Updated on 2024/03/14

写真a

 
SUGIMOTO Masayuki
 
Organization
Nagoya University Hospital Vascular Surgery Lecturer
Graduate School
Graduate School of Medicine
Title
Lecturer
External link

Degree 1

  1. 医学博士 ( 2008.3   名古屋大学 ) 

Research Interests 4

  1. Vascular biology

  2. Surgery

  3. Endovascular

  4. Vascular

Research Areas 1

  1. Others / Others  / Vascular surgery

Education 2

  1. Nagoya University   Graduate School, Division of Medical Sciences

    - 2008.3

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    Country: Japan

  2. Nagoya University   Faculty of Medicine

    - 1999.3

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    Country: Japan

Professional Memberships 1

  1. 心臓血管外科学会

 

Papers 62

  1. Giant Brachial Artery Aneurysm

    Kawai Y., Sugimoto M.

    European Journal of Vascular and Endovascular Surgery   Vol. 67 ( 1 ) page: 152 - 152   2024.1

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    Language:English   Publisher:European Journal of Vascular and Endovascular Surgery  

    DOI: 10.1016/j.ejvs.2023.10.002

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  2. Optimal D-Dimer Cutoff Values for Diagnosing Deep Vein Thrombosis in Patients with Comorbid Malignancies

    Niimi K., Nishida K., Lee C., Ikeda S., Kawai Y., Sugimoto M., Banno H.

    Annals of Vascular Surgery   Vol. 98   page: 293 - 300   2024.1

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    Background: Patients with malignancy are at high risk of venous thromboembolism, and early diagnosis is important. The Khorana score is known as a risk assessment for cancer-related thrombosis during chemotherapy, but there are still few reports on its diagnostic potential, the optimal D-dimer cutoff values for indications other than chemotherapy and the use of the Khorana score in combination with D-dimers. In this study, we examined the clinical appropriateness of increasing the D-dimer cutoff value. Methods: We retrospectively studied 208 malignancies out of 556 patients who underwent lower extremity venous ultrasonography at our hospital over a 2-year period from January 2018 to December 2019. The optimal D-dimer cutoff value for predicting deep vein thrombosis (DVT) in patients with malignancy was calculated by the Youden index. The usefulness of the Khorana score alone and the model combining the Khorana score with D-dimer for predicting DVT diagnosis was compared using receiver operating characteristic analysis. Results: Of 208 eligible patients, 59 (28.4%) had confirmed DVT. The optimal D-dimer cutoff value for predicting DVT comorbidity in patients with malignancy was 3.96 μg/mL. When the new D-dimer cutoff value was set at 4.0 μg/mL, the odds ratio (OR) for DVT diagnosis was 4.23 (95% confidence interval (CI) 2.10–8.55, P < 0.001), which was higher than the OR of 1.33 (95% CI: 0.98–1.81, P = 0.064) for the Khorana score. The area under the curve for the Khorana score and D-dimer was 0.714, which was significantly higher than the 0.611 for the Khorana score alone, with the difference being significantly higher at 0.103 (P = 0.004, 95% CI: 0.033–0.173). Conclusions: The optimal D-dimer cutoff value for the diagnosis of DVT in patients with malignancy was 4.0 μg/mL. It was also suggested that the combination of the Khorana score with the D-dimer level was more accurate in diagnosing DVT than the Khorana score alone.

    DOI: 10.1016/j.avsg.2023.06.033

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  3. Two-step arterial reconstruction technique for en bloc resection of a large retroperitoneal liposarcoma involving the common iliac artery

    Sunagawa M., Yokoyama Y., Banno H., Sugimoto M., Mizuno T., Yamaguchi J., Onoe S., Watanabe N., Kawakatsu S., Ebata T.

    Surgery Today   Vol. 53 ( 11 ) page: 1320 - 1324   2023.11

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    Retroperitoneal liposarcoma (RPLS) is a rare but challenging neoplasm, which is frequently associated with iliac vessel invasion. We describe how we used a two-step arterial reconstruction technique to perform en bloc resection of a large RPLS involving the iliac arteries in three patients. A temporal long in situ graft bypass was established using a prosthetic vascular graft during dissection of the tumor. This bypass provided an unobscured surgical field, while maintaining blood flow in the lower limb during the operation. After removal of the tumor and washing out the abdominal cavity, the new prosthetic vascular graft of a suitable length was placed. No graft-related complications, including vascular graft infection or graft occlusion, occurred during the follow-up period. This novel technique appears to provide a safe and effective way to remove large RPLSs involving the retroperitoneal major vessels.

    DOI: 10.1007/s00595-023-02684-y

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  4. Factors Associated With Spontaneous Sac Shrinkage in Patients With Persistent Type 2 Endoleaks After EVAR

    Sugimoto M., Banno H., Sato T., Ikeda S., Tsuruoka T., Kawai Y., Niimi K., Kodama A., Komori K.

    Journal of Endovascular Therapy   Vol. 30 ( 4 ) page: 525 - 533   2023.8

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    Purpose: Despite controversy surrounding the management of type 2 endoleaks (T2ELs) after endovascular aortic aneurysm repair (EVAR), the current European guidelines recommend reintervention for T2ELs when the aneurysm expands by ≥10 mm. Meanwhile, sac shrinkage ≥10 mm can be considered low risk for failure even with T2ELs, and the guidelines suggest less frequent follow-up delayed until 5 years after EVAR. This study reviewed patients with persistent T2ELs to identify predictors of spontaneous sac shrinkage (SpS) within 5 years. Methods: A retrospective review of elective EVAR for infrarenal aortic aneurysms between June 2007 and December 2017. Patients with >1 year follow-up and persistent T2ELs, defined as T2ELs confirmed at both the 6 and 12 month follow-up with contrast-enhanced computed tomography (CT), were included. Any reintervention or type 1 or 3 endoleaks within 12 months were excluded. SpS was defined as a ≥10 mm reduction in diameter without any reintervention. Aneurysm enlargement (AnE) was defined as a ≥5 mm increase in diameter. Factors associated with SpS within 5 years were analyzed. The clinical outcomes were reviewed. Results: Among 726 patients, 162 patients had persistent isolated T2ELs. After excluding 21 patients, 141 patients were enrolled. During a median follow-up of 43 months (interquartile range [IQR], 26–60), 28 SpS and 39 AnE were observed, and 31 reinterventions were performed. The cumulative rates of SpS were 14.2%±2.9% and 25.6%±5.1% at 1 and 5 years. Cox regression analysis revealed that the presence of ≥6 patent lumbar arteries had a significant negative correlation with SpS (p=0.036). During further follow-up after SpS, 2 reinterventions for type 1a and 3b endoleaks were required at 49 and 45 months. Conclusions: Patients with fewer patent lumbar arteries were likely to experience SpS within 5 years, even in the presence of persistent T2ELs. Follow-up imaging studies were advisable earlier than 5 years, even after SpS.

    DOI: 10.1177/15266028221083457

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  5. Postendovascular Aneurysmal Repair Increase in Local Energy Loss for Fusiform Abdominal Aortic Aneurysm: Assessments With 4D flow MRI

    Horiguchi R., Takehara Y., Sugiyama M., Hyodo R., Komada T., Matsushima M., Naganawa S., Mizuno T., Sakurai Y., Sugimoto M., Banno H., Komori K., Itatani K.

    Journal of Magnetic Resonance Imaging   Vol. 57 ( 4 ) page: 1199 - 1211   2023.4

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    Background: Although endovascular aneurysmal repair (EVAR) is a preferred treatment for abdominal aortic aneurysm (AAA) owing to its low invasiveness, its impact on the local hemodynamics has not been fully assessed. Purpose: To elucidate how EVAR affects the local hemodynamics in terms of energy loss (EL). Study Type: Prospective single-arm study. Field Strength/Sequence: A 3.0 T/4D flow MRI using a phase-contrast three-dimensional cine-gradient-echo sequence. Population: A total of 13 consecutive patients (median [interquartile range] age: 77.0 [73.0, 78.8] years, 11 male) scheduled for EVAR as an initial treatment for fusiform AAA. Assessment: 4D flow MRI covering the abdominal aorta and bilateral common iliac arteries and the corresponding stent-graft (SG) lumen was performed before and after EVAR. Plasma brain natriuretic peptide (BNP) was measured within 1 week before and 1 month after EVAR. The hemodynamic data, including mean velocity and the local EL, were compared pre-/post-EVAR. EL was correlated with AAA neck angle and with BNP. Patients were subdivided into deformed (N = 5) and undeformed SG subgroups (N = 8) and pre-/post-EVAR BNP compared in each. Statistics: Parametric or nonparametric methods. Spearman's rank correlation coefficients (r). The interobserver/intraobserver variabilities with Bland–Altman plots. A P value < 0.05 is considered significant. Results: The mean velocity (cm/sec) at the AAA was five times greater after EVAR: 4.79 ± 0.32 vs. 0.91 ± 0.02. The total EL (mW) increased by 1.7 times after EVAR: 0.487 (0.420, 0.706) vs. 0.292 (0.192, 0.420). The total EL was proportional to the AAA neck angle pre-EVAR (r = 0.691) and post-EVAR (r = 0.718). BNP (pg/mL) was proportional to the total EL post-EVAR (r = 0.773). In the deformed SG group, EL (0.349 [0.261, 0.416]) increased 2.4-fold to 0.848 (0.597, 1.13), and the BNP 90.3 (53.6, 105) to 100 (67.2, 123) post-EVAR. Conclusion: The local EL showed a 1.7-fold increase after EVAR. The larger increase in the EL in the deformed SG group might be a potential concern for frail patients. Evidence Level: 1. Technical Efficacy: Stage 2.

    DOI: 10.1002/jmri.28359

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  6. One-year sac regression is associated with freedom from fatal adverse events after endovascular aneurysm repair

    Ikeda S., Sato T., Kawai Y., Tsuruoka T., Sugimoto M., Niimi K., Banno H.

    Journal of Vascular Surgery   Vol. 77 ( 1 ) page: 136 - 142.e2   2023.1

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    Objective: Although the predictors of long-term prognosis after endovascular aneurysm repair (EVAR) have been investigated, several reports have suggested that early sac shrinkage (ESS) is associated with superior long-term prognosis. However, it was not clear whether ESS was associated with aneurysm-related mortality. The aim of this study was to define fatal adverse events and to examine their association with ESS. Methods: All consecutive patients who underwent EVAR for an abdominal aortic aneurysm at Nagoya University Hospital between June 2007 and August 2018 were identified. We defined ESS as an aneurysm diameter decrease of 10 mm or more at 1 year after EVAR, and we defined fatal adverse events as aneurysm-related death, aneurysm sac rupture, open conversion, secondary type Ia endoleak, or secondary type IIIa/b endoleak. Then, we evaluated the association between ESS and fatal adverse events and identified predictors of ESS. Results: During the study period, 553 patients were identified and included. Fatal adverse events occurred in 42 patients (7.6%), and the details of the fatal adverse events were as follows: 13 aneurysm-related deaths, 17 aneurysm sac ruptures, 14 open conversions, 13 type Ia endoleaks, and 6 type III endoleaks. ESS occurred in 146 patients (26.4%). Kaplan-Meier curves showed that the ESS group had a significantly lower incidence of fatal adverse events (P <.001). Multivariate analysis showed that there were significant differences in terms of 5 or more preoperatively patent lumbar arteries (odds ratio [OR], 0.67; P =.049; 95% confidence interval [CI], 0.45-1.00), chronic kidney disease (OR, 0.49; P <.01; 95% CI, 0.29-0.84), and Zenith endograft use (OR, 1.76; P <.01; 95% CI, 1.16-2.67). Furthermore, the percentage of cases that achieved an aneurysm diameter of less than 40 mm was significantly higher in the ESS group (76.0% vs 15.5%; P <.01). The use of Zenith endografts showed a significantly higher rate of aneurysm disappearance than the use of Endurant endografts (P <.01) and Excluder endografts (P <.01). In addition, it was found that ESS was more likely to occur with the use of Zenith endografts, even when propensity score matching was performed for the neck morphology. Conclusions: ESS was associated with a lower rate of life-threatening adverse events after EVAR. The use of Zenith endografts was a predictor of ESS and was associated with increased rates of long-term sac shrinkage and aneurysm disappearance compared with the Endurant and Excluder endografts. Using the predictors of ESS identified in this study, we may be able to expand the indications for EVAR to patients with a longer life expectancy.

    DOI: 10.1016/j.jvs.2022.08.017

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  7. The Association Between the D-dimer Level at 1 Year After EVAR and Sac Diameter Change in Patients With Persistent Type 2 Endoleak

    Sugimoto M., Sato T., Ikeda S., Kawai Y., Niimi K., Banno H.

    Journal of Endovascular Therapy     page: 15266028231170165   2023

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    Purpose: Recent studies suggested that continuous clotting renewal in thrombi plays a central role in sac enlargement after endovascular aneurysm repair (EVAR). We reviewed patients with persistent type 2 endoleak (T2EL) to estimate the impact of D-dimer level on sac enlargement. Methods: A retrospective review of elective EVAR for infrarenal abdominal aortic aneurysm performed between June 2007 and February 2020. Persistent T2EL was defined as T2EL confirmed at both the 6 and 12 month contrast-enhanced computed tomography (CECT) follow-ups. “Isolated” T2EL was defined as T2EL without other types of endoleak within 12 months. Patients with >2 year follow-up, persistent isolated T2ELs, and D-dimer level data at 1 year (DD1Y) were included. Patients with any reintervention within 12 months were excluded. The association between DD1Y and aneurysm enlargement (AnE), defined as a ≥5 mm diameter increase, within 5 years was analyzed. Among 761 conventional EVAR, 515 patients had >2 years of follow-up. Thirty-three patients with any reintervention within 12 months and 127 patients without CECT at either 6 or 12 months were excluded. Among 131 patients with persistent isolated T2ELs, 74 patients with DD1Y data were enrolled. During a 37 month median follow-up [25–60, IQR], 24 AnEs were observed. In the AnE patients, the median DD1Y was significantly higher than that in the other patients (12.30 [6.88–21.90] vs 7.62 [4.41–13.00], P=0.024). ROC curve analysis indicated that the optimal cutoff point of DD1Y for AnE was 5.5 µg/mL (AUC=0.681). In univariate analysis, angulated neck, occlusion of the inferior mesenteric artery, and DD1Y≥5.5 µg/mL were significantly associated with AnE (P= 0.037, 0.038, and 0.010). Cox regression analysis revealed that DD1Y≥5.5 µg/mL was correlated with AnE (P=0.042, HR [95% CI] 4.520 [1.056–19.349]). Conclusion: A 1 year higher D-dimer level can potentially predict AnE within 5 years in persistent T2EL patients. AnE was considered improbable when the D-dimer level was low enough. Clinical Impact: The present study suggests that a 1-year higher D-dimer level could potentially predict aneurysm expansion within 5 years in patients with persistent type 2 endoleak (T2EL). On the other hand, aneurysm expansion was considered unlikely if the D-dimer level was low enough. As there are many patients with T2EL who require regular follow-up, any predictor of future aneurysm expansion could be of great help in conserving medical resources. In patients with a low likelihood of future expansion, we might consider delaying follow-up, similar to patients with sac shrinkage.

