Language：English   Publisher：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

Web of Science

Scopus

PubMed

Language：English  

DOI： 10.1186/s40792-024-01856-3

Web of Science

PubMed

Language：English   Publisher：Springer Berlin Heidelberg  

症例は28歳男性。持続する腹痛があり、直径10cmの巨大な後腹膜腫瘍と精巣腫瘍と診断された。精巣腫瘍の診療ガイドラインに従い、高位精巣摘除術を施行した。組織学的検査の結果、腫瘍はセミノーマであった。さらに化学療法を行い、腫瘍の縮小を確認した後、横隔膜下リンパ節と後腹膜腫瘍を腹部大動脈とともに切除した。腹部大動脈は腎動脈下腹部大動脈から末端部まで切除し、人工大動脈で再建した。術後4日目に大量の胸水を認め、ドレナージ、絶食およびソマトスタチン療法などの保存療法を行ったが改善がみられず、リンパ漏と診断された。術後13日目の両側鼠径リンパ節の順行性リンパ管造影では漏出部位を特定できなかった。術後15日目の逆行性経静脈的リンパ管造影で、胸管の閉塞およびリピオドール造影剤の流出が確認された。胸管塞栓術後、排液量は100mL/日まで減少した。その後再発はみられず、術後29日目に退院した。

Language：English   Publisher：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

Web of Science

Scopus

PubMed

Language：English   Publisher：European Journal of Vascular and Endovascular Surgery  

Objective: The incidence and related factors of spontaneous occlusion of a patent inferior mesenteric artery (IMA) after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) without pre-emptive embolisation remain unclear. This study aimed to elucidate the incidence, clinical implications, and predictors of spontaneous IMA occlusion after EVAR. Methods: This was a single centre, retrospective cohort study. Patients who underwent elective EVAR between 2007 and 2022 were categorised into three groups (group 1, spontaneous IMA occlusion; group 2, patent IMA with no type II endoleak [T2EL] from IMA; group 3, T2EL from IMA). Endpoints were the incidence of spontaneous IMA occlusion, sac enlargement, freedom from re-intervention, and overall survival after EVAR. Results: Of 372 cases of elective EVAR for AAA, 230 who had patent IMA pre-operatively were analysed, after excluding 127 with pre-occluded IMA and 15 who underwent pre-emptive IMA embolisation. Spontaneous IMA occlusion occurred in 101 patients (43.9%). The sac enlargement rate was lower in group 1 than in groups 2 and 3. The freedom from re-intervention rate was higher in group 1 than in group 3 but did not differ between groups 1 and 2. Multivariable analysis revealed the absence of antiplatelet therapy, pre-operative higher haematocrit, absence of concomitant iliac artery aneurysm, posterior thrombus in the sac, and use of Endurant as predictors associated with spontaneous IMA occlusion. Spontaneous IMA occlusion was observed in 7.1% and 77.5% of patients with zero and four or five predictors, respectively. Conclusion: Spontaneous IMA occlusion occurred in nearly half of cases and was associated with positive clinical outcomes. In patients with a high prediction of spontaneous IMA occlusion, pre-emptive IMA embolisation may be omitted.

DOI： 10.1016/j.ejvs.2024.09.036

Scopus

PubMed

Language：English   Publisher：Vascular  

Objective: The present study aimed to examine which nutritional index, such as the controlling nutritional status (CONUT), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI), is better for predicting prognosis in patients with chronic limb-threatening ischemia (CLTI) following revascularization. Method: We retrospectively analyzed data of patients who underwent revascularization for CLTI between 2008 and 2020. The endpoints were 2-year overall survival and limb salvage. The optimal cutoff values of 2-year overall survival and major amputation were determined by receiver operating characteristic curve analyses. Result: A total of 238 patients with CLTI and 289 limbs were analyzed. The 2-year overall survival rates were 48.9%, 54.6%, and 53.5% in patients with CONUT score ≥4, PNI score <42.6, and GNRI <98.4 compared with 80.0%, 80.0%, and 78.4% in patients with CONUT score <4, PNI score ≥42.6, and GNRI ≥98.4 (p < 0.01). Age, non-ambulatory status, hemodialysis, and nutritional indices were independent risk factors for 2-year mortality in the multivariate analyses. The 2-year limb salvage rates were 70.1%, 82.2%, and 81.9% in patients with CONUT score ≥7, PNI score <41.9, and GNRI <95.3 compared with 92.8%, 98.3%, and 94.2% in patients with CONUT score <7, PNI score ≥41.9, and GNRI ≥95.3 (p < 0.01). Wound, ischemia, and foot infection stage and each nutritional index (CONUT and PNI) were independent risk factors for major amputation in multivariate analyses. The overall survival and limb salvage rates of patients with malnutrition diagnosed by CONUT score were poor compared with those of normal nutrition or malnutrition diagnosed by PNI and/or GNRI scores. Conclusion: The CONUT, PNI, and GNRI scores can predict the 2-year overall survival in patients with CLTI after revascularization. The CONUT and PNI scores were associated with major amputation.

