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Current Status of a Nationwide Registry for Vascular Surgery in Japan

  • Kimihiro Komori
    Correspondence
    Corresponding author.
    Affiliations
    Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
    Chief Director of the Japanese Society of Vascular Surgery (JSVS), former Director of the Japan Committee for Stentgraft Management (JACSM) and EJVES Editorial Board member
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Open ArchivePublished:May 09, 2021DOI:https://doi.org/10.1016/j.ejvs.2021.04.011
      In Japan, in 2010, the Surgical Clinical Society established the General Incorporated Association National Clinical Database (NCD) as a surgical case database. This year, 2021, marks the eleventh year since its establishment. The Japanese Society of Vascular Surgery (JSVS) is promoting research in vascular surgery by using these NCD data to compile new evidence to be widely shared to benefit the association’s members.
      As one of the first attempts by the JSVS to use NCD data from vascular surgery cases, a study entitled “Treatment outcomes of infected abdominal aortic and common iliac artery aneurysms: a nationwide multicentre retrospective study” was conducted. Infected aneurysms account for approximately 1% – 2% of abdominal aortic and common iliac artery aneurysms (aortic/CIA aneurysms). Although a relatively rare condition, it is often challenging to treat. The effectiveness of endovascular aortic aneurysm repair (EVAR) is not clearly accepted, and, at present, there is a paucity of recommendations with strong evidence in the guidelines.
      • Wanhainen A.
      • Verzini F.
      • Van Herzeele I.
      • Allaire E.
      • Bown M.
      • Cohnert T.
      • et al.
      European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms.
      This study aimed to collect surgical cases of infected aneurysms registered in the NCD and examine their pathophysiology, surgical procedures, and post-operative prognosis. The conclusion was that open surgery showed a relatively favourable outcome, while EVAR performance was acceptable. These results suggest favourable outcomes following surgical management of infected abdominal aortic/CIA aneurysms, and EVAR showed outcomes similar to those of open repair. The results of this study were recently accepted for publication.
      • Hosaka A.
      • Kumamaru H.
      • Takahashi A.
      • Azuma N.
      • Obara H.
      • Miyata T.
      • et al.
      on behalf of the Japanese Society for Vascular Surgery Database Management Committee. Treatment outcomes of infected abdominal aortic and common iliac artery aneurysms: a nationwide multicenter retrospective study.
      In addition to this study, two other studies, entitled “A national multicentre observational study on treatment options for open surgery and EVAR for ruptured abdominal aortic aneurysms” and “An examination of surgical procedures and prognosis for popliteal artery entrapment syndrome”, respectively, are being conducted.
      Furthermore, the JSVS established the JAPAN Critical Limb Ischaemia Database (JCLIMB). There is an increasing number of the patients with chronic limb threatening ischaemia (CLTI) registered in clinical practice, and efforts to improve the treatment outcomes have become an important and urgent issue. In Japan, patient characteristics are different from other countries owing to the high prevalence of diabetes and renal replacement therapy in Japanese patients.
      • 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.
      JCLIMB is a database that registers the background, treatment details, early prognosis, and remote prognosis of patients with CLTI who have been treated, including non-surgical conservative treatment. The JSVS is compiling the data from these cases using the NCD as the surgical patient registration database.
      The purpose of JCLIMB is as follows: firstly, to clarify the overall characteristics of patients with CLTI in Japan and the current state of CLTI treatment by registering and tracking the treated patients with CLTI in the database, and analysing their long term outcomes; secondly, to create a Japanese guideline for CLTI treatment and to improve the quality of care for the increasing number of patients with CLTI by analysing various treatment methods and long term prognosis. The manuscript summarising the results of this study is in press.
      • Miyata T.
      • Mii S.
      • Kumamaru H.
      • Takahashi A.
      • Miyata H.
      The Japanese Society for Vascular Surgery JCLIMB Committee. Risk prediction model for early outcomes of revascularization for chronic limb-threatening ischaemia.
      The aortic aneurysm treatment strategy is one of the concerns of the vascular surgeon. Endovascular repair is widely accepted as a primary treatment strategy. In Japan, the Japanese Committee for Stent graft Management (JACSM) was established in December 2006 after receiving regulatory approval for commercially available stent grafts. Thereafter, the organisation’s management committee established the necessary format and criteria to examine the practitioner, instructor, and facilities involved in “abdominal aortic aneurysm stent graft” treatments. The qualification examinations for performing EVAR began in June 2007. In March 2008, in accordance with the ‘Thoracic aortic aneurysm stent graft implementation standards’, a standard examination for performing thoracic EVAR (TEVAR) was also initiated. Under the initiative of the JACSM, the practitioner is obliged to register all cases. Its primary purpose is to collect and analyse data to establish safety measures, improve the quality of the treatment methods, and disclose the results to foster national medical knowledge to promote health and welfare.
      In 2010, a paper published in EJVES introduced the JACSM and presented the registry’s preliminary data.
      • Obitsu Y.
      • Ishimaru b S.
      • Shigematsu H.
      The education system to master endovascular aortic repair in Japan – the Japanese Committee for Stentgraft Management.
      In 2019, the EVAR data summary was published.
      • Hoshina K.
      • Ishimaru S.
      • Sasabuchi Y.
      • Yasunaga H.
      • Komori K.
      Japan Committee for Stentgraft Management (JACSM)
      Outcomes of endovascular repair for abdominal aortic aneurysms: a nationwide survey in Japan.
      In addition to the two manuscripts introducing the JACSM and its registry, the committee reported the outcomes related to TEVAR.
      • Hoshina K.
      • Kato M.
      • Ishimaru S.
      • Michihata N.
      • Yasunaga H.
      • Komori K.
      on behalf of the Japan Committee for Stentgraft Management (JACSM). Impact of the urgency and the landing zone on the in-hospital death, the stroke and the paraplegia after thoracic endovascular aortic repair: a nationwide survey in Japan.
      In addition, in 2021, the JACSM demonstrated the number of EVAR procedures and the mortality and complication rates in 2017 in Japan.
      • Hoshina K.
      • Komori K.
      • Kumamaru H.
      • Shimizu H.
      The outcomes of endovascular aneurysm repair in Japan in 2017: a report from the Japanese Committee for Stentgraft Management.
      Since 2019, clinical research using the data from JACSM has been solicited nationwide.
      Finally, I would like to introduce a brief history of the Japanese Society for Vascular Surgery. The first meeting of the Vascular Surgery Study Group was held in April 1963. It was established as a place where young vascular surgeons could discuss research in vascular surgery frankly. Until the seventeenth meeting in 1989, the study group functioned with a relatively closed format; however, during this period, the number of vascular surgery researchers increased significantly. In 1990, the name was changed to the “Vascular Surgery Forum”, and it was decided that abstracts would be solicited widely. Subsequently, in 1992, after 20 meetings had taken place since the establishment of the Vascular Surgery Study Group, the name was changed to the “Japanese Society for Vascular Surgery”, and a new start was made by creating a “new comprehensive society of vascular surgery”. The number of members as of March 2021 was3 775 (3 528 males and 247 females), and annual vascular surgery cases have been reported in English language journals since 2011. The annual number of cases in 2014 was 113 296.
      The Japanese Society for Vascular Surgery Database Management Committee Member, and NCD Vascular Surgery Data Analysis Team. Vascular Surgery in Japan: 2014 Annual Report by the Japanese Society for Vascular Surgery.
      In this editorial, I have introduced the nationwide registry of vascular surgery cases in Japan. The JSVS will continue to promote dissemination of Japanese data to the world.

