Akihiro Hosaka

Tokyo Metropolitan Tama Medical Center, Edo, Tōkyō, Japan

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Publications (34)66.65 Total impact

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    ABSTRACT: The object of the study is to determine the long-term outcomes of surgical treatment of patients with popliteal artery entrapment syndrome at a single institute. We retrospectively reviewed 19 limbs of 16 consecutive patients who underwent surgery for popliteal artery entrapment syndrome at our hospital over the past 36 years. The popliteal artery was stenotic in 11 limbs, occlusive in 7 limbs, and compressed and deviated by the medial head of the gastrocnemius muscle but not damaged in 1 limb. Six limbs were treated with autologous saphenous vein bypass, 10 with bypass or venous patch graft concomitant with musculotendinous section, and 3 limbs underwent musculotendinous section alone. The 10-year cumulative patency of the 13 limbs treated with bypass was 100%, although two of them showed occlusion at 23 and 12 years after surgery. One patient who received a venous patch graft showed occlusion 15 years after surgery. Additionally, one asymptomatic patient with an apparently non-damaged popliteal artery who received preventive musculotendinous section alone showed stenosis of the artery 2 years after musculotendinous section. In conclusion, the bypass patency observed in this study was excellent in the long term. Careful examination of popliteal artery anatomy using imaging studies is essential for selecting the appropriate surgical procedure for popliteal artery entrapment syndrome. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
    Vascular 11/2014; · 0.86 Impact Factor
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    ABSTRACT: Aim: The viscoelastic properties of the artery are known to be altered in patients with vascular diseases. However, few studies have evaluated the viscoelasticity of the vascular wall in humans. We sought to investigate the degree of viscoelastic deterioration of the carotid artery and assess its clinical implications.Methods: Between January 2011 and June 2013, patients in whom the toe-brachial index was measured at the vascular laboratory were included in this single-institute retrospective observational study. I(*), a parameter of viscoelastic deterioration, was computed using a non-invasive ultrasonic Doppler effect sensor on the carotid artery. I(*) is a non-dimensional value, and I(*)>0 is considered abnormal. Other patient characteristics were identified and tested for correlations with I(*).Results: The study included 383 patients. The mean I(*) value was 0.13±0.22 with a normal distribution. Factors that increased the I(*) value were a female sex (0.18±0.23 vs. 0.10±0.21, P<0.001), age ≥ 60 (0.14±0.22 vs. 0.06±0.23, P<0.05) and systolic blood pressure of >140 (0.15±0.22 vs. 0.10±0.22, P<0.05). I(*) abnormality was a significant risk factor for coronary artery disease (OR 2.20, 95% CI 1.00-4.80, P<0.05) in a univariate analysis. In the multivariate analysis, I(*) abnormality was also found to be an independent risk factor for coronary artery disease (OR 4.56, 95% CI 1.21-30.1, P<0.05).Conclusions: I(*) may reflect the degree of atherosclerotic changes in the arterial wall and could possibly be used to predict coronary artery disease.
    Journal of atherosclerosis and thrombosis. 11/2014;
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    ABSTRACT: Despite improvements in therapeutic modalities, the treatment of arterial aneurysms complicating Behçet's disease (BD) is still challenging. This study examined the long-term prognosis after surgery for arterial aneurysms in BD.
    International angiology: a journal of the International Union of Angiology 10/2014; 33(5):419-25. · 1.46 Impact Factor
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    ABSTRACT: Objective To evaluate the outcomes of surgical revascularization for critical limb ischemia in patients with end-stage renal disease (ESRD). Patients and methods From 2004 to 2010, 184 patients with 213 critically ischaemic limbs caused by arteriosclerosis were admitted to The University of Tokyo Hospital. The outcomes of primarily surgical revascularization-based treatments were retrospectively compared in patients with ESRD (ESRD group: 79 patients, 101 limbs) and without ESRD (non-ESRD group: 105 patients, 112 limbs) during the same period. Results Arterial reconstruction was performed on 56 limbs in 46 patients in the ESRD group and 78 limbs in 73 patients in the non-ESRD group (55% vs. 70%; p = .03). Major amputation was performed in 6 of 48 limbs with patent grafts in the ESRD group because of uncontrolled infection or progression of necrosis. The limb salvage rate after arterial reconstruction was significantly lower in the ESRD group than in the non-ESRD group (p = .0019). The postoperative survival rate was lower in the ESRD group than in the non-ESRD group, although this difference was not significant (p = .052). Associated cardiovascular disease and systemic infection were the most frequent causes of death in the ESRD group. There was no significant difference in graft patency between the two groups after distal bypass surgery; however, the limb salvage rate was significantly lower in the ESRD group than in the non-ESRD group (p = .03). Conclusions Critical limb ischemia associated with ESRD has a poor prognosis. Infection control is particularly important for achievement of good treatment outcomes.
    Journal of Vascular Surgery 09/2014; · 2.88 Impact Factor
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    ABSTRACT: The effect of peripheral arterial disease (PAD) among young and middle-aged adults can be significant, but no previous study has examined the prognosis and the associated health care cost of the disease in this population. We evaluated the clinical and economic burden of PAD in patients from a large claims database to clarify the effect of the disease on a relatively young working Japanese population.
    Clinical therapeutics. 07/2014;
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    ABSTRACT: Background:Renal insufficiency is the most frequent complication of surgeries that involve suprarenal aortic cross-clamping. Although some studies have assessed the risk of intraoperative renal ischemia by comparing juxtarenal abdominal aortic aneurysms (AAAs) and infrarenal AAAs, a critical limitation is the difference in these patients' clinical backgrounds and aneurysmal features. The present study evaluated the effect of suprarenal aortic clamping by comparing a juxtarenal AAA group with a subgroup of infrarenal AAAs (ie, short and/or large neck).Methods and Results:Among patients who underwent open surgery for AAA, the 2 types of AAA were selected and compared: juxtarenal AAA (JR group: n=35) and infrarenal AAA with short (<15 mm) and/or large (>28 mm) aneurysmal neck that only required infrarenal aortic clamping (SL group: n=26). Postoperative renal function was evaluated using the RIFLE classification. There were no significant differences between groups in baseline characteristics, comorbidities, and intraoperative variables. There were no adverse events leading directly to in-hospital mortality in either group. The rate of postoperative renal insufficiency (estimated glomerular filtration rate decrease ≥-25%) was not significantly different between groups.Conclusions:The outcomes of the 2 groups were similar, indicating that intraoperative renal ischemia with no specific intraoperative protection would not adversely affect postoperative outcomes.
    Circulation Journal 07/2014; · 3.58 Impact Factor
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    ABSTRACT: Exclusion of the accessory renal arteries (ARAs) is required during endovascular aneurysm repair if they arise from the sealing zone or aneurysm sac. Here, we report a case of successful endovascular treatment for a common iliac artery aneurysm located close to the aortic bifurcation and associated with nephrotic syndrome in a 51-year-old man. The bilateral ARAs were successfully preserved using kissing stent grafts. During surgery, the proximal ends of endografts inserted from the bilateral femoral arteries were adjusted so that they met at the same level in the aorta, and simultaneous balloon dilatation was performed. This method can be a useful treatment option for common iliac aneurysms in cases with large ARAs.
    Journal of vascular surgery. 06/2014;
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    ABSTRACT: Aortic aneurysms are sometimes accompanied with disseminated intravascular coagulation (DIC). The definitive treatment of DIC is removal of underlying disease; surgical repair for the aortic aneurysms. Heparin, anticoagulant and other antifibrinolytic agents have been administered preoperatively to alleviate DIC whose bleeding tendency could cause high mortality and morbidity; however, their effectiveness was indeterminate. An 84-year-old man was presented with abdominal aortic aneurysm accompanied by DIC and underwent aneurysmectomy. After having confirmed that combined use of heparin and gabexate mesilate was ineffective, we used recombinant human soluble thrombomodulin (rhsTM), which has been reported to be more effective and safer than the heparin, for a week preoperatively, and demonstrated dramatic improvement of DIC. RhsTM should be a novel powerful therapeutic option for aneurysm-induced DIC.
    Blood coagulation & fibrinolysis: an international journal in haemostasis and thrombosis 12/2013; · 1.25 Impact Factor
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    ABSTRACT: Primary iliac venous aneurysm is an extremely rare clinical entity. We report a case of primary external iliac venous aneurysm containing an intraluminal thrombus that caused pulmonary thromboembolism in a 22-year-old woman. The aneurysm and pulmonary emboli were detected during examination for sudden onset of dyspnea. After receiving anticoagulation and thrombolytic therapy, the patient underwent aneurysm resection. We devised venoplasty using a dual-row saphenous vein patch to cover the large defect of the vessel wall. Primary iliac venous aneurysms associated with pulmonary thromboembolism are uncommon and surgical repair is made difficult by the fragility of the affected vessel. We reviewed the clinical features of this unusual entity.
    Surgery Today 11/2013; · 0.96 Impact Factor
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    ABSTRACT: Aim: In Trans-Atlantic Inter-Society Concensus (TASC) II, patients at risk for critical limb ischemia (CLI) without symptoms are termed "chronic subclinical ische mia," but research are still lacking. The objective was to find out whether clinically asymptomatic contralateral limbs at the time of treatment for ipsilateral CLI could be regarded as "chronic subclinical ischemia". Methods: Ninety-six patients with CLI who had no symptoms in the contralateral limb were retrospectively reviewed. The symptoms of the contralateral limb after initial intervention for the ipsilateral limb were surveyed. Risk factors for developing CLI and tissue loss were then analyzed. Results: Five patients (5.2%) became claudicants, 37 patients (38.5%) had symptoms of CLI, and 14 (14.6%) experienced tissue loss during the follow-up period. The overall CLI-free rates at 12, 36, and 60 months were 79.2%, 55.2%, and 45.8%, respectively, while the tissue loss-free rates at 12, 36, and 60 months were 91.3%, 78.8%, and 78.8%, respectively. Risk factor for developing CLI on the contralateral limb was having skin perfusion pressure (SPP) <40 mmHg at the surgery for ipsilateral limb. The presence of SPP <40 mmHg and end stage renal failure with hemodialysis resulted in a significantly high probability of tissue loss. Conclusion: Patients with CLI with an asymptomatic contralateral limb with an SPP value <40 mmHg are at a high risk of developing CLI and tissue loss during the follow-up period. Information on the contralateral limb at initial surgery may help to speculate the fate of the asymptomatic contralateral limb.
    International angiology: a journal of the International Union of Angiology 10/2013; 32(5):526-31. · 1.46 Impact Factor
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    ABSTRACT: Endovascular revascularization has recently been established as a less invasive treatment method for chronic mesenteric ischemia. However, intestinal necrosis caused by distal embolization following this procedure has not been emphasized. The present report describes a 59-year-old man who was treated with endovascular revascularization for chronic mesenteric ischemia. After the procedure, he was diagnosed with intestinal necrosis caused by distal embolization. Despite emergent bowel resection, he died on postoperative day 109. Although endovascular revascularization for chronic mesenteric ischemia is less invasive and may be suitable for high-risk patients, attention should be paid to avoid embolic complications that can cause intestinal infarction possibly leading to a fatal condition.
    BMC Gastroenterology 07/2013; 13(1):118. · 2.11 Impact Factor
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    ABSTRACT: A true pancreaticoduodenal artery aneurysm (PDAA) is a rare disease, and has some unique characteristics: a high rupture risk and a strong correlation with celiac trunk stenotic lesions (CTSL). We showed here that our treatment strategy for PDAA. Seven consecutive patients with PDAA at our institution from 1998 to 2011 were retrospectively reviewed. Of the 7 patients, five were male and two were female, with a mean age of 55 ± 9.7 years. Three aneurysms were diagnosed incidentally, and the remaining four ruptured. The locations of the aneurysm were the anterior superior pancreaticoduodenal artery (ASPDA) in 3 patients and the inferior pancreaticoduodenal artery (IPDA) in four. CTSL found 3 patients in the IPDA. Of four ruptured patients, emergency catheter coil embolization was performed in three, and a simple ligation was performed in one. Three patients with non-ruptured aneurysms in the IPDA with a CTSL underwent direct aneurysm resection with arterial reconstruction. Six patients were successfully treated without complications or the appearance of new aneurysms during the follow-up period. The treatment strategy for PDAA should be selected by the site of the aneurysm, the patients' condition, and the anatomical situation. A hybrid treatment could be considered a beneficial option for a CTSL.
    Annals of Vascular Diseases 01/2013; 6(4):725-9.
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    ABSTRACT: Outcomes of abdominal aortic aneurysm (AAA) repair have improved in the 2 decades since the emergence of endovascular aneurysm repair (EVAR). However, EVAR is considered a contraindication for shaggy aorta because of the high risk of shower embolization. Recently, statins have been implicated in preventing embolization in patients with shaggy aorta via its pleiotropic effects, including atheroma reduction and coronary artery stabilization. We selected pitavastatin, a statin with potent effects, discovered and developed by a Japanese company because it has shown excellent pleiotropic effects on atheromatous arteries in the Japanese population. A randomized comparison study of dose-dependent effects of pitavastatin in patients with AAA with massive atheromatous aortic thrombus (PROCEDURE study) has begun. PROCEDURE has an enrollment goal of up to 80 patients with AAA with massive aortic atheroma (excluding intrasac atheroma), randomly allocated into 2 groups receiving pitavastatin at a dose of 1 or 4 mg/day. The endpoints of the PROCEDURE study include change in atheroma volume, major adverse events related to shower embolization after aneurysm repair, and lipid-lowering effects. When complete, results of the PROCEDURE study should provide objective evidence to use statins preoperatively for AAA with massive aortic atheroma.
    Annals of Vascular Diseases 01/2013; 6(1):62-6.
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    ABSTRACT: We retrospectively analysed surgically treated abdominal aortic aneurysm (AAA) in patients with massive atheroma in the aneurysmal neck and compared the outcomes of endovascular aneurysm repair (EVAR) and open surgery (OS) to determine an appropriate strategy for massive neck atheroma cases. A retrospective study was performed in 326 consecutive patients who underwent EVAR and in 247 patients who underwent OS. We defined massive neck atheromas if the following characteristics were observed: (1) thickness ≥ 5 mm; (2) the circumference of the infrarenal aorta ≥ 75%; and (3) length ≥ 5 mm. Twenty-eight patients (8.5%) in the EVAR group and 22 (8.9%) in the OS group met these criteria. We modified the previously published reporting standards on the basis of the selection of systemic and embolisation-related complications. Patients in the EVAR group had less intra-operative blood loss, shorter operation time, and shorter hospital stays after the operation (P < 0.01). No perioperative deaths were observed in either group. Major complications were categorised as early (in-hospital) or late (outpatient, within 6 months). Five and three patients in the OS and EVAR groups had early complications, but the difference was not statistically significant. In contrast, 7 patients in the EVAR group had late complications, compared to no patients in the OS group (P = 0.01). Kaplan-Meier analysis revealed a significantly higher survival rate in the OS group (P = 0.011). Two of the 4 patients with suprarenal clamping developed major complications. Mild eosinophilia was observed in 10 patients in the EVAR group. Proteinuria occurred or worsened in 5 EVAR patients and 1 OS patient. Compared to OS patients, EVAR patients with massive neck atheroma tend to develop late-phase complications possibly related to cholesterol crystal embolisation. The clinical features of massive neck atheroma patients receiving EVAR should be carefully monitored even after hospital discharge.
