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ABSTRACT: Bleeding from the distal anastomosis suture line in total arch replacement is a serious and major concern for surgeons. We present a simple, flanged elephant trunk technique to reduce or eliminate bleeding from the distal anastomosis suture line in total arch replacement using a multibranched arch graft. This method allows not only a secure and reinforced distal anastomosis, but also simultaneous elephant trunk insertion.
Annals of Vascular Surgery 03/2013; · 1.03 Impact Factor
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ABSTRACT: Since the first report by Cooley and colleagues in 1975 [Cooley DA, Norman JC, Mullins CE, Grace R. Left ventricle to abdominal aorta conduit for relief of aortic stenosis. Cardiovasc Dis 1975;2:376-83], an apicoaortic valved conduit bypass has been usually administrated to selected patients presenting with certain clinical conditions or complications such as aortic stenosis associated with porcelain aorta, unclampable atherosclerotic aorta, resternotomy, or previous coronary bypass surgery. On the other hand, thoracic endovascular aortic repair for various aortic lesions has become a promising and less invasive therapy. We encountered a critical case of a patient suffering from aortic graft stenosis due to malformation of a previous thoracic endovascular aortic repair procedure originally performed for acute type A aortic dissection. Because of a deep sternal wound infection, apicoaortic valved conduit bypass from the left ventricular apex to the abdominal aorta was successfully performed.
The Annals of thoracic surgery 01/2013; 95(1):323-5. · 3.74 Impact Factor
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ABSTRACT: When operating on patients with type B aortic dissection, the preoperative hemodynamics and malperfusion of visceral organs should be considered. We report a 70-year-old man with dissecting distal arch aneurysm following type B aortic dissection, whose celiac artery arose from a false lumen and who was successfully treated with total arch replacement and ascending graft-celiac artery bypass.
General Thoracic and Cardiovascular Surgery 04/2012; 60(7):440-2.
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ABSTRACT: To minimize surgical invasiveness for extensive aortic aneurysms and expand the indications for thoracic endovascular aortic repair (TEVAR), we evaluated outcomes of hybrid procedures combining conventional surgical aortic repair and TEVAR for thoracic aortic aneurysms.
The following hybrid procedures were performed: second-stage TEVAR after total aortic arch replacement using the elephant trunk as the landing zone in 17 patients; and for multiple aortic aneurysms, vascular graft replacement and TEVAR in 13 patients, vascular graft replacement and TEVAR with bypass in 2 patients, and TEVAR with bypass in 23 patients.
There were three (5.3%) hospital deaths, from serious complications including stroke, paraplegia, paraparesis, and aspiration pneumonia; and eight late deaths. There was only one aneurysm-related death, of a patient who underwent emergency surgery for an esophageal fistula resulting from enlargement of a residual false lumen of a thoracoabdominal aorta after second-stage TEVAR.
Hybrid procedures minimize surgical invasiveness in thoracic aortic aneurysm repair, but further evaluation of a larger number of patients is necessary.
Surgery Today 07/2011; 41(7):922-7. · 1.22 Impact Factor
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ABSTRACT: Revascularization of aortic arch vessels was performed with thoracic endovascular aortic repair (TEVAR) to preserve the endoprosthesis landing zone in 19 high-risk patients.
The operative procedure used was a bypass or transposition involving the common carotid and subclavian arteries. Homemade fenestrated stent-grafts, deployed in landing zone 0, were used for TEVAR.
All lesions resolved without endoleaks. No perioperative deaths occurred; seven patients had postoperative complications. One patient with acute respiratory distress syndrome required reoperation to change the bypass route and permit tracheostomy. One patient died of pneumonia 2 months after treatment, after an anastomotic pseudoaneurysm and cerebral infarction developed and an operation was performed to obtain hemostasis. The procedure-related mortality was 5.3%.
Aortic arch vessel revascularization before TEVAR may permit less invasive surgery, although careful patient selection is essential.
Annals of Vascular Surgery 04/2011; 25(6):748-51. · 1.03 Impact Factor
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ABSTRACT: Staged repair of extensive thoracic aortic aneurysms is complicated, with a high incidence of interval rupture between stages. We describe the systematic staged hybrid procedure of a previous endovascular repair of a descending aortic aneurysm and open surgical repair of an aortic arch aneurysm. In the second-stage arch repair, the stent graft was easily retracted and fixed, without dissection, around the aortic arch aneurysm distal side. Extensive thoracic aortic aneurysms were managed without interim rupture or neurologic deficits. This approach avoided the potential for interim rupture because recovery from the first-stage endovascular repair was shorter than that from open repair.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 02/2011; 54(2):507-10. · 3.52 Impact Factor
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ABSTRACT: Genitourinary anomalies are a tremendous challenge for the vascular surgeon, especially when dealing with an abdominal aortic aneurysm. We report a case of crossed-fused renal ectopia, a rare anomaly accompanied by abdominal aortic aneurysm. Bilateral renal arteries and one aberrant artery from the right common iliac artery supply the ectopic kidney. Because renal ischemia during aortic reconstruction can be a serious problem, we reconstructed a temporary right axillo-left renal artery bypass graft first, then reimplanted the aberrant renal artery. When choosing the procedure for renal preservation, preoperative multidetector-row computed tomography was useful to plan the operative strategy.
