Shunsuke Endo

Jichi Medical University, Totigi, Tochigi, Japan

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Publications (150)195.14 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: We report a case involving a female patient with frequent relapse, pleural dissemination, and port site recurrence (PSR) of a pleural solitary fibrous tumor (SFT). At the age of 55 years, she underwent tumor resection via video-assisted thoracoscopic surgery (VATS). The tumor arose from the mediastinal pleura; it was 7 cm in diameter and well demarcated. Histological examination showed neither hemorrhage nor necrosis, but moderate cellularity was present, and the Ki-67 labeling index was 15%. Despite complete resection, the tumor relapsed in the ipsilateral thoracic cavity 3 years postoperatively, and thoracoscopic complete tumor resection was performed; however, pleural lavage cytology (PLC) showed the presence of tumor cells. Multiple pleural dissemination and PSR developed 7 years after the initial surgery. The port site recurrent tumor was resected with the intercostal muscle via VATS. This case illustrates that a SFT may disseminate despite the fact that histological examination shows no evidence of malignancy.
    No preview · Article · Dec 2015 · Journal of Thoracic Disease
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    ABSTRACT: The switch/sucrose non-fermenting (SWI/SNF) complex has recently emerged as a novel tumor suppressor in various human cancers. In the present study, we analyzed the expression of multiple SWI/SNF subunits in primary non-small cell lung cancer (NSCLC). A total of 133 NSCLC, consisting of 25 squamous cell carcinomas (SCC), 70 adenocarcinomas (AD), 16 large cell carcinomas (LC), and 22 pleomorphic carcinomas (PL), were immunohistochemically examined for the expression of BRG1, BRM, BAF47, ARID1A, and ARID1B. The frequency at which reductions in the expression of BRG1 were observed was significantly higher in the LC-PL group (13/38, 34.2%) than in the SCC-AD group (7/95, 7.4%). Similarly, the frequency at which reductions in the expression of BRM were observed was significantly higher in the LC-PL group (17/38, 44.7%) than in the SCC-AD group (14/95, 14.7%). The loss of the expression of ARID1A, ARID1B, and BAF47 was observed only in a fraction of NSCLC cases. Furthermore, the frequency at which the concurrent loss of multiple subunits of the SWI/SNF complex was observed was significantly higher in the LC-PL group (10/38, 26.3%) than in the SCC-AD group (8/95, 8.4%). Collectively, these results indicate that the loss of the SWI/SNF complex was related to dedifferentiation in NSCLC.
    No preview · Article · Oct 2015 · Pathology International
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    ABSTRACT: Soft coagulation is a hemostat system of electrosurgical units, which automatically regulates its output voltage below 200 V, to avoid excessive output that causes carbonization of the target tissue. However, this new minimally invasive technology still has the potential risk of tissue damage during surgery. We encountered three patients with bronchial injury caused by the above system; one of whom had bronchopleural fistula. This is believed to be the first report emphasizing the adverse effects of the soft coagulation system in thoracic surgery, giving a warning to the application of this convenient device.
    No preview · Article · Sep 2015 · Journal of Thoracic Disease
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    ABSTRACT: Postoperative bronchopleural fistula is one of the most life-threatening complications after anatomical pulmonary resection. Bronchopleural fistula may cause empyema and aspiration pneumonia with subsequent acute respiratory distress syndrome. Surgical interventions for bronchopleural fistula can prolong hospitalization and impair postoperative quality of life. Postoperative care requires minimally invasive endoscopic occlusion. We retrospectively reviewed the records of 7 patients who developed bronchopleural fistula among 689 patients who underwent segmentectomy or lobectomy without sleeve resection for lung cancer in Jichi Medical University from 2009 to 2013. Bronchopleural fistula occurred in the right lower bronchial stump in 3 patients, in the superior segmental bronchus of the right lower lobe in 2, in the superior segmental bronchus of the left lower lobe in one, and in the right intermediate bronchus in one. Flexible bronchoscopy was used to occlude 3-mm fistulas with polyglycolic acid mesh in 2 patients. Larger fistulas in 5 patients were occluded with polyglycolic acid mesh plus fibrin glue to secure the mesh. The median procedure was 37 min. Procedures were considered complete upon resolution of air leakage from the chest drainage system. Bronchoscopic interventions for bronchopleural fistula were repeated an average of 2 times. No procedure-related complications or death occurred. Bronchoscopic interventions were successful in all patients. Bronchoscopic occlusion with polyglycolic acid mesh with or without fibrin glue is easy and feasible as the first step in postoperative management of bronchopleural fistula. © The Author(s) 2015.
