Acute Arterial Occlusive Disease Research Articles

Comparative analysis of vascular closure devices for neuroendovascular procedures using Perclose versus Angioseal

BackgroundThe common femoral artery is most frequently accessed for neuroendovascular procedures. Occasionally, postoperative hemostasis is difficult to attain. We comparatively analyzed the vascular closure devices, Angioseal and Perclose, and evaluated the puncture-site complications. Methods357 patients who underwent endovascular treatment via femoral artery puncture and achieved hemostasis using a device were included. We studied the hemostatic method and associated puncture-site complications for various conditions. Ordinal logistic multiple regression analysis was performed for age, sex, sheath diameter, hemostatic method, number of antiplatelet agents, and object disease to identify the factors associated with puncture-site complications. ResultsAngioseal was used in 233 cases, and Perclose in 124 cases. Non-surgical complications were observed in 7.3 % and 0.8 % patients respectively. Complications requiring surgery occurred in 0.9 % of Angioseal, while none of Perclose. The complication rate at the puncture site was 10 % for unruptured aneurysms, 2.3 % for ruptured aneurysms, 3.5 % for carotid artery stenosis, and 4.0 % for acute arterial occlusive disease. Complication-related factors (P < 0.05) were fewer for Perclose (P = 0.0013,OR = 0.09) and higher for unruptured aneurysms (P = 0.0085, OR = 3.62). ConclusionsPerclose is a vascular closure device with rare puncture-site complications for neurosurgical diseases. Unruptured aneurysm cases require careful attention to puncture-site complications.

Acute arterial occlusive disease due to tumor thrombus from lung metastasis of breast cancer with cartilaginous and osseous metaplasia: a case report

BackgroundTumor embolization due to venous infiltration of breast cancer pulmonary metastases is very rare.Case presentationA 72-year-old female was diagnosed with triple-negative breast cancer. Neoadjuvant chemotherapy was discontinued because of progressive disease, and a right mastectomy with sentinel lymph node biopsy was performed. The pathological analysis of surgical specimens revealed carcinoma with cartilaginous and/or osseous metaplasia. At 22 months after surgery, lung metastasis was observed, and 6 months after initiating treatment for lung metastases, she complained of sudden numbness in the left-lower limb with trouble walking. Ultrasonography showed an embolism in the left popliteal artery, and contrast computed tomography showed enlarged lung metastases and infiltration of the left-upper lobe disease into the left superior pulmonary vein and left atrium. Acute arterial occlusive disease in the left-lower limb caused by the tumor embolism was suspected, so an endovascular thrombectomy was performed. Tumor emboli were removed by embolectomy catheter.ConclusionThis report of lung metastasis from breast cancer with cartilaginous and/or osseous metaplasia and acute lower-limb artery occlusion due to a tumor thrombus adds useful information to the literature on these extremely rare cases.

Vascular Surgery in Japan: 2016 Annual Report by the Japanese Society for Vascular Surgery.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeon in Japan in 2016, as analyzed by database management committee (DBC) members of the JSVS.Materials and Methods: To survey the current status of vascular treatments performed by vascular surgeons in Japan, the DBC members of the JSVS analyzed the vascular treatment data provided by the National Clinical Database (NCD), including the number of treatments and early results such as operative and hospital mortality.Results: In total 136,414 vascular treatments were registered by 1,070 institutions in 2016. This database is composed of 7 fields including treatment of aneurysms, chronic arterial occlusive disease, acute arterial occlusive disease, vascular injury, complication of previous vascular reconstruction, venous diseases, and other vascular treatments. The number of vascular treatments in each field was 21,653, 17,560, 4,983, 2,557, 846, 54,462 and 34,353, respectively. In the field of aneurysm treatment, 19,144 cases of abdominal aortic aneurysm (AAA) including common iliac aneurysm were registered, and 60.3% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,714 (9.4%) cases were registered as ruptured AAA. The operative mortality of ruptured and unruptured AAA was 15.7%, and 0.6%, respectively. 35.9% of ruptured AAA were treated by EVAR, and the EVAR ratio was gradually increasing, but the operative mortality of open repair and EVAR for ruptured AAA was 15.8%, and 15.3%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 9,303 cases, including 1,329 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) was performed in 8,257 cases. The EVT ratio was gradually increased at 47.0%. The number of varicose vein treatment tremendously increased to 52,639, and 68.5% of the cases were treated by endovenous laser ablations (EVLA). Regarding other vascular operations, 32,779 cases of vascular access operations and 1,411 lower limb amputation surgeries were included.Conclusions: The number of vascular treatments increased since 2011, and the proportion of endovascular procedures increased in almost all field of vascular diseases, especially EVAR for AAA, EVT for chronic arterial occlusive disease, and EVLA for varicose veins. (This is a translation of Jpn J Vasc Surg 2021; 30: 23–41.)