Annals of Vascular Surgery 11/2010; 24(8):1137.e1-5. · 1.03 Impact Factor
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ABSTRACT: We investigated the surgical results of secondary thoracic endovascular aneurysm repair (TEVAR) using the elephant trunk graft after total aortic arch replacement (TAR) for extensive thoracic aortic lesions.
The subjects comprised 16 patients who underwent TEVAR as a staged procedure following TAR at our institution between 1997 and 2007. Long-term results were retrospectively surveyed (mean observation period 68.4 months). We performed TEVAR with the elephant trunk graft as a proximal landing zone for the descending thoracic repair, the mean duration between TAR and TEVAR was 4.7 weeks for the staged operations and 18.3 months for the nonstaged operations.
Early results were good in all cases, with no deaths and no noteworthy complications. For the seven patients without dissection, long-term results were also good. Among the nine patients with dissection, the false lumen in the thoracoabdominal area enlarged in three during follow-up. We performed thoracoabdominal repair in two, but one died of an aneurysm-esophageal fistula. There was only one long-term aneurysm-related death.
Second-stage TEVAR using the elephant trunk graft after TAR allows less invasive surgery for extensive aortic lesions and achieves good long-term results. However, enlargement of the false lumen was a long-term concern in patients with aortic dissection, and careful follow-up is essential.
General Thoracic and Cardiovascular Surgery 10/2010; 58(10):501-5.
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ABSTRACT: Since its introduction in the 1990s, the number of thoracic endovascular aortic repairs is increasing rapidly. However, data on the operative method for reoperation after failed thoracic endovascular aortic repairs are still scanty. We describe the surgical technique of total arch replacement with partial stent removal and the elephant trunk procedure for failed thoracic endovascular aortic repair.
The Annals of thoracic surgery 08/2010; 90(2):677-8. · 3.74 Impact Factor
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ABSTRACT: No generally accepted treatment of multiple mycotic aortic aneurysms of the thoracic and abdominal aorta has yet been established. We report a 67-year-old man with widespread mycotic aortic aneurysms previously treated for malignant lymphoma and interstitial pneumonia. He was successfully treated by a two-stage hybrid surgical procedure comprising open and endovascular methods. This is apparently the first report of repair of multiple mycotic aortic aneurysms using a hybrid procedure.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 04/2010; 51(6):1521-4. · 3.52 Impact Factor
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ABSTRACT: Popliteal artery entrapment syndrome (PAES) is rare congenital anomaly that occurs due to compression of the popliteal artery by adjacent musculotendinous structures. We report a 54-year-old woman with PAES of total popliteal arterial occlusion was successfully treated by release of the muscle bundle and reconstruction of the popliteal artery. Pathologic examination revealed that the extracted portion of the popliteal artery had chronic total occlusion with fibrosis and destruction of internal elastic membrane. We should deliberate whether we reconstruct the popliteal artery in addition to release of the aberrant muscle bundle due to the preoperative examination to prevent the reoperation.
Annals of Vascular Diseases 01/2010; 3(2):157-9.
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ABSTRACT: Ehlers-Danlos syndrome is a rare inherited disease of connective tissue. Patients with type IV Ehlers-Danlos syndrome are likely to present with arterial disorders such as aneurysm or dissection. We report a 20-year-old man with type IV Ehlers-Danlos syndrome in whom a subclavian arterial rupture was successfully treated with transcatheter coil embolization.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 10/2009; 50(5):1191-5. · 3.52 Impact Factor
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The Journal of thoracic and cardiovascular surgery 04/2008; 135(3):702-3. · 3.41 Impact Factor
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ABSTRACT: A 72-year-old man was admitted to our hospital for dyspnea and chest pain. Coronary artery bypass grafting (CABG) was scheduled because of severe stenosis of the left main trunk. Computed tomography showed severe atherosclerotic lesions in the whole aorta, especially in the ascending aorta. Although off-pump CABG was thought to be the 1st choice, we determined that it would be difficult to establish a cardiac support device due to atherosclerotic lesions in case of sudden deterioration. We performed on-pump beating CABG with axillary cannulation with an 8 mm tube graft. Postoperatively, we recognized no symptoms of stroke, and the patient was discharged on the 12th postoperative day. Axillary cannulation using a side graft was useful in the presence of atherosclerotic lesions in the ascending aorta.
Kyobu geka. The Japanese journal of thoracic surgery 02/2008; 61(1):73-7.
