記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: To compare 3 surgical procedures (ascending aortic replacement [AAR], total arch replacement with conventional elephant trunk [cET], or frozen elephant trunk [FET]) for acute type A aortic dissection (ATAAD). Additionally, the AAR group was stratified by the presence or absence of arch vessel dissection (AVD), and outcomes were evaluated among the 4 groups. METHODS: Patients who underwent AAR or total arch replacement with cET or FET for DeBakey type I ATAAD between December 2006 to December 2024 at 5 institutions were included. The cumulative incidence of aortic events, defined as aortic enlargement, aortic reintervention, or aorta-related adverse events, was compared between procedures using pairwise comparisons adjusted by inverse probability of treatment weighting. RESULTS: Of the total 334 patients, 136 with AAR, 94 with cET, and 104 with FET were enrolled. The 5-year cumulative incidence of aortic events was lower for FET compared with that for cET and AAR (AAR: 57.7% vs cET: 49.1% vs FET: 25.2%). Further stratification of the AAR group revealed worse outcomes for AAR with AVD (hazard ratio, 2.25; 95% confidence interval, 1.28-3.95; P = .005). FET showed superior outcomes compared with all other groups, including AAR without AVD (hazard ratio, 0.25; 95% confidence interval, 0.09-0.67; P = .006). CONCLUSIONS: FET for ATAAD was associated with a lower incidence of aortic events compared with other procedures. FET may be a beneficial option for ATAAD with AVD, which is associated with a higher incidence of aortic events after AAR.

DOI： 10.1093/ejcts/ezaf419

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jvs.2025.02.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: The efficacy of antegrade cardioplegia delivery (ACD) versus retrograde cardioplegia delivery remains controversial. This study aimed to compare the efficacy of intermittent and isothermic ACD (IIACD) with continuous and hypothermic retrograde cardioplegia delivery (CHRCD) in patients undergoing isolated aortic valve replacement (AVR). METHODS: This retrospective study reviewed 164 patients who underwent isolated AVR. After propensity score matching was performed for age, sex, body surface area, European System for Cardiac Operative Risk Evaluation, operation time, cardiopulmonary bypass time, and aortic crossclamp time, 62 patients were assigned to either the IIACD or CHRCD group. Myocardial injury was assessed using peak levels of creatine kinase-MB (CK-MB) and aspartate aminotransferase (AST) level within 1 week postoperatively. Echocardiographic changes and clinical outcomes were also evaluated. RESULTS: Postoperative peak CK-MB and AST levels were significantly lower in the IIACD group. CK-MB levels were 31.4 ± 51.8 ng/mL (IIACD) versus 49.8 ± 37.2 ng/mL (CHRCD), P < .001, AST levels were 56.2 ± 54.7 U/L (IIACD) versus 70.9 ± 37.9 U/L (CHRCD), P < .001. There were no significant differences in postoperative ejection fraction or mortality between the groups. CONCLUSIONS: Despite the use of continuous hypothermic cardioplegia in the CHRCD group, IIACD provided superior myocardial protection. ACD may offer a safer cardioplegia strategy during AVR.

DOI： 10.1016/j.xjtc.2025.08.006

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: To evaluate the long-term surgical outcomes of advanced renal cell carcinoma with a thrombus extending into the inferior vena cava (IVC). METHODS: From 2008 to 2023, 29 patients underwent radical nephrectomy with IVC reconstruction. Surgical procedures were stratified by the cephalad extension of the IVC thrombus: from the renal vein into the infrahepatic segment (level I, n = 2), below the hepatic vein (level II, n = 20), and into the suprahepatic segment (level > III, n = 7; including 1 level IV). RESULTS: IVC reconstruction was performed by direct suturing in 18 patients (62.1%), patch repair in 8 (27.6%), and graft replacement in 3 (10.3%). Operative outcomes for levels I, II, and >III were associated with the rate of thoraco-laparotomy (0%, 5.0%, and 43.9%, respectively) and use of cardiopulmonary bypass (0%, 5.0%, and 85.7%, respectively). Although 1 level III patient (3.4%) died due to acute pulmonary embolism during surgery, there was no significant difference in the incidence of postoperative complications according to the level of tumor thrombus extension. The 5-year overall survival and cause-specific survival were 53.8% and 65.7%, respectively. CONCLUSION: Although tumor thrombus extension can influence surgical invasiveness, our strategy did not impact perioperative outcomes and may enhance advanced renal cell carcinoma prognosis.

DOI： 10.1016/j.avsg.2025.07.037

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Thrombus formation in atrial fibrillation is caused by blood flow stagnation within the left atrial appendage (LAA). It is believed that blood flow tends to stagnate within the LAA even in patients with sinus rhythm and high risk of stroke. This study evaluated blood flow within the LAA using four-dimensional flow magnetic resonance imaging among patients stratified by the congestive heart failure, hypertension, age, diabetes mellitus, prior stroke, vascular disease, age, sex category (CHA2DS2-VASc) score. METHODS: Ninety-eight participants with sinus rhythm (70 patients, 28 controls) underwent non-contrast four-dimensional flow magnetic resonance imaging. Participants were divided into low- and high-risk groups (CHA2DS2-VASc scores 0-2 and 3-9, respectively. Blood flow parameters, including the blood flow volume in the basal, middle, and top segments of the LAA, were analyzed and compared between groups. RESULTS: The blood flow volume was significantly reduced in the top segment of the LAA in the high-risk group (low-risk: 3.13 ± 1.07 mL/cm2 vs. high-risk: 2.54 ± 0.96 mL/cm2, p = 0.006). However, the blood flow volume in the basal and middle segments did not differ significantly between the two groups (basal segment, p = 0.14; middle segment, p = 0.44). In addition, larger LAA volumes (EDV, ESV, and mean volume) were associated with reduced top-segment flow, but correlations with intra-LAA flow were not statistically significant. CONCLUSIONS: In patients with high CHA2DS2-VASc scores, blood flow stagnation can occur in the LAA top segment even in the presence of sinus rhythm. Establishing blood flow-based criteria may enhance the potential applications of LAA closure to prevent stroke.

DOI： 10.1007/s11748-025-02216-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 73-year-old female patient was diagnosed with unresectable locally advanced pancreatic cancer at 72 years of age and underwent chemotherapy. Due to a successful response to chemotherapy, she was scheduled for a pancreaticoduodenectomy and common hepatic artery resection by the gastrointestinal surgery department. As the common hepatic artery was to be resected, our cardiovascular surgery department was consulted for vascular reconstruction to ensure hepatic blood flow. During the surgery, our team intervened prior to tumor resection. The pancreaticoduodenal artery was infiltrated by the tumor and required resection. Although the common hepatic artery proximal to its branches had to be resected, we determined that a direct end-to-end anastomosis between the remaining common hepatic artery and the proper hepatic artery was feasible. To maintain a wide anastomotic opening, both ends were trimmed obliquely. An end-to-end anastomosis was performed using 6-0 PROLENE® Polypropylene Suture (Ethicon, Johnson & Johnson, Somerville, NJ, USA). Blood flow was confirmed to be adequate using a flow meter. Subsequently, the gastrointestinal surgery department proceeded with tumor resection. The patient had an uneventful postoperative course and was discharged on postoperative day 22. This case highlights that prompt, direct hepatic arterial reconstruction can safely preserve hepatic inflow without the need for interposition grafting.

DOI： 10.7759/cureus.94956

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jvs.2025.05.128

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Endovascular treatment (EVT) for patients with an occlusive lesion of the femoropopliteal artery is performed worldwide due to its effectiveness. However, lesions in chronic limb-threatening ischemia (CLTI) are complex and a major concern in superficial femoral artery (SFA) EVT. Despite this, a detailed study of SFA EVT, and especially selection of the final device as a drug-coated balloon (DCB) or a stent, has not been performed in patients with CLTI. The aim of this stud was to compare the clinical outcomes of SFA EVT using a DCB or a stent in patients with CLTI. METHODS: A multicenter retrospective observational study was performed at 21 Japanese centers. Comparisons were made between patients undergoing initial SFA EVT with a DCB or stenting after inverse probability of treatment weighting using the propensity score to control for potential confounding (patient demographics, comorbidities, medications, and procedural details). The primary outcome measure was major adverse limb events (MALE). We adopted cause-specific hazard models, using Fine and Gray's proportional hazards model in which death was treated as a competing risk. Secondary outcome measures were also evaluated: (1) technical success; (2) slow flow; (3) death within 30 days; (4) major adverse events within 30 days; (5) restenosis; (6) target lesion revascularization; (7) acute occlusion; (8) wound healing; (9) major amputation; and (10) all-cause mortality. RESULTS: The study included 900 CLTI cases that underwent EVT with a DCB (n = 458) or stenting (n = 442) and had a median follow-up period of 17.5 months (interquartile range, 6.2-31.9 months). The DCB group had a lower risk of MALE than the stent group, with a hazard ratio of 0.68 (95% confidence interval, 0.52-0.89; P = .005). Subsequent analysis for the secondary outcome measures demonstrated that the DCB group had a higher prevalence of postprocedural slow flow and a lower incidence rate of acute occlusion (both P < .005 after Bonferroni correction). CONCLUSIONS: DCB angioplasty had a lower risk of MALE than stenting. These results suggest that a DCB might be more beneficial in initial SFA intervention in patients with CLTI.

DOI： 10.1016/j.jvs.2025.02.010

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記述言語：日本語   出版者・発行元：(一社)日本静脈学会  

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.ejvsvf.2025.05.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Proximal neck dilatation (PND) is a common issue after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs), being a potential cause of stent graft migration or type Ia endoleak. The ALTO stent graft, featuring a unique polymer sealing mechanism, has been reported to exhibit less PND. This study aims to compare PND and clinical outcomes between the ALTO stent graft and alternative self-expanding stent grafts. METHODS: The CustomSEAL study is a multi-center retrospective observational study involving 18 institutions in Japan. It compares EVAR outcomes using the ALTO stent graft and alternative self-expanding stent grafts for fusiform AAAs. The primary outcome measure was the difference in PND at 12 months post-EVAR. Secondary outcome measures included aneurysm sac diameter changes, reintervention rates, and mortality outcomes during the follow-up. RESULTS: After propensity score matching, 111 patient pairs were extracted. Baseline characteristics, including proximal neck length/diameter and stent graft oversizing, were comparable between groups. The ALTO stent graft was associated with significantly less PND at 12 months (2.3% vs. 26.7%, P < 0.001). There were no significant differences in perioperative outcomes, aneurysm sac diameter changes, reintervention rates, or overall survival between the groups. CONCLUSIONS: The ALTO stent graft demonstrated significantly less PND at 12 months post-EVAR compared to alternative self-expanding stent grafts, highlighting its potential advantage in exerting less chronic expanding force on the proximal aortic neck. Long-term follow-up is needed to validate the clinical benefits of the ALTO stent graft over the alternative self-expanding stent grafts. LEVEL OF EVIDENCE: Non-randomized controlled cohort/follow-up study.

