Objective:We evaluated the long-term outcomes of obturator bypass. Material and Methods: A total of 16 patients (13 males and 3 females; 17 limbs) who underwent obturator bypass surgery at our department between April 1995 and March 2008 were included. Results: Their ages ranged from 50 to 90 with a mean of 74 years. Inguinal infections observed in the 16 patients consisted of vascular graft infections in 13 patients, hemostatic device infections following endovascular therapy in two patients, and femoral artery infections following coronary angiography in one patient. The cumulative patency rate was 69% for 3 years and 43% for 5 years. The cumulative survival rate was 64% for 3 years and 55% for 5 years. Conclusion: Obturator bypass surgery was successfully performed with favorable results for arterial infections and vascular graft infections in the inguinal region.Keywords: obturator bypass, inguinal arterial infections, infections of femoro-popliteal artery bypass grafts surgery to treat them. The obturator bypass we used in this study has a number of advantages, including less graft infections thanks to deep graft routes and shorter graft lengths than other bypasses. We evaluated the long-term outcomes of this operative procedure.

Surgeons should be aware of diaphragmatic hernia in obese patients who have undergone coronary artery bypass grafting (CABG) using a gastroepiploic artery graft (GEA), even if the antegastric route is utilized. We report a case of diaphragmatic hernia, which occurred 88 months after initial CABG. A 64-year-old obese man underwent surgical repair of a diaphragmatic hernia. At initial surgery, the diaphragm was incised vertically and re-sutured, leaving a route for GEA graft. Both the stomach and the lateral segment of the liver were dislocated in the pericardial space. The diaphragmatic defect was closed with a polytetrafluoroethylene patch.

IntroductionWe have increasingly encountered patients with arteriosclerosis obliterans-associated critical limb ischemia in association with increases in diabetic patients and those with subsequent dialysis. The first-line treatment of critical limb ischemia is endovascular treatment or bypass. The TASC II 1) indicates one of these depending on the location and range of lesions. Objective: This study was conducted to determine whether to perform endovascular intervention or bypass surgery as a treatment option for critical limb ischemia (CLI) with lesions in the popliteal artery or below. Subjects and Methods: A total of 150 patients (164 limbs) with CLI underwent endovascular intervention or bypass surgery for lesions in the popliteal artery or below at our department between May 1995 and June 2011. Therapeutic outcomes were examined by surgical technique. An indication for endovascular intervention was established with the combination of (1) poor general condition, and (2) a stenotic or occlusive lesion ≤5 cm. Results: The bypass group (group B) comprised 119 patients (99 males, 20 females) with 131 affected limbs at 46 to 89 years of age (mean: 70 years). The endovascular intervention group (group E) comprised 31 patients (25 males, 6 females) with 33 affected limbs at 47 to 89 years of age (mean: 72 years). There was no significant difference in patient demography between the two groups. Regarding preoperative complications, hypertension was observed in 54% and 61% of the subjects in groups B and E, respectively, diabetes in 36% and 55%, renal dysfunction in 29% and 58%, ischemic heart disease in 27% and 32%, and cerebrovascular disorder in 18% and 23%; renal dysfunction accounted for a significantly higher percentage in group E. As for early postoperative complications, subjects in group B experienced wound infections (6 patients), hemorrhage (2), thrombosis (2), pneumonia (1), and another complication (1), and those in group E experienced wound infections (1) and another complication (1). The hospital mortality rate was 0.8% (1 patient) for group B and 0% for group E. The 3-year cumulative primary patency rate was 72% for group B and 54% for group E; the rate was significantly higher for group B. The 3-year secondary patency rate was 82% for group B and 60% for group E. The 3-year limb salvage rate was 86% for group B and 82% for group E; there was no significant difference between the two groups. The 5-year survival rate was 57% for group B and 42% for group E; the survival rate was significantly lower for group E. Conclusion: For the study population of CLI patients with lesions in the popliteal artery or below, the patency rate was higher for the bypass group than for the endovascular intervention group, whereas there was no difference in the limb salvage rate. Based on the findings in prognosis for survival, the indication for endovascular intervention at our department is believed to be appropriate. (*English translation of Jpn J Vasc Surg 2013; 22: 715-718) Bypass vs. Endovascular Therapy of Infr...

We evaluated the surgical outcomes and postoperative venous functions achieved with each of our surgical procedures for primary varicose veins of great saphenous trunk. Thigh stripping combined with saphenous trunk foam sclerotherapy, endovenous laser ablation with 980-nm diode laser combined with saphenous trunk foam sclerotherapy and subfascial endoscopic perforating vein surgery combined with stripping achieved good surgical outcomes. Postoperative venous function by air plethysmography showed significant improvement with all surgical procedures. In our surgical experience with primary varicose veins of great saphenous trunk, endovenous laser ablation combined with saphenous trunk foam sclerotherapy should be performed if the average diameter of the saphenous vein with valvular insufficiency is less than 10 mm and thigh stripping combined with saphenous trunk foam sclerotherapy should be performed if the average diameter exceeds 10 mm in C2-C4a cases of the CEAP classification. In C4b-C6 cases of the CEAP classification, subfascial endoscopic perforating vein surgery combined with stripping should be performed. Based on good surgical outcomes and improvement of postoperative venous functions with all surgical procedures, we conclude that our surgical strategy for primary varicose veins of saphenous trunk is adequate.

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