Hajime Tsuyuki

A Case of Recurrent Deep Vein Thrombosis in an Extremely Elderly Patient Treated with Intermittent Edoxaban

Yosuke Mihara, Naoto Yamamoto, Nozomu Ishikawa, Yusuke Endo et autres

症例は90歳代女性．リウマチ性多発筋痛症でプレドニゾロンを内服していた．転倒後に左下肢の腫脹を認め，エコー検査で左中枢型深部静脈血栓症を指摘されたため，エドキサバン30 mgで治療を開始した．治療開始から13カ月で貧血の進行を認め，治療を中断したが1カ月で深部静脈血栓の再発を認めた．エドキサバン30 mgの内服を再開したが，関節血腫や消化管出血を発症した．エドキサバンの減量を行ったが，その後も輸血を要する貧血の進行を認めたため最終的にはエドキサバン15 mgを3日に1回投与する間欠的投与にて，貧血の進行や再発なく経過している．本症例では，再発性深部静脈血栓症に対して抗凝固療法の継続が必要であったが，超高齢，腎機能低下，貧血の進行といった問題があり治療に難渋した．エドキサバンの超低用量かつ間欠的投与は一般的な治療ではなくエビデンスに乏しいが，十分に患者背景を検討した上で症例によっては治療の選択肢の1つになり得ると考えた．

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Age-related differences in elastin content and mechanical properties influence susceptibility to hypoperfusion-induced abdominal aortic aneurysm

Nozomu Ishikawa, Naoki Unno, Kazunori Inuzuka, Hajime Tsuyuki et autres

Abdominal aortic aneurysm (AAA) predominantly affects older individuals, yet the mechanisms by which aging increases susceptibility to aneurysm formation remain incompletely understood. The infrarenal aorta, where most AAAs develop, possesses sparse adventitial vasa vasorum (VV), suggesting limited mural perfusion reserve. We hypothesized …

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Regional tissue oxygen saturation as an indicator of wound healing during endovascular treatment for chronic limb-threatening ischaemia

Hajime Tsuyuki, Masaki Sano, Kazunori Inuzuka, Kazuto Katahashi et autres

Objective: It is important to evaluate limb blood flow during the perioperative period to salvage affected limbs in patients with chronic limb-threatening ischaemia (CLTI). However, it is difficult to evaluate limb blood flow during endovascular treatment (EVT). This study aimed to investigate …

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Inferior Vena Cava Thrombosis After Nephrectomy of the Native Kidneys in Patients With Autosomal Dominant Polycystic Kidney Disease

Yuto Matsushita, Kyohei Watanabe, Taro Aoki, Hajime Tsuyuki et autres

ABSTRACT Background Inferior vena cava (IVC) thrombosis associated with autosomal dominant polycystic kidney disease (ADPKD), caused by mechanical compression from a large liver or renal cysts, has previously been reported. However, postoperative thrombosis following nephrectomy of the native kidneys has not been …

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Technical threshold for endovascular repair in isolated common iliac artery aneurysms based on loss of the proximal landing zone at smaller diameters

Nozomu Ishikawa, Kazunori Inuzuka, Masaki Sano, Kazuto Katahashi et autres

Objective Current guidelines recommend increasing diameter thresholds for intervention in isolated iliac artery aneurysms based on rupture risk. However, anatomical feasibility and procedural complexity have not been fully considered. This study evaluated the relationship between aneurysm size and endovascular treatment strategy. Methods …

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Prevalence of median arcuate ligament syndrome and associated visceral artery aneurysms: Insights from computed tomography radiology reports in a single institution and management strategies

Yusuke Endo, Kazunori Inuzuka, Masaki Sano, Kazuto Katahashi et autres

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Anticoagulant Prophylaxis with Edoxaban for Asymptomatic Isolated Distal Deep Vein Thrombosis in Perioperative Hip Fracture Patients

