記述言語：英語   出版者・発行元：Annals of Vascular Surgery  

Background: This study aimed to analyze the clinical outcomes after revascularization for chronic limb-threatening ischemia (CLTI) in patients aged ≥ 80 years and < 80 years. Methods: We retrospectively analyzed multicenter data of 789 patients who underwent infrainguinal revascularization for CLTI between 2015 and 2021. The end points were 2-year overall survival (OS), amputation-free survival (AFS), limb salvage (LS), and postoperative complications. Results: A total of 90 patients aged ≥ 80 years and 200 patients aged < 80 years underwent bypass surgery (BSX), and 205 patients aged ≥ 80 years and 294 patients aged < 80 years underwent endovascular therapy (EVT). Before the propensity score matching, multivariate analyses showed that age ≥ 80 years, lower body mass index and serum albumin levels, nonambulatory status, and end-stage renal disease were independent risk factors for 2-year mortality in the BSX and EVT groups. After propensity score matching, the 2-year OS was better in the < 80 years cohort than in the ≥ 80 years cohort in both the BSX and EVT groups (P = 0.018 and P = 0.035, respectively). There was no difference in the 2-year LS rates between the < 80 years and the ≥ 80 years cohorts in both the BSX and EVT groups (P = 0.621 and P = 0.287, respectively). According to the number of risk factors, except for age ≥ 80 years, there was no difference in the 2-year AFS rates between the < 80 years and ≥ 80 years cohorts for the BSX and EVT groups with 0–1 risk factor (P = 0.957 and P = 0.655, respectively). However, the 2-year AFS rate was poor, especially in the ≥ 80 years cohort in the BSX with 2–4 risk factors (P = 0.015). The Clavien–Dindo ≥ IV complication rates tended to be higher in the ≥ 80 years cohort than in the < 80 years cohort only in the BSX with 2–4 risk factors (P = 0.056). Conclusions: Patients with CLTI aged ≥ 80 years had poorer OS than those aged < 80 years. However, there was no difference in LS between the ≥ 80 years and < 80 years cohorts in both the BSX and EVT groups. Although age ≥ 80 years was associated with poorer OS, patients with 0–1 risk factor may benefit from revascularization, including BSX, because no difference was observed in AFS or Clavien–Dindo ≥ IV complications.

DOI： 10.1016/j.avsg.2024.04.006

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記述言語：英語   出版者・発行元：Journal of Vascular Surgery  

Objective: This study aimed to compare the influence of inframalleolar (IM) P0/P1 on wound healing in bypass surgery vs endovascular therapy (EVT) in patients with chronic limb-threatening ischemia (CLTI). Methods: We retrospectively analyzed the multicenter data of patients who underwent infra-inguinal revascularization for CLTI between 2015 and 2022. IM P represents target artery crossing into foot, with intact pedal arch (P0) and absent or severely diseased pedal arch (P1). The endpoints were wound healing, limb salvage (LS), and postoperative complications. Results: We analyzed 66 and 189 propensity score-matched pairs in the IM P0 and IM P1 cohorts, respectively. In the IM P0 cohort, the 1-year wound healing rates were 94.5% and 85.7% in the bypass surgery and EVT groups, respectively (P = .092), whereas those in the IM P1 cohort were 86.2% and 66.2% in the bypass surgery and EVT groups, respectively (P < .001). In the IM P0 cohort, the 2-year LS rates were 96.7% and 94.1% in the bypass surgery and EVT groups, respectively (P = .625), and those in the IM P1 cohort were 91.8% and 81.5% in the bypass surgery and EVT groups, respectively (P = .004). No significant differences were observed between the bypass surgery and EVT in terms of postoperative complication rates in either the IM P0 or P1 cohorts. Conclusions: Bypass surgery facilitated better wound healing and LS than EVT in patients with IM P1. Conversely, no differences in wound healing or LS were observed between groups in patients with IM P0. Bypass surgery should be considered a better revascularization strategy than EVT in patients with tissue loss and IM P1 disease.