DOI： 10.1007/s00270-025-03996-x

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: The relationship between cooling status during aortic surgery with hypothermic circulatory arrest and postoperative neurologic dysfunction remains unknown. In the present study, we evaluated the effect of cooling status on transient neurologic dysfunction after total arch replacement. METHODS: We studied patients who underwent elective total arch replacement with hypothermic circulatory arrest and antegrade selective cerebral perfusion from December 2011 to January 2021. Changes in tympanic temperature trends recorded during surgery were plotted. Several parameters, including the nadir temperature, cooling speed, and degree of cooling (cooling area, or the area under the curve of inverted temperature trends from cooling to rewarming as calculated by the integral method), were analyzed. The relationships between these variables and transient neurologic dysfunction were evaluated. RESULTS: Transient neurologic dysfunction was observed in 33 (14.5%) of the 228 included patients. In the transient neurologic dysfunction group, the cooling area was larger (2417.3 vs. 1920.8 °C min; P < 0.001) and the cooling speed was higher (0.68 vs. 0.51 °C/min; P < 0.001) than in the non-transient neurologic dysfunction group. A multivariate logistic model revealed that both the cooling area (odds ratio = 1.13 per 100 °C min; P < 0.001) and cooling speed (odds ratio = 3.69 per °C/min; P = 0.041) were independent risk factors for transient neurologic dysfunction. CONCLUSIONS: Both the cooling area, which indicates the degree of cooling, and cooling speed had significant relationships with transient neurologic dysfunction after total arch replacement. Together, these findings indicate that overcooling and rapid cooling may contribute to brain injury.

DOI： 10.1007/s11748-024-02068-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 33-year-old man was brought to the emergency department after sustaining multiple traumas. The interventional radiology team performed vascular embolization via a 6 Fr sheath inserted into the right common femoral artery due to suspected bleeding from the duodenum. The man underwent multidisciplinary management. On day 3 after injury, contrast-enhanced computed tomography (CT) revealed a pseudoaneurysm in the right common femoral artery, the radiology team opted for thrombin injection therapy, and the patient was monitored. No swelling was initially observed. However, repeat contrast-enhanced CT demonstrated a pseudoaneurysm on postinjury day 9, indicating that thrombin treatment had failed. Vascular surgery was considered, and emergency surgical intervention was performed on the same day. A pseudoaneurysm and a 6 Fr sheath puncture site were identified through a right inguinal incision, and hemostasis was achieved. The postoperative course was uneventful, and the patient was transferred for rehabilitation on postoperative day 19 following pseudoaneurysm repair. This case involved the development of a femoral artery pseudoaneurysm following endovascular treatment for multiple traumas. Although the interventional radiology team performed a local thrombin injection, the treatment ultimately failed, necessitating vascular surgery intervention. The patient underwent open surgical repair without complications. With the increasing use of local thrombin injection for pseudoaneurysms, careful post-treatment monitoring is essential, and surgical intervention should be considered at an appropriate time if necessary.

DOI： 10.7759/cureus.80640

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Chronic inflammation is involved in the development of abdominal aortic aneurysm (AAA). A tertiary lymphoid structure (TLS) within vascular lesions has recently been focused on for its role in modulation of inflammation in local tissues. We aimed to elucidate the relationships between TLS and pathophysiology of AAA. METHODS: Abdominal aortic samples obtained from 37 patients with AAA (men/women: 34/3, age: 72.8±9.9 years) and 15 autopsied patients who died from non-aortic events (men/women: 11/4, age: 65.5±9.8 years) were investigated. RESULTS: TLSs in AAA lesions were confirmed by focal infiltration of CD3-positive cells surrounding germinal center-like structures containing CD20-positive cells between the tunica adventitia and tunica media layers. The formation of a TLS was significantly more prevalent in AAA patients than in autopsied patients. The number of TLSs in AAA lesions was positively correlated with sac diameter (r=0.357, P=0.035) and the amount of intraluminal thrombosis (r=0.466, P=0.005). T cells and B cells were predominant cellular populations among CD45+ cells in AAA lesions. There was a significantly positive correlation between the proportions of interfollicular T follicular helper (CD3+CD4+CD45RA-CXCR5+PD-1+) cells and double negative B (CD3-CD19+IgD-CD27-) cells, and they were positively correlated with sac diameter, intraluminal thrombosis, and serum lipids. Deposited single-cell RNA-sequencing data for AAA showed that T follicular helper cells and double negative B cells were associated with lipid metabolism, T cell activation/proliferation and inflammation. CONCLUSIONS: The formation of a TLS in AAA lesions is associated with sac diameter and intraluminal thrombosis in connection with interfollicular T follicular helper cells and double negative B cells, which may contribute to the pathophysiology of AAA and might be novel therapeutic targets for the development of AAA.

DOI： 10.1161/JAHA.124.040279

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1177/17085381241236569

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/ccd.31319

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

An 85-year-old man underwent abdominal aortic aneurysm (AAA) repair with a synthetic graft at age 48. Sac enlargement, likely due to an endoleak, was observed during follow-up, and covered stents were placed in the graft limbs at age 80. Despite this, the sac continued to enlarge, leading to a referral to our institution. Imaging revealed an endoleak from an uncovered graft section. An EXCLUDER® stent graft (W. L. Gore & Associates, Inc., Flagstaff, AZ) was placed to cover the graft entirely, resolving the endoleak. The patient was discharged on postoperative day 5. This case highlights the rare failure of a synthetic graft after 37 years.

DOI： 10.7759/cureus.77408

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.ejvsvf.2024.12.001

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The aim of this study was to evaluate the impact of intercostal nerve cryoablation on postoperative pain, opioid usage, and lung expansion after open aortic repair via left thoracotomy. METHODS: This retrospective study included 62 patients who underwent aortic repair via left thoracotomy between 2017 and 2023. Patients were divided into cryoablation (n = 32) and non-cryoablation (n = 30) groups. Pain was assessed using the Numerical Rating Scale (NRS), and lung volume was measured using computed tomography 1 week postoperatively. RESULTS: The cryoablation group showed significantly lower mean NRS scores (1.7 vs. 2.4, p <0.01) and lower opioid consumption (6.2% vs. 56.6%, p <0.01). The left lung volume ratio was significantly higher in the cryoablation group (72.3% vs. 62.4%, p = 0.05). CONCLUSIONS: Intercostal nerve cryoablation effectively reduces postoperative pain and opioid consumption and enhances pulmonary expansion after left thoracotomy. This technique may offer a favorable analgesic option in thoracic aortic surgery.

DOI： 10.5761/atcs.oa.25-00127

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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掲載種別：研究論文（学術雑誌）  

DOI： 10.3390/jcm14010039

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1177/15266028241305960

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1177/15266028241302658

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.avsurg.2024.100346

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The patient was a 33-year-old male. He was noted to have a systolic murmur in the aortic valve region during childhood and underwent balloon valvuloplasty at a pediatric clinic. However, he was not followed up thereafter. Recently, he began experiencing exertional dyspnea and presented to our cardiology department. Detailed examinations, including echocardiography, revealed moderate aortic regurgitation and stenosis, and a unicuspid aortic valve was suspected morphologically. After discussing the findings with the patient, he opted for surgical treatment. The operation was performed under general anesthesia via a median sternotomy. Intraoperative inspection of the aortic valve confirmed a unicuspid morphology, consistent with the preoperative findings. The unicuspid valve was excised and replaced with a mechanical valve (St. Jude Medical (SJM) 25 mm). The surgery was completed without complications, and the postoperative course was uneventful. The patient was discharged home on postoperative day 10. Five years postoperatively, the patient remains asymptomatic and in good condition. Given the rarity of unicuspid aortic valve cases, this report is of significant clinical value.

DOI： 10.7759/cureus.75305

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

An aortoenteric fistula (AEF) is a rare but life-threatening condition where an abnormal connection forms between the aorta and the gastrointestinal tract, most commonly the duodenum. It can be primary (arising spontaneously due to an aortic aneurysm or infection) or secondary (complicating prior vascular surgery). Immediate recognition and surgical intervention are critical to manage severe gastrointestinal bleeding and prevent fatal outcomes. A 71-year-old male developed an AEF following abdominal aortic graft surgery. Four months postoperatively, he presented with persistent lower gastrointestinal bleeding and was diagnosed with a secondary AEF. A staged surgical approach was employed, involving initial bowel resection, stoma creation, and graft cleaning, followed by subsequent aortic graft replacement with omental flap coverage. Postoperatively, a graft rupture at the proximal anastomosis required emergency endovascular stenting, which stabilized the patient. Antibiotic therapy successfully managed graft infection, including meropenem, linezolid, and later levofloxacin. The patient was discharged home on day 65 and has remained free of aortic events for five years. This case illustrates the complexity of AEF management, emphasizing the importance of a multidisciplinary, staged approach to achieve infection control, hemostasis, and long-term stability. He has been followed up in an outpatient clinic since then. He is now 76 years old, five years later, and is progressing without an aortic event.

DOI： 10.7759/cureus.75026

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/ejcts/ezae404

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: This study was performed to assess postoperative aortic remodelling (AR) after total arch replacement for acute type A aortic dissection (AAD) with a frozen elephant trunk (FET) or conventional elephant trunk (cET). Furthermore, the shape of the residual true lumen was analysed based on elliptical Fourier analysis and evaluated as a predictor of AR. METHODS: This study involved patients who underwent total arch replacement with a cET or FET for AAD from December 2006 to January 2023 at five institutions. AR was assessed at the levels of the 4th thoracic vertebra (Th4), Th7, Th10, and above the coeliac trunk. The shape of the residual true lumen at all four levels was analysed based on elliptical Fourier analysis to calculate shape patterns as principal component (PC) values. Inverse probability of treatment weighting was performed for adjustment between the groups. RESULTS: In total, 180 patients (88 with cET and 92 with FET) were enrolled. The complete AR rate, defined as false lumen remodelling throughout the entire descending thoracic aorta, was significantly higher in the FET than cET group (63.4% vs 32.0%, P = 0.0013). The inverse probability of treatment weighting-adjusted Fine-Gray regression model revealed that the mean PC2 (hazard ratio, 0.22; P < 0.001) and PC3 (hazard ratio, 0.24; P = 0.009) of the four levels were independent predictors of complete AR. CONCLUSIONS: In AAD repair, the AR rate was significantly higher with use of the FET than cET. The shape patterns of the residual true lumen can be an important reference for predicting postoperative AR.

DOI： 10.1093/ejcts/ezae375

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report a 75-year-old female with a history of two heart operations: aortic valve replacement (St. Jude MedicalTM 21 mm) at the age of 44 years for severe rheumatic aortic stenosis and mitral valve replacement (CarbomedicsTM 29 mm) at the age of 51 years for rheumatic mitral regurgitation. Decades later, she presented with exertional dyspnea. Echocardiography revealed aortic stenosis with an effective orifice area of 0.79 cm². Coronary angiography showed #6 75% stenosis and a limited mechanical valve opening. After a thorough discussion, the patient agreed to undergo redo surgery. The surgery involved re-median sternotomy, left internal thoracic artery (LITA) harvesting, pannus removal, and replacement of the aortic valve with a 20 mm ATS advanced performance (AP) prosthesis (ATS Medical, Minneapolis, MN) in a supra-annular position. The LITA-left anterior descending (LAD) bypass was completed, and the patient was weaned from the cardiopulmonary bypass without complications. Postoperatively, the right phrenic nerve paralysis caused transient respiratory challenges requiring tracheotomy and prolonged ventilation. Rehabilitation improved diaphragmatic function and respiratory independence. At six months, the right phrenic nerve function had recovered, and the patient resumed walking independently with a cane. Two years postoperatively, the patient remained ambulatory and attended independent outpatient follow-ups. This report highlights the potential for gradual recovery from phrenic nerve paralysis following open heart surgery, emphasizing the importance of long-term multidisciplinary care.