DOI： 10.1177/17085381221102801

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：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)

Language：English   Publisher：Annals of Vascular Surgery  

Background: The present study aimed to determine the preferred initial revascularization procedure between bypass surgery and endovascular therapy (EVT) in patients with chronic limb-threatening ischemia (CLTI) categorized as indeterminate according to the Global Vascular Guidelines (GVG). Methods: We retrospectively analyzed the multicenter data of patients who underwent infrainguinal revascularization for CLTI categorized as indeterminate according to the GVG between 2015 and 2020. The end point was the composite of relief from rest pain, wound healing, major amputation, reintervention, or death. Results: A total of 255 patients with CLTI and 289 limbs were analyzed. Of the 289 limbs, 110 (38.1%) and 179 (61.9%) underwent bypass surgery and EVT, respectively. The 2-year event-free survival rates with respect to the composite end point were 63.4% and 28.7% in the bypass and EVT groups, respectively (P < 0.01). Multivariate analysis revealed that increased age (P = 0.03); decreased serum albumin level (P = 0.02); decreased body mass index (P = 0.02); dialysis-dependent end-stage renal disease (P < 0.01); increased Wound, Ischemia, and foot Infection (WIfI) stage (P < 0.01); Global Limb Anatomic Staging System (GLASS) III (P = 0.04); increased inframalleolar grade (P < 0.01); and EVT (P < 0.01) were independent risk factors for the composite end point. In the WIfI−GLASS 2−III and 4−II subgroups, bypass surgery was superior to EVT with regard to 2-year event-free survival (P < 0.01). Conclusions: Bypass surgery is superior to EVT in terms of the composite end point in patients classified as indeterminate according to the GVG. Bypass surgery should be considered an initial revascularization procedure, especially in the WIfI−GLASS 2−III and 4−II subgroups.

DOI： 10.1016/j.avsg.2023.05.014

Web of Science

Scopus

PubMed

Language：English   Publisher：Annals of Vascular Surgery  

Background: Left renal vein division (LRVD) is a maneuver performed during open surgical repair for abdominal aortic aneurysms. Even so, the long-term effects of LRVD on renal remodeling are unknown. Therefore, we hypothesized that interrupting the venous return of the left renal vein might cause renal congestion and fibrotic remodeling of the left kidney. Methods: We used a murine left renal vein ligation model with 8-week-old to 12-week-old wild-type male mice. Bilateral kidneys and blood samples were harvested postoperatively on days 1, 3, 7, and 14. We assessed the renal function and the pathohistological changes in the left kidneys. In addition, we retrospectively analyzed 174 patients with open surgical repairs between 2006 and 2015 to assess the influence of LRVD on clinical data. Results: Temporary renal decline with left kidney swelling occurred in a murine left renal vein ligation model. In the pathohistological assessment of the left kidney, macrophage accumulation, necrotic atrophy, and renal fibrosis were observed. In addition, Myofibroblast-like macrophage, which is involved in renal fibrosis, was observed in the left kidney. We also noted that LRVD was associated with temporary renal decline and left kidney swelling. LRVD did not, however, impair renal function in long-term observation. Additionally, the relative cortical thickness of the left kidney in the LRVD group was significantly lower than that of the right kidney. These findings indicated that LRVD was associated with left kidney remodeling. Conclusions: Venous return interruption of the left renal vein is associated with left kidney remodeling. Furthermore, interruption in the venous return of the left renal vein does not correlate with chronic renal failure. Therefore, we suggest careful follow-up of renal function after LRVD.

