11 research outputs found

    Preceding Coil Embolization for Internal Iliac Artery Aneurysm before Open Repair

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    Introduction: In the era of endovascular repair, open repair for abdominal aortic aneurysm (AAA) is still needed in the patients who had anatomical difficulties with the endovascular repair. Open repair for internal iliac artery aneurysm (IIAA) is a challenge because of the deep operating field, which is associated with high morbidity. Therefore, we performed preceding coil embolization for IIAA before open repair to control the bleeding from gluteal arteries. Materials and Methods: The present study is a retrospective case series study. Ten patients underwent preceding coil embolization for IIAA before open repair between January 2010 and August 2015. Three patients had two-stage coil embolization for bilateral IIAA. Six patients also had infrarenal AAAs. After preceding coil embolization, open repair consisting of vascular graft replacement with aneurysmectomy and closure of IIAA was undertaken. Results: The mean age was 72.5 ± 10.7 years. There were nine men and one woman. Operative time and intraoperative bleeding were 270 ± 50 min and 817 ± 671 mL, respectively. There was no postoperative mortality. Three patients developed morbidity, which consisted of paralytic ileus, pneumonia, and shower embolization caused by shaggy aorta. No recurrent IIAA, buttock claudication, and intestinal ischemia after the open repair were observed. Conclusion: Preceding coil embolization for IIAA before open repair may be an effective procedure to control the bleeding from gluteal arteries and prevent recurrent IIAA

    Comparison of Multifurcated and Composite Vascular Grafts for Abdominal Aortic Aneurysms with Iliac Arterial Lesions

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    Introduction: Reconstructing the internal iliac artery (IIA) may help to prevent pelvic ischemia during open repair of abdominal aortic aneurysms (AAAs) with iliac arterial lesions. Composite grafts combined with Y-shaped and straight vascular grafts have previously been used to reconstruct the IIA. However, multifurcated vascular grafts have recently been used to treat AAAs with iliac arterial lesions. We, therefore, assessed the viability of multifurcated vascular grafts for AAAs with iliac arterial lesions. Materials and Methods: We retrospectively reviewed 87 patients who underwent elective open repair with reconstruction of IIAs under infrarenal clamp for AAAs with iliac arterial lesions between April 2002 and August 2015. Forty-three patients received multifurcated vascular grafts including 23 patients who underwent reconstructed unilateral IIA, and 44 patients received composite grafts including forty patients with reconstructed unilateral IIA. We compared the multifurcated and composite graft groups among all patients and also compared among patients who underwent unilateral IIA reconstruction. Results: There were no significant differences between the two groups among all patients in terms of intra- and post-operative data. There were no cases of hospital death or buttock claudication. In propensity score matching analysis among patients with unilateral IIA reconstruction, 22 patients were extracted each group. There were no significant differences in any preoperative or perioperative parameters between the groups. Conclusions: We could not show the availability of open repair using multifurcated vascular grafts for AAA with iliac arterial lesions with comparable results compared to composite grafts

    Increased expression of T cell activation markers (CD25, CD26, CD40L and CD69) in atherectomy specimens of patients with unstable angina and acute myocardial infarction

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    Atherosclerotic plaques contain a chronic immune mediated inflammation in which T cells play an important role. A previous study revealed that the numbers of interleukin-2 receptor-positive T cells is increased in culprit lesions of patients with acute coronary syndromes; a finding of considerable interest since it indicates a recent change in the intraplaque T cell mediated immune response. Confirmation of this observation is important, because it could provide insight into the onset of the acute event. We have, therefore, expanded our earlier work by using a panel of different T cell activation markers (CD25, CD26, CD40L, CD69). The study is based on 58 culprit lesions from patients who underwent coronary atherectomy. There were four groups of patients: chronic stable angina (n = 13), stabilized unstable angina (n = 16), refractory unstable angina (n = 15), and acute myocardial infarction (AMI; n = 14). Activated T cells were expressed as a percentage of the total of CD3-positive cells. CD25, CD26, CD40L, and CD69/CD3 percentages increased with the severity of the coronary syndrome. In patients with AMI all percentages were significantly higher than in patients with chronic stable angina. CD25, CD26, CD40L, and CD69/CD3 percentages in patients with an unstable condition (refractory unstable angina and AMI) were significantly higher than those in patients with a stable condition (chronic stable or stabilized unstable angina) The finding that the percentage of T cells with recent onset activation is significantly increased in the culprit lesions of patients with acute coronary syndromes suggests strongly that a recent change in pathogenic stimulation has occurred leading to local T cell activation. (C) 2003 Elsevier Science Ireland Ltd. All rights reserve
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