DOI： 10.7759/cureus.74783

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 63-year-old man was diagnosed with myelodysplastic syndrome (MDS) at the age of 62 by the hematology department. The patient underwent four cycles of azacitidine (AZA) therapy, followed by successful bone marrow transplantation (BMT). Subsequently, he was hospitalized twice for graft-versus-host disease (GVHD). Prednisolone was initially administered at 60 mg and was gradually tapered to 10 mg/day. Additionally, the patient was prescribed 10 mg/day of a Janus kinase inhibitor. At age 63, approximately one month prior to admission, he began experiencing recurrent upper respiratory symptoms with fevers of around 37°C. He developed a persistent fever of 38°C, accompanied by dyspnea on exertion, and visited the hematology outpatient clinic. Chest radiography revealed prominent pulmonary congestion, leading to the decision to perform echocardiography, which revealed severe aortic valve regurgitation with vegetation attached to the valve. Laboratory findings included a white blood cell count of 13,200/μL and a C-reactive protein (CRP) level of 13.7 mg/dL. Blood cultures revealed the presence of gram-positive cocci. As the patient's respiratory condition progressively worsened, emergency aortic valve replacement was planned. Additionally, because of a history of percutaneous coronary intervention (PCI) at another institution, he was referred for a coronary artery bypass graft (CABG) on the right coronary artery to be performed concurrently. Surgery was performed via median sternotomy under cardioplegic arrest. The aortic valve was perforated at the right coronary cusp and was covered with vegetation. The patient underwent aortic valve replacement with a biological valve, and a saphenous vein graft was used for bypass grafting to the posterior descending branch of the right coronary artery. Postoperatively, antibiotic therapy was administered without infection recurrence. The patient was discharged 47 days postoperatively. This case demonstrated the rapid progression of infective endocarditis following BMT, highlighting the need for prompt recognition and management.

DOI： 10.7759/cureus.73564

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The patient an 85-year-old female resided in a care facility where she maintained an independent daily activity level. She was discovered hunched over a table in her room, displaying reduced responsiveness and prompting an emergency call. Initially, her blood pressure was within 60 mmHg, and she was transported by ambulance to our hospital. Further examination revealed acute Stanford type A aortic dissection accompanied by signs of cardiac tamponade, necessitating urgent surgery. The operation was performed under general anesthesia and tracheal intubation. After exposing the femoral vessels through an incision in the right groin, cannulation was achieved for cardiopulmonary bypass. Subsequently, a median sternotomy was performed and the pericardium was opened. Blood within the pericardial cavity was carefully exposed and blood pressure was monitored. The pericardial cavity contained a large number of dark red hematomas. A left ventricular vent was inserted and cooling was initiated. The circulatory arrest was achieved at a rectal temperature of 28°C, accompanied by antegrade cerebral perfusion and selective antegrade myocardial protection to facilitate cardiac arrest. The entry tear was located on the dorsal aspect of the ascending aorta. Additionally, the ascending aorta was trimmed proximal to the brachiocephalic artery and a 26-mm Gelweave graft was anastomosed. Circulation was subsequently resumed, and rewarming commenced. The proximal dissection was extended to the non-coronary cusp, where BioGlue was applied to bond the intima and adventitia, followed by a partial adventitial inversion. The proximal anastomosis was then completed. The total operation duration was 366 min. The patient was extubated, and oral intake was initiated the following day. However, postoperative delirium persisted, and the patient developed a cerebral infarction triggered by paroxysmal atrial fibrillation. Her daily activities declined, and she experienced complications including pneumonia and urinary tract infection, which responded to antibiotic therapy. The patient was discharged on postoperative day 49.

DOI： 10.7759/cureus.74567

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jvs.2024.10.023

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 78-year-old female presented with a history of left atrial myxoma resection 12 years before presentation. The initial surgery involved a median sternotomy and cardiopulmonary bypass for tumor excision. Sternal closure was achieved using six titanium wires, with the lowermost wire noted to be slightly elevated from the sternum immediately post-operation. The patient, an active individual who regularly practiced yoga, including frequent prone positions, was discharged from follow-up two years postoperatively without complications. However, 12 years after the initial surgery, the patient experienced pain at the lower end of the median sternotomy site, prompting her first visit to our outpatient clinic within a decade. Physical examination revealed palpable subcutaneous protrusion of the lowermost sternal wire with visible skin discoloration. Although no evidence indicated wire penetrating the skin, wire removal was deemed necessary. Comparison with previous lateral chest radiographs demonstrated a progressive increase in wire angulation over time. The patient was admitted and the protruding wire was removed under local anesthesia. Her postoperative course was uneventful, leading to discharge on the sixth day after the procedure.

DOI： 10.7759/cureus.71324

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: This study aimed to evaluate the long-term outcomes of surgical strategies for communicating DeBakey IIIb chronic dissecting aortic aneurysm, considering the optimal primary surgical repair to prevent aortic events. METHODS: From 2002 to 2021, 101 patients with communicating DeBakey IIIb chronic dissecting aortic aneurysm who underwent surgical repair were categorized based on the primary surgical repair: 1-stage repair of thoracoabdominal aortic aneurysm (TAAAR) (n = 22) or staged repair, such as descending thoracic aneurysm repair (DTAR) (n = 43) or total arch replacement with elephant trunk implantation (TARET) (n = 25), and thoracic endovascular aortic repair (TEVAR) (n = 11). Early and late postoperative outcomes were compared among the groups. RESULTS: Early outcomes for TAAAR, DTAR, TARET, and TEVAR were associated with the incidence of stroke (9.1% vs 0% vs 4.0% vs 9.1%, respectively), spinal cord injury (13.6% vs 4.7% vs 8.0% vs 0%, respectively), and in-hospital mortality (9.1% vs 2.3% vs 0% vs 9.1%, respectively). During follow-up, the 10-year overall survival and 7-year aortic event-free rates for TAAAR, DTAR, TARET, and TEVAR were 61.8%, 71.6%, 21.5%, and 26.5% and 93.8%, 84.3%, 74.4%, and 51.4%, respectively. TAAAR had significantly higher overall survival (P = .05) and aortic event-free rates (P = .03) than TEVAR. TARET (hazard ratio, 2.27; P < .01) and TEVAR (hazard ratio, 3.40; P < .01) were independently associated with the incidence of aortic events during follow-up. CONCLUSIONS: Considering the optimal primary surgical repair based on long-term outcomes, TEVAR was not a durable treatment option. Patient-specific TAAAR or DTAR should be considered rather than defaulting to minimally invasive primary repairs for all patients with communicating DeBakey IIIb chronic dissecting aortic aneurysm.

DOI： 10.1016/j.xjon.2024.05.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Surgical treatment of infected aneurysms is problematic due to their high complication and mortality rates. Infected aortic aneurysms are at high risk of rupture and should be operated on as soon as possible after diagnosis. A 72-year-old female patient with a medical history of diabetes mellitus, hyperlipidemia, and hypertension presented with a fever of 38°C and back pain, without any apparent cause, in 2021. Her C-reactive protein (CRP) level increased to 20 mg/dL. Further evaluation with contrast-enhanced computed tomography (CT) revealed a low-density area with air pockets surrounding the abdominal aorta. The patient was diagnosed with native abdominal aortic infection and transferred to our hospital for treatment. The next day, endovascular aortic repair (EVAR) was performed using an Endurant stent graft (161682). Postoperatively, the patient was treated with antibiotics, and subsequently, blood infection was alleviated. Moreover, the CRP levels normalized. Follow-up contrast-enhanced CT showed resolution of the air pockets surrounding the abdominal aorta. The patient was discharged home on postoperative day 33. During her three-year follow-up as an outpatient, no recurrence of the infection was detected. While open surgical repair with prosthetic graft replacement is often the preferred treatment for infected abdominal aortic aneurysms, in select cases, as demonstrated by our patient, EVAR can be employed to prevent rupture, followed by antibiotic therapy to achieve infection control.

DOI： 10.7759/cureus.68287

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The purpose of this study was to statistically analyze the factors that influence cardiovascular surgery recruitment. METHODS: Fifth- and sixth-year medical students and first-year residents who participated in cardiovascular surgery-related events at our university over a 10-year period from April 2013 to August 2022 were included. The primary endpoint was admission to the department of cardiovascular surgery. Gender, participation in sixth-year elective clinical training, participation in national academic conferences, participation in cardiovascular surgery summer school, and the cost of participation in these events (airfares and lodging) were included as analytic factors. RESULTS: Fifty-three participants attended cardiovascular surgery events during the study period. The sample included 48 males (84%) and 9 females (16%), and 3 fifth-year medical students (5%), 45 sixth-year students (79%), and 9 students in their first year of clinical training (16%). Eighteen (32%) of the participants eventually joined the department. Gender, participation in national academic conferences, cardiovascular surgery summer school, and cost of participation were not significantly related to the decision to join the department, but participation in elective clinical training was significantly positively related to the decision to join the department for sixth-year students (p < 0.01). CONCLUSIONS: We statistically analyzed the factors involved in the recruitment of students and initial clinical residents to the department of cardiovascular surgery. The results showed that participation in elective clinical training was significantly positively associated with the decision to join the department, suggesting that efforts to encourage participation in elective clinical training are important.

DOI： 10.1007/s11748-023-01995-8

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記述言語：日本語   出版者・発行元：(一社)日本静脈学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本静脈学会  

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 79-year-old man underwent bioprosthetic valve replacement for aortic regurgitation 10 years previously (Carpentier-Edwards PERIMOUNT Magna Ease, 21 mm; Edwards Lifesciences, Irvine, CA, USA). The indexed effective orifice area decreased to 0.422 cm2/m2, and heart failure symptoms appeared. The patient underwent aortic valve replacement through a redo median sternotomy. A perivalvular leak was observed on transesophageal echocardiography at the time of weaning from cardiopulmonary bypass. The patient was judged to have a leak characteristic of bioprosthetic valves and was monitored closely. Postoperative echocardiography showed that the perivalvular leak had decreased to a trivial level, indicating that the intraoperative decision had been correct. We report this case because such intraoperative judgments are difficult to make.