    No preview · Article · Jul 2015 · Asian cardiovascular & thoracic annals
  • Tomoyuki Nakano · Shunsuke Endo
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    ABSTRACT: Mediastinal tumor occasionally causes life-threatening symptoms by infection, enlargement, and invasion to intrathoracic organs requiring an emergent treatment, while routine chest computed tomography (CT) can increasingly lead to incidental diagnosis of an asymptomatic mediastinal tumor. Cystic teratoma is one of the mediastinal tumors with lethal symptoms by rupture into the intrathoracic organs and/or cavities. Emergent tumor resection should be recommended when clinical characters suggest the diagnosis. Mediastinal tumors can cause airway stenosis by direct invasion and/or compression. Urgent airway reconstruction either by bronchoscopic interventions including stent or by surgery depends on causative diseases. Anterior mediastinal tumors such as thymic tumors can cause superior vena cava (SVC) syndrome. SVC reconstruction using a grafting method followed by radical tumor resection is recommended when the thymic epithelial tumor can be resectable. SVC reconstruction can provide a good quality of life and subsequent adjuvant therapy to some patients with the tumor responding to chemo-radiation therapy, even when the tumor is unresectable. The treatment strategy for lethal mediastinal tumors should be planned by physicians, radiologists and anesthesiologists other than thoracic surgeons.
    No preview · Article · Jul 2015 · Kyobu geka. The Japanese journal of thoracic surgery
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    ABSTRACT: The indications for video-assisted thoracoscopic surgery (VATS) for advanced-stage lung cancer are expanding, but the criteria vary among institutions. This study compared the minimal invasiveness and oncologic validity of VATS lobectomy and thoracotomy lobectomy for the treatment of large-diameter primary lung cancer. We retrospectively reviewed clinical features and surgical outcomes of 68 patients who underwent anatomical pulmonary resection for primary lung cancer of >5-cm diameter from July 2006 to March 2013. The patients were divided into a VATS group (Group V, n = 35) and a thoracotomy group (Group T, n = 33). Group V exhibited less intraoperative bleeding (p = 0.012) and had a shorter length of postoperative hospital stay (p = 0.024). The 1- and 5-year overall survival rates were 91.3% and 39.3% in Group V and 84.8% and 56.9% in Group T, respectively (p = 0.48). Multivariate analysis showed that limited lymph node dissection contributed to local recurrence. The extraction bag lavage cytology in Group V revealed that the positivity rate was 35.7%. VATS for primary lung cancer of >5-cm diameter is similar to thoracotomy in terms of surgical outcomes. Large tumors must be carefully maneuvered during VATS to prevent cancer cell spillage.
