The underlying mechanisms of abdominal aortic aneurysms (AAAs) are not fully understood. Given the multifactorial nature of AAA development and progression, a comprehensive approach is essential. Throughout my academic career, I conducted various studies on AAA. To better understand this mechanism, I initially developed an elastase-infused rat AAA model and applied it to nanoparticle drug delivery systems. While open surgery has traditionally been the standard treatment for AAA, endovascular aneurysm repair (EVAR) has seen significant advancements over the past 25 years. However, insufficient evidence exists regarding this novel treatment, particularly in Japan. To address this issue, we analyzed extensive datasets on EVAR using various registries, including the Japanese Committee for Stent Graft Management. Furthermore, through medical–engineering collaboration, simulation methods were utilized to generate evidence addressing clinical questions encountered in practice.

Chronic limb-threatening ischemia (CLTI) occurs in the advanced stage of peripheral artery disease and is associated with high risks of mortality and amputation. Universal management strategies are not always applicable, owing to population diversity, and the Western trials may not be applicable to Japanese patients, owing to differences in demographics and clinical profiles. This paper examines the outcomes of revascularization in Japanese CLTI patients and emphasizes the benefits of tailored management. Post-hoc analysis of the bypass versus angioplasty in severe ischemia of the leg (BASIL)-1 trial validated the use of the Global Limb Anatomic Staging System for predicting the outcomes of endovascular therapy (EVT) but not bypass surgery (BS). The SPINACH (surgical reconstruction versus peripheral intervention in patients with critical limb ischemia) registry revealed comparable 3-year amputation-free survival rates between patients who underwent EVT and those who underwent BS, with patient-specific factors such as limb status and general health influencing its success. Revascularization improved the quality of life, but benefits declined over time, especially in non-ambulatory and older patients on dialysis. Surgical reconstruction is better for preserving ambulation. Retrospective studies revealed pedal branch artery bypass as a viable option, functional independence as a predictor of survival, and zinc supplementation as promising for wound healing. Future research should focus on refining these strategies and exploring innovative approaches to overcome persistent challenges in CLTI care.

One of the factors that contribute to the development of aortic aneurysms is hemodynamic factors. In this study, we analyzed the hemodynamic changes in a stented saccular abdominal aortic aneurysm model to improve hemodynamic factors. We discovered that stenting reduced wall shear stress, mean flow velocity in the aneurysm, energy loss, and pressure loss coefficient, and improved hemodynamics around the saccular abdominal aortic aneurysm. Stenting is expected to become a new treatment modality for abdominal aortic aneurysms. (This is a translation of J Jpn Coll Angiol 2022; 62: 111–119.)

Objectives: Endovascular aortic repair (EVAR) should be performed using a less invasive procedure based on the patient’s clinical condition, as many patients who undergo this procedure are elderly and have poor surgical tolerance. We report our experience and results of percutaneous EVAR under local anesthesia in order to practice minimally invasive EVAR at our hospital.

Methods: In August 2019, we started percutaneous EVAR using Perclose ProGlide under local anesthesia. We compared the backgrounds and surgical outcomes of patients who underwent EVAR at our hospital before and after the introduction of percutaneous EVAR under local anesthesia.

Results: We included 148 patients in this study. The age at surgery and prevalence of severe renal dysfunction were significantly higher in percutaneous EVAR under local anesthesia group. The operative time and postoperative hospital stay were significantly shorter in the percutaneous EVAR group under local anesthesia.

Conclusions: The introduction of percutaneous EVAR under local anesthesia enabled minimally invasive EVAR to be performed safely even in high-risk patients. (This is a translation of J Jpn Coll Angiol 2022; 62: 1–5.).

Endovenous surgery in the treatment of varicose veins generally consists of laser or radiofrequency ablation (RFA) as endovenous thermal ablation (ETA) with a phlebectomy or foam sclerotherapy of tributary varicose veins to improve symptomatic or cosmetic problems. Nevertheless, the efficacy of their concomitant treatments is still controversial for a decade. In the guidelines of the Japanese Society of Phlebology, concomitant phlebectomy of tributary varicose veins with ETA is described that it is not recommended officially. In our hospital, RFA without concomitant phlebectomy of tributary varicose veins accounts for 74% of the RFA cases and it shows a relatively higher percentage than other institutions in Japan. The data of RFA without concomitant phlebectomy of tributary varicose veins are evenly matched in RFA with concomitant treatments in our data concerning recurrence, remnants, endovenous heat-induced thrombosis (EHIT), and complications. This article provides the conclusion that it would be acceptable to perform isolated RFA compared to RFA with concomitant phlebectomy or foam sclerotherapy of tributary varicose veins in short- and mid-term periods. In addition, concomitant treatments might contribute to rapid improvement of the short-term and better long-term outcomes, not to mention cosmetic problems that are not identified demonstrably. (This is a translation of J Jpn Coll Angiol 2022; 62: 49–54.)

