3.Perigraft Seroma after Endovascular Repair of the Abdominal Aortic Aneurysm
Naoki Toya ; Takao Ohki ; Makoto Sumi ; Hisano Toriumi ; Yuka Negishi
Japanese Journal of Cardiovascular Surgery 2003;32(5):285-287
A 75-year-old man underwent endovascular repair of the abdominal aortic aneurysm. The procedure was aorto-uni-femoral endograft and femorofemoral crossover bypass using PTFE graft. The postoperative course was satisfactory, but 4 years after operation, he was admitted complaining of abdominal fullness. CT scan showed significant increase of aneurysm diameter to 13cm without evidence of endoleak. Endograft replacement with a new Dacron graft was carried out. Intraoperative findings suggested perigraft seroma related to the use of PTFE, and there was no endoleak. The postoperative course was uneventful. Pathological finding of aneurysm showed a lack of hemocytes and thrombocytes.
4.A Case of Coral Reef Aorta Causing Blue Toe Syndrome
Koji Maeda ; Naoki Toya ; Kenjiro Kaneko ; Koji Kurosawa ; Yuka Negishi ; Yuji Kanaoka ; Takao Ohki
Japanese Journal of Cardiovascular Surgery 2007;36(4):202-205
A 53-year-old man presented with a painful, non-healing ischemic ulcer of the left fifth toe. The patient was initially treated conservatively for 4 months with local debridement and medication with antiplatelet therapy but his symptoms and the ulcer was refractory. A computed tomography revealed a bulky, irregular, gritty, localized calcification of the infra-renal aorta and was compatible with the so-called “coral reef aorta”. Angiography confirmed the findings of the CT scan, and there was no evidence of occlusive lesions in the distal runoff vessels. A diagnosis of blue toe syndrome secondary to infra-renal coral reef aorta was made. In order to prevent further embolization, the patient underwent aortic excision with PTFE grafting via a retroperitoneal incision. In order to increase the microcirculation of the toe and to aid in the healing of the ulcer, a lumbar sympathectomy was performed simultaneously. The ulcer healed completely on postoperative day 47. The treatment method for coral reef aorta depends on the presence or absence of global ischemia of the lower extremity and embolic complications.
5.A Case of Urgent Thoracic Endovascular Aortic Repair with the Double-Chimney Graft Technique for a Ruptured Thoracic Aortic Aneurysm
Kota Shukuzawa ; Naoki Toya ; Yasutake Momokawa ; Soichiro Fukushima ; Tadashi Akiba ; Takao Ohki
Japanese Journal of Cardiovascular Surgery 2015;44(4):228-231
A 73-year-old woman suffered from ruptured aortic arch aneurysm into mediastinum. The patient was treated by thoracic endovascular aortic repair with the double-chimney graft technique. Three days later, computed tomography (CT) revealed type 1a endoleak (EL) between the chimney grafts. Ten days later, the patient was treated by coil embolization of the aneurysm from the left subclavian artery. The patient recovered, and was without aortic aneurysm events during six months of follow up.
6.Renal Arteriovenous Malformation with Multiple Renal Artery Aneurysms Treated by Control of the Arterial Inflow Alone
Kenjiro Kaneko ; Makiko Omori ; Hirotsugu Ozawa ; Shigeki Hirayama ; Yuji Kanaoka ; Takao Ohki
Japanese Journal of Cardiovascular Surgery 2016;45(6):306-312
Endovascular treatment is a first-line treatment for renal arteriovenous malformations (AVMs). Endovascular treatment might be effective in patients with aneurysmal-type renal AVMs, which involve one feeding artery and one drainage vein, because control of the feeding artery, rather than the aneurysm itself, could have a therapeutic effect. Herein, we describe two cases of patients with renal AVM with multiple renal artery aneurysms, who were treated by controlling the arterial inflow alone. In Case 1, the patient was a 76-year-old woman with renal AVM discovered during examination for another medical condition. A computed tomography scan revealed four renal aneurysms (φ38/44/24/35 mm) ranging from an intimal defect in the right renal artery to the drainage vein running into the inferior vena cava (IVC). Although we had planned to use a covered stent in the right renal artery to cover the intimal defect without embolization of the aneurysms, a minor artery proximal to the aneurysm was found near the orifice of the right renal artery. Therefore, we used a covered stent in the right renal artery after embolization of the most proximal aneurysm was performed. In Case 2, a 78-year-old man was referred to our facility because a renal AVM was found during examination for lower back pain. The distal posterior branch of the right renal artery attached to the multiple aneurysms and directly drained into the IVC, which was diagnosed as an aneurysmal-type renal AVM. Because there were no arteries arising from the aneurysms in the right renal artery, which fed the renal parenchyma, embolization of only the inflow artery was performed. For both patients, renal blood flow was maintained without any decrease of the renal function. In these patients, although renin-angiotensin system activity was within the normal range, and blood pressure became better controlled postoperatively. In addition, there was significant improvement in the brain natriuretic peptide (BNP) levels postoperatively. Thus, we believe that unstable hypertension and/or high-output heart failure as well as the aneurysmal size should be assessed in the management of renal AVMs.
