Impact of Accessory Renal Artery Embolization on Renal Deterioration Under Endovascular Aortic Repair

OBJECTIVE

The optimal management strategy for patients with accessory renal arteries undergoing endovascular aortic repair is unclear. This study aimed to investigate the impact of accessory renal artery (aRA) embolization on postoperative renal deterioration and to identify the predictors of postoperative renal deterioration in patients who underwent endovascular aortic repair (EVAR).

METHODS

A retrospective single-centre observational study was conducted at our hospital. Of 331 consecutive patients who underwent endovascular aortic repair between April 2011 and February 2021, 29 patients with an aRA were included in this study. Spearman's rank correlation coefficients of decrease in estimated glomerular filtration rate (eGFR), renal volume reduction rate, infarcted renal volume, and quantity of contrast use for postoperative renal deterioration were analyzed. The correlation coefficients of the correlations between infarcted renal volume, renal volume reduction rate, and decrease in eGFR and the rate of aRA diameter were also analyzed. Multivariable nominal logistic regression analyses were conducted to evaluate the odds of postoperative renal deterioration.

RESULTS

The renal volume reduction rate and infarcted renal volume had a significant positive correlation with the decrease in eGFR. Body surface area and preoperative renal volume were significantly but negatively correlated with the decrease in eGFR. The infarcted renal volume, renal volume reduction rate, and decrease in eGFR were significantly and positively correlated with the aRA diameter. The odds ratio for decreased eGFR rate in preoperative renal volume was .96 (95% CI 0.930‒.996, P = .009).

CONCLUSIONS

EVAR with aRA embolization impacts postoperative renal deterioration in patients with preoperative low renal volume, and the diameter of the embolized aRA might be a predictor of postoperative renal deterioration.

Endovascular Aneurysm Repair Using Physician-Modified Fenestrated Endurant Contralateral Limb for Internal Iliac Artery Preservation

CLINICAL IMPACT

We developed a novel Endovascular aortic repair technique for internal iliac artery preservation using a physician modified Endurant contralateral limb. This procedure was safe and reliable for preserving internal iliac artery flow in 24 patients with common and internal iliac artery aneurysms. We believe that our technique has the potential to expand the anatomic indications for internal iliac artery preserving procedures.

[Compartment Syndrome After Stanford Type A Acute Aortic Dissection Surgery:Report of a Case]

A 53-year-old man presented to the emergency department with chest and back pain. Contrast-enhanced computed tomography( CT) revealed a Stanford type A acute aortic dissection with a pseudo-lumen occlusion. On the same day, the patient underwent emergent aortic arch replacement with frozen elephant trunk. When introducing cardiopulmonary bypass, arterial cannula was inserted into the right femoral artery. The day after surgery, swelling of the right lower leg appeared with CK and intramuscular compartment pressure elevation. Thus, the patient was diagnosed with compartment syndrome and decompressive fasciotomy was performed. Although there was no preoperative blood flow disturbance in the lower extremities on preoperative CT, lower limbs ischemia happened. Necrotic muscles in his right leg required debridement, but amputation was not needed. The patient was discharged unaided utilising orthotics on the day 120. In muscular, young male patients, care should be taken in the method of blood delivery.

[Stanford Type A Acute Aortic Dissection Complicated by Right Lung Hemorrhage:Report of a Case]

A 59-year-old woman was transferred to our hospital because of a sudden onset of chest and back pain. Computed tomography (CT) demonstrated Stanford type A acute aortic dissection with cardiac tamponade and right airway bleeding. Hemorrhage from ruptured false lumen extended along the pulmonary artery (PA), compression of the right PA were recognized due to hematoma surrounding the PA. An emergency operation was performed. The primary tear was located at the distal aortic arch, and total arch replacement with frozen elephant trunk was performed. During the operation, she had airway bleeding. The bleeding was thought to be due to the hematoma extending along the pulmonary artery. She was extubated 7th postopratively. She was discharged 44 days after the operation.