DOI： 10.1007/s12055-023-01681-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Aortic dissection with malperfusion necessitates emergency surgery and is associated with poor outcomes. Therefore, in this study, we analyzed patients' treatment courses from the initial management to hospital discharge in cases of acute aortic dissection (AAD) with malperfusion and investigated the risk factors associated with mortality. METHODS: We evaluated cases of AAD with malperfusion treated at our institution over a 16-year period from 2007 to 2022. The primary endpoint was in-hospital mortality. The study's primary outcome measure was mortality during hospitalization. We collected and analyzed data encompassing preoperative patient characteristics, Stanford classification, sites of preoperative malperfusion, surgical techniques employed, and postoperative complications. These variables were examined to identify factors associated with in-hospital mortality. RESULTS: During the study period, 366 patients were admitted with AAD, 102 of whom had malperfusion. There were 62 men (61%) and 40 women (39%), with a mean age of 64 ± 13 years (range: 28-87 years). According to the Stanford classification, 75 (74%) and 27 (26%) patients had type A and B aortic dissection, respectively, and 29 patients (28%) presented with shock. Preoperative malperfusion sites included the brain, coronary arteries, abdominal viscera, limbs, and spinal cord in 40 (39%), 10 (10%), 34 (33%), 52 (51%), and six (6%) patients, respectively. Eleven (11%) patients required immediate intervention in the emergency department. The treatments administered to the patients were as follows: ascending aortic replacement, 30 (29%) patients; aortic arch replacement, 34 (33%) patients; root replacement, three (3%) patients; thoracic endovascular aortic repair (TEVAR), 12 (12%) patients; non-anatomic bypass, five (5%) patients; and conservative management, five (5%) patients. In-hospital mortality occurred in 23 (23%) patients. Multivariate logistic regression analysis identified preoperative coronary malperfusion as an independent risk factor of mortality. CONCLUSION: Preoperative coronary malperfusion is an independent risk factor for in-hospital mortality in patients with AAD presenting with malperfusion.

DOI： 10.7759/cureus.65822

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掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE Publications  

Objectives

Endoleaks are important complications of endovascular aortic repair. Usually, endoleaks are judged indirectly by aortography or postoperative computed tomography. However, findings from these modalities are difficult to distinguish because of the divergency of endoleaks. Few studies have reported direct visualization of endoleaks. Herein, we introduce a direct procedure for intraoperatively evaluating endoleaks using angioscopy.

Methods

From April 2023, consecutive patients with an abdominal aortic aneurysm, except emergency cases and those of narrow access, seen at Sunagawa City Medical Center were enrolled in our study. Endoleaks were detected by intraoperative angioscopy using a novel endovascular procedure.

Results

Seven patients underwent endovascular aortic repair of an abdominal aortic aneurysm with intraoperative angioscopy. None of the enrolled patients experienced complications. The procedure revealed types 2, 3a, and 4 endoleaks.

Conclusions

This is the first study to demonstrate intraoperative visualization of endoleaks using angioscopy. Direct findings observed by this novel procedure might provide information on the velocity and volume of the endoleak, providing comprehensive insights into the intra-sac hemodynamics after the endovascular aortic repair.

その他リンク： https://journals.sagepub.com/doi/full-xml/10.1177/17085381241264719

DOI： 10.1177/17085381241264719

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Perforation by pacemaker leads, although rare, is a complication reported since the introduction of pacemaker therapy. Although historically reported frequencies were as high as 5%, recent reports have cited frequencies ranging from 1 to 2%. We report a case where a screw-type atrial lead slightly penetrated the right atrial wall, causing chronic abrasion of the ascending aorta, resulting in shock. CASE PRESENTATION: A 54-year-old male presented with dilated cardiomyopathy diagnosed at 40 years of age when he developed decompensated heart failure. Despite ongoing treatment, his heart failure worsened, leading to hospitalization at the age of 54. During his hospital stay, he experienced cardiac arrest that required cardiopulmonary resuscitation, followed by a return of spontaneous circulation. He was subsequently transferred to our institution after initiation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and an intra-aortic balloon pump (IABP). Echocardiography revealed an ejection fraction of 25%, left ventricular end-diastolic diameter of 60 mm, and severe mitral regurgitation (MR). Transcatheter mitral valve repair was performed to treat severe MR, followed by implantation of a cardiac resynchronization therapy defibrillator (CRT-D). Three months later, the patient was brought to our emergency department by ambulance because of hypotension. Contrast-enhanced computed tomography revealed pericardial effusion causing cardiac tamponade, necessitating emergency pericardial decompression via left fourth intercostal mini-thoracotomy and drain placement. Upon transfer to the intensive care unit, 1200 mL of blood was drained from the chest tube, prompting a return to the operating room for a median sternotomy. It was discovered that the pacemaker lead on the left side of the right atrium had slowly eroded into the aorta, leading to perforation. The ascending aorta was repaired and hemostasis was achieved; the patient recovered uneventfully and was discharged on postoperative day 18. CONCLUSIONS: The pacemaker lead perforated the right atrium; chronic abrasion of the lead against the ascending aorta resulted in bleeding from the ascending aorta 3 months later.

DOI： 10.1186/s43044-024-00494-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jvs.2023.08.115

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

An 85-year-old man underwent hemiarthroplasty for a left intertrochanteric femoral fracture at another hospital two years prior. While under outpatient monitoring, the left femur displacement occurred. Therefore, total hip arthroplasty of the left hip was scheduled. However, during acetabular cup insertion damage to the inner plate led to a sudden decrease in blood pressure from 120 to 60 mmHg. The physicians suspected a pelvic vascular injury and promptly stopped the procedure. In case of adhesion between the acetabular cup and the left iliac vein, intraoperative vascular damage would be repaired via endovascular intervention. Subsequently, orthopedic surgery was cautiously performed, taking into account the potential of a vascular injury. The surgery proceeded as planned without vascular intervention. This case involved a patient with suspected injury to the iliac vein and artery during acetabular cup placement. Following comprehensive enhanced CT and angiography tests, orthopedic surgery was performed in preparation for potential vascular damage, demonstrating the multidisciplinary approach to managing such cases.

DOI： 10.7759/cureus.60589

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J01122&link_issn=&doc_id=20240528210003&doc_link_id=10.4326%2Fjjcvs.53.100&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.53.100&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The case involves a 37-year-old female who was diagnosed with undifferentiated immunodeficiency and protein-losing gastroenteropathy at the age of 26 and was under outpatient care in the gastroenterology department while taking Prednisolone 15mg. At the age of 37, she experienced loss of consciousness and was diagnosed with a right occipital lobe arteriovenous malformation upon investigation. Although initially managed conservatively, she presented the following month with a right-sided headache and vomiting and was urgently transported to our hospital. Imaging with contrast-enhanced CT revealed bleeding from the arteriovenous malformation. Emergency craniotomy was performed, followed by ventricular drainage. Two weeks later, she underwent transcatheter arterial embolization of the main feeder via the right femoral artery approach, followed by excision of the arteriovenous malformation the next day. Subsequently, she had an uneventful recovery. A confirmation CT angiography before discharge revealed severe stenosis of the right common femoral artery, leading to a referral to the cardiovascular surgery department. The stenosis was attributed to the Pro-Glide used for hemostasis during the embolization procedure. Repair surgery was performed, during which CT angiography revealed arteriovenous malformations in both the popliteal fossae and the foot.

DOI： 10.7759/cureus.58336

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

医中誌

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/icvts/ivae044

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 77-year-old male patient with immunoglobulin (Ig)G4-related disease was diagnosed with a 60-mm aortic arch aneurysm and atherosclerosis of the aorta advanced throughout the body. Aortic arch replacement surgery was performed with circulatory arrest at 28°C. One week later, the patient developed acute pancreatitis, followed by encapsulated necrosis in the chronic phase. After debridement surgery, the patient's condition improved.

DOI： 10.7759/cureus.56805

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/omcr/omae015

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In patients with retrosternal neo-esophageal conduit after right thoracotomy, the approach to cardiac surgery could be challenging. Particularly, in patients with infective endocarditis, there is a risk of injury to the conduit through standard median sternotomy. Moreover, right lung adhesions could be predicted. Herein, we present a case of successful mitral valve repair in a patient with infective endocarditis through a redo right thoracotomy after esophageal reconstruction. CASE PRESENTATION: A 66-year-old male patient was diagnosed with infective endocarditis and a large anterior mitral leaflet vegetation after a previous esophageal reconstruction via right thoracotomy for esophageal cancer. Due to the retrosternal esophageal reconstruction, we performed a mitral valve repair through a redo right thoracotomy. After resecting the vegetation, the defect was closed with a fresh autologous pericardial patch. Mitral valve annuloplasty was performed. Postoperatively, antibiotics controlled the infection. The patient was discharged on postoperative day 30. CONCLUSIONS: Successful mitral valve repair was performed for infective endocarditis through a redo right thoracotomy after esophageal reconstruction.

DOI： 10.1186/s40792-024-01836-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 66-year-old man with a history of type 2 diabetes mellitus who was undergoing hemodialysis presented with angina. Coronary angiography revealed triple-vessel coronary artery disease. He underwent multiple percutaneous coronary interventions due to recurrent restenosis and was referred for coronary artery bypass grafting (CABG). The left internal thoracic artery and bilateral saphenous veins were harvested under general anesthesia. Four CABGs were performed: left internal thoracic artery to the left anterior descending artery; saphenous vein graft to the obtuse marginal branch of the circumflex artery; and saphenous vein graft to two sites in the right coronary artery. Intraoperative assessment with transit-time flow measurements showed no abnormalities, and the surgery was completed. On postoperative day seven, coronary and graft angiography revealed dissection of the left internal thoracic artery at its midportion with restricted flow. On postoperative day eight, a surgical intervention was performed to excise the dissected segment of the left internal thoracic artery. The dissection site was identified by fluorescence imaging. The dissected segment was excised, and the artery was re-anastomosed. The postoperative course was uneventful, and graft angiography performed on postoperative day 22 confirmed good blood flow. Fluorescence imaging was valuable in identifying the dissection site in the left internal thoracic artery.

DOI： 10.7759/cureus.55199

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記述言語：英語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：英語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：英語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：英語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：英語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background We focused on coronary artery bypass grafting using the great saphenous vein and compared the no-touch great saphenous vein and conventional great saphenous vein. Methods Coronary artery bypass grafting using the great saphenous vein was performed at our hospital over a 15-year period from 2007/04 to 2022/08. The primary endpoint was the patency of the great saphenous vein at discharge, and secondary endpoints were delayed healing of the great saphenous vein harvest wound, delayed healing of the mid-thoracic wound, and factors related to coronary artery bypass surgery. Results There were 183 patients who underwent coronary artery bypass surgery using the great saphenous vein during the study period. There were 131 male patients (72%) and 52 female patients (28%) with a mean age of 69 years (38-94 years). The method of harvesting the great saphenous vein was a no-touch great saphenous vein graft (NT-SVG) in 29 cases (16%) and conventional SVG in 154 cases (84%). Patients were divided into two groups: the NT-SVG group and the standard-collection saphenous vein graft (SVG) group. We compared graft patency at discharge, healing failure of the lower leg wound, healing failure of the mid-thoracic wound, and flow by transit-time flow measurement (TTFM). Conclusion There were no significant differences in perioperative outcomes between the NT-SVG and conventional SVG groups in this study.

