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SurgeryVascular Surgery

Introduction

 We originated from the vascular research team of the former first department of surgery and became an independent division in 2002. The research and clinical practice of vascular surgery has been a center of great interest for our predecessors since Professor Saito, who founded the former first department of surgery in 1919, had pioneered the development of angiography ahead of the time. In the era of Professor Shionoya (1984-1991), the clinical and research activity in the area of vascular surgery has progressed. Especially, his research into Buerger's disease achieved global reputation.
 In 2002, as a head of our new independent division, Professor Kimihiro Komori assumed the position of professor.

Research Projects

OUR TOPICS OF RESEARCH

A. Basic scientific research/ At the bench
1.Molecular mechanism of late failure of bypass grafts
2.Gene- and drug-therapy targeting the intimal hyperplasia
3.Therapeutic angiogenesis for critical limb ischemia
4.Biological marker of intestinal ischemia after aortic surgery
5.Molecular mechanisms of development of aortic aneurysm
6.Experimental animal model of aortic aneurysm
7.Prevention of prosthetic graft infection after surgery

B. Clinical research/ At the bedside
1.Therapeutic angiogenesis for critical limb ischemia
2.Control and prevention of late failure of bypass grafts
3.Clinical and histopathological study of Buerger’s disease
4.Gene- and drug-therapy targeting the intimal hyperplasia
5.Development of non-invasive diagnostic measures

OVERVIEW
 Intimal hyperplasia after the revascularization is a major cause of restenosis of graft or stent, and results in the late failure. Our team has been challenging to elucidate the mechanism of intimal hyperplasia using the molecular biology. Our goal is the development of brand-new technology to prevent the hyperplasia and to improve the clinical outcomes after revascularization.
 On the other hand, we have been developing and performing therapeutic angiogenesis for patients suffering from critical ischemic limbs, but in whom bypass surgery is not feasible.

A. Modulation of intimal hyperplasia
 In animal models, we have revealed following mechanisms.
1. Abnormal blood flow enhances intimal hyperplasia of autologous vein graft
2. Low shear stress suppress the production of prostacyclin (PGI2) and Nitric Oxide(NO) significantly in vein graft, but not in arterial graft. 
3. Dyslipidemia enhances the intimal hyperplasia.

a. Gene therapy
 We have reported that transfection of ecNOS gene using HVJ liposome as a vector inhibited the intimal hyperplasia. Moreover, in-vivo transfection of 'decoy' against AP-1 also significant inhibitory effects.
 Moreover, we revealed that intimal hyperplasia could be controlled by the introduction of anti-sense ODN targeting midkine(Am J Physiol 2005) and siRNA (J Vasc Surg 2006).

Rabbit Vein graft model
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Histological findings of vein graft after 28 days
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b. Pharmacological therapy
 We elucidated the inhibitory effect of pravastatin against intimal hyperplasia.(J Vasc Surg, 2005)

Suppression of intimal hyperplasia by Pravastatin
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B. Therapeutic angiogenesis
 We study therapeutic angiogenesis by cell transplantation and by gene therapy. In our hospital, monocytes derived from bone marrow were transplanted to seven critical ischemic limbs, achieving good clinical results. Implanatation of CD 34 positive cells were also performed in our hospitals, and its early results were promising. (Lancet2002)。As for gene therapy, we have reported that introduction of FGF to ischemics limbs improve the blood supply (Am J Physiol 2003).

C. Buerger's disease - Histopathological findings -
 Although incidence of Buergers's disease is rapidly decreasing even in Japan, it is still one of major causes of severe limb ischemia and its etiology is yet to be elucidated. We have many historical cohort of patients and histological specimen of Buerger's disease. With these resources, our study focuses on the clinical and histopathological aspects of this disease and tries to elucidate the unknown mechanisms.