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ABSTRACT: Purpose: We evaluated the operative results of our treatment for multiple aortic aneurysms by means of a hybrid procedure consisting of a combination of conventional surgical maneuvers and simultaneous or sequential endovascular aortic repair (EVAR). Materials and Methods: From August 1998 to April 2007, a total of 15 patients, 11 men and 4 women, ranging in age from 62 to 78 years, were treated with hybrid procedures for multiple aortic aneurysms. The pathology of these patients were, atherosclerotic aneurysm in 12 patients, atherosclerotic aneurysm associated with chronic dissection in 2 and type III chronic dissection in 1 patient. The distribution of aneurysmal locations were as follows: 5 patients had aneurysms at the arch and descending aorta, 1 had at the arch and thoracoabdominal aorta, 6 at the descending and abdominal aorta. Two patients with chronic dissection had simultaneous abdominal aortic aneurysms. In all except 1 of the 7 patients who had abdominal aortic aneurysm, we performed abdominal aneurysmectomy and EVAR simultaneously. In 7 patients, EVAR was performed sequentially after graft replacement surgery. In 2 patients, EVAR was the initial procedure followed by conventional surgery. The mean interval between first and second stage procedures was approximately 4 months. Results: One patients died of methicillin resistant Staphylococcus aureus pneumonia 3 months after the simultaneous procedure, all others were discharged and survive. In particular, no major EVAR linked complication was observed in the follow-up period (range 3 to 91 months, mean 46 months). Conclusion: The hybrid procedure for the treatment of multiple aortic aneurysmal disease is less invasive compared to conventional staged surgery and the outcome in terms of mortality and morbidity in hospital as well as long-term follow-up are satisfactory.
Annals of Vascular Diseases 01/2008; 1(1):40-4.
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ABSTRACT: We report on a case of a 65-year-old man who was admitted for anterior chest pain on effort. He had received coronary artery bypass grafting (CABG) surgery 20 years ago with saphenous vein grafts (SVGs) to the left anterior descending artery (LAD) and right coronary artery (RCA). An angiography demonstrated large aneurysmal dilatation of both grafts and a fistulous communication between the middle portion of the right SVG and the right atrium (RA). The aneurysm was excised surgically, and the fistula was closed with the right atrial wall with additional bypass grafts of the left internal thoracic artery (LITA) and gastroepiploic artery (GEA).
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 01/2007; 12(6):435-7. · 0.69 Impact Factor
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ABSTRACT: We tried to experimentally clarify the flow dynamic differences under flow competitive conditions between the internal thoracic artery (ITA) and gastroepiploic artery (GEA) as in-situ arterial bypass conduits.
The ITA and the GEA were anastomosed close together to the left anterior descending artery (LAD) in 8 pigs. Flow characteristics of the ITA and the GEA were analyzed using a transit time flowmeter under the following flow competitive conditions; condition A: the ITA, GEA and LAD were left open, condition B: either of the ITA or GEA were clamped and the LAD was left open, condition C: the ITA and GEA were open but the proximal LAD was clamped, condition D: either of the ITA or GEA were clamped and the proximal LAD was also clamped.
The flow volume of the ITA was significantly (p<0.001) greater than that of the GEA in condition A (27 +/- 11 ml/min vs. -4 +/- 9 ml/min), B (26 +/- 17 ml/min vs. -1 +/- 14 ml/min) and C (38 +/- 14 ml/min vs. 0 +/- 4 ml/min), but did not differ (p=0.685) in condition D (29 +/- 6 ml/min vs. 31 +/- 14 ml/min). Retrograde flow in systole and antegrade flow in diastole was seen in the GEA in condition A, B and C.
Under flow competitive conditions, flow of the GEA was inferior to that of the ITA. These data suggested that the GEA is more sensitive to competitive flow than the ITA. This may be due to anatomical differences between these in-situ bypass conduits.
The Japanese Journal of Thoracic and Cardiovascular Surgery 07/2006; 54(6):233-8.
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ABSTRACT: The patient was a 61-year-old female. She underwent mitral valve replacement (MVR) with a 27 mm Carbomedics valve and tricuspid valve annuloplasty using the DeVega method in September 1997. She has received anticoagulant therapy by aspirin and warfarin in a nearby hospital. Because of aggravating dyspnea and chest pain after an acute upper respiratory inflammation, she was transferred to our hospital on an emergency basis on April 14, 2003. Upon admission she went into cardiogenic shock and multiple-organ failure. Biolite carbon coating prevents adhesion of thrombus or pannus on the sewing cuff of Carbomedics valve, and there were few reports of Carbomedics valve dysfunction by pannus formation. But in this case cineradiography demonstrated the prosthetic valve was fixed in the closed position. We diagnosed acute heart failure due to a stuck valve in the mitral position, and redo MVR was performed in emergency. Thrombotic pannus extended from the sewing cuff and into the orifice on the inflow and outflow sides of the valve, and fixed both leaflets in a closed position. The postoperative course was uneventful, and she was discharged on the 20th postoperative day, and now anticoagulant therapy is managed in the outpatient clinic of our hospital. A combination of cineradiography and echocardiography provides a detailed diagnosis of asymptomatic valve dysfunction. Periodical examination by a prosthetic valve specialist is necessary in order to perform adequate anticoagulant therapy, echocardiography and cineradiography after prosthetic valve replacement.
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 07/2005; 11(3):186-9. · 0.69 Impact Factor
