Debranching and Endovascular Repair for Kommerell's Diverticulum Involving Right-Sided Aortic Arch with Mirror Image Branching / 日本心臓血管外科学会雑誌

A 71-year-old man with an abnormal shadow on chest x-ray was given a diagnosis of Kommerell's diverticulum involving the right-sided aortic arch with mirror image branching. Furthermore, mild funnel chest had been seen on CT scan more than 10 years earlier. The patient was followed up because there were no symptoms ; the Kommerell's diverticulum expanded to reach 63 mm in diameter. To eliminate the risk of rupture, we performed thoracic endovascular aortic repair (TEVAR) with a commercially available device, consisting of bypass grafting of the supra-aortic branches. The patient was discharged from the hospital in good clinical condition, with no signs of endoleak and currently shows no indications of device migration. We thus concluded that debranching TEVAR for Kommerell's diverticulum with right-sided aortic arch is minimally invasive, safe, and effective. Availability of this device that has a new performance feature is expected to improve treatment results and lead to advances in minimally invasive endovascular repair.

A Successful Case of Axillo-Axillary Bypass Grafting with Mild Hypothermia for High-Risk Subclavian Steal Syndrome / 日本心臓血管外科学会雑誌

A 67-year-old man, who had suffered from right cerebral infarction that resulted in left hemiparesis, underwent right superficial temporal artery-middle cerebral artery anastomosis in 1991. From March 2000, dizziness occurred during use of his right hand. His arteriogram revealed late filling of the occluded right subclavian artery by reversed flow from the right vertebral artery and 50% stenosis of the left internal carotid artery. We performed subcutaneous axillo-axillary bypass grafting with mild hypothermia on June 1st, 2000. An 8mm ePTFE tube with a ring was anastomosed to both axillary arteries in end-to-side fashion with continuous sutures. Thereafter, symptoms disappeared. One month after the procedure, his arteriogram showed that the bypass filled the right vertebral artery in an antegrade fashion as well as the right axillary artery. Axillo-axillary bypass grafting with mild hypothermia seemed to be safe and effective for high-risk subclavian steal syndrome.

Long Term Clinical Results in Axillofemoral Bypass for Aortoiliac Occlusive Disease, Especially in Terms of QOL / 日本心臓血管外科学会雑誌

The purpose of this study is to clarify the appropriateness of axillofemoral bypass for high-risk patients with aortoiliac occlusive disease. From February 1986 through November 1997, 50 axillofemoral bypasses were performed at our institution. The mean age of patients was 70.3± 9.6 years (range 28 to 86 years) and 90% of them had severe associated disease. Twenty-nine grafts had axillounifemoral configuration and 21 grafts had axillobifemoral configuration. The primary and secondary patency rate, during this 11-year period (mean follow-up 47.0±30.1months), were 66.4 % and 78.3% at 5 years, with no change thereafter. The mortality rate within 30days was 2%. During the follow-up period 22 died mainly due to heart disease, cerebrovascular disease or malignant tumor, and the survival rate at 5 years was 56.3%. Fontaine classification evaluation revealed that ischemic symptoms improved in 78% of 28 survivors. According to QOL study 75% of survivors were satisfied with daily life, and their performance status improved after operation. These findings indicate that axillofemoral bypass may be an appropriate procedure for high risk patients with aortoiliac occlusive disease.