DOI： 10.7759/cureus.50777

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記述言語：日本語   出版者・発行元：(一社)日本フットケア・足病医学会  

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 74-year-old man with pemphigoid, for which he was on a daily regimen of 14 mg of prednisolone and immunosuppressive drugs, was admitted to the orthopedic surgery department with a fever of 38 °C. An MRI scan of his head revealed multiple bilateral cerebral infarcts, and echocardiography showed a 30-mm structure attached to the anterior apex of the mitral valve. The patient was diagnosed with infective endocarditis and administered antibiotic therapy. Five days after the diagnosis, the patient underwent mitral valve surgery, during which the mitral valve was observed to be severely deteriorated and hence replaced with a bioprosthetic valve. Blood flow disturbance was observed in the right lower extremity, and a thrombectomy was performed. A dispersed vegetation around the heart was observed and removed. After the surgery, the patient progressed without mediastinitis and had a good postoperative course. He was discharged from the hospital on the 56th postoperative day after continued antibiotic therapy.

DOI： 10.7759/cureus.48474

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: After a median sternotomy, mediastinitis may develop, necessitating reopening of the chest. Rarely, reoperation due to hematoma after cardiovascular surgery is experienced. In the present case, we experienced a patient who initially had mediastinitis, but later developed a chronic hematoma and underwent multiple surgeries. CASE PRESENTATION: The patient was a 40-year-old man who underwent aortic valve replacement for a bicuspid aortic valve and a graft for a dilated ascending aorta. Postoperatively, he developed hematoma in the anterior mediastinum on multiple occasions with repeated episodes of infection that required multiple median sternotomies. CONCLUSIONS: We reported our experience with a rare case of multiple median sternotomies. In the early stage, mediastinitis due to infection was observed, and in the late stage, mediastinal dilatation due to hemorrhage was observed.

DOI： 10.1186/s43044-023-00411-z

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Various preventive measures and treatment methods exist to prevent paraplegia during thoracic aortic surgery. Postoperative cerebrospinal fluid drainage (CSFD) is one of the treatment options when paraplegia occurs. This study aimed to evaluate the neurological efficacy of postoperative CSFD in patients undergoing thoracic aortic and thoracoabdominal aortic surgery. METHODS: We analyzed perioperative data from 85 patients who underwent perioperative CSFD for thoracic and thoracoabdominal aortic surgery between January 2006 and December 2022, focusing on neurological changes. A total of 61 patients (72%) received preoperative CSFD, and 24 patients (28%) received postoperative CSFD. Perioperative neurological data were analyzed with a focus on perioperative changes. RESULTS: In the postoperative CSFD group, the manual muscle test (MMT) score before CSFD was 0.8, that just after CSFD was 2.4, and that at discharge was 3.0. Therefore, postoperative CSFD improved MMT scores compared with preoperative CSFD. The mean time between surgery completion and postoperative CSFD implantation was 9.8 hours. However, 6 (25%) of the patients who developed postoperative paraplegia and underwent early postoperative CSFD remained paraplegic without any improvement. In the preoperative CSFD group, there was only one case (2%) of postoperative paraplegia. CONCLUSIONS: Postoperative CSFD improved the neurological prognosis of individuals undergoing thoracic aortic and thoracoabdominal aortic surgery. However, 25% of the patients remained paraplegic despite postoperative CSFD.

DOI： 10.21037/jtd-23-631

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present a case of an 82-year-old male patient with a history of severe mitral regurgitation, severe aortic regurgitation, chronic atrial fibrillation, and suicide attempts due to depression. The patient underwent mitral valvuloplasty and aortic valve replacement for mitral valve regurgitation and aortic valve regurgitation. The patient was extubated on the morning of the sixth postoperative day, but he was reintubated in the evening because of hypotension and an unstable respiratory status. Echocardiography revealed Takotsubo cardiomyopathy development, and the patient was treated with intra-aortic balloon pump (IABP) implantation, which was removed on postoperative day 11.

DOI： 10.7759/cureus.43175

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The purpose of this study is to evaluate the results of vascular surgery performed at our hospital, a tertiary emergency general hospital, in patients undergoing surgery in other departments. The results of the study were reviewed. METHODS: The study included cases in which cardiovascular surgery was performed at the request of other departments over a 15-year period from January 2006 to October 2022. Patient backgrounds, departments that requested surgery, surgical procedures, use of extracorporeal circulation, and surgical techniques were reviewed. Patients with femoral artery exposure or ECMO removal during transcatheter aortic valve implantation (TAVI) requested by cardiology were excluded. RESULTS: There were 58 vascular surgery cases requested by other departments during the study period. The age was 63±14 years, 43 (74%) were male and 15 (26%) were female. The departments of the patients were urology in 29 (50%), gastroenterology in 18 (31%), orthopedics in seven (12%), emergency department in three (5%), and obstetrics and gynecology in one (2%). The following surgical procedures were performed: tumor resection and reconstruction due to tumor invasion of the inferior vena cava in 27 cases (47%), bypass to secure intraperitoneal arterial blood flow in 15 cases (26%), bypass during resection of the femoral tumor in four cases (7%), hemostasis due to trauma in three cases (5%), intraperitoneal hemostasis in three cases (5%), thrombectomy in two cases (3%), and others in four cases (7%). Extracorporeal circulation was used in six (10%) of the patients. CONCLUSION: A 15-year case study of vascular surgery supports operations requested by other departments at our hospital. All reconstructed sites were open at the time of discharge.

DOI： 10.7759/cureus.43833

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report a case of a 71-year-old female with a primary cardiac tumor. The patient had undergone surgery for uterine cancer 10 years ago and presented to a nearby clinic complaining of dyspnea on exertion. Chest X-ray revealed cardiac enlargement, prompting further investigations, which revealed a massive tumor protruding into the left atrium and extending toward the outer wall of the left ventricle. The patient was referred to a cardiac surgery department for myocardial biopsy. The tumor biopsy confirmed a diagnosis of a vascular tumor. Due to the tumor's large size and the difficulty in achieving complete resection, a conservative approach was chosen as the patient expressed a preference for non-surgical treatment. This is an extremely rare case of a large primary cardiac tumor, and we report it accordingly.

DOI： 10.7759/cureus.43818

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We herein report the 10-year surgical course of a 27-year-old woman who underwent two surgeries after being diagnosed with Loeys-Dietz syndrome. As described in previous cases, this patient developed ectopic arterial enlargement. We followed her temporal changes over a 10-year period, including the changes in computed tomography, pathology, and surgery.

DOI： 10.1186/s13019-023-02322-1

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01122&link_issn=&doc_id=20230731170013&doc_link_id=10.4326%2Fjjcvs.52.269&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.52.269&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: This multicenter, prospective, observational study aimed to compare Zilver PTX and Eluvia stents in real-world settings for treating femoropopliteal lesions as the differences in the 1-year outcomes of these stents have not been elucidated. MATERIALS AND METHODS: Overall, 200 limbs with native femoropopliteal artery disease were treated with Zilver PTX (96 limbs) or Eluvia (104 limbs) at 8 Japanese hospitals between February 2019 and September 2020. The primary outcome measure of this study was primary patency at 12 months, defined as a peak systolic velocity ratio of ≤2.4, without clinically-driven target lesion revascularization (TLR) or stenosis ≤50% based on angiographic findings. RESULTS: The baseline clinical and lesion characteristics of Zilver PTX and Eluvia groups were roughly comparable (of all limbs analyzed, approximately 30% presented with critical limb-threatening ischemia, approximately 60% presented with Trans-Atlantic Inter-Society Consensus II C-D, and approximately half had total occlusion), except for the longer lesion lengths in the Zilver PTX group (185.7±92.0 mm vs 160.0±98.5 mm, p=0.030). The Kaplan-Meier estimates of primary patency at 12 months were 84.9% and 88.1% for Zilver PTX and Eluvia, respectively (log-rank p=0.417). Freedom from clinically-driven TLR rates were 88.8% and 90.9% for Zilver PTX and Eluvia, respectively (log-rank p=0.812). CONCLUSIONS: The results of the Zilver PTX and Eluvia stents were not different regarding primary patency and freedom from clinically-driven TLR at 12 months after treating patients with femoropopliteal peripheral artery disease in real-world settings. CLINICAL IMPACT: This is the first study to reveal that the Zilver PTX and Eluvia have similar results in real-world practice when the proper vessel preparation is performed. However, the type of restenosis in the Eluvia stent may differ from that in the Zilver PTX stent. Therefore, the results of this study may influence the selection of DES for femoropopliteal lesions in routine clinical practice.

DOI： 10.1177/15266028231179861

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01375&link_issn=&doc_id=20230731050002&doc_link_id=%2Fdc7hksrg%2F2023%2F006801%2F003%2F0009-0014%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdc7hksrg%2F2023%2F006801%2F003%2F0009-0014%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To report the initial outcomes of physician-modified inner branched endovascular repair (PMiBEVAR) for pararenal aneurysms (PRAs), thoracoabdominal aortic aneurysms (TAAAs), and aortic arch aneurysms in high-surgical-risk patients. MATERIALS AND METHODS: A total of 10 patients (6 men; median age, 83.0 years) treated using PMiBEVAR were enrolled in this retrospective, single-center study. All patients were at high surgical risk because of severe comorbidities (American Society of Anesthesiologists physical status score≥3 or emergency repair). End points were defined as technical success per patient and per vessel (successful deployment), clinical success (no endoleaks postoperatively), in-hospital death, and major adverse events. RESULTS: There were 3 PRAs, 4 TAAAs, and 3 aortic arch aneurysms with 12 renal-mesenteric arteries and 3 left subclavian arteries incorporated by inner branches. The technical success rate was 90.0% (9/10) per patient and 93.3% (14/15) per vessel. The clinical success rate was 90% (9/10). There were 2 in-hospital deaths, unrelated to aneurysms. Paraplegia and shower emboli occurred separately in 2 patients. Three patients experienced prolonged ventilation for 3 days after surgery. Aneurysm sac shrinkage occurred in 4 patients, and aneurysm size stabilized in 1 patient during follow-up, more than 6 months later. None of the patients required intervention. CONCLUSION: PMiBEVAR is a feasible approach for treating complex aneurysms in high-surgical-risk patients. This technology may complement the existing technology in terms of improved anatomical adaptability, no time delay and practicability in many countries. However, long-term durability remains undetermined. Further large-scale and long-term studies are needed. CLINICAL IMPACT: This is the first clinical study to investigate outcomes of physician-modified inner branched endovascular repair (PMiBEVAR). PMiBEVAR for treating pararenal aneurysm, thoracoabdominal aortic aneurysm, or aortic arch aneurysm is a feasible procedure. This technology is likely to complement existing technology in terms of improved anatomical adaptability (compared to off-the-shelf devices), no time delay (compared to custom-made devices), and the potential to be performed in many countries. On the other hand, surgery time varied greatly depending on the case, suggesting a learning curve and the need for technological innovation to perform more consistent surgeries.