    Preview · Article · May 2015
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    ABSTRACT: Eemerging evidence confirms a central role of Akts in cancer. To evaluate the relative contribution of deregulated Akts and their clinicopathological significance in lung carcinomas, overexpression, activation of Akts and AKT gene increases were investigated. Immunohistochemical staining for 108 cases revealed overexpression of total-Akt, Akt1, Akt2 and Akt3 in 61.1%, 47.2%, 40.7%, 23.1%, respectively and phosphorylated-Akt in 42.6%. Expression of total-Akt, Akt2 and Akt3 were frequently observed in small cell carcinoma, but phosphorylated-Akt and Akt1 were more frequently observed in squamous cell carcinoma. Fluorescence in situ hybridization analysis to evaluate gene increases of AKT1-3 revealed amplification of AKT1 in 4.2% and AKT1 increase by polysomy of chromosome 14 in 27.3%. For AKT2, amplification was observed in 3.2% and polysomy of chromosome 19 in 26.3%. AKT3 increase was observed in 40.0% only by polysomy of chromosome 1. Although "Fluorescence in situ hybridization-positive" AKT1 and AKT2 gene increases (amplification/high-level polysomy) were found exclusively in the cases overexpressing total-Akt, Akt1 or Akt2, respectively, AKT3 increase was irrelevant of Akt3 expression. Statistically, expressions of Akt2, p-Akt and cytoplasmic-p-Akt were correlated with lymph node metastasis (p=0.0479, p=0.0371 and p=0.0310, respectively). Although AKT1 and AKT2 gene increase showed the positive correlation with, or trends towards tumor size (p=0.0430, p=0.0590, respectively), AKT3 did not. In conclusion, Akt isoforms are differentially involved in pathological phenotype of lung carcinoma in a diverse manner. Since abnormality of Akt1/AKT1 and Akt2/AKT2 correlated with clinicopathological profiles, Akt1/2-specific targeting may open the novel therapeutic window for the group showing Akt deregulation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Preview · Article · Apr 2015 · Cancer Science
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    ABSTRACT: We report a case involving an intrathoracic desmoid tumor in a 68-year-old woman who had undergone video-assisted thoracoscopic right basal segmentectomy for lung cancer 1 year earlier. The well demarcated tumor was 9 cm × 6 cm × 6 cm in size, was located in the right apico-posterior thorax and had invaded the chest wall. The patient complained of a dull shoulder pain as a result of rapid tumor enlargement. En bloc tumor resection, including the apico-posterior chest wall extending from the 1st to the 4th rib, was successful. The patient had no recurrent tumor at 5 years after the second surgery. Intrathoracic desmoid tumor could occur, even when the tumor arises at a distance from the port and thoracotomy sites after thoracoscopic surgery.
    No preview · Article · Apr 2015 · Journal of Thoracic Disease
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    ABSTRACT: We reviewed the medical records of 1,047 consecutive patients with lung cancer who underwent surgery between April 2005 and March 2014. Among them 49 patients(4.7%)had concomitant ischemic heart disease. Coronary angiography showed coronary artery stenosis in 41 patients, of whom 14 patients received bare metal stents and 9 patients received drug-eluting stents. Three patients underwent plain old balloon angioplasty. Coronary artery bypass graft were performed in 5 patients. Eight patients with coronary spastic angina were also included in the present study. Aspirin administration was continued in 9 patients and heparinization was performed in 14 patients during the perioperative period. Postoperative major adverse cardiac events within 30-days occurred in 3 patients(6.1%)resulting in a single fatality(2.0%). No major cardiac events, including stent thrombosis, developed in patient who received coronary stent. Perioperative aspirin administration and heparinization were not significantly associated with intraoperative bleeding during the operation.
    No preview · Article · Apr 2015 · Kyobu geka. The Japanese journal of thoracic surgery
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    ABSTRACT: Aberrant pulmonary artery exposed by high-blood pressure over a long period in adult-type pulmonary sequestration can be susceptible to arteriosclerotic change and aneurysmal formation. Dividing this aneurysmal artery has a risk of stump leakage and aneurysm. We herein report a 64-year-old man with an aberrant aneurysm of intralobar pulmonary sequestration. Thoracoscopic resection of the sequestrated lung was performed uneventfully by prior endovascular occlusion of the aberrant aneurysm.
    No preview · Article · Mar 2015 · Journal of Thoracic Disease
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    ABSTRACT: Solitary fibrous tumor is a rare mesenchymal neoplasm, characterized by peculiar histological features composed by the proliferation of spindle cells in "patternless pattern". Although it has been known to sometimes be accompanied by epithelioid cells, the presence of a well-formed epithelial structure is far more rare. We describe herein the case of a 60-year-old female with the radiological finding of a single nodular lesion in the anterior mediastinum. Histopathological examination of the surgically resected specimen led to the diagnosis of solitary fibrous tumor of the thymus with a spectrum of well-formed epithelial components: i) glandular structure, reminiscent of breast or eccrine gland, ii) neural tube-like structure, and iii) clusters of endocrine-like cells. Immunohistochemical analysis revealed that the spindle cells expressed CD34, vimentin, bcl-2 and Stat-6, but not keratin (cytokeratin-AE1/AE3) or epithelial membrane antigen. In contrast, the epithelial components lost expression of most of these marker proteins, including Stat-6, but continued to express vimentin and strongly expressed keratin. Since no relevant past literature was found, the current case could be interpreted as a unique and previously undescribed variant of solitary fibrous tumor comprising conventional spindle cells with a spectrum of well-formed epithelial components. Pathogenesis that may have given rise to these variegated mixtures of spindle cells and epithelial components in a single tumor is also discussed.