Nozomu Ishikawa, Naoto Yamamoto, Tatsuro Yata, Takafumi Kayama et autres

一般的な下腿限局型深部静脈血栓症（DVT）は中枢伸展リスクや肺血栓塞栓症（PTE）リスクが低く，画一的な抗凝固療法は推奨されていない．一方，大腿骨近位部骨折（HF）周術期はDVT伸展リスクが高いが，治療量の抗凝固療法では出血リスクが懸念される．HF周術期における無症候性下腿限局型DVTに対する抗凝固療法には明確な推奨がなく，エドキサバンによる通常の予防的抗凝固療法の妥当性を後方視的に検討した．2017年4月から2022年9月に当院でHF手術を受けた患者のうち，周術期に無症候性下腿限局型DVTを指摘された連続74例を対象とした．エドキサバンによる予防52例のうち，30 mg内服が23例，減量基準のため15 mg内服が29例だった．抗凝固療法期間は5–28日（中央値14日）．抗凝固療法開始後から3カ月間の有症状VTEの再発はなかった．HF周術期に発症した無症候性下腿限局型DVTに対して，特別な治療は必要なく，HF周術期の一般的な予防策で有症状VTEの発生を安全に抑制できる可能性が示唆された．

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Retrospective Study of 43 Cases of Visceral Artery Aneurysms: Evaluation of Surgical Indications Based on the 2020 Revised Guidelines of the Society for Vascular Surgery

Nozomu Ishikawa, Kazunori Inuzuka, Masaki Sano, Kazuto Katahashi et autres

Objectives: Advancements in imaging technology have led to an increase in the incidental detection of visceral artery aneurysms (VAAs), which are associated with high mortality when ruptured. In 2020, the Society for Vascular Surgery (SVS) released updated guidelines, replacing the previous 2005 …

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A Case of Elbow Extension Limitation Caused by Phlebosclerosis Following Peripheral Intravenous Chemotherapy: A Case Report and Literature Review

Nozomu Ishikawa, Kazunori Inuzuka, Masaki Sano, Kazuto Katahashi et autres

We report a rare case of phlebosclerosis in the left antecubital region after peripheral intravenous chemotherapy, which caused elbow contracture. A 54-year-old woman with breast cancer underwent partial mastectomy of the right breast and 8 courses of neoadjuvant chemotherapy, 6 of which …

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Tissue oxygen saturation as an indicator of wound healing around endovascular treatment in chronic limb-threatening ischemia

Hajime Tsuyuki

雑誌掲載タイトル: Regional tissue oxygen saturation as an intraoperative indicator of wound healing following endovascular treatment for chronic limb-threatening ischemia

Recent Experience with Inferior Vena Cava Filters

Nozomu Ishikawa, Naoto Yamamoto, Yusuke Endo, Hajime Tsuyuki et autres

下大静脈フィルター（IVCF）は長期留置に伴う合併症もあり早期回収が推奨されるが，大きなフィルター内血栓があると回収時に肺動脈血栓塞栓症（PTE）を生じる可能性がある．2017年4月～2021年12月に診察した静脈血栓塞栓症（VTE）308例のうち下肢深部静脈血栓症（DVT）は271例（うち中枢型148例）．IVCFを留置した12例について検討した（中枢型DVTの8.1%）．IVCFはニューハウスプロテクトSE 1例，OptEase 2例，ALN 9例．回収なしが3例，画像上フィルター内血栓なく回収が4例，2 cm未満の血栓あり回収が3例，4 cm以上の大きな血栓あり直接作用型経口抗凝固薬（DOAC）強化療法後回収が2例．全例で有症状PTEなし．DOAC強化療法の2例とも出血性合併症なし．血栓溶解療法では出血リスクがある場合でもDOAC強化療法でフィルター内血栓を縮小させて有症状PTEを発症することなくIVCF回収が可能であることが示唆された．ガイドラインが改訂され，使用頻度が減少しているなか，IVCFの適正使用についても考察した．

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Risk and Prognosis of Upper Extremity Deep Vein Thrombosis

Yusuke Endo, Naoki Unno, Naoto Yamamoto, Masaki Sano et autres

Objectives: We aimed to investigate the clinical features of upper extremity deep vein thrombosis (UEDVT).Methods: We retrospectively reviewed the background, thrombus site, treatment, and outcome of 76 UEDVT patients.Results: Of the 76 UEDVT patients, 44 (57.9%) were men, and 51 (67.1%) were …

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