal artery. 3D-CT scan, ultrasonography and MRA were useful for preoperative diagnosis and evaluation of postoperative condition.

A case of pseudoaneurysm of the external iliac artery after a total hip arthroplasty is reported. A 48-year-old man had undergone a total left hip arthroplasty 5 years previously. Acute arterial occlusion (AAO) of the left lower extremity occurred 3 times. AAO was due to pseudoaneurysm of the external iliac artery, which was detected by rotating digital subtraction angiography (DAS). Aneurysmectomy and reconstruction were carried out. Rotating DSA was useful for the diagnosis of this unusual case of pseudoaneurysm of the external iliac artery after a total hip arthroplasty is unusual.

We encountered a recurrent suprarenal abdominal aortic aneurysm (AAA) patient with coronary artery disease and hyperlipidemia after repair of infrareanal AAA. A 72-year-old woman complaining of an abdominal throbbing mass was admitted. Computed tomography (CT) and aortography revealed infrarenal AAA which was totally removed and Dacron graft was replaced. The patient was followed as an outpatient. At the time of initial graft replacement there was no remarkable aneurysmal change in suprarenal abdominal aorta. Five years after the initial operation, a suprarenal AAA 5cm in diameter was detected by ultra sonographic examination. CT scan and aortography confirmed suprarenal AAA involving the celiac trunk of the supramesenteric artery and renal artery. Redo AAA operation with reconstruction of these branches was performed under V-A bypass support in a thoracoabdominal approach. Slight renal and liver dysfunction occurred postoperatively. However, serum creatine GOT and GPT values normalized by the ninth postoperative day. Postoperative aortography revealed patency of all branches.

Reperfusion injury occasionally occurred after revasculization of acute arterial occlusion (AAO). The most common reason of death is myonephropatic metabolic syndrome due to reperfusion injury. This paper focusses on the criterion of systemic inflammatory response syndrome (SIRS). From January 1987 to April 1996, we treated 89 patients (male 59/female 30) with lower limb AAO. The mean age was 68.5 (ranging from 16 to 94) years old. There were 59 cases of thrombosis, 25 of embolism, 2 trauma and 3 dissecting aneurysm of the aorta. These patients were divided into two groups according to whether or not they fulfilled the criterion of SIRS. Of these patients, 46 cases met the criterion of SIRS (SIRS group) but the other 43 did not (non-SIRS group). We compared the two groups. The mortality of the SIRS group (23.9%) was higher than the non-SIRS group (2.3%). The ischemic time of the SIRS group (83.1±113.3 hours) was longer than the non-SIRS group (37.5±38.2 hours). Complications of MNMS were more common in the SIRS group (15.3%) than in the non-SIRS group (2.3%). The ischemic area in the SIRS group was remarkably less than in the non-SIRS group. Conclusion: The criterion of SIRS as indicated by the measurement of interleukin 8 (IL-8) was a useful prognostic parameter for limb salvage rate and mortality of AAO patients.

In general the incidence of peripheral arterial aneurysm is said to be low. We focussed on popliteal aneurysm and enrolled 18 legs in 14 patients with popliteal aneurysm who visited us during the period from 1974 to January 1998 in our study. Acute arterial occlusion was observed as a complication in 6 of the 14 patients (42.9%) and rupture developed in 4 patients (28.6%), and on those occasions this disease was frequently detected and treated for the first time. Although this disease is said to scarcely affect prognosis, we encountered patients for whom amputation of the leg was unfortunately required. This disease was thus considered to require sufficient care. Popliteal arterial aneurysm is frequently palpable from the body surface and increased recognition of this disease should enable more appropriate treatment.

PURPOSE: To identify the parameters on noncontrast computed tomography (NCCT) that best predict the success of shock wave lithotripsy (SWL). MATERIALS AND METHODS: We reviewed the records of 75 patients who underwent SWL for urinary calculi measuring 5 to 20 mm. Using NCCT images, we estimated the largest stone cross-sectional area and contoured the inner edge of the stone. Clinical outcome was classified as successful (stone-free or <4 mm in diameter) or failed (stone fragments, > or =4 mm). The impact of preoperative parameters was evaluated by univariate and multivariate analysis. RESULTS: The overall success rate was 73.3%. Average stone attenuation value, stone length, and stone cross-sectional area in the success and failure groups were 627.4+/-166.5 HU (Hounsfield unit) vs. 788.1+/-233.9 HU (p=0.002), 11.7+/-3.8 mm vs. 14.2+/-3.6 mm (p=0.015), and 0.31+/-0.17 cm2 vs. 0.57+/-0.41 cm2 (p<0.001), respectively. In the multivariate analysis, stone attenuation value was the only independent predictor of SWL success (p=0.023), although stone cross-sectional area had a tendency to be associated with SWL success (p=0.053). Patients were then classified into four groups by using cutoff values of 780 HU for stone attenuation value and 0.4 cm2 for cross-sectional area. By use of these cutoff values, the group with a low stone attenuation value and a low cross-sectional area was more than 11.6 times as likely to have a successful result on SWL as were all other groups (odds ratio, 11.6; 95% confidence interval, 3.9 to 54.7; p<0.001). CONCLUSIONS: Stone attenuation value and stone cross-sectional area are good predictors of extracorporeal SWL outcome.
Humans ; Lithotripsy ; Multivariate Analysis ; Shock ; Treatment Outcome ; Urinary Calculi

Retrospective cohort study.