Addressing Arteriosclerosis
Rapid Support with Emergency Treatment

We provide treatment through a combination of endovascular catheter therapy, surgical revascularization, and bypass surgery. For critical limb ischemia with ulcers, we offer comprehensive therapy, including bypass procedures for below-the-knee lesions and ulcer management.

Providing Medical Institution

Kishiwada Tokushukai Hospital

〒596-0042
4-27-1 Kamoricho, Kishiwada City

https://kishiwada.tokushukai.or.jp/en/

Specialty

**Cardiovascular Surgery:**
1. Coronary Artery Disease
2. Heart Valve Disease
3. Aortic Aneurysm
4. Aortic Dissection
5. Arteriosclerosis Obliterans
6. Arterial Thrombosis
7. Complications of Myocardial Infarction
- Ischemic Cardiomyopathy
- Left Ventricular Rupture
- Left Ventricular Aneurysm
- Ventricular Septal Rupture
- Papillary Muscle Dysfunction (Mitral Regurgitation)
8. Infective Endocarditis
9. Intracardiac Tumors

**Cardiology:**
1. Ischemic Heart Disease (e.g., Angina, Myocardial Infarction)
2. Lower Limb Arteriosclerosis Obliterans
3. Arrhythmia
4. Heart Valve Disease
5. Aortic Stenosis
6. Mitral Regurgitation

**Lower Gastrointestinal Surgery**
*Da Vinci Si - Robot-Assisted Surgery*
1. Malignant Diseases
2. Surgical Treatment of Small and Large Intestine Diseases
3. Primarily Surgical and Medical Treatments for Colon and Rectal Cancer
4. Robot-Assisted Surgery
5. Laparoscopic Surgery
6. Multimodal Therapy Combining Surgery, Chemotherapy, and Radiation Therapy
7. Systemic Chemotherapy for Unresectable Colorectal Cancer

**Breast Surgery:**
1. Breast-Conserving Surgery
2. Mastectomy
3. Sentinel Lymph Node Biopsy
4. Lymph Node Dissection
5. Breast Reconstruction Using Autologous Tissue

**Neurosurgery:**
1. Stroke
2. Cerebral Hemorrhage
3. Subarachnoid Hemorrhage
4. Cerebral Infarction
5. Head Trauma
6. Traumatic Intracranial Hematoma
7. Skull Fracture
8. Chronic Subdural Hematoma
9. Brain and Spinal Cord Tumors
10. Acoustic Neuroma
11. Pituitary Tumor
12. Meningioma
13. Metastatic Brain Tumors
14. Functional Neurological Disorders
15. Facial Spasm
16. Trigeminal Neuralgia
17. Epilepsy
18. Normal Pressure Hydrocephalus

**Urology**
*Da Vinci Si - Robot-Assisted Surgery*
1. Robot-Assisted Laparoscopic Radical Prostatectomy
2. Prostate Cancer
3. Renal Cancer
4. Upper Urinary Tract Cancer
5. Urolithiasis (Urinary Stones)

**Radiology:**
1. Comprehensive Imaging Diagnosis (X-ray, Ultrasound, CT, MRI, Angiography, PET)
2. Liver Tumors
3. Gastrointestinal Hemorrhage
4. Arterial Embolization for Hemoptysis and Traumatic Hemorrhage
5. Transcatheter Venous Embolization for Gastric Varices
6. Intra-Arterial Chemotherapy for Cancer
7. Reservoir Placement
8. CT-Guided Biopsy (Interventional Radiology - IVR)
9. TomoTherapy - Radixact

**Dialysis**
*Travel Hemodialysis* (Available for Individual Travelers Only, Not for Groups)

**Other**
*Second Opinion* (In-person Only, Online Not Available)

Eligibility Criteria/Exclusions for Treatment

[Eligibility Criteria] 1. Medical Information: - Diagnosis (e.g., arteriosclerosis obliterans, arterial thrombosis, ischemic limb) - Detailed symptoms (e.g., presence of ulcers, leg pain, numbness, cold sensation) - Test results from other hospitals (e.g., vascular ultrasound, CT, angiography) - Comorbidities (e.g., diabetes, chronic renal failure, hypertension) 2. Treatment History: - History of vascular treatments (e.g., catheter-based therapy, bypass surgery) - Current medications (e.g., anticoagulants, antiplatelet drugs) - Assessment of side effects or effectiveness of previous treatments 3. Age and Physical Fitness: - Evaluation of surgical tolerance in elderly patients or those with underlying conditions - Assessment of overall health for suitability for catheter therapy or bypass surgery 4. Treatment Duration, Hospital Stay, and Time: - Expected hospitalization period and postoperative rehabilitation duration - Urgency of surgery and readiness for emergency procedures 5. Urgency: - Determination of the need for emergency surgery in cases of acute thrombosis or critical limb ischemia - Cases requiring 24/7 response readiness 6. Other Conditions: - Eligibility for patients requiring long-term care for ulcers or critical limb ischemia - Adjustment of treatment plans based on the patient’s lifestyle and preferences

Precautions / Contraindications

1. Cases Excluded from Surgery:
- Severe comorbidities (e.g., advanced renal failure, liver failure, active infections) significantly increase surgical risks, making surgery inapplicable.
- Severely impaired cardiac function increases the risks of surgery and anesthesia, necessitating careful consideration of treatment options.
- Anatomical issues with blood vessels or valve conditions may make minimally invasive procedures (e.g., MICS or TAVI) unsuitable.

2. Contraindications for Specific Treatments:
- For **mechanical valves**, the need for lifelong anticoagulation (e.g., warfarin) may contraindicate use in patients at high risk of bleeding.
- In cases of infective endocarditis, surgery is contraindicated until the infection is controlled.

3. Considerations for Medication Therapy:
- Patients on anticoagulants or antiplatelet drugs may need to discontinue these before surgery, adhering strictly to the recommended discontinuation period.
- Special attention is required for patients with a history of allergies or adverse reactions to medications.



Preoperative Instructions to Communicate

1. Preoperative Preparation:
- All preoperative tests (e.g., echocardiography, CT, blood tests) must be completed as they are essential for accurate diagnosis and treatment planning.
- Adherence to instructions for discontinuation periods of anticoagulants or antiplatelet drugs is critical.
- Patients should follow any preoperative fasting or dietary restrictions.

2. Risks of Postoperative Complications:
- Risks such as bleeding, infection, or thrombosis must be explained. For mechanical valve procedures, lifelong anticoagulation therapy is mandatory, along with the associated bleeding risks.
- Patients should be informed about the potential for valve dysfunction or restenosis, emphasizing the importance of follow-up care.

3. Hospitalization and Postoperative Care:
- Post-surgery hospitalization typically lasts several days to a week, with close monitoring of recovery progress.
- Rehabilitation may be necessary, particularly to improve physical strength and support cardiac function.
- Adherence to post-discharge restrictions (e.g., activity limitations, dietary adjustments) is essential.

4. Regular Follow-Up:
- Regular outpatient visits and tests (e.g., echocardiography) are required post-surgery. For patients on anticoagulants, frequent blood tests will also be necessary.
- Immediate contact with a healthcare provider is crucial if any abnormal symptoms (e.g., chest pain, shortness of breath, fever) occur.

5. Cost Explanation:
- Provide an estimate of the costs for surgery, hospitalization, and follow-up care.

6. Emergency Response:
- Ensure patients have contact information for an emergency-ready medical facility in case of post-discharge issues such as chest pain, shortness of breath, or fever.