ABSTRACT
We report the case of a 76-year-old man who developed type IA endoleak through the fenestration after 1-debranch TEVAR using a Najuta endograft. The patient was admitted with expansion of the aneurysm after TEVAR, for additional therapy. Type IA endoleak through a fenestration has remained a significant clinical concern and its treatment is challenging. We performed Zone 0 TEVAR using the “Squid-Capture” technique assisted in situ stent-graft fenestration. Cerebral vessels were perfused by a percutaneous cardiopulmonary support system during in situ stent-graft fenestration, and the cerebral branch was clamped at the proximal site. It is difficult to operate the catheter inside the endoskeleton structure of a Najuta endograft, but several innovations were effective. Test dilation of the balloon catheter was performed to ensure that the wire did not interfere with the endoskeleton. Avoiding interference with the endoskeleton is important. The Squid-Capture technique allows safe and secure puncture of the graft. The operation was completed successfully. After this procedure, the endoleak disappeared. It is considered to be a useful method for treatment of endoleak through the fenestration.
ABSTRACT
Patients with Parkinson's disease (PD) experience difficulties with activities of daily living (ADLs) at workplace and in their social life depending on the extent of disease progression. Because of their disabilities, patients with PD are forced into early retirement compared to other people of their age group. We present our experience with the rehabilitation of three patients with PD using levodopa-carbidopa intestinal gel (LCIG) treatment for their return to work. The rehabilitation program comprised the following three modules：1) evaluating the patients' ability to walk indoor for a short time；2) assessing their standing and sitting positions to enable them to more easily handle a device；and 3) improving their upper limb function, including skilled movements, for operating a device in emergency. Finally, all three patients exhibited improvements in the Timed Up and Go test results and device operation. Two of the patients returned to their former workplace within 10 months of LCIG treatment initiation and the remaining patient found new employment 1 year after treatment commencement.In conclusion, establishing a rational support system that involves rehabilitation programs and information sharing across multiple occupations is essential for the return to work of patients with PD receiving LCIG treatment.
ABSTRACT
Patients with Parkinson's disease (PD) experience difficulties with activities of daily living (ADLs) at workplace and in their social life depending on the extent of disease progression. Because of their disabilities, patients with PD are forced into early retirement compared to other people of their age group. We present our experience with the rehabilitation of three patients with PD using levodopa-carbidopa intestinal gel (LCIG) treatment for their return to work. The rehabilitation program comprised the following three modules：1) evaluating the patients' ability to walk indoor for a short time；2) assessing their standing and sitting positions to enable them to more easily handle a device；and 3) improving their upper limb function, including skilled movements, for operating a device in emergency. Finally, all three patients exhibited improvements in the Timed Up and Go test results and device operation. Two of the patients returned to their former workplace within 10 months of LCIG treatment initiation and the remaining patient found new employment 1 year after treatment commencement.In conclusion, establishing a rational support system that involves rehabilitation programs and information sharing across multiple occupations is essential for the return to work of patients with PD receiving LCIG treatment.
ABSTRACT
We report a case of successfully treated mesenteric ischemia following emergency endovascular aortic repair (EVAR) for ruptured abdominal aortic aneurysm (r-AAA). A 79-year-old man, who had received hemodialysis for 5 years for diabetic nephropathy, presented with sudden onset abdominal pain. Contrast-enhanced computed tomography revealed an rAAA with a 60-mm diameter in the infrarenal abdominal aorta. Emergency EVAR was performed. After completion of stent graft placement, intraoperative angiogram revealed serious imaging delay of the superior mesenteric artery. An emergency saphenous vein bypass was performed from the right external iliac artery to the ileocolic artery. The postoperative course was uneventful, and there has been no evidence of endoleak or enlargement of aneurysm diameter during the follow-up period of 2 years.
ABSTRACT
The use of axillofemoral bypass grafts (AxFG) has became a widely accepted treatment for high-risk patients with aortoiliac occlusive disease. On the other hand, AxFG has been associated with a variety of complications in the upper extremity. A symptom of upper extremity thromboembolism after AxFG occlusion is reported as axillofemoral bypass graft stump syndrome (AxFSS). We report the case of a 55-year-old man with repeated AxFSS after an AxFG occlusion. He underwent brachial artery exploration and embolectomy. Angiograms showed an embolus floating in the axillary artery, which originated from the occluded graft stump. The stump was obliterated with a metallic stent introduced through the same arteriotomy made for the embolectomy. The endovascular treatment of AxFSS is minimally invasive and is an effective modality in this condition.
