Long-Term Results after Prosthetic Bypass Surgery for Chronic Limb Ischemia / 日本心臓血管外科学会雑誌

We evaluated long-term results of 126 consecutive bypass surgeries for chronic limb ischemia including 54 aorto-femoral (AF), 26 femoro-femoral crossover (FF), 7 axillo-femoral (AxF), and 39 femoro-above the knee popliteal (FP) bypasses. Patients who had undergone FF bypasses were significantly older than those who received AF bypasses (<i>p</i><0.01). Preoperative ankle brachial pressure indices (ABI) of the AxF and FF patients were significantly lower than those of AF patients (<i>p</i><0.05). Compared with AF patients, the AxF and FF groups included significantly higher percentages of Fontaine III and IV limbs treated by limb salvage surgery (<i>p</i><0.05). The cumulative graft patency rates 5 years after AF, FF, and FP bypasses were 94.7%, 91.3%, and 64.3%, respectively. In the FP group, patients with intermittent claudication before surgery showed a 5-year graft patency rate of 82.5%, while that in patients who underwent surgery for limb salvage was 43.3%. The secondary graft patency rates 5 years after AF, FF, and FP bypasses were 94.6%, 91.3%, and 83.3%, respectively. All patients whose bypass grafts were occluded were male and were smokers. Poor run-off and insufficient anticoagulation therapies were also associated with graft occlusion. Two of the 12 patients who developed graft occlusion underwent limb amputation.

A Case of Endovascular Stent-Graft Treatment for Traumatic Thoracic Aortic Dissecting Aneurysm Complicated with Multiple Injuries / 日本心臓血管外科学会雑誌

We report the use of endovascular stent-graft treatment for a case of traumatic thoracic aortic dissecting aneurysm complicated with multiple injuries. A 65-year-old man who had fallen from a 6m high roof was admitted to our hospital with severe circulatory failure and deep coma. Examination showed right hemopneumothorax, hematoma around the thoracic descending aorta and abdominal cavity, and bone fractures of all right ribs, skull, right clavicle, pelvis and lumbar vertebra. The patient recovered without major neurological deficit, but a dissecting aortic aneurysm approximately 6.5cm in diameter occurred at the proximal portion of the descending aorta. Since we considered that conventional aortic repair would be difficult with high operative risks based on the complicated thoracic and head injuries, we performed an endovascular stent-graft treatment. The postoperative course was uneventful and the aneurysmal diameter has been decreasing to date.