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 03/2012; 43(3):257-61. · 2.92 Impact Factor
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    ABSTRACT: We report a patient with inflammatory abdominal aortic aneurysm who underwent endovascular aneurysm repair, despite his having an allergy to iodinated contrast medium and anatomy unsuitable for the procedure. Intravascular ultrasound-guided and CO2-assisted aortic stent graft placement was performed, and the procedures resulted in the successful exclusion of the aneurysm with regression of the mantle sign and resolution of hydronephrosis.
    Annals of Vascular Diseases 01/2012; 5(1):104-8.
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    ABSTRACT: A 61-year-old woman with multiple splanchnic arterial aneurysms (SAAs) was transferred to our hospital in a state of shock. She underwent coil embolization under the diagnosis of ruptured pancreaticoduodenal artery aneurysm. Follow-up computed tomography performed 2 weeks later showed rapid enlargement of a gastric artery aneurysm, and she underwent an additional embolization. Atherosclerotic, inflammatory or hereditary causes were excluded, and the patient was clinically diagnosed with segmental arterial mediolysis accompanied by multiple SAAs, one of which showed acute remodeling after endovascular treatment.
    Annals of Vascular Diseases 01/2012; 5(4):449-53.
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    ABSTRACT: Preoperative examination for abdominal aortic aneurysms (AAAs) occasionally reveals an abnormal decrease in coagulation factors and thrombocytopenia, fulfilling the criteria for disseminated intravascular coagulation (DIC). Treatment of the underlying disorder is indispensable for alleviating DIC. We report an uncommon case of a patient with AAA and DIC who showed prolonged thrombocytopenia despite successful treatment of AAA and temporary recovery of coagulation factors. A 70-year-old man presented with AAA and shaggy aorta accompanied by DIC and underwent aneurysmectomy. Combined preoperative use of nafamostat mesilate and recombinant human soluble thrombomodulin was effective in controlling DIC. Although recovery of coagulation factors was observed after surgery, the thrombocytopenia continued throughout the postoperative course and was refractory to platelet transfusion. Because HPA antibody and PA-IgG were present, a trial administration of γ-globulin was performed; this resulted in rapid improvement of thrombocytopenia. Although DIC recurred again 2 weeks thereafter, coagulation factors subsequently recovered without any medication.
    Case reports in vascular medicine. 01/2012; 2012:265860.
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    ABSTRACT: Endovascular aneurysm repair (EVAR) was first approved in Japan in 2007. In order to avoid the learning curve generally seen in the initial stages of implementation, we have aimed for procedural perfection. As the proximal type I endoleak (EL) is associated with a higher risk of late conversion and rupture, so we have treated the intraoperative type I EL scrupulously. The hostile neck, which is known to be a risk for perigraft leakage, is the focus of this study. We showed both the middle-term results of EVAR in our country and the possible necessity of intraoperative management for the hostile neck. From a consecutive series of 134 patients who underwent EVAR of abdominal aortic aneurysms, 129 cases in which contrast agent was used intraoperatively were selected. All cases had at least 12-month follow-up postoperatively (12-40 months). Of the 129 selected cases, 49 cases (37%) that did not fulfill the commercially recommended criteria of the aneurysmal neck (length <15 mm and angle >60° of the aneurysm or >45° of the suprarenal aorta) were assigned to the off-label group. The other 80 cases were assigned to the on-label group. We carefully observed the completion angiography and when we found or suspected a type I EL, we performed a re-touch up, changed to a non-compliant balloon, and used a supportive device, such as a PalmazTM stent or aortic cuffs, in sequence. No postoperative type I ELs were detected within the follow-up period. Intraoperative type I ELs were detected more frequently in the off-label group (51%) than the on-label group (20%) (P<0.01). The rate of type I EL in the off-label group in terms of the neck length criteria (11/14 cases) was higher than that in the on-label group (30/115 cases) (P<0.01). In terms of the neck angle, patients in the off-label group had a greater tendency to develop the type I EL than those in the on-label group (18/42 vs. 23/87 cases) (P=0.06). Off-label usage regarding aneurysmal neck length and angle tends to be incomplete without additional procedures. Conversely, various techniques, including non-compliant balloon usage and aortic stenting or cuffs, produce good results for the intraoperative type I EL. We found a relationship between the neck condition and the intraoperative type I EL, and showed the importance of strictly obeying our simple algorithm against the proximal type I EL.
