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1.
Ann Vasc Dis ; 17(2): 211-214, 2024 Jun 25.
Article in English | MEDLINE | ID: mdl-38919314

ABSTRACT

We present a new technique for carotid artery reconstruction using a modified bifurcated saphenous vein graft in a patient with a malignant neck tumor. This technique can optimize the size match between the SVG and common carotid artery, as well as the internal and external carotid arteries. Post operative computed tomography performed a year after the operation demonstrated excellent graft alignment and patent carotid arteries.

2.
Ann Thorac Cardiovasc Surg ; 19(1): 70-2, 2013.
Article in English | MEDLINE | ID: mdl-22673548

ABSTRACT

A 68-year-old man underwent double-valve replacement (DVR) for active infective endocarditis caused by Enterococcus faecalis. Postoperative coronary angiography (CAG) revealed a saccular aneurysm originating from the distal portion of LMCA with severe stenosis at the ostium of the left anterior descending (LAD) artery and left circumflex artery (LCx). Emergent surgical resection with concomitant coronary artery bypass grafting were performed.Mycotic coronary artery aneurysms have a great tendency to rupture, and this may result in cardiac tamponade and sudden death. Early recognition and prompt surgical intervention is mandatory to minimize those fatal complications.


Subject(s)
Aneurysm, Infected/microbiology , Aortic Valve/surgery , Coronary Aneurysm/microbiology , Endocarditis, Bacterial/surgery , Enterococcus faecalis/isolation & purification , Gram-Positive Bacterial Infections/surgery , Heart Valve Prosthesis Implantation/adverse effects , Mitral Valve/surgery , Aged , Aneurysm, Infected/diagnosis , Aneurysm, Infected/surgery , Anti-Bacterial Agents/therapeutic use , Aortic Valve/microbiology , Coronary Aneurysm/diagnosis , Coronary Aneurysm/surgery , Coronary Angiography , Coronary Artery Bypass , Early Diagnosis , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/microbiology , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/microbiology , Humans , Male , Mitral Valve/microbiology , Predictive Value of Tests , Reoperation , Treatment Outcome
3.
Asian Cardiovasc Thorac Ann ; 20(4): 466-8, 2012 Aug.
Article in English | MEDLINE | ID: mdl-22879559

ABSTRACT

Acute type A aortic dissection in a patient with persistent with left superior vena cava is a very rare condition. There are some technical problems encountered during cardiovascular surgery in such a patient. We describe successful repair of acute type A aortic dissection complicated persistent with left superior vena cava, and the technical difficulties encountered during surgery.


Subject(s)
Aortic Aneurysm, Thoracic/complications , Aortic Dissection/complications , Vena Cava, Superior/abnormalities , Acute Disease , Aged , Aortic Dissection/surgery , Aortic Aneurysm, Thoracic/surgery , Female , Humans
4.
Ann Vasc Dis ; 5(1): 69-72, 2012.
Article in English | MEDLINE | ID: mdl-23555489

ABSTRACT

The optimal surgical management of patients with concomitant abdominal aortic aneurysm (AAA) and gastrointestinal malignancy remains controversial. A 79 year-old man who presented with hematemesis was found to have advanced gastric cancer concomitant with infrarenal AAA. The patient underwent simultaneous endovascular aneurysm repair (EVAR) and distal gastrectomy. The postoperative course was uneventful. The present case illustrates the clinical utility of EVAR for the high-risk patient with concomitant AAA and gastrointestinal malignancy.

5.
Ann Vasc Dis ; 5(2): 225-8, 2012.
Article in English | MEDLINE | ID: mdl-23555517

ABSTRACT

Endovascular repairs of thoracic and thoracoabdominal aortic aneurysm have recently been proposed as a less invasive alternative to conventional open surgical repair. In selective cases, adjunctive bypass surgery may be required to provide an adequate landing zone. We describe a case of staged hybrid debranching and thoracic endovascular aneurysm repair for distal aortic arch and thoracoabdominal aortic aneurysms after conventional open repair of the descending aorta.

7.
Asian Cardiovasc Thorac Ann ; 15(5): 444-5, 2007 Oct.
Article in English | MEDLINE | ID: mdl-17911078

ABSTRACT

The Heartstring system was developed to avoid the use of side-biting aortic clamps, but the sealing system sometimes tears. To solve this problem, a string is wound around the coiled seal and pulled gently.


