1
|
Fukada J, Fukata K, Abe T, Koike N, Kota R, Kitagawa Y, Shigematsu N. Can Mean Pericardial Irradiated Dose (MPD) Predict Pericardial Effusion after Chemoradiotherapy in Esophageal Cancer Patients? Normal Tissue Complication Probability (NTCP) Model-Based Analyses. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
2
|
Kumabe A, Fukada J, Kota R, Koike N, Shiraishi Y, Seki S, Yoshida K, Kitagawa Y, Shigematsu N. Long-term results of concurrent chemoradiotherapy with daily-low-dose continuous infusion of 5-fluorouracil and cisplatin (LDFP) for Stage I-II esophageal carcinoma. Dis Esophagus 2018; 31:4714779. [PMID: 29228166 DOI: 10.1093/dote/dox138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/01/2017] [Indexed: 12/11/2022]
Abstract
We investigated long-term treatment outcomes and the feasibility of chemoradiotherapy consisting of daily-low-dose 5-fluorouracil and cisplatin (LDFP) chemotherapy plus radiotherapy for Stage I-II squamous cell esophageal cancer. Treatment records from the 2000 through 2008 period were reviewed retrospectively. Fractionated radiotherapy was performed with a total dose of 60 Gy delivered in 2 Gy per fraction. LDFP chemotherapy, as continuous infusion of 200 mg/m2 5-fluorouracil combined with one hour infusion of 4 mg/m2 cisplatin, was administered on the same days as radiotherapy. Survival was calculated by the Kaplan-Meier method. Survival, responses, failure patterns, and toxicities were evaluated. Seventy-six (47 stage I and 29 stage II) patients were analyzed with a median follow-up of 93.6 months. The 8-year overall survival (OS), progression-free survival (PFS) and cause-specific survival (CSS) rates were 63.4%, 49.8%, and 76.7%, respectively. The 8-year OS, PFS, and CSS for stage I and stage II patients were 71.0%/56.1%/82.9% and 45.2%/40.2%/66.6%, respectively. Sixty-eight patients (89.5%) completed the treatment regimen. A complete response (CR) was achieved in 68 patients (89.5%). Twenty-five patients (36.8%) experienced recurrence after CR. The failure patterns were (overlap included): local failure (n = 12), nodal metastasis (n = 12), distant metastasis (n = 3), details unknown (n = 2). Salvage therapy was performed for local failure; endoscopic therapy (n = 7) or surgery (n = 2). Six patients remain alive without relapse after salvage endoscopic therapy. Major Grade 3 or higher acute adverse events were leukopenia (22%), anorexia (17%), and esophagitis (11%). Major late toxicities (Grade 3 or 4) involved pericardial effusion (12%), pleural effusion (4%), and esophageal stenosis (3%). Chemoradiotherapy with LDFP provided favorable long-term survival with acceptable toxicity for Stage I-II squamous cell esophageal cancer. The tumor response was excellent, but close endoscopic follow-up is essential for detecting and treating local recurrence.
Collapse
Affiliation(s)
- A Kumabe
- Department of Radiology and Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - J Fukada
- Department of Radiology and Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - R Kota
- Department of Radiology and Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - N Koike
- Department of Radiology and Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Y Shiraishi
- Department of Radiology and Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - S Seki
- Department of Radiation Oncology, Saitama Medical University Hospital, Saitama, Tokyo, Japan
| | - K Yoshida
- Department of Radiology and Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Y Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - N Shigematsu
- Department of Radiology and Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
3
|
Fukada J, Kitago M, Sutani S, Itano O, Hanada T, Kitagawa Y, Shigematsu N. Quantification of Interfraction and Intrafraction Pancreas Motion Using Pancreatic Stent. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
4
|
Yanase Y, Fukada J, Tamiya Y. Internal iliac artery aneurysmo-colonic fistula after endovascular stent-graft repair: a case report. Ann Vasc Dis 2015; 8:46-8. [PMID: 25848433 DOI: 10.3400/avd.cr.14-00109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/12/2014] [Indexed: 11/13/2022] Open
Abstract
We describe rare ilio-enteric fistula that developed after endovascular repair of a left internal iliac artery aneurysm (IIAA). An 83-year-old man with a history of previous surgeries via laparotomies suddenly developed a high fever 3 years after undergoing endovascular abdominal aortic repair (EVAR) with a stent-graft to treat a left isolated IIAA. Computed tomography imaging revealed a fistula between the IIAA and the sigmoid colon. A colostomy was created because severe intraperitoneal adhesions prevented resection of the IIAA. The postoperative course was uneventful and the patient remained free of infection without antibiotics. Residual aneurysms can cause complications after EVAR.
Collapse
Affiliation(s)
- Yohsuke Yanase
- Department of Cardiovascular Surgery, Otaru Municipal Medical Center for Brain, Cardiovascular and Mental Disorders, Otaru, Hokkaido, Japan
| | - Johji Fukada
- Department of Cardiovascular Surgery, Otaru Municipal Medical Center for Brain, Cardiovascular and Mental Disorders, Otaru, Hokkaido, Japan
| | - Yukihiko Tamiya
- Department of Cardiovascular Surgery, Otaru Municipal Medical Center for Brain, Cardiovascular and Mental Disorders, Otaru, Hokkaido, Japan
| |
Collapse
|
5
|
Mishima K, Mishima-Kaneko M, Saya H, Ishimaru N, Yamada K, Fukada J, Nishikawa R, Kawata T. RT-21 * Mre11-Rad50-Nbs1 COMPLEX INHIBITOR MIRIN ENHANCES RADIOSENSITIVITY IN HUMAN GLIOBLASTOMA CELLS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou270.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
6
|
Fukada J, Shigematsu N, Takeuchi H, Shiraishi Y, Hanada T, Ohashi T, Kota R, Kumabe A, Sutani S, Kitagawa Y. Symptomatic Pericardial Effusion After Chemoradiation Therapy for Esophageal Cancer: A Historical Comparison. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
7
|
Hanada T, Shiraishi Y, Ohashi T, Fukada J, Shigematsu N. Variation of Rectal Volumes and Dosimetry Values Including NTCP Due to Interfractional Variability Receiving 2D-based IG-IMRT for Prostate Cancer. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.2046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Ohashi T, Momma T, Yamashita S, Hanada T, Fukada J, Shigematsu N. 1023 poster IMPACT OF POSTURAL CHANGES IN POSTIMPLANT DOSIMETRIC ANALYSIS FOR I-125 PROSTATE BRACHYTHERAPY. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71145-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
9
|
Ohashi T, Momma T, Yamashita S, Hanada T, Fukada J, Shiraishi Y, Shigematsu N. Impact on MRI-based Postimplant Dosimetric Assessment for Permanent Prostate Brachytherapy using Contrast-enhanced T1 Weighted Images. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
10
|
Fukada J, Shigematsu N, Ohashi T, Hanada T, Takeuchi H, Hashimoto S, Kitagawa Y. Interfraction Esophageal Motion in Patients Receiving Radiotherapy for Esophageal Cancer. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
11
|
Shigematsu N, Fukada J, Ohashi T, Oku Y, Kitagawa Y, Kawaguchi O, Kunieda E. Symptomatic and Asymptomatic Pericardial Effusion after Definitive Radiotherapy or Concurrent Chemoradiotherapy for Esophageal Cancer - Dose Volume Analyses. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
12
|
Fujisawa Y, Kurimoto Y, Morishita K, Fukada J, Saito T, Ohori S, Abe T. Aortocaval fistula after endovascular stent-grafting of abdominal aortic aneurysm. J Cardiovasc Surg (Torino) 2009; 50:387-389. [PMID: 18948877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The authors present a case report of a 79-year-old man with insufficient cardiac contractile function who underwent endovascular stent-grafting for an abdominal aortic aneurysm. Thirty months later, the aneurysm ruptured into the inferior vena cava and subsequently formed an aortocaval fistula caused by migration of the stent-graft. Urgent secondary endovascular stent-grafting successfully excluded the blood flow into the vena cava. Endovascular stent-grafting is deemed suitable for treating this serious disorder, especially in severely debilitated or compromised patients who might not withstand a standard surgical intervention. Furthermore, in patients with previous stent-grafting, since the primary stent-graft makes repair by open surgery more difficult, a secondary endovascular intervention is recommended if feasible.