DOI： 10.1177/15266028231169183

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

医中誌

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: We analyzed the temperature in proximal aortic repair with moderate hypothermic circulatory arrest (HCA) and evaluated the effect of the cooling status on postoperative outcomes. METHODS: A total of 340 patients who underwent elective ascending aortic replacement or total arch replacement with moderate HCA from December 2006 to January 2021 were studied. The change in body temperature trends recorded during surgery was shown graphically. Several parameters, such as the nadir temperature, cooling speed and the degree of cooling (cooling area), which was the area under curve of inverted temperature trends from cooling to rewarming as calculated by the integral method, were analyzed. The relationships between these variables and a major adverse outcome (MAO) postoperatively defined as prolonged ventilation (>72 h), acute renal failure, stroke, reoperation for bleeding, deep sternal wound infection or in-hospital death were evaluated. RESULTS: An MAO was observed in 68 patients (20%). The cooling area was larger in the MAO group than in the non-MAO group (1668.7 vs 1383.2°C min; P < 0.0001). A multivariate logistic model showed that old myocardial infarction, peripheral vascular disease, chronic renal dysfunction, cardiopulmonary bypass time and the cooling area were independent risk factors for an MAO (odds ratio = 1.1 per 100°C min; P < 0.001). CONCLUSIONS: The cooling area, which indicates the degree of cooling, shows a significant relationship with an MAO after aortic repair. This finding indicates that the cooling status with HCA can affect clinical outcomes.

DOI： 10.1093/icvts/ivac282

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circj.CJ-22-0550

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jvscit.2022.04.016

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jcin.2022.03.010

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hematocrit (Hct) values after the initiation of cardiopulmonary bypass (CPB) must be maintained appropriately to avoid perioperative complications. Therefore, an accurate prediction is required. However, the standard prediction equation often results in actual values that are lower than the predicted values. This study aimed to clarify the limits of agreement (LOA) and bias of the prediction equations and investigate better the prediction equations. A retrospective study was performed on adult patients between April 2015 and December 2020. Study 1 included 158 patients, and Study 2 included 55 patients. The primary outcomes were the LOA and bias between the predicted and measured Hct values after the initiation of CPB, and two studies were conducted. In Study 1, total blood volume (TBV) was estimated, and the new blood volume index (BVI) was calculated. BVI was also evaluated for the overall value and gender differences. Therefore, the patient's background was compared by gender differences. In, Study 2 the conventional predicted equation (Eq. 1), the predicted equation using the new BVI (Eq. 2), and the predicted equation using the new BVI including physiological factors in the TBV equation (Eq. 3) were compared. In Study 1, BVI was 53 (44-67) mL/kg. In Study 2, bias ± LOA was - 2.5 ± 6.8% for Eq. 1, 0.1 ± 6.6% for Eq. 2, and 0.4 ± 6.2% for Eq. 3. The new equation is expected to predict the Hct value after the initiation of CPB with better LOA and bias than the conventional equation.

DOI： 10.1007/s10047-021-01295-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present a case report of a 30-year-old Marfan syndrome patient who underwent a David procedure for severe aortic valve insufficiency and Valsalva aneurysm. Harvested aortic walls were examined by pathologists. Although the tunica media of the ascending aorta contained aligned elastic fibers, the aortic root media lacked aligned elastic fibers.

DOI： 10.5761/atcs.cr.22-00044

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Thoracoabdominal aortic aneurysm (TAAA) repair remains challenging in patients with high surgical risk. We report a case of TAAA in an 84-year-old woman with type Ib endoleak after thoracic endovascular aortic repair with coeliac artery coverage due to impending ruptured TAAA. A stent graft was assembled to create 3 fenestrations and sew 3 inner grafts for the superior mesenteric artery (SMA) and bilateral renal arteries. This stent graft system was inserted into the thoraco-abdominal aorta and partially unsheathed until the first inner branch endograft fully expanded. The wire was used to catheterize the stent graft, inner branch, and SMA from the left upper limb, and a bridge stent was deployed from the inner branch to the SMA. A similar procedure was performed for bilateral renal arteries. The stent graft system was fully unsheathed. Postoperative computed tomography angiography revealed no endoleak and good flow of the visceral artery. The use of the physician-modified inner branched endograft system described is feasible and can make TAAA endovascular repair simpler and safer.

DOI： 10.1093/ejcts/ezab543

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We created an estimation model for hypothermic circulatory arrest time and analyzed the risk factors for major adverse outcomes in total arch replacement. METHODS: This study involved 272 patients who underwent total arch replacement. The estimation model for hypothermic circulatory arrest time was established using multiple linear regression analysis, and the predicted hypothermic circulatory arrest time from this model was analyzed to detect risk factors. RESULTS: Atrial fibrillation, rupture, malperfusion, saccular aneurysm, cardiopulmonary bypass time, and hypothermic circulatory arrest time were identified as independent risk factors associated with major adverse outcomes. The estimation model for hypothermic circulatory arrest time was established as follows: hypothermic circulatory arrest time = 99.3 - 0.19 × age + 0.65 × body mass index + 6.19 × previous cardiac operation + 11.7 × acute dissection + 8.9 × rupture + 0.19 × aortic angulation + 0.15 × length to the distal anastomosis site - 6.17 × total arch replacement surgeon case volume - 3.06 × surgery year. The predicted hypothermic circulatory arrest time calculated by this estimation model was evaluated using multivariate logistic analysis, which identified atrial fibrillation, rupture, malperfusion, saccular aneurysm, and predicted hypothermic circulatory arrest time as risk factors. CONCLUSIONS: As with the actual hypothermic circulatory arrest time, the predicted hypothermic circulatory arrest time using our model detected significant factors associated with major adverse outcomes. These results indicated that this prediction model for hypothermic circulatory arrest time may be effective.

DOI： 10.1016/j.athoracsur.2020.12.060

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Cases of coronary artery occlusion due to the exclusion of pulmonary artery aneurysm are extremely rare, and there are few reports of surgical treatment. A 60-year-old woman with pulmonary hypertension due to an atrial septal defect and obstruction of the left main coronary trunk due to the exclusion of a giant pulmonary artery aneurysm underwent surgery. The surgery included atrial septal defect closure, tricuspid annulus plasty, pulmonary artery aneurysmorrhaphy, and coronary artery bypass grafting. One and a half years after the surgery, no re-expansion of the pulmonary artery was observed, and the symptoms of heart failure had improved. There are no reports of improvement in pulmonary valve regurgitation by aneurysmorrhaphy in pulmonary artery aneurysm. Surgery for pulmonary artery aneurysm with the exclusion of other organs was effective, and aneurysmorrhaphy for pulmonary artery aneurysm was acceptable.

DOI： 10.1007/s11748-021-01653-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: There are a lot of reports of the renal failure and heart failure due to coarctation of the aorta. However, there are no case reports in which revascularization dramatically improved left ventricular function in patients with progressive decline in left ventricular function. Herein, we present a rare case in which the left ventricular function was dramatically improved by surgical treatment for progressive left ventricular dysfunction due to atypical coarctation of the aorta. CASE PRESENTATION: A 58-year-old man underwent left axillary artery-bilateral femoral artery bypass at another hospital for atypical coarctation of the aorta due to Takayasu's arteritis. Approximately 10 years later, he was re-hospitalized for heart failure, and the left ventricular ejection fraction gradually decreased to 28%. Computed tomography showed severe calcification and stenosis at the same site from the peripheral thoracic descending aorta to the lower abdominal aorta of the renal artery, and aortography showed delayed bilateral renal artery blood flow. An increase in plasma renin activity was also observed. Despite the administration of multiple antihypertensive drugs, blood pressure control was insufficient. We decided to perform surgical treatment to improve progressive cardiac dysfunction due to increased afterload and activated plasma renin activity. Descending thoracic aorta-abdominal aorta bypass and revascularization of the bilateral renal arteries via the great saphenous vein grafts were performed. Postoperative blood pressure control was improved, and the dose of antihypertensive drugs could be reduced. Plasma renin activity decreased, and transthoracic echocardiography 1.5 years later showed an improvement in contractility with a left ventricular ejection fraction of 58%. CONCLUSION: In atypical coarctation of the aorta in patients with decreased bilateral renal blood flow, heart failure due to renal hypertension, and progressive decrease in left ventricular contractility, descending thoracic aorta-abdominal aortic bypass and bilateral renal artery recirculation can be extremely effective.

DOI： 10.1186/s13019-021-01598-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1177/1358863X21995573

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Ischaemic spinal cord injury (SCI) is one of the most serious complications of aortic surgery. Ischaemic SCIs occur due to various aetiologies, and prediction of the risk is difficult. Magnetic resonance imaging (MRI) is useful to detect the details of spinal cord infarction. There are few studies about MRI for evaluating ischaemic SCI after cardiovascular surgery and aortic events. We report 9 cases of postoperative ischaemic SCI and analyse their MRI features. METHODS: T2-weighted MRI scans of 9 patients who developed ischaemic SCI due to cardiovascular surgery and aortic events between 2012 and 2017 were evaluated. RESULTS: In all patients, high-intensity areas were observed on T2-weighted magnetic resonance images. The site of infarction was the thoracic spinal cord level (9 cases) and additionally at the lumbar spinal cord level (5 cases). The area of infarction area was categorized based on the arterial territory: anterior spinal artery territory (3 cases), posterior spinal artery territory (2 cases), spinal sulcal artery territory (1 case) and artery of Adamkiewicz territory (3 cases). CONCLUSIONS: MRI revealed the infarction sites in all cases and the differences in the infarction patterns in each case. MRI could thus be useful for investigating the aetiology of ischaemic SCI following aortic surgeries and events.

DOI： 10.1093/ejcts/ezaa476

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To assess skin perfusion pressure (SPP) changes after endovascular treatment (EVT) of patients with chronic limb-threatening ischemia (CLTI) and to explore preoperative factors that affect SPP changes. MATERIALS AND METHODS: This prospective, multicenter study recruited 147 patients (mean age 74 years; 99 men) with ischemic wounds at 6 vascular centers in Japan between July 2017 and December 2018. Over half of the patients (92, 63%) were diabetic, and 76 (52%) required dialysis. Sixty-four patients (43%) had WIfI (wound, ischemia, foot infection) wound grades of 2 or 3; 59 (40%) had foot infections. SPP was measured before and 1, 2, 7, and 30 days after EVT to establish inline flow to the ischemic foot based on the angiosome concept when feasible. The anterior and posterior tibial arteries and the peroneal artery were revascularized in 66 (45%), 50 (34%), and 30 (21%) patients, respectively. RESULTS: Both the dorsal and plantar SPPs at 1 or 2 days post-EVT were significantly higher than those at baseline (p<0.001), and both SPPs increased further at 1 month compared with those at 1 (p=0.001) or 2 days (p=0.006) post-EVT. SPP increases occurred on the dorsal and plantar surfaces of the foot regardless of the vessel revascularized. The SPP increase at 1 month after EVT was significantly lower in patients with foot infections than that in those without foot infections (p=0.003). Age, sex, diabetes, dialysis, wound severity, and direct revascularization did not affect the pattern of SPP change. CONCLUSION: The SPP increased continuously up to 1 month after EVT, though the increase was smaller in patients with wound infections. The SPP on the dorsal and plantar surfaces increased, regardless of the vessel revascularized, which could justify indirect revascularization when direct revascularization is technically challenging.