Objectives: Advancements in imaging technology have led to an increase in the incidental detection of visceral artery aneurysms (VAAs), which are associated with high mortality when ruptured. In 2020, the Society for Vascular Surgery (SVS) released updated guidelines, replacing the previous 2005 ACC/AHA recommendations. This study aimed to evaluate the impact of the new guidelines through a retrospective analysis of VAA cases treated at our department.

Methods: We retrospectively reviewed 43 cases of VAA treated between 2002 and 2024 at our department. Each case was re-evaluated to determine whether it met the treatment criteria defined in the 2020 SVS guidelines.

Results: Of the 43 cases, 23 (53.5%) met the new guideline criteria. Notably, treatment eligibility for renal and splenic artery aneurysms decreased significantly due to the revised aneurysm size threshold, raised from 2 to 3 cm. The remaining 20 cases were considered ineligible based solely on size, with the exception of cases involving young female patients, ruptured aneurysms, symptomatic lesions, or pseudoaneurysms.

Conclusions: The 2020 SVS guidelines impose stricter treatment indications for VAAs. However, clinical decisions should also consider aneurysm location, patient age, gender, symptoms, and rupture risk on an individual basis.

Objectives: A narrow aortic bifurcation poses technical challenges during endovascular aneurysm repair (EVAR). We aim to compare the unibody AFX2 (Endologix, Irvine, CA, USA) vs the bifurcated ALTO (Endologix) system in EVAR patients with a narrow bifurcation.

Methods: Retrospective single-center study, including patients undergoing standard EVAR over 3 years. Patients with a bifurcation diameter <20 mm were identified, and outcomes were compared between the AFX2 and ALTO groups. Primary endpoints were primary and overall technical success, primary and overall clinical success, rate of adverse limb events, rate of limb occlusion, and need for secondary interventions. The analysis was repeated using a diameter threshold of <18 mm.

Results: Among 151 cases, 26 presented with bifurcations <20 mm and 12 with <18 mm. In the primary analysis, 15 patients were treated with the AFX2 and 11 with the ALTO endograft. Both groups achieved 100% technical and clinical success. No limb occlusions occurred, and no reinterventions were recorded. Preoperative anatomy was suitable for ALTO in all cases, while eligibility for AFX2 was 15 out of 26 cases. Secondary analysis displayed similar results.

Conclusions: In patients with narrow aortic bifurcation, the AFX2 endograft can be safely used when appropriate anatomic conditions are met. If the AFX2 system is unsuitable due to other anatomic restrictions, the ALTO endograft is a viable alternative.

Objectives: The venous cuff technique has been used primarily for arterial bypass using artificial grafts to the lower extremities. The boat-form vein cuff was designed to allow adjustment of the size and angle of the anastomosis at any anatomic site. We report our experience and outcomes of the original vein cuff technique in various peripheral artery bypass grafting procedures.

Methods: A total of 10 patients underwent arterial bypass grafting using a polytetrafluoroethylene (PTFE) graft with a boat-form venous cuff. The indications for the surgery consisted of peripheral artery disease (n = 4), acute limb ischemia (n = 4), chronic mesenteric ischemia (n = 1), and traumatic upper limb ischemia (n = 1). Five patients required emergency surgery. Surgical outcomes, such as mortality and morbidity, limb salvage rate, and graft patency, were examined using perioperative and postoperative follow-up data.

Results: There were no operative deaths or serious complications, including amputation of the lower extremity. During the follow-up period (44 ± 36.9 months), the PTFE graft remained patent in 9 patients (90%). In 1 patient, occlusion of the femoropopliteal bypass graft was observed 3 months after surgery.

Conclusions: The simple design and creation of the boat-form vein cuff are useful at any anatomical site in peripheral artery bypass grafting with a PTFE graft.

Objectives: Gait disturbances increase mortality rates in lower extremity artery disease. Changes in gait biomechanics after endovascular therapy for intermittent claudication associated with lower extremity artery disease remain unknown. This prospective study investigated the effect of endovascular therapy on gait biomechanics in intermittent claudication.