Subject(s)
Coronary Artery Bypass/instrumentation , Anastomosis, Surgical/instrumentation , Coronary Artery Bypass/adverse effects , Equipment Design , Graft Occlusion, Vascular/prevention & control , Humans , Suture Techniques , Treatment Outcome
8.
Heart Vessels ; 20(5): 212-6, 2005 Sep.
Article in English | MEDLINE | ID: mdl-16160903

ABSTRACT

We studied the outcome of our modified aortic arch replacement procedure in which the distal end of the graft is anastomosed between the left common carotid artery and the left subclavian artery including the postoperative physical status of the left arm in comparison with the conventional technique. We assessed the surgical outcome of 26 patients who underwent our new technique and 11 patients who underwent the conventional one. Postoperative clinical symptoms and physical status of the left arm were also evaluated. No operative deaths were observed in the new technique group and one operative death was observed in the conventional group (9.1%). No significant differences between the two groups in postoperative clinical symptoms and the physical status of the left arm were observed. Our "distal anastomosis to the proximal level of the left subclavian artery" technique made aortic arch replacement easier and steadier with a satisfactory surgical outcome in comparison with the conventional method. The postoperative clinical symptoms and physical status of the left arm in the new technique group were identical to those in the conventional group.


Subject(s)
Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Blood Vessel Prosthesis Implantation/methods , Aged , Analysis of Variance , Anastomosis, Surgical , Arm/blood supply , Female , Humans , Male , Middle Aged , Postoperative Complications , Subclavian Artery , Treatment Outcome
9.
Heart Vessels ; 20(4): 167-70, 2005 Jul.
Article in English | MEDLINE | ID: mdl-16025367

ABSTRACT

A 68-year-old man with ischemic heart disease, abdominal aortic aneurysm, and rectal cancer was referred. Coronary angiography indicated triple-vessel disease with jeopardized collaterals, and dipyridamole myocardial scintigraphy disclosed no viability in the inferior, posterior, and lateral walls. Abdominal computed tomography scanning revealed an infrarenal abdominal aortic aneurysm, 65 mm in diameter, with an expanding rate of 8 mm/year. Barium enema revealed stenosis 4 cm in length 5 cm inward from the anal verge, and an endoscopic finding was ulcerated type tumor with a clear margin and circumferential stenosis. Histological examination of a biopsy specimen revealed adenocarcinoma, and the clinical stage in the Japanese classification of colorectal carcinoma was II according to other examinations. Simultaneous operations were scheduled because of the jeopardized collaterals of the coronary arteries, rapid expansion of the aneurysm, and subileus due to the cancer. The patient underwent simultaneous off-pump coronary artery bypass grafting to the left anterior descending artery with the in situ internal thoracic artery through a median sternotomy, abdominal aortic aneurysm repair with a tube graft through a median laparotomy, and the Miles' operation with total mesorectal excision. Although infection of the perineal wound was postoperatively recognized, it remained local and was healed with irrigation only. The patient is doing well 12 months after the operation, without myocardial ischemic symptoms or recurrence of the cancer.


Subject(s)
Adenocarcinoma/surgery , Aortic Aneurysm, Abdominal/surgery , Coronary Disease/surgery , Rectal Neoplasms/surgery , Adenocarcinoma/complications , Aged , Aortic Aneurysm, Abdominal/complications , Coronary Artery Bypass, Off-Pump , Coronary Disease/complications , Humans , Male , Rectal Neoplasms/complications
10.
Heart Vessels ; 20(4): 186-9, 2005 Jul.
Article in English | MEDLINE | ID: mdl-16025372

ABSTRACT

A 71-year-old man presented with hemoptysis due to chronic contained rupture of the descending thoracic aorta after sepsis by Escherichia coli complicated with transrectal biopsy of the prostate, and underwent urgent graft replacement. The aorta had an almost normal caliber and ruptured into the left lung without abscess. The perforated site of the lung was filled with gelatin-resorcinol-formaldehyde glue, and the defect of the aortic wall was closed. Without graft infection, lung abscess, or sepsis, the patient was discharged followed by 1 month's intravenous administration of cefazolin and piperacillin sensitive to Escherichia coli after the surgery.


