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Annals of vascular diseases 12(4) 514-518 2019年12月25日 査読有りObjective: Saphenous varicose veins can be accomplished by various operative techniques that result in stripping, ablation, or ligation of the venous reflux section. Great saphenous vein (GSV) stripping is one of the standard operations for varicose veins to eliminate reflux of the sapheno-femoral junction. The goal of any treatment regimen is to eliminate the junctional varicose reflux to control congestive dysfunction. Endovenous laser ablation (EVLA) is safe and effective with less postoperative pain, bleeding, and peripheral nerve damage than open surgery. In this study, a patient with severe progression of primary saphenous varicose veins is presented. We report the outcome of combined surgical strategy and perioperative treatment for extremely swollen varicose veins of the lower limbs to improve leg symptoms and congestion and/or promote skin ulcer healing. Materials and Methods: The subjects included 42 patients (51 limbs) who underwent EVLA with stripping. The patients comprised 24 males and 18 females, who presented a maximum GSV diameter >15 mm. The Clinical-Etiological-Anatomic-Pathophysiologic classification identified 9, 20, 9, 2, 6, and 5 limbs with C2, C3, C4a, C4b, C5, and C6, respectively, among the 42 patients. Results: EVLA was used to treat GSV with a mean length of 16.1±2.8 cm. The mean of the maximum GSV diameter was 16.8±3.2 mm (14.6-21.8 mm). The preoperative visual analog scale (VAS) score was 82.1±12.1. After operation, the VAS gradually deteriorated to 31.3±17.9 (p<0.0001), 2.8±3.6 (p<0.0001), and 1.2±1.8 (p<0.0001) in 7 days, 1 month, and 3 months, respectively. Conclusion: We obtained a satisfactory outcome from our combined strategy and perioperative treatment for extremely swollen saphenous varicose veins. This approach may show the possibility that lower saphenous varicose veins can induce cosmetic and minimally invasive ameliorated intervention to avoid late-phase incompetent perforating veins.
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Annals of vascular surgery 46 367.e7-367.e10 2018年1月 査読有りA venous aneurysm is a relatively rare disease defined by cystic vasodilated lesions in a general vein. Popliteal venous aneurysm (PVA) is a rare clinical entity, and the first signs may be a thromboembolic event. They can cause potentially life-threatening diseases, such as pulmonary embolism and deep venous thrombosis. A left-sided inferior vena cava (IVC) is a common anomaly associated with venous thrombus, resulting in anatomical variations in the venous return from the lower limbs. The general vascular malformation of PVA and left-sided IVC should also be preoperatively understood because of the unpredictable risk of thromboembolic complications.
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The Journal of dermatology 44(10) e254-e255 2017年10月 査読有り
MISC
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日本外科学会雑誌 114(2) 253-253 2013年3月5日
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Annals of vascular surgery 27(2) 154-61 2013年2月 査読有りBACKGROUND: Abdominal aortic aneurysm diameter is usually measured by the maximum minor-axis diameter on axial computed tomography (CT). However, this "traditional" diameter may underestimate the real size, as the aorta is not always straight and the aneurysm shape is sometimes in the form of an ellipse along the cross section. Therefore, we measured maximum major-axis diameters using a three-dimensional (3D) workstation and compared them with the traditional maximum minor-axis diameters measured using thin-slice axial CT. METHODS: CT data of 141 AAA patients (with fusiform aneurysms) were stored in a 3D workstation. These thin-slice CT images were reviewed on the 3D workstation to obtain curved multiplanar reconstruction images (CPR images). Using the CPR images, we measured the maximum major-axis and minor-axis diameters on CPR and the angle of the aneurysms to the body axis. RESULTS: The mean traditional maximum minor-axis diameter was 51.2 ± 8.2 mm, whereas the mean maximum major-axis diameter on CPR was 54.7 ± 10.1 mm. Sixty eight patients had a mean aneurysm size of <50 mm when measured by the traditional minor-axis diameter. Among these patients, five (7.4%) had a major-axis diameter >55 mm on CPR. CONCLUSION: The measurement of the traditional maximum minor-axis diameter of aneurysms is useful in the case of most patients. However, the traditional maximum minor-axis diameter may underestimate the real aneurysmal diameter, particularly in patients with an ellipse-shaped aneurysm. The maximum major-axis diameter as measured using CPR images is effective for representing the real aneurysmal size.