Collapse
Affiliation(s)
- Y Fujisawa
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | | | | | | | | | | | | |
Collapse
|
13
|
Fukada J, Shigematsu N, Kitagawa Y, Ohashi T, Kutsuki S, Kunieda E, Shiraishi Y, Kubo A, Kawase T. Pleural and Pericardial Effusion after Radiotherapy or Concurrent Chemo-radiotherapy (CCR) for Esophageal Cancer - Single Institutional Retrospective Study. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
14
|
Fukada J, Shigematsu N, Tomita T, Kubo A. Radiotherapy Concurrent With Weekly Docetaxel for Advanced Cancer of Oropharynx and Hypopharynx. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
15
|
Kawase T, Takeda A, Kunieda E, Ishibashi R, Kamikubo Y, Sugawara A, Ohashi T, Fukada J, Shigematsu N, Kubo A. Symptomatic Extrapulmonary Soft-Tissue Fibrosis Resulting From Hypofractionated Stereotactic Radiotherapy Pulmonary Nodular Lesion. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
16
|
Fujisawa Y, Morishita K, Fukada J, Hachiro Y, Saito T, Abe T. Strategy for adult aortic coarctation complicated by coronary artery disease. Asian Cardiovasc Thorac Ann 2007; 15:e41-2. [PMID: 17540981 DOI: 10.1177/021849230701500329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortic coarctation in adults is sometimes associated with a fragile aortic wall and may be complicated by coronary artery disease and ascending aortic dilation. Successful management of aortic coarctation in a 45-year-old man with coronary artery disease is described. Tube graft replacement was carried out without cross clamping, under circulatory arrest with axillary artery and graft inflow.
Collapse
Affiliation(s)
- Yasuaki Fujisawa
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan.
| | | | | | | | | | | |
Collapse
|
17
|
Fujisawa Y, Morishita K, Fukada J, Kawaharada N, Hachiro Y, Abe T. Treatment methods for spinal cord injury caused by acute type B aortic dissection. Asian Cardiovasc Thorac Ann 2006; 14:e106-7. [PMID: 17130311 DOI: 10.1177/021849230601400625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute distal aortic dissection rarely causes spinal cord ischemia presenting with paraplegia or paraparesis. Spinal cord involvement has poor outcomes, and there is no established effective treatment for this disorder. In this report we describe the acute conservative treatment of two cases of paraplegia/paraparesis due to acute type B aortic dissection. Early reversal of lower-limb dysmobility was achieved.
Collapse
Affiliation(s)
- Yasuaki Fujisawa
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo 0608543, Japan.
| | | | | | | | | | | |
Collapse
|
18
|
Kurimoto Y, Morishita K, Kawaharada N, Fukada J, Hachiro Y, Fujisawa Y, Saitoh T, Yama N, Hase M, Narimatsu E, Asai Y. Initial experiences in management of blunt aortic injury taking associated brain injury into consideration. Circ J 2006; 70:198-201. [PMID: 16434815 DOI: 10.1253/circj.70.198] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although endovascular stent-grafting (SG) has become acceptable for blunt aortic injury (BAI), open surgical repair (OR) does provide reliable, good long-term results. A current surgical strategy for BAI, taking account of associated brain injury, is presented and preferable initial management for BAI is proposed. METHODS AND RESULTS The surgical strategy for BAI was established in 2001: SG is performed for patients with obvious brain injuries, but OR is performed for patients without brain injury, and conservative treatment should be used initially for patients with critical non-aortic injuries. Between 2001 and 2004 20 patients with BAI were admitted to hospital: 16 blunt aortic ruptures and 4 blunt aortic dissections. Of them 15 patients underwent surgery (SG, 9; OR, 6) and 5 patients were treated conservatively. One patient died from associated lung injury after SG, all patients treated conservatively died because of associated brain injuries or another rupture of BAI, and 2 elderly patients treated by OR died within 1 year from postoperative respiratory failure. CONCLUSION This brain-injury conscious surgical strategy for BAI provided acceptable early results. OR should be chosen for young patients without brain injury, but endovascular SG seems to be a better initial treatment for elderly patients or patients with other comorbidities.
Collapse
Affiliation(s)
- Yoshihiko Kurimoto
- Departments of Traumatology and Critical Care Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Morishita K, Kawaharada N, Fukada J, Abe T. Does Arch Clamping Increase Stroke Rates? Ann Thorac Surg 2006; 81:789-90; author reply 790. [PMID: 16427915 DOI: 10.1016/j.athoracsur.2005.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Revised: 01/26/2005] [Accepted: 03/01/2005] [Indexed: 11/17/2022]
|
20
|
Morishita K, Kawaharada N, Fukada J, Kuwaki K, Abe T. Reply. Ann Thorac Surg 2005. [DOI: 10.1016/j.athoracsur.2005.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
Tachibana K, Morishita K, Kurimoto Y, Fukada J, Hachiro Y, Abe T. Endovascular stent-grafting for thoracoabdominal aortic aneurysm following bypass grafting to superior mesenteric and celiac arteries: report of two cases. Ann Thorac Cardiovasc Surg 2005; 11:335-8. [PMID: 16299463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Two high-risk patients underwent an endovascular stent-grafting for thoracoabdominal aortic aneurysms (TAAA) following bypass-grafting to the visceral arteries. The first patient was a 73-year-old woman with severe ischemic heart disease (IHD) and chronic respiratory failure. The second patient was a 59-year-old woman with myelodysplastic syndromes (MDSs) and hepatic cell carcinoma (HCC). In general, TAAA is not considered to be indicated for endovascular stent-grafting because of the need to revascularize the visceral vessels. However, in some selected cases, such as the two cases presented herein, endovascular stent-grafting combined with bypass-grafting of the visceral arteries can be a feasible and a less-invasive alternative to conventional surgery.