ABSTRACT
An 83-year-old woman with unstable angina pectoris underwent percutaneous coronary intervention (PCI) of the left circumflex artery, and her condition improved. However, on the eighth day after PCI, she went into a stated shock, and echocardiogram confirmed a large amount of pericardial effusion. Pericardiocentesis was immediately performed, and bloody pericardial effusion was drained. Cardiac rupture was suspected, although the cause was unknown. Emergency sternotomy was performed, and blow out type cardiac rupture in the center of a thumb-sized infarction was found at the area of the obtuse marginal branch. The ruptured left ventricular wall was successfully closed with 2 mattress sutures because the infarcted area was relatively small. Postoperative course was good, and she was discharged on the 25th postoperative day. In this case, the cause of cardiac rupture was thought to be a small branch of the left circumflex artery, which was occluded during PCI. This is one of the rare but important mechanisms of cardiac tamponade after PCI.
Subject(s)
Humans , Female , Tomography, X-Ray Computed , Paresis , Dysarthria , Magnetic Resonance Imaging , InfarctionABSTRACT
Cerebral venous thrombosis(CVT)is a rare cerebrovascular disorder. However, many reports have suggested that the prognosis of CVT is better than arterial ischemic infarction accompanied with cytotoxic edema. In this report, we present three cases of CVT to explain the possible effectiveness of using a rehabilitation approach. Case 1 was a 51-year-old female oculist with amnestic aphasia and mild right hemiparesis. MRI revealed a massive edematous lesion in the left basal ganglia and thalamus, due to thrombus in the vein of Galen. Speech therapy to facilitate word recall showed remarkable benefit, sufficient enough for her to return to work. Case 2 was a 68-year-old male tax accountant with fluent aphasia. MRI showed multiple contrast-enhanced lesions in his left temporal lobe, due to a lack of venous flow in the left transverse sinus. Speech therapy was also effective enough for him to return to work at 35 days after onset. Case 3 was a 57-year-old male pilot. He suddenly presented severe generalized convulsions controlled by venous anesthetic under mechanical ventilation, due to CVT in the superior sagittal sinus with bilateral frontal hemorrhagic infarction. After extubation, he was transferred to our hospital at 38 days after the disease onset, presenting frontal lobe dysfunction, including apathy, emotional incontinence, and grasp reflexes. During 43 hospitalization days, physical and occupational therapy resulted in drastic improvement in this patient's Barthel index score, from 0 to 50. In conclusion, an early rehabilitation approach should be recommended for CVT, since a better prognosis can be anticipated than in arterial ischemic infarction, regardless of the severity of original brain damage.
ABSTRACT
When performing surgery of the thoracic aorta, several supporting methods must be easily available to facilitate various grafting procedures which are selected as the most suitable method for each case. We report on a practical cardiopulmonary bypass (CPB) circuit which can be used in the surgical treatment of any thoracic aortic disease: aortic dissection, true aneurysm involving the aortic arch, descending aortic aneurysm or thoraco-abdominal aortic aneurysm. The circuit design is based on a percutaneous cardiopulmonary support system. We added some modifications to the system for managing CPB simply. The improved bypass circuit was applied in operations on 26 patients and yielded excellent clinical results. The advantages of the circuit are listed as follows: 1) If massive bleeding occurs during closed-circuit CPB, the blood can be sucked into a built-in hard shell reservoir on the venous side of the bypass, and can immediately be returned back into the bypass circuit. 2) Using clamping forceps it is possible to easily switch between closed-circuit CPB and conventional CPB using gravitational venous return. 3) Selective cerebral or other organ perfusion can be done by a built-in roller pump distal to the oxygenator. The perfusion line using the roller pump diverges from the main line using the centrifugal pump kept in a spinning state. If the hypothermic method is used, the lower body is perfused via a femoral arterial cannulation by the centrifugal pump, and the upper body by the roller pump with right subclavian arterial cannulation. When the cardiac rhythm changes to ventricular fibrillation in cooling the patient, the flow ratio of the lower body to the upper body must be 1:1, since retrograde perfusion from the femoral artery may cause cerebral infarction due to embolism of dislodged debris or thrombi from the aneurysm.