DOI： 10.1016/j.jvs.2024.04.040

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記述言語：英語   出版者・発行元：Journal of Vascular Surgery  

Objective: This study aimed to evaluate treatment outcomes after bypass surgery or endovascular therapy (EVT) in average- and high-risk patients with chronic limb-threatening ischemia (CLTI). Methods: We retrospectively analyzed multicenter data of patients who underwent infra-inguinal revascularization for CLTI between 2015 and 2022. A high-risk patient was defined as one with estimated 30-day mortality rate ≥5% or 2-year survival rate ≤50%, as determined by the Surgical Reconstruction vs Peripheral Intervention in Patients With Critical Limb Ischemia (SPINACH) calculator. The amputation-free survival (AFS), limb salvage (LS), wound healing, and 30-day mortality were compared separately for the average- and high-risk patients between the bypass and EVT with propensity score matching. Results: We analyzed 239 and 31 propensity score-matched pairs in the average- and high-risk patients with CLTI. In the average-risk patients, the 2-year AFS and LS rates were 78.1% and 94.4% in the bypass group and 63.0% and 87.7% in the EVT group (P <.001 and P =.007), respectively. The 1-year wound healing rates were 88.6% in the bypass group and 76.8% in the EVT group, respectively (P <.001). The 30-day mortality was 0.8% in the bypass surgery and 0.8% in the EVT group (P =.996). In the high-risk patients, there was no differences in the AFS, LS, and wound healing between the groups (P =.591, P =.148, and P =.074). The 30-day mortality was 3.2% in the bypass group and 3.2% in the EVT group (P =.991). Conclusions: Bypass surgery is superior to EVT with respect to the AFS, LS, and wound healing in the average-risk patients. EVT is a feasible first-line treatment strategy for high-risk patients with CLTI undergoing revascularization, based on the lack of significant differences in the 2-year AFS rate, between the bypass surgery and EVT cohorts.

DOI： 10.1016/j.jvs.2024.03.025

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記述言語：英語   出版者・発行元：European Journal of Vascular and Endovascular Surgery  

Objective: This study aimed to evaluate three survival prediction models: the JAPAN Critical Limb Ischaemia Database (JCLIMB), Surgical Reconstruction Versus Peripheral Intervention in Patients With Critical Limb Ischaemia (SPINACH), and Vascular Quality Initiative (VQI) calculators. Methods: Multicentre data of patients who underwent infrainguinal revascularisation for chronic limb threatening ischaemia between 2018 and 2021 were analysed retrospectively. The prediction models were validated using a calibration plot analysis with the intercept and slope. The discrimination was evaluated using area under the curve (AUC) analysis. The observed two year overall survival (OS) was evaluated by the Kaplan – Meier method. The two year OS predicted by each model at < 50%, 50 – 70%, and > 70% was defined as high, medium, and low risk, respectively. Results: A total of 491 patients who underwent infra-inguinal revascularisation were analysed. The rates of surgical revascularisation, endovascular therapy, and hybrid therapy were 26.5%, 70.1%, and 5.5%, respectively. The average age was 75.6 years, and the percentages of patients with diabetes mellitus and dialysis dependent end stage renal disease were 66.6% and 44.6%, respectively. The tissue loss rate was 85.7%. The intercept and slope were −0.13 and 1.18 for the JCLIMB, 0.11 and 0.82 for the SPINACH, and −0.15 and 1.10 for the VQI. The AUC for the two year OS of JCLIMB, SPINACH, and VQI were 0.758, 0.756, and 0.740, respectively. The observed two year OS rates of low, medium, and high risk using the JCLIMB calculator were 80.1%, 61.1%, and 28.5%, respectively (p < .001), using the SPINACH calculator were 81.0%, 57.0%, and 38.1%, respectively (p < .001), and using the VQI calculator were 77.8%, 45.8%, and 49.6%, respectively (p < .001). Conclusion: The JCLIMB, SPINACH, and VQI survival calculation models were useful, although the OS predicted by the VQI model appeared to be lower than the observed OS.

