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Introduction: Component separation (CS) of the Zenith Dissection Endovascular Graft and Stent have been reported with some causes. However, CS caused by aortic elongation has not yet been reported. A long treatment range with the sacrifice of some intercostal arteries (ICAs) is sometimes needed when repairing CS because of the large difference in the diameter between the proximal and distal landing zones with a reverse taper. Case presentation: A 78-year-old man, who underwent thoracic endovascular aortic repair (TEVAR) using a Zenith Dissection Graft and stents for acute type B aortic dissection 3 years and 8 months previously was admitted to our hospital with severe back pain. Contrast-enhanced computed tomography (CT) showed separation of the SG and bare stent, and aortic elongation. As there was a large difference in the diameter of the proximal and distal landing zones with a reverse taper, a long treatment range with the sacrifice of two large ICAs was needed. Thus, TEVAR using an inverted thoracic SG technique was performed in order to shorten the treatment range to preserve a large ICA and reduce the risk of paraplegia. Completion angiography showed that the separation was repaired with preservation of the large ICA. The postoperative course was uneventful, and he was discharged on postoperative day 10 with relief of his severe pain. At 1 year after secondary TEVAR, CT showed that the diameter of the descending aorta had decreased with no separation of the SGs. Conclusion: Deployment of an inverted thoracic SG for the treatment of CS of the Zenith Dissection Endovascular Graft and Stent is a feasible and effective procedure to preserve ICAs. An overlapping range of >1.5 times the length of a bare stent within an SG is needed to prevent CS of the Zenith Dissection Endovascular Graft and Stent caused by aortic elongation. [ABSTRACT FROM AUTHOR]

Background: The eicosapentaenoic acid to arachidonic acid ratio (EPA/AA) is attracting attention as a risk factor for peripheral artery disease (PAD). However, there have been few studies investigating the relationship between the EPA/AA ratio and atherosclerotic risk factors in patients with PAD. The purpose of the present study was to analyze atherosclerotic risk factors in patients with PAD to identify those factors associated with a low EPA/AA ratio. Methods.: The data of patients treated for symptomatic PAD at Tokyo Medical University Hospital and Eniwa Midorino Clinic between April 2014 and March 2018 were retrospectively analyzed. Results.: A total of 149 patients were tested for blood levels of n-3 and n-6 polyunsaturated fatty acids, including EPA and AA. 73 patients had a low EPA/AA ratio (<0.4) and 76 patients had a high EPA/AA ratio (≥ 0.4). Univariate analysis showed that older age (≥ 75 years), female sex, smoking history, body mass index (BMI), and hemoglobin A1C (HbA1C) were associated with the low EPA/AA ratio. Multivariable analysis showed that older age (odds ratio [OR], 0.34; 95% confidential interval [CI], 0.15-0.76; p = 0.008), BMI (OR, 0.87; 95% CI, 0.77-0.98; p = 0.027), smoking history (OR, 2.67; 95% CI, 1.09-6.55; p = 0.007), and HbA1C (OR, 0.46; 95% CI, 0.29-0.72; p = 0.020) were independently associated with the low EPA/AA ratio. Conclusions.: The EPA/AA ratio was related to existing arteriosclerotic risk factors in patients with PAD; it was positively correlated with older age, increasing BMI, and higher HbA1C, whereas it was negatively correlated with smoking history. These results suggest that the EPA/AA ratio may be closely intertwined with other atherosclerotic risk factors and have an influence on cardiovascular health. [ABSTRACT FROM AUTHOR]