DOI： 10.1016/j.avsg.2023.03.035

Web of Science

Scopus

PubMed

Language：English   Publisher：European Journal of Vascular and Endovascular Surgery  

Objective: This study aimed to analyse the influence of the Global Anatomic Staging System (GLASS) and inframalleolar (IM) disease on the treatment outcomes of patients with chronic limb threatening ischaemia (CLTI) who undergo endovascular treatment (EVT) Methods: Data of patients who underwent infrainguinal endovascular therapy (EVT) for CLTI between 2015 and 2019 at two centres were analysed retrospectively. The endpoints were major amputation, major adverse limb events (MALE), and wound healing. Results: Overall, 276 patients and 340 limbs were analysed. The number of revascularisations for an infrapopliteal lesion was 48 (70.6%), 63 (63.0%), and 142 (82.6%) in the GLASS I, GLASS II, and GLASS III stages, respectively (p < .001). There was no statistically significant difference in limb salvage among the GLASS stages (p = .78). The limb salvage rates at one year were 94.6%, 88.0%, and 70.0% in the IM P0 P1, and P2 groups, respectively (p < .001). Multivariable analysis showed that Wound, Ischemia, and foot Infection (WIfI) stage, and IM grade were risk factors for major amputation. The freedom from MALE rates at two years were 60.5%, 45.3%, and 41.1% in the GLASS I, II, and III stages, respectively (p = .003) and 64.1%, 43.5%, and 18.4% in the IM P0, P1, and P2 groups, respectively (p < .001). Multivariable analysis demonstrated that WIfI stage, GLASS stage, IM grade, and infrapopliteal revascularisation were risk factors for MALE. There was no significant difference in wound healing among GLASS I – III (p = .75). The wound healing rates at 365 days were 78.6%, 68.6%, and 42.0% in the IM P0, P1, and P2 groups, respectively (p = .065). Multivariable analysis showed that WIfI stage and IM P2 were risk factors for incomplete wound healing. Conclusion: GLASS IM was associated with major amputation, MALE, and wound healing, while GLASS stage was associated with only MALE.

DOI： 10.1016/j.ejvs.2022.11.023

Web of Science

Scopus

PubMed

Language：English   Publisher：Physiological Reports  

Macrophages play crucial roles in abdominal aortic aneurysm (AAA) formation through the inflammatory response and extracellular matrix degradation; therefore, regulating macrophages may suppress AAA formation. Interleukin-38 (IL-38) is a member of the IL-1 family, which binds to IL-36 receptor (IL1RL2) and has an anti-inflammation effect. Because macrophages express IL1RL2, we hypothesized that IL-38 suppresses AAA formation by controlling macrophages. We assessed a C57BL6/J mouse angiotensin II-induced AAA model with or without IL-38 treatment. RAW 264.7 cells were cultured with tumor necrosis factor-α and treated with or without IL-38. Because p38 has important roles in inflammation, we assessed p38 phosphorylation in vitro and in vivo. To clarify whether the IL-38 effect depends on the p38 pathway, we used SB203580 to inhibit p38 phosphorylation. IL1RL2+ macrophage accumulation along with matrix metalloproteinase (MMP)-2 and -9 expression was observed in mouse AAA. IL-38 reduced the incidence of AAA formation along with reduced M1 macrophage accumulation and MMP-2 and -9 expression in the AAA wall. Macrophage activities including inducible nitric oxide, MMP-2, and MMP-9 production and spindle-shaped changes were significantly suppressed by IL-38. Furthermore, we revealed that inhibition of p38 phosphorylation diminished the effects of IL-38 on regulating macrophages to reduce AAA incidence, indicating the protective effects of IL-38 depend on the p38 pathway. IL-38 plays protective roles against AAA formation through regulation of macrophage accumulation in the aortic wall and modulating the inflammatory phenotype. Using IL-38 may be a novel therapy for AAA patients.

