2022/05/24 更新

写真a

カワイ ヨウヘイ
川井 陽平
KAWAI Yohei
所属
医学部附属病院 血管外科 病院講師
職名
病院講師
外部リンク

学位 1

  1. 博士(医学) ( 2020年3月   名古屋大学 ) 

 

論文 18

  1. 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   81 巻   頁: 154 - 162   2022年4月

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

    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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  2. 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 : official journal of the Japanese Circulation Society   advpub 巻 ( 0 )   2022年3月

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    記述言語:英語   出版者・発行元:一般社団法人 日本循環器学会  

    DOI: 10.1253/circj.CJ-21-0832

    PubMed

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

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

    JOURNAL OF ENDOVASCULAR THERAPY     頁: 15266028221083457   2022年3月

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    記述言語:日本語   出版者・発行元:Journal of Endovascular Therapy  

    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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  4. Preoperative sarcopenia and malnutrition are correlated with poor long-term survival after endovascular abdominal aortic aneurysm repair

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

    SURGERY TODAY   52 巻 ( 1 ) 頁: 98 - 105   2022年1月

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    記述言語:日本語   出版者・発行元:Surgery Today  

    Purpose: Sarcopenia and malnutrition are often used as surrogates for frailty, which is predictive of poor prognosis after surgery. We investigated the effects of sarcopenia and malnutrition on mortality after endovascular aneurysm repair (EVAR). Methods: The subjects of this study were patients who underwent EVAR at our hospital between June 2007 and December 2013, excluding those who underwent reintervention. The psoas muscle area at the L4 level was used as an indicator of sarcopenia. The Geriatric Nutritional Risk Index was used as an indicator of malnutrition. Results: There were 324 patients included in the study, with a mean age of 78.1 years and a median follow-up period of 56.7 months. Multivariate analysis revealed that sarcopenia (HR, 1.79; p =.042) and malnutrition (HR, 1.78; p =.043) were independent prognostic factors. Patients with both factors were classified as the high-risk group and others were classified as the low-risk group. The survival rate was significantly lower in the high-risk group than in the low-risk groups (p <.001). Even after propensity score matching, the high-risk group had a significantly lower survival rate (p <.001). Conclusion: Both sarcopenia and malnutrition were associated with long-term mortality after EVAR. Patients with both indicators had a poor mid-term survival.

    DOI: 10.1007/s00595-021-02362-x

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  5. Endovascular Aneurysm Repair Compared With Open Repair Does Not Improve Survival in Octogenarians

    Banno Hiroshi, Sugimoto Masayuki, Sato Tomohiro, Ikeda Shuta, Kawai Yohei, Tsuruoka Takuya, Kodama Akio, Komori Kimihiro

    CIRCULATION JOURNAL   85 巻 ( 12 ) 頁: 2166 - +   2021年12月

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    記述言語:日本語   出版者・発行元:Circulation Journal  

    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.

    DOI: 10.1253/circj.CJ-21-0574

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

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

    ANNALS OF VASCULAR SURGERY   75 巻   頁: 420 - 429   2021年8月

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

    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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  7. 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   73 巻 ( 5 ) 頁: 1557 - 1565.e1   2021年5月

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

    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.

    DOI: 10.1016/j.jvs.2020.09.026

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  8. 内臓動脈瘤の診断と治療

    児玉 章朗, 佐藤 誠洋, 池田 脩太, 川井 陽平, 鶴岡 琢也, 飯井 克明, 杉本 昌之, 新美 清章, 坂野 比呂志, 古森 公浩

    日本血管外科学会雑誌   30 巻 ( 2 ) 頁: 79 - 83   2021年3月

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    記述言語:日本語   出版者・発行元:特定非営利活動法人 日本血管外科学会  

    <p>今回,内臓動脈瘤につき,簡潔に病因,治療適応,治療法について述べた.内臓動脈瘤は腹部大動脈から分岐する腹腔動脈,上腸間膜動脈,腎動脈,下腸間膜動脈およびその分枝に形成された動脈瘤を指す.比較的稀な疾患であるためエビデンスが乏しい一方,近年の画像診断の進歩とともに,日常臨床で遭遇する機会もしばしばある.最近海外からもガイドラインが提唱されており,われわれ血管外科医は理解を深めておく必要がある.</p>

    DOI: 10.11401/jsvs.21-00004

    CiNii Research

  9. 重症虚血肢の創傷治癒と亜鉛欠乏,ならびにマウス虚血モデルの亜鉛欠乏と血管新生の関連

    鶴岡 琢也, 児玉 章朗, 小山 明男, 池田 脩太, 川井 陽平, 榊原 昌志, 飯井 克明, 高橋 範子, 新美 清章, 杉本 昌之, 坂野 比呂志, 柴田 玲, 古森 公浩

    日本心臓血管外科学会雑誌   50 巻 ( 1 ) 頁: 1-lxiv - 1-lxv   2021年1月

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    記述言語:日本語   出版者・発行元:特定非営利活動法人 日本心臓血管外科学会  

    DOI: 10.4326/jjcvs.50.1.lxiv

    CiNii Research

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

    Banno Hiroshi, Ikeda Shuta, Kawai Yohei, Meshii Katsuaki, Takahashi Noriko, Sugimoto Masayuki, Kodama Akio, Komori Kimihiro

    JOURNAL OF VASCULAR SURGERY   72 巻 ( 5 ) 頁: 1552 - 1557   2020年11月

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

    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.

    DOI: 10.1016/j.jvs.2020.02.025

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  11. 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   72 巻 ( 1 ) 頁: E188 - E189   2020年7月

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    記述言語:日本語  

    Web of Science

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

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

    JOURNAL OF VASCULAR SURGERY   72 巻 ( 1 ) 頁: E88 - E88   2020年7月

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    記述言語:日本語  

    Web of Science

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

    Kawai Yohei, Sugimoto Masayuki, Aikawa Kiyoshi, Komori Kimihiro

    ANNALS OF VASCULAR SURGERY   66 巻   頁: 344 - 350   2020年7月

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

    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.

    DOI: 10.1016/j.avsg.2019.12.025

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

    Banno Hiroshi, Ikeda Shuta, Kawai Yohei, Fujii Takayuki, Akita Naohiro, Takahashi Noriko, Sugimoto Masayuki, Kodama Akio, Komori Kimihiro

    JOURNAL OF VASCULAR SURGERY   71 巻 ( 2 ) 頁: 450 - 456   2020年2月

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

    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.

    DOI: 10.1016/j.jvs.2019.03.061

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  15. A Ruptured Popliteal Artery Aneurysm Treated with Coil Embolization.

    Kawai Y, Morimae H, Matsushita M

    Annals of vascular diseases   12 巻 ( 1 ) 頁: 80 - 82   2019年3月

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    記述言語:英語  

    DOI: 10.3400/avd.cr.18-00125

    PubMed

  16. Montelukast, a Cysteinyl Leukotriene Receptor 1 Antagonist, Induces M2 Macrophage Polarization and Inhibits Murine Aortic Aneurysm Formation

    Kawai Yohei, Narita Yuji, Yamawaki-Ogata Aika, Usui Akihiko, Komori Kimihiro

    BIOMED RESEARCH INTERNATIONAL   2019 巻   頁: 9104680   2019年

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    記述言語:日本語   出版者・発行元:BioMed Research International  

    Background. The pathogenesis of abdominal aortic aneurysm (AAA) is characterized by atherosclerosis with chronic inflammation in the aortic wall. Montelukast is a selective cys-LT 1 receptor antagonist that can suppress atherosclerotic diseases. We evaluated the in vitro properties of montelukast and its in vivo activities in an angiotensin II-infused apolipoprotein E-deficient (apoE-/-) AAA mouse model. Methods. The mouse monocyte/macrophage cell line J774A.1 was used in vitro. M1 macrophages were treated with montelukast, and gene expressions of inflammatory cytokines were measured. Macrophages were cultured with montelukast, then gene expressions of arginase-1 and IL (interleukin)-10 were assessed by quantitative polymerase chain reaction, arginase-1 was measured by fluorescence-activated cell sorting, and IL-10 concentration was analyzed by enzyme-linked immunosorbent assay. In vivo, one group (Mont, n=7) received oral montelukast (10 mg/kg/day) for 28 days, and the other group (Saline, n=7) was given normal Saline as a control for the same period. Aortic diameters, activities of matrix metalloproteinases (MMPs), cytokine concentrations, and the number of M2 macrophages were analyzed. Results. Relative to control, montelukast significantly suppressed gene expressions of MMP-2, MMP-9, and IL-1β, induced gene expressions of arginase-1 and IL-10, enhanced the expression of the arginase-1 cell surface protein, and increased the protein concentration of IL-10. In vivo, montelukast significantly decreased aortic expansion (Saline vs Mont; 2.44 ± 0.15 mm vs 1.59 ± 0.20 mm, P<.01), reduced MMP-2 activity (Saline vs Mont; 1240 μM vs 755 μM, P<.05), and induced infiltration of M2 macrophages (Saline vs Mont; 7.51 % vs 14.7 %, P<.05). Conclusion. Montelukast induces M2 macrophage polarization and prevents AAA formation in apoE-/- mice.

    DOI: 10.1155/2019/9104680

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  17. 急性腸管虚血を合併した上腸間膜動脈解離に対し,開腹下に上腸間膜動脈逆行性ステント挿入術を施行した2例

    松下 昌裕, 森前 博文, 小山 明男, 玉井 宏明, 川井 陽平

    脈管学   58 巻 ( 10 ) 頁: 201 - 204   2018年10月

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    記述言語:日本語   出版者・発行元:日本脈管学会  

    <p>上腸間膜動脈(SMA)解離は,まれに腸管虚血のため血行再建が必要となる。SMA解離に対し,逆行性ステント挿入術を行った2例を経験した。開腹して露出したSMAから解離部に逆行性にステントを挿入し,1例はSMA解離部の内膜固定術を追加した。2例とも,腸管血流は回復し,術後経過は良好であった。バイパス術や経皮的ステント挿入術よりも,成功率が高い方法と考えられた。</p>

    DOI: 10.7133/jca.18-00024

    CiNii Research

  18. Direct oral anticoagulant導入後の深部静脈血栓症症例の検討

    新美 清章, 小山 明男, 川井 陽平, 秋田 直宏, 藤井 孝之, 榊原 昌志, 鶴岡 琢也, 高橋 範子, 杉本 昌之, 児玉 章朗, 坂野 比呂志, 古森 公浩

    静脈学   29 巻 ( 1 ) 頁: 13 - 19   2018年2月

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    記述言語:日本語   出版者・発行元:日本静脈学会  

    <p>目的:今回DOAC(direct oral anticoagulant)導入後の深部静脈血栓症(DVT)の治療成績について検討.</p><p>対象・方法:2015年1月から2016年12月までのDVT 39例(エドキサバン20例・リバーロキサバン9例・アピキサバン10例)を対象.</p><p>結果:平均年齢66.4歳,平均観察期間は4カ月,担がん状態22例(56.4%),初期ヘパリン使用は5例であった.リバーロキサバン4例・アピキサバン5例で初期強化療法行った.血栓の縮小または完全消失はDVTで69%,肺塞栓症(PE)で88.9%であったが,DOACの種類・初期強化療法の有無で差はなかった.有害事象回避率は3カ月77.1%・6カ月70.1%で,出血イベント回避率は3カ月96.3%・6カ月87.5%であった.有害事象はすべて投与4カ月以内に発生した.</p><p>まとめ:DVTに対するDOACでの治療成績は有効性・出血イベント回避率とも良好であり,第一選択として適切と考える.</p>

    DOI: 10.7134/phlebol.17-16

    CiNii Research

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科研費 2

  1. 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

    研究課題/研究課題番号:21K08840  2021年4月 - 2024年3月

    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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    担当区分:研究分担者 

    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.

  2. 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

    研究課題/研究課題番号:21K08839  2021年4月 - 2024年3月

    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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    担当区分:研究代表者 

    配分額:4290000円 ( 直接経費:3300000円 、 間接経費:990000円 )

    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。