    DOI: 10.1177/15266028231170165

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  8. Epicardial adipose tissue volume is associated with abdominal aortic aneurysm expansion

    Kawai Y., Banno H., Sato T., Ikeda S., Tsuruoka T., Sugimoto M., Niimi K., Kodama A., Matsui K., Matsui S., Komori K.

    Journal of Vascular Surgery   Vol. 76 ( 5 ) page: 1253 - 1260   2022.11

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    Background: The epicardial adipose tissue volume (EATV) is associated with cardiovascular diseases such as coronary artery disease. However, no information is available regarding the relationship between the EATV and abdominal aortic aneurysm (AAA) expansion. In the present study, we evaluated the association between the EATV and AAA growth and sought to identify the predictors of AAA expansion. Methods: Between June 2009 and December 2019, 906 patients had undergone endovascular or open repair of AAAs at our institution. Patients with previous cardiac surgery, previous ascending thoracic aortic surgery, a ruptured AAA, an infected AAA, an inflammatory AAA, a saccular aneurysm, a solitary iliac aneurysm, or reintervention after treatment of the AAA were excluded. A total of 237 patients with at least two preoperative computed tomography (CT) scans performed >180 days apart were included in the present study. The EATV within the pericardium was retrospectively quantified from the preoperative non–contrast-enhanced CT images using a three-dimensional workstation. The EATV index was defined as the EATV divided by the body surface area. The AAA expansion rate was defined as an increase in the AAA diameter annually, and the patients were divided into the slow-expansion group (expansion rate, <5 mm/y) and the fast-expansion group (expansion rate, ≥5 mm/y). The correlation between the expansion rate and the EATV index was analyzed, and the cutoff value for the EATV index was determined using a receiver operating characteristics curve. Multivariate analysis was used to assess the predictors of the AAA expansion rate. Results: The expansion rate of AAA correlated positively with the EATV index (R = 0.237; P < .001). The initial aneurysm diameter (P < .001) and EATV index (P = .009) differed significantly between the two groups. The cutoff for the EATV index was 60.3 cm3/m2 (area under the curve, 0.658; 95% confidence interval [CI], 0.568–0.749; sensitivity, 1.000; specificity, 0.309). Multivariate analysis revealed that the initial aneurysm diameter and an EATV index of >60.3 cm3/m2 were significantly associated with the AAA expansion rate. Conclusions: The results of the present study have demonstrated that the EATV index is associated with AAA expansion.

    DOI: 10.1016/j.jvs.2022.04.032

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  9. Impact of Serum Zinc Level and Oral Zinc Supplementation on Clinical Outcomes in Patients Undergoing Infrainguinal Bypass for Chronic Limb-Threatening Ischemia

    Kodama A., Komori K., Koyama A., Sato T., Ikeda S., Tsuruoka T., Kawai Y., Niimi K., Sugimoto M., Banno H., Nishida K.

    Circulation Journal   Vol. 86 ( 6 ) page: 995 - 1006   2022.6

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    Background: Zinc (Zn) has been reported to play an important role in wound healing (WH). Nevertheless, the effect of Zn in chronic limb-threatening ischemia (CLTI) patients is unclear. This study investigated the effect of Zn on the clinical outcomes of CLTI patients undergoing bypass surgery. Methods and Results: This study reviewed 111 consecutive patients who underwent an infrainguinal bypass from 2012 to 2020. Patients with Zn deficiency (serum Zn level <60 μg/dL) received oral Zn supplementation and maintained a normal level until WH. This study aimed to explore: (1) the effect of Zn deficiency; and (2) Zn supplementation in Zn-deficient patients on the clinical outcomes of this cohort. Patients with Zn deficiency, Zn supplementation, and no Zn supplementation despite Zn deficiency accounted for 48, 21, and 42 patients, respectively. (1) Zn deficiency was associated with WH (HR, 0.47; 95% CI, 0.29-0.78: P=0.003), major adverse limb events (MALE) (HR, 2.53; 95% CI, 1.26-5.09: P=0.009), and major amputation or death (HR, 3.17; 95% CI, 1.51-6.63: P=0.002). (2) Zn supplementation was positively related to WH (HR, 2.30; 95% CI, 1.21-4.34: P=0.011). This result was confirmed using propensity score matching (HR, 2.24; 95% CI, 1.02-4.87: P=0.043). Conclusions: The current study revealed that Zn level was associated with clinical outcomes in CLTI patients after bypass surgery. Oral Zn supplementation could improve WH in these patients.

    DOI: 10.1253/circj.CJ-21-0832

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  10. New Morphological Factor for Predicting Late Proximal Type I Endoleak after Endovascular Aneurysm Repair

    Banno H., Sugimoto M., Sato T., Ikeda S., Kawai Y., Tsuruoka T., Kodama A., Komori K.

    Annals of Vascular Surgery   Vol. 81   page: 154 - 162   2022.4

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    Background: Although we have witnessed several cases of late proximal type I endoleak (T1AEL) after endovascular aneurysm repair (EVAR), most patients did not have “hostile neck” preoperatively. We hypothesized that the distance between the lowest renal artery and the neck angulation point and neck length are the 2 most important factors for maintaining long-term proximal sealing. This study evaluated “neck hostility,” which is the product of the distance to the angulation point and the neck length, as a preoperative morphological risk factor for the development of late T1AEL after EVAR. Methods: A retrospective review of a prospectively assembled database was performed for all patients who had undergone EVAR at a single institution from June 2007 to May 2017. Patient demographics and preoperative imaging data were collected, and Cox regression analysis was performed to identify the risk factors for late T1AEL. Results: Of the 655 patients who underwent EVAR during the study period, 115 were excluded due to complex EVAR (n = 14), primary indications for iliac aneurysms (n = 86), primary T1AEL (n = 3), or other reasons (n = 15). Of the remaining 537 patients, twelve patients (2.2%) developed late T1AEL a median of 3.2 (interquartile range [IQR]; 3.0, 5.4) years after EVAR. Receiver operating characteristic (ROC) curve analysis revealed a neck hostility cutoff value of 8. Cox regression analysis revealed that a neck hostility value ≤8 and conical neck anatomy were risk factors for the development of late T1AEL after EVAR. Well-known hostile neck factors such as short neck, severe angulated neck, and severe calcification/thrombus in the proximal neck were not significantly different. Conclusions: The present study demonstrated a correlation between late T1AEL and the product of the angulation distance and the neck length. This factor may be useful for predicting poor late proximal outcomes after EVAR.

    DOI: 10.1016/j.avsg.2021.09.049

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  11. Predictors of infrapopliteal vein bypass graft revision in patients with chronic limb-threatening ischemia

    Kawai Y., Kodama A., Sato T., Ikeda S., Tsuruoka T., Sugimoto M., Niimi K., Banno H., Komori K.

    Vascular     page: 17085381221124706   2022

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    Purpose: Surgical revascularization is the standard treatment for chronic limb-threatening ischemia (CLTI). However, some patients may require reintervention. The Global Anatomic Staging System (GLASS), which evaluates the complexity of infrainguinal lesions, was proposed. This study aimed to identify predictors for graft revision and evaluate whether GLASS impacts vein graft revision. Methods: Between 2011 and 2018, CLTI patients who underwent de novo infrapopliteal bypass using autogenous veins were retrospectively analyzed. To assess anatomic complexity with GLASS, femoropopliteal, infrapopliteal, and inframalleolar/pedal (IM) disease grades were determined. The outcomes of patients with or without graft revision were compared. Cox regression analysis was performed. Results: Thirty-six of the 80 patients underwent reintervention for graft revision. Compared to the non–graft revision group, the graft revision group exhibited significantly higher rates of GLASS stage III (66% vs 81%, p = 0.046) and grade P2 IM disease (25% vs 58%, p = 0.009). Multivariate analysis revealed that IM grade P2 (hazard ratio [HR], 3.35; 95% confidence interval [CI], 1.66–6.75; p = 0.001) and spliced vein grafts (HR, 3.18; 95% CI, 1.43–7.06; p = 0.005) were significantly associated with graft revision. Conclusions: This study demonstrated that IM grade P2 and spliced vein grafts were predictors of graft revision. The GLASS stratification of IM disease grade may be useful in optimizing treatment for CLTI.

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  12. Severe Tortuosity of the Distal Descending Thoracic Aorta Affects the Accuracy of Distal Deployment During a Thoracic Endovascular Aortic Repair

    Sato T., Banno H., Ikeda S., Kawai Y., Tsuruoka T., Sugimoto M., Niimi K., Kodama A., Komori K.

    Journal of Endovascular Therapy     page: 15266028221141023   2022

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    Purpose: An accurate distal deployment is essential for successful thoracic endovascular aortic repair (TEVAR) of a paradiaphragmatic aortic aneurysm. This study aimed to investigate the anatomical and intraoperative factors that affect the accuracy of distal deployment during TEVAR. Methods: We conducted a retrospective review of preoperative and postoperative computed tomography scans of 426 patients undergoing TEVAR at our institution between October 2008 and May 2021, of which the stent-graft was attempted to be deployed just above the celiac axis or the superior mesenteric artery in 56 patients. Based on the anatomical factors related to the malposition (deployed >10 mm away from the target vessel) and the greater curve to the straight-line ratio (G/S ratio), the patients were categorized as severe tortuosity (n=21) and mild tortuosity (n=35) groups to compare the operative and clinical outcomes. Result: Stent-graft malpositioning occurred in 21 cases. Among all anatomical variables, only the G/S ratio was significantly larger in the malpositioned cases (p=0.049). A cutoff G/S ratio value of 1.15 was determined using the receiver operating curve analysis. In the severe tortuosity group, the distal end of the stent-graft was significantly farther (median: 10.0 [interquartile range (IQR): 2.5–19.5] mm vs 3.0 [0–8.0] mm; p=0.015) from the target vessel, and the tilt angle of the stent-graft’s distal edge was larger (median: 21.4 [IQR: 15.8–24.5] vs 9.5 [5.5–12.5] degree; p<0.01) than that in the mild tortuosity group. Both groups were comparable for the incidence of a primary type Ib endoleak (p=0.454), a secondary type Ib endoleak (p=1.0), and the rate of distal reintervention (p=0.276). Conclusion: Severe tortuosity in the distal descending thoracic aorta is associated with a malpositioned and tilted distal end of the stent-graft. Clinical Impact: Thoracic endovascular aortic repair (TEVAR) for paradiaphragmatic thoracic aortic aneurysms requires accurate distal landing. In this paper, a retrospective CT analysis revealed that the greater curve to the straight-line ratio (G/S ratio) was associated to affects the malposition of the stent graft, defined as being deployed more than 10 mm away from the target vessel. Further, a comparative analysis based on the G/S ratio demonstrated that severe aortic tortuosity was associated with a more distal and tilted deployment of the stent graft.

    DOI: 10.1177/15266028221141023

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  13. Clinical Comparison between Early and Late Spontaneous Sac Shrinkage after Endovascular Aortic Aneurysm Repair

    Sugimoto M., Banno H., Sato T., Ikeda S., Tsuruoka T., Kawai Y., Niimi K., Kodama A., Komori K.

    Annals of Vascular Surgery   Vol. 75   page: 420 - 429   2021.8

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    Background: Early spontaneous shrinkage (ESS) of abdominal aortic aneurysm (AAA) within 1 year after endovascular aortic aneurysm repair (EVAR) could be a predictor of durable success. However, late spontaneous shrinkage (LSS) during longer follow-up has not been well addressed. We compared late complications of ESS and LSS. Methods: Our series of elective EVAR for infrarenal AAA from June 2007 to December 2017 was reviewed. Patients with ≥1 year of follow-up with computed tomography (CT) studies were included. Patients with any reintervention within 1 year were excluded. Spontaneous shrinkage (SpS) was defined as a diameter reduction ≥10 mm without any reintervention. ESS was defined as SpS within 1 year, and LSS was defined as SpS occurring after 1 year of follow-up. Aneurysms that became larger than the original size after SpS were defined as re-expansion. Late complications (re-expansion, reintervention, and aneurysm-related death) and related factors were compared between ESS and LSS. Results: A total of 495 patients were enrolled. Median follow-up was 43 months [24–67, interquartile range (IQR)]. Among patients, 126 ESS and 55 LSS occurred. The cumulative rates of SpS were 25.7±2.0%, 37.4±2.4%, and 47.3±3.7% at 1, 3, and 7 years, respectively. There was 1 re-expansion and 6 reinterventions during further follow-up after SpS. The rates of freedom from late complications at 5 years were not significantly different between ESS (89.2±4.0%) and LSS (95.8±4.1%) (P = 0.465). Regression analysis revealed that the Zenith device was significantly related to ESS compared to the Excluder (P = 0.006) and Endurant (P = 0.040). More than 6 preoperative patent lumbar arteries negatively correlated with ESS (P = 0.023). However, these factors had no significant impact on LSS. Conclusions: The rates of late complications after SpS were comparable between ESS and LSS. Patients with delayed sac shrinkage with a reduction in diameter ≥10 mm should expect the same durable success as patients with quick shrinkage.

    DOI: 10.1016/j.avsg.2021.02.014

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  14. Time-to-Event Analysis of the Impact of Endovascular Aortic Aneurysm Repair on Chronic Renal Decline

    Sugimoto M., Banno H., Sato T., Ikeda S., Tsuruoka T., Kawai Y., Niimi K., Kodama A., Komori K.