Collapse
Affiliation(s)
- Kazutoshi Tachibana
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | | | | | | | | | | |
Collapse
|
22
|
Hyodoh H, Kawaharada N, Akiba H, Tamakawa M, Hyodoh K, Fukada J, Morishita K, Hareyama M. Usefulness of Preoperative Detection of Artery of Adamkiewicz with Dynamic Contrast-enhanced MR Angiography. Radiology 2005; 236:1004-9. [PMID: 16020556 DOI: 10.1148/radiol.2363040911] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate the detection of the artery of Adamkiewicz at magnetic resonance (MR) angiography and the effect such detection has on outcome after surgical graft placement in a series of patients with thoracoabdominal aortic disease. MATERIALS AND METHODS This study had ethics committee approval, and written informed consent was obtained from all patients. Fifty patients (38 men, 12 women; age range, 47-83 years; mean age, 67.2 years) who were scheduled to undergo thoracoabdominal aortic surgery for treatment of thoracoabdominal aortic aneurysm (n = 42) or thoracoabdominal aortic dissection (n = 8) were enrolled in the study. MR angiography was performed with a 1.5-T system by using dynamic three-dimensional fast spoiled gradient-recalled acquisition in the steady state with a bolus of contrast material and saline injection (4 mL/sec). Differences in the cross-clamping time, bypass time, total surgery time, and spinal complication rate between patients in whom the artery of Adamkiewicz was identified (group A) and those in whom the artery was not identified (group B) were evaluated with chi(2) or Mann-Whitney U testing. RESULTS In 42 of the 50 patients (84% [group A]), at least one artery of Adamkiewicz was seen to arise from an intercostal artery. Two arteries of Adamkiewicz were identified in four of the patients (8%). The artery of Adamkiewicz could not be detected with MR angiography in eight patients (group B). The ranges of cross-clamping, bypass, and total surgery times, respectively, were 30-199 minutes (mean, 78.4 minutes +/- 39.1 [standard deviation]), 30-298 minutes (mean, 96.9 minutes +/- 60.0), and 135-665 minutes (mean, 354.9 minutes +/- 133.9) in group A and 53-124 minutes (mean, 72.8 minutes +/- 29.8), 10-124 minutes (mean, 66.0 minutes +/- 41.0), and 220-405 minutes (mean, 315.6 minutes +/- 68.8) in group B. Spinal complications occurred in two patients in group B but in none of the patients in group A (P < .001). CONCLUSION The artery of Adamkiewicz was detected in a large percentage of patients in whom there were no spinal complications, unlike the spinal complications that occurred in the patients in whom the artery was not detected.
Collapse
Affiliation(s)
- Hideki Hyodoh
- Department of Radiology, Sapporo Medical University, S-1 W-16 Chuo-ku, Sapporo 060-8543, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Morishita K, Kawaharada N, Fukada J, Kurimoto Y, Fujisawa Y, Saito T, Abe T. Midterm Results of Surgical Treatment of Thoracic Aortic Disease in Dialysis Patients. Ann Thorac Surg 2005; 80:96-100. [PMID: 15975348 DOI: 10.1016/j.athoracsur.2005.01.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2004] [Revised: 01/18/2005] [Accepted: 01/20/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND We investigated the influence of dialysis on late aortic events in end-stage renal failure patients who had undergone replacement of the thoracic aorta. METHODS Between 1990 and 2003, 28 dialysis patients underwent thoracic aortic aneurysm repair. The cause was non-dissection in 17 patients and dissection in 11 patients. Six patients needed emergency operations. After the initial operation, 10 patients in the dialysis group had a patent false channel distal to the operative area, and 7 patients in the dialysis group had untreated separate aneurysms. These lesions were defined as residual aneurysms. We performed a retrospective case-control analysis of survival and late aortic events (enlargement of the remaining thoracic aorta, sudden death and reoperation) in dialysis patients versus carefully matched non-dialysis patients. Matching criteria included age, sex, cause, operative procedures, operative date, and operative status (elective or emergency). RESULTS Survival rates at 1 and 5 years for dialysis patients versus non-dialysis patients were 63 +/- 9% vs. 85 +/- 7% and 41 +/- 11% versus 64 +/- 13%, respectively (p = 0.02). Four of nine late deaths in the dialysis group were due to rupture of residual aneurysm. Freedom from late aortic events for dialysis patients versus non-dialysis patients was 91+/- 6% versus 92 +/- 5% and 25 +/- 14% versus 68 +/- 12% at 1 and 5 years, respectively (p = 0.0073). CONCLUSIONS There is a high incidence of late aortic events in dialysis patients undergoing thoracic aortic aneurysm repair. This finding indicates the need for close follow-up examination of dialysis patients who have undergone surgical treatment of thoracic aortic disease.
Collapse
Affiliation(s)
- Kiyofumi Morishita
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
Acute distal aortic dissection sometimes causes one or more visceral vessels to be stenosed by the thrombosed false lumen. Although stenosis of the only celiac artery (CA) usually does not cause ischemic symptoms because of the extensive collateral pathways of the mesenteric circulation, we experienced a rare case of CA compression syndrome which was caused by acute type B aortic dissection. The principal symptom was severe epigastric pain that was refractory to medicinal treatment. The angiogram showed absence of the anatomically well-developed collateral pathways between the CA and the superior mesenteric artery. We treated the patient with percutaneous transluminal angioplasty in the CA. This report indicates that attention should be given to the possibility of CA compression syndrome in the case of acute distal aortic dissection and that endovascular management can be successfully applied to control symptoms caused by the syndrome, which is otherwise extremely difficult to repair directly by surgery.
Collapse
Affiliation(s)
- Yasuaki Fujisawa
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | | | | | | | | | | |
Collapse
|
25
|
Kawaharada N, Morishita K, Fukada J, Hachiro Y, Fujisawa Y, Saito T, Kurimoto Y, Abe T. Stroke in surgery of the arteriosclerotic descending thoracic aortic aneurysms: influence of cross-clamping technique of the aorta. Eur J Cardiothorac Surg 2005; 27:622-5. [PMID: 15784361 DOI: 10.1016/j.ejcts.2004.11.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2004] [Revised: 11/23/2004] [Accepted: 11/29/2004] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The risk of stroke caused by dislodgment of loose atheromatous plaque or mural emboli is increased by cross-clamping of the aorta. Some patients undergo descending thoracic aortic aneurysm repair with proximal aortic cross-clamping between the left common carotid artery and the left subclavian artery. The objective of this study was to determine the influence of proximal aortic cross-clamping in arteriosclerotic aneurysm or dissecting aneurysm repair. METHODS Between May 1984 and May 2003, 81 patients underwent elective surgery for distal arch or descending aortic aneurysm repair with proximal aortic cross-clamping between the left common carotid artery and the left subclavian artery. To evaluate the influence of the proximal aortic cross-clamping, patients were divided into two groups: patients who had undergone arteriosclerotic aneurysm repair (group I, n=25) and patients who had undergone dissecting aneurysm repair (group II, n=56). RESULTS Eight (9.9%) of the 81 patients had a stroke. Six strokes occurred in operations for arteriosclerotic aneurysm repair group I and two strokes occurred in operations for dissecting aneurysm repair group II (24 vs 3.6%; p=0.009). In-hospital mortality rates were 12% in group I and 8.9% in group II (p=0.70). Major postoperative complications included renal failure requiring hemodialysis (in 4.2% of the patients in group I and in 8.3% of the patients in group II, p=0.99) and pulmonary complication (in 20% of the patients in group I and in 16% of the patients in group II, p=0.67). CONCLUSION Cross-clamping between head vessels should be avoided if at all possible when operating on patients who have arteriosclerotic descending thoracic aneurysms.
Collapse
Affiliation(s)
- Nobuyoshi Kawaharada
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Morishita K, Kawaharada N, Fukada J, Hachiro Y, Kurimoto Y, Fujisawa Y, Saito T, Abe T. Descending Thoracic Aortic Aneurysm Repair With the Aid of Partial Cardiopulmonary Bypass: Heparin-coated Circuits Versus Nonheparin-coated Circuits. Artif Organs 2005; 29:300-5. [PMID: 15787624 DOI: 10.1111/j.1525-1594.2005.29051.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We have performed descending thoracic aortic aneurysm repairs with partial cardiopulmonary bypass, including heparin-coated circuits. The aim of this study was to evaluate (i) the impact of partial cardiopulmonary bypass on distal organ function and surgical outcomes; and (ii) the effectiveness of using heparin-coated circuits for preventing bleeding complications. METHODS From July 1980 to June 2004, 309 patients underwent descending thoracic aortic aneurysm repairs using partial cardiopulmonary bypass. Their mean age was 61 years (range 19-81 years). One hundred of the 309 patients underwent repair of descending thoracic aortic aneurysm with heparin-coated circuits. Blood data for renal and hepatic function were collected on the day before the operation and postoperative days. RESULTS The in-hospital mortality was 15%. Distal organ dysfunction included spinal cord dysfunction in 2 patients (0.7%) and renal failure necessitating hemodialysis in 15 patients (5%, 15/297: excluded 12 dialysis patients). Multivariate analyses showed that preoperative hemodialysis and emergency operation were risk factors for operative mortality and that emergency operation was a risk factor for requiring hemodialysis. Renal and hepatic function normalized by 2 weeks after surgery. There were no significant differences between the heparin-coated group and nonheparin-coated group in amounts of packed red cells, fresh frozen plasma, and platelets transfused during the procedures. CONCLUSIONS Our data showed that partial cardiopulmonary bypass is a safe and effective method for distal perfusion. Using this technique, descending thoracic aortic aneurysm repair can be performed with acceptable mortality and morbidity. However, the superiority of heparin-coated circuits over nonheparin-coated ones was not proved.
Collapse
Affiliation(s)
- Kiyofumi Morishita
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Central Ward, Sapporo 060-8543, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Kurimoto Y, Morishita K, Kawaharada N, Fukada J, Asai Y, Abe T. Initial management of acute type-A aortic dissection with a thrombosed false lumen: a retrospective cohort study. Surg Today 2004; 34:652-7. [PMID: 15290393 DOI: 10.1007/s00595-004-2798-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2003] [Accepted: 01/20/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE Acute type-A aortic dissection with a clotted false lumen is often managed conservatively; however, we found that surgery has a better outcome. METHODS Enhanced computed tomography (CT) showed a clotted false lumen in the ascending aorta in 38 (33.3%) of 114 patients with acute type-A aortic dissection. After the exclusion of 8 patients whose condition was too critical for comparison, 13 patients who were hemodynamically stable and did not have pericardial effusion, organ ischemia, or a dilated ascending aorta greater than 50 mm in diameter, were managed conservatively (group C) and 17 were managed surgically (group S). We compared the early and late results of both groups. RESULTS The early mortality rates were 23.1% in group C and 0% in group S ( P = 0.037). The early deaths in group C were caused by redissection in the acute phase. The actuarial survival rates and dissection-related event-free rates 5 years after onset in groups C and S were 64.1% and 80.8% ( P = 0.131) and 46.2% and 92.9% ( P = 0.002), respectively. CONCLUSION The early mortality rate and dissection-related event-free rate were better after surgery than after conservative treatment. The indications for conservative management should be limited because redissection is usually fatal.
Collapse
Affiliation(s)
- Yoshihiko Kurimoto
- Department of Traumatology and Critical Care Medicine, Sapporo Medical University, S 1, W 16, Sapporo 060-8543, Japan
| | | | | | | | | | | |
Collapse
|
28
|
Morishita K, Kurimoto Y, Kawaharada N, Fukada J, Hachiro Y, Fujisawa Y, Abe T. Descending Thoracic Aortic Rupture: Role of Endovascular Stent-Grafting. Ann Thorac Surg 2004; 78:1630-4. [PMID: 15511446 DOI: 10.1016/j.athoracsur.2004.05.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2004] [Indexed: 11/16/2022]
Abstract
BACKGROUND The mortality of patients with descending thoracic aortic rupture who are treated by conventional surgery is high. Our current strategy for the management of descending thoracic aortic rupture is to treat seriously ill patients with endovascular stent-grafting using handmade grafts, and to treat other patients with traditional open repair. The aim of this study was to assess the early results of our strategy. METHODS Twenty-nine consecutive patients with descending thoracic aortic rupture were referred to Sapporo Medical University Hospital from June 2001 to January 2004. Eighteen of these 29 patients were selected for endovascular stent-grafting because of polytrauma (n = 7), comorbidities (n = 6), advanced age (n = 2), past history of left thoracotomy (n = 2), and patient's preference (n = 1). The remaining 11 patients underwent traditional graft replacement of the diseased aorta. Their outcomes and follow-up data were collected and analyzed retrospectively. RESULTS The in-hospital mortality rate was 14% (4/29). The mortality rate for surgical patients and stent-grafting patients was 9% (1/11) and 17% (3/18), respectively. The survival rate of patients at 2 years was 63% +/- 10%. In the follow-up period, 2 of the 18 patients who underwent endovascular stent-grafting required open repair, and 1 patient underwent a redo endovascular stent-grafting procedure because of stent failure. One of these 3 patients died of an intraoperative retrograde type A aortic dissection. CONCLUSIONS The early results of endovascular stent-grafting for the treatment of high-risk patients with descending thoracic aortic rupture are promising. Early results of open repair can also be improved by the selection of stabilized patients. However, the requirement of reintervention indicates that detailed follow-up examinations in patients who have undergone endovascular stent-grafting with handmade stent-grafts should be performed.