7.Two Cases of Thoracic Endovascular Aortic Repair Using the Carotid Artery as the Access Route
Riha SHIMIZU ; Makoto SUMI ; Yuri MURAKAMI ; Takao OHKI
Japanese Journal of Cardiovascular Surgery 2022;51(1):39-43
Thoracic Endovascular Aortic Repair (TEVAR) is widely used for high-risk patients with thoracic aortic pathology. However, access to the thoracic aorta can be difficult because TEVAR requires the introduction of a large a sheath especially in those with aortoiliac occlusive diseases and thoracic shaggy aorta. We herein report two cases of TEVAR in which the common carotid artery was used as the access route. Case 1 : An 86-year-old male patient whose past surgical history was significant for infected abdominal aortic aneurysm with abdominal aortic stump closed and axillo-bilateral femoral bypass. Computed tomography revealed a saccular aneurysm of the descending aorta, which required a carotid artery approach as the access route. Case 2 : A 79-year-old female patient who developed type A thoracic aortic dissection. She was considered to be of prohibitive risk for surgical repair and was treated conservatively. However, an intramural hematoma with an ulcer-like projection lesion in the ascending aorta expanded and definitive treatment was indicated. Because the descending aorta was significantly shaggy, we decided to perform TEVAR via the right common carotid artery as the access route. Both patients' pathology was successfully treated and were discharged without any complications. TEVAR via common carotid artery access is a useful and safe procedure for patients in whom femoral and abdominal aortic aorta access is not feasible or safe.
8.Xanthogranulomatous Inflammation of the Aortic Aneurysm Wall after Endovascular Aortic Repair for Abdominal Aortic Aneurysm
Shuichi OKONOGI ; Satoshi OHKI ; Kiyomitsu YASUHARA ; Ayako NAGASAWA ; Takao MIKI ; Ryo YAMAGUCHI ; Yusuke KATO ; Tamiyuki OBAYASHI
Japanese Journal of Cardiovascular Surgery 2023;52(2):114-117
A 77-year-old woman underwent endovascular abdominal aortic repair (EVAR) for an abdominal aortic aneurysm (AAA).Five years after surgery, she visited the hospital with the chief complaint of a fever. Enhanced computed tomography (CT) showed enlargement of the AAA around the stent-graft and a mass, which was suspected to be an abscess, outside the aneurysm. A blood test revealed a high level of inflammatory response. The patient was diagnosed with infectious AAA. She received antibiotics; however, the inflammatory response did not completely improve. A second CT scan revealed that the suspected abscess had a spreading tendency. The patient was referred to our hospital for a highly suspected stent-graft infection. We performed Y-graft replacement using a rifampicin-immersed graft, and as much as possible of the wall around the aortic aneurysm was removed. The inflammatory response improved rapidly after the operation, and the patient was discharged 15 days later. According to the results of a pathological examination, a diagnosis of xanthogranulomatous inflammation and fibrosis was made. Here, we report a rare case of xanthogranulomatous inflammation of the aortic aneurysm wall after EVAR.
9.A comparison of distal endoluminal graft fixation methods: Healing characteristics of metallic stents and the endoluminal suture technique.
Ricardo Jose T. Quintos II ; Takao Ohki ; Frank J. Veith
Philippine Journal of Surgical Specialties 2019;74(1):1-8
RATIONALE:
Endoluminal grafts (EG) are a promising alternative to
conventional open surgical approaches in the treatment of aneurysmal
and occlusive arterial diseases. These devices generally employ
metallic stents to secure the proximal and distal EG extents. However,
the problem of intimal hyperplasia at the distal EG anastomotic ends
similarly affect long-term outcomes as in conventional interposition
grafting methods. A technique of distal EG anastomosis using handsewn endoluminal sutures is described and its effects on subsequent
development of intimal hyperplasia compared with that of metallic
endoluminal stents
METHODS:
Ten adult mongrel dogs underwent bilateral common iliac
artery endoluminal grafting procedures. On one side, the distal EG
anastomosis was anchored with metallic stents while on the
contralateral side the distal EG was secured with endoluminal
sutures. The grafts were harvested after one month and the intimal
characteristics were observed using histopathological methods.
RESULTS:
Distal EG metallic stents and endoluminal sutures resulted
in similar patency rates of 90%. The average time to deploy distal
EG metallic stents was 56 seconds, while the average time to secure
the distal EG anastomosis using endoluminal sutures was 3 minutes
42 seconds. Metallic stents induced the development of intimal
hyperplasia to a degree greater than endoluminal sutures (316 ±
12 μm vs. 245 ± 30 μm, p<0.05), but did not affect patency.
CONCLUSION
Hand sewn endoluminal suture technique results in a
lesser degree of intimal hyperplasia compared with that produced by
endoluminal metallic stents, while the patency rates are comparable.
Stents