DOI： 10.14814/phy2.15581

Web of Science

Scopus

PubMed

Language：English   Publisher：Journal of Vascular Surgery  

Objective: Ureteroarterial fistula (UAF) is lethal condition. However, no consensus has been reached regarding the diagnosis and treatment of UAF owing to its rarity. The aim of our report was to present an actual case of UAF and systematically review the symptoms, risk factors, diagnosis, and treatment of this condition. Methods: The case study was of a 52-year-old woman who had experienced a massive hemorrhage during urinary stent replacement. For the systematic review of studies of UAF, those written in English and reported from 1939 to 2020 were searched for on PubMed using the keywords “uretero-arterial fistula,” “arterio-ureteral fistula,” and “hematuria.” Results: We included 121 studies with 235 patients (mean age, 66.0 years; 139 women [59.1%]) in our review. UAF had occurred most frequently in the common iliac artery (n = 112; 47.7%). Almost all patients (n = 232; 98.7%) had complained of hematuria. The risk factors for UAF were pelvic surgery (n = 205; 87.2%), the long-term use of urinary stents (n = 170; 72.3%), oncologic radiotherapy (n = 107; 45.5%), and malignancy (n = 159; 67.7%). Although computed tomography can detect various useful findings such as extravasation, pseudoaneurysm, hydronephrosis, and opacification of ureters, it was diagnostically useful for only one third of the cases. Angiography was useful for the diagnoses of UAF for 124 (66.3%) of the 187 patients (79.6%) who had undergone angiography. With regard to treatment, endovascular approaches have been widely used in recent years because their invasiveness is lesser than that of open surgical repair. In the era of endovascular therapy, the indications for open surgical repair include ureteral-intestinal fistula, abscess formation, and graft infection after endovascular therapy. Conclusions: Computed tomography can be recommended as the first examination for patients with risk factors for UAF because of its usefulness. Subsequently, angiography should be considered because UAF can be treated using an endovascular approach after diagnostic angiography. The diagnosis and treatment of UAF can often be difficult; therefore, the important first step of diagnosis is suspecting the occurrence of UAF and using a multidisciplinary approach.

DOI： 10.1016/j.jvs.2022.05.015

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：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)

Language：English   Publisher：Journal of Vascular Surgery  

Objective: The aim of the present study was to analyze the influence of abdominal aortic aneurysm sac shrinkage on the long-term outcomes after endovascular aneurysm repair (EVAR) between patients with favorable and hostile neck anatomy. Methods: In the present study, we retrospectively analyzed data from 268 patients with fusiform aneurysm and sac behavior who had been evaluated for ≥1 year after EVAR. Hostile neck anatomy was defined as a proximal aneurysmal neck length of <10 mm or proximal neck angle of ≥60°. The primary end point was sac shrinkage, and the secondary end points included reintervention and a composite of rupture, type Ia endoleak, and late open conversion. Results: No differences were found in sac shrinkage between the patients with favorable and hostile neck anatomy (P =.47). Multivariate analysis revealed that an occluded inferior mesenteric artery (P =.04), the presence of posterior thrombus (P <.01), and no antiplatelet therapy (P =.01) were positive factors for sac shrinkage. The reintervention-free survival rate was better for patients with sac shrinkage compared with those without sac shrinkage regardless of the proximal neck anatomy (P <.01). The event-free survival rate of the composite end point at 5 and 10 years was 97.5% and 83.5% for patients with favorable neck anatomy and 86.8% and 81.0% for those with hostile neck anatomy, respectively (P =.02). In the subgroup with sac shrinkage, the event-free survival rates at 5 and 10 years were 98.7% and 98.7% for those with favorable neck anatomy and 92.7% and 82.4% for those with hostile neck anatomy, respectively (P =.02). In contrast, the event-free survival for patients without sac shrinkage did not differ between those with favorable and hostile neck anatomy (P =.08). Multivariate analysis showed that a hostile neck anatomy (hazard ratio, 3.32; 95% confidence interval, 1.26-8.80; P =.02) and no sac shrinkage (hazard ratio, 3.88; 95% confidence interval, 1.25-12.0; P =.02) were significant risk factors for the composite end point of rupture, type Ia endoleak, and late open conversion. Conclusions: Proximal neck anatomy did not affect sac shrinkage after EVAR. Sac shrinkage has been a good surrogate marker of better long-term outcomes after EVAR for patients with favorable neck anatomy. In contrast, critical events such as rupture and type Ia endoleak can occur even after sac shrinkage has been achieved in patients with hostile neck anatomy.

