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Article in Japanese | WPRIM | ID: wpr-822047


Background : The surgical repair of acute aortic dissection type A [AAD (A)] by reconstructing the left subclavian artery (LSCA) is sometimes difficult because of the deep surgical field and the occurrence of left recurrent nerve palsy or bleeding. In Japan, since 2014, a commercially available open stent graft (J-graft OPEN STENT) has been used for promoting thrombosis of the false lumen in the descending aorta. This report presents an efficacy evaluation of the surgeon-made in situ Fenestrated Open Stent (FeneOS) for LSCA reconstruction in a patient with AAD (A). Method : We performed surgery with FeneOS using the open stent graft by first deploying it from the entry of the LSCA into the descending aorta and manually making a hole on the LSCA side of the stenting portion ; then, the four-branched J graft was anastomosed between the left common carotid (lt. CCA) and SCA (ZONE 2). At our institution, 47 patients with AAD (A) underwent this surgery with FeneOS from 2014 to 2019 (FeneOS group) and 97 patients with AAD (A) underwent a normal open-stenting procedure from 2008 to 2014 (non-FeneOS group). We analyzed the postoperative results of patients in the FeneOS and non-FeneOS groups. Results : Preoperative characteristics of patients in both groups were similar. Patients in the FeneOS group had an acceptable postoperative course, with no 30-day or in-hospital deaths. The mean operation time, cardiopulmonary bypass time, selective cerebral perfusion time, and open distal anastomosis time were significantly shorter in patients in the FeneOS group (p<0.01). None of the patients had left recurrent nerve palsy, and postoperative computed tomography or arterial echo showed that the blood flow through the LSCA was intact and revealed no endoleakage. Conclusion : FeneOS is simple, fast, and less invasive for the reconstruction of the LSCA without the risk of left recurrent nerve palsy and can be effective for treating patients with AAD (A).

Article in Japanese | WPRIM | ID: wpr-688472


This case report aimed to evaluate the efficacy of applying VIABAHN endoprosthesis at the dissection re-entry of the right renal artery after thoracic endovascular aortic repair (TEVAR) in a patient with a chronic type B dissected thoracoabdominal aneurysm. A 78-year-old man was given a diagnosis of type B aortic dissection 5 years ago and underwent a successful TEVAR operation. Two years later, he developed complications such as chronic expanding aortic dissections ; thus, he underwent a second endovascular repair. Enhanced computed tomography (CT) scanning at the five-year follow-up after initial endovascular repair showed a 58-mm diameter thoracoabdominal dissected aneurysm. It also showed an apparent entry point dissection arising from the lower thoracic aorta and a re-entry point at the base of the right renal artery. Although the right renal artery was affected by the dissecting false lumen, all other abdominal branches were intact. He was treated with VIABAHN via occlusion of the re-entry of the dissection and reconstruction of the right renal artery. The patient recovered uneventfully and was discharged 10 days after the operation. Postoperative enhanced CT scanning showed that the aortic false lumen was completely thrombosed, and the right renal arterial flow had significantly improved. Although TEVAR is the standard treatment in acute complicated type B dissections, its role in chronic type B dissections remains controversial. Our technique of using VIABAHN for the reconstruction of the right renal artery showed promising results for patients with chronic type B dissections.

Article in Japanese | WPRIM | ID: wpr-379334


<p>The objective of this case report was to evaluate the efficacy of the Plug Attachment Technique (PAT) with the Amplatzer Vascular Plug (AVP) in endovascular aneurysm repair (EVAR) in a case of ruptured abdominal aortic aneurysm (rAAA). An 84-year-old woman was taken by ambulance to our hospital. The enhanced CT scan showed an rAAA of 90 mm (Fitzgerald classification 3). The patient was immediately transferred to the operation room and treated with EVAR followed by the closing of the rupture cite using AVP, the Plug Attachment Technique (PAT). The total operation time was 158 min. The patient recovered uneventfully after the operation and was discharged 30 days after the onset. EVAR has been recognized as an efficient acute therapy in cases of rAAA internationally. However, in comparison with the conventional open surgery, we are often facing the critical complications after EVAR in case of rAAA, continuous bleeding thorough the rupture cite and acute compartment syndrome. Our Plug Attachment Technique (PAT) with the Amplatzer Vascular Plug (AVP) may not cause such complications and lead to improved results for EVAR in case of rAAA.</p>

Article in Japanese | WPRIM | ID: wpr-374584


The objective of this study was to assess the long-term outcomes of aortic valve replacement (AVR) for aortic valve stenosis (AS) in patients undertaking chronic renal hemodialysis at the time of the operation. Seventy five hemodialysis patients who underwent AVR between January 1993 and September 2012 were taken into account in this study. Operations included 40 isolated AVR and 35 concomitant AVR and coronary artery bypass grafting (CABG). Other combined AVR (mitral valve operation and aortic root operation) and emergency operations were excluded. Mean patients' age was 66.7 (±8.5) years and 53 out of 75 (70.6%) were male. The etiology of renal failure consisted of diabetic nephropathy (22 cases, 29.3%) and non-diabetic renal failure (53 cases, 70.7%). The mean duration of hemodialysis was 8.1 years. The operative mortality was 6.6%. The 1-year, 3-year, 5 year, and 10-year survival rates were 74.5, 42.1, 29.9, and 6.8%, respectively. Statistical analysis revealed that aortic valve area of less than 0.9 cm<sup>2</sup> and serum cholinesterase of less than 200 IU/<i>l </i>lead to significant risk for mortality (<i>p</i><0.05). There was no clear difference between the outcomes of isolated AVR and concomitant AVR and CABG. This study suggests that earlier surgical intervention for AS in hemodialysis patients can improve the long-term outcomes, and serum cholinesterase can be a useful preoperative marker to assess operative results.

Article in Japanese | WPRIM | ID: wpr-362950


There were 3,129 consecutive patients who underwent CABG by only one operator at Kishiwada Tokushukai Hospital between January 1991 and December 2010. These patients included 236 patients requiring chronic renal hemodialysis at the time of operation. They consisted of 181 men and 55 women, with an average age of 64.1±9.7 years. The mean duration of hemodialysis was 10.1±20.4 years. Diabetic nephropathy (133 cases, 56.4%) was the most common disease leading to required for hemodialysis. The operative mortality and the hospital mortality were 3.4% and 6.4% respectively. The 1-year survival rate, the 3-year survival rate, the 5 year survival rate and the 10-year survival rate were 72.4%, 48.3%, 32.4% and 14.3%. Multivariate logistic analysis revealed that only peripheral artery disease (PAD) was a significant risk factor for mortality (<i>p</i><0.05). The infectious diseases were the most common cause of long term death (24.1%). The mortality rates of CABG in patients with dialysis-dependent renal failure are still higher than those for non-hemodialysis patients. Our data suggest that PAD is a great risk factor for mortality following CABG in hemodialysis patients.