[Hybrid Treatment of the Intrathoracic Right Subclavian Artery Aneurysm:Report of a Case]

A 78-years-old woman was referred to our institution for the treatment of right subclavian artery (SCA) aneurysm. She previously underwent total arch replacement via median sternotomy approach. Preoperative computed tomography revealed a 55 mm sized SCA aneurysm. Stent graft was inserted from brachiocephalic artery to right common carotid artery via the graft anastomosed. The orifice of the right SCA was covered with stent graft inserted into the right common carotid artery-brachiocephalic artery and the right SCA was occluded with coils distal to the aneurysm, carotid-SCA bypass was performed with 8 mm ePTFE graft. Postoperative examination confirmed complete exclusion of the aneurysm and patency of the bypass graft. We thought that hybrid treatment for this patient was a less invasive alternative to conventional surgical procedure.

[Internal Hernia Accompanying Intestinal Necrosis after Aortic Arch Replacement:Report of a Case]

A 76-year-old man with thoracic aortic aneurysm was admitted to our hospital. Aortic arch replacement was performed uneventfully. He suffered from abdominal pain 17 days after the operation. Computed tomography (CT) scan revealed a strangulated bowel obstruction, and we performed emergent open abdominal surgery. During the operation, we found an adhesion between the greater omentum and the retroperitoneum. The small intestine was intussuscepted into this site, and strangulated with necrosis of a 35-cm length. We performed a partial resection of the small intestine. We encountered rare strangulated bowel obstruction after open heart surgery due to adhesion of the great omentum in a patient without a history of abdominal surgery.

[Aortic Valve Replacement for Libman-Sacks Endocarditis:Report of a Case]

A 36-year-old woman with severe aortic valve stenosis was admitted to our hospital. She had been diagnosed with antiphospholipid syndrome complicated with systemic lupus erythematosus (SLE) and had been taking prednisolone( 10 mg/day) for 22 years. As SLE patients with prolonged steroid use are known to be at risk of an aortic dissection and aneurysm, femoral artery was chosen for arterial perfusion to reduce a risk of aortic dissection. Aortic valve replacement was performed uneventfully, because the aorta was treated carefully during the operation. Negative microbial culture and pathological examination of the resected aortic valve demonstrated an atypical vegetation, the findings of which were typically characteristic of Libman-Sacks endocarditis in SLE. She was discharged without complications 23 days after the operation.

[Localized Stenosis in a Non-anastomotic Site of the Ascending Aorta to Bifemoral Bypass Graft:Report of a Case]

An 85-year-old man received simultaneous coronary artery bypass grafting (CABG) and the ascending aorta to bifemoral bypass with a Dacron graft 11 years ago. He suffered from intermittent claudication. Angiography demonstrated a localized stenosis in a non-anastomotic site, straight portion of the graft. He received percutaneous transluminal angioplasty. The right ankle-brachial pressure index (ABI) improved from 0.58 to 0.74 and left ABI improved from 0.52 to 0.71. One year later, intermittent claudication appeared again, right ABI decreased to 0.53 and left ABI decreased to 0.52. Computed tomography( CT) demonstrated restenosis at the same portion of the graft. A re-do operation was performed, stenotic portion was removed and replaced by a new ePTFE graft. No restenosis was seen three years after the second operation. We thought that repeated temporary compression of the graft might have led to a clot formation in the non-anastomotic site.

Coronary artery bypass grafting in a patient with situs inversus totalis: a case report

Background

Coronary artery bypass grafting in situs inversus totalis patients has been seldom reported in the literature.

Case presentation

A 76-year-old woman visited our hospital for chest pain and dyspnea that had started about 5 years earlier. Coronary angiography revealed triple-vessel disease, and computed tomography showed situs inversus totalis. Coronary artery bypass grafting was performed. In this case, the main operating surgeon stood on the right side of the patient until cardiopulmonary bypass was established and then switched positions to the left side of the patient for anastomosis.

