Oral Iron Absorption of Ferric Citrate Hydrate and Hepcidin-25 in Hemodialysis Patients: A Prospective, Multicenter, Observational Riona-Oral Iron Absorption Trial.

Oral ferric citrate hydrate (FCH) is effective for iron deficiencies in hemodialysis patients; however, how iron balance in the body affects iron absorption in the intestinal tract remains unclear. This prospective observational study (Riona-Oral Iron Absorption Trial, R-OIAT, UMIN 000031406) was conducted at 42 hemodialysis centers in Japan, wherein 268 hemodialysis patients without inflammation were enrolled and treated with a fixed amount of FCH for 6 months. We assessed the predictive value of hepcidin-25 for iron absorption and iron shift between ferritin (FTN) and red blood cells (RBCs) following FCH therapy. Serum iron changes at 2 h (ΔFe2h) after FCH ingestion were evaluated as iron absorption. The primary outcome was the quantitative delineation of iron variables with respect to ΔFe2h, and the secondary outcome was the description of the predictors of the body's iron balance. Generalized estimating equations (GEEs) were used to identify the determinants of iron absorption during each phase of FCH treatment. ΔFe2h increased when hepcidin-25 and TSAT decreased (-0.459, -0.643 to -0.276, p = 0.000; -0.648, -1.099 to -0.197, p = 0.005, respectively) in GEEs. FTN increased when RBCs decreased (-1.392, -1.749 to -1.035, p = 0.000) and hepcidin-25 increased (0.297, 0.239 to 0.355, p = 0.000). Limiting erythropoiesis to maintain hemoglobin levels induces RBC reduction in hemodialysis patients, resulting in increased hepcidin-25 and FTN levels. Hepcidin-25 production may prompt an iron shift from RBC iron to FTN iron, inhibiting iron absorption even with continued FCH intake.

Long-term results of second-stage thoracic endovascular aortic repair following total aortic arch replacement.

PURPOSE: We investigated the surgical results of secondary thoracic endovascular aneurysm repair (TEVAR) using the elephant trunk graft after total aortic arch replacement (TAR) for extensive thoracic aortic lesions. METHODS: The subjects comprised 16 patients who underwent TEVAR as a staged procedure following TAR at our institution between 1997 and 2007. Long-term results were retrospectively surveyed (mean observation period 68.4 months). We performed TEVAR with the elephant trunk graft as a proximal landing zone for the descending thoracic repair, the mean duration between TAR and TEVAR was 4.7 weeks for the staged operations and 18.3 months for the nonstaged operations. RESULTS: Early results were good in all cases, with no deaths and no noteworthy complications. For the seven patients without dissection, long-term results were also good. Among the nine patients with dissection, the false lumen in the thoracoabdominal area enlarged in three during follow-up. We performed thoracoabdominal repair in two, but one died of an aneurysm-esophageal fistula. There was only one long-term aneurysm-related death. CONCLUSION: Second-stage TEVAR using the elephant trunk graft after TAR allows less invasive surgery for extensive aortic lesions and achieves good long-term results. However, enlargement of the false lumen was a long-term concern in patients with aortic dissection, and careful follow-up is essential.

Hybrid treatment of multiple aortic aneurysms by combined conventional surgery and endovascular aortic repair.

PURPOSE: We evaluated the operative results of our treatment for multiple aortic aneurysms by means of a hybrid procedure consisting of a combination of conventional surgical maneuvers and simultaneous or sequential endovascular aortic repair (EVAR). MATERIALS AND METHODS: From August 1998 to April 2007, a total of 15 patients, 11 men and 4 women, ranging in age from 62 to 78 years, were treated with hybrid procedures for multiple aortic aneurysms. The pathology of these patients were, atherosclerotic aneurysm in 12 patients, atherosclerotic aneurysm associated with chronic dissection in 2 and type III chronic dissection in 1 patient. The distribution of aneurysmal locations were as follows: 5 patients had aneurysms at the arch and descending aorta, 1 had at the arch and thoracoabdominal aorta, 6 at the descending and abdominal aorta. Two patients with chronic dissection had simultaneous abdominal aortic aneurysms. In all except 1 of the 7 patients who had abdominal aortic aneurysm, we performed abdominal aneurysmectomy and EVAR simultaneously. In 7 patients, EVAR was performed sequentially after graft replacement surgery. In 2 patients, EVAR was the initial procedure followed by conventional surgery. The mean interval between first and second stage procedures was approximately 4 months. RESULTS: One patients died of methicillin resistant Staphylococcus aureus pneumonia 3 months after the simultaneous procedure, all others were discharged and survive. In particular, no major EVAR linked complication was observed in the follow-up period (range 3 to 91 months, mean 46 months). CONCLUSION: The hybrid procedure for the treatment of multiple aortic aneurysmal disease is less invasive compared to conventional staged surgery and the outcome in terms of mortality and morbidity in hospital as well as long-term follow-up are satisfactory.