Faculty Members

FacultyPositionDepartment
Kimihiro Komori Professor Vascular surgery
Hiroshi Banno Lecturer Vascular surgery
Akio Kodama Lecturer Vascular surgery
Kiyoaki Niimi Assistant professor Vascular surgery
Masayuki Sugimoto Assistant professor Vascular surgery
Akio Koyama Assistant professor Vascular surgery

Bibliography

  • 2016
    1. Sugimoto M, Torsello GF, Torsello GB, Austermann M, Stachmann A, Bisdas T. Post-market clinical experience with the INCRAFT AAA stent graft system for challenging access routes. Ann Vasc Surg, 2016 [in press]
    2. Tokunaga S, Ihara T, Banno H, Kodama A, Sugimoto M, Komori K. The relationship between temporal changes in proximal neck angulation and stent graft migration after endovascular abdominal aortic aneurysm repair. Ann Vasc Surg, 2016. [Epub ahead of print]
    3. Maekawa T, Komori K, Kodama A, Banno H, Narita H, Sugimoto M. The impact of inflow treatment for claudicants with both aortoiliac and femoropopliteal occlusive disease. Surg Today, 2016. [Epub ahead of print]
    4. Watanabe Y, Shibata R, Ouchi N, Kambara T, Ohashi K, Jie L, Inoue Y, Murohara T, Komori K. Adiponectin ameliorates endotoxin-induced acute cardiac injury. Biomed Res Int. 2016. [in press]
    5. Tanaka A, Ishii H, Suzuki S, Ota T, Oshima H, Usui A, Komori K, Murohara T. Influence of False Lumen Status on the Prognosis of Acute Type A Aortic Dissection without Urgent Surgical Treatment. J Atheroscler Thromb, 2016. [Epub ahead of print]
    6. Hayashi H, Sato W, Kosugi T, Nishimura K, Sugiyama D, Asano N, Ikematsu S, Komori K, Nishiwaki K, Kadomatsu K, Matsuo S, Maruyama S, Yuzawa Y. Efficacy of urinary midkine as a biomarker in patients with acute kidney injury. Clin Exp Nephrol. 2016 Aug 16. [Epub ahead of print]
    7. Ihara T, Komori K, Banno H, Kodama A, Yamamoto K, Sugimoto M. Relationship between the distal migration and length of the distal landing zone after endovascular aneurysm repair (EVAR). Surg Today, 2016; 46:56-61.
    8. Tokuda Y, Oshima H, Narita Y, Abe T, Araki Y, Mutsuga M, Fujimoto K, Terazawa S, Yagami K, Ito H, Yamamoto K, Komori K, Usui A. Hybrid versus open repair of aortic arch aneurysms: comparison of postoperative and mid-term outcomes with a propensity score-matching analysis. Eur J Cardiothorac Surg, 2016; 49:149-56.
    9. Yokoi H, Ohki T, Kichikawa K, Nakamura M, Komori K, Nanto S, O'Leary EE, Lottes AE, Snyder SA, Dake MD. Zilver PTX Post-Market Surveillance Study of Paclitaxel-Eluting Stents for Treating Femoropopliteal Artery Disease in Japan: 12-Month Results. JACC Cardiovasc Interv, 2016; 9:271-7.
    10. Shi C, Tercero C, Wu X, Ikeda S, Komori K, Yamamoto K, Arai F, Fukuda T. Real-time in vitro intravascular reconstruction and navigation for endovascular aortic stent grafting. Int J Med Robot. 2016 [in press]
    11. Kojima M, Carlos T, Yamamoto K, Ikeda S, Ooe K, Arai F, Komori K, Fukuda T:Evaluation of Active Catheter for Branched Stent Graft with Numerical Simulation under Pulsatile Flow. 日本ロボット学会誌. [in press]
    12. Koyama A, Komori K, Otsuka R, Kajikuri J, Itoh T. Dipeptidyl-peptidase 4 inhibitor reduces intimal hyperplasia in rabbit autologous jugular vein graft under poor distal runoff. J Vasc Surg, 2016; 63:1360-70.
    13. Yamamoto K, Komori K, Narita H, Morimae H, Tokuda Y, Araki Y, Oshima H, Usui A. A 'through-and-through bowing technique' for antegrade thoracic endovascular aneurysm repair with total arch debranching: a technical note and the initial results. Eur J Cardiothorac Surg, 2016; 49:1264-9.
