This study aimed to evaluate the short- and long-term outcomes of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs), with a particular focus on the impact of immunosuppressive therapy. The authors retrospectively reviewed the institutional data of patients with AAAs who underwent EVAR between 2008 and 2023. A total of 307 consecutive patients underwent elective EVAR for AAA. Of these, 26 patients (8.5%) were receiving immunosuppressive therapy (IT group). Patients in the IT group had a significantly higher incidence of early postoperative complications than those in the non-IT group (42.3% vs. 17.4%). The mean follow-up period was 40.7 ± 33.6 months. The cumulative incidence of sac shrinkage was similar between the groups, whereas the cumulative incidence of sac expansion was significantly higher in the IT group. The rates of reintervention and open aneurysmorrhaphy were also significantly higher in the IT group. The use of immunosuppressive therapy was one of the significant risk factors for late sac expansion (hazard ratio, 4.66, 95% confidence interval, 2.12-10.23). Overall survival was similar regardless of immunosuppressive therapy status. Immunosuppressive therapy may be associated with an increased risk of early postoperative complications and late sac expansion in patients undergoing EVAR.
The objective of this study was to compare the adhesive strength and flexibility of 3 surgical sealants-synthetic (Hydrofit; Sanyo Chemical Industries, Kyoto, Japan), albumin-based (BioGlue; Artivion, Kennesaw, GA, USA), and fibrin-based (Beriplast; CSL Behring, Tokyo, Japan)-which are commonly used in cardiovascular surgery but unexplored under identical experimental conditions. Adhesive strength was evaluated using a tensile adhesion test on collagen, polyester, and polytetrafluoroethylene substrates. Flexibility was assessed by measuring the maximum stress and elongation at failure in Hydrofit and BioGlue film samples. Beriplast was excluded as it failed to form films. Hydrofit and BioGlue showed similar collagen-collagen adhesion strengths (p = 0.11), while Beriplast was significantly weaker (p <0.01). Hydrofit outperformed both BioGlue and Beriplast (p <0.01) in collagen-polyester and collagen-expanded polytetrafluoroethylene (ePTFE) adhesions. Hydrofit also demonstrated a significantly higher elongation rate, strength, and maximum stress before rupture than BioGlue. These surgical sealants possess distinct adhesive and mechanical characteristics. Hydrofit showed stable adhesion across various substrates, with notable flexibility. BioGlue displayed adequate adhesion on collagen surfaces but had restricted flexibility. Beriplast demonstrated reduced adhesion. Although only adhesive strength and flexibility were evaluated, such properties may offer valuable insights into sealant traits contextually. These potentially aid in the selection of appropriate sealants for cardiovascular procedures that require both durable adhesion and tissue compliance. Further in vivo validation is warranted.
We assessed the outcomes of simultaneous coronary and vascular revascularization in 6 patients with multivessel coronary artery disease and vascular pathologies, including abdominal aortic aneurysm, carotid artery stenosis, and critical limb ischemia. The patients (mean age: 73.6 years) underwent off-pump coronary artery bypass grafting combined with carotid endarterectomy, femoropopliteal bypass, open abdominal aortic grafting, or endovascular therapy. The average surgical duration was 396 min (blood loss: 47-2000 mL), with no major perioperative complications. Simultaneous coronary and vascular surgeries may reduce perioperative complications and eliminate the bleeding hazards associated with dual antiplatelet therapy, while helping to reduce healthcare costs by avoiding staged procedures.
The purpose of this study was to evaluate the results of endovascular therapy (EVT) with common femoral artery (CFA) endarterectomy site access for lower extremity artery disease (LEAD). Records were reviewed retrospectively for patients who underwent EVT with CFA endarterectomy site access from 2014 to 2023 at 7 hospitals. A total of 74 EVT procedures with CFA endarterectomy site access were performed in 65 patients with LEAD. The median [interquartile range] interval between CFA endarterectomy and the first EVT access was 435 [237-1153] days. Technical success of EVT was achieved in 72 procedures (97%). Technical success of the puncture was achieved in all 74 procedures (100%). The median [interquartile range] puncture time and hemostasis time were 4 [2-6] and 13 [10-20] min, respectively. Two cases (3%) had access site hematoma, which was cured with conservative treatment. The CFA after endarterectomy may be a safe and suitable access site for EVT.