Collapse
Affiliation(s)
- Kiyofumi Morishita
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | | | | | | | | | | | | |
Collapse
|
29
|
Kawaharada N, Morishita K, Fukada J, Yamada A, Muraki S, Hachiro Y, Fujisawa Y, Saito T, Kurimoto Y, Abe T. Minilaparotomy Abdominal Aortic Aneurysm Repair Versus the Retroperitoneal Approach and Standard Open Surgery. Surg Today 2004; 34:837-41. [PMID: 15449153 DOI: 10.1007/s00595-004-2841-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2003] [Accepted: 03/09/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE We evaluated the surgical results of minilaparotomy abdominal aortic aneurysm (AAA) repair in comparison with those of standard open repair and retroperitoneal approach repair. METHODS Between February 2000 and January 2003, 30 patients with AAA underwent minimal incision laparotomy repair (MINI) through an abdominal incision 7-12 cm long. Their clinical characteristics and in-hospital outcome were then compared with those of patients who had undergone repair of AAA by a standard open technique (OPEN) or retroperitoneal approach technique (RETRO). RESULTS There were significant differences between the MINI, OPEN, and RETRO groups in the time until the patient was able to resume eating (2.4 +/- 1.0 vs 4.4 +/- 2.4* vs 2.8 +/- 1.9 postoperative days [PODs], respectively; *P < 0.05), the time until ambulation outside the room (2.1 +/- 0.7 vs 3.5 +/- 1.3* vs 2.5 +/- 1.9 PODs, respectively; *P < 0.05), and the operation times (188 +/- 43* vs 256 +/- 77 vs 238 +/- 59 min, respectively; *P < 0.05). CONCLUSION Minilaparotomy repair is a feasible technique, which combines the benefits of a small incision with those of conventional open repair. With the exception of patients with an iliac artery aneurysm extending to the external or internal iliac artery, MINI repair should be considered for the elective treatment of patients with aortic disease.
Collapse
Affiliation(s)
- Nobuyoshi Kawaharada
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, S 1, W 16, Chuo-ku, Sapporo 060-8543, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Kawaharada N, Morishita K, Hyodoh H, Fujisawa Y, Fukada J, Hachiro Y, Kurimoto Y, Abe T. Magnetic resonance angiographic localization of the artery of Adamkiewicz for spinal cord blood supply. Ann Thorac Surg 2004; 78:846-51; discussion 851-2. [PMID: 15337003 DOI: 10.1016/j.athoracsur.2004.02.085] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to determine whether the artery of Adamkiewicz (ARM) can be detected by magnetic resonance angiography and to determine the usefulness of preoperative magnetic resonance angiography evaluation of the ARM. METHODS Between April 2000 and December 2003, 120 patients underwent magnetic resonance angiography for detection of the ARM. The morphology of the anterior spinal artery at the ARM junction, as revealed by magnetic resonance angiography, in 99 patients in whom ARM was preoperatively detected was classified into the following three types: noncontinuation of the anterior spinal artery above the ARM junction (type A), continuation of the anterior spinal artery above and below the ARM junction (type B), and noncontinuation of the anterior spinal artery below the ARM junction (type C). RESULTS The ARMs were detected in 99 (83%) of 120 patients, and from a total of 110 ARMs 105 (95%) originated from intercostal arteries branching from the left side and 94 (86%) originated between Th9 and Th11. Two ARMs were found in 11 (11%) of 99 patients in whom ARMs were detected. In 107 patients, who underwent magnetic resonance angiography to reveal the morphology of the anterior spinal artery at the ARM junction, the patterns of the anterior spinal artery were type A in 59 patients (55%), type B in 21 patients (20%), type C in 3 patients (3%) and not classified in 24 patients (22%). No spinal cord injury occurred in patients in whom the ARM had been preoperatively detected. CONCLUSIONS Preoperative detection of the ARM is possible by magnetic resonance angiography and is very useful for reducing the incidence of ischemic injury of the spinal cord.
Collapse
Affiliation(s)
- Nobuyoshi Kawaharada
- Department of Thoracic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Schena S, Kurimoto Y, Fukada J, Tack I, Ruiz P, Pang M, Striker LJ, Aitouche A, Pham SM. Effects of ventricular unloading on apoptosis and atrophy of cardiac myocytes1. J Surg Res 2004; 120:119-26. [PMID: 15172198 DOI: 10.1016/j.jss.2003.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Ventricular unloading decreases cardiac ventricular mass. This loss of ventricular mass can be due to either atrophy (a reversible process) or apoptosis (an irreversible process) of the cardiac myocytes. We investigated the effect of ventricular unloading on atrophy and apoptosis of cardiac myocytes, using working and nonworking transplant heart models in rats. MATERIALS AND METHODS ACI rats underwent heterotopic heart transplantation with two different techniques to create working and nonworking cardiac grafts. Cardiac grafts were harvested at different time points after transplantation. TUNEL, caspase-3 assay, and electron microscopy were used to assess the degree of apoptosis while cellular atrophy was estimated by calculation of the cytoplasmic index (CI = mean sectional cytoplasmic area/nucleus). RESULTS Ventricular mass reduction was more pronounced in nonworking than in working hearts (P < 0.05). Apoptotic index and caspase-3 activities increased in both groups, peaking at 3 days after transplantation, but were not significantly different between the two models. The cytoplasmic index was significantly lower in nonworking than in working grafts (P < 0.05). CONCLUSIONS These data suggest that cellular atrophy is the primary mechanism that accounts for myocardial weight reduction following ventricular unloading. The inference is that ventricular unloading by ventricular assist devices may not cause permanent loss of cardiac myocytes, thus allowing for functional recovery.
Collapse
Affiliation(s)
- Stefano Schena
- Department of Surgery, University of Miami, Miami, Florida 33136, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Kurimoto Y, Morishita K, Fukada J, Kawaharada N, Komatsu K, Yama N, Asai Y, Abe T. A simple but useful method of screening for mesenteric ischemia secondary to acute aortic dissection. Surgery 2004; 136:42-6. [PMID: 15232538 DOI: 10.1016/j.surg.2003.12.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND In spite of recent improvements in treatment for acute aortic dissection, mesenteric ischemia secondary to aortic dissection is still challenging. We propose a simple screening method to detect mesenteric ischemia secondary to acute aortic dissection. METHODS From 1991 to 2002, 245 patients with acute aortic dissection were admitted to our hospital. Nine (3.7%) of those were complicated with mesenteric ischemia. The clinical records of those 9 patients were retrospectively analyzed. The ratios of the diameter of the superior mesenteric vein (SMV) to that of the superior mesenteric artery (SMA) were calculated in patients with mesenteric ischemia (group M) and in patients without mesenteric ischemia (group C). Blood test data, including results of arterial blood gas analysis, in the 2 groups were also compared. RESULTS The SMV/SMA ratios in groups M and C were 1.16 +/- 0.33 and 1.78 +/- 0.29, respectively (P=.003). A cutoff value of the SMV/SMA ratio was 1.5 (sensitivity, 88.9%; specificity, 88.9%) with an odds ratio of 64.0. Although there were differences between the 2 groups in glutamate oxaloacetate transaminase, lactate dehydrogenase, creatine phosphate kinase, pH, and lactate values, the measurement of lactate was especially useful (P=.002). CONCLUSIONS The combination of the SMV/SMA ratio and lactate concentration is a useful screening method to detect mesenteric ischemia secondary to acute aortic dissection.