Methods: We recruited 10 patients (14 affected limbs) with intermittent claudication caused by isolated aortoiliac artery lesions who underwent endovascular therapy, and 10 healthy controls. Using 3-dimensional motion analysis, we measured biomechanical gait parameters preoperatively and over 6 months postoperatively, comparing them with those of healthy controls.

Results: One month after endovascular therapy, parameters improved significantly compared with preoperative values: step length (preoperative median 52.47 [interquartile range 47.11, 60.33]–postoperative 58.53 [54.63, 64.54] cm; P < 0.0037), walking speed (90.17 [73.98, 108.9]–103.49 [97.66, 117.94] cm/s; P = 0.0022), hip flexor moment (−0.75 [−1.04, −0.51] to −0.94 [−1.07, −0.74] Nm/kg; P = 0.04), and pull-off power generated by hip flexor muscles (H3, 0.68 [0.38, 1]–0.86 [0.72, 1.1] W/kg; P = 0.018). Preoperative joint power declined significantly compared to control parameters. However, 6 months postoperatively, no significant differences were observed.

Conclusions: Endovascular therapy for isolated aortoiliac artery lesions improved biomechanical gait parameters in patients with intermittent claudication.

Objectives: Thoracic endovascular aneurysm repair (TEVAR) has revolutionized the treatment of thoracic aortic aneurysms (TAA) by providing a less invasive alternative to open surgery. This study aims to identify risk factors for early mortality following TEVAR for degenerative TAA using a machine learning-based decision tree analysis (DTA).

Methods: This retrospective observational study analyzed 79 patients who underwent elective TEVAR to identify predictors of early mortality (within 2 years) using decision tree analysis. The dataset included 36 variables, covering age, sex, nutritional status, comorbidities, inflammation, immune status, and surgical details. The decision tree classifier was developed and validated using Python 3.7 with the scikit-learn toolkit.

Results: DTA identified octogenarian status as the strongest predictor of early mortality, followed by poor nutritional status, debranching procedures, and compromised immunity. The model identified 7 terminal nodes, with early mortality risk ranging from 0% to 77.7%. It demonstrated moderate accuracy (65.8%) and high sensitivity (81.0%) but had relatively low specificity (60.3%), effectively identifying high-risk patients.

Conclusions: Machine learning-based DTA identified key predictors of early mortality following TEVAR, including octogenarian status, poor nutritional status, compromised immunity, and debranching procedures. The model provides an interpretable risk stratification tool, but its clinical applicability requires further validation.

Objectives: Peri-aortitis following endovascular aneurysm repair (EVAR) is a rare phenomenon with unclear pathogenesis. In this study, we investigated its clinical features and sac prognosis.

Methods: A retrospective analysis was conducted on 1369 EVAR. Peri-aortitis was defined using post-EVAR computed tomography. Clinical and imaging data were assessed.

Results: Peri-aortitis following EVAR was identified in 12 patients (0.89%) with a mean age of 74 ± 8.9 years; 83.3% were male, and 41.7% had allergic or autoimmune histories. There were eight symptomatic cases (66.7%), including seven with fever, three with back or abdominal pain, and one with hydronephrosis. Precautionary antibiotic treatment was administered in five febrile cases. Although persistent and recurrent inflammation was observed in two cases (16.7%) each, inflammation resolved spontaneously in seven patients (58.3%). One (8.3%) needed steroid therapy for severe back pain. Aneurysm shrinkage was observed in seven cases (58.3%), while enlargement was noted in one case (8.3%) with type II endoleak. No correlation was found between aneurysm growth and peri-aortitis development.

Conclusions: Peri-aortitis following EVAR may present significant challenges, including differentiation from infection, management of symptomatic cases requiring medical therapy, and addressing recurrences. Accurate diagnosis, individualized treatment, and meticulous follow-up are essential for favorable outcomes.

Objectives: We primarily aimed to compare the acute effects of hand-squeezing exercises, with and without tourniquet-like compression, on vessel size 5 minutes post-exercise in patients after arteriovenous fistula (AVF) creation. The secondary aim was to assess differences in AVF blood flow rates between the 2 interventions.

Methods: A randomized study was conducted at a university hospital in Bangkok, Thailand, from October 2018 to September 2023. Seventy-eight participants, 2 weeks post-first-time autogenous AVF creation, were randomized into 2 groups: a non-compression group (n = 39) performing 5 minutes of hand-squeezing exercises and a compression group (n = 39) performing the same exercises with tourniquet-like compression. Ultrasound measured venous diameter and blood flow rates pre- and post-exercise.