Conclusion

CABG was successfully completed in a patient with situs inversus totalis. The position shift helped improve the safety and ease of the surgery.

Association of personal and familial suicide risk with low serum cholesterol concentration in male lithium patients

OBJECTIVE

We sought to establish whether low cholesterol concentration may be associated with a personal history of attempted suicide or a family history of completed suicide in psychiatric out-patients on maintenance lithium treatment, who represent a population at risk for suicide.

METHOD

We retrospectively reviewed charts regarding 783 out-patients consecutively admitted to a lithium clinic from 1976 to 1999. Individual age- and gender-specific quartile of serum cholesterol concentration were correlated against personal lifetime suicide attempts and completed suicide in first-degree relatives.

RESULTS

The proportion of men with a personal lifetime history of attempted suicide, especially if violent, and that of men with history of completed suicide in a first-degree relative were significantly higher among the group with cholesterol concentration in the lowest quartile compared to the group with cholesterol levels above the 25th percentile.

CONCLUSION

Low cholesterol concentration should be studied further as a potential biological/genetic marker of suicide risk.

Comparison of sperm motility test methods (except computer-assisted sperm analysis) in rats under the condition of alfa-chlorohydrin treatment--collaborative investigation

A comparison among rat sperm motility test methods including percent of motile sperm (% Motile), scoring method (Scoring), Ishii's method, Progressive Motility Test (PMT) and Sperm Quality Analyzer (SQA), was conducted using data gathered from eleven laboratories. As a unified study design, mature male rats were orally treated daily for approximately 1 week with alpha-chlorohydrin (ACH), which is known to affect the sperm motility at the epididymis, at dose levels of 2.5, 5 and 10 mg/kg, and then subjected to more than two test methods for sperm motility in each laboratory. Scoring (4 or 5 grades), Ishii's method, PMT and SQA showed high sensitivity for the detection of the effects of ACH, which were not considered to be inferior to a computer-assisted sperm analyzer (CASA). Longer incubation time before testing was considered to contribute to detecting the effects of ACH. In particular, we realized that Scoring was a favorable method even if the demerit of poor objectivity was allowed for. Percent Motile showed lower sensitivity than other test methods. The differences in sensitivity between % Motile and other methods were considered to be based on whether the defects of progressive motion could be detected. Although % Motile cannot clearly judge whether immotile sperm are dead or alive, the value is a great help for the interpretation of the result from other methods. Based on the characters for detectability, objectivity and efficiency, the most suitable method of sperm motility should be selected according to the purpose of the toxicity study.

Family-based association study between bipolar disorder and DRD2, DRD4, DAT, and SERT in Sardinia

Association analysis of candidate genes may represent a strategy for clarifying the genetic components involved in bipolar disorder. Polymorphism at dopamine receptor genes DRD2, DRD4, and dopamine and serotonin transporter genes (DAT, SERT) has been used in previous association studies. Some authors have reported positive association between certain alleles and bipolar disorder, using the case-control design. In this family-based association study of DRD2, DRD4, DAT, and SERT, the distribution of parental nontransmitted alleles was compared with that of alleles transmitted to 53 Sardinian probands suffering from bipolar disorder. The transmission disequilibrium test (TDT) was used to detect any disproportionate transmission of alleles by heterozygous parents to affected children. No differences were found between the allele distribution of polymorphisms at DRD2, DRD4, DAT, and SERT in probands and parental nontransmitted chromosomes. TDT did not reveal any difference between transmitted and nontransmitted alleles. Our results do not support the hypothesis of a role for DRD2, DRD4, DAT, or SERT in bipolar disorder. Previously reported positive associations between DRD2 or SERT and bipolar disorder were conceivably due to stratification dependent on the case-control design, even though our sample might have failed to detect small associations due to limited power.