    Annals of Vascular Surgery   Vol. 74   page: 165 - 175   2021.7

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    BACKGROUND: Although randomized studies have revealed the long-term outcomes of the endovascular repair (ER) of abdominal aortic aneurysm (AAA) compared to open repair (OR), there is controversy surrounding chronic renal decline (CRD) after ER. This study reviewed our propensity-matched cohorts of ER and OR to compare CRD rates using a time-to-event analysis. The ER groups undergoing suprarenal (SR) or infrarenal (IR) proximal fixation were also compared with the OR group. METHODS: This retrospective review of infrarenal AAA repair was conducted from June 2007-December 2017. Patients with ≥1 year of follow-up were included. Cases of supra/pararenal AAAs, infectious AAAs, rupture, or severe chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m2 or dependence on renal replacement therapy) were excluded. CRD was defined as eGFR decline of >20% or de novo hemodialysis during follow-up. Patients treated with ER (ER group) and OR (OR group) were propensity-score matched for age, sex, comorbidities, ejection fraction, respiratory function, and baseline eGFR. Kaplan-Meier analysis compared the freedom from CRD rates of the matched cohorts (mER and mOR groups). Patients treated with SR and IR fixation devices (SR and IR groups) were also separately matched to the OR group, followed by analysis. RESULTS: In total, 1087 patients underwent elective AAA repair. Among them, 944 (512 ER and 432 OR) were enrolled. The ER group was older than the OR group (median age 79 vs 71; P<0.001). The ER group had significantly lower baseline eGFR and more comorbidities than the OR group. Among 187 propensity-score matched pairs (187 mER and 187 mOS patients), background characteristics, including age and baseline eGFR, were comparable, but median renal function follow-up was significantly longer in the mER group than in the mOR group (48 vs 26 months; P<0.001). CRD was observed in 57 patients in the mER group and 30 patients in the mOR group. Kaplan-Meier analysis of the freedom from CRD showed no significant difference between the matched groups (P=0.268); however, in the later follow-up of >4 years, CRD was more common in the mER group. The matched analyses between the OR group and specific fixation groups, comprising 102 OR-SR and 73 OR-IR pairs, demonstrated no significant differences in CRD. CONCLUSIONS: Compared to OR, there was no significant impact of ER on CRD at up to 4 years, supporting the safety of ER in terms of the mid-term renal outcome of our present clinical practice.

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  15. Midterm Outcomes of Zone 0 Antegrade Endograft Implantation During Type I Hybrid Aortic Arch Repair

    Banno H., Mutsuga M., Sugimoto M., Tokuda Y., Kodama A., Usui A., Komori K.

    European Journal of Vascular and Endovascular Surgery   Vol. 61 ( 6 ) page: 938 - 944   2021.6

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    Objective: Type I hybrid arch repair has become popular as a procedure that is less invasive than total arch replacement. The major advantage of this technique is that antegrade endograft implantation can be performed during the procedure, thereby avoiding the complications of introducing the endograft from the groin. The aim of this study was to assess the midterm outcomes of type I hybrid aortic arch repair with antegrade endograft implantation. Methods: Thirty consecutive patients who underwent type I hybrid repair with antegrade endograft implantation from 2009 to 2015 were reviewed retrospectively. Patient demographics, and peri-operative and late results were collected from a prospective database and analysed. Results: Four patients (13%) were female and the median age was 78 years. Median aneurysm size was 64 mm. Six patients (20%) developed stroke, and the 30 day mortality rate was 3%. Two patients suffered aortic dissection at the site of debranching anastomosis. The median follow up was 5.2 years. All aneurysms remained stable or had decreased in size at three years, and 82% were stable at five years. Overall survival was 79% at three years and 71% at five years. The rates of freedom from aorta related death were 86% at three and five years, respectively. During the follow up period, three additional left subclavian artery embolisations and one endograft relining due to type IIIb endoleak were required. Conclusion: Midterm outcomes of type I hybrid aortic arch repair with antegrade endograft implantation for aortic arch aneurysms are reported. Although the incidence of peri-operative stroke was high, late sac behaviour was acceptable.

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  16. Low-density vulnerable thrombus/plaque volume on preoperative computed tomography predicts for spinal cord ischemia after endovascular repair for thoracic aortic aneurysm

    Banno H., Kawai Y., Sato T., Tsuruoka T., Sugimoto M., Kodama A., Komori K.

    Journal of Vascular Surgery   Vol. 73 ( 5 ) page: 1557 - 1565.e1   2021.5

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    Background: Similar to open surgical repair, thoracic endovascular aortic repair (TEVAR) carries a risk of spinal cord ischemia (SCI). However, the generally lower incidence of SCI after TEVAR compared with that after open surgical repair, despite the inability to preserve the intercostal arteries, indicates different pathophysiologic mechanisms with the two procedures. We hypothesized that a microembolism from an aortic mural thrombus is the main cause of SCI. Thus, we evaluated the association between the density of a mural thrombus in the descending thoracic aorta and the development of SCI. Methods: A retrospective review of a prospectively assembled database was performed for all patients who had undergone surgery at a single institution from October 2008 to December 2018. Patient demographics and procedure-related variables were collected. The volume and Hounsfield unit (HU) value of mural thrombi in the whole descending thoracic aorta were estimated on preoperative computed tomography using a three-dimensional workstation. Logistic regression analysis was performed to identify the risk factors for SCI development. Results: Of the 367 patients who had undergone TEVAR during the study period, 155 were excluded because of previous arch surgery (n = 59), previous descending thoracic aortic surgery (n = 6), previous TEVAR (n = 6), unavailability of optimal preoperative computed tomography data (n = 17), double-barreled dissection (n = 40), and other reasons. The mean ± standard deviation age of the remaining 212 patients was 75.8 ± 6.4 years, and 42 (19.8%) were women. Of the 212 patients, 14 (6.6%) developed SCI after TEVAR. The low mean density of the mural thrombus, total thrombus volume, low-density (≥−100 HU but <30 HU) thrombus volume, intermediate-density (≥30 HU but <150 HU) thrombus volume, treatment length, urgent surgery, and baseline dialysis differed significantly between patients with and without SCI. Although subsequent multivariate analysis could not be performed owing to the small number of SCI events, vulnerable low-density thrombus/plaque was a stronger predictor among the aneurysm-related factors of SCI after TEVAR on univariate analysis. Well-known risk factors, such as distal coverage between T8 and L1, left subclavian artery coverage, previous abdominal aortic surgery, and prophylactic spinal drainage, did not show significant differences. Conclusions: The results from the present study have demonstrated that among aneurysm-related factors, a lower density mural thrombus/plaque in the descending thoracic aorta is a predictor of SCI development after TEVAR. These results suggest that microembolism is one of the important mechanisms of SCI after TEVAR, which might change the prophylactic strategy.

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  17. Long-Term Effectiveness of a Drug-Eluting Stent for Femoropopliteal In-Stent Restenosis: Subanalysis of the Zilver PTX Japan Post-Market Surveillance Study

    Sugimoto M., Komori K., Yokoi H., Ohki T., Kichikawa K., Nakamura M., Nanto S., O’Leary E.E., Lottes A.E., Saunders A.T., Dake M.D.

    Journal of Endovascular Therapy   Vol. 28 ( 2 ) page: 229 - 235   2021.4

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    Purpose: To present a subgroup analysis of patients from a large real-world study evaluating the safety and effectiveness of the Zilver PTX drug-eluting stent (DES) for treating femoropopliteal in-stent restenosis (ISR). Materials and Methods: This study examined patients enrolled in the Zilver PTX Japan Post-Market Surveillance Study (ClinicalTrials.gov identifier NCT02254837), a prospective, multicenter registry of 904 symptomatic patients with 1082 femoropopliteal lesions treated with the DES at 95 institutions in Japan. Five-year outcomes, including mortality, stent radiography, freedom from target lesion revascularization (TLR), and clinical benefit, were evaluated for 177 patients (mean age 74.2±8.3 years; 118 men) with 204 ISR lesions treated with the Zilver DES. Over half of the patients (108, 61.0%) were diabetic. Mean lesion length was 17.8±10.4 cm, and a third (72, 35.3%) were total occlusions. Outcome measures were all-cause mortality, thrombosis, freedom from TLR, and clinical benefit, defined as freedom from persistent or deteriorating ischemic symptoms. Results: No device-related or procedure-related deaths or paclitaxel-related adverse events were reported. All-cause mortality was 25.1% at 5 years. Stent fracture was observed in 5 stents through 5 years. The 5-year rate of freedom from clinically-driven TLR was 73.4%, and the rate of clinical benefit was 63.6%. Improvement in Rutherford category and ankle-brachial index was sustained through 5 years. Conclusion: The safety and effectiveness of the Zilver PTX stent for the treatment of femoropopliteal ISR lesions demonstrated that this device provides a favorable treatment option in this difficult-to-treat subgroup.

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  18. The association between perioperative embolization of hypogastric arteries and type II endoleaks after endovascular aortic aneurysm repair

    Meshii K., Sugimoto M., Niimi K., Kodama A., Banno H., Komori K.

    Journal of Vascular Surgery   Vol. 73 ( 1 ) page: 99 - 107   2021.1

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    Objective: Type II endoleaks (T2ELs) are the most common type of endoleak after endovascular aneurysm repair (EVAR). The iliolumbar artery arising from the hypogastric artery is often a major source of T2ELs, and transarterial embolization of the iliolumbar artery through the hypogastric artery is sometimes performed to interrupt sac expansion during follow-up. Considering the equivocal results of an association between hypogastric embolization and T2ELs in previous studies, this topic has re-emerged after the advent of iliac branch devices. This study reviewed our series to clarify whether hypogastric embolization is associated with T2ELs at 12 months after EVAR. Methods: Patients who underwent elective EVAR between June 2007 and May 2017 at our institution were retrospectively reviewed. Patients with postoperative computed tomography angiography (CTA) at 12 months were included. Patients in whom CTA revealed type I or type III endoleaks during follow-up, who required reinterventions before 12 months, and who had solitary iliac aneurysms were excluded. The primary outcome was the incidence of T2ELs at 12 months after EVAR. The associations of patients' characteristics, anatomic factors, hypogastric embolization, and type of endograft with the primary outcome were analyzed. Results: In total, 375 patients were enrolled. During the median follow-up of 59.5 months (interquartile range, 19-126 months), 40 patients died, and 50 reinterventions were performed. In 108 patients (28.8%), either hypogastric artery was embolized to extend distal landings to the external iliac artery. Bilateral and unilateral embolization was performed in nine and 99 patients, respectively. In total, 153 patients (40.8%) had T2ELs found by CTA at 12 months. In the univariate analysis, the status of hypogastric artery occlusion or embolization was not significantly different between patients with and without T2ELs. However, there were not enough patients to detect a 10% difference in T2ELs with >80% statistical power. In the multivariate analysis, significant associations with T2EL were observed for female sex (P =.049), patent inferior mesenteric artery (P =.006), and presence of five or more patent lumbar arteries (P <.001) but not for hypogastric embolization. In addition, compared with the Zenith (Cook Medical, Bloomington, Ind) endograft, the Excluder (W. L. Gore & Associates, Flagstaff, Ariz) endograft was significantly related to T2EL (P =.001). Conclusions: No significant association between hypogastric embolization and T2EL was demonstrated in this retrospective study, which lacked adequate statistical power.

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  19. Endovascular aneurysm repair compared with open repair does not improve survival in octogenarians

    Banno H., Sugimoto M., Sato T., Ikeda S., Kawai Y., Tsuruoka T., Kodama A., Komori K.

    Circulation Journal   Vol. 85 ( 12 ) page: 2166 - 2171   2021

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    Background: Not every elderly person is frail, and whether it would be beneficial to perform endovascular aneurysm repair (EVAR) solely because a patient is older is unclear. This study aimed to compare the results of EVAR and open surgical repair (OSR) in elderly individuals. Methods and Results: From May 1998 to March 2021, 828 EVAR patients and 886 OSR patients with abdominal aortic aneurysm (AAA) were reviewed. Patients aged ≥80 years were included among them. After propensity score matching by age, sex, and American Society of Anesthesiologists (ASA) classification, the outcomes were compared between patients who underwent EVAR and OSR. The study cohort was composed of 351 EVAR patients and 90 OSR patients. The groups had similar comorbidities, except that EVAR patients were significantly older and had higher ASA classifications. After propensity score matching, 79 pairs of patients were selected. The 30-day mortality (0 vs. 1.2%) and aneurysm-related death (ARD) rates during follow up (2.3% vs. 2.3%, respectively) were similar between the groups. Kaplan-Meier curves revealed that estimated overall survival and freedom from ARD were also similar. Conclusions: This study suggests that EVAR cannot improve survival outcomes compared with OSR if applied solely because a patient is aged ≥80 years. Not only age but also other risk factors and quality of life after surgery need to be further studied.

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  20. Early and midterm outcomes of celiac artery coverage during thoracic endovascular aortic repair

    Banno H., Ikeda S., Kawai Y., Meshii K., Takahashi N., Sugimoto M., Kodama A., Komori K.

    Journal of Vascular Surgery   Vol. 72 ( 5 ) page: 1552 - 1557   2020.11

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    Background: In thoracic endovascular aortic repair (TEVAR), covering the celiac artery (CA) is sometimes necessary to secure the distal seal. We report the outcomes of planned CA coverage in our experience with TEVAR. Methods: Cases requiring CA coverage during TEVAR from October 2008 to September 2018 were retrospectively reviewed. Patient demographics, indications for CA coverage, communication between the CA and the superior mesenteric artery (SMA), concomitant CA embolization, and perioperative and late results were collected in a prospective database and analyzed. Results: During the study decade, 357 patients underwent TEVAR at our institution. Of these patients, 15 (4.2%) required CA coverage. All 15 patients were male, and the mean age was 72.8 years (range, 44-80 years). The mean aneurysm size was 67.5 mm (range, 50-82 mm). The etiologies included 10 degenerative aneurysms (66.7%; 2 ruptures [13.3%], 4 dissecting aneurysms [26.7%], and 1 case of type IB endoleak [6.7%]) after TEVAR. Communicating collaterals between the CA and the SMA were confirmed by preoperative computed tomography angiography in eight patients (53.3%) and by intraoperative angiography in four patients (26.7%). Seven patients (46.7%) underwent concomitant embolization of the CA. CA coverage offered a mean extension of 20.3 mm (range, 12-22 mm) in the length of the distal seal. Postoperative computed tomography angiography revealed a type IB endoleak that resolved spontaneously in one patient (6.7%). Postoperative complications included splenic infarction/pancreatitis in one patient (6.7%) and spinal cord ischemia in two patients (13.3%). There were no cases of postoperative in-hospital mortality. During the follow-up period (mean, 3.6 years; range, 0.9-8.0 years), two patients developed a new type IB endoleak. One patient underwent distal extension of the stent graft with ilio-SMA bypass, and one patient was observed conservatively in accordance with the patient's decision. There were no cases of type II endoleak via the CA. Most aneurysms (86.7%) were stable or reduced in size at the most recent follow-up. There were no cases of targeted aneurysm-related death during the follow-up period. Conclusions: Our study demonstrates the safety and efficacy of CA coverage in facilitating adequate distal sealing in selected patients undergoing TEVAR. Because the distal sealing length is not completely sufficient in most cases requiring CA coverage, the long-term efficacy of CA coverage during TEVAR should be determined in a large prospective study.