    14. Hayashi K, Hirashiki A, Kodama A, Kobayashi K, Yasukawa Y, Shimizu M, Kondo T, Komori K, Murohara T. Impact of preoperative regular physical activity on postoperative course after open abdominal aortic aneurysm surgery. Heart Vessels, 2016; 31:578-83.
  • 2015
    1. Miyachi H, Takahashi M, Komori K. A Novel Approach against Vascular Intimal Hyperplasia Through the Suppression of Girdin. Ann Vasc Dis, 2015; 8:69-73.
    2. Takahashi N, Shibata R, Ouchi N, Sugimoto M, Murohara T, Komori K. Metformin stimulates ischemia-induced revascularization through an eNOS dependent pathway in the ischemic hindlimb mice model. J Vasc Surg, 2015; 61:489-96.
    3. Sugimoto M, Miyachi H, Morimae H, Kodama A, Narita H, Banno H, Yamamoto K, Komori K. The fate of ischemic limbs in patients with Buerger's disease based on our 30-year experience: does smoking have a definitive impact on the late loss of limbs? Surg Today, 2015; 45:466-70.
    4. Tanaka A, Ishii H, Oshima H, Narita Y, Kodama A, Suzuki S, Komori K, Usui A, Murohara T. Inverse association between diabetes and aortic dilatation in patients with advanced coronary artery disease. Atherosclerosis, 2015; 242:123-127.
    5. Yamamoto K, Komori K , Banno H , Narita H , Kodama A , Sugimoto M. Validation of Patient Selection for Endovascular Aneurysm Repair or Open Repair of Abdominal Aortic Aneurysm – Single-Center Study –. Circ J, 2015; 79:1699-705.
    6. Sugimoto M, Kodama A, Narita H, Banno H, Yamamoto K, Komori K. Pre- and Intraoperative Predictors of Delirium after Open Abdominal Aortic Aneurysm Repair. Ann Vasc Dis, 2015; 8:215-9.
    7. Sugimoto M, Panuccio G, Bisdas T, Berekoven B, Torsello G, Austermann M. Tortuosity is the significant predictive factor for renal branch occlusion after branched endovascular aortic aneurysm repair. Eur J Vasc Endovasc Surg, 2015;51:350-7.
  • 2014
    1. Tamai H, Kobayashi M, Takeshita K, Kodama A, Banno H, Narita H, Yamamoto K, Komori K. Possible involvement of Notch signaling in the pathogenesis of Buerger's disease. Surg Today, 2014; 44 :307-13.
    2. Kodama A, Itoh T, Komori K. Possible roles of 5-HT in vein graft failure due to intimal hyperplasia 5-HT, nitric oxide and vein graft. Surg Today,2014; 44:213-218.
    3. Kobayashi M, Sugimoto M, Komori K. Endarteritis Obliterans in the Pathogenesis of Buerger's Disease From the Pathological and Immunohistochemical Points of View.Circ J, 2014; 78:2819-26.
    4. Nakamura M, Miyata T, Ozeki Y, Takayama M, Komori K, Yamada N, Origasa H, Satokawa H, Maeda H, Tanabe N, Unno N, Shibuya T, Tanemoto K, Kondo K, Kojima T. Current Venous Thromboembolism Management and Outcomes in Japan– Nationwide The Japan Venous Thromboembolism Treatment Registry Observational Study - . Circ J, 2014; 78:708-717.
    5. Miyachi H, Mii S, Enomoto A, Murakumo Y, Kato T, Asai N, Komori K , Takahashi M:Role of Girdin in intimal hyperplasia in vein grafts and efficacy of atelocollagen-mediated application of small interfering RNA for vein graft failure. J Vasc Surg, 2014; 60:479-489.
    6. Oshima H, Yamamoto K, Komori K, Usui A. Usefulness of bridging thoracic endovascular aortic repair and sac irrigation followed by open repair in patients with mycotic thoracic aortic aneurysms. J Thorac Cardiovasc Surg, 2014; 148:2422-4.
    7. Kodama A , Sugimoto M , Kuma S , Okazaki J , Mii S , Komori K. Clinical Outcomes After Infrainguinal Bypass Grafting for Critical Limb Ischaemia in Patients with Dialysis-dependent End-stage Renal Failure. Eur J Vasc Endovasc Surg, 2014; 48:695-702.
  • 2013
    1. Ihara T, Komori K, Yamamoto K, Kobayashi M, Banno H, Kodama A. Three-Dimensional Workstation is Useful for Measuring the Correct Size of Abdominal Aortic Aneurysm Diameters. Ann Vasc Surg, 2013; 27:154–161.