    No preview · Article · Dec 2014 · International journal of clinical and experimental pathology
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    ABSTRACT: We performed an immunohistochemical analysis of the expression of zinc-finger E-box binding homeobox 1 (ZEB1), a master regulator of epithelial-mesenchymal transition (EMT), and determined its relationship with E-cadherin in 157 non-small cell lung carcinomas (93 adenocarcinomas, 36 squamous cell carcinomas, 18 large cell carcinomas, and 10 pleomorphic carcinomas). Although the expression of E-cadherin was low in the subset of adenocarcinomas (10%) and squamous cell carcinomas (11%), ZEB1 expression was only observed in one case of squamous cell carcinoma and none of the adenocarcinomas. In contrast, the low expression of E-cadherin (50% and 90%, respectively) and the positive expression of ZEB1 (11% and 50%, respectively) were more frequently observed in poorly differentiated carcinomas (large cell carcinomas and pleomorphic carcinomas). Overall, the expression of ZEB1 was inversely correlated with that of E-cadherin. Furthermore, the distribution of ZEB1-positive cancer cells was more restricted than in the area in which the expression of E-cadherin was lost, and the former was detected within the latter. We concluded that the expression of ZEB1 was not necessarily associated with the low expression of E-cadherin in lung adenocarcinomas and squamous cell carcinomas. The expression of ZEB1 correlated with an undifferentiated and/or sarcomatoid morphology that may occur in the late stage of EMT.
    No preview · Article · Oct 2014 · Pathology International
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    ABSTRACT: Nowadays, a diaphragmatic lesion is sometimes resected with use of an automatic stapling device, especially through video-assisted thoracoscopic procedure. We herein report 2 patients with a diaphragmatic hernia after diaphragmatic resection by automatic stapling devices. Etiology and cause of postoperative diaphragmatic hernia are discussed. Diaphragmatic resection by mechanical stapler was performed for thymic epithelial tumor recurring at the diaphragmatic pleura in both patients: 48-year-old man and 72-year-old woman. The former patient underwent a right diaphragmatic resection (3×4 cm in size) with a cartridge of mechanical stapler. Computed tomography (CT) and magnetic resonance imaging showed asymptomatic right diaphragmatic hernia 2 months after surgery. No symptom and progression occurred 8 years later. The latter patient underwent a right diaphragmatic resection (6×7 cm in size) with 2 cartridges of mechanical stapler. Diaphragmatic hernia advanced 7 months after surgery and required surgical intervention. Diaphragmatic repair was successful with the use of 8×6 cm expanded polytetrafluoroethylene patch. Surgical stump after diaphragmatic resection with automatic stapling device is easy to rupture during diaphragmatic movement synchronized with respiratory movement. Diaphragmatic resection with use of stapling device, which is a simple procedure, should be contraindicated.