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  21. Endovenous Laser Ablation with and Without Concomitant Phlebectomy for the Treatment of Varicose Veins: A Retrospective Analysis of 954 Limbs

    Kawai Y., Sugimoto M., Aikawa K., Komori K.

    Annals of Vascular Surgery   Vol. 66   page: 344 - 350   2020.7

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    Background: Endovenous laser ablation (EVLA) with concomitant phlebectomy is commonly performed in many institutions. However, phlebectomy is associated with cosmetic complications such as surgical scarring, hemorrhage, and hematoma. This study aims to compare the need for additional sclerotherapy during follow-up after EVLA with and without concomitant phlebectomy. Methods: Between November 2013 and December 2018, we performed EVLA on 1,363 limbs in 1,009 patients with symptomatic primary varicose veins, of which 954 limbs in 771 patients with great saphenous vein (GSV) or small saphenous vein (SSV) insufficiency were included in this study. Data were collected prospectively and supplemented with retrospective medical record review. Demographic and clinical characteristic profiles were collected. The outcomes of EVLA with or without concomitant phlebectomy were compared. Logistic regression was used to assess predictors for additional sclerotherapy after EVLA. Results: CEAP classification (P < 0.001), operative time (P < 0.001), laser device type (P < 0.001), length of the treated vein (P < 0.001), linear endovenous energy density (P < 0.001), and tumescent local anesthesia volume (P < 0.001) differed significantly. Pain after EVLA was significantly more frequent in the nonphlebectomy group than in the phlebectomy group (P = 0.005). During follow-up, 34 of 954 limbs (3.6%) underwent additional sclerotherapy for residual visible varicose veins after EVLA. No statistical difference was found in the rate of additional sclerotherapy between the groups (P = 0.849). Logistic regression showed that female sex (odds ratio [OR], 6.18; 95% confidence interval [CI], 1.86–20.6; P = 0.003) is significantly associated with additional sclerotherapy, and concomitant phlebectomy is not a significant predictor of additional sclerotherapy (OR, 0.844; 95% CI, 0.375–1.90; P = 0.682). Conclusions: Patient preference for additional sclerotherapy was comparable between those who underwent EVLA with and without concomitant phlebectomy. This result supports our present strategy of avoiding simultaneous phlebectomy at the time of primary EVLA.

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  22. Influence of Preoperative Sarcopenia and Nutritional Status on Midterm and Long-term Mortality of Abdominal Aortic Aneurysm After Endovascular Aneurysm Repair

    Ikeda, S; Kodama, A; Komori, K; Banno, H; Sugimoto, M; Niimi, K; Kawai, Y; Tsuruoka, T

    JOURNAL OF VASCULAR SURGERY   Vol. 72 ( 1 ) page: E88 - E88   2020.7

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  23. Aneurysm Sac Thrombus Volume Predicts Aneurysm Expansion with Type II Endoleak After Endovascular Aneurysm Repair

    Fujii T., Banno H., Kodama A., Sugimoto M., Akita N., Tsuruoka T., Sakakibara M., Komori K.

    Annals of Vascular Surgery   Vol. 66   page: 85 - 94.e1   2020.7

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    Background: Several studies have analyzed risk factors that may influence the incidence of type II endoleak with sac expansion after endovascular aneurysm repair (EVAR). However, the impact of intraluminal thrombus volume on the incidence of sac expansion with type II endoleak requires further analysis. This study examined the correlation between preoperative intraluminal thrombus and the incidence of type II endoleak and late sac expansion by measuring the thrombus volume. Methods: Between June 2007 and March 2014, 423 patients underwent EVAR at our institution. Two hundred and eighty patients with preoperative and postoperative computed tomography angiography (CTA) were included in this study. Data were collected prospectively and supplemented with a retrospective review of the medical records and radiologic images, and demographic and clinical characteristic profiles were collected. Logistic regression and Cox regression analyses were used to assess each variable's association with the incidences of persistent or new endoleak and sac expansion. Results: Of the 280 patients, 46.7% (131 patients) had persistent type II endoleak, and 19.6% (55 patients) had persistent type II endoleak with significant sac expansion (≥5 mm). The mean follow-up duration was 60 months (interquartile range, 24–72 months). Cox regression analysis showed that older age (P = 0.001), intraluminal thrombus volume ratio (thrombus volume [T vol]/aortic aneurysm volume [A vol]) (P = 0.042) and IMA diameter (P = 0.004) were significant predictors of the incidence of sac expansion with persistent or new type II endoleak. The receiver operating characteristic curve analysis revealed a cutoff of 51% T vol/A vol (area under the curve [AUC]: 0.59) and 2.9 mm (area under the curve [AUC]: 0.60). The rate of freedom from sac expansion (≥5 mm) during followup was significantly higher in patients with ≥51% T vol/A vol than in those with a lower T vol/A vol (P = 0.010). Conclusions: Preoperative sac thrombus volume, IMA diameter, and older age predict the incidence of aneurysm expansion with type II endoleak after EVAR.

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  24. Zinc Deficiency and Clinical Outcome After Infrainguinal Bypass Grafting for Critical Limb Ischemia.

    Koyama A, Kodama A, Tsuruoka T, Fujii T, Sugimoto M, Banno H, Komori K

    Circulation reports   Vol. 2 ( 3 ) page: 167 - 173   2020.2

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  25. Suprarenal fixation is associated with worse midterm renal function after endovascular abdominal aortic aneurysm repair compared with infrarenal fixation

    Banno H., Ikeda S., Kawai Y., Fujii T., Akita N., Takahashi N., Sugimoto M., Kodama A., Komori K.

    Journal of Vascular Surgery   Vol. 71 ( 2 ) page: 450 - 456   2020.2

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    Background: Several reports have indicated that suprarenal (SR) fixation may impair renal function after endovascular abdominal aortic aneurysm repair (EVAR). However, most were short-term or at most, 1-year observational studies; therefore, the midterm effects on renal function remain unclear. This study aimed to identify predictors of midterm renal dysfunction after EVAR and compare renal outcomes in patients after EVAR with SR and infrarenal (IR) fixation. Methods: A total of 467 patients who underwent EVAR of nonruptured IR abdominal aortic aneurysm between 2007 and 2014 were reviewed in a prospectively collected database. Patients on hemodialysis at baseline were excluded. Among the remaining patients, those with 3-year laboratory testing were included in this study. Patients who developed acute kidney injury were excluded from the late renal function estimation. Predictors of 3-year renal function decline were estimated using logistic regression analysis. In addition, patients undergoing EVAR with IR (IR group) and SR fixation devices (SR group) were propensity matched by age, sex, baseline renal function, baseline aneurysm diameter, comorbidities, smoking habits, and regular use of medicines that may act on kidney function. Changes in renal function after surgery were compared between the IR group and the SR group. Results: During the study period, 237 patients (102 IRs and 135 SRs) were followed up with laboratory testing 3 years after surgery. Logistic regression analysis revealed that the use of a SR fixation device was independently predictive of a more than 20% decrease in the estimated glomerular filtration rate at 3 years after EVAR (odds ratio, 2.06; 95% confidence interval, 1.18-3.58; P =. 011). Eleven patients who developed acute kidney injury (1 IR and 10 SRs) were excluded from the subsequent analysis. After propensity score matching, 87 pairs were selected (mean age, 77.2 ± 6.3 years; 151 males [86.8%]). The mean follow-up duration was 5.5 ± 1.8 years. In the SR group, estimated glomerular filtration rate at 3 years after surgery decreased significantly more than that in the IR group (mean of 17.8% vs 11.6%, respectively; P =. 034). Conclusions: This study suggests that, compared with EVAR with IR endograft fixation, EVAR with SR endograft fixation is associated with worse outcomes for midterm renal function.

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  26. Associations of nutritional status and muscle size with mortality after open aortic aneurysm repair

    Kodama A., Takahashi N., Sugimoto M., Niimi K., Banno H., Komori K.

    Journal of Vascular Surgery   Vol. 70 ( 5 ) page: 1585 - 1593   2019.11

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    Objective: Open surgical repair (OSR) for abdominal aortic aneurysms is a more invasive approach than endovascular aneurysm repair but has more enduring results and may lead to a lower reintervention rate. Therefore, strict selection of patients should be based on assessments of both early and late outcomes. The controlling nutritional status (CONUT) score and skeletal muscle mass index (SMI) have been reported as indicators of nutritional status and muscle size, respectively. The aim of this study was to identify prognostic factors, including sarcopenia and nutritional status, for early and late outcomes. Methods: We reviewed data from 360 consecutive abdominal aortic aneurysm patients who underwent OSR from 2007 to 2014. We collected data on patients' characteristics, nutritional status (CONUT score), and muscle size (SMI). Cox proportional hazards analysis and logistic regression analysis identified independent predictors of midterm mortality and Clavien-Dindo class IV complications as late and early outcomes, respectively. Results: During the study period, 360 patients underwent elective OSR. The following characteristics were associated with midterm mortality: age >71 years (hazard ratio [HR], 4.92; 95% confidence interval [CI], 1.41-17.13; P =.01), low SMI (HR, 4.32; 95% CI, 1.16-16.13; P =.03), CONUT score indicating a moderate risk of malnutrition (vs normal status or mild risk: HR, 4.16; 95% CI, 1.03-16.76; P =.045), and estimated glomerular filtration rate <30 mL/min/1.73 m2 (HR, 3.54; 95% CI, 1.09-11.47; P =.035). Two patients died within 30 days of undergoing OSR (0.6%). A CONUT score indicating moderate risk (HR, 4.42; 95% CI, 1.01-19.28; P =.048), estimated glomerular filtration rate <30 mL/min/1.73 m2 (HR, 7.34; 95% CI, 2.20-24.51; P <.001), and diabetes mellitus (HR, 3.71; 95% CI, 1.25-11.00; P =.02) were independent predictors of Clavien-Dindo class IV complications. Conclusions: These results may be useful for identifying and optimizing treatment of high-risk patients who will not benefit from OSR so that endovascular aneurysm repair or no intervention can be recommended. Consideration of nutritional status and sarcopenia may therefore support the development of a more personalized, cost-effective treatment strategy.

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  27. Proximal Bare Stent May Reduce Bird-Beak Configuration, Which is Associated with Distal Migration of Stent Graft in the Aortic Arch

    Banno H., Akita N., Fujii T., Tsuruoka T., Takahashi N., Sugimoto M., Niimi K., Komori K.

    Annals of Vascular Surgery   Vol. 56   page: 108 - 113   2019.4

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    Background: Prior studies have shown that a bird-beak configuration causes serious complications after thoracic endovascular aortic repair (TEVAR). However, factors that cause bird-beak configurations are poorly understood. The purpose of this study was to assess the influences of anatomical and device-related factors on bird-beak configuration. Methods: Sixty-eight consecutive patients (47 men, mean age, 72.8 ± 9.8 years) who underwent TEVAR with proximal fixation in zones 1 to 3 from March 2009 to February 2017 were included. Preoperative and postoperative computed tomography (CT) scans were retrospectively reviewed. Relationships between the incidence of a bird-beak configuration, preoperative aortic arch morphology, and type of stent graft were estimated. The influence of a bird-beak configuration on endograft migration over time was also estimated for 47 patients who underwent CT 12 months after TEVAR. Results: The patients' aortic arch pathologies included 52 aneurysms, 11 aortic dissections, 4 pseudoaneurysms, and 1 patent ductus arteriosus. Stent grafts with (the proximal bare stent group [PBS group]) and without (the nonbare stent group [NBS group]) a proximal bare stent were implanted in 24 and 44 patients, respectively. A bird-beak configuration was detected in 30 patients (mean length ± standard deviation [SD], 6.2 ± 3.4 mm; mean angle ± SD, 31.7 ± 14.7°) and was significantly more frequent in the NBS group (n = 29) than in the PBS group (n = 1) (P < 0.001). Proximal landing zone, aortic lengths, and aortic arch morphology, including the radius, tortuosity, and angulation of aortic arch curvature, were not associated with the bird-beak configuration. The migration distance after 1 year was significantly longer in patients with a bird-beak configuration (3.5 ± 6.1 mm) than in patients without a bird-beak configuration (0.5 ± 1.0 mm) (P = 0.015). Conclusion: This study demonstrated that in aortic arch TEVAR, the use of stent graft with a proximal bare stent may reduce bird-beak configuration, which is associated with distal migration of the stent graft during follow-up.

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  28. Effect of intraoperative division of the left renal vein on the fate of renal function and left renal volume after open repair of para-and juxtarenal aortic aneurysm

    Sugimoto M., Takahashi N., Niimi K., Kodama A., Banno H., Komori K.

    Circulation Journal   Vol. 83 ( 9 ) page: 1844 - 1850   2019

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    Background: The effect of left renal vein division (LRVD) during open surgery (OS) for pararenal and juxtarenal abdominal aortic aneurysm (P/JRAA) on postoperative renal function remains controversial, so we focused on chronic renal decline (CRD) and separately examined renal volume as a surrogate index of split renal function. Methods and Results: The 115 patients with P/JRAA treated with OS from June 2007 to January 2017 were reviewed: 26 patients without LRVD were matched to 27 patients with LRVD according to preoperative chronic kidney disease (CKD) stage and proximal clamp sites. The effect of LRVD on CRD was investigated by a time-to-event analysis. During a median follow-up of 23.5 months, CRD occurred in 5 patients with LRVD and in 4 patients without LRVD. Comparison of freedom from CRD showed no significant difference between the matched groups (P=0.870). The separate renal volumes were evaluated before surgery and at 1 and 2 years of follow-up using CT images from 18 patients with LRVD. At 2 years, the mean renal volume had decreased by 15% in the left kidney and by 9% in the right kidney (P=0.052 and 0.148, respectively), but the left-to-right renal volume ratio showed no significant change (P=0.647). Conclusions: LRVD had no significant effect on CRD or left renal volume relative to the right renal volume for up to 2 years.

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  29. Three cases of dorsal metatarsal artery bypass in patients with Buerger disease

    Kodama A., Takahashi N., Sugimoto M., Niimi K., Banno H., Komori K.

    Journal of Vascular Surgery Cases and Innovative Techniques   Vol. 4 ( 3 ) page: 185 - 188   2018.9

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    Buerger disease is a rare peripheral vascular disease that most frequently affects young men and is strongly correlated with tobacco use. Although several options have been suggested, no consensus exists on the management of patients with Buerger disease except for smoking cessation. Revascularization is sometimes required to salvage ischemic limbs; however, it is often not feasible because of a lack of distal target vessels. Herein, we present the cases of three patients with tissue loss and gangrene due to Buerger disease. These patients underwent dorsal metatarsal artery bypass and avoided amputation.

