Experience of Popliteal Arterial Aneurysm / 日本心臓血管外科学会雑誌

In general the incidence of peripheral arterial aneurysm is said to be low. We focussed on popliteal aneurysm and enrolled 18 legs in 14 patients with popliteal aneurysm who visited us during the period from 1974 to January 1998 in our study. Acute arterial occlusion was observed as a complication in 6 of the 14 patients (42.9%) and rupture developed in 4 patients (28.6%), and on those occasions this disease was frequently detected and treated for the first time. Although this disease is said to scarcely affect prognosis, we encountered patients for whom amputation of the leg was unfortunately required. This disease was thus considered to require sufficient care. Popliteal arterial aneurysm is frequently palpable from the body surface and increased recognition of this disease should enable more appropriate treatment.

The Role of Systemic Inflammatory Response Syndrome for Acute Arterial Occlusion of the Lower Limb / 日本心臓血管外科学会雑誌

Reperfusion injury occasionally occurred after revasculization of acute arterial occlusion (AAO). The most common reason of death is myonephropatic metabolic syndrome due to reperfusion injury. This paper focusses on the criterion of systemic inflammatory response syndrome (SIRS). From January 1987 to April 1996, we treated 89 patients (male 59/female 30) with lower limb AAO. The mean age was 68.5 (ranging from 16 to 94) years old. There were 59 cases of thrombosis, 25 of embolism, 2 trauma and 3 dissecting aneurysm of the aorta. These patients were divided into two groups according to whether or not they fulfilled the criterion of SIRS. Of these patients, 46 cases met the criterion of SIRS (SIRS group) but the other 43 did not (non-SIRS group). We compared the two groups. The mortality of the SIRS group (23.9%) was higher than the non-SIRS group (2.3%). The ischemic time of the SIRS group (83.1±113.3 hours) was longer than the non-SIRS group (37.5±38.2 hours). Complications of MNMS were more common in the SIRS group (15.3%) than in the non-SIRS group (2.3%). The ischemic area in the SIRS group was remarkably less than in the non-SIRS group. Conclusion: The criterion of SIRS as indicated by the measurement of interleukin 8 (IL-8) was a useful prognostic parameter for limb salvage rate and mortality of AAO patients.

The Role of ICAM-1 and IL-8 in Reperfusion Injury Following Acute Arterial Occlusion of the Extremities / 日本心臓血管外科学会雑誌

A model of reperfusion injury following acute arterial occlusion was made in Wistar strain rat. Using this model, changes in and the role of interleukin-8 (IL-8) and intercellular adhesion molecule-1 (ICAM-1) were estimated. The rats were divided into two groups as follows; the infra-renal aorta and the bilateral common femoral artery were ligated for six hours and released (reperfusion group, <i>n</i>: 4), and only preparation of these arteries with no clamp was performed in the control group (<i>n</i>: 4). CPK and IL-8 were measured, and various organs (heart, lung, kidney, femoral artery and carotid artery) were extracted, then ICAM-1 was evaluated immunohistochemistrically, using anti-rat ICAM-1 antibody (1A29). CPK showed a significantly high value in the reperfusion group. After the reperfusion, IL-8 increased significantly and remained high in the reperfusion group. Immunohistologically, the manifestation of ICAM-1 was recognized in the various organs of the reperfusion group. These results suggests that the high IL-8 values and the manifestation of ICAM-1 were caused by disorders in various organs by neutrophils, and these mechanisms may be related to the incidence of myonephropathic metabolic syndrome (MNMS), which is caused by acute arterial occlusion disease.