Results: Both groups showed increased venous diameter, but the difference between the groups was not statistically significant (mean difference: 0.18 mm with compression vs. 0.12 mm without; P = 0.489). Blood flow rates increased significantly in the compression group compared to the non-compression group (mean difference: 171.49 vs. 24.44 mL/min; P = 0.002).

Conclusion: Hand-squeezing exercises with tourniquet-like compression significantly improved AVF blood flow rates acutely, supporting its potential to enhance AVF maturation. Further research is needed to assess long-term benefits.

Objectives: Acute hemorrhagic rectal ulcer (AHRU) occurs with a sudden onset of painless bloody stools and is caused by impaired blood flow in the rectal mucosa due to arteriosclerosis or prolonged bedridden status. Little information is available about AHRU in patients with chronic limb-threatening ischemia (CLTI). This study aimed to identify factors related to AHRU among CLTI patients after bypass surgery.

Methods: Between 2019 and 2023, we enrolled 80 CLTI patients at our institution who underwent bypass surgery using autogenous veins. Data were collected prospectively and supplemented with retrospective medical record reviews. Information regarding demographic and clinical characteristics was collected. The outcomes of patients without AHRU (non-AHRU group) and those with AHRU (AHRU group) were compared. Logistic regression analysis was used to assess factors associated with AHRU after bypass surgery.

Results: During the study period, 6 of the 80 patients (7.5%) experienced AHRU after bypass surgery. There was no significant difference in the global limb anatomic staging system (GLASS) or wound ischemia and foot infection (WIfI) stage between the 2 groups. The percentage of patients taking oral steroids was significantly greater in the AHRU group. In addition, the AHRU group had a significantly greater percentage of postoperative ambulatory failure and a longer hospital stay. In the univariate analysis of factors associated with the incidence of AHRU after bypass surgery, steroid use (odds ratio [OR], 13.8; 95% confidence interval [CI], 2.19–86.9; P = 0.005) and nonambulatory status after surgery (OR, 7.22; 95% CI, 1.26–41.4; P = 0.026) were significant factors.

Conclusions: Steroid use and postoperative nonambulatory status were associated with AHRU after bypass surgery for CLTI.

Objectives: This study aimed to investigate the actual detection process and diagnostic methods for asymptomatic abdominal aortic aneurysm (AAA) in a multicenter setting, and to plan an effective screening strategy for asymptomatic AAA.

Methods: The subjects of this multicenter study were collected in a retrospective manner at 7 facilities. A total of 1894 patients with AAA, including iliac artery aneurysms, who were considered asymptomatic with a confirmed initial diagnosis from January 2018 to December 2022, were collected and reviewed.

Results: A total of 1666 patients who were diagnosed with asymptomatic AAA were included [83.9% males, median age of 75 (69–81) years]. Asymptomatic AAAs were frequently diagnosed during examinations for other diseases in 1339 patients (80.4%), whereas health screenings accounted for only 313 (18.8%). Computed tomography (CT) was the most commonly used diagnostic method (n = 1352, 81.2%) compared to abdominal ultrasonography (n = 252, 15.2%).

Conclusions: Asymptomatic AAAs are detected incidentally during examinations for other diseases, and there is an urgent need to promote health screening. Most AAAs are diagnosed by CT; nevertheless, we consider that abdominal ultrasonography would be the most appropriate modality for AAA screening because of its reasonable accuracy, noninvasiveness, and low cost.

Objectives: The Gore iliac branch endoprosthesis (IBE) enables internal iliac artery (IIA) reconstruction, extending the indications of endovascular aneurysmal repair (EVAR); however, the up-and-over technique is challenging. This study aimed to clarify the advantages and procedural limitations of the up-and-over technique.

Methods: From January 2019 to October 2022, 22 patients who underwent IIA reconstruction with Gore IBE were enrolled. The patients were divided into the S and Up groups that underwent IIA reconstruction using the standard and up-and-over techniques, respectively. Aortic anatomic measurements, surgical factors, and postoperative outcomes were examined.

Results: No significant differences in operative time, fluoroscopy time, contrast medium use, blood loss volume, and length of postoperative hospital stay were observed between the S (12 patients) and Up (10 patients) groups. However, the distance from the lower renal artery to the reconstructed IIA origin was considerably shorter in the Up group than in the S group. During the 19-month follow-up, no adverse events were observed in the Up group.