    No preview · Article · Oct 2014 · Kyobu geka. The Japanese journal of thoracic surgery
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    ABSTRACT: In lung tumors, the association between carcinoids and high-grade neuroendocrine tumors (HGNETs) is controver-sial. To understand the phenotypic similarities/differences between lung carcinoids and HGNETs, we comparatively investigated the expression of three kinds of developing neural transcription factors (DNTFs: BRN2, TTF1 and ASCL1) and multiple endocrine neoplasia type 1 (MEN1) as well as RB1 and P53 using 18 carcinoids and 16 HGNETs. The DNTFs were expressed in 10 of the 18 carcinoids and in all the HGNETs, while normal neuroendocrine cells, which are considered the major cell origin of lung carcinoids and small cell carcinomas, did not express DNTFs. Both the DNTF -and DNTF + carcinoids contained typical and atypical carcinoids. All the DNTF -carcinoids examined were formed in the bronchial wall. All the MEN1 -carcinoids examined were classified into the DNTF -carcinoids, while all the HGNETs expressed MEN1. This finding suggests that DNTF -MEN1 -carcinoids are unlikely to be precursors of HGNETs. Although the status of RB1 and P53 between carcinoids and HGNETs were apparently different, the DNTF + carcinoids of two male patients and one female patient revealed mor-phologies resembling HGNET cells and relatively high Ki67 indices. Further investigation of DNTF expression in carcinoids might provide important clues to understand the association between carcinoids and HGNETs. The World Health Organization (WHO) classifies morphologi-cally identifiable lung neuroendocrine (NE) tumors (NETs) into four categories: typical carcinoid (TC), atypical carcinoid (AC), small cell carcinoma (small cell lung cancer, SCLC) and large cell NE carcinoma (LCNEC). 1–3 Carcinoid tumors are histologically and clinicopathologically subclassified as TC (low-grade NET) or AC (intermediate-grade NET) according to mitotic count and the presence/absence of necrotic foci, 3
    No preview · Article · Aug 2014 · Pathology International
  • Tomoyuki Nakano · Shunsuke Endo
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    ABSTRACT: Video-assisted thoracoscopic surgery (VATS) has been a mainstay in surgical interventions for an early staged lung cancer over a decade. VATS procedures are nowadays categorized into 2 groups. One is a modified open procedures through a mini-thoracotomy with customization of conventional instruments. The other is a port-access procedure with use of newly developed instruments for endoscopic surgery. The optimal device adapting for individual surgical manipulations should be selected to make a VATS procedure safer and more feasible. The sample extraction using a bag is a most important step when VATS is completed, because the rupture of bag can result in cancer cell contamination. More useful devices adapting either for mini-thoracotomy VATS or for port-access VATS, will be developed with advancement of medical technology.
    No preview · Article · Jul 2014 · Kyobu geka. The Japanese journal of thoracic surgery
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    ABSTRACT: Objectives: Video-assisted thoracic surgery is widely applied for resection of mediastinal tumors. The mediastinal mature teratoma, however, is usually operated on via an open approach because it is generally large, making it difficult to dissect under a thoracoscopic view and remove it from the thoracic cavity. We attempted to extract intracystic material during video-assisted thoracic surgery to facilitate dissection and removal of the tumor from the thoracic cavity. Methods: From January 1998 to April 2013, 13 patients (9 women, 4 men; mean age 33 years, range 17-54 years) with mediastinal mature teratomas were operated on via video-assisted thoracic surgery. Intracystic contents of the tumor were aspirated before dissection or after the teratoma was dissected and placed in the retrieval pouch. Results: None of the patients required conversion to an open procedure. Operating time was 95-184 min (mean 132 min). Blood loss during the operation amounted to 10-300 mL (mean 78 mL). The tumor size ranged from 5 to 12 cm (mean 8 cm). In all cases, the tumors were confirmed pathologically to be mature cystic teratomas with no malignant components. During and after follow-up, all patients continue to do well without recurrence. Conclusion: Extraction of intracystic contents enabled thoracoscopic resection of large mature mediastinal teratomas.
    No preview · Article · May 2014 · Asian cardiovascular & thoracic annals
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    ABSTRACT: We report a case of an 18-year old female patient with symptomatic extralobar pulmonary sequestration. The initial symptom was sudden-onset right lateral abdominal pain. Enhanced computed tomography showed a 5 cm in diameter, spindle-shaped mass located in the costophrenic sinus with no aberrant artery. Exploratory thoracoscopy showed a haemorrhagic mass caused by strangulation of an aberrant vessel originating from the intercostal artery. Pathological findings revealed pulmonary sequestration with haemorrhagic infarction. The strangulated aberrant artery was clearly demonstrated by video imaging.