DOI： 10.1016/j.jvs.2022.03.011

Web of Science

Scopus

PubMed

Language：English   Publisher：Japan Atherosclerosis Society  

<p><b>Aim:</b> To assess the results of a phase I/IIa open-label dose-escalation clinical trial of 5-day repeated intramuscular administration of pitavastatin-incorporated poly (lactic-co-glycolic acid) nanoparticles (NK-104-NP) in patients with chronic limb threatening ischemia (CLTI).</p><p><b>Methods:</b> NK-104-NP was formulated using an emulsion solvent diffusion method. NK-104-NP at four doses (nanoparticles containing 0.5, 1, 2, and 4 mg of pitavastatin calcium, n=4 patients per dose) was investigated in a dose-escalation manner and administered intramuscularly into the ischemic limbs of 16 patients with CLTI. The safety and therapeutic efficacy of treatment were investigated over a 26-week follow-up period.</p><p><b>Results:</b> No cardiovascular or other serious adverse events caused by NK-104-NP were detected during the follow-up period. Improvements in Fontaine and Rutherford classifications were noted in five patients (one, three, and one in the 1-, 2-, and 4-mg dose groups, respectively). Pharmacokinetic parameters including the maximum serum concentration and the area under the blood concentration–time curve increased with pitavastatin treatment in a dose-dependent manner. The area under the curve was slightly increased at day 5 compared with that at day 1 of treatment, although the difference was not statistically significant.</p><p><b>Conclusions:</b> This is the first clinical trial of pitavastatin-incorporated nanoparticles in patients with CLTI. Intramuscular administration of NK-104-NP to the ischemic limbs of patients with CLTI was safe and well tolerated and resulted in improvements in limb function.</p>

DOI： 10.5551/jat.58941

Web of Science

Scopus

PubMed

CiNii Research

Language：English   Publisher：(一社)日本動脈硬化学会  

包括的高度慢性下肢虚血患者16例(男性10例、女性6例、平均72.4±11.1歳)を対象に、ピタバスタチン封入ナノ粒子製剤(NK-104-NP)の有効性と安全性について検討した。対象は慢性重症虚血肢に対するNK-104-NPの医師主導治験に登録されたFontaine分類がIIIまたはIV度の患者で、広範な組織喪失を有するRutherford分類6群の患者は除外した。患者をピタバスタチンカルシウムとして0.5、1、2、4mgを含有するNK-104-NPを反復筋肉内投与するNP0.5群、NP1群、NP2群、NP4群の4群に分類した。平均追跡期間は26週で、4例が死亡した。いずれも非治療関連死で、NK-104-NPによる心血管疾患または重篤な有害事象は皆無であった。ピタバスタチンの血漿中および尿中薬物濃度は用量依存的に増加した。ピタバスタチンの代謝物であるラクトン体の最高血中濃度も用量依存的に増加した。投与5日後の血中濃度-時間曲線下面積(AUC)は初日に比べて上昇したが、統計的に有意でなかった。体重、体温、血圧等の生理学的検査および心機能検査で変化は見られず、足関節上腕血圧比に有意な変化はなかった。

Language：English   Publisher：Annals of Vascular Surgery  

Background: Iliac artery aneurysms (IAAs) are life-threatening once ruptured. Although some studies have revealed the pathology of IAAs, clinical information on IAAs is still limited. Moreover, previous studies were conducted in Western countries; thus, we aimed to identify the natural history of iliac artery aneurysms in a Japanese cohort. The purpose of this study was to investigate the IAA expansion rate in a Japanese cohort to consider the management of small IAAs and to identify indications for surgical intervention. Methods: Patients with iliac artery aneurysms were retrospectively reviewed. The primary outcome was the expansion rate of IAAs. We also investigated the correlation between expansion rate and patients’ characteristics. Natural histories, including surgical interventions and rupture, were also assessed. Results: The mean expansion rate in our study was 1.59 ± 1.16 mm/year. There was a positive correlation between expansion rate and aneurysm diameter, which was estimated by y = 0.0052 × (X − 23.270)2 + 0.0632 × X − 0.0517, where y is the expansion rate, and X is aneurysm diameter. The freedom from surgical intervention rate of IAAs was 85.5% at 1 year, 54.0% at 3 years, and 41.5% at 5 years. No factors, except initial aneurysm diameter, were revealed as independent predictors of surgical intervention. We experienced one ruptured IAA, which showed unexpected rapid growth from 30.1 mm to 56.3 mm over 15 months during conservative management. This case demonstrated that IAAs ≥30 mm should be carefully followed up and considered for surgical intervention. Conclusions: We conclude that larger aneurysms have greater expansion rates. Because IAAs ≥30 mm carry a risk of rapid expansion resulting in rupture, careful follow-up, and surgical intervention should be performed if iliac artery aneurysms are ≥30 mm in diameter.