Conclusions: The up-and-over technique can be a valuable option for cases where IIA reconstruction is difficult with standard procedures with Gore IBE. Therefore, understanding the procedural precautions and ensuring safety are crucial to its success.

Objectives: Surgical thrombectomy has been established as an effective treatment for acute limb ischemia (ALI). Nevertheless, manipulation via the common femoral artery (CFA) to retrieve thrombus in the infra-popliteal artery sometimes proves less effective.

Methods: We retrospectively reviewed patients undergoing surgical thrombectomy for infra-inguinal ALI from January 2010 to December 2022. The primary endpoint was the rate of amputation. Secondary endpoints were technical and clinical success rates, incidence of distal embolism, and freedom from reintervention.

Results: A total of 35 patients underwent surgical thrombectomy where the popliteal artery or below is occluded. The CFA approach was utilized in 13, and the below-knee popliteal artery (BKPA) approach in 22. There were no differences in background between groups. The reintervention rate was lower in the BKPA group (BKPA group: 0% vs. CFA group: 30.8%; P = 0.01). The BKPA group showed a significantly lower incidence of distal embolism (BKPA group: 4.5% vs. CFA group: 38.5%; P = 0.02) and freedom from reintervention (BKPA group 100% at 12 months vs. CFA group: 68.7% at 12 months; log-rank P = 0.01).

Conclusions: The BKPA approach-first strategy for surgical thrombectomy in the management of ALI is feasible with better outcomes compared with the CFA approach.

Objectives: The pathophysiological mechanism of abdominal aortic aneurysm (AAA) remains unclear. We previously reported that Bifidobacterium adolescentis levels were reduced in the feces of patients with AAA by 16S ribosomal ribonucleic acid (RNA) gene sequencing. In this study, we increased the number of cases and conducted metagenomic analyses to examine bacterial genes associated with the pathophysiology of AAA.

Methods: For gut microbiota data, feces from 55 patients with AAA and 52 patients with no history of AAA, lower extremity artery disease, or coronary artery disease (control group) were collected. Metagenomic analysis was performed by collecting raw stool samples from patients. For intestinal microbiota analysis, metagenomic analysis of the fecal samples was performed.

Results: Oral bacteria, including Actinomyces oris (p <0.0001), Streptococcus salivarius (p <0.001), Lactobacillus salivarius (p <0.001), and Streptococcus sp. (p <0.001), were increased in the feces of patients with AAA. In addition, bacterial genes related to alpha lipoic acid (ALA) biosynthesis (M00882, M00883, and M00884, p <0.0001) were decreased in patients with AAA.

Conclusions: In the feces of patients with AAA, there was an increase in oral bacteria, and the expression of bacterial genes related to ALA biosynthesis was reduced. The results suggest the possibility of developing gut microbial drug treatments for AAA.

Objectives: We sought to clarify the interface pressure (IP) and its variation by applying Biflex16, a calibrated bandage, to the lower leg.

Methods: In Study I, 50 participants applied a bandage to the lower leg of a single subject in two ways: first, with 50% overlap, while the calibration rectangle became a square (Application 1), and then with 50% overlap without intentional stretch (Application 2) which served as a control. In Study II, another 51 participants applied the bandage to their lower leg via Application 1. The IP was measured at the level of the transposition of the medial gastrocnemius muscle into the Achilles tendon (B1).

Results: In Study I, the median IP (37 mmHg) and interquartile range (IQR; 9 mmHg) in the standing position were the same for Applications 1 and 2. In Study II, the obtained IP and IQR values were 38 and 12 mmHg, respectively, in the sitting position. This IP was similar to that obtained in Study I, and no correlation was found between IP and leg circumference.

Conclusions: The variation in the IP obtained by the calibrated bandage was reasonably small when applied via Application 1. The obtained IPs did not correlate with the leg circumference.

Objectives: We investigated the association between brachial-ankle pulse wave velocity (PWV) and arterial stiffness and distensibility in the aneurysmal sac of abdominal aortic aneurysm (AAA).

Methods: Data from 49 patients with AAA from June 2020 to November 2022 at Tokyo Medical University Hospital were retrospectively analyzed. Brachial-ankle PWV (cm/s) was obtained via an automated oscillometric method. Regional arterial stiffness and distensibility parameters, such as stiffness parameter (β), pressure-strain elasticity modulