Thoracic endovascular aortic repair has revolutionized the treatment of thoracic aortic diseases. It is now indicated not only for descending aortic aneurysms, but also for acute and chronic type B dissections and blunt thoracic aortic injuries. In addition, the scope of treatment is expanding. The thoracic aortic stent graft has been on the market in Japan for 15 years with good results, and the number of operations continues to increase. However, although stent grafts are highly recommended in Japanese and international guidelines for many aortic diseases, re-intervention increases over time in all disease groups. Careful follow-up is important because of morphologic changes and new complications after treatment.

Endovascular treatment (EVT) is now performed worldwide for patients with lower extremity artery disease, due to its safety and advances in devices. However, a common femoral artery (CFA) lesion often has severe calcification, and balloon angioplasty alone for such a lesion is ineffective in terms of patency. EVT with stent implantation for a CFA lesion may result in stent fracture and difficulty with puncture for another intervention during the follow-up period. Given these issues, endarterectomy for a CFA lesion remains as the gold standard treatment in the endovascular era. However, the method of endarterectomy (i.e., arterial incision, patch use or not, patch material, intimal layer fixation or not) differs among centers. Thus, further investigation is needed for each method to promote performance of high quality CFA endarterectomy by vascular surgeons in the current endovascular era.

The indications for endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) have expanded significantly. Recently, 2020 guideline on diagnosis and treatment of aortic aneurysm and aortic dissection was published in Japan. Furthermore, treatment outcomes of EVAR in Japan using big data from the Japanese Committee for Stentgraft Management (JACSM) have been reported. While good short-term results have been reported in Japan, long-term results in Europe and the United States have revealed that open surgical repair is superior to EVAR. Although advances in technology and devices are expected to improve the long-term results of EVAR and further expand its indications for AAA, open surgical repair should be selected in appropriate cases based on considering the anatomical characteristics and surgical risks of individual patients.

Varicose veins are generally benign. Therefore, treatment is indicated in cases of symptoms and/or stasis dermatitis. Treatment methods are determined by a comprehensive review of the results of ultrasound, interviews, visual inspection and palpation. There are conservative and invasive treatments for varicose veins, with invasive treatment generally chosen for severe cases with stasis dermatitis or ulcers. Approximately 90% of invasive treatments for saphenous varicose veins in Japan involve endovenous thermal ablation using radiofrequency or laser. Endovenous treatment using cyanoacrylate adhesive, which is covered by national insurance in 2019, is suitable for elderly patients, bilateral cases, and treatment of multiple saphenous veins because it does not require TLA anesthesia and postoperative elastic stockings. In recent years, the widespread adoption of minimally invasive treatments has led to an increase in inappropriate treatment with endovenous treatment for cases that do not meet the criteria, which has become a significant societal issue. Inappropriate treatment of asymptomatic or mild cases should never be performed.

Compartment syndrome after revascularization for acute limb ischemia often affects the lower legs, forearms and hands, but rarely the feet. If left untreated, foot compartment syndrome can result in toe deformities such as claw toe and chronic pain, and if the condition does not improve conservatively, surgical treatment including amputation is required. We encountered a 61-year-old man with toe deformity that appeared to be due to foot compartment syndrome that developed after revascularization for acute lower limb ischemia. He had pain on walking in the tip of his left second claw toe, which was difficult to manage with conservative physiotherapy, so he came to our hospital. After angiography confirmed that blood flow to the toes was maintained, percutaneous flexor tenotomy was performed and the patient was finally able to walk without toe pain. Although rare, foot compartment syndrome occurs after revascularization of acute lower limb ischemia, so it is necessary to recognize the pathology and manage the complications of foot compartment syndrome.

Superior mesenteric artery syndrome associated with abdominal aortic aneurysm is a relatively rare disease. A 77-year-old male patient had been suffering from nausea and vomiting for about 2 months and had been suffering from anorexia. He visited his previous doctor for a thorough examination, and CT imaging revealed an abdominal aortic aneurysm, 52 mm in diameter and stenosis of third portion of the duodenum between the superior mesenteric artery and the abdominal aortic aneurysm. He was diagnosed superior mesenteric artery syndrome, as a case of clinical symptoms, and was introduced to our department for that surgical repair. In this case, the patient had history of cerebral infarction. Considering patient’s status, less invasive surgery should have been adopted, but it was necessary to improve duodenal passage, prosthetic graft replacement was performed. We report a case in which an abdominal aortic aneurysm was resected, and the duodenal compression was released, resulting in a cure of superior mesenteric artery syndrome.

In addition to conventional bypass surgery, endovascular treatment of popliteal artery aneurysms has recently been increasingly reported. However, there are few reports of peripheral stent grafts for the treatment of pseudoaneurysms after femoropopliteal bypass, as in the present case. An 82-year-old man underwent right superficial femoral-left popliteal artery bypass and right common iliac-external iliac artery stenting for arteriosclerosis obliterans 7 years ago. He visited our outpatient clinic for popliteal pain persisting for one month. Enhanced CT revealed a pseudoaneurysm of the distal anastomosis site. Peripheral stentgraft, VIABAHN (W. L. Gore, Flagstaff, AZ, USA), was urgently implanted to cover the distal anastomosis. And the patient was discharged 5 days after surgery with no perioperative complications.

Popliteal artery (PA) entrapment syndrome is a rare cause of popliteal artery aneurysm (PAA). Therefore, accurate diagnosis and definitive surgical management are required. We encountered a case of a middle-aged woman with a large pseudo aneurysm due to symptomatic anatomic entrapment. A 48-year-old woman with right leg edema and fatigue was referred to our department. Contrast-enhanced computed tomography revealed a 31 mm-diameter right PAA with a saccular shape resulting from type II entrapment syndrome. The right PAA compressed the right popliteal vein, causing right leg edema. Thus, elective surgery was scheduled. The patient was placed in the prone position, and a posterior approach with an L-shaped incision was performed. The PA was compressed by the medial gastrocnemius muscle arising from an abnormal lateral position. PAA originates in the distal part of the compressed lesion. The medial gastrocnemius muscle was divided. The PAA was resected and replaced with a saphenous vein graft from the left thigh. The postoperative course was uneventful, and the patient was discharged with satisfactory symptom reliefs. PA entrapment syndrome should be considered before treating PAA, especially atypical pseudoaneurysm without significant atherosclerosis.