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  30. Anatomical suitability of the Gore Excluder iliac branch endoprosthesis in Japanese patients with common iliac aneurysms treated by standard Excluder endografts.

    Sugimoto M, Takahashi N, Niimi K, Kodama A, Banno H, Komori K

    Annals of vascular surgery   Vol. 50   page: 179 - 185   2018.7

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    DOI: 10.1016/j.avsg.2017.11.071

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  31. Long-term fate of renal function after open surgery for juxtarenal and pararenal aortic aneurysm.

    Sugimoto M, Takahashi N, Niimi K, Kodama A, Banno H, Komori K

    Journal of vascular surgery   Vol. 67 ( 4 ) page: 1042 - 1050   2018.4

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    DOI: 10.1016/j.jvs.2017.07.121

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  32. Association between preoperative frailty and mortality in patients with critical limb ischemia following infrainguinal bypass surgery ― Usefulness of the Barthel index

    Kodama A., Koyama A., Sugimoto M., Niimi K., Banno H., Komori K.

    Circulation Journal   Vol. 82 ( 1 ) page: 267 - 274   2018

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    Background: Most patients with critical limb ischemia (CLI) exhibit severe comorbidities accompanied by frailty. This study assessed and risk-stratified mortality after infrainguinal bypass (IB) in CLI and investigated the effects of frailty. Methods and Results: The study retrospectively reviewed 107 consecutive CLI patients who had undergone de novo IB due to atherosclerotic disease. Data regarding patient age, comorbidities, laboratory data, and functional status were collected; functional status was evaluated using the Barthel index (BI) and nutritional status was evaluated using albumin concentrations and body mass index (BMI). Mean (±SD) BI and BMI were 75±16 and 22±4 kg/m 2 , respectively. BI (hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.94–0.99, P=0.004), BMI (HR 0.85; 95% CI 0.75–0.95, P=0.003), atrial fibrillation (AF; HR 5.31; 95% CI 2.12–13.30, P<0.001), and ejection fraction (EF; HR 0.94; 95% CI 0.91–0.98, P=0.003) were independent predictors of mortality. Patients were divided into 2 groups based on BI (BI >75, n=71; and BI <70, n=36). Survival after IB was significantly lower for the lower BI group (P<0.001, log-rank test). After propensity score matching, post-IB survival remained significantly lower in the lower BI group (P=0.02). Conclusions: BI, BMI, AF, and EF were independently associated with all-cause mortality after IB for CLI. BI and BMI may be useful in identifying and optimizing treatment for high-risk frail patients.

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  33. Impact of renal arterial morphology on fluoroscopy time in chimney endovascular aneurysm repair.

    Sugimoto M, Torsello G, Donas KP

    Vascular   Vol. 25 ( 5 ) page: 514 - 519   2017.10

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  34. Postmarket Clinical Experience with the INCRAFT AAA Stent Graft System for Challenging Access Routes.

    Sugimoto M, Torsello GF, Torsello GB, Austermann M, Stachmann A, Bisdas T

    Annals of vascular surgery   Vol. 40   page: 120 - 127   2017.4

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  35. The impact of inflow treatment for claudicants with both aortoiliac and femoropopliteal occlusive disease

    Maekawa T., Komori K., Kodama A., Banno H., Narita H., Sugimoto M.

    Surgery Today   Vol. 47 ( 3 ) page: 293 - 300   2017.3

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    Purpose: This study evaluated the early and long-term results of the sole use of endovascular treatment in the treatment of inflow lesions in claudicants with both aortoiliac and femoropopliteal (FP) lesions. Methods: A retrospective study that included 100 limbs in 73 patients was performed. The patency rates of aortoiliac artery stents, the continued clinical improvement rates, the risk factors for persistent disabling claudication after inflow revascularization, and the rates of freedom from additional FP procedures were examined. Result: After inflow revascularization, almost complete relief from intermittent claudication was seen in 79 % of the limbs, while 21 % of the limbs continued to suffer from disabling claudication. A multivariate analysis showed that a run-off score of ≥7 was an independent predictor for persistent disabling claudication after aortoiliac revascularization [hazard ratio (HR) 5.11, 95 % confidence interval (CI) 1.34–19.45; P = 0.02]. The primary patency rates at 1, 3, 5, and 6 years were 96, 96, 96 and 89 %, respectively. The secondary patency rate at 6 years was 100 %. The continued clinical improvement rates at 1, 3, 5, and 6 years were 81, 78, 78 and 72 %, respectively. The rates of freedom from additional FP procedures at 1, 3, 5, and 6 years were 97, 90, 90, and 90 %, respectively. Conclusions: Aortoiliac endovascular revascularization is effective treating claudicants with both aortoiliac and femoropopliteal lesions. Furthermore, a run-off score of ≥7 appears to be a potential predictor for persistent disabling claudication.

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  36. The Relationship between Temporal Changes in Proximal Neck Angulation and Stent-Graft Migration after Endovascular Abdominal Aortic Aneurysm Repair

    Tokunaga S., Ihara T., Banno H., Kodama A., Sugimoto M., Komori K.

    Annals of Vascular Surgery   Vol. 39   page: 119 - 127   2017.2

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    Background In recent years, endovascular abdominal aortic aneurysm repair (EVAR) for treating abdominal aortic aneurysms (AAA) has become quite prevalent in Japan. Though little information is available about temporal changes in proximal neck angulation due to the difficulties encountered in measuring the angle. Therefore, we examined temporal changes in proximal neck angulation and its relationship to stent-graft migration after EVAR. Methods Between June 2007 and March 2010, 159 patients underwent EVAR for treatment of fusiform AAAs at our hospital. This study focuses on the 80 patients among this group whose treatment sites and subsequent stent grafts were examined by contrast computed tomographic angiography before surgery, directly after surgery (within 4 days), as well as 1 year and 2 years thereafter. We created curved planar reconstruction (CPR) images and measured the length of migration and neck angle using our method. Results At 2 years after EVAR, the average length of proximal landing zone was 21.4 ± 9.2 mm. The average length of stent migration after 2 years was 1.41 ± 2.68 mm. The average neck angle was 33.9° preoperatively and 29.9° directly after surgery yielding a significant difference. However, 1 and 2 years after surgery the average neck angle was 28.2° and 28.4°, respectively. The number of patients experiencing a change >6° in the angle of the proximal neck between the preoperative condition and that directly after surgery was 16 (34.8%) with the use of Zenith stent grafts (n = 46) and 14 (41.2%) with the use of Excluder stent grafts (n = 34). There was no correlation between the proximal neck angle and migration of the proximal stent graft. In addition, there was no correlation between the changes in proximal neck angle and the secondary intervention rate and the occurrence of endoleak. Conclusions There was a significant change in the neck angle between the preoperative condition and the immediate postoperative condition. However, there was no clear relationship found between the angle of the neck and the proximal stent-graft migration. Postoperative changes in the proximal neck angle just after EVAR and subsequent temporal changes during a 2-year follow-up period do not appear to predict stent-graft migration, secondary intervention rates, or the occurrence of endoleak.

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  37. Long-term Comparison of Endovascular and Open Repair of Abdominal Aortic Aneurysms: Retrospective Analysis of Matched Cohorts with Propensity Score

    Sugimoto Masayuki, Koyama Akio, Niimi Kiyoaki, Kodama Akio, Banno Hiroshi, Komori Kimihiro

    ANNALS OF VASCULAR SURGERY   Vol. 43   page: 96 - 103   2017

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  38. Postoperative outcomes of hybrid repair in the treatment of aortic arch aneurysms

    Narita H., Komori K., Usui A., Yamamoto K., Banno H., Kodama A., Sugimoto M.

    Annals of Vascular Surgery   Vol. 34   page: 55 - 61   2016.7

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    Background The advent of thoracic endovascular aneurysm repair (TEVAR) has bought about a tremendous revolution in the treatment strategy for aortic arch aneurysms. We reviewed our experience using TEVAR with the hybrid approach in the treatment of aortic arch aneurysms to evaluate its feasibility, safety, and effectiveness. Methods Between October 2008 and July 2014, 61 consecutive patients (51 men; mean age 75.8 ± 7.7 years; range, 43-85 years) underwent elective treatment for aortic arch aneurysms with the hybrid approach. The 61 patients were separated into 2 groups. Thirty-five patients underwent total debranching TEVAR for zone 0 (debranching TEVAR group), 26 patients underwent long elephant trunk (ET) followed by secondary retrograde TEVAR (ET group). Preoperative, perioperative, and follow-up data were collected retrospectively in the database. Results The technical success rate was 100%. The paraplegia rates in total debranching TEVAR and long ET TEVAR and were 2.9% and 3.8%, respectively. The stroke rates in total debranching TEVAR and long ET TEVAR were 11.4% and 7.7%, respectively. The overall 30-day mortality and in-hospital mortality rates for all 61 patients were 0% and 3.4% (n = 2; both were in the total debranching TEVAR group), respectively. There were no perioperative type 1 or 3 endoleaks that required secondary intervention. The mean hospital stay was 15.8 days. The median follow-up was 309 ± 303 days. No aneurysm-related deaths occurred during follow-up. Conclusions The hybrid approach can be safely performed with good technical success and good midterm results. In future, new alternative devices for aortic arch pathologies, such as a branched stent graft that eliminates extra-anatomic bypass, should be developed.

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  39. Tortuosity is the Significant Predictive Factor for Renal Branch Occlusion after Branched Endovascular Aortic Aneurysm Repair

    Sugimoto M., Panuccio G., Bisdas T., Berekoven B., Torsello G., Austermann M.

    European Journal of Vascular and Endovascular Surgery   Vol. 51 ( 3 ) page: 350 - 357   2016.3

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    Objective After multi-branched endovascular aneurysm repair (mbEVAR), renal branch occlusion is the most frequent form of branch failure. Pre-operative renal angulation and post-operative morphology of the renal branch were quantified and their impact on occlusion was analyzed. Methods Patients who underwent mbEVAR between January 2010 and December 2013 were reviewed retrospectively. Only renal branches constructed with caudally directed cuffs were included. Patients without post-operative computed (CT) angiography were excluded. The main outcome was the primary patency of the renal branches. The renal angulation and the morphology of renal branch (bridging length, renal coverage length, tortuosity index, and angulation of distal renal artery) were quantified using CT. The impacts of morphology, implanted stents, and patient characteristics were investigated by time to event analyses. Results Ninety renal arteries in 49 patients were enrolled. Median follow up was 12 months (IQR 6-20 months). Balloon expandable stent grafts were used in 93% (84/90) of renal branches. Self expandable stent grafts were used in 12. Ninety-one percent (82/90) were lined with self expandable bare stents. Ten branches occluded after 8 months (median; IQR 1-14 months). Four of them underwent re-interventions, achieving secondary patency. The median renal angulation was -10° (IQR -40 to 0). The median bridging length was 42 mm (IQR 39-46 mm) and renal coverage 17 mm (IQR 12-22 mm). Median tortuosity index was 1.11 (IQR 1.04-1.19). The angulation of the distal renal artery was 140.7 ± 20.5°. In multivariate analysis, a tortuosity index > 1.11 was identified as the only significant predictor for occlusion (hazard ratio: 4.94; 95% CI: 1.01-24.30, p =.04). Conclusions High tortuosity was a significant predictor for the occlusion of renal branches, but renal angulation, bridging length, and the extent of renal coverage were not. By avoiding highly tortuous renal branch paths, good outcomes are expected even in upwardly directed renal arteries. Longer paths are acceptable.

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  40. Relationship between the distal migration and length of the distal landing zone after endovascular aneurysm repair (EVAR)

    Ihara T., Komori K., Banno H., Kodama A., Yamamoto K., Sugimoto M.

    Surgery Today   Vol. 46 ( 1 ) page: 56 - 61   2016.1

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    Background and purpose: Endovascular aneurysm repair (EVAR) is the main treatment for patients with abdominal aortic aneurysms. This study examines the relationship between the migration of the distal landing zone and the length of the landing zone. Materials and methods: The subjects of this study were 36 patients who underwent contrast-enhanced computed tomography 1 year after EVAR. We constructed curved multi-planar reconstruction imaging and measured the length of migration, the angle of the common iliac artery, and the diameter of the distal landing zone. Results: The mean length of migration was 1.2 ± 1.7 mm. Fifty-four legs had a distal landing zone of over 15 mm and 18 legs had a distal landing zone of less than 15 mm. Four (7.4 %) of the 54 legs with a landing zone of over 15 mm and 3 (16.7 %) of the 18 legs with a landing zone of less than 15 mm had migration of over 3 mm. This difference was significant (P = 0.05). Conclusion: The rate of migration on the distal landing zone 1 year after EVAR was reasonable when the length of the landing zone was about 15 mm. It is possible that significant migration can occur in patients with distal landing zones less than 10 mm in length.

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  41. Validation of patient selection for endovascular aneurysm repair or open repair of abdominal aortic aneurysm: Single-center study

    Yamamoto K., Komori K., Banno H., Narita H., Kodama A., Sugimoto M.

    Circulation Journal   Vol. 79 ( 8 ) page: 1699 - 1705   2015.7

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    Background: To validate the criteria for endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm (AAA) at Nagoya University Hospital, the results of both treatments were retrospectively compared. Methods and Results: Patient selection for EVAR was primarily based on suitable anatomy, minimum age 75 years, and significant comorbidity. From June 2007 to April 2014, 426 patients were treated via EVAR (EVAR group) and 346 patients were treated with open surgery (OS group). The mortality rates of the EVAR and OS groups were not significantly different (0.2% vs. 1.1%; P=0.33). Patient age, operation time, amount of bleeding, and duration of hospital stay were significantly lower in the EVAR group compared with the OS group. The incidence of comorbidity was higher in the EVAR group compared with the OS group. The incidence of early postoperative complications was significantly higher in the OS group, whereas the incidence of late complications for both groups was similar. The cumulative aneurysm-related survival rates were similar (98.9% vs. 98.5%; P=0.767). The cumulative survival rates and reintervention-free rates at 5 years were lower for the EVAR group (76% vs. 89%, P=0.019; 81% vs. 89%, P=0.046). Conclusions: Patient selection practices and criteria for EVAR and open repair at Nagoya University Hospital are generally acceptable.

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  42. Risk factors for spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms

    Bisdas T., Panuccio G., Sugimoto M., Torsello G., Austermann M.