The frozen elephant trunk (FET) technique, initially developed as a one-stage procedure to treat extensive thoracic aortic aneurysms, has since been adapted to address acute and chronic aortic dissections by closing entry tears and expanding the true lumen. It has become widely adopted due to its effectiveness in managing aortic diseases. We present the case of a 39-year-old female with microscopic polyangiitis (MPA) who developed recurrent type B aortic dissection accompanied by rapid expansion. The patient, a compromised host with multiple comorbidities such as glomerulonephritis, chronic renal failure, alveolar hemorrhage, and acute pancreatitis, required urgent surgical intervention. Given the complexity of her condition and the high risks associated with direct surgery, a staged approach was selected. The first stage involved using a novel FET prosthesis, the FROZENIX Partial ET (FPET), inserted via median sternotomy, followed by a left thoracotomy for non-deep hypothermic circulatory arrest (non-DHCA) descending aortic replacement. The surgery led to favorable outcomes without any major complications or sequelae. FPET offers distinct advantages in this complex scenario. Its design features a 2 cm stent-free distal section, which reduces the risk of distal stent graft-induced new entries (dSINEs) and simplifies anastomosis during the second stage of surgery. For patients with severe comorbidities and anatomical challenges that make the thoracic endovascular aortic repair (TEVAR) unsuitable, a staged open surgical approach is a viable alternative, mitigating the risks linked to DHCA. This case underscores the utility of a staged surgical approach using FPET in managing complicated chronic type B aortic dissection in patients with significant comorbidities. The FPET prosthesis facilitates effective lesion control while minimizing the risk of dSINEs and streamlining subsequent surgical procedures, presenting a promising strategy for similar complex cases., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kinoshita et al.)

Direct oral anticoagulants (DOACs) are widely used in cardiovascular medicine. Although rivaroxaban has potential benefits for anticoagulation in certain contexts, DOACs remain contraindicated in patients with mechanical heart valves. This case report highlights the life-threatening risks of rivaroxaban use in patients with mechanical aortic valves, underscoring the lack of proven efficacy and the necessity of adhering to established anticoagulation protocols with warfarin for this patient population. Here, we report a case of a 65-year-old man who had previously undergone aortic valve replacement and developed a thrombus in the mechanical aortic valve six months after switching from warfarin to rivaroxaban. The patient experienced a sudden loss of consciousness and chest discomfort. Echocardiography revealed a thrombus in the valve requiring urgent reoperation and replacement with a bioprosthetic valve. The postoperative recovery was uneventful., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kinoshita et al.)

A patient underwent surgical resection twice for primary and metastatic dedifferentiated liposarcomas. Computed tomography revealed a tumor mass at the cavoatrial junction. Prompt surgical resection of the tumor with thrombectomy was successfully performed using cardiopulmonary bypass with hypothermic circulatory arrest. Despite the poor prognosis of metastatic or recurrent liposarcoma, the patient has survived for 8 years since the first tumor resection.

Objective: The relationship between nutritional status and morbidity and death in a number of diseases and disorders has garnered considerable attension. In patients having endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA), we assessed the prognostic value of nutritional markers of albumin (ALB), body mass index (BMI), and geriatric nutritional risk index (GNRI) for long-term mortality. Materials and Methods: Retrospective data analysis was done on patients who had undergone elective EVAR for AAA more than 5 years earlier. Results: A total of 176 patients underwent EVAR for AAA between March 2012 and April 2016. The optimal cutoff value of ALB, BMI, and GNRI for predicting long-term mortality was calculated as 3.75 g/dL (area under the curve [AUC] 0.64), 21.4 kg/m 2 (AUC 0.65), and 101.4 (AUC 0.70), respectively. Low ALB, low BMI, and low GNRI as well as age ≥75 years, chronic obstructive pulmonary disease, chronic kidney disease, and active cancer were independent risk factors for long-term mortality. Conclusion: Malnutrition, which is measured by ALB, BMI, and GNRI, is an independent risk factor for long-term mortality in patients receiving EVAR for AAA. Of the nutritional markers, the GNRI can be the most reliable nutritional indicator to identify a potentially high-risk group of mortality after EVAR., Competing Interests: Disclosure StatementThe authors report no actual or possible conflict of interest in relation to this article., (© 2023 The Editorial Committee of Annals of Vascular Diseases.)