DOI： 10.1177/1526602820963932

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Generally, proximal endograft failure after total arch debranching and thoracic endovascular repair (TEVAR) is one of the most difficult problems because re-sternotomy poses extremely high risks to patients with high surgical risk. Herein, we report an endovascular technique using surgeon-modified endovascular grafts for a patient with ruptured arch aneurysm caused by type Ia endoleak following total arch debranching and TEVAR.

DOI： 10.1007/s11748-020-01414-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Limited data is available on the use of a polyester graft limb with a helical stent configuration deployed in the external iliac artery (EIA) during endovascular aneurysm repair (EVAR), so we prospectively analyzed the efficacy of the Zenith Spiral-Z limb deployed in the EIA.Methods and Results:Patients undergoing EVAR using a Zenith stent-graft and Spiral-Z limb deployed in the EIA were prospectively registered in 24 Japanese institutions from June 2017 to November 2017. In total, 65 patients (74 limbs) (mean age: 77.1±8.0 years, 87.7% men, mean abdominal aortic aneurysm (AAA) diameter: 51.9±7.2 mm, mean iliac artery aneurysm (IAA) diameter: 38.3±10.0 mm) were registered and followed up. The most common reason for deployment in the EIA was a common IAA (43 limbs, 58.1%), and 8 limbs (10.8%) had a bare nitinol stent placed at the Spiral-Z limb. A total of 61 patients (70 limbs) completed a 24-month follow-up. There were 2 Spiral-Z limb stenoses and 1 occlusion, leading to a primary patency of 95.5% and a secondary patency of 100%, at 24 months. Buttock claudication occurred in 24.3% of the limbs treated at 1 month but decreased to 4.3% at 24 months. CONCLUSIONS: Our multicenter prospective study showed that Spiral-Z limb deployed in the EIA was associated with satisfactory results and seems to be a durable option, even in the era of iliac branch devices.

DOI： 10.1253/circj.CJ-20-0195

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose: To evaluate the effect of vessel calcification on in-stent restenosis (ISR) after drug-coated stent (DCS) placement in the femoropopliteal segment. Materials and Methods: A retrospective multicenter study was undertaken involving 220 consecutive symptomatic patients (mean age 73.1±8.3 years; 175 men) with femoropopliteal lesions in 230 limbs treated with the Zilver PTX DCS and having duplex surveillance after the endovascular procedures. Mean lesion length was 16.4±9.8 cm (range 2-40); there were 104 (45.2%) total occlusions and 68 (29.6%) in-stent restenoses (ISR). Twenty (8.7%) vessels had no runoff. The majority of lesions (148, 64.3%) were calcified according to the peripheral arterial calcium scoring system (PACSS). Primary patency was evaluated by duplex. Lesions were classified as either PACSS 0-2 (none or unilateral wall calcification) or PACSS 3 and 4 (bilateral wall calcification). Multivariate analysis was performed to identify variables associated with ISR; the results are given as the hazard ratio (HR) and 95% confidence interval (CI). Results: The 1-, 2-, and 5-year primary patency and freedom from clinically-driven target lesion revascularization estimates were 75.9%, 63.6%, and 45.0%, and 84.7%, 73.7%, and 54.2%, respectively. Major amputations were performed on 4 limbs during follow-up. In multivariate analysis, vessel calcification (adjusted HR 1.718, 95% CI 1.035 to 2.851, p=0.036) was significantly correlated with the occurrence of ISR, along with lesion length (adjusted HR 1.041, 95% CI 1.013 to 1.070, p=0.003), and cilostazol administration (adjusted HR 0.476, 95% CI 0.259 to 0.876, p=0.017). Conclusion: This study suggested that bilateral vessel wall calcification was an independent risk factor for ISR in complex femoropopliteal lesions after Zilver PTX DCS placement, along with lesion length; cilostazol administration had a protective effect.

DOI： 10.1177/1526602819860124

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 74-year-old woman was admitted for the management of nausea with hyponatremia. On the 19th day of hospitalization, the patient developed cardiac arrest and needed cardiopulmonary resuscitation (CPR). CPR was successful but the patient developed multiple rib fractures with flail chest by CPR. Because of persistent dyspnea, surgery for fixing of the fractured ribs was performed using 4 titanium plates, with prompt improvement of the flail chest after the operation.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Often, we experience cases of aneurysm shrinkage and no aneurysm shrinkage after successful endovascular aortic aneurysm repair, without postoperative endoleaks. We studied these cases to ascertain the predictive factors for aneurysm shrinkage. METHODS: From 2007 to 2014, we selected 255 cases that comprised aneurysm shrinkage (>4 mm) and no-shrinkage cases (shrinkage from 0 to 4 mm). Excluding 36 cases of endoleaks, 43 cases without 1-year follow-up computed tomography scan, and 3 cases of aortic dissection, we assessed 93 cases of aneurysm shrinkage (S group) and 80 cases of no aneurysm shrinkage (N group) at 1-year follow-up. RESULTS: No significant differences were found in sex, comorbidities (diabetes mellitus, chronic kidney disease, hemodialysis, and malignancy), and medications (antiplatelet drugs, anticoagulant drugs, steroids, and statins). Advanced age was a strong negative predictive factor for aneurysm shrinkage (N: 75.0 ± 1.0 vs. S: 72.1 ± 0.9 years; P = 0.023), and intraoperative endoleaks were more frequent in the N group (N: 31.3 vs. S: 9.7%; P = 0.001). Neck thrombus was more likely in the N group (N: 17.5 vs. S: 7.5%; P = 0.045), but it had a strong correlation with intraoperative endoleaks (P = 0.008). In the multivariate analysis, patient age and intraoperative endoleaks were predictive factors for aneurysm shrinkage. CONCLUSIONS: Advanced age and intraoperative endoleaks were negative predictive factors for aneurysm shrinkage at 1-year follow-up after successful endovascular treatment without postoperative endoleaks.

DOI： 10.1016/j.avsg.2018.04.032

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

An 83-year-old woman with a Kommerell diverticulum was treated by anatomical endovascular repair with a deep site in-situ fenestration instead of complex debranching techniques. The main component of the thoracic stent-graft was deployed just distal to the third cervical branch to completely exclude the Kommerell diverticulum. A deep site in-situ fenestration was made on the main component using a radiofrequency needle through the left subclavian artery, and a stent-graft was deployed to bridge the main component to the left subclavian artery. Six months postoperatively, the Kommerell diverticulum was completely excluded with excellent left subclavian artery patency.

DOI： 10.1177/0218492318785250

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 19-year-old male patient was admitted to our hospital after developing infectious endocarditis associated with methicillin-sensitive bovine Staphylococcus aureus septicemia. Brain magnetic resonance imaging confirmed occipital lobe cerebral bleeding. An echocardiogram showed severe mitral regurgitation with vegetation on the posterior mitral leaflet. We performed mitral valve replacement. However, a hepatic artery aneurysm and a ruptured splenic artery aneurysm was found on the 5th postoperative day and coil embolization was accordingly performed. The patient suffered repeated cerebral bleeding and received external decompression. He was discharged on the 92nd day after the valve replacement. Our case is rare in that methicillin-sensitive bovine Staphylococcus aureus isolated from human is extremely unusual especially complicated by multiple peripheral aneurysms. This is the 1st reported case of methicillin-sensitive bovine Staphylococcus aureus isolated from human in the Japanese literature.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To evaluate outcomes of physician-modified thoracic stent-grafts for the treatment of aortic arch aneurysms. METHODS: A retrospective dual-center analysis was performed involving 36 patients (mean age 74.7±9 years, range 58-91; 27 men) with an aortic arch lesion who were treated between November 2013 and June 2016 using physician-modified thoracic stent-grafts. Half of the patients had a degenerative aneurysm; the remainder had type B dissection (n=9), traumatic transection (n=3), type Ia endoleak after previous endografting (n=5), or aortoesophageal fistula (n=1). All patients were considered to be at high surgical risk. Patients were treated using an aortic arch stent-graft with a single fenestration (n=24) or a proximal scallop (n=12); zone 0 was involved in 16 patients, zone 1 in 9, and zone 2 in 11. The modified thoracic stent-graft was deployed after supra-aortic branch revascularization in 24 (67%) patients. RESULTS: Mean time required for stent-graft modifications was 18 minutes (range 14-21). Technical success was obtained in all cases with no type I endoleak. One (3%) patient had a stroke without permanent sequelae. The 30-day mortality was 6%. During a mean follow-up of 11.4±6 months (range 2-36), there were no conversions to open repair. The overall mortality was 14%; aorta-related mortality was 6%. CONCLUSION: Our experience suggests that physician-modified thoracic stent-grafts are feasible for aortic arch lesions and provide encouraging results in the short term. Durability concerns will need to be assessed.

DOI： 10.1177/1526602817714206

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Echographic examination for leg vein thromboembolism was carried out in 123 patients scheduled for thoracic surgery. Preventive measures for thromboembolism were conducted after the risk assessment. Echography was done after surgery in 72 cases, most of which were cases of lung malignant tumors, and thromboembolism was detected in 4 cases. Thus, the incidence rate of venous thromboembolism was 5.6%( 4/72). There was no patients who developed pulmonary thromboembolism during the examination period, suggesting reasonable risk assessment and preventive measures in our procedure.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A pedicled pericardial fat pad (PPFP) is often used in pulmonary resection to reinforce bronchial sutures. Here, we assessed the significance of PPFP by serial chest computed tomography (CT). Ten cases in which bronchial stump were covered with a PPFP in the past 6 years were reviewed. The procedures were pneumonectomy (3), lobectomy (6), and a segmentectomy. According to the CT value evaluated serially PPFP was recognized as fat tissue until 1~2 postoperative months. No cases of bronchopleural fistulae was encountered in this series. The coverage of the sutures with the PPFP was thought to contribute to the prevention of bronchial fistula by staying around bronchial stump for at least 1 to 2 months.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Aneurysms of the aortic arch are technically challenging to repair with thoracic endovascular aneurysm repair (TEVAR). Various optional techniques such as debranching or hybrid TEVAR enable landing zones to extend, however, there is still room for improvement. We have performed total debranching to facilitate TEVAR with adequate central neck length more than 2.5 cm. In summary our procedure has 3 features:mini-thoracotomy to minimize its surgical stress which might cause post-operative respiratory failure, side-to-side anastomosis of trifurcated graft with ascending aorta to avoid its kinking after chest closure, and the usage of Pruitt-Inahara shunt tube during anastomoses of the carotid artery.