    Journal of Vascular Surgery   Vol. 61 ( 6 ) page: 1408 - 1416   2015.6

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    Objective The introduction of fenestrated and multibranched endografting transformed the treatment paradigm of patients with thoracoabdominal aortic aneurysms (TAAAs). However, despite the minimally invasive character of the procedure, spinal cord ischemia (SCI) remains a devastating complication. The aim of this study was to address the SCI rates after endovascular TAAA repair and to analyze potential risk factors leading to this complication. Methods A consecutive cohort of patients with nonruptured TAAAs treated by means of fenestrated and multibranched endografting between January 2010 and September 2014 was analyzed. Neurologic examination was routinely performed by an independent neurologist before operation and at discharge. The main outcome measure was the onset of SCI (paraplegia or paraparesis). Secondary outcomes were neurologic complications associated with cerebrospinal fluid drainage (CSFD) and 30-day mortality. Finally, a multivariate regression analysis identified risk factors for SCI. Results A consecutive 142 patients with TAAAs (Crawford type II, n = 54 [38%]; type III, n = 76 [54%]; type IV, n = 12 [8%]) were included in this study. The majority of patients (n = 129 [91%]) were treated for an atherosclerotic aneurysm, whereas 13 patients (9%) were treated for a postdissection aneurysm. The mean maximal aortic diameter was 65 ± 13 mm. SCI developed in 23 patients (16%; paraplegia in 12 [8%] and paraparesis in 11 [8%]). Of these 23 patients, 10 patients (43%) showed the neurologic deficit directly after the procedure, 11 patients (48%) in the first 24 hours, and 2 patients (9%) after 24 hours. There was an improvement of the neurologic status in the majority of patients, with only three patients (2%) showing irreversible paraplegia at discharge. There was no difference in the 30-day mortality between patients with and without SCI (no SCI, n = 3 [3%] vs SCI, n = 1 [4%]; P =.511). Prophylactic use of CSFD before the procedure was performed in 64 patients (45%), and among them, 4 patients (6%) developed a CSFD-associated complication. No clinical benefit for patients receiving prophylactic placement of CSFD was found (P =.498). The multivariate analysis revealed the percentage of thoracic aortic coverage as the only significant risk factor for SCI (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; P =.001). Conclusions The SCI rate after endovascular repair of TAAA was 16%, with 8% of those patients suffering from paraplegia. Prophylactic use of CSFD could not reduce the SCI rate and was associated with 6% adverse events. The percentage of thoracic aortic coverage was the most powerful determinant of SCI in these series.

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  43. The fate of ischemic limbs in patients with Buerger’s disease based on our 30-year experience: does smoking have a definitive impact on the late loss of limbs?

    Sugimoto M., Miyachi H., Morimae H., Kodama A., Narita H., Banno H., Yamamoto K., Komori K.

    Surgery Today   Vol. 45 ( 4 ) page: 466 - 470   2015.4

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    Purpose: We herein review the long-term results of our series of critical ischemic limbs caused by Buerger’s disease.

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  44. Metformin stimulates ischemia-induced revascularization through an eNOS dependent pathway in the ischemic hindlimb mice model

    Takahashi N., Shibata R., Ouchi N., Sugimoto M., Murohara T., Komori K.

    Journal of Vascular Surgery   Vol. 61 ( 2 ) page: 489 - 496   2015.2

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    Objective As first-line treatment for type 2 diabetes, metformin has gained a strong position. In addition, type 2 diabetics benefit from the fact that metformin is associated with a reduction in cardiovascular events. Nevertheless, there is a dearth of information concerning the functional role of metformin in regulating angiogenesis. Our present study explores whether metformin is involved in the modulation of the revascularization processes in vivo by employing a hindlimb mice model of ischemia-induced angiogenesis. Methods For comparative purposes, randomly selected wild-type (WT) mice or endothelial nitric oxide synthase (eNOS) deficient mice were assigned to one of two groups. One group was orally administered a daily dose of metformin through a gastric tube whereas the other group served as a control with no metformin administered. Both groups were subjected to unilateral hindlimb ischemia. Laser Doppler analysis coupled with capillary density staining with CD31was the method employed to determine revascularization. Adenosine monophosphate-activated protein kinase (AMPK) and eNOS phosphorylation levels were assessed using Western blot analysis. Results Subsequent to hindlimb ischemic surgery, in comparison to the nontreated mice, metformin-treated WT mice showed accelerated limb perfusion, which was substantiated by laser Doppler blood-flow measurements and the presence of increased capillary density in the ischemic adductor muscle. Treatment with metformin significantly enhanced the increase in AMPK and eNOS phosphorylation levels of muscle tissues in WT mice induced by ischemia. In eNOS- deficient knockout mice, there was a significant increase in ischemic tissue AMPK phosphorylation induced by metformin; however, blood flow recovery in ischemic limb after surgery was unaffected. Conclusions Metformin promoted revascularization in the presence of tissue ischemia through an AMPK/eNOS-related mechanism. Our study indicates that, in addition to its glucose-lowering effect, metformin fosters improved revascularization, which is responsible for its positive effect on patients with critical limb ischemia.

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  45. Pre- and Intraoperative Predictors of Delirium after Open Abdominal Aortic Aneurysm Repair.

    Sugimoto M, Kodama A, Narita H, Banno H, Yamamoto K, Komori K

    Annals of vascular diseases   Vol. 8 ( 3 ) page: 215 - 9   2015

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  46. Clinical outcomes after infrainguinal bypass grafting for critical limb ischaemia in patients with dialysis-dependent end-stage renal failure

    Kodama A., Sugimoto M., Kuma S., Okazaki J., Mii S., Komori K.

    European Journal of Vascular and Endovascular Surgery   Vol. 48 ( 6 ) page: 695 - 702   2014.12

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    Objective To assess and risk-stratify the medium-term clinical outcomes after infrainguinal bypass grafting (IBG) to treat critical limb ischaemia (CLI) in patients with end-stage renal disease.

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  47. Management of symptomatic abdominal aortic aneurysms following emergency computed tomography.

    Matsushita M, Ikezawa T, Sugimoto M, Idetsu A

    Surgery today   Vol. 44 ( 4 ) page: 620 - 5   2014.4

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  48. Endarteritis obliterans in the pathogenesis of buerger’s disease from the pathological and immunohistochemical points of view

    Kobayashi M., Sugimoto M., Komori K.

    Circulation Journal   Vol. 78 ( 12 ) page: 2819 - 2826   2014

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    Buerger’s disease (thromboangiitis obliterans) is considered to be a nonatherosclerotic, inflammatory, and vasoocclusive disease, although the details of the mechanisms of pathogenesis remain unknown. The occurrence of the disease is strongly related to tobacco abuse and its progression is closely linked to continued smoking. The purpose of this review article is to demonstrate the pathological characteristics of arteries affected with Buerger’s disease from a possible immunoreactive point of view. In addition, we present the mechanisms for preserving the architecture of the arterial wall in affected vasculatures. Thereafter, we discuss the possibility that the pathogenesis of Buerger’s disease is a type of endarteritis obliterans, deeply connected to the Notch pathway, distinct from arteriosclerosis obliterans and other vasculitides.

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  49. Quality of life and the venous function of the lower limb after harvest of autologous external iliac vein grafts: A clinical follow-up study

    Kaneoka Y., Maeda A., Sugimoto M., Isogai M., Ishibashi H.

    Surgery Today   Vol. 43 ( 11 ) page: 1254 - 1260   2013.11

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    Purpose: To investigate the quality of life and venous function of the lower limbs after right external iliac vein (REIV) grafting for digestive surgery. Method: The study subjects included 66 patients treated surgically for hepatopancreatobiliary malignancy who underwent concomitant resection with REIV for use as autologous grafts. Fifteen patients completed the Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ), and the venous function was assessed using air plethysmography (APG) and duplex ultrasound in 10 patients. The outcomes of the 15 patients were analyzed statistically. Results: Postoperative morbidity related to graft harvest occurred in three of the 66 patients (5 %). The right legs of the follow-up patients were 6 ± 3 % larger than the left legs. The mean CIVIQ score was acceptably low at 27; however, moderate symptoms (e.g., pain upon long-time standing or walking) occurred in seven of the 15 patients. APG revealed moderate to severe outflow obstructions that did not improve during long-term observation. The blood flow depicted on duplex ultrasonography was significantly associated with the patients' symptoms. No deep venous reflux was encountered, and no right leg skin changes or venous claudication developed. Conclusions: The symptoms occurring after REIV resection can be unexpectedly prolonged. These unfavorable effects must be kept in mind and the possible sequelae should be carefully explained to patients preoperatively. © 2012 Springer Japan.

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  50. Mycotic aneurysm of the tibioperoneal trunk which precipitated acute compartment syndrome: Report of a case

    Sugimoto M., Komori K.

    Surgery Today   Vol. 42 ( 10 ) page: 1001 - 1004   2012.10

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    Mycotic aneurysms located in the tibioperoneal trunk are extremely rare, with only a few cases reported in the literature. Because of their infrequency and clinical presentations mimicking other etiologies, clinicians generally do not arrive at the diagnosis until the diameter becomes large enough to detect pulsation. We herein report a case of a 52-year-old male with an aneurysm of the tibioperoneal trunk resulting from infective endocarditis. His early clinical presentation was acute compartment syndrome of unknown cause, and a fasciotomy was performed by orthopedists who did not recognize the underlying aneurysm. Later, enhanced computed tomography revealed that an irregularly shaped aneurysm existed in his right tibioperoneal trunk. After the sepsis was controlled with the use of systemic antibiotics, resection of the aneurysm was performed in advance of cardiac surgery. No clinical symptoms due to ischemia were observed without any revascularization. Postoperative computed tomography demonstrated fine enhancement of the peroneal and posttibial arteries via collaterals. © Springer 2012.

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  51. Surgical experience of 13 infected infrarenal aortoiliac aneurysms: Preoperative control of septic condition determines early outcome

    Sugimoto M., Banno H., Idetsu A., Matsushita M., Ikezawa T., Komori K.

    Surgery   Vol. 149 ( 5 ) page: 699 - 704   2011.5

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    Background: The surgical management of infected aneurysms remains challenging and controversial. We aimed to assess the results of our retrospective series of patients surgically treated for infected infrarenal aortoiliac aneurysms and to verify our strategy. Methods: Retrospective case review of a single center. Results: Between January 1994 and December 2008, 545 patients with infrarenal aortoiliac aneurysms underwent surgery at our institution. Among these cases, 13 (2.4%) were classified as primary infected aneurysms. Seven were located in the infrarenal aorta and 6 were located in the iliac artery. The identified pathogens were Salmonella species (n = 2), methicillin-resistant Staphylococcus aureus (n = 2), and others. Systemic antibiotics were administered preoperatively to control septic conditions. At the time of surgery, 4 (31%) aneurysms had ruptured already. All but 2 cases, which were treated with extra-anatomic bypass, were repaired in situ using a Dacron graft. Although no in-hospital deaths occurred among the 3 patients who underwent planned surgery after successful control of septic conditions, 4 of 8 patients who underwent emergency surgery under septic conditions died during the early postoperative period. No signs of persistent or recurrent infection have been observed in our surviving patients with a mean follow-up of 40 months. Conclusion: Timely surgical intervention after controlling sepsis provided excellent outcomes, whereas the mortality rate of patients with sepsis or rupture was still high. Debridement of periaortic-infected tissue and in situ prosthetic graft repair are feasible. © 2011 Mosby, Inc.

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  52. Solitary profunda femoris artery aneurysm.

    Idetsu A, Sugimoto M, Matsushita M, Ikezawa T

    Annals of vascular surgery   Vol. 25 ( 4 ) page: 558.e13 - 5   2011.5

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  53. Novel technique of retrograde cerebral perfusion for descending aortic repair: Direct cannulation into left internal jugular vein

    Toyama M., Matsuura A., Miyahara K., Saito S., Matsushita M., Sugimoto M.

    General Thoracic and Cardiovascular Surgery   Vol. 59 ( 4 ) page: 304 - 306   2011.4

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    We performed descending thoracic aortic repair via posterolateral thoracotomy using retrograde cerebral perfusion with direct cannulation into the left internal jugular vein. No postoperative neurological dysfunction was observed. This patient was discharged without any adverse events. © 2011 The Japanese Association for Thoracic Surgery.

    DOI: 10.1007/s11748-010-0588-9

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  54. Therapeutic approach against intimal hyperplasia of vein grafts through endothelial nitric oxide synthase/nitric oxide (eNOS/NO) and the Rho/Rho-kinase pathway

    Sugimoto M., Yamanouchi D., Komori K.

    Surgery Today   Vol. 39 ( 6 ) page: 459 - 465   2009.6

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    Late graft failure of autologous vein grafts is associated with intimal hyperplasia resulting from the migration and proliferation of vascular smooth muscle cells (VSMCs). Endothelial nitric oxide synthase (eNOS) is an enzyme that synthesizes nitric oxide (NO). An impairment of NO-mediated vasorelaxation and increases in cell proliferation occurs in vein grafts after the surgery and these pathophysiological changes cause intimal thickening. The Rho/Rho-kinase pathway negatively regulates eNOS and is involved in intimal hyperplasia. Several studies have been conducted with the goal of controlling intimal hyperplasia targeting eNOS/NO and the Rho/Rho-kinase pathway. The oral administration of drugs, such as Rho-kinase inhibitor, l-arginine, beta-blocker and statins, significantly suppressed intimal thickening in animal models. This study revealed that statins upregulate eNOS through Rho-kinase inhibition to suppress intimal hyperplasia. The intraluminal gene transfer of eNOS inhibited intimal hyperplasia, thereby reducing the cell proliferation. These approaches are thus considered to be potentially promising therapeutic modalities for graft failure. © 2009 Springer.

    DOI: 10.1007/s00595-008-3912-6

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  55. Rho-Kinase Phosphorylates PAR-3 and Disrupts PAR Complex Formation

    Nakayama M., Goto T.M., Sugimoto M., Nishimura T., Shinagawa T., Ohno S., Amano M., Kaibuchi K.