Collapse
Affiliation(s)
- Yoshihiko Kurimoto
- Department of Traumatology and Critical Care Medicine, Sapporo Medical University, Sapporo, Japan
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Hachiro Y, Kawaharada N, Morishita K, Fukada J, Fujisawa Y, Kurimoto Y, Abe T. [Thoracoabdominal aortic aneurysm repair after detection of the Adamkiewicz artery by magnetic resonance angiography; a way to shorten operating time and improve outcome]. Kyobu Geka 2004; 57:280-3. [PMID: 15071860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Surgical results were compared between 18 patients (group A) who underwent preoperative anatomic characterization of the Adamkiewicz artery by magnetic resonance angiography (MRA) and 38 patients (group B) without such imaging. In group A, intercostal or lumbar arteries related to the aneurysm were reattached to the graft only when they represented the origin of the Adamkiewicz artery. In group B, reconstruction from the Th 7 intercostal and the L2 lumbar arteries was performed whenever possible. In-hospital mortality was 16.7% in group A and 15.8% in group B. Total aortic clamp time and operating time were only 84 and 437 min in group A, compared with 134 and 589 min in group B. Three patients showed postoperative paraplegia in group B. No spinal cord injury occurred in patients whose artery had been detected preoperatively. Preoperative anatomic delineation of the Adamkiewicz artery by MRA can reduce risk of ischemic injury to the spinal cord and decrease operating time required for repair of thoracoabdominal aortic aneurysms.
Collapse
Affiliation(s)
- Y Hachiro
- Department of Second Surgery, Sapporo Medical University, Sapporo, Japan
| | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
BACKGROUND The outcome of thoracoabdominal aortic aneurysm repair through redo-left thoracotomy after operations for descending thoracic aortic aneurysms was investigated. METHODS Between May 1982 and March 2003, 100 patients underwent thoracoabdominal aortic aneurysm repair in elective surgery without profound hypothermic circulatory arrest. Thirty of these patients had previously undergone operations for descending thoracic aortic aneurysms. To evaluate the influence of previous descending thoracic aortic aneurysm repairs on the results of thoracoabdominal aortic aneurysm replacements, patients were divided into two groups: (1) patients who had previously undergone descending thoracic aortic aneurysm repair (group I; n = 30), and (2) patients who had not previously undergone descending thoracic aortic aneurysm repair (group II; n = 70). RESULTS The distal aortic perfusion time and operation time were both longer in group I than in group II, but there was no significant difference between the two groups in total selective visceral and renal perfusion time or aortic clamp time. In-hospital mortality rates were 13% in group I and 19% in group II (p = 0.52). Major postoperative complications included paraplegia (10% of patients in group I and 4.3% of patients in group II; p = 0.36), renal failure requiring hemodialysis (20% of patients in group I and 11% of patients in group II; p = 0.35), respiratory failure (30% of patients in group I and 19% of patients in group II; p = 0.22). CONCLUSIONS Previously descending thoracic aortic aneurysm and redo-left thoracotomy do not adversely affect the outcome of thoracoabdominal aortic aneurysm repair.
Collapse
Affiliation(s)
- Nobuyoshi Kawaharada
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | | | | | | | | | | |
Collapse
|
35
|
Morishita K, Kawaharada N, Fukada J, Kurimoto Y, Fujisawa Y, Saito T, Abe T. O11-06 Descending thoracic aortic aneurysm repair with the aid of partial cardiopulmonary bypass: results in 310 patients. Int J Cardiol 2004. [DOI: 10.1016/s0167-5273(04)80128-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
36
|
Fujisawa Y, Morishita K, Kawaharada N, Fukada J, Saito T, Abe T. P10-01 Outcomes of secondary interventions after descending aortic aneurysm endovascular repair. Int J Cardiol 2004. [DOI: 10.1016/s0167-5273(04)80222-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
37
|
Fukada J, Morishita K, Ingu A, Kawaharada N, Fujisawa Y, Hasegawa T, Abe T. Comparative Study of the Effect on Clinical Outcome of the Use of an Open Circuit and the Use of a Closed Circuit in Cardiopulmonary Bypass for a Graft Replacement of the Descending Thoracic or Thoracoabdominal Aorta. Surg Today 2004; 34:11-5. [PMID: 14714222 DOI: 10.1007/s00595-003-2639-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2002] [Accepted: 05/27/2003] [Indexed: 11/25/2022]
Abstract
PURPOSE We studied the benefits of reduced systemic heparinization in a heparin-coated cardiopulmonary bypass (CPB) system for graft replacement of the descending thoracic (TA) or thoracoabdominal aorta (TAA). METHODS Fifty-five patients were assigned to two groups: one group in which closed CPB circuits with reduced heparinization by elimination of the hard shell reservoir were used (group A, n = 36) and one group in which open circuits with full heparinization were used (group B, n = 19). RESULTS The transfusion requirement tended to be greater as the duration of CPB increased, even in group A. The incidences of renal dysfunction in two groups were not significantly different. Only the incidence of pulmonary dysfunction was significantly higher in group B. A reduction of systemic heparinization had no benefit for perioperative bleeding. In the TAA operation, the total amount of hemorrhaging in group A was greater than that in group B, but the difference was not significant. CONCLUSIONS No beneficial effects of the use of heparin-coated CPB circuits on the amount of perioperative bleeding and postoperative organ damage, including renal dysfunction, were found in this study. However, our findings suggest that it may be better to avoid the use of closed CPB circuits in operations with a prolonged duration of CPB, such as a TAA operation.
Collapse
Affiliation(s)
- Johji Fukada
- Department of Cardiothoracic Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan
| | | | | | | | | | | | | |
Collapse
|
38
|
Kurimoto Y, Morishita K, Kawaharada N, Fukada J, Asai Y, Abe T. A Case Report of Blunt Aortic Arch Injury Treated by Immediate Stent-Grafting. Eur J Vasc Endovasc Surg 2003; 26:445-7. [PMID: 14512010 DOI: 10.1016/s1078-5884(03)00077-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Y Kurimoto
- Department of Traumatology and Critical Care Medicine, Sapporo Medical University, Japan
| | | | | | | | | | | |
Collapse
|
39
|
Fukada J, Morishita K, Kawaharada N, Kurimoto Y, Muraki S, Satsu T, Abe T. Retrosternal friction-induced late disruption of the anastomotic site between Bentall's valved conduit and an aortic arch graft: report of a case. Surg Today 2003; 33:287-9. [PMID: 12707825 DOI: 10.1007/s005950300064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We report a case of late mediastinal false aneurysm originating from disruption of the suture line between synthetic vascular grafts for aortic root and total aortic arch replacements. This aneurysm developed without any infection in a patient with Marfan's syndrome. To our knowledge, this event has never been reported before. The only possible cause of this disruption was that the monofilament suture was broken by continuous friction between the pointed anastomotic line and the sternum since the operation. The treatment options for this unusual event after extended synthetic graft replacement are discussed.