PubMed

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01122&link_issn=&doc_id=20221121310009&doc_link_id=10.4326%2Fjjcvs.51.368&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.51.368&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01122&link_issn=&doc_id=20220728190012&doc_link_id=10.4326%2Fjjcvs.51.249&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.51.249&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01375&link_issn=&doc_id=20220721160006&doc_link_id=%2Fdc7hksrg%2F2022%2F006701%2F007%2F0033-0038%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdc7hksrg%2F2022%2F006701%2F007%2F0033-0038%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01375&link_issn=&doc_id=20220721160002&doc_link_id=%2Fdc7hksrg%2F2022%2F006701%2F003%2F0010-0015%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdc7hksrg%2F2022%2F006701%2F003%2F0010-0015%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01122&link_issn=&doc_id=20220328200010&doc_link_id=10.4326%2Fjjcvs.51.118&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.51.118&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本人工臓器学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：市立函館病院  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J01247&link_issn=&doc_id=20211025430002&doc_link_id=%2Fer5hakod%2F2021%2F004501%2F002%2F0006-0010%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer5hakod%2F2021%2F004501%2F002%2F0006-0010%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J01375&link_issn=&doc_id=20210115020005&doc_link_id=%2Fdc7hksrg%2F2020%2F006502%2F006%2F0126-0132%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdc7hksrg%2F2020%2F006502%2F006%2F0126-0132%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(株)南江堂  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J00393&link_issn=&doc_id=20200520090018&doc_link_id=10.15106%2Fj_geka82_486&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_geka82_486&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J02873&link_issn=&doc_id=20210225320001&doc_link_id=%2Ffj4kekka%2F2020%2F002906%2F001%2F0361-0364%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffj4kekka%2F2020%2F002906%2F001%2F0361-0364%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(公社)日本診療放射線技師会  

医中誌

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記述言語：英語   出版者・発行元：(一社)日本インターベンショナルラジオロジー学会  

医中誌

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記述言語：日本語   出版者・発行元：(株)南江堂  

74歳女。前胸部陥凹、努力性呼吸を主訴とした。QT延長症候群に伴う多形性心室頻拍から心室細動、さらには心停止状態となり、心肺蘇生を果たしたが、胸骨圧迫により多発肋骨骨折を生じた。気管内挿管、人工呼吸器装着という治療経過から胸郭動揺に対して内固定を3日間行い、入院22日目に人工呼吸器を離脱したが、左前胸部の陥凹が著しく増悪した。入院43日目の当科初診時には酸素化は保たれていたが、奇異性呼吸による呼吸障害、喀痰排出障害を認め、胸部CTでは左第2～6肋骨のそれぞれの肋軟骨接合部近傍2ヶ所および右第3～6肋骨に骨折を認めた。整復手術の適応と判断して肋骨固定用チタンプレートによる外科的整復を行ったところ、奇異性努力性呼吸は解消し、CT上も胸部陥凹は矯正された。

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J00349&link_issn=&doc_id=20190411040017&doc_link_id=1390564238085781248&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390564238085781248&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：公益社団法人 日本超音波医学会  

その他リンク:： https://search.jamas.or.jp/link/ui/2019194602

DOI： 10.3179/jjmu.jjmu.a.123

CiNii Research

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J02873&link_issn=&doc_id=20190709390007&doc_link_id=%2Ffj4kekka%2F2019%2F002803%2F007%2F0205-0208%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffj4kekka%2F2019%2F002803%2F007%2F0205-0208%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

医中誌

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記述言語：日本語   出版者・発行元：日本下肢救済・足病学会  

医中誌

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記述言語：日本語   出版者・発行元：日本下肢救済・足病学会  

医中誌

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記述言語：日本語   出版者・発行元：日本下肢救済・足病学会  

医中誌

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記述言語：日本語   出版者・発行元：日本下肢救済・足病学会  

医中誌

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記述言語：日本語   出版者・発行元：日本下肢救済・足病学会  

医中誌

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記述言語：日本語   出版者・発行元：日本下肢救済・足病学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：英語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本静脈学会  

医中誌

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記述言語：日本語   出版者・発行元：(株)南江堂  

症例は19歳男性で、39℃を超える発熱を認めた。発熱が改善せず肝機能障害を併発した。心エコー検査で僧帽弁に疣贅を認め、感染性心内膜炎(IE)と診断した。意識混濁のため頭部CTを施行し、脳出血を認めた。頭部MRI所見では、右後頭葉皮質下に出血性脳梗塞を認めた。腹部CT所見では、脾梗塞、両側腎梗塞を認めた。血液培養結果は、メチシリン感受性黄色ブドウ球菌陽性(遺伝子型KE91株ST20コアグラーゼ型VIII)であった。出血性脳梗塞を伴う活動期IEおよび僧帽弁閉鎖不全症と診断した。可動性の疣贅を認めるものの人工心肺使用に伴う脳出血の増悪リスクが高いと考え、抗生物質治療を開始した。その後の頭部CTで出血に著変なく、入院後15日目に手術を施行した。僧帽弁形成術は困難と判断し、前尖・後尖をすべて切除し、人工弁置換術を施行した。経過良好であったが術後4日目の血液検査でHb、RBCの急激な低下を認めた。CTで肝動脈瘤および破裂性脾動脈瘤を認め、緊急コイル塞栓術を施行した。術後14日に意識混濁を認め、頭部CTで脳出血の再発を認めたため、緊急開頭減圧術を施行した。術後92日に独歩で自宅退院した。

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J00349&link_issn=&doc_id=20180207150007&doc_link_id=1390565159918978560&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390565159918978560&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J01422&link_issn=&doc_id=20171109420002&doc_link_id=10.7133%2Fjca.17-00017&url=https%3A%2F%2Fdoi.org%2F10.7133%2Fjca.17-00017&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：日本下肢救済・足病学会  

医中誌

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記述言語：日本語   出版者・発行元：日本下肢救済・足病学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

医中誌

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記述言語：日本語   出版者・発行元：日本下肢救済・足病学会  

医中誌

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記述言語：日本語   出版者・発行元：日本下肢救済・足病学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：道南医学会  

医中誌

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記述言語：日本語   出版者・発行元：道南医学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(公社)日本診療放射線技師会  

医中誌

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

医中誌

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記述言語：日本語   出版者・発行元：(株)南江堂  

手術前後に下肢静脈超音波検査(エコー)を導入後に、呼吸器外科で手術を行った123例(術式内訳は肺葉切除58例、気胸手術33例、肺部分切除9例、胸腺手術5例、縦隔腫瘍手術4例、その他6例)中、緊急手術、急性期再手術を行った11例を除く112例を対象に、手術前後にエコーを行った78例の静脈血栓塞栓症(VTE)発生頻度を調査した。術前エコーを行った54例でVTEは認めず、術後エコーを行った72例中4例に下肢VTEを認め、この4例は術前エコーでVTEを認めず、術中・術直後にVTEが形成されたと思われ、VTE発症率は5.6%(4/72)であった。呼吸器外科総手術123例に肺血栓塞栓症は認めなかった。下肢VTE形成を認めた4例は、全て肺葉切除+リンパ節郭清を行っており、当院作成の高リスクに分類され、予防策として間欠的空気圧迫が行われていた。4例中3例にwarfarin potassiumを使用し、1例は拒否したが、全例が2.5～5ヵ月で血栓は消失した。

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J00349&link_issn=&doc_id=20160713230001&doc_link_id=1390283684943547904&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390283684943547904&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：英語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：日本下肢救済・足病学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本静脈学会  

医中誌

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記述言語：日本語   出版者・発行元：日本下肢救済・足病学会  

医中誌

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記述言語：日本語   出版者・発行元：日本下肢救済・足病学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

医中誌

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記述言語：日本語   出版者・発行元：日本下肢救済・足病学会  

医中誌

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記述言語：日本語   出版者・発行元：日本下肢救済・足病学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本人工臓器学会  

医中誌

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記述言語：日本語   出版者・発行元：日本下肢救済・足病学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器外科学会  

医中誌

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記述言語：英語   出版者・発行元：(一社)日本外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本人工臓器学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)小切開・鏡視外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

2007～2013年に大動脈疾患に対して外科治療を行った患者のうち術前から透析を受けていた20例の中期成績を報告した。大動脈疾患の内訳は、腹部大動脈瘤8例、真性胸部大動脈瘤6例、慢性B型大動脈解離2例、急性A型大動脈解離2例、急性B型大動脈解離破裂1例、胸腹部大動脈瘤破裂1例であった。術式の内訳は、ステントグラフト留置術14例、人工血管置換術6例であった。術後30日以内の早期死亡が4例(20%)あり、死因はそれぞれ多臓器不全、多発脳梗塞、急性心筋梗塞、急性肺血栓塞栓症であった。術後の生存率(1年・3年)は、1年が64±11%、3年が43±12%であった。大動脈疾患関連事象回避率(1年・3年)は、1年が46±13%、3年が20±12%であった。

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J01422&link_issn=&doc_id=20140826320002&doc_link_id=10.7133%2Fjca.14-00012&url=https%3A%2F%2Fdoi.org%2F10.7133%2Fjca.14-00012&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：日本語   出版者・発行元：(公社)全国自治体病院協議会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J02873&link_issn=&doc_id=20140502420004&doc_link_id=%2Ffj4kekka%2F2014%2F002303%2F004%2F0695-0699%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffj4kekka%2F2014%2F002303%2F004%2F0695-0699%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本静脈学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本静脈学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(株)南江堂  

有茎傍心膜脂肪組織(以下PPFP)は気管支縫合部の補強材料として代表的な自己組織材料であり、当院でも頻用している。今回、2005～2010年に呼吸器外科手術でPPFPを使用した10例のCT所見をもとにPPFPの術後変化を解析し、PPFP使用の意義について検討した。結果、術後1～2ヵ月の時点でPPFPの脂肪組織としてのCT値は保たれていたことから、気管支縫合部補強目的のPPFP被覆は意義があると考えられた。

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J00349&link_issn=&doc_id=20131121120004&doc_link_id=1390282763054690816&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390282763054690816&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J02873&link_issn=&doc_id=20131101370004&doc_link_id=%2Ffj4kekka%2F2013%2F002206%2F004%2F0881-0885%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffj4kekka%2F2013%2F002206%2F004%2F0881-0885%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(株)南江堂  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J00349&link_issn=&doc_id=20130926210012&doc_link_id=1390282763052828416&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390282763052828416&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

医中誌

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記述言語：日本語   出版者・発行元：市立函館病院  

下肢の慢性静脈不全を原因とする静脈性潰瘍や湿疹に不全穿通枝が大きく関わることは20世紀初頭から注目されており、Lintonは静脈性潰瘍を治療するために筋膜下穿通枝を結紮する術式を開発した。この方法は長い間手術療法の第一選択とされてきたが、健常ではない皮膚に長い切開線を置くことから創部合併症が多いという欠点があった。この欠点を補う目的で皮膚への切開をほとんど必要としない内視鏡下不全穿通枝切離術(SEPS)が1980年にドイツで開始され、現在世界で最も受け入れられた治療法となっているが、本邦では保険診療で認められていないため、先進医療として限られた施設でのみ行われている。当院ではこれまでLintonの方法を行っていたが、やはり創部合併症が多いことから、SEPSの導入を決意した。今回、第一例目を経験し、良好な結果が得られたので報告した。

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J01247&link_issn=&doc_id=20131203440001&doc_link_id=%2Fer5hakod%2F2013%2F003701%2F001%2F0001-0003%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer5hakod%2F2013%2F003701%2F001%2F0001-0003%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本静脈学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本静脈学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会