    Developmental Cell   Vol. 14 ( 2 ) page: 205 - 215   2008.2

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    A polarity complex of PAR-3, PAR-6, and atypical protein kinase C (aPKC) functions in various cell polarization events. PAR-3 directly interacts with Tiam1/Taim2 (STEF), Rac1-specific guanine nucleotide exchange factors, and forms a complex with aPKC-PAR-6-Cdc42•GTP, leading to Rac1 activation. RhoA antagonizes Rac1 in certain types of cells. However, the relationship between RhoA and the PAR complex remains elusive. We found here that Rho-kinase/ROCK/ROK, the effector of RhoA, phosphorylated PAR-3 at Thr833 and thereby disrupted its interaction with aPKC and PAR-6, but not with Tiam2. Phosphorylated PAR-3 was observed in the leading edge, and in central and rear portions of migrating cells having front-rear polarity. Knockdown of PAR-3 by small interfering RNA (siRNA) impaired cell migration, front-rear polarization, and PAR-3-mediated Rac1 activation, which were recovered with siRNA-resistant PAR-3, but not with the phospho-mimic PAR-3 mutant. We propose that RhoA/Rho-kinase inhibits PAR complex formation through PAR-3 phosphorylation, resulting in Rac1 inactivation. © 2008 Elsevier Inc. All rights reserved.

    DOI: 10.1016/j.devcel.2007.11.021

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  56. Rho-kinase phosphorylates eNOS at threonine 495 in endothelial cells

    Sugimoto M., Nakayama M., Goto T.M., Amano M., Komori K., Kaibuchi K.

    Biochemical and Biophysical Research Communications   Vol. 361 ( 2 ) page: 462 - 467   2007.9

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    Language:English   Publisher:Biochemical and Biophysical Research Communications  

    Endothelial nitric oxide synthase (eNOS) produces nitric oxide (NO), which is involved in various physiological functions of the cardiovascular system. eNOS is activated by dephosphorylation at Thr495 and phosphorylation at Ser1177. Inhibition of Rho-kinase, an effector of the small GTPase RhoA, leads to activation of Akt/PKB, which phosphorylates eNOS at Ser1177 and thereby promotes NO production. However, little is known about the effects of Rho-kinase on phosphorylation of Thr495. We here found that the constitutively active form of Rho-kinase phosphorylated eNOS at Thr495 in vitro. Expression of the constitutively active form of RhoA or Rho-kinase increased this phosphorylation in COS-7 cells. Addition of thrombin to cultured human umbilical vein endothelial cells induced phosphorylation of eNOS at Thr495. Treatment with Y27632, a Rho-kinase inhibitor, suppressed thrombin-induced phosphorylation at Thr495. These results indicate that Rho-kinase can directly phosphorylate eNOS at Thr495 to suppress NO production in endothelium. © 2007 Elsevier Inc. All rights reserved.

    DOI: 10.1016/j.bbrc.2007.07.030

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  57. Rho-kinase phosphorylates PAR-3 and regulates cell polarity.

    Nakayama, M; Goto, T; Sugimoto, M; Nishimura, T; Hoshino, M; Ohno, S; Amano, M; Kaibuchi, K

    JOURNAL OF PHARMACOLOGICAL SCIENCES   Vol. 103   page: 50P - 50P   2007

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  58. Identification of Par3asa novel substrate of Rho-kinase

    Nakayama, M; Nishimura, T; Sugimoto, M; Goto, T; Ohno, S; Amano, M; Kaibuchi, K

    JOURNAL OF PHARMACOLOGICAL SCIENCES   Vol. 100   page: 182P - 182P   2006

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  59. Rho-kinase phosphorylates eNOS at Thr495 in vascular endothelial cells, and inactivates it

    Sugimoto, M; Nakayama, M; Goto, T; Amano, M; Komori, K; Kaibuchi, K

    JOURNAL OF PHARMACOLOGICAL SCIENCES   Vol. 100   page: 278P - 278P   2006

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  60. Hydrophilic statin suppresses vein graft intimal hyperplasia via endothelial cell-tropic Rho-kinase inhibition

    Yamanouchi D., Banno H., Nakayama M., Sugimoto M., Fujita H., Kobayashi M., Kuwano H., Komori K.

    Journal of Vascular Surgery   Vol. 42 ( 4 ) page: 757 - 764   2005.10

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    Language:English   Publisher:Journal of Vascular Surgery  

    Background: Recent studies suggest that statins can protect the vasculature in a manner that is independent of their lipid-lowering activity through inhibition of the small guanosine triphosphate-binding protein, Rho, and Rho-associated kinase. Little information is available on the inhibitory effect of statins on vein graft intimal hyperplasia, the main cause of late graft failure after bypass grafting. We therefore examined the effects of a hydrophilic statin on vein graft intimal hyperplasia in vivo and Rho-kinase activity in vitro. Methods: In the first experiment, rabbits were randomized to a control group (n = 7) that was fed regular rabbit chow or to a pravastatin group (n = 7) that was fed regular rabbit chow supplemented with 10 mg/kg pravastatin sodium. The branches of the jugular vein were ligated and an approximately 3-cm segment of the jugular vein was taken for an autologous reversed-vein graft. The carotid artery was cut and replaced with the harvested autologous jugular vein. At 2 and 4 weeks after the operation, vein grafts in both groups were harvested, and intimal hyperplasia of the vein grafts was assessed. In the second experiment, human umbilical vein endothelial cells and vascular smooth muscle cells were cultured and then treated with 1 μmol/L and 30 μmol/L pravastatin for 24 hours and harvested. Immunoblotting was performed on the resulting precipitates. Quantitative evaluation of phosphorylated myosin binding subunit and endothelial nitric oxide synthase was performed by densitometric analysis. Results: We demonstrated that oral administration of the hydrophilic statin pravastatin to normocholesterolemic rabbits inhibited intimal hyperplasia of carotid interposition-reversed jugular vein grafts 4 weeks after implantation (pravastatin group, 39.5 ± 3.5 μm vs control group, 64.0 ± 7.1 μm; n = 7; P < .05) and suppressed cell proliferation and apoptosis in the neointima 2 weeks after implantation. In addition, we found that pravastatin inhibited Rho-kinase activity and accelerated endothelial nitric oxide synthase expression in human umbilical vein endothelial cells but did not inhibit Rho-kinase activity in vascular smooth muscle cells. Conclusions: These novel findings clearly demonstrate that a hydrophilic statin can suppress intimal hyperplasia of the vein graft in vivo and also show endothelial cell-tropic inhibition of Rho-kinase in vitro. Furthermore, these results strongly support the clinical use of hydrophilic statins to prevent intimal hyperplasia of the vein graft after bypass grafting. Clinical Relevance: Late graft failure caused by neointimal hyperplasia limits the efficacy of vein grafting. Various treatments were examined to reduce neointimal hyperplasia, but a standard clinical treatment has not yet been established. We report here the inhibitory effect of pravastatin on the development of vein graft intimal hyperplasia. In addition, we demonstrate that pravastatin showed endothelial cell-tropic benefits through both the inhibition of Rho-kinase activity and acceleration of eNOS expression in vitro. Because the clinical benefits and safety of pravastatin have been established to a certain extent through long-term clinical usage, pravastatin may soon become standard treatment after vein bypass grafting. Copyright © 2005 by The Society for Vascular Surgery.

    DOI: 10.1016/j.jvs.2005.05.041

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  61. Clinical Comparison Between Early and Late Spontaneous Sac Shrinkage After Endovascular Aortic Aneurysm Repair

    Sugimoto Masayuki, Ikeda Shuta, Kawai Yohei, Tsuruoka Takuya, Niimi Kiyoaki, Kodama Akio, Banno Hiroshi, Komori Kimihiro

    JOURNAL OF VASCULAR SURGERY   Vol. 72 ( 1 ) page: E188 - E189   2020.7

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  62. Buerger’s disease (thromboangiitis obliterans)

    Sugimoto M.

    Systemic Vasculitides: Current Status and Perspectives     page: 361 - 376   2016.1

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    Publisher:Systemic Vasculitides: Current Status and Perspectives  

    DOI: 10.1007/978-3-319-40136-2_31

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Books 1

  1. Buerger’s disease (thromboangiitis obliterans)

    Sugimoto M., Komori K.

    Systemic Vasculitides: Current Status and Perspectives  2016.1  ( ISBN:9783319401348

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    Language:Japanese

    Buerger’s disease (also known as thromboangiitis obliterans) is a nonatherosclerotic, inflammatory, segmental peripheral vascular occlusive disease that typically affects young male smokers. The patients typically present with ischemic symptoms caused by stenosis or occlusion of the distal small arteries. Superficial thrombophlebitis often occurs, which is migratory and frequently correlates with disease activity. The disease escalates usually at the age of 30-40 years and thereafter symptoms diminish. This disease had been more frequently reported in the Mediterranean, Middle East, and Far East Asia, but the number of patients is decreasing. There are two characteristic histopathological findings. One is that inflammatory infiltrating cells are well recognized, predominantly in the thrombi and the intima. The other is that the internal elastic lamina and all layers of the vessel wall structures are well preserved. Buerger’s disease is distinguishable from atherosclerosis and other vasculitides by this characteristic preserved elastic lamina. There are several clinical diagnostic criteria for Buerger’s disease, which mostly require a compatible history, supportive physical findings, diagnostic vascular abnormalities on imaging studies, and current or past smoking. The etiology of Buerger’s disease still remains to be elucidated and no therapeutic guidelines exist. However, smoking clearly associates with its exacerbation and remission. Absolute smoking cessation is the one and only definitive therapy for Buerger’s disease. The fate of ischemic limb in Buerger’s disease is not so poor compared to that in atherosclerotic disease, provided that the patients maintain smoking cessation. As for the life expectancy, long-term survival is generally considered not to be affected by Buerger’s disease, due to the rare involvement of cerebral, coronary, and visceral arteries.

    DOI: 10.1007/978-3-319-40136-2_31

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KAKENHI (Grants-in-Aid for Scientific Research) 14

  1. 大動脈ステントグラフト術後タイプ2エンドリークに対する新規診断・治療戦略の開発

    Grant number:22K08917  2022.4 - 2025.3

    科学研究費助成事業  基盤研究(C)

    杉本 昌之, 児玉 章朗, 竹原 康雄, 坂野 比呂志, 川井 陽平

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    Grant amount:\4030000 ( Direct Cost: \3100000 、 Indirect Cost:\930000 )

    腹部大動脈ステントグラフト留置術(EVAR)後の「type 2 endoleak」( T2EL)は高頻度の合併症であるが治療方針のエビデンスは乏しい。4D-flow MRは血行動態という「動的」要因を非侵襲的に評価可能である。本研究はEVAR患者を対象とし、1)4D-flow MRでT2ELによる瘤内圧変化や血液流入といった「動的」因子を定量化するとともに、2)EVAR後の中~長期成績(瘤径、T2EL、再治療)を観察する。データ解析によってT2ELの病態解明とT2EL治療の最適化と長期予後改善を目指す。

  2. 胸部大動脈ステントグラフト内挿術後脊髄障害発症機序の解明と新規予防戦略の展開

    Grant number:21K08840  2021.4 - 2024.3

    科学研究費助成事業  基盤研究(C)

    坂野 比呂志, 古森 公浩, 児玉 章朗, 新美 清章, 杉本 昌之, 川井 陽平

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    胸部下行大動脈瘤に対する外科的人工血管置換術(以下,OSR)では血流低下により脊髄虚血(以下,SCI)が発症することが知られているが,ステントグラフト内挿術(以下,TEVAR)では脆弱な大動脈壁在血栓の微小塞栓によりSCIが起こるという仮説を立て,自験例で証明した(J Vasc Surg 2020 in press).しかし残念ながら自験例のみでは十分な検討を行うには症例数が不足している.本研究の目的は,多施設共同研究による大規模データを用いて胸部下行大動脈壁在血栓の性状とTEVAR後SCIの発症の関連を調べ,今後の予防戦略に関するエビデンスを構築することにある.
    日本ステントグラフト実施基準管理委員会(JACSM)データを利用した新規研究課題として申請し,採択された.再度委員とのミーティングを行い,現時点ではNCDデータとして手術日,手術時年齢,性別,瘤の病因,クレアチニン値,eGFR,呼吸障害,高血圧,脳障害,肝機能障害,慢性透析,頸動脈病変,冠動脈疾患,脊髄神経障害,胸部大動脈瘤手術の既往,腹部大動脈瘤手術の既往,開胸手術歴,家族歴,マルファン,大動脈炎,川崎病,ベーチェット,膠原病,心疾患NYHA,瘤の形態,初回治療,追加治療,中枢固定部口径,動脈瘤径,末梢固定部口径,ステントグラフト機種名,ステントグラフトタイプ名,麻酔法,中枢内挿部性状,内挿位置,エンドリーク,術中追加治療,閉塞分枝動脈,分枝動脈バイパス術式,血管損傷,術中経過,術後合併症(エンドリーク,新たな狭窄・閉塞,新たな動脈損傷,輸血,血栓・塞栓,腎機能障害,新規血液透析,脳神経障害,対麻痺,多臓器障害,瘤破裂,創部合併症).追加収集情報としてSG末端の椎体レベル,治療長( Centerline計測),左鎖骨下動脈・内腸骨動脈の開存の有無,大動脈手術既往(胸部・腹部),常用薬,術前脊髄ドレナージの有無,対麻痺発症の場合,発症日,完全か,不全か,退院時ADL,症状消失の場合その治癒日.画像データとしてSCI発症症例,および無作為に抽出した同例数のSCI非発症例の術前後のCT画像データ(スライス間隔1mm以下の動脈相造影CT画像)を収集する方向で検討中である.
    本研究は日本ステントグラフト実施基準管理委員会(JACSM)データを利用した全国データ研究であるが,現在(2016年以降)JACSMデータはNational Clinical Database(NCD)レジストリーにリンクされている.このNCD登録項目に必要な新規項目を追加して,新たなデータを収集するため,本研究の前段階としてNCDのシステム構築が必要となる.現在NCD側の事情で,複数の研究課題の依頼がきているために,対応をしていただけておらず,その進行が極めて遅れているのが実情である.
    できるだけ早期にNCD側と打ち合わせを行い,追加項目の設定,システムの構築を行う.さらに参加施設への呼びかけを行っていき,追加項目の入力と術前CT画像の送付を行っていただく.