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Surgery today 42(12) 1206-9 2012年12月 査読有りWe report a case of late type III B endoleak from a fabric tear in the main body of a Zenith bifurcated stent-graft approximately 19 months after implantation. A follow-up computed tomography (CT) scan showed gradual growth in the size of the aneurysm, but no apparent endoleak was recognized. However, the CT scan had demonstrated a mosaic pattern in the aneurysm sac, which could indicate an endoleak from a fabric tear. The defect was repaired by implantation of body extensions, but the patient died 5 h after the procedure.
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The International journal of angiology : official publication of the International College of Angiology, Inc 21(3) 147-50 2012年9月 査読有りInfective abdominal aortic aneurysm (IAAA) is relatively rare, but a case which is caused by Haemophilus influenzae type B is very rare. We experienced one IAAA case due to H. influenzae type B. The patient was 69-year-old man presenting with severe abdominal and back pain and elevated C-reactive protein (CRP), as inflammatory marker. The patient was found to have saccular aneurysm infrarenal aorta on computed tomography scanning. First, we started to treat him with antibiotic agent and second, we operated him at day 8 after admission with expanded polytetrafluoroethylene graft. Revascularization was made in situ reconstruction. As the result of culture with aneurysm wall, we found that the cause of this aneurysm was the infection of H. influenzae type B. As far as we know, this bacterium is scarcely reported as the cause of infective aortic aneurysms. We reported this IAAA case with the review of the English literature.
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ペインクリニック 33(7) 979-983 2012年7月神経障害性疼痛の治療薬、プレガバリン(Lyrica)は、本邦では2010年8月に末梢神経障害性疼痛にも保険適応拡大が認められた。今回われわれは、プレガバリン内服により下肢虚血性末梢動脈疾患による末梢神経障害性疼痛患者の鎮痛効果、副作用について評価したので報告する。(著者抄録)
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Annals of vascular surgery 26(5) 731.e1-4-e1-4 2012年7月 査読有りWe present a case of a left subclavian artery aneurysm in a 48-year-old man with Marfan syndrome. Aneurysms of the subclavian artery are rare in patients with Marfan syndrome. Resection of the aneurysm and interposition with a synthetic graft were performed through a supra- and infraclavicular incision, without resecting the clavicle. Histological findings were compatible with Marfan syndrome. In patients with Marfan syndrome, regular follow-up is important because of the occurrence of peripheral aneurysms other than the aorta.
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日本血管外科学会雑誌 21(3) 300-300 2012年5月
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日本血管外科学会雑誌 21(3) 303-303 2012年5月
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日本血管外科学会雑誌 21(3) 307-308 2012年5月
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脈管学 52(April) 207-210 2012年4月症例1は68歳男性で、糖尿病の既往があった。心房細動で植込み型除細動器(ICD)挿入のためワルファリン休薬中で、ICD挿入4日目に突然両下肢脱力、冷感を認め、大腿動脈以下の拍動を触知せず、CTで腹部大動脈終末部に多量の血栓を認め、発症3時間後に血栓除去術を行った。術後2週目に再度両下肢の虚血症状が出現し、CT上両下肢動脈塞栓の診断で再度血栓除去術を行った。その後、左鼠径部の創感染をきたし、糖尿病のため感染コントロールは困難で、左総大腿動脈が破綻して出血し、手術的止血も効果なく、全身状態の悪化とARDS発症で人工呼吸管理を行うも、初回手術後54日目に呼吸不全で死亡した。なお、創感染部と血管壁からCitrobacter Koseriが検出された。症例2は71歳女性で、突然の両下肢脱力で受診した。大腿動脈以下の拍動を触知せず、CTで腹部大動脈終末部に多量の血栓を認め、発症8時間後に血栓除去術を行った。術後経過は良好で術後14日目に独歩退院した。
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日本外科学会雑誌 113(臨増2) 581-581 2012年3月
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日本心臓血管外科学会雑誌 41(Suppl.) 201-201 2012年3月
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脈管学 52(March) 181-184 2012年3月48歳女。右下肢の軽度安静時疼痛を主訴とした。24歳時に糖尿病と診断され、内服治療中であった。29歳時から筋強直性ジストロフィー(MyD)で近医通院中であり、高血圧、高脂血症でも内服治療中であった。MRA、動脈造影で右総腸骨動脈、右浅大腿動脈、左浅大腿動脈に有意な狭窄を認めた。MyDに併存したsmall aorta syndrome(SAS)と診断し、血管内治療を施行した。右浅大腿動脈狭窄部からPTAバルーンで拡張し、続いて右総腸骨動脈狭窄部にステントを留置した。術後動脈造影、IVUSでは動脈に解離も認めず、拡張良好であった。下肢症状も軽快し退院した。
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日本血管外科学会雑誌 21(1) 25-28 2012年2月症例は75歳、男性。2010年6月から300m程度の歩行で左下肢痛がみられたため当院外来を受診された。8月下旬、左下腿安静時痛が出現したため入院、加療となった。超音波検査にて左右総腸骨動脈に狭窄病変を有する、閉塞性動脈硬化症と診断された。血液生化学検査は血清Cre 2.8mg/dl、24時間クレアチン・クリアランスは24.6ml/分と低値を示した。慢性腎不全を呈しており、われわれは炭酸ガスを用いての血管内治療を選択した。動脈病変の画像診断、治療において、腎不全やアレルギー患者ではヨード造影剤の使用は限定される。それに対して、慢性腎不全患者に対する医療用炭酸ガス造影による血管内治療が近年報告されるようになってきた。ヨード造影剤使用に制限のある症例に対して、炭酸ガス造影、IVUSを用いることにより、下腿動脈においても血管内治療により良好な結果を得た1例を経験した。(著者抄録)
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Surgery today 42(2) 121-6 2012年1月 査読有りPURPOSE: We conducted this study to compare the cost of open surgical repair (OR) with that of endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm (AAA). METHODS: Between January 2007 and November 2008, 70 patients underwent open repair and 57 patients underwent EVAR. We evaluated the total cost, including that of the Diagnosis Procedure Combination (DPC), that of the surgical procedure, that of materials such as grafts and guide wires, and that of the anesthesia. RESULTS: The mean costs for OR versus EVAR were as follows: DPC, \632,370 versus \490,050, respectively, which was significant; anesthesia, \123,540 versus \86,220, respectively (P < 0.05); and materials, \257,770 versus \2,113,280, respectively (P < 0.05). Thus, the mean total cost was \1,825,830 versus \3,159,270 for open repair and EVAR, respectively (P < 0.05). CONCLUSIONS: New technologies should not only be clinically effective, but also cost effective. EVAR is less invasive clinically, but the cost of endovascular prostheses and other materials remains high.
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脈管学 51(4) 415-422 2011年12月ミッドカイン(MK)は、細胞の生存や移動を促進し、癌の進行、炎症性疾患の発症、傷害を受けた組織の保存・修復に深く関与する。血管狭窄モデル、静脈グラフトモデル、ステント留置モデルを用いた検討では、ミッドカインはいずれにおいても血管内膜肥厚に関与していることが示され、特に、前2者ではMKの抑制により内膜肥厚も抑制された。MKを標的とした分子標的薬、薬剤溶出型ステントの開発が期待される。
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CARDIOVASCULAR PATHOLOGY 20(5) 266-271 2011年9月 査読有りBackground: The architecture of the arterial wall affected with Buerger's disease has been known to be preserved in all three layers, while the one affected by arteriosclerosis obliterans (ASO) is degenerated and destroyed. We analyzed affected arteries with immunohistochemical methods to clarify the differences between Buerger's disease and ASO. Materials and methods: Crural arteries obtained from 13 patients with Buerger's disease and 6 patients with ASO at our institute were studied. In addition, we examined seven specimens from six patients who were thought to be normal (without Buerger's disease or ASO) as negative control. Immunohistochemical studies were performed on paraffin-embedded tissues. The primary antibodies were urokinase-type plasminogen activator (uPA) and matrix metalloproteinase-3 (MMP-3). Both are known to play an important role of extracellular proteolysis and to activate each other. Additionally, plasminogen activator inhibitor-1(PAI-1) was also examined. Results: In Buerger's disease, PAI-1 was well expressed along the internal elastic lamina. Urokinase-type plasminogen activator and MMP-3 were slightly positive in intima and media. In ASO, a slight amount of PAI-1 was recognized on vessel walls, and both uPA and MMP-3 were strongly positive in media. In addition, in the control group, PAI-1, uPA, and MMP-3 were well expressed in media. Conclusion: In Buerger's disease, PAI-1 was strongly expressed around the internal elastic lamina, while both uPA and MMP-3 were slightly recognized on vessel walls. These findings could be one of the reasons the general architecture of vessel walls in Buerger's disease is preserved. (C) 2011 Elsevier Inc. All rights reserved.
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静脈学 22(2) 139-139 2011年6月
書籍等出版物
6講演・口頭発表等
51共同研究・競争的資金等の研究課題
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日本学術振興会 科学研究費助成事業 2012年4月 - 2015年3月
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日本学術振興会 科学研究費助成事業 2010年 - 2012年
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日本学術振興会 科学研究費助成事業 2010年 - 2012年
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日本学術振興会 科学研究費助成事業 2009年 - 2011年
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日本学術振興会 科学研究費助成事業 2008年 - 2010年