Objective We previously observed that silencing of eukaryotic translation initiation factor 3 subunit e (eIF3e), a hypoxia-independent downregulator of hypoxia-inducible factor 2α (HIF-2α), led to ...neoangiogenesis by promoting HIF-2α activity under normoxic conditions. In the current study, we investigated whether temporary silencing of eIF3e in muscles affects blood flow recovery in a mouse ischemic limb model. Methods eIF3e silencing was performed using small interfering RNA (siRNA), and changes in gene transcription and protein expression were analyzed in vitro using murine primary skeletal muscle myoblast and human primary skeletal muscle myoblast cell cultures. In unilateral femoral artery ligation experiments, eIF3e siRNA-expressing plasmids were injected into the muscles of BALB/c mice near the ligation sites, and tissue damage and loss of limb function were scored for 28 days while serial measurements of limb perfusions were performed with laser Doppler perfusion imaging. Results Silencing of eIF3e in murine primary skeletal muscle myoblasts led to stabilization of HIF-2α and upregulation of angiogenic transcripts, including basic fibroblast growth factor and platelet-derived growth factor B ( P < .05), and the supernatant of eIF3e -silenced human primary skeletal muscle myoblasts triggered the tube formation of human umbilical vein endothelial cells. The in vivo mouse model of hindlimb ischemia revealed that single intramuscular injections of eIF3e siRNA-expressing plasmids significantly enhanced perfusion of ischemia-damaged limbs ( P < .05) at days 7 and 14 and functional recovery at days 7, 14, and 21 ( P < .05). Conclusions eIF3e is an angiogenesis suppressor and may be a therapeutic target for promoting angiogenesis after ischemic injuries.
Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta and inferior vena cava (IVC) are exposed. The ...proximal infrarenal aorta and the distal aorta are dissected for clamp placement and needle puncture, respectively. Special attention is paid to avoid dissection between the aorta and the IVC. After clamping the aorta, a 25 G needle is used to puncture both walls of the aorta into the IVC. The surrounding connective tissue is used for hemostatic compression. Successful creation of the AVF will show pulsatile arterial blood flow in the IVC. Further confirmation of successful AVF can be achieved by post-operative Doppler ultrasound.
The histological effects of silk fibroin (SF) in vascular grafts have not been clarified comprehensively in a large-animal model. This study aimed to observe the histological changes in vascular ...grafts by using
Bombyx mori
SF in a dog model. A splice graft consisting of SF and control grafts were implanted in the abdominal aorta of dogs, and the histological characteristics of the 2 types of grafts in each splice graft were compared. Five splice grafts consisted of one graft made of polyester (PE) fibers coated with SF and another coated with gelatin, 4 splice grafts consisted of one graft made of SF fibers coated with gelatin and another made of PE fibers coated with gelatin, and 2 splice grafts consisted of one graft made of SF fibers coated with SF and another made of PE fibers coated with SF. The graft made of PE fibers coated with SF showed more endothelial cells than the graft made of PE fibers coated with gelatin. The grafts using SF as a coating material or graft fibers showed a thinner luminal layer than the grafts made of PE fibers coated with gelatin. This study suggests that SF use for vascular grafts has advantages of rapid endothelialization and tendency to form thin luminal layers.
The histological effects of silk fibroin in vascular grafts were clarified comprehensively on a large-animal model.
Revascularization surgery for penile calciphylaxis Akai, Atsushi, MD; Okamoto, Hiroyuki, MD, PhD; Shigematsu, Kunihiro, MD, PhD ...
Journal of vascular surgery,
12/2013, Letnik:
58, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Calciphylaxis, a systemic disorder seen in 1%-4% of patients with end-stage renal disease, is a cause of penile ischemic gangrene. We present a case of successful revascularization surgery for penile ...calciphylaxis. An arterial bypass to the deep dorsal penile vein relieved the rest pain and stopped expansion of the gangrenous lesion.
Exclusion of the accessory renal arteries (ARAs) is required during endovascular aneurysm repair if they arise from the sealing zone or aneurysm sac. Here, we report a case of successful endovascular ...treatment for a common iliac artery aneurysm located close to the aortic bifurcation and associated with nephrotic syndrome in a 51-year-old man. The bilateral ARAs were successfully preserved using kissing stent grafts. During surgery, the proximal ends of endografts inserted from the bilateral femoral arteries were adjusted so that they met at the same level in the aorta, and simultaneous balloon dilatation was performed. This method can be a useful treatment option for common iliac aneurysms in cases with large ARAs.
We evaluated the current clinical experience of temporary inferior vena cava (IVC) filter placement and its related complications.
From January 2000 to December 2005, we enrolled 33 patients (8 men ...and 25 women) who underwent percutaneous insertion of a temporary IVC filter in the Department of Vascular Surgery of Tokyo University Hospital. Deep vein thrombosis (DVT) was proven in 78.8% of the patients. The indications for filter insertion were contraindication to anticoagulation therapy (9.1%), thrombolytic therapy (12.1%), perioperative prophylactic implantation (84.8%), pregnancy with DVT (3.0%), and prophylactic implantation in the absence of DVT (15.2%). A Neuhaus Protect was used in 13 patients, and an Antheor was used in 20 patients.
The mean ± SD duration of filter placement was 10.6 ± 7.0 days. There was no case of pulmonary embolism during filter protection and retraction. Filter thrombosis (capture of thrombus) was observed in four patients (12.1%), who then received additional thrombolytic therapy. Thrombi were dissolved by thrombolysis in three, one of whom had replacement with a permanent filter. The thrombus was not dissolved in one patient and was removed under venotomy at the insertion site. Major filter-related complications occurred in nine patients (27.3%), including filter dislocation in four patients (12.1%), catheter fracture in three (9.1%), and catheter-related infection in one (3.0%). In a patient with giant ovarian cancer, the IVC was nearly occluded with massive thrombus around the filter 2 days after operation, and the vena cava was then ligated under open laparotomy. No patients died during filter protection and retraction.
Temporary IVC filters were effective for the prevention of fatal pulmonary embolism. However, our experience of a high incidence of complications related to temporary filters suggests that this device has limited indications and supports the need for innovative design of temporary filters.
Aortic aneurysms are sometimes accompanied with disseminated intravascular coagulation (DIC). The definitive treatment of DIC is removal of underlying disease; surgical repair for the aortic ...aneurysms. Heparin, anticoagulant and other antifibrinolytic agents have been administered preoperatively to alleviate DIC whose bleeding tendency could cause high mortality and morbidity; however, their effectiveness was indeterminate. An 84-year-old man was presented with abdominal aortic aneurysm accompanied by DIC and underwent aneurysmectomy. After having confirmed that combined use of heparin and gabexate mesilate was ineffective, we used recombinant human soluble thrombomodulin (rhsTM), which has been reported to be more effective and safer than the heparin, for a week preoperatively, and demonstrated dramatic improvement of DIC. RhsTM should be a novel powerful therapeutic option for aneurysm-induced DIC.
Background and aims: In Japan, stripping under general anesthesia, lumbar anesthesia and tumescent local anesthesia has been used in the treatment of primary varicose veins due to saphenous vein ...insufficiency. However endovenous laser ablation (EVLA) using a 980 nm diode laser has received National Health Insurance (NHI) coverage in 2011, while EVLA using a 1470 nm diode laser with a radial 2-ring fiber has received coverage in 2014. As a result, the use of EVLA has become widespread in Japan. We herein report on the results of varicose veins treatment at our hospital. Subject and methods: Two hundred eighty-nine patients with saphenous vein reflux who received treatment between October 2013 and December 2015 were included in the present study. The surgical results (operating time, complications, ablation rate, linear endovenous energy density LEED, and the incidence of surgical site infections SSI) were retrospectively assessed and compared among the patients who underwent stripping (group A) and those who underwent EVLA (group B) according to the Japan Guidelines for EVLA. Results: Group A and group B included 49 patients and 240 patients, respectively. Group B comprised 20 patients who underwent EVLA using a 980 nm laser (group B1) and 240 patients who underwent EVLA using a 1470 nm laser (group B2). The operative time in group A was 48 ± 16 minutes, whereas that in group B was 28 ± 10 minutes. The operative time, the length of the treated vein and LEED in groups B1 and B2 were 40 ± 11 and 27 ± 10 minutes, 36 ± 10 and 33 ± 10 cm and 84 ± 10 and 77 ± 18 J/cm², respectively. Furthermore, the mean operative time in group B1 (with no phlebectomy) was 31 ± 9 minutes, whereas that in group B2 (with no phlebectomy) was 22 ± 7 minutes, which was statistically significant (p‹0.05). The level of pain peak was day 1 in group A patients and on days 3-7 in group B1 patients; the group B2 patients felt little pain. Surgical site infection at the phlebectomy site was observed in two group B2 patients. EVLA resulted in an occlusion rate of 99.6% at approximately two years after surgery. Conclusions: This study showed that EVLA using the 1470-nm laser caused less pain and bruising than EVLA using the 980-nm laser. The operative time of EVLA was approximately 9 minutes shorter than that of stripping. Therefore, EVLA using the 1470-nm laser might be the first treatment of choice for patients with saphenous vein reflux. However conventional surgery remains important because EVLA is not suitable in cases in which the diameter of the saphenous veins is ›20 mm or in patients with highly tortuous veins.
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