Early detection of arteriosclerotic disease with subsequent initiation of medical therapy is expected to lead to reducing cerebrovascular and cardiovascular diseases. It has been studied in Western ...countries whether the screening for asymptomatic peripheral artery disease with the ankle-brachial index (ABI) test, which is also a simple diagnostic method for arteriosclerotic diseases, can reduce cerebrovascular and cardiovascular events to identify the individuals who may benefit from early therapeutic intervention. While introducing such studies, the possibility of ABI screening in Japan was discussed. In order to carry out ABI screening successfully in Japan, it is necessary to collect insufficient data and clarify the evidence of the Japanese.
Background:The epidemiology and clinical features of thromboangiitis obliterans (TAO) in Japan have not been updated extensively.Methods and Results:This retrospective study used the Japanese ...Ministry of Health, Labour and Welfare (JMHLW) medical support system database and associated health insurance data. The number of medical financial support recipients registered as TAO patients and estimated prevalence of TAO decreased from fiscal year (FY) 2000 (10,089 and 7.95 95% confidence interval, CI: 7.79–8.10 per 100,000 population) to FY 2010 (7,147 and 5.58 95% Cl: 5.45–5.71 per 100,000) and leveled off until 2014. The prevalence of TAO among patients with peripheral arterial occlusive diseases declined from 7.15% (95% Cl: 7.00–7.31) in FY 2008 to 6.12% (95% Cl: 5.98–6.26) in FY 2014. Clinicodemographic features were obtained from 89 new recipients in FY 2013 and 2014: 12 (13%) women, 36 (40%) aged ≥50 years, 26 (29%) had probable onset age ≥50 years, 7 (8%) were non-smokers, and 12 (13%) had arteriosclerosis-related comorbidities. The symptoms were similar regardless of registration age, smoking history, or sex. Although 40 (45%) had digit ulcers, only 12 (13%) fulfilled Shionoya’s criteria. They rarely had infrapopliteal lesions combined with upper extremity involvement or phlebitis.Conclusions:The prevalence of TAO has decreased in Japan. In the current diagnosis of TAO, various clinical characteristics including late onset, arteriosclerotic factors, non-smoking, or mild symptoms should be considered.
Abstract Objective Spontaneous celiac artery (CA) dissection without associated aortic dissection is a rare condition. Although this condition has been diagnosed more frequently with the advent of ...improved diagnostic imaging modalities, its pathogenesis and treatment strategy remain to be established. The present study examined the clinical features and outcomes of conservative management of this disease. Methods The study included 12 patients (10 men and two women) in whom spontaneous CA dissection was diagnosed between 2007 and 2015. The medical records of each patient were retrospectively reviewed. Results The mean age at diagnosis was 56.4 years (range, 42-77 years). Eight patients presented with abdominal or back pain, and the remaining four patients were asymptomatic and diagnosed incidentally. Four patients had a history of hypertension, and six had a history of smoking. Celiac trunk compression by the median arcuate ligament was found in two patients. The dissection extended into the common hepatic artery in five patients and into the splenic artery in four patients. Retroperitoneal hemorrhage was found in 2 patients, splenic infarction in 3, and transient mild liver dysfunction in 2. All patients were treated conservatively: two patients received short-term anticoagulation and antiplatelet therapy, and antihypertensive treatment was initiated in three patients. The mean follow-up period was 35.5 months (range, 5-101 months). Distal extension of the dissection occurred in one patient within a week of the initial symptom, which was also managed conservatively. Late aneurysmal degeneration was not observed in any of the patients, and none required endovascular or surgical treatment. Conclusions If the general condition of the patient is stable, then CA dissection can be managed with careful conservative treatment, even in patients with associated retroperitoneal hemorrhage. Long-term anticoagulation or antiplatelet medication may not be necessary in most patients with this condition.
Surgical interventions are performed to ameliorate the complications of Takayasu’s arteritis, which adversely affects life expectancy. However, the efficacy of surgery in relation to long-term ...survival of the patients remains to be evaluated. A retrospective review was performed on 110 consecutive patients with Takayasu’s arteritis who underwent surgical treatment at our single institution. Survival was compared with the reported results of medically treated patients according to Ishikawa’s prognostic classification. There were 12 hospital deaths, and the remaining 98 patients were followed up from 10 months to 48.4 years (mean 21.6 years). A serious long-term complication was anastomotic aneurysms with a cumulative incidence at 10 and 20 years of 7.8 and 14.8 %, respectively. Thirty-seven late deaths were observed and the major causes were congestive heart failure and anastomotic aneurysms. The cumulative survival rate at 10 and 20 years was 84.3 and 70.4 %, respectively. In patients classified as stage 3 by Ishikawa, surgery seemed to increase survival; however, surgery-associated complications conversely decreased the survival of patients with stage 1 disease. Surgery seems to increase the long-term survival of patients with stage 3 Takayasu’s arteritis by Ishikawa’s prognostic classification. Conservative treatment is recommended for those with stage 1 or 2 disease. Anastomotic aneurysms may occur at any time after surgery, and regular follow-up is mandatory for the rest of the patient’s life. This article was based on previous reports by the author with several additional patients and follow-up periods.
Background: Epidemiology and clinical management of acute venous thromboembolism (VTE) are not readily available in Japan. Methods and Results: The Japan VTE Treatment Registry (JAVA) is a ...multicenter cohort study of consecutive patients with an objectively confirmed, symptomatic acute pulmonary embolism (PE), symptomatic acute deep vein thrombosis (DVT), or asymptomatic acute proximal DVT. Of the 1,076 patients enrolled with acute VTE, 68.7% presented with an isolated DVT; 17.0% had PE alone; and 14.4% had both. VTE management was characterized by a high rate of inferior vena cava filter insertion (40.6%), frequent thrombolysis (21.1%), and sub-therapeutic unfractionated heparin-based anticoagulation, followed by warfarin prescription, mostly targeting an international normalized ratio of 2.0 (range, 1.5–2.5). During a mean observation period of 252.5 days, 29 recurrent cases of VTE were documented, yielding an incidence rate of 3.9 per 100 patient-years. A total of 123 patients died during the study period, corresponding to a rate of 16.6 deaths per 100 patient-years. The incidence of major bleeding was 3.2% per patient-year, including 2 fatal hemorrhages and 7 intracranial hemorrhages. Conclusions: VTE management in Japan is characterized by a highly aggressive strategy in the acute phase, in contrast to protocols that use low-level anticoagulation. The VTE recurrence rates in Japan and Western countries are similar, but mortality is higher in Japan, with significant variability depending on patient and management characteristics. (Circ J 2014; 78: 708–717)
Aim: We investigated the clinical usefulness of carotid arterial strain and the strain rate for evaluating the progression of arteriosclerosis measured using a two-dimensional speckle-tracking method ...in carotid ultrasonography. Methods: We enrolled 259 participants (age: 64±12 years; men: 149; women: 110) in this retrospective analysis. The circumferential strain and the strain rate were measured in bilateral common carotid arteries, and the lowest values were used for the analyses. To assess the characteristics of strain and the strain rate, we investigated the associations between the strain values and gender, age, body mass index (BMI), blood pressure (BP), and the presence of hypertension, diabetes mellitus, and hyperlipidemia. We also examined the explanatory factors for the strain values using clinical parameters along with the intima-media thickness (IMT), the ankle brachial index (ABI), and the cardio-ankle vascular index (CAVI) as possible candidates. Finally, we investigated whether the strain values might be an independent predictor for vascular diseases using multivariate logistic regression analyses. Results: The carotid circumferential strain and the strain rate were significantly correlated with age, IMT, and the CAVI, but not with the BMI, BP, or ABI. Strain and the strain rates were lower in participants with hypertension or cerebrovascular disease and were selected as significant predictive factors for the presence of cerebrovascular diseases, together with diabetes and the CAVI. Conclusions: Strain and the strain rate of carotid arteries, which could represent local arterial stiffness, might be associated with atherosclerosis and could possibly be used to predict cerebrovascular disease.
Background:Distal bypass is the first-line treatment for patients with critical limb ischemia (CLI). In Japanese high-volume centers, approximately half of these patients are on hemodialysis (HD). We ...have treated such patients first with bypass using a multidisciplinary perioperative strategy. We reveal the recent characteristics of patients who underwent distal bypass and the surgical outcomes in Japan, especially focusing on the foot conditions by using the wound, ischemia, and foot infection (WIfI) classification.Methods and Results:The 152 patients underwent distal bypass in a tertiary center hospital, and we compared patients on HD (HD group) to those not on HD (non-HD group). There were significant differences between the 2 groups in the overall survival, major adverse cardiac event-free survival and amputation-free survival (AFS) rates (P<0.0001). The procedural outcomes were analyzed via primary and secondary patency, and there was no difference. In the subanalysis of limb status using WIfI stage, the AFS rate of the HD group was significantly worse than that of the non-HD group for WIfI stage 4 patients.Conclusions:The life and limb prognoses of patients with CLI and HD were worse than those of non-HD patients. There was no difference in surgical outcomes suggested by the graft patency rates between the 2 groups. AFS in WIfI stage 4 was significantly worse in the HD group, which indicated the importance of preoperative limb status. (Circ J 2016; 80: 2382–2387)
Objectives Isolated dissection of a splanchnic artery, including the celiac artery, superior mesenteric artery (SMA), and inferior mesenteric artery, and their branches, is a relatively rare ...condition. This study was conducted to define the characteristics of patients with splanchnic artery dissection and the clinical course of isolated splanchnic artery dissection. Methods The records of 19 patients were reviewed to survey demographic data, the location of dissection, symptoms, diagnostic modalities, treatment, and long-term outcome. Results The locations of dissection were the superior mesenteric artery (SMA) in 11 patients, celiac artery in 3, both celiac artery and SMA in 2, and common hepatic artery, celiac artery to splenic artery, and celiac artery to proper hepatic artery in 1 each. In all but one with systemic sclerosis and Sjögren syndrome, the underlying cause of dissection was unclear. There were 12 asymptomatic and seven symptomatic patients. All cases were diagnosed by computed tomography. Surgical treatment was performed in one patient with a large aneurysm of the common hepatic artery, and the remaining 18 patients were followed-up conservatively. The mean follow-up duration was 20.9 ± 25.4 months (range, 2-116 months). No expansion or progression of the false lumen was observed in these patients. Conclusion Patients with spontaneous dissection of the splanchnic arteries are often asymptomatic, and in this series, none developed significant end organ ischemia. Most patients with this rare condition can be managed expectantly with clinical follow-up including computed tomography imaging to assess aneurysm formation.
The aim of this study was to create prediction models for two year overall survival (OS) and amputation free survival (AFS) after revascularisation in patients with chronic limb threatening ischaemia ...(CLTI).
This was a retrospective analysis of prospectively collected multicentre registry data (JAPAN Critical Limb Ischaemia Database; JCLIMB). Data from 3 505 unique patients with CLTI who had undergone revascularisation from 2013 to 2017 were extracted from the JCLIMB for the analysis. The cohort was randomly divided into development (2 861 patients) and validation cohorts (644 patients). In the development cohort, multivariable risk models were constructed to predict two year OS and AFS using Cox proportional hazard regression analysis. These models were applied to the validation cohort and their performances were evaluated using Harrell’s C index and calibration plots.
Kaplan–Meier estimates of two year OS and AFS post-revascularisation in the whole cohort were 69% and 62%, respectively. Strong predictors for OS consisted of age, activity, malignant neoplasm, chronic kidney disease (CKD), congestive heart failure (CHF), geriatric nutritional risk index (GNRI), and sex. Strong predictors for AFS included age, activity, malignant neoplasm, CKD, CHF, GNRI, body temperature, white blood cells, urgent revascularisation procedure, and sex. Prediction models for two year OS and AFS showed good discrimination with Harrell’s C indexes of 0.73 (95% confidence interval CI 0.69 – 0.77) and 0.72 (95% CI 0.68 – 0.76), respectively
Prediction models for two year OS and AFS post-revascularisation in patients with CLTI were created. They can assist in determining treatment strategies and serve as risk adjustment modalities for quality benchmarking for revascularisation in patients with CLTI at each facility.
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