Subject(s)
Aneurysm, Infected/microbiology , Aortic Aneurysm, Thoracic/microbiology , Aortic Rupture/microbiology , Escherichia coli Infections/complications , Aged , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/surgery , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Aortic Rupture/diagnostic imaging , Aortic Rupture/surgery , Chronic Disease , Escherichia coli Infections/diagnosis , Humans , Male , Tomography, X-Ray Computed
11.
Ann Vasc Surg ; 19(2): 267-9, 2005 Mar.
Article in English | MEDLINE | ID: mdl-15776306

ABSTRACT

Dissection limited to the abdominal aorta contributes 4% of all aortic dissections, and inflammatory injury of the aortic media is one of factors associated with dissection. In multiple myeloma, leukocytoclastic vasculitis of the skin has been known. We describe limited dissection of an abdominal aortic aneurysm with dense lymphocyte infiltration in a 62-year-old man with multiple myeloma. Although it is unclear whether the lymphocyte infiltration in the aortic wall, which was denser than that of atherosclerotic aneurysm, was associated with multiple myeloma, the excessive aortic wall inflammation may have somewhat influenced aneurysm formation or aortic dissection.


Subject(s)
Aortic Aneurysm, Abdominal/complications , Aortic Dissection/complications , Multiple Myeloma/complications , Aortic Dissection/diagnostic imaging , Aortic Dissection/surgery , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/surgery , Humans , Male , Middle Aged , Radiography
12.
Ann Vasc Surg ; 19(1): 108-12, 2005 Jan.
Article in English | MEDLINE | ID: mdl-15714378

ABSTRACT

In a case of thrombosed abdominal aortic aneurysm, intraluminal and intrathrombotic pressures were simultaneously measured 3 cm distal to the left renal vein level (#1), at the inferior mesenteric artery level (#2) (3 cm distal to #1), 3 cm distal to #2 (#3), and at the aortic bifurcation level (#4) (3 cm distal to #3). The intraluminal pressure (at #1) was 154/72 (101) mmHg, and the intrathrombotic pressures at #2, #3, and #4 were 138/77 (100), 137/74 (97), and 135/68 (96) mmHg, respectively. The percentages of the systolic and mean intrathrombotic pressures to the intraluminal pressure were 90% and 99% at #2, 89% and 96% at #3, and 88% and 95% at #4, respectively. The mural thrombus of an aneurysm does not significantly decrease the pressure on the aneurysmal wall, even in a thrombosed aneurysm.


Subject(s)
Aortic Aneurysm, Abdominal/physiopathology , Blood Pressure/physiology , Thrombosis/physiopathology , Aged , Femoral Artery/physiopathology , Humans , Iliac Artery/physiopathology , Male , Mesenteric Artery, Inferior/physiopathology , Renal Veins/physiopathology
14.
J Vasc Surg ; 39(5): 1125-7, 2004 May.
Article in English | MEDLINE | ID: mdl-15111873

ABSTRACT

The first case of an aneurysm of the femoral artery occupationally exposed to a vibratory tool is described. A 72-year-old man with a right common femoral artery aneurysm had had an occupational history of putting a "breaker," which breaks concrete into pieces by means of powerful vibration, on the right groin for more than 10 years. The patient underwent aneurysmectomy and graft replacement, with reconstruction of the deep femoral artery. Pathologic examination of the resected aneurysm revealed fibrosis and lipid deposition in the intima, well-maintained elastic fibers without disruption in the media, and thickened adventitia, in place of the typical findings of atherosclerosis.


Subject(s)
Aneurysm/etiology , Cumulative Trauma Disorders/surgery , Femoral Artery , Occupational Diseases/etiology , Vibration/adverse effects , Aged , Aneurysm/surgery , Humans , Male , Occupational Diseases/surgery , Time Factors
18.
Ann Vasc Surg ; 17(4): 461-3, 2003 Jul.
Article in English | MEDLINE | ID: mdl-14670028

ABSTRACT

Isolated true aneurysm of the subclavian artery is rare and can rupture, thrombose, embolize, or cause symptoms by local compression. We describe a case of a 67-year-old man with proximal left subclavian artery aneurysm presenting with hemoptysis, hoarseness, and diplopia. These symptoms suggested that the aneurysm ruptured, that the left recurrent laryngeal nerve was compressed by it, and that its mural thrombus caused cerebral embolism. It was incidentally confirmed that the aneurysm grew at the rate of 1.31 cm/year, from 3.0 to 4.2 cm in diameter for 11 months, preciously measured in a computed tomography scan. The aneurysm was successfully repaired via partial cardiopulmonary bypass and separate perfusion of the left common carotid artery through cross-clamping the descending thoracic aorta and the aortic arch between the origins of the brachiocephalic artery and the left common carotid artery. Neither partial clamping of the aortic arch at the portion branching the left subclavian artery nor taping the aortic arch between the origins of the left common carotid artery and the left subclavian artery could be achieved.


Subject(s)
Aneurysm, Ruptured/surgery , Aneurysm/complications , Aneurysm/surgery , Subclavian Artery , Aged , Cardiopulmonary Bypass , Carotid Artery, Common , Diplopia/etiology , Hemoptysis/etiology , Hoarseness/etiology , Humans , Male , Perfusion
19.
Ann Thorac Surg ; 76(4): 1298-301, 2003 Oct.
Article in English | MEDLINE | ID: mdl-14530037

ABSTRACT

A 68-year-old man with aortic arch aneurysm was referred to our department. Preoperative carotid echography and magnetic resonance angiography revealed occlusion of the left internal carotid artery. Single-photon emission computed tomography scanning indicated that cerebral blood flow was decreased and reactivity to acetazolamide was reduced in the left temporal lobe. A successful superficial temporal artery-middle cerebral artery anastomosis was first made by neurosurgeons. A postoperative single-photon emission computed tomography scan showed that cerebral blood flow and reactivity to acetazolamide were remarkably improved. Two months after the anastomosis, the aortic arch aneurysm was successfully repaired.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Carotid Stenosis/complications , Carotid Stenosis/surgery , Cerebral Revascularization , Middle Cerebral Artery/surgery , Temporal Arteries/surgery , Acetazolamide , Aged , Aorta, Thoracic , Carotid Artery, Internal , Carotid Stenosis/diagnostic imaging , Humans , Male , Tomography, Emission-Computed, Single-Photon
20.
J Thorac Cardiovasc Surg ; 126(2): 415-9, 2003 Aug.
Article in English | MEDLINE | ID: mdl-12928638

ABSTRACT

BACKGROUND: In acute type A dissection, replacing the ascending aorta with the transverse aortic arch recently has been recommended for event-free long-term survival. Since 1994, we have performed our new transverse aortic arch replacement, in which the distal end of the graft is anastomosed between the left common carotid artery and the left subclavian artery to reduce the risk by obtaining a good surgical view, resulting in good hemostasis. The "elephant trunk technique" was used in anticipation of a staged descending aortic operation for residual dissecting aorta. We analyzed the surgical survival of patients with Stanford type A aortic dissection undergoing our operative procedure using hypothermic selective antegrade cerebral perfusion. METHODS: We performed our new technique in 27 patients (aged 61 +/- 11 years, 15 male and 12 female patients, 22 patients with acute type A dissection, and 5 patients with chronic dissection). RESULTS: One in-hospital death (3.7% in total: 4.5% in acute dissection, 0% in chronic dissection) occurred in patients undergoing our new technique. Actuarial survival (including early death) was 91% at 5 years after the operation. One late death occurred as the result of a malignant tumor. Four patients underwent a staged reoperation for aneurysmal dilatation of the residual descending aorta or renal and splenic embolism as the result of thrombus from the false lumen 2 to 11 months (mean interval 6 months) after the initial operation. They have been doing well since the reoperation. CONCLUSIONS: Our "distal anastomosis to the proximal level of the distal aortic arch" technique made aortic arch replacement easier and improved the survival of the arch replacement for aortic dissection, especially for acute type A dissection, by securing hemostasis in the suture line. Combining the elephant trunk technique with our new procedure is useful to perform a staged aortic replacement for dilatation and complication of the false lumen in the descending aorta.


Subject(s)
Aorta, Thoracic/pathology , Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Acute Disease , Aged , Anastomosis, Surgical , Aortic Dissection/mortality , Aortic Aneurysm, Thoracic/mortality , Chronic Disease , Female , Follow-Up Studies , Hospital Mortality , Humans , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/mortality , Subclavian Artery/pathology , Subclavian Artery/surgery , Time Factors , Tomography, X-Ray Computed , Treatment Outcome
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