The superficialized brachial artery (SBA) is an important alternative vascular access for hemodialysis patients when autogenous vein fistula creation is not feasible. However, repeated puncture of the SBA can lead to severe complications such as aneurysm formation, pseudoaneurysm, and infection. This study aimed to review surgical strategies for revascularization and infection control in SBA aneurysms. We retrospectively analyzed 8 cases of SBA aneurysms treated at our institution between November 2020 and June 2025. Patient demographics, comorbidities, surgical procedures, and outcomes were evaluated based on medical records and follow-up data. Patients ranged in age from 43 to 81 years and had been on dialysis for an average of 19 years. Six aneurysms were ruptured, and 5 were associated with infection. Brachial artery bypass was the most common procedure, performed in 6 patients using autologous veins or prosthetic grafts. One patient underwent fistula closure with a bovine pericardial patch, and another received direct arterial anastomosis. In infected cases, autologous vein bypass or aneurysm resection with direct anastomosis was performed after thorough debridement. All patients maintained adequate dialysis access postoperatively. Revascularization of the SBA using autologous vein bypass is effective for managing aneurysms, especially in infected cases. Careful infection control and individualized surgical planning are essential for maintaining safe dialysis access and preserving limb function.
An 80-year-old female presented with a thoracoabdominal aortic aneurysm (TAAA) that had progressively enlarged to a diameter of 58 mm. She was scheduled for TAAA repair; however, she had a severe obstructive ventilatory disorder, which posed significant risks. Both open repair and general anesthesia were deemed to carry a high risk of respiratory complications. Consequently, an endovascular TAAA repair was performed using a physician-modified inner-branched endograft under locoregional anesthesia. This approach successfully treated the TAAA without any major complications. This strategy opens up the possibility of treating TAAA in patients with severe comorbidities that were previously challenging to treat.
Serious complications due to remote control often may occur during endovascular surgery. Therefore, it is necessary to know what complications are likely to occur or how to bail out those complications. Herein, we explain complications related to endovascular surgery and their bail-out procedures. (This is a translation of Jpn J Vasc Surg 2024; 33: 131-136.).
Tracheo-innominate artery fistula (TIF) is rare but potentially fatal, especially in pediatric patients. We present a case treated by emergency endovascular stenting followed by elective open surgery. Stent grafting achieved immediate hemostasis and served as a lifesaving bridge, but its limitations-including risks of infection, rebleeding, and graft mismatch due to somatic growth-made definitive surgery necessary. Laryngoscopic findings revealed intratracheal graft exposure, prompting timely graft removal and tracheal repair. This staged strategy highlights both the value of stenting as bridging therapy and the importance of early multidisciplinary planning in pediatric TIF.
There are no guidelines to suggest repair versus ligation for traumatic deep venous injuries. We aimed to compare the outcomes after reconstruction versus ligation of isolated traumatic venous injuries. This systematic review and meta-analysis (PROSPERO Registration Number: CRD42019143136) included all literature reported on the management of isolated venous injuries in adult trauma patients, excluding case reports from 1950 to 2020. Primary outcomes were mortality and amputation, while compartment syndrome, chronic venous hypertension, deep venous thrombosis, and pulmonary embolism were the secondary outcomes. PubMed, Google Scholar, Cochrane database, and Web of Science were searched. Study selection and synthesis were done following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 25 studies were included. All the studies were observational, with the majority being retrospective in nature. Results of our meta-analysis show that ligation is significantly associated with higher rates of amputation (odds ratio [OR] = 1.73, 95% confidence interval [CI] = 1.20-2.48, p = 0.003) and mortality (OR = 1.50, 95% CI = 1.09-2.06, p = 0.01), whereas there is no significant difference in the rates of chronic venous insufficiency, deep venous thrombosis, and pulmonary embolism. There is insufficient data to analyze various types of venous repair, as well as to account for clinical severity at the time of presentation. Our results favor repair over ligation.
Percutaneous transluminal renal angioplasty (PTRA) is a treatment for renovascular hypertension due to renal artery stenosis. However, postoperative complications in stent re-stenosis/occlusion may occur frequently. A 60-year-old male patient presented to our hospital with uncontrolled hypertension and a deterioration of renal function. He had undergone an initial renal stenting 10 years earlier, followed by repeat PTRAs during follow-up for in-stent restenosis. The left renal stent was found to be completely occluded, while the right renal stent was found to be 75% stenosed. We performed an aorto-renal artery bypass. The bypass was patent without stenosis and the renovascular hypertension was recovered.