    International angiology: a journal of the International Union of Angiology 10/2011; 30(5):467-73. · 1.46 Impact Factor
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    ABSTRACT: Thoracic venous aneurysm is an extremely rare condition. This report describes the case of a 70-year-old woman with a left brachiocephalic venous aneurysm that caused recurrent nerve paralysis. Contrast-enhanced computed tomography and venography revealed a venous aneurysm, 4 cm in size, located adjacent to the venous angle. Anticoagulation therapy was started, and 1-1/2 months later, the aneurysm greatly decreased in size and showed marked calcification along its periphery. Venous aneurysms that shrink after anticoagulation therapy are exceptionally rare. The clinical features of this condition have been briefly reviewed.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 06/2011; 54(6 Suppl):77S-9S. · 3.52 Impact Factor
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    ABSTRACT: Despite improvement of devices, endovascular aneurysm repair (EVAR) is still challenging in cases with associated aneurysmal involvement of the iliac arteries. This study examined the safety and efficacy of EVAR with concomitant unilateral embolization of the internal iliac artery (IIA) and contralateral external-to-internal iliac artery bypass grafting, with bilateral endograft limbs extended into the external iliac arteries (EIAs). The study included 22 consecutive patients (mean age, 74 years) who underwent elective endovascular repair of aortoiliac or iliac aneurysms, with concomitant coil embolization of the unilateral IIA and contralateral EIA-to-IIA bypass in the same operative setting. Five patients had a unilateral IIA aneurysm, and eight had bilateral IIA aneurysms. EIA-to-IIA bypass grafting was performed through the retroperitoneal approach. The perioperative and midterm outcome of the procedure was assessed. The procedure was successfully performed in all cases. Eleven patients underwent IIA embolization at the main trunk, and the other 11 cases required IIA occlusion at distal branches. There was no perioperative death or severe complication. The mean follow-up period was 15.7 ± 7.8 months, ranging from 2 to 32 months. The bypass remained patent in all cases, and there was no occurrence of graft-related complication. Enlargement of aneurysms or development of type I endoleak was not observed. Persistent mild buttock claudication occurred in two patients (9%) ipsilaterally to the occluded IIA; one patient after IIA occlusion at the main trunk and the other at distal branches. No other pelvic ischemic manifestation was observed. EVAR with simultaneous unilateral IIA embolization and contralateral EIA-to-IIA bypass grafting is feasible, with a relatively low risk of complications. It can be a useful treatment option in cases with complex aortoiliac aneurysms, including those with bilateral IIA aneurysms.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 05/2011; 54(4):960-4. · 3.52 Impact Factor

Publication Stats

133 Citations
66.65 Total Impact Points

Institutions

  • 2014
    • Tokyo Metropolitan Tama Medical Center
      Edo, Tōkyō, Japan
  • 2004–2013
    • The University of Tokyo
      • • Department of Vascular Surgery
      • • Faculty & Graduate School of Medicine
      • • Department of Surgical Sciences
      Tokyo, Tokyo-to, Japan
  • 2011
    • Tokyo Medical University
      • Division of Cardiovascular Surgery
      Edo, Tōkyō, Japan
    • Morinomiya University of Medical Sciences
      Ōsaka, Ōsaka, Japan
  • 2007–2010
    • University Hospital Medical Information Network
      Edo, Tōkyō, Japan