      References

        • Wanhainen A.
        • Verzini F.
        • Van Herzeele I.
        • Allaire E.
        • Bown M.
        • Cohnert T.
        • et al.
        European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms.
        Eur J Vasc Endovasc Surg. 2019; 57: 8-93
        • Hosaka A.
        • Kumamaru H.
        • Takahashi A.
        • Azuma N.
        • Obara H.
        • Miyata T.
        • et al.
        on behalf of the Japanese Society for Vascular Surgery Database Management Committee. Treatment outcomes of infected abdominal aortic and common iliac artery aneurysms: a nationwide multicenter retrospective study.
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        • 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
        • Miyata T.
        • Mii S.
        • Kumamaru H.
        • Takahashi A.
        • Miyata H.
        The Japanese Society for Vascular Surgery JCLIMB Committee. Risk prediction model for early outcomes of revascularization for chronic limb-threatening ischaemia.
        Br J Surg. 2021; ([Epub ahead of print])https://doi.org/10.1093/bjs/znab036
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        • Ishimaru S.
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        J Vasc Surg. 2021; ([In Press])
        • Hoshina K.
        • Komori K.
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      1. The Japanese Society for Vascular Surgery Database Management Committee Member, and NCD Vascular Surgery Data Analysis Team. Vascular Surgery in Japan: 2014 Annual Report by the Japanese Society for Vascular Surgery.
        Ann Vasc Dis. 2020; 4: 474-493

      Biography

      Professor Kimihiro Komori is the Chief Director of the Japanese Society of Vascular Surgery (JSVS), the former Director of the Japan Committee for Stentgraft Management (JACSM) and a member of the Editorial Board of the Eur J Vasc Endovasc Surg.

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