Endovascular treatment (EVT) is now performed worldwide for patients with lower extremity artery disease due to its safety and advances in devices. However, a common femoral artery (CFA) lesion often has severe calcification, and balloon angioplasty alone for such a lesion is ineffective in terms of patency. EVT with stent implantation for a CFA lesion may result in stent fracture and difficulty with puncture for subsequent interventions during the follow-up period. Given these issues, endarterectomy for a CFA lesion remains as the gold standard treatment in the endovascular era. However, the method of endarterectomy (i.e., arterial incision, patch use or not, patch material, intimal layer fixation or not) differs among centers. Thus, further investigation is needed for each method to promote the performance of high-quality CFA endarterectomy by vascular surgeons in the current endovascular era. (This is a translation of Jpn J Vasc Surg 2024; 33: 91-95.).
The anatomy of the short common iliac artery (CIA) limits distal sealing during endovascular aneurysm repair (EVAR) and often necessitates internal iliac artery (IIA) embolization. We report the case of a 73-year-old man with an infrarenal abdominal aortic aneurysm and an extremely short right CIA that precluded open repair and application of iliac branch devices. As a salvage approach, EVAR was combined with the placement of a covered stent from the right external iliac artery to the IIA and a femorofemoral bypass. Follow-up imaging at 21 months demonstrated preserved pelvic circulation, absence of aneurysm sac enlargement, and sustained graft patency without limb ischemia.
Thoracic endovascular aortic repair has revolutionized the treatment of thoracic aortic diseases. It is now indicated not only for descending aortic aneurysms but also for acute and chronic type B dissections and blunt thoracic aortic injuries. In addition, the scope of treatment is expanding. The thoracic aortic stent graft has been on the market in Japan for 15 years with good results, and the number of operations continues to increase. However, although stent grafts are highly recommended in Japanese and international guidelines for many aortic diseases, re-intervention increases over time in all disease groups. Careful follow-up is important because of morphologic changes and new complications after treatment. (This is a translation of Jpn J Vasc Surg 2024; 33: 73-77.).
We aimed to elucidate the long-term outcomes of acute symptomatic spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) to inform optimal decision-making during the acute phase. We retrospectively collected and analyzed data from 14 consecutive patients diagnosed with SIDSMA by using computed tomography angiography (CTA) between January 2010 and August 2024. The cohort comprised 13 males and 1 female, with a mean age of 59.36 ± 14.90 years. All patients presented with acute abdominal pain, and some experienced vomiting. Thirteen patients received conservative treatment, while only 1 patient underwent open surgery with extra-anatomical bypass; this patient required no further intervention 10 years postoperatively. One of the patients, whose abdominal pain worsened with food intake, showed SMA stenosis and decreased intestinal blood flow. His symptoms improved after heparin anticoagulation therapy followed by direct oral anticoagulant therapy. Over a follow-up period of 7.20 ± 3.21 years, none of the patients experienced recurrent SIDSMA-related abdominal pain, and all survived without the need for additional invasive treatment. Conservative treatment effectively manages SIDSMA over the long term without reintervention. Early diagnosis and management of intestinal ischemia are essential for optimal treatment outcomes.
Diagnosis and treatment of cardiovascular diseases often require the administration of iodinated contrast media. However, it is sometimes difficult to use such contrast media in patients with renal dysfunction because direct mechanisms of tubular cell injury and indirect mechanisms of medullary ischemia, together with the contrast medium, may cause contrast-induced nephropathy (CIN). Although the frequency of developing CIN is said to be lower than previously estimated, once it develops, there is no effective treatment, and it may affect mortality. Therefore, before using a contrast medium, it is necessary to identify the risk factors of CIN in patients-including chronic kidney disease, advanced age, and diabetes mellitus-and understand the risk differences between intravenous and intra-arterial contrast medium administration. If there is any risk, intravenous saline or sodium bicarbonate treatments may be used to prevent CIN onset, and the use of minimum amounts of contrast media, within the corresponding range, may be recommended. (This is a translation of Jpn J Vasc Surg 2024; 33: 143-147.).