Vascular Surgery in Japan: 2015 Annual Report by the Japanese Society for Vascular Surgery.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeon in Japan in 2015, as analyzed by database management committee (DBC) members of the JSVS.Materials and Methods: To survey the current status of vascular treatments performed by vascular surgeons in Japan, the DBC members of the JSVS analyzed the vascular treatment data provided by the National Clinical Database (NCD), including the number of treatments and early results such as operative and hospital mortality.Results: In total 124,299 vascular treatments were registered by 1,038 institutions in 2015. This database is composed of 7 fields including treatment of aneurysms, chronic arterial occlusive disease, acute arterial occlusive disease, vascular injury, complication of previous vascular reconstruction, venous diseases, and other vascular treatments. The number of vascular treatments in each field was 22,041, 15,671, 4,779, 2,313, 857, 48,837, and 29,801, respectively. In the field of aneurysm treatment, 18,907 cases of abdominal aortic aneurysm (AAA) including common iliac aneurysm were registered, and 57.6% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,850 (9.8%) cases were registered as ruptured AAA. The operative mortality of ruptured and un-ruptured AAA was 16.0%, and 0.6%, respectively. 33.6% of ruptured AAA were treated by EVAR, and the EVAR ratio was gradually increasing, but the operative mortality of open repair and EVAR for ruptured AAA was 16.6%, and 14.5%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 8,230 cases, including 1,194 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) was performed in 7,441 cases. The EVT ratio was gradually increased at 47.4%. Venous treatment including 47,046 cases with varicose vein treatments and 531 cases with lower limb deep vein thrombosis were registered. Regarding other vascular operations, 29,801 cases of vascular access operations and 1,511 lower limb amputation surgeries were included.Conclusions: The number of vascular treatments increased since 2011, and the proportion of endovascular procedures increased in almost all field of vascular diseases, especially EVAR for AAA, EVT for chronic arterial occlusive disease, and endovenous laser ablation (EVLA) for varicose veins. (This is a translation of Jpn J Vasc Surg 2020; 29: 161–179.)

Vascular Surgery in Japan: 2014 Annual Report by the Japanese Society for Vascular Surgery.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeon in Japan in 2014, as analyzed by database management committee (DBC) members of the JSVS.Materials and Methods: To survey the current status of vascular treatments performed by vascular surgeons in Japan, the DBC members of the JSVS analyzed the vascular treatment data provided by the National Clinical Database (NCD), including the number of treatments and early results such as operative and hospital mortality.Results: In total 113,296 vascular treatments were registered by 1,002 institutions in 2014. This database is composed of 7 fields including treatment of aneurysms, chronic arterial occlusive disease, acute arterial occlusive disease, vascular injury, complication of previous vascular reconstruction, venous diseases, and other vascular treatments. The number of vascular treatments in each field was 21,085, 14,344, 4,799, 2,088, 1,598, 42,864, and 26,518, respectively. In the field of aneurysm treatment, 17,973 cases of abdominal aortic aneurysm (AAA) including common iliac aneurysm were registered, and 55.7% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,824 (10.1%) cases were registered as ruptured AAA. The operative mortality of ruptured and un-ruptured AAA was 16.1%, and 0.6%, respectively. 32.1% of ruptured AAA were treated by EVAR, and the EVAR ratio was gradually increasing, but the operative mortality of open repair and EVAR for ruptured AAA was 15.7%, and 18.0%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 8,020 cases, including 1,210 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) were performed in 6,324 cases. The EVT ratio was gradually increased at 44.1%. Venous treatment including 41,246 cases with varicose vein treatments and 520 cases with lower limb deep vein thrombosis were registered. Regarding other vascular operations, 25,024 cases of vascular access operations and 1,322 lower limb amputation surgeries were included.Conclusions: The number of vascular treatments increased since 2011, and the proportion of endovascular procedures increased in almost all field of vascular diseases, especially EVAR for AAA, EVT for chronic arterial occlusive disease, and endovenous laser ablation (EVLA) for varicose veins. (This is a translation of Jpn J Vasc Surg 2020; 29: 15–31.)