Collapse
Affiliation(s)
- Johji Fukada
- Department of Cardiothoracic Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan
| | | | | | | | | | | | | |
Collapse
|
40
|
|
41
|
Kurimoto Y, Morishita K, Kawaharada N, Fukada J, Abe T. Stent-grafting for a thoracic aortic aneurysm ruptured into the right pleural cavity. Eur J Vasc Endovasc Surg 2003; 25:185-7. [PMID: 12552484 DOI: 10.1053/ejvs.2002.1787] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Y Kurimoto
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University, Sapporo 060-8543, Japan
| | | | | | | | | |
Collapse
|
42
|
Muraki S, Fukada J, Morishita K, Kawaharada N, Abe T. Acute type A aortic dissection with intestinal ischemia predicted by serum lactate elevation. Ann Thorac Cardiovasc Surg 2003; 9:79-80. [PMID: 12667135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Mesenteric ischemia can complicate acute aortic dissection. We report a case of acute type A aortic dissection with perioperative intestinal ischemia, which clinically manifested on the second postoperative day. Serial monitoring of serum lactate level by a conventional blood gas analyzer was useful for early diagnosis and for timely treatment of intestinal ischemia. In this report, monitoring of serum lactate level as a key for the successful management of intestinal ischemia is suggested.
Collapse
Affiliation(s)
- Satoshi Muraki
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | | | | | | | | |
Collapse
|
43
|
Fukada J, Morishita K, Kawaharada N, Yamauchi A, Hasegawa T, Satsu T, Abe T. Isolated cerebral perfusion for intraoperative cerebral malperfusion in type A aortic dissection. Ann Thorac Surg 2003; 75:266-8. [PMID: 12537227 DOI: 10.1016/s0003-4975(02)04283-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cerebral malperfusion due to expansion of a false lumen can occur acutely during aortic repair when retrograde femoral perfusion is initiated. We detected this catastrophe by a rapid decrease in regional cerebral oxygenation and successfully treated it by immediate isolation of the cerebral circulation from the systemic circulation. The surgical management, including the above technique, for this rare event is described.
Collapse
Affiliation(s)
- Johji Fukada
- Department of Cardiothoracic Surgery, Sapporo Medical University School of Medicine, South-1, West-12, Chuo-ku, Sapporo 0608543, Japan
| | | | | | | | | | | | | |
Collapse
|
44
|
Fukada J, Morishita K, Kawaharada N, Muraki S, Satsu T, Kurimoto Y, Abe T. [Antegrade selective cerebral perfusion for extended total arch replacement using separated graft technique; reassessment from the type of aneurysms and dissections]. Kyobu Geka 2002; 55:1087-93; discussion 1093-6. [PMID: 12476555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
One hundred eighty two patients with thoracic aortic aneurysms or dissections who required total arch replacement (TAR) were operated on with separated graft technique and selective cerebral perfusion (SCP) between 1991 and 2000. These patients were divided into 4 groups according to the pathology as follows: group 1; acute type A dissection, group 2; chronic type A dissection, group 3; distal arch aneurysm and group 4; proximal arch aneurysm. For SCP, both the innominate artery and the left common carotid artery were cannulated when the patient was cooled to a rectal temperature of 22 degrees C. Hospital mortalities were 27% in group 1, 14% in group 2, 19% in group 3, and 8% in group 4. Independent predictors of hospital mortality were shock, visceral, and leg ischemia in group 1, and circulatory arrest time of the lower half body to be more than 1 hour and cardiopulmonary bypass time to be more than 5 hours in group 3. Permanent neurological complication occurred in 3% in group 1 and 8% in group 3. Hospital mortality was affected by the type of aneurysms and dissections. It is necessary to give careful consideration to the indication of TAR with SCP, especially in acute type A dissection and distal arch aneurysm.
Collapse
Affiliation(s)
- J Fukada
- Department of Cardiothoracic Surgery, Sapporo Medical University, Sapporo, Japan
| | | | | | | | | | | | | |
Collapse
|
45
|
Fukada J, Morishita K, Hyodoh H, Kawaharada N, Muraki S, Miyajima M, Abe T. Descending or thoracoabdominal aortic aneurysm repair without intercostal vessel reconstruction using contrast magnetic resonance angiography: report of two cases. Surg Today 2002; 32:163-6. [PMID: 11998947 DOI: 10.1007/s005950200012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Two high-risk patients underwent a graft replacement for descending thoracic or thoracoabdominal aortic aneurysms without the reconstruction of any intercostal and lumbar arteries. The first patient was an 81-year-old woman with asthma and renal dysfunction who was diagnosed to have a descending thoracic aortic aneurysm extending from the Th8 to Th12 level. Contrast magnetic resonance angiography (MRA) demonstrated the Adamkiewicz artery to originate from the left second lumbar artery. The second patient was a 59-year-old man with left ventricular dysfunction due to aortic and mitral stenoses who was diagnosed to have a Crawford type IV thoracoabdominal aortic aneurysm. Contrast MRA showed the Adamkiewicz artery to originate from the left ninth intercostal artery. In general, the reestablishment of the spinal cord's blood supply, whenever possible, is generally considered to be necessary in such patients to prevent spinal cord injury. However, the reimplantation of intercostal vessels is the most complex aspect of this surgical modality, and therefore, it may cause a substantial increase in the cardiopulmonary bypass time. However, at least in some cases, such as the two cases presented herein, the use of contrast MRA was found to reduce the risk in surgery for descending thoracic or thoracoabdominal aortic aneurysms by eliminating the need for any intraoperative management of the intercostal and lumbar arteries.
Collapse
Affiliation(s)
- Johji Fukada
- Department of Cardiothoracic Surgery, Sapporo Medical University School of Medicine, Japan
| | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
To minimize surgical trauma, we performed graft replacement of a descending aortic aneurysm through a minithoracotomy (12 cm) with the use of thoracoscopy and special vascular clamps. Contrast magnetic resonance angiography can be useful for preventing postoperative paraplegia by revealing the Adamkiewicz artery. The patient was satisfied with the postoperative comfort and good cosmetic result. Further refinement of the technique and instrumentation would make this technique a valuable adjunct to conventional thoracic aortic surgery.
Collapse
Affiliation(s)
- Johji Fukada
- Department of Cardiothoracic Surgery, Sapporo Medical University School of Medicine, Japan.
| | | | | | | | | | | |
Collapse
|
47
|
Fukada J, Morishita K, Naraoka S, Kawaharada N, Tabata A, Hyodoh H, Abe T. Significance of distal fenestration in graft replacement for chronic aortic dissection. J Cardiovasc Surg (Torino) 2002; 43:655-6. [PMID: 12386578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
It is recently controversial whether distal fenestration is necessary in graft replacement for chronic aortic dissection. Several groups started to try the exclusion of intimal entry by the insertion of a stent-graft as a treatment for chronic aortic dissection, while conventional surgical techniques consisted of graft replacement with distal anastomosis to both the true and false channels. It should be kept in mind that the resultant occlusion of the false lumen after obliteration of the false channel could promote spinal cord ischemia. We report a patient with delayed paraplegia after graft replacement without distal fenestration for chronic type B aortic dissection. It is possible that not all cases of chronic aortic dissection are good for stent-grafting.