Femoropopliteal (FP) arterial lesions represent the most prevalent and challenging targets for endovascular therapy (EVT) in patients with lower extremity artery disease (LEAD). Despite significant advances in device technology, FP interventions continue to be limited by high rates of restenosis and occlusion. To date, no conclusive evidence has demonstrated the superiority of any specific endovascular device strategy for FP artery disease. Importantly, stent restenosis is characterized by longer lesion lengths and a higher incidence of occlusive failure, which may substantially compromise the feasibility of subsequent reintervention.
We conducted a detailed comparison of inpatient medical costs between endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) for abdominal aortic aneurysms. We evaluated 312 EVAR and 205 OAR cases performed at our institution between January 2007 and December 2017. Patient background characteristics were adjusted between the EVAR and OAR groups using propensity score matching (PSM). Surgical outcomes and inpatient medical costs were compared. After PSM, 161 cases were included in each group for comparison. Operative time, blood loss, intensive care unit (ICU) stay, and hospital stay were significantly lower in the EVAR group than in the OAR group. Total inpatient medical costs were significantly higher in the EVAR group (3111× 103 vs. 2156 × 103 JPY [Japanese yen], p <0.01). The surgical material costs in the EVAR group were significantly higher than those in the OAR group, accounting for 58% of total medical expenses. Other costs (diagnosis procedure combination, ICU management, surgical procedure, transfusion, intraoperative injection, and room) were all lower in the EVAR group than in the OAR group. The cost-saving effects of EVAR, such as reduced transfusion costs and ICU stay fees, were offset by the significantly higher cost of surgical materials.
Acute limb ischemia (ALI) is a sudden decrease in lower limb arterial perfusion that poses a threat not only to limb viability but alsoto life and requires urgent evaluation and management. The etiology of ALI is broadly divided into embolism and thrombosis, along with various comorbidities. Severity and treatment strategy should be determined based on physical and image findings. Revascularization can be performed surgically (thromboembolectomy or bypass), endovascularly, or through a hybrid procedure. In all cases, it is important to conduct intraoperative angiography and perform the necessary additional procedures. A prompt response to myonephropathic metabolic syndrome or compartment syndrome during or after revascularization is also essential. ALI is a serious condition that requires emergency treatment, and it is important to be familiar with all treatment options, including surgical and endovascular treatments, fasciotomy, and primary limb amputation, and to promptly provide the best available initial treatment at each facility. (This is a translation of Jpn J Vasc Surg 2024; 33: 199-204.).
Coronavirus disease 2019 (COVID-19) causes endothelial injury through inflammatory and hypoxic stress, leading to vascular dysfunction and immunothrombosis. The plasma level of von Willebrand factor (VWF) could serve as a biomarker of vascular injury. While elevated VWF predicts mortality in severe COVID-19, its relationship with post-discharge functional outcomes remains unclear. This study aimed to determine whether plasma VWF antigen (VWF:Ag) levels at admission predict functional status at discharge in patients hospitalized for COVID-19. This was a single-center prospective cohort study conducted at Tokai University Hospital from July to September 2021. We evaluated the relationship between plasma VWF:Ag levels at admission and a Clinical Frailty Scale (CFS) score ≥4 at discharge using univariable and multivariable logistic regression analyses. A total of 97 patients were enrolled in the study. The median VWF:Ag level at admission was 330.0% (95% confidence interval [CI]: 273.0-391.8). Univariable analysis showed a significant association between elevated VWF:Ag levels and CFS score ≥4 at discharge. This association remained significant after adjusting for age and sex (odds ratio 1.010, 95% CI: 1.000-1.010, p = 0.005). Elevated VWF:Ag levels at admission predict poor functional outcomes at discharge in COVID-19 patients, independent of age and sex.
Endovascular treatment for patients with lower extremity artery disease (LEAD) has expanded its indications owing to the evolution of devices, improvements in techniques, and the establishment of clinical evidence. In particular, improvements in balloon and stent performance have significantly contributed to improved treatment outcomes. Herein, we describe the current status of basic balloon- and stent-related topics for the treatment of LEAD. (This is a translation of Jpn J Vasc Surg 2024; 33: 281-288.).