    Preview · Article · Apr 2014 · Interactive Cardiovascular and Thoracic Surgery
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    ABSTRACT: Sample extraction from the thoracic cavity through an intercostal space during video-assisted thoracoscopic surgery can result in cancer cell contamination by tumour crushing and tumour cell extravasation, and may have adverse effects on the surgical outcome. Lavage cytology of the sample extraction bag was investigated to clarify the risk of cancer cell spillage and identify the clinicopathological features associated with susceptibility to cancer cell spillage during extraction. Lavage cytology of the sample extraction bag was investigated in 464 patients with negative pleural lavage cytology who underwent lung resection for primary lung cancer via video-assisted thoracoscopic surgery between January 2010 and December 2012. The surgical procedures, pathological findings and clinical course were evaluated by hospital record review. The incidence of positive bag lavage cytology (BLC) was 13.6%. Statistically significant factors associated with susceptibility to BLC positivity were tumour size, standardized uptake value of positron emission tomography, pathological features such as pathological N score, pleural invasion, vascular invasion and papillary-predominant adenocarcinoma. Among patients with Stage I lung cancer, the survival rate was significantly lower in the BLC-positive group than in the BLC-negative group. BLC positivity can be related to oncological characteristics such as tumour invasiveness and adhesiveness as opposed to tumour size and surgical margin, and may help to determine the prognosis of Stage I lung cancer. The sample extraction bag must be carefully manoeuvred through the intercostal space to prevent cancer cell dissemination to the chest wall or thoracic cavity.
    Preview · Article · Feb 2014 · Interactive Cardiovascular and Thoracic Surgery
  • Shinichi Otani · Shinichi Yamamoto · Shunsuke Endo
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    ABSTRACT: Residual space empyema, that is a lifethreatening complication after major pulmonary resection, is based on postresectional hematoma, wound suppuration, and/or bronchopleurl fistula, demanding different strategies from parapneumonic empyema. Optimal managements should be occasionally completed in relation to the patient's physical conditions, serological findings, pathogens, and bronchopleural fistula. Bronchoscopic intervention can be a useful tool for a bronchopleural fistula when small. Thoracoscopic intervention can overcome the intractable residual space empyema. These interventions can save such invasive procedure as open window thoracotomy or thoracoplasty leading to damage pulmonary function as well as cosmetics, and prolong hospitalization. Vacuum-assisted closure system other than conventional thoracoplasty or thoracomyoplasty can be of help to obliterate the residual space empyema cavity after open window thoracotomy.
    No preview · Article · Jul 2013 · Kyobu geka. The Japanese journal of thoracic surgery
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    ABSTRACT: Objectives: Graft occlusion is a problem after superior vena cava (SVC) reconstruction for thoracic malignancy. Expanded polytetrafluoroethylene (ePTFE) is considered to be an optimal material for venous reconstruction.Methods: We reviewed the hospital records of 13 patients who underwent complete resection of thoracic malignancy invading the SVC, including SVC reconstruction with ePTFE grafts. Single bypass grafting was performed in two patients (one right-sided, one left-sided) and double bypasses grafting was performed in the other patients. All patients received antithrombotic therapy after surgery. Eight patients died of recurrence or other disease during the follow-up period (range 5-41 months).Results: Of the 24 grafts in 13 patients, graft patency was confirmed in 20 grafts in 9 patients at a mean time follow-up time of 47.8 ± 50.0 months after surgery. In the remaining four grafts in four patients, occlusion was diagnosed at a mean time of 1.25 ± 0.50 months after surgery. All obstructed grafts were left-sided bypass grafts in patients who underwent double bypass grafting, and did not result in SVC syndrome.Conclusions: SVC reconstruction with ringed ePTFE grafts was safe and had good outcomes. In patients who underwent double bypasses grafting, the left-sided bypass grafts were susceptible to occlusion.
    No preview · Article · Jun 2013

Publication Stats

744 Citations
195.14 Total Impact Points


  • 1994-2015
    • Jichi Medical University
      • • Department of Pathology
      • • Division of General Surgery
      • • Department of Surgery
      • • Division of Cardiovascular Surgery
      Totigi, Tochigi, Japan
  • 2008
    • Saitama Medical University
      Saitama, Saitama, Japan
  • 2006
    • Aomori Prefectural Central Hospital
      Aomori, Aomori, Japan
  • 1989
    • University of Tsukuba
      • Institute of Clinical Medicine
      Tsukuba, Ibaraki, Japan