DOI： 10.1016/j.ejvs.2023.12.023

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記述言語：英語   出版者・発行元：Journal of Vascular Surgery  

Objective: To examine limb salvage (LS) and wound healing in dialysis-dependent and -independent patients with chronic limb-threatening ischemia (CLTI) after infrainguinal bypass surgery or endovascular therapy (EVT). Methods: We retrospectively analyzed the multi-center data of patients who underwent infrainguinal revascularization for CLTI with Wound, Ischemia, and foot Infection (WIfI) stage 2 to 4 between 2015 and 2020. The primary endpoint was LS. The secondary endpoint included wound healing, amputation-free survival (AFS), periprocedural complications, and 2-year survival. Comparison of these outcomes were made after propensity score matching. Results: We analyzed 252 dialysis-dependent (318 limbs) and 305 dialysis-independent (354 limbs) patients. Propensity score matching extracted 202 pairs with no significant differences in characteristics. The LS rate in bypass surgery was better than that in EVT in dialysis-dependent patients (P <.001). There was no significant difference in the LS rates between bypass surgery and EVT in dialysis-independent patients (P =.168). The wound healing rate of bypass surgery was better than that of EVT both dialysis-dependent and -independent patients with CLTI. The AFS rate of bypass surgery was better than that of EVT in dialysis-dependent patients (P <.001). There was no significant difference in the AFS rates between bypass surgery and EVT in dialysis-independent patients (P =.099). There was no significant difference in the occurrence of Clavien-Dindo ≥ IV and V between bypass surgery and EVT in dialysis-dependent and -independent patients. Age ≥75 years, serum albumin levels <3.5 g/dL, and non-ambulatory status were risk factors for 2-year mortality in dialysis-dependent patients. The 2-year survival rates in dialysis-dependent patients with risk factors of 0, 1, 2, and 3 were 82.5%, 67.1%, 49.5%, and 10.2%, respectively (P <.001). Conclusions: For LS and wound healing, bypass surgery was preferred for revascularization in dialysis-dependent patients with WIfI stage 2 to 4. Although dialysis dependency was one of the risk factors for 2-year mortality, dialysis-dependent patients, who have 0 to 1 risk factors, may benefit from bypass surgery, as 2-year survival of >50% is expected.

DOI： 10.1016/j.jvs.2023.09.035

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記述言語：日本語   出版者・発行元：血管外科症例検討会  

症例1は75歳、男性。閉塞した腋窩-両大腿動脈バイパスのstump syndromeにより、右下肢急性動脈閉塞症を発症した。緊急で右下肢の血栓除去術を行い、待機的にグラフト末梢吻合部の離断を行う方針とした。しかし、翌日に対側の下肢にも急性動脈閉塞が発生したため、対側の血栓除去術に加え、バイパスの末梢吻合部の離断を行った。症例2は71歳、男性。閉塞した大腿-大腿動脈交叉バイパスのstump syndromeにより、左下肢急性動脈閉塞を発生した。血栓除去術と左側の吻合部の離断を行った。非解剖学的バイパスの閉塞に伴う急性動脈閉塞症に対しては、血栓除去術に加えて、閉塞したバイパスの吻合部の離断も検討するべきである。(著者抄録)

記述言語：英語   出版者・発行元：JGH Open  

Background and Aim: The risk of hepatocellular carcinoma (HCC) persists in a condition of sustained virologic response (SVR) after hepatitis C virus (HCV) eradication. Comprehensive molecular analyses were performed to test the hypothesis that epigenetic abnormalities present after an SVR play a role in hepatocarcinogenesis. Methods: Whole-genome methylome and RNA sequencing were performed on HCV, SVR, and healthy liver tissue. Integrated analysis of the sequencing data focused on expression changes in transcription factors and their target genes, commonly found in HCV and SVR. Identified expression changes were validated in demethylated cultured HCC cell lines and an independent validation cohort. Results: The coincidence rates of the differentially methylated regions between the HCV and SVR groups were 91% in the hypomethylated and 71% in the hypermethylated regions in tumorous tissues, and 37% in the hypomethylated and 36% in the hypermethylated regions in non-tumorous tissues. These results indicate that many epigenomic abnormalities persist even after an SVR was achieved. Integrated analysis identified 61 transcription factors and 379 other genes that had methylation abnormalities and gene expression changes in both groups. Validation cohort specified gene expression changes for 14 genes, and gene ontology pathway analysis revealed apoptotic signaling and inflammatory response were associated with these genes. Conclusion: This study demonstrates that DNA methylation abnormalities, retained after HCV eradication, affect the expression of transcription factors and their target genes. These findings suggest that DNA methylation in SVR patients may be functionally important in carcinogenesis, and could serve as biomarkers to predict HCC occurrence.

