We report a case experiencing repeated common iliac artery (CIA) occlusion due to an unexpected stent deformation. A 74-year-old man with intermittent claudication had undergone balloon-expandable stenting for the left CIA. Six years after his first stent implantation, his left CIA was totally occluded inside the stent. We performed revascularization for the left CIA and achieved sufficient balloon inflation and balloon-expandable stenting. Then, one and a half years later, his left CIA was re-occluded. CT angiography showed compression by the protruding hyperostotic lumbar vertebral body, such that both stents had become deformed into a crescent shape. We were told that he had been using a powerful massage machine to stretch and relieve his spondylotic back pain. We suspected that the external pressure of the hyperostotic spondylosis and massage might have caused the CIA compression and repeated crush of the stents.

No abstract

The prognostic evaluation of endoscopic injection sclerotherapy (EIS) for patients with severe esophageal varices in unresectable hepatocellular carcinoma complicated with advanced liver cirrhosis (HCC c̄ LC) was studied. (1) Cumulative survival rate and cause of death were compared in cases of variceal bleeding managed by EIS (18 cases) to cases with variceal bleeding without EIS (12 cases). (2) Cumulative percentage of patients free of bleeding, cumulative survival rate and cause of death were compared in cases managed by prophylactic EIS (14 cases) to cases without prophylactic EIS (30 cases). In the two bleeding groups with and without EIS, and in the non‐bleeding groups with and without prophylactic EIS, patients of each group were comparable in respect to sex ratio, age, and Child's classification. In the bleeding groups, cumulative survival rate at 30 days after EIS was significantly higher in cases with EIS than cases without EIS (P < 0.01). The rate of death after initial bleeding was 16. 7% in cases with EIS and 66.7% in cases without EIS: statistical significance was demonstrated in these two groups (P < 0.01). In the non‐bleeding groups, cumulative percentage of patients free of bleeding and cumulative survival rate were significantly higher in cases with EIS than those without EIS (P < 0.01 and P < 0.05, respectively). Furthermore, no bleeding fatalities from varices were seen in cases with prophylactic EIS. We suggest that EIS improves survival rate and prophylactic EIS prevents variceal bleeding leading to death in cases of unresectable HCC c̄ LC.

Endoscopic mucosal resection (EMR), namely strip biopsy, to eradicate gastric mucosal lesions requires certain special techniques, including submucosal injection of appropriate agents. This experimental study using dogs was conducted to compare, with regard to the degree of duration of mucosal elevation and subsequent histologic changes of the gastric wall, three injection materials; physiological saline, hypertonic saline with epinephrine (HSE) and 10% soybean oil. The duration of mucosal elevation which should be sufficient for the EMR procedure did not differ between the three agents. The post‐injection histologic changes included vessel dilatation in the peri‐muscularis mucosae, dilatation of the lymphatic channels and vessel congestion. These changes appeared in all injection material groups, and the vessel congestion was found to be more conspicuous in the HSE group. All EMRs in this series were performed by single snare cutting, which was also evaluated. The margin of the stripped material was well limited to the submucosal layer in all cases, but the depth of the ulcers formed varied. The healing process of the ulcer for the first 4 weeks was delayed in the soybean oil group. Although there were few cases of perforation in this experiment and some subjects had adhesion between the gastric serosa and adjacent organs, the single snare method could be applicable for clinical use by skilled hands.

A 64‐year‐old female underwent catheter ablation of long R‐P' tachycardia. Ventricular pacing exhibited retrograde conduction with an identical atrial activation sequence as during tachycardia because of an accessory pathway (AP) with a long VA conduction. A radiofrequency application within the posterior coronary sinus (CS) could achieve a change of activation pattern from distal‐to‐proximal to proximal‐to‐distal within CS proximal to the ablation site, caused by conduction block of CS musculature (CSM) at the proximal site. This phenomenon could explain that this AP was connected between the CSM and the left ventricle, in site far away from the discrete connection between the left atrium and CSM.