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TI: In order to explain some of the work that I did, I would like to touch upon the various diseases that affect the circulation. Primarily, we're talking about the arterial circulation, and there are two basic problems that can occur. First is the most common disease known as atherosclerosis or in lay terms, hardening of the arteries. And basically what happens in this situation is the blockage that occurs in the arteries as a result of deposits of cholesterol and calcium, the artery eventually shuts down, and when the circulation is impaired to vital organs such as the kidneys or the bowel or to the brain, that has a bad outcome. The second problem that occurs to arteries is that the arterial wall becomes diseased. It becomes weaker, weakened, and eventually dilates and ruptures much like a tire would when the walls are weakened, and it will blow out, and of course, with the result in bleeding, the outcome is not good. So in repairing these conditions, the arteries are either replaced or they're bypassed or they're cleaned out. And initially, when you first started vascular surgery, the arteries were replaced by human arteries which were harvested at autopsy, and when I started my practice here in Portland, I started a blood vessel bank in order to do this. Subsequently, there have been artificial arteries manufactured, and they are now widely used, and the main arteries are made out of Dacron and Teflon. When the arteries are diseased to the extent that the circulation is blocked, my endeavors were in the area where the arteries were cleaned out and the circulation restored. And the advantage of doing this particular type of a repair was that you ended up with the patient's own tissues.

The arterial wall comprised mainly of about three layers, and the inner layer, of course, is a very thin membrane. The second layer is more muscular which allows the arteries to contract. This is the layer in which much of the cholesterol deposit is made, and of course, it builds up in the lumen causing obstruction. The outer layer is a sheath which is the strongest part of the artery, and when you remove the diseased portion of the inner two layers, this layer is the one remaining vessel that functions as a normal artery. The big advantage of doing this operation is that when you leave the patient's own tissue, it is very resistant to infection and the complications of infection. The problem with this kind of surgery is that in large vessels, removing this material is well tolerated, the vessel stays open, but as the vessel gets tinier, smaller in diameter, the success there is not as good. And one is able to clean out the arteries all the way from the level of the kidneys, which is high in the abdomen, down to about the knees. The vessels in the thigh and around the knee is about the size of a cigarette, quite small, and when you open these arteries and clean them out and sew them back together again, we have a hard time keeping them open and the blood flowing. The segment of the artery is in the pelvis. It goes into the groin, also is fairly small, and the problem here is the access to these arteries because of the groin area, and also it is deep in the pelvis. And cleaning out these arteries here have not been generally successful because of the difficulty in getting to it and also the size.

I devised a method whereby this could be done more readily by dividing the artery at the level of the groin and bringing it back up into the pelvis and turn the artery inside out much as you would roll up your sleeves and remove the diseased portion. This turned out to be quite successful, and I did a series of these operations and then began reporting them as the results were very favorable and with minimum amount of complications. After my publications, I've noted that many of the European and South American surgeons have adopted this operation which I found out later, and the technique is now known as the Inahara technique. The procedure now is not being done very commonly because the easy accessibility of artificial arteries to bypass these diseased areas; and fortunately, the use of prosthetic arteries had been fairly successful too, but they do have a greater incidence of complications.

<End Segment 10> - Copyright © 2003 Oregon Nikkei Endowment and Densho. All Rights Reserved.