Vascular Surgery in Japan: 2013 Annual Report by the Japanese Society for Vascular Surgery.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeon in Japan in 2013, as analyzed by database management committee (DBC) members of the JSVS.Materials and Methods: To survey the current status of vascular treatments performed by vascular surgeons in Japan, the DBC members of the JSVS analyzed the vascular treatment data provided by the National Clinical Database (NCD), including the number of treatments and early results such as operative and in-hospital mortality.Results: In total 100,470 vascular treatments were registered by 1,045 institutions in 2013. This database is composed of 7 fields including treatment of aneurysms, chronic arterial occlusive disease, acute arterial occlusive disease, vascular injury, complication of previous vascular reconstruction, venous diseases, and other vascular treatments. The number of vascular treatments in each field was 19,439, 13,276, 4,688, 1,563, 1,777, 37,643, and 23,971, respectively. In the field of aneurysm treatment, 16,694 cases of abdominal aortic aneurysm (AAA) including common iliac aneurysm were registered, and 52.9% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,598 (9.6%) cases were registered as ruptured AAA. The operative mortality of ruptured and un-ruptured AAA was 17.9%, and 1.0%, respectively. 25.5% of ruptured AAA were treated by EVAR, and the EVAR ratio was gradually increasing, but the operative mortality of open repair and EVAR for ruptured AAA was 16.1%, and 15.8%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 7,437 cases, including 1,121 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) were performed in 5,839 cases. The EVT ratio was gradually increased at 44.0%. Venous treatment including 35,986 cases with varicose vein treatments and 506 cases with lower limb deep vein thrombosis were registered. Regarding other vascular operations, 22,572 cases of vascular access operations and 1,185 amputation surgeries were included.Conclusions: The number of vascular treatments increased since 2011, and the proportion of endovascular procedures increased in almost all field of vascular diseases, especially EVAR for AAA, EVT for chronic arterial occlusive disease, and endovenous laser ablation (EVLA) for varicose veins. (This is a translation of Jpn J Vasc Surg 2019; 28: 273–292.)

Vascular Surgery in Japan: 2012 Annual Report by the Japanese Society for Vascular Surgery.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatments performed by vascular surgeons in Japan in 2012, as analyzed by database management committee (DBC) members of the JSVS.Materials and Methods: To survey the current status of vascular treatments performed by vascular surgeons in Japan, the DBC members of the JSVS analyzed the vascular treatment data provided by the NCD vascular surgery data analysis team, including the number of treatments and early clinical results such as operative and in-hospital mortality.Results: In total 95,979 vascular treatments were registered by 1,043 institutions in 2012. This database is composed of 7 fields including treatment of aneurysms, chronic arterial occlusive disease, acute arterial occlusive disease, vascular injury, complication of previous vascular reconstruction, venous diseases, and other vascular treatments. The number of vascular treatments in each field was 19,600, 13,141, 4,600, 1,623, 1,973, 30,725, and 24,332, respectively. In the field of aneurysm treatment, 15,745 cases with abdominal aortic aneurysms (AAA) including common iliac aneurysms were registered, and 47.6% were treated by stent graft. Among AAA cases, 1,704 (10.8%) cases were registered as ruptured AAA. The operative mortality of ruptured and non-ruptured AAA was 17.8%, and 0.8%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 7,859 cases, including 1,173 distal bypasses to the crural or pedal artery, whereas endovascular procedures were performed in 5,282 cases. Venous treatment including 30,088 cases with varicose vein treatments and 395 cases with lower limb deep venous thrombosis were registered. Regarding other vascular operations, 22,654 cases of vascular access operations and 1,390 amputation surgeries were included. The number of lower limb amputations was still increasing and the mortality rate of amputation surgery was also still high; both of these issues require improvement.Conclusions: The number of vascular treatments increased since 2011, and the proportion of endovascular procedures increased in almost all fields of vascular diseases, especially endovascular aneurysm repair (EVAR) for aneurysms and endovenous laser ablation (EVLA) for varicose veins. (This is a translation of Jpn J Vasc Surg 2018; 27: 437–456.)

A Case of Persistent Sciatic Aneurysm with Lower Extremity Acute Arterial Occlusive Disease

A Case of Persistent Sciatic Aneurysm with Lower Extremity Acute Arterial Occlusive Disease

急性動脈塞栓症を発症した上行大動脈内血栓症の1例

急性動脈塞栓症（左尺骨動脈閉塞）を発症した上行大動脈内血栓症の1例を経験したので報告する．症例は61歳男性．左前腕に突然疼痛，チアノーゼが出現し，当院救急搬送となった．造影CTにて左尺骨動脈閉塞および上行大動脈に内腔を50%以上占拠する巨大血栓を認めたため，人工心肺使用，循環停止下に血栓除去術を施行した．病理組織検査では大動脈内膜は肥厚と軽度のアテローム変性を認め，血栓はフィブリン血栓であった．術後経過に問題なく，術後22日目退院となった．若干の文献的考察を加え報告する．

Presentation of Gastric Adenocarcinoma with Acute Arterial Occlusive Disease, Nonbacterial Thrombotic Endocarditis and Pyogenic Liver Abscess

Fatal outcome at early presentation of cancer is rare. Here, a case is discussed of a 53 year old female that presented with an acute onset of left lower extremity pain with paleness, pulselessness, abdominal cramps and vomiting that had been present for several weeks. Rapid evaluation led to the initial diagnosis of metastasized gastric cancer that had evolved to hepatic abscedation and aortic valve endocarditis. The patient rapidly developed severe sepsis with multiple organ failure and died 48 hours after presentation.