DOI： 10.1016/j.avsg.2021.10.063

Scopus

PubMed

Language：English   Publisher：Annals of Vascular Surgery  

Objectives: The Global Limb Anatomic Staging System (GLASS) was proposed for evaluating the anatomic complexity of arterial disease in patients with chronic limb-threatening ischemia (CLTI). We aimed to examine the relationship between GLASS stage and treatment outcomes after infrainguinal revascularization in patients with CLTI. Methods: We retrospectively analyzed data of patients undergoing infrainguinal revascularization for CLTI between 2010 and 2018 to examine whether GLASS stage affects the limb salvage, wound healing, and overall survival (OS). Results: Throughout the study period, 153 CLTI patients and 190 limbs with Fontaine classification III and IV were analyzed for major amputation and OS, and 125 patients and 157 limbs of Fontaine classification IV were analyzed for wound healing. The number of patients with WIfI stage 1, 2, 3, and 4 was 14 (7.4%), 44 (23.2%), 65 (34.2%), and 67 (53.3%), respectively. The number of patients with GLASS stage I, II, and III was 23 (12.1%), 48 (25.3%), and 119 (62.6%), respectively. Among the 190 limbs, the number subject to bypass surgery, endovascular therapy, and hybrid therapy was 132 (69.5%), 39 (20.5%), and 19 (10.0%), respectively. A multivariate analysis showed that only WIfI stage and inframalleolar (IM) disease were risk factors for major amputation and impaired wound healing. There was no relationship between GLASS stage and limb salvage or wound healing. A multivariate analysis revealed that age, geriatric nutritional risk index and GLASS stage were risk factors for 2-year OS (P < 0.01). Patients with all risk factors had a poor prognosis (35.3% at 2 years). Conclusion: WIfI stage and IM disease predicted limb salvage and wound healing after infrainguinal revascularization in patients with CLTI. Although GLASS stage did not affect limb salvage or wound healing, it was a prognostic factor for poor OS. The GLASS staging could be useful for deciding between bypass surgery and endovascular therapy in prediction of prognosis.

DOI： 10.1016/j.avsg.2021.09.054

Web of Science

Scopus

PubMed

Language：English   Publisher：European Journal of Vascular and Endovascular Surgery  

Objective: The present study aimed to determine the factors related to relief from rest pain, wound healing, major adverse limb events (MALEs), and prognosis after infrainguinal revascularisation in patients with chronic limb threatening ischaemia (CLTI). Methods: The data of patients who underwent infrainguinal revascularisation for CLTI between 2010 and 2020 was analysed retrospectively. The endpoint was the composite of relief from rest pain, wound healing, MALE, or death. Results: A total of 234 limbs in 187 patients with CLTI were analysed. Of the 234 limbs, 149 (63.7%) underwent bypass surgery and 85 (36.3%) underwent endovascular therapy (EVT). The event free survival rates with respect to the composite endpoint at two years were 30.4% in the EVT and 48.5% in the bypass groups, respectively (p = .005). The event free survival rates at two years were 56.7% in bypass surgery and 29.5% in EVT in the indeterminate subgroup (p = .051). Multivariable analysis revealed that age (hazard ratio [HR] 1.03; 95% confidence interval [CI] 1.01 – 1.05; p < .001), coronary artery disease (CAD) (HR 1.45; 95% CI 1.01 – 2.07; p = .042), haemodialysis (HR 1.74; 95% CI 1.22 – 2.48; p = .002), Wound, Ischaemia and foot Infection stage (HR 1.34; 95% CI 1.07 – 1.68; p = .012), Global Limb Anatomical Staging System stage (HR 1.31; 95% CI 1.01 – 1.72; p = .043), EVT (HR 1.90; 95% CI 1.31 – 2.74; p < .001), Geriatric Nutritional Risk Index (HR 0.98; 95% CI 0.97 – 0.99; p = .021), and non-ambulatory status (HR 1.89; 95% CI 1.31 – 2.74; p < .001) were risk factors for the composite endpoint. Conclusion: Bypass surgery is superior to EVT with respect to the composite endpoint including relief from rest pain, wound healing, MALE, or death. Bypass surgery may be considered as the treatment of choice, instead of EVT, in patients in the indeterminate group according to the Global Vascular Guidelines preferred revascularisation method.

