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Published Papers 【 display / non-display 】

• Motor Evoked Potential Monitoring Helps Avoid Paraplegia in Thoracic Endovascular Aortic Repair for Ruptured Type B Aortic Dissection: A Case Report

  Higa Shotaro, Nagano Takaaki, Ando Mizuki, Kise Yuya, Nakaema Moriyasu, Furukawa Kojiro

  Japanese Journal of Vascular Surgery ( JAPANESE SOCIETY FOR VASCULAR SURGERY )  30 ( 5 ) 291 - 294   2021.09

  Type of publication: Research paper (scientific journal)

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  <p>False lumen rupture in acute type B aortic dissection is fatal, and preserving life is the priority during treatment. However, when paraplegia develops, it leads to a decrease in activities of daily living and affects outcomes. We report a case in which intraoperative monitoring of motor-evoked potentials (MEPs) helped respond to changes in MEPs, thus avoiding paraplegia development. A 60-year-old man presented with chest and back pain, and computed tomography revealed acute type B dissection and extravasation in the mediastinum from the false lumen near the entry of the proximal descending aorta. Thoracic endovascular aortic repair (TEVAR) was performed from Zone 2; no MEP changes were observed immediately after the stent graft was placed. While controlling pseudo luminal blood flow, MEPs started decreasing 51 min after stent graft placement and disappeared 78 min later. Although MEPs did not recover by increasing mean blood pressure, they recovered when a bare stent was placed in the left subclavian artery to secure antegrade blood flow. In conclusion, the patient did not develop paraplegia after TEVAR. Monitoring MEP is important even in emergencies to prevent paraplegia.</p>

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• EVAR with Embolization of the Right Internal Iliac Artery Using IMPEDE

  Higa Shotaro, Nagano Takaaki, Uejo Akino, Ando Mizuki, Yamashiro Satoshi

  The Journal of Japanese College of Angiology ( Japanese College of Angiology )  60 ( 9 ) 167 - 170   2020.09

  Type of publication: Research paper (scientific journal)

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  <p>IMPEDE using Shape memory polymer was approved as a new embolic material in Japan, February 2020. We report a case of an 82-year-old man who was performed the superior and inferior gluteal arteries embolization with IMPEDE (IMP-10) prior to EVAR. Although it is necessary to examine the timing and frequency of contrast for confirming embolism in order to prevent the delay of thrombus formation, post-operative CT has few artifacts and it is easy to evaluate endoleak. We considered that IMPEDE is useful embolic material.</p>

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• A Case Report after Two Years of Total Debranching and Endovascular Repair for Kommerell Diverticulum

  Hayakawa Masato, Nishizima Isao, Nagano Takaaki, Shinzato Kento, Ikemura Ryo, Miyagi Kazufumi, Iha Kiyoshi, Senaha Shigenobu, Shimoji Mitsuyoshi, Akasaki Mitsuru

  Japanese Journal of Cardiovascular Surgery ( The Japanese Society for Cardiovascular Surgery )  48 ( 3 ) 202 - 205   2019.05

  Type of publication: Research paper (scientific journal)

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  <p>A 78-year-old woman with abnormal shadows on computed tomography (CT) was given a diagnosis of right-sided aortic arch and Kommerell diverticulum (KD), accompanied by aberrant left subclavian artery. Although no symptoms were observed, the maximum diameter of the aneurysm was 63 mm, and surgical intervention was chosen because of the possibility of rupture. At first, a 4-branched blood vessel prosthesis with a side branch was anastomosed to the ascending aorta. Next, after reconstructing the cervical branches, a Conformable GORE^® TAG^® (W.L. Gore and Associates, 34 mm×200 mm) was inserted from the side branch and expanded in the range of Zones 0 to Th 7. Finally, ALSA coil embolization was performed. She was discharged on postoperative day 36, and at her 2-year follow-up, she was doing well, with shrinkage of Kommerell diverticulum.</p>

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• Thoracic endovascular aortic repair for mycotic thoracic aortic aneurysm

  Nishijima Isao, Uejyo Akino, Ikemura Ryo, Tokeshi Yoshihiro, Miyagi Kazufumi, Iha Kiyoshi, Akasaki Mitsuru, Nagano Takaaki

  Journal of the Japanese Society of Intensive Care Medicine ( The Japanese Society of Intensive Care Medicine )  24 ( 2 ) 126 - 130   2017

  Type of publication: Research paper (scientific journal)

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  <B>Objective:</B> To investigate outcomes of patients with mycotic thoracic aortic aneurysm treated with thoracic endovascular aortic repair (TEVAR) in our hospital. <B>Material and methods:</B> Between March 2012 and November 2013, 5 patients underwent TEVAR. We analyzed bacterial culture results, rates of perioperative complications and mortality. <B>Results:</B> Five patients (3 men, 2 women) had a mean age of 79.6 years (range, 61-98 years). There were no cases with fistula formation between the aorta and the intestine or bronchi. After the diagnosis was made, all patients empirically received broad-spectrum antibiotics. All the patients immediately underwent TEVAR. On blood culture, <I>Bacteroides fragilis</I>, methicillin-sensitive <I>Staphylococcus aureus</I>, penicillin-resistant <I>Streptococcus pneumoniae</I>, <I>Escherichia coli</I>, and <I>Streptococcus agalactiae</I> were identified. Thereafter, specific antibiotic treatment was administered according to culture and susceptibility results and was continued for 6 weeks. The antibiotic treatment was then changed from intravenous to oral form and was continued indefinitely. The postoperative complications included incisional hernia in one case and thoracic hematoma in another case. All the patients remained alive throughout the follow-up duration (mean duration, 15.2 months; range, 7-29 months).

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