  3. Development of Rupture-Risk-Prediction System for Aortic Aneurysm Using Fluid&#8211;Structure Interaction Analysis.

    Grant number:21H02868  2021.4 - 2024.3

    Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (B)

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  4. ロイコトリエン-リポキシゲナーゼ代謝系をターゲットとした新規血管病治療の探索研究

    Grant number:21K08839  2021.4 - 2024.3

    科学研究費助成事業  基盤研究(C)

    川井 陽平, 古森 公浩, 坂野 比呂志, 児玉 章朗, 杉本 昌之, 新美 清章

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    動脈硬化性疾患は、慢性炎症が関与していることが知られている。近年、気管支喘息の治療で用いられるロイコトリエン拮抗薬が心血管疾患に対する新たな創薬として標的となっている。動脈硬化において、ロイコトリエン-リポキシゲナーゼ系代謝物がマクロファージに作用することで炎症性作用を惹起し、動脈硬化の進展に寄与していることが報告されている。これを阻害するロイコトリエン拮抗薬が動脈硬化性疾患に対する新規治療戦略になりうる。
    本研究の意義は、ロイコトリエン-リポキシゲナーゼ代謝系を抑制する薬物の血管病に関連する抗炎症作用に関して検討し、動脈瘤、閉塞性動脈硬化症に対する新たな治療戦略を提唱することにある。
    ロイコトリエン-リポキシゲナーゼ系代謝物がマクロファージに作用することで炎症性作用を惹起し、動脈硬化の進展に寄与していることが報告されている。目的は、ロイコトリエン-リポキシゲナーゼ代謝系を抑制する薬物の血管病に関連する抗炎症作用に関して検討し、血管疾患に対する新たな治療戦略を提唱することにある。方法:マウスマクロファージを培養後、matrix metalloproteases(MMPs)やcytokinesの発現を誘導するためTNF-αで刺激した。その後、モンテルカストを含む培地を添加し、マクロファージからmRNAを抽出し、逆転写酵素にてcDNAを生成した後qPCRを用いて遺伝子発現解析を行った。添加濃度は投与なし(control)、2μM、20μMで行った。qPCR時にはGAPDH,TNF-α,interleukin(IL)-1b,NF-κB,monocyte chemotactic protein(MCP)-1を使用した。GAPDH当たりの相対的発現量を比較することで評価した。結果:IL-1b (control vs 2μM vs 20μM; 1.37 vs 1.27 vs 0.56)、NF-κB (control vs 2μM vs 20μM; 0.97 vs 0.94 vs 0.68)であり、これらはcontrolに対して20μMで有意に遺伝子発現が抑制された(p<0.05)。MCP-1 (control vs 2μM vs 20μM; 0.9 vs 0.9 vs 0.8)とTNF-α (control vs 2μM vs 20μM; 27.9 vs 31.1 vs 25.8)では有意差を認めなかった。結論:In vitroでは、モンテルカスト投与でIL-1b, NF-κBの遺伝子発現は有意に抑制され、マクロファージに対する抗炎症効果を確認することができた。
    ロイコトリエン-リポキシゲナーゼ代謝系を抑制する薬物であるモンテルカストの投与により、まずin vitroにおいて動脈瘤形成や動脈硬化に関与するとされるIL-1b, NF-κBの遺伝子発現が有意に抑制されたことを示すことができた。実験動物モデル(マウス腹部大動脈瘤モデル、poor run offモデル、ステント留置モデル)に対するロイコトリエン-リポキシゲナーゼ代謝系を抑制する薬物の効果に関する検討については開始されていない。
    今後、エラスチンを主成分とする弾性繊維などの細胞外マトリクスの分解を促進するmatrix metalloproteinase (MMP)-2及びMMP-9やその他の炎症性メディエーターなどに対するロイコトリエン-リポキシゲナーゼ代謝系を抑制する薬物の効果を調べる必要があり、さらには動物モデルを使用して大動脈瘤拡大抑制効果や内膜肥厚抑制効果などを調べる実験が必要と考えられた。

  5. 亜鉛をターゲットとした閉塞性動脈硬化症に対する新しい治療戦略

    Grant number:20K09123  2020.4 - 2022.3

    科学研究費助成事業  基盤研究(C)

    古森 公浩, 坂野 比呂志, 児玉 章朗, 新美 清章, 杉本 昌之

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    亜鉛は生命体における必須ミネラルで、近年亜鉛欠乏と動脈硬化との関連が報告されている。また我々は重症下肢虚血における下肢バイパス術の臨床的検討において亜鉛欠乏群では、正常群に比べバイパス開存率・救肢率・Amputation free survaival・創傷治癒率は不良であることを世界で初めて報告した。亜鉛欠乏と血管内膜肥厚および下肢虚血作成後の血管新生反応に及ぼす影響についての検討は、これまでになされていない。本研究の目的は、亜鉛欠乏モデルに関して検討し閉塞性動脈硬化症(ASO)に対する新規治療戦略を提唱することにある。
    【目的】 亜鉛欠乏は、創傷治癒遅延、心血管障害など、様々な障害を引き起こすことが知られている。我々は重症虚血肢患者の亜鉛欠乏群は亜鉛正常群に比べ救肢率、創傷治癒率、いずれも有意差をもって低値であることを既に報告している。今回、我々はその機序解明のため、マウスモデルを用いて亜鉛欠乏が血管新生能に与える影響を検討した。
    【方法】 野生型マウスに亜鉛欠乏食を週令3週より投与し、亜鉛欠乏モデルを作成。亜鉛欠乏(ZD)群と対照(C)群について、週令10週で左大腿動脈を結紮し、虚血肢を作成。虚血後の血管新生能を、レーザードップラー法(LDBF)による虚血肢/健肢の血流を比較した。また、活性酸素種(ROS)の検出を目的としてジヒドロエチジウム(DHE)染色と血中D-ROM濃度を測定し、血清ニトロチロシンをELISAで定量化した。筋組織中のNADPH oxidase(Nox)のサブユニット(Nox2、p22phox、p47phox、p67phox)および血管内皮増殖因子(VEGF)をRT-PCRで解析した。
    【結果】 ZD群では、筋線維中のDHEの発色が増強し、血中D-ROM濃度も有意に増加した。LDBFにて測定した虚血肢/健肢血流比が、C群と比較し、術後14日目以降有意に低下 していた。毛細血管密度もZD群が有意に低かった。また、ZD群は虚血組織の筋線維におけるジヒドロエチジウム(DHE)の発現は増加し、血中D-ROM濃度、血清ニトロチロシン濃度のいずれも有意に上昇した。虚血肢内転筋のRT-PCRの解析の結果、NoxのサブユニットはいずれもZD群で有意に増加し、VEGFの発現は低下した。

  6. Exploratory research of novel management targeting Xa inhibitor for vascular diseases

    Grant number:18K08728  2018.4 - 2021.3

    Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

    BANNO Hiroshi

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    Aneurysm model: Xa inhibitor was administered to mouse ascites-derived macrophages and gene expression analysis was performed. Apixaban administration suppressed MCP-1 expression, and edoxaban administration significantly increased TNF-α, IL-1b, IL-6, cathepsin K, and S gene expression. Therefore, apixaban and edoxaban were administered to the mouse aneurysm model, but the aneurysm-suppressing effect was not confirmed. On the contrary, anal bleeding was observed at all concentrations as a possible side effect.
    Intimal hyperplasia model: A bypass model using the external jugular vein as a graft was created using rabbits. The intimal hyperplasia was evaluated by classifying into the edoxaban-administered group and the non-administered group, but no significant difference was observed between the two groups.

  7. Impact of Clopidogrel and Prasugrel on suppression of autogenous vein graft.

    Grant number:15K10240  2015.4 - 2018.3

    Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

    KODAMA Akio

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    We performed reversed vein graft under normal and poor run-off model. At first some of grafted veins were occluded because of technical problems, thereby, it was difficult to evaluate the effects of Clopidogrel and Prasugrel. Finally the technical problems were resolved. At the same time we tried to search the optimal administration methods and dosage of these drugs. However, we could not to find them. Therefore, we made some grafted veins of Edoxaban-treated rabbits. The assessment of intimal hyperplasia did not show significant differences in their lumen area, intimal thickness, medial thickness, and intima/media index between control grafted veins and Edoxaban-treated grafted veins.

  8. Potent Inhibiting Effect of Activated vitamine D3 on Aortic Aneurysm Dilatation

    Grant number:17K10753  2017.4 - 2020.3

    NIIMI Kiyoaki

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    The activity of endogenous MCP-1 was significantly lower in the calsitriol group than in the Saline group. However, there was no significant difference in expression level of IL-1βand MMP-9 causing degeneration of the extracellular matrix between the Saline and calsitriol groups. In that series, we decided to evaluate another anti-inflammatory subject that can suppress atherosclerotic disease. Montelukast is a selective CVS-LT-1receptor antagonist that could surpress atherosclerotic diseases. We evaluated the in vitro properties of montelukast and its in vivo activities in an angiotensinⅡ-infused apolipoprotein E-deficient AAA mouse model. Relative to control,montelukast significantly suppressed gene expression of MMP-2, MMP-9, and IL-1β.In vivo,montelukast significantly decreased aortic expansion and induced infiltration of M2 macrophages.

  9. Functions of Nitric Oxide and Endothelium-derived Hyperpolarizing Factor are impaired in Poor Run-off Autogenous Rabbit Arterial Grafts

    Grant number:17H04290  2017.4 - 2020.3

    KOMORI Kimihiro

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    Background: Vascular endothelium induces smooth muscle cell (SMC) relaxation mainly mediated by endothelium-derived nitric oxide (EDNO) and endothelium-derived hyperpolarizing factor (EDHF). The present study was undertaken to determine whether the functions of EDNO and EDHF might be altered in poor run-off artery graft compared to “non-occluded graft”. Methods: The carotid artery was excised and implanted in its original position as an autogenous graft(“non-occluded graft”), and the most inferior branch of the external carotid artery served as the only outflow for the present conditions (“poor run-off graft”).
    Conclusions: The functions of both EDNO and EDHF are impaired in poor run-off artery grafts.

  10. 3D Imaging Analysis to Elucidate Predictors for Long-term results after Endovascular Aortic Aneurysm Repair

    Grant number:16K10657  2016.4 - 2019.3

    SUGIMOTO Masayuki

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    Authorship:Principal investigator 

    Grant amount:\4810000 ( Direct Cost: \3700000 、 Indirect Cost:\1110000 )

    In this observational clinical study, longitudinal anatomical measurement of abdominal aortic aneurysms after endovascular repair was performed using a dedicated 3D workstation (Aquarius; TeraRecon). Statistical analysis of those anatomical factors, in combination with clinical data, has revealed: 1) specific clinical backgrounds of our series in comparison with other large clinical studies, 2) several predictors for long-term outcomes such as aneurysmal shrinkage. Notably, our study has elucidated new insights about predictors for type II endoleak and resulting aneurysm enlargement.

  11. The protective effects of adiponectin of CaCl2-induced aneurysm formation

    Grant number:25462160  2013.4 - 2016.3

    TOKUNAGA Seisaku

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    Abdominal aortic aneurysm (AAA) is a feature of various vascular disorders including atherosclerosis and hypertension. A peroxisome proliferator-activated receptor-γ(PPARγ) ligand, pioglitazone is a relative new class of oral agent for the treatment of type 2 diabetes and insulin resistance. Pioglitazone has beneficial effects on endothelial function, hypertension and atherosclerosis. Here we investigated the effect of pioglitazone on AAA. The AAA model was induced by CaCl2 in male mice, and mice were treated with pioglitazone as food admixture at a concentration of 0.01%. Treatment of wild-type (WT) mice with pioglitazone attenuated CaCl2-induced aneurysm formation in mice. Pioglitazone also increased plasma adiponectin level in WT mice. However, adiponectin-deficient mice did not affect in CaCl2-induced aneurysm formation. These data provide direct evidence that pioglitazone protects against CaCl2-induced aneurysm formation via an adiponectin-independent mechanism.

  12. New therapeutic approach for targeting endothelium-derived hyper polarizing factor in the intimal hyperplasia of vein and artery grafts.

    Grant number:25293295  2013.4 - 2016.3

    KOMORI Kimihiro

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    The vascular endothelium induces smooth muscle relaxation mainly mediated by nitric oxide (NO) and endothelium-derived hyperpolarizing factor (EDHF). The present study was undertaken to determine whether the functions of NO and EDHF may be altered in rabbit artery grafts.
    At 28 days after the operation.Intimal hyperplasia was observed in "artery graft". When compared with "control artery","artery graft” exhibited greater acetylcholine-induced endothelium-dependent relaxation. Both the acetylcholine-induced increase in endothelial cell [Ca2+]i and the endothelium-dependent SMC hyperpolarization were weaker in "artery graft". Endothelial NO release under basal conditions was enhanced, while acetylcholine-induced endothelium-dependent SMC hyperpolarization was reduced in artery grafts.
    It is suggested that enhanced NO production is responsible for the increased acetylcholine-induced endothelium-dependent relaxation, and for minimizing intimal hyperplasia, in a rabbit artery graft.

  13. The effect of PPARalpha agonist fibrate on the intimal hyperplasia of autologous jugular vein grafts

    Grant number:24591873  2012.4 - 2015.3

    SUGIMOTO MASAYUKI

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    Authorship:Principal investigator 

    Grant amount:\5330000 ( Direct Cost: \4100000 、 Indirect Cost:\1230000 )

    The purpose of this study is to examine the effect of drugs on intimal hyperplasia. We did not receive the effect of PPARα agonist fibrate, however, dipeptidyl peptidase 4 inhibitors, which are widely used in patients with type 2 diabetes mellitus, inhiibit the intimal hyperplasia of autologous jugular vein grafts. The rabbits were randomly divided into vildagliptin (a potent dipeptidyl peptidase 4 inhibitor) group and , control group. Results: Under fasting conditions, vildagliptin increased the plasma GLP-1 concentration, without affecting plasma glucose. Acetylcholine induced endothelium-dependent relaxation only in the vildagliptin group. Intimal hyperplasia was significantly less in the vildagliptin group than in the controls. Conclusions: Vildagliptin increased the plasma GLP-1 concentration. It also enhanced acetylcholine-induced [Ca2+]i- independent endothelial nitric oxide release and reduced vein graft intimal hyperplasia, independently of any glycemic control action.

  14. New strategy using diabetes therapeutic drug for the patients with vascular disease

    Grant number:24659586  2012.4 - 2014.3

    KOMORI KIMIHIRO

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    (Background) We investigated whether metformin modulates the revascularization processes in vivo employing a hindlimb model of ischemia-induced angiogenesis. (Methods)Wild-type (WT) mice or eNOS deficient (eNOS-KO) mice were randomly divided into two groups. Mice were treated with or without metformine and were subjected to unilateral hind limb ischemia.(Results)WT mice (metformin group) showed accelerated limb perfusion following hindlimb ischemic surgery based upon laser Doppler measurements of blood flow and increased capillary density in ischemic muscle compared to non-treated mice. Metformin group significantly enhanced ischemia-induced increase in AMPK and eNOS phosphorylation levels in WT mice. In eNOS-KO mice, metformin significantly increased the phosphorylation of AMPK in ischemic tissue, but did not affect blood flow recovery in ischemic limb. (Conclusions)Metformin could promote revascularization in response to tissue ischemia via an AMPK/eNOS-dependent mechanism.

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