These results suggest that predeployment testing with the Retriever under evoked spinal cord potential monitoring is promising as a predictor of spinal cord ischemia in candidates for stent graft repair of thoracic aortic aneurysms.

Obstructive sleep apnea (OSA) is not only a cause of hypertension; it also possibly affects the pathogenesis and progression of aortic disease because an inspiratory effort-induced increase in negative intrathoracic pressure generates mechanical stress on the aortic wall. The objective of the present study was to examine the incidence by location of OSA as a complication in patients with aortic aneurysm and patients with aortic dissection (AD). An overnight sleep study was conducted in the following study groups: the aortic disease group (n = 95) consisting of patients with thoracic aortic aneurysm (TAA, n = 32), patients with abdominal aortic aneurysm (AAA, n = 36), and patients with AD (n = 27); and a control group (n = 32), consisting of patients with coronary risk factors who were matched with the aortic disease group for age, gender, and body mass index (BMI). The 3% oxygen desaturation index (ODI) was significantly higher in all the TAA, AAA, and AD groups (P = 0.045, P = 0.003, and P = 0.005, respectively) than in the control group. The incidence of moderate to severe OSA [apnea hypopnea index (AHI) ≥15 events/h] was significantly higher in the first three groups (P = 0.026, P = 0.001, P = 0.003, respectively) than in the control group, while no significant difference was found between the TAA group and the AAA group with respect to these variables. Furthermore, no significant differences were found between the thoracic AD subgroup and the abdominal AD subgroup with respect to AHI and 3% ODI, as well as with respect to the incidences of moderate to severe OSA. Patients with TAA, patients with AAA, and patients with AD showed high incidences of moderate to severe OSA. Although this result suggests that OSA may be one of risks for aortic disease, unelucidated mechanism(s) other than negative intrathoracic pressure may be involved in the pathogenesis of aortic disease.

We present two cases of severely calcified thoracoabdominal aortic aneurysm treated by means of endografting with a retrograde aortomesenteric bifurcated bypass graft reconstructing the celiac axis and superior mesenteric artery. To avoid spinal ischemia, we monitored evoked spinal cord potential and performed an occlusion test of the intercostal arteries using a retrievable stentgraft. No change in evoked spinal cord potential was noted, and no endoleaks or complications, including paraplegia, were observed. This procedure is a feasible and less-invasive treatment for severely calcified thoracoabdominal aortic aneurysms.

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Aim:To assess the utility of skin perfusion pressure (SPP) measurement in evaluating the outcome of vascular constructions for critical limb ischemia (CLI) patients. Methods: We retrospectively studied 19 lower limbs in 18 patients who underwent arterial reconstruction for CLI from whom SPP measurements had been obtained pre-and postoperatively between 2008 and 2010. Six limbs whose ulcers had healed postoperatively were classified into group H, 7 limbs whose ulcers had not healed into group U, and 6 limbs without ulcers into group N. SPP values were compared among these groups. Results: The preoperative SPP values in all groups were <30 mmHg, without significant differences among the groups. The SPP values in groups H and N significantly improved after operation, and those in group U were significantly lower than those in the other groups. Conclusions: SPP measurement before and after arterial reconstruction is useful to assess improvement in tissue circulation and to predict the likelihood of wound healing. An SPP value ≥30 mmHg was considered necessary for wound healing, supporting the findings of the few reports in the literature on the usefulness of SPP for assessing vascular reconstruction effects on ulcer wound healing.

In the present study, a large initial diameter and family history of aortic aneurysm were independent risk factors for more rapid growth of small AAAs. Although few studies have reported similar findings thus far, family history of aortic aneurysm should be carefully considered during follow-up of patients with small AAAs.

Early results following the introduction of stent grafts were generally good. The procedure spread safely without the learning curve seen in the initial stages following introduction of new medical materials, indicating that the practice standards were appropriate.

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp istal bypass has been established as the most effective treatment for critical limb ischemia of peripheral arterial disease (PAD). In particular, bypass to the paramalleolar arteries is considered to enable complete revascularization through the pedal lesion. It is still a challenging procedure, however, because the long-term patency rate is not satisfactory, despite recent progress in surgical techniques and postoperative management. Early graft failure might be due to poor anastomotic technique, presence of inadequate run-off vessels, or marked calcification of the target artery and/or poor quality of the conduit vein. Although many papers have been published concerning the long-term patency of distal bypass, 1-3 the factors subsequently affecting the patency rate have not yet been elucidated. In the present report, data were reviewed and the factors affecting long-term patency were investigated. Patient background profile and technical factors involved in the distal bypass operation to the paramalleolar tibial artery were considerably similar in each patient due to the presence of similar risk factors of atherosclerosis and coexistent atherosclerotic vascular diseases. The extent of the disease was similar, variation in surgical techniques was limited, and surgical procedures and postoperative care were uniform in general. Thus, we believe that it would be beneficial to analyze the results of paramalleolar distal bypass to elucidate the risk factors of graft failure. In particular, Japanese subjects are very homogeneous genetically, 4,5 which favors determination of the substantial factors involved in graft failure. MethodsWe retrospectively studied 65 legs of 60 consecutively treated Japanese patients (49 men, 11 women; age range, 42-87 years; average, 70.5 years) with PAD who underwent distal bypass to the paramalleolar tibial artery (artery supplying the distal third of the calf) 6 for critical limb ischemia (Table 1). All the patients had lower extremity ischemic ulcer or necrosis. Ankle brachial pressure index, skin perfusion pressure and angiography showed the lesions to be of ischemic origin, and they met the criteria for critical limb ischemia in the Trans-Atlantic Inter-Society Consensus (TASC) guidelines. Comorbidity factors consisted of diabetes in 43 patients (66%), hypertension in 42 (65%), dyslipidemia in 12 (18%), chronic renal failure Background: The results of paramalleolar distal bypass for critical limb ischemia in patients with peripheral arterial disease were reviewed to determine the factors affecting the long-term patency of this procedure in Japanese subjects.