研究者詳細 - 杉本　昌之

論文 - 杉本　昌之

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

Sugimoto M., Torsello G.F., Torsello G.B., Austermann M., Stachmann A., Bisdas T.

Annals of Vascular Surgery 40 巻頁： 120 - 127 2017年4月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Annals of Vascular Surgery

Background The INCRAFT system is a new device that has become available in Europe in September 2014 after the announcement of the 2-year results of the INNOVATION trial. However, no data in the “real-world” practice exist. Herein, we report our early series of consecutive patients treated with the INCRAFT after its launch on the market. Methods Prospectively collected data of patients enrolled in the INNOVATION trial (group IT) and consecutive patients from CE Mark approval to April 2015 (group CM) were retrospectively evaluated and compared. Main outcomes were any device- or procedure-related major adverse event (MAE) within 30 days and survival and reinterventions during follow-up. Results Seventeen patients were included in group IT (median follow-up [95% CI]; 60.4 months [55–63]), and 24 patients were in group CM (12.5 [6.6–13.5]). The patients’ comorbidities were comparable between the groups. The average diameter of aortic bifurcation and the bilateral external iliac arteries was significantly smaller in group CM. Adjunctive interventions for iliac artery disease were performed in 8 patients (33%) in group CM, whereas no adjunctive was required in group IT. MAEs within 30 days were not significantly different between 2 groups. Survival and reintervention rates were also equivalent after a median follow-up of 13 months. Conclusions Compared to our patients recruited for the INNOVATION trial, the patients after CE Mark approval had significantly more challenging access routes reflecting the difficulties of “real-world” conditions. Despite frequent adjunctive procedures in group CM, the early performance of the endograft was encouraging so far. Long-term surveillance of those patients remains mandatory.

DOI： 10.1016/j.avsg.2016.07.073

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 47 巻 ( 3 ) 頁： 293 - 300 2017年3月

記述言語：日本語出版者・発行元：Surgery Today

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.

DOI： 10.1007/s00595-016-1399-0

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 39 巻頁： 119 - 127 2017年2月

記述言語：日本語出版者・発行元：Annals of Vascular Surgery

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.

DOI： 10.1016/j.avsg.2016.05.128

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 34 巻頁： 55 - 61 2016年7月

記述言語：英語出版者・発行元：Annals of Vascular Surgery

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.

DOI： 10.1016/j.avsg.2015.11.041

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 51 巻 ( 3 ) 頁： 350 - 357 2016年3月

記述言語：英語出版者・発行元：European Journal of Vascular and Endovascular Surgery

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.

DOI： 10.1016/j.ejvs.2015.09.013

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 46 巻 ( 1 ) 頁： 56 - 61 2016年1月

記述言語：英語出版者・発行元：Surgery Today

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.

DOI： 10.1007/s00595-014-1100-4

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 79 巻 ( 8 ) 頁： 1699 - 1705 2015年7月

記述言語：日本語出版者・発行元：Circulation Journal

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.

DOI： 10.1253/circj.CJ-14-1160

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 61 巻 ( 6 ) 頁： 1408 - 1416 2015年6月

記述言語：英語出版者・発行元：Journal of Vascular Surgery

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.

DOI： 10.1016/j.jvs.2015.01.044

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 45 巻 ( 4 ) 頁： 466 - 470 2015年4月

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 61 巻 ( 2 ) 頁： 489 - 496 2015年2月

記述言語：英語出版者・発行元：Journal of Vascular Surgery

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.

DOI： 10.1016/j.jvs.2013.09.061

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 8 巻 ( 3 ) 頁： 215 - 9 2015年

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 48 巻 ( 6 ) 頁： 695 - 702 2014年12月

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 78 巻 ( 12 ) 頁： 2819 - 2826 2014年12月

記述言語：英語出版者・発行元：Circulation Journal

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.

DOI： 10.1253/circj.CJ-14-0656

Management of symptomatic abdominal aortic aneurysms following emergency computed tomography.

Matsushita M, Ikezawa T, Sugimoto M, Idetsu A

Surgery today 44 巻 ( 4 ) 頁： 620 - 5 2014年4月

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 43 巻 ( 11 ) 頁： 1254 - 1260 2013年11月

記述言語：日本語出版者・発行元：Surgery Today

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.

DOI： 10.1007/s00595-012-0406-3

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

Sugimoto M., Komori K.

Surgery Today 42 巻 ( 10 ) 頁： 1001 - 1004 2012年10月

記述言語：英語出版者・発行元：Surgery Today

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.

DOI： 10.1007/s00595-012-0175-z

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 149 巻 ( 5 ) 頁： 699 - 704 2011年5月

記述言語：日本語出版者・発行元：Surgery

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.

DOI： 10.1016/j.surg.2010.12.015

Solitary profunda femoris artery aneurysm.

Idetsu A, Sugimoto M, Matsushita M, Ikezawa T

Annals of vascular surgery 25 巻 ( 4 ) 頁： 558.e13 - 5 2011年5月

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 59 巻 ( 4 ) 頁： 304 - 306 2011年4月

記述言語：日本語出版者・発行元：General Thoracic and Cardiovascular Surgery

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

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 39 巻 ( 6 ) 頁： 459 - 465 2009年6月

記述言語：日本語出版者・発行元：Surgery Today

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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