    2. Inoue Y, Yoshikawa D, Ishii H, Isobe S, Kumagai S, Suzuki S, Okumura S ,Hayashi M, Matsubara T, Ohshima S, Banno H, Komori K, Kato K, Murohara T:Post Stress Perfusion Abnormalities Detected by Myocardial Perfusion SPECT Predict Long-Term Mortality after Elective Abdominal Aortic Aneurysm Repair.Circ J. 77(5):1229–1234,2013
    3. Miyata S, Noda A, Nishikimi N, Iwami Yamada A, Murohara T, Komori K. Disproportionate change of blood flow between the upper limbs and the lower limbs in healthy young adults during recovery from exercise. Gazzetta Medica Italiana Archivio per le Scienze Mediche, 2013; 172 :131-136.
  • 2012
    1. Banno H, Morimae H, Ihara T, Kobayashi M, Yamamoto K, Komori K. Late type III endoleak from fabric tears of a Zenith stent graft: report of a case. Surgery Today, 2012; 42:1206-9.
    2. Hori A, Shibata R, Morisaki K, Murohara T, Komori K. Cilostazol stimulates revascularisation in response to ischaemia via an eNOS-dependent mechanism. Eur J Vasc Endovasc Surg, 2012; 43:62-5.
    3. Morimae H, Maekawa T, Tamai H, Takahashi N, Ihara T, Hori A, Narita H, Banno H, Kobayashi M, Yamamoto K, Komori K. Cost disparity between open repair and endovascular aneurysm repair for abdominal aortic aneurysm: a single-institute experience in Japan. Surg Today, 2012; 42:121-6.
    4. Maekawa T, Komori K, Kajikuri J, Itoh T. Characteristics of the actions by which 5-hydroxytryptamine affects electrical and mechanical activities in rabbit jugular vein graft. Br J Pharmacol, 2012; 166:1419-32.
    5. Shi C, Tercero C, Ikeda S, Ooe K, Fukuda T, Komori K, Yamamoto K. In vitro three-dimensional aortic vasculature modeling based on sensor fusion between intravascular ultrasound and magnetic tracker. Int J Med Robot, 2012; 8:291-299.
    6. Shigematsu H, Komori K, Tanemoto K, Harada Y, Nakamura M. Clopidogrel for Atherothrombotic Event Management in Patients with Peripheral Arterial Disease (COOPER) Study: Safety and Efficacy of Clopidogrel versus Ticlopidine in Japanese Patients. Ann Vasc Dis, 2012; 5 :364-375.
    7. Yamanouchi D, Takei Y, Komori K. Balanced mineralization in the arterial system : possible role of osteoclastogenesis /osteoblastogenesis in abdominal aortic aneurysm and stenotic disease. Circ J, 2012; 76 :2732-7.
    8. Sugimoto M, Komori K. Mycotic aneurysm of the tibioperoneal trunk which precipitated acute compartment syndrome: report of a case. Surg Today, 2012; 42:1001-4.
    9. Morisaki K, Kobayashi M, Miyachi H, Maekawa T, Tamai H, Takahashi N, Watanabe Y, Morimae H, Ihara T, Kodama A, Narita H, Banno H, Yamamoto K, Komori K. Subclavian artery aneurysm in Marfan syndrome. Ann Vasc Surg, 2012 ;26 :731.
    10. Banno H, Kobayashi M, Yamamoto K, Komori K. Late type Ⅲendoleak from fabric tears of a zenith stent graft: report of a case. Surg Today, 2012; 42:1206-1209.
  • 2011
    1. Sugimoto M, Banno H, Idetsu A, Matsushita M, Ikezawa T, Komori K. Surgical experience of 13 infected infrarenal aortoiliac aneurysms: preoperative control of septic condition determines early outcome. Surg Today, 2011; 149:699-704.
    2. Sato T, Tamai H, Kobayashi M, Yamamoto K, Komori K. Immunohistochemical properties in the patients with Buerger's disease - possible role of plasminogen activator inhibitor-1(PAI-1)for preservation of vessel wall architecture. Cardiovasc Pathol, 2011; 20:266-71.
    3. Morisaki K, Shibata R, Takahashi N, Ouchi N, Maehara Y, Murohara T, Komori K. Pioglitazone prevents intimal hyperplasia in experimental rabbit vein grafts. J Vasc Surg, 2011; 54:1753-9.

Research Keywords

Intimal hyperplasia、 EVAR、 TEVAR、 Therapeutic angiogenesis