DOI： 10.1002/jgh3.12833

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記述言語：日本語   出版者・発行元：血管外科症例検討会  

症例は、78歳、女性。心窩部不快感を自覚し近医を受診し、腹部超音波検査で下大静脈腫瘍を指摘された。腹部造影CT画像上、肝内下大静脈から腎静脈合流部レベルの下大静脈を占拠する、約50mmの不均一な増強を示す腫瘤を認めた。腫瘍により、左腎静脈起始部は閉塞しており、右腎静脈と右卵巣静脈起始部が近接しており、両腎静脈の血流は側副路を介して下大静脈に還流していた。右腎静脈再建の可能性を考慮し、長時間の下大静脈遮断に備え、一時的静脈バイパスの併用下に下大静脈切除・再建を施行した。右腎静脈は右卵巣静脈と共に起始部を下大静脈健常側に残す形で、腫瘍および下大静脈を切除し、右腎静脈は温存可能であった。腫瘍は病理組織学的に下大静脈原発平滑筋肉腫であった。(著者抄録)

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Macrophage-like cells derived from vascular smooth muscle cells (SMCs) play critical roles in atherogenesis, and DNA hydroxymethylation was implicated in transdifferentiation. We examined transcriptomes and (hydroxy)methylomes of human coronary artery SMCs during cholesterol-induced transdifferentiation. A unique approach of exhaustive identification of differentially expressed genes followed by Gene Ontology-centric clustering facilitated deeper understanding of multifaceted modulations of genes involved in extracellular matrix organization, angiogenesis, cell migration, hypoxia response, and cholesterol biosynthesis. Intriguingly, type I interferon response was transiently activated, presumably forming an immuno-metabolic circuit with cholesterol metabolism. Neither global nor DEG-proximal changes were evident in (hydroxy)methylation. These results would not only provide a unique data resource for atherosclerosis research but present a potentially useful approach in transcriptome data interpretation.

DOI： 10.1016/j.bbrep.2021.101061

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3400/avd.oa.20-00030

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objectives: Controlling Nutritional Status (CONUT) is a useful screening tool for malnutrition in patients with various diseases; however, how CONUT-diagnosed malnutrition affects patients with aortic arch aneurysm is unknown. This study aimed to reveal the utility of CONUT for detecting the patients with high-risk aortic arch aneurysm with malnutrition. Methods: Sixty patients treated for aortic arch aneurysms with elective thoracic endovascular aneurysm repair from 2009 to 2015 were retrospectively analyzed at a single institution. Preoperative nutrition status was evaluated by CONUT, and a CONUT score ≥ 3 was defined as malnutrition. The influence of malnutrition on the patients’ overall survival, aneurysm-related death-free rates, and prevalence of re-interventions were also analyzed. Results: Twenty-three patients were diagnosed with malnutrition. Overall survival was significantly lower in the malnutrition group (P = 0.0036). The multivariate Cox proportional hazard analysis revealed that age (P < 0.0001) and malnutrition (P = 0.0457) were negative predictors of overall survival. Conversely, the two groups did not differ significantly in aneurysm-related death-free rates (P = 0.7879) and the prevalence of re-interventions (P = 0.7879). Conclusions: Malnutrition diagnosed by CONUT as well as age is a negative predictor of survival prognosis in patients with aortic arch aneurysm.

DOI： 10.1177/1708538119869458

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