Collapse
Affiliation(s)
- J Fukada
- Cardiothoracic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | | | | | | | | | | | | |
Collapse
|
48
|
Kawaharada N, Morishita K, Fukada J, Muraki S, Yamada A, Satsu T, Abe T. [Minimal incision abdominal aortic aneurysm repair]. Zentralbl Chir 2002; 127:737-9. [PMID: 12221550 DOI: 10.1055/s-2002-33948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The use of a limited incision for abdominal aortic aneurysm (AAA) repair was evaluated, and its outcome was analyzed in comparison to standard open repair. PATIENTS AND METHODS Between February 2000 and August 2001, 20 patients with an AAA underwent minimal incision repair (MINI) for tube graft implantation. The minimal skin incision was made after localization of aneurysm neck and aortic bifurcation by CT and DSA. For repair of the upper part of the AAA the abdominal incision was retracted toward the head of the patient who was in a jackknife decubitus position. Conversely, when the peripheral portion of the AAA was treated, the abdominal incision was retracted caudally with the patient in a flat or slightly bent decubitus position. The operation itself was performed using the standard conventional technique. The length of the abdominal incision was 10 cm. Clinical characteristics and in-hospital outcome of this procedure were compared to a group of patients who underwent repair of AAA by means of a standard open technique (OPEN). RESULTS Patients age in the MINI and OPEN groups were similar (69 +/- 11 vs. 69 +/- 9 years). However, there were significant differences between the MINI and OPEN groups in the time for starting oral intake of food (2,4 +/- 1,2 vs. 7,4 +/- 5,5 postoperative days, p = 0,003), time for starting to walk outside the room (2,2 +/- 0,7 vs. 4,6 +/- 2,2 postoperative days, p = 0,01) and operation times (197 +/- 37 vs. 294 +/- 83 min, p = 0,0004). CONCLUSION Minimal incision repair is technically feasible and combines the benefits of a minimal incision with those of conventional open repair, reducing patient recovery time.
Collapse
Affiliation(s)
- N Kawaharada
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | | | | | | | | | | | | |
Collapse
|
49
|
Fukada J, Morishita K, Kawaharada N, Yamada A, Baba T, Harada N, Abe T. [Surgical treatment of cardiovascular manifestations of Marfan syndrome]. Kyobu Geka 2002; 55:658-62. [PMID: 12174652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The present study determines the effect of surgical treatment of cardiovascular manifestations of Marfan syndrome in 72 patients by 114 operations, during 34-year period. This therapy resulted in aortic root repair, aortic arch replacement, or both in 78, mitral valve repair in 9, descending thoracic aortic replacement in 14, thoracoabdominal aortic replacement in 10, and abdominal aortic replacement in 6, including total aortic replacement in 4 and nearly total aortic replacement in 4 patients. Fusiform aneurysms were present in the the ascending aorta in 37, the aortic arch in 2, the thoracoabdominal aorta in 2, and the abdominal aorta in 6 patients. Aortic dissection occurred in 40 (55.6%), including type A aortic dissection in 29 patients. Aortic root repair included separate valve-graft in 8, Bentall composite valve-graft in 25, composite valve-graft with button technique in 26, composite valve-graft with interposition graft technique in 10, and valve sparing procedure in 5 patients. The overall early (30-day) mortality was 7.9%. The early survival was 75% in separate valve-graft procedure and 99.2% in composite valve-graft procedure. Late coronary dehiscence did not occur in the patients with Bentall technique in which the reattachments of coronary ostia were performed in 2 layers, but occurred in 50% of patients with the coronary anastomoses in 1 layer. Aortic valve regurgitation relapsed in 2 of the 5 patients with valve sparing procedure. Event free rate for the patients with composite valve-graft using button technique was 81.1% at 10 years. There were 14 late deaths; dissection or rupture of the residual aorta, composite graft endocarditis and cardiac failure were the principle causes of late deaths. In conclusion, Marfan patients with cardiovascular diseases can undergo surgical treatment with a low operative risk and low morbidity. Although late endocarditis remains a serious problem, we believe that Marfan syndrome is a contraindication for valve sparing procedure. Because of the potential for late dissection or aneurysm in other areas of the aorta, patients with Marfan syndrome should have serial computed tomographic scans indefinitely.
Collapse
Affiliation(s)
- J Fukada
- Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Japan
| | | | | | | | | | | | | |
Collapse
|
50
|
Kawaharada N, Morishita K, Fukada J, Yamada A, Muraki S, Hyodoh H, Abe T. Thoracoabdominal or descending aortic aneurysm repair after preoperative demonstration of the Adamkiewicz artery by magnetic resonance angiography. Eur J Cardiothorac Surg 2002; 21:970-4. [PMID: 12048072 DOI: 10.1016/s1010-7940(02)00097-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The outcome of thoracoabdominal or descending aortic aneurysm repair after preoperative demonstration of the artery of Adamkiewicz (ARM) by magnetic resonance angiography (MRA) was investigated. METHODS Between January 2000 and December 2001, 40 consecutive patients who had aneurysms of the thoracoabdominal or descending aorta underwent preoperative MRA to visualize the ARM. Thirty-two patients underwent replacement of the aneurysms, and 25 patients (TAAA, 11; TAA, 14) underwent replacement of the aneurysms with preoperative detection of the ARM. Only intercostal or lumbar arteries in aneurysms, which were detected as the origin of the ARM, were reattached to the graft. The results of thoracoabdominal aortic aneurysm operations in 11 patients in whom the ARM was preoperatively detected (group I) were compared with the results of TAAA operations in 26 patients in whom the ARM was not preoperatively detected (group II). RESULTS MRA demonstrated the ARM in 29 (73%) of the 40 patients. The laterality of the arteries originated from the left side in 29 (100%) and between Th9 and Th12 in 25 (86%), between Th9 and L1 in 28 (97%) of the 29 patients. No spinal cord injury occurred in patients (TAAA and TAA) in whom the ARM had been preoperatively detected. Major complications following TAAA operations included paraplegia (0% in group I and 8% in group II), respiratory failure (9% in group I and 23% in group II), and renal failure requiring hemodialysis (18% in group I and 22% in group II). Operation times were 439+/-99 min in group I and 620+/-200 min in group II (P=0.008). CONCLUSIONS Preoperative detection of the ARM is possible by MRA and is very useful for reducing the incidence of ischemic injury of the spinal cord and for reducing the time of an operation for repair of an aneurysm of the thoracoabdominal or descending aorta.
Collapse
Affiliation(s)
- Nobuyoshi Kawaharada
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Japan.
| | | | | | | | | | | | | |
Collapse
|