DOI： 10.1016/j.ejvs.2021.12.043

Web of Science

Scopus

PubMed

Language：English   Publisher：The Editorial Committee of Annals of Vascular Diseases  

<p>We report a case of an 83-year-old man with a ruptured internal iliac artery (IIA) aneurysm after endovascular repair, which was treated via the ligation of IIA and tight suture of the aneurysm sac. Although there were no findings of obvious endoleak after endovascular treatment, the IIA aneurysm increased in size and eventually ruptured. We presumed that pressure to IIA aneurysm via the embolized IIA led to rupture. Aneurysm sac expansion may lead to a rupture despite no endoleak being detected; therefore, close follow-up or re-intervention must be considered. Tight embolization of IIA may prevent endotension in the same case.</p>

DOI： 10.3400/avd.cr.21-00019

Web of Science

PubMed

CiNii Research

Language：English   Publisher：「Annals of Vascular Diseases」編集事務局  

症例は83歳男性で、右内腸骨動脈(IIA)動脈瘤を呈した。高血圧、心房細動、慢性心疾患などの既往があり、ワルファリン服用歴があった。AMPLATZE.R Vascular Plug IIを用いた右IIAの塞栓術後、総腸骨動脈から外腸骨動脈へのステントグラフト挿入などのIIA動脈瘤治療のための血管内治療を受けた。初回治療から2年後、CT検査により動脈瘤は徐々に拡大し、直径50mmとなった。血管造影ではエンドリークを認めなかった。その1ヵ月後、貧血が検出され、CT検査により右IIA動脈瘤の周囲に血腫を認めたが、エンドリークの所見はなかった。全身麻酔下で後腹膜アプローチによる待機的開腹手術を行った。右IIA動脈瘤の前部に破裂孔を認めた。総腸骨動脈と外腸骨動脈はクランプされていなかった。動脈瘤嚢を切開し、管腔内血栓を除去した。動脈瘤周囲の新鮮血腫は可能な限り除去した。前回の血管内治療で右IIAに展開したAMPLATZER Vascular Plug IIを抜去した。IIA遠位部を縫合し、動脈瘤嚢を強固に縫合した。貧血は改善し、開腹手術後のCT検査では血腫の拡大は認めなかった。

Language：English   Publisher：Journal of Vascular and Interventional Radiology  

Purpose: To evaluate the influence of antiplatelet or anticoagulant therapy on sac behavior after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Materials and Methods: This study retrospectively analyzed data from patients with favorable neck anatomy who underwent EVAR between 2007 and 2019. Patients with ruptured AAA and ≤1 year of sac behavior evaluation were excluded. Sac shrinkage after 1 year, persistent type II endoleak, and late sac expansion were examined. Results: In total, 182 patients with favorable neck anatomy were included in this study. A multivariable analysis identified an occluded inferior mesenteric artery (IMA; P = .049), the presence of a posterior thrombus (P = .009), and no antiplatelet therapy (P = .012) as factors positively associated with sac shrinkage at 1 year. Persistent type II endoleak was detected in 56 (30.8%) patients, with patent IMA (P = .006), the lack of a posterior thrombus (P = .004), the number of patent lumbar arteries (P = .004), and antiplatelet therapy (P = .039) being identified as significant risk factors. The multivariable analysis identified a larger initial AAA diameter (P < .001), the lack of a posterior thrombus (P = .038), and antiplatelet and anticoagulant therapies (P = .038 and P = .003, respectively) as risk factors for late sac expansion. Conclusions: After EVAR in patients with favorable neck anatomy, antiplatelet therapy is associated with the lack of sac regression at 1 year, whereas antiplatelet and anticoagulant therapies are risk factors for late sac expansion.

DOI： 10.1016/j.jvir.2021.10.025

Web of Science

Scopus

PubMed

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：English  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese