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Joon Bum Kim - One of the best experts on this subject based on the ideXlab platform.
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an eight branched aortic graft for reconstruction of visceral and Intercostal Arteries during extent ii thoraco abdominal aortic surgery
European Journal of Cardio-Thoracic Surgery, 2018Co-Authors: Sung Jun Park, Joon Bum KimAbstract:Reconstruction of the visceral and Intercostal Arteries is the most challenging part in the open repair of thoraco-abdominal aortic aneurysm. For efficient and expeditious reconstruction of these branching vessels, a technique of using a pre-handsewn 8-branch aortic graft (octopod technique) has been adopted. The octopod graft was manually constructed using commercially available two 4-branch aortic grafts that were spatially oriented based on the preoperative computed tomographic images and connected each other prior to surgery. This approach was adopted in 12 open repairs of extent II thoraco-abdominal aortic aneurysms from 2015 to 2017, including 8 Marfan patients. Median pump and procedural times were 173 (102-207) min and 437 (343-489) min, respectively. There was no operative mortality or spinal cord injury. The octopod technique for open thoraco-abdominal aortic aneurysm repair showed excellent early results with high procedural efficiency.
Munetaka Masuda - One of the best experts on this subject based on the ideXlab platform.
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Coil embolization of Intercostal Arteries accessed by surgical exposure for type II endoleak after thoracic endovascular aortic repair
Journal of vascular surgery, 2019Co-Authors: Norihisa Karube, Keiji Uchida, Tomoki Cho, Tomoyuki Minami, Munetaka MasudaAbstract:Many patients with type II endoleak after thoracic endovascular aortic repair (TEVAR) are closely observed without secondary intervention. Herein, we report a new technique of coil embolization for type II endoleak from Intercostal Arteries after TEVAR for ruptured acute type B aortic dissection. A hybrid procedure of exposing Intercostal Arteries via subcostal incision in the prone position and transcatheter technique enables embolization of Intercostal Arteries at their origin from the aorta. This technique could avoid lung injury and be applicable in multiple Intercostal Arteries. This technique may be a useful secondary intervention for type II endoleak after TEVAR caused by Intercostal Arteries.
Sung Jun Park - One of the best experts on this subject based on the ideXlab platform.
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an eight branched aortic graft for reconstruction of visceral and Intercostal Arteries during extent ii thoraco abdominal aortic surgery
European Journal of Cardio-Thoracic Surgery, 2018Co-Authors: Sung Jun Park, Joon Bum KimAbstract:Reconstruction of the visceral and Intercostal Arteries is the most challenging part in the open repair of thoraco-abdominal aortic aneurysm. For efficient and expeditious reconstruction of these branching vessels, a technique of using a pre-handsewn 8-branch aortic graft (octopod technique) has been adopted. The octopod graft was manually constructed using commercially available two 4-branch aortic grafts that were spatially oriented based on the preoperative computed tomographic images and connected each other prior to surgery. This approach was adopted in 12 open repairs of extent II thoraco-abdominal aortic aneurysms from 2015 to 2017, including 8 Marfan patients. Median pump and procedural times were 173 (102-207) min and 437 (343-489) min, respectively. There was no operative mortality or spinal cord injury. The octopod technique for open thoraco-abdominal aortic aneurysm repair showed excellent early results with high procedural efficiency.
Norihisa Karube - One of the best experts on this subject based on the ideXlab platform.
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Coil embolization of Intercostal Arteries accessed by surgical exposure for type II endoleak after thoracic endovascular aortic repair
Journal of vascular surgery, 2019Co-Authors: Norihisa Karube, Keiji Uchida, Tomoki Cho, Tomoyuki Minami, Munetaka MasudaAbstract:Many patients with type II endoleak after thoracic endovascular aortic repair (TEVAR) are closely observed without secondary intervention. Herein, we report a new technique of coil embolization for type II endoleak from Intercostal Arteries after TEVAR for ruptured acute type B aortic dissection. A hybrid procedure of exposing Intercostal Arteries via subcostal incision in the prone position and transcatheter technique enables embolization of Intercostal Arteries at their origin from the aorta. This technique could avoid lung injury and be applicable in multiple Intercostal Arteries. This technique may be a useful secondary intervention for type II endoleak after TEVAR caused by Intercostal Arteries.
Nobuyoshi Kawaharada - One of the best experts on this subject based on the ideXlab platform.
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Is the number of covered Intercostal Arteries a predictor of postoperative spinal cord ischemia after thoracic endovascular aortic repair?
'Sigma Xi', 2018Co-Authors: Yosuke Kuroda, Toshiro Ito, Hiroki Uchiyama, Naomi Yasuda Toshitaka Watanabe, Junji Nakazawa, Ryo Harada, Nobuyoshi KawaharadaAbstract:Objective: The purpose of this study was to investigate the impact of the number of covered Intercostal Arteries (ICAs) on postoperative spinal cord ischemia (SCI) after Thoracic endovascular aortic repair (TEVAR).Methods: A retrospective review of a collected database was performed for all patients who underwent TEVAR at the Sapporo Medical University between January 2006 and February 2016. The pre- and post-operative thin slice contrast-enhanced computed tomography was performed, and ICAs were evaluated. Preoperative demographics, procedure-related variables, and clinical details related to SCI were examined. Logistic regression analysis was performed to identify risk factors for the development of SCI.Results: Of the 263 patients who underwent TEVAR during the study period, 11 patients (4.1%) developed SCI. The number of patent preoperative ICAs was 10.1 ± 4.4. There was no significant difference in the number of patent ICAs between the SCI and No SCI groups. On the other hand, the number of postoperative covered ICAs was 4.8 ± 3.3. The number of covered ICAs was higher in the SCI than No SCI group (8.3 ± 2.9 vs 4.7 ± 3.2, p = 0.001). The cut-off value was set at 6 ICAs by ROC curve analysis. Multivariate analysis demonstrated that in TEVAR, the covering of 6 or more ICAs by stent grafts became a significant risk factor for SCI (odds ratio, 10.9; p = 0.029).Conclusions: The number of covered ICAs becomes a predictor of postoperative SCI after TEVAR. The patient with 6 or more ICAs covered by stent grafts is deemed to require a more careful perioperative management
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spinal cord protection with selective spinal perfusion during descending thoracic and thoracoabdominal aortic surgery
Interactive Cardiovascular and Thoracic Surgery, 2010Co-Authors: Nobuyoshi Kawaharada, Tetsuya Koyanagi, Yoshihiko Kurimoto, Toshiro Ito, Ryo Harada, Hideki Hyodoh, Atsushi Watanabe, Tetsuya HigamiAbstract:Open repair of aortic aneurysm causes spinal cord perfusion pressure to decrease due to the steal phenomenon from the bleeding of Intercostal Arteries and cross-clamping of the aorta. We attempted to perfuse the Intercostal Arteries for preoperative detection of the artery of Adamkiewicz using newly developed catheters. Fifteen patients underwent selective spinal perfusion with our original catheter as spinal protection during the procedure of distal descending thoracic aneurysm (DTA) or thoracoabdominal aortic aneurysm (TAAA) repair. Seven patients had distal DTA and eight had TAAA. Monitoring of motor evoked potential (MEP) was performed in all patients throughout the operation. The perfusion flow was 30-40 ml/min for each Intercostal artery and was adjusted to keep the proximal circuit pressure at 150-200 mmHg. The average number of perfused Intercostal Arteries was 2.3 per patient and the number of Intercostal Arteries reimplanted per patient was 2.5. Intercostal Arteries were reimplanted using an interpositional graft. MEPs were still observable after graft replacement in all patients and there were no cases of paraparesis/paraplegia. All patients were discharged ambulatory. Selective spinal perfusion maintains the quantity of total blood flow in the spinal cord and is very useful for reducing the incidence of ischemic injury of the spinal cord during operation.
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institutional report vascular thoracic spinal cord protection with selective spinal perfusion during descending thoracic and thoracoabdominal aortic surgery
2010Co-Authors: Nobuyoshi Kawaharada, Tetsuya Koyanagi, Yoshihiko Kurimoto, Toshiro Ito, Ryo Harada, Hideki Hyodoh, Atsushi Watanabe, Tetsuya HigamiAbstract:Open repair of aortic aneurysm causes spinal cord perfusion pressure to decrease due to the steal phenomenon from the bleeding of Intercostal Arteries and cross-clamping of the aorta. We attempted to perfuse the Intercostal Arteries for preoperative detection of the artery of Adamkiewicz using newly developed catheters. Fifteen patients underwent selective spinal perfusion with our original catheter as spinal protection during the procedure of distal descending thoracic aneurysm (DTA) or thoracoabdominal aortic aneurysm (TAAA) repair. Seven patients had distal DTA and eight had TAAA. Monitoring of motor evoked potential (MEP) was performed in all patients throughout the operation. The perfusion flow was 30–40 mlymin for each Intercostal artery and was adjusted to keep the proximal circuit pressure at 150–200 mmHg. The average number of perfused Intercostal Arteries was 2.3 per patient and the number of Intercostal Arteries reimplanted per patient was 2.5. Intercostal Arteries were reimplanted using an interpositional graft. MEPs were still observable after graft replacement in all patients and there were no cases of paraparesisyparaplegia. All patients were discharged ambulatory. Selective spinal perfusion maintains the quantity of total blood flow in the spinal cord and is very useful for reducing the incidence of ischemic injury of the spinal cord during operation. 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.
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Examination of Intercostal Arteries with Transthoracic Doppler Sonography
Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, 2009Co-Authors: Tetsuya Koyanagi, Toshio Baba, Atsushi Watanebe, Nobuyoshi Kawaharada, Yoshihiko Kurimoto, Masanori Nakamura, Tetsuya HigamiAbstract:Objective: There has been no study on the measurement of blood flow of the Intercostal artery (ICA) or lumbar artery (LA) with the use of transthoracic Doppler sonography. Here, the method of the ICA depiction and flow measurement were described, and we suggested the clinical usage of this method. Methods: Twelve healthy subjects were examined. The performance of transthoracic Doppler sonography was approached from the back on lateral decubitus position. The Intercostal artery was depicted by two-dimension mode with color flow, and the inner diameter was measured. Peak systolic velocity (PSV), end-diastolic velocity (EDV), velocity-time integral (VTI), and heart rate (HR) were measured with pulsed Doppler, and the blood flow was calculated. Results: Bilateral ICAs and LAs from Th4 to L4 were measurable with this method. The PSV of Lt Th9 was the fastest at 43.3 ± 10.1 cm/sec and the PSV of the ICAs gradually decreased as distance from Th9 increased. As for the flow volume, the left Th11 was the greatest at 99.7 mL/min, and the flow volume of the ICA gradually decreased as distance from Th11 increased. The velocity and blood flow of right ICA tended to be lower than the left in the same spinal level. Conclusions: Evaluation technique of serial ICAs and LAs was shown. We think that it may be a clinically useful method in the study of spinal cord circulation in the repair of cases of descending thoracic or thoracoabdominal aortic aneurysm. (Echocardiography 2010;27:17-20)