Acute Arterial Occlusive Disease caused by An Intimal Angiosarcoma

Acute Arterial Occlusive Disease caused by An Intimal Angiosarcoma

Acute Popliteal Artery Occlusion after Revision Total Knee Arthroplasty.

Acute arterial occlusions are a rare complication of total knee arthroplasty (TKA). However, in revision TKA, the risk of such complications is higher and these complications can lead to amputation if not adequately treated. We describe a case of acute popliteal artery occlusion 4 hours after second revision TKA in a patient with a history of several surgical procedures because of periprosthetic infection at a previous hospital. Revascularization was achieved via bypass grafting and amputation was narrowly avoided despite time lag after symptom onset to revascularization. In this case, it was possible that the arterial disease that accompanied the vascular endothelium injury such as pseudoaneurysm had existed since the previous surgery at another hospital and was destroyed by the surgical procedure, which led to the formation of thrombosis and arterial occlusion. Preoperative evaluation of the arterial condition should be considered to avoid acute arterial occlusive disease, especially in patients who had several previous surgical procedures.

Carbon Dioxide Angiography as a useful method to the assessment of acute arterial occlusive disease of lower extremity

Carbon Dioxide Angiography as a useful method to the assessment of acute arterial occlusive disease of lower extremity

Treatment of acute limb ischemia with focus on endovascular techniques

Acute limb ischemia is still the most frequent cause of major limb loss. Timely and fast revascularization is the key for limb salvage and patient survival. Large randomized trials showed equivalency of surgical and endovascular revascularization by means of local lysis with urokinase (TOPAS, STILE). New lytic agents and their modified application such as via a pulse spray catheter or combined with an ultrasound catheter and the combination with glycoprotein IIb/IIIa receptor antagonists have increased the efficacy and speed of thrombolysis. Recently, mechanical thrombectomy devices have become more widespread because intervention time and bleeding complications can be reduced. This review article summarizes the clinical presentation of and the treatment options for acute arterial occlusive disease caused either by embolism or local thrombosis.

Acute Arterial Occlusive Disease

Acute Arterial Occlusive Disease

急性動脈血行障害に対する血行再建手術成績 原因別の比較検討

急性動脈血行障害に対する血行再建手術成績 原因別の比較検討

主題IV-30 急性下肢動脈閉塞症治療の問題点

主題IV-30 急性下肢動脈閉塞症治療の問題点

Platelet coagulant activities in arterial occlusive disease of the eye.

Ischemic optic neuropathy and retinal arterial occlusion are 2 forms of arterial occlusive disease affecting the eye. Reports in the literature suggest platelet hyperactivity in acute arterial occlusive diseases affecting other organ systems. Therefore, 14 patients with ischemic optic neuropathy and 17 patients with central or branch retinal artery occlusion were studied to determine whether platelets have a role in the pathogenesis of these vascular occlusive disorders. The results of the following investigations were no different in these patients compared with those in 18 control patients with non-vascular eye diseases: prothrombin times, partial thromboplastin times, plasma fibrinogen, factor V, factor VIII, platelet counts and threshold concentrations of ADP, epinephrine and collagen resulting in secondary platelet aggregation and serotonin release. In contrast, platelet coagulant activities concerned with the early stages of intrinsic coagulation were significantly increased in patients with retinal artery occlusion without hypertension or type IV hyperlipoproteinemia, but generally normal in patients with ischemic optic neuropathy and in patients with retinal artery occlusion associated with hypertension, type IV hyperlipoproteinemia, diabetes mellitus and generalized atherosclerosis. These results are consistent with a platelet contribution to retinal arterial occlusive disease in patients without other known contributing factors such as hypertension, serum lipid abnormalities, diabetes mellitus and generalized atherosclerosis and may have implications regarding prophylaxis.

PURPURA GANGRENOSA TREATED WITH HYPERBARIC OXYGENATION.

Hyperbaric oxygenation was used in the treatment of purpura gangrenosa (fulminans). Hyperoxic therapy was employed in an apparently successful effort to reverse and prevent ischemic tissue damage. The prompt improvement of involved areas during treatment and the subsequent complete resolution of the peripheral lesions with loss of tissue is unusual in this severe and commonly fatal illness. Further trial of hyperoxia in the prompt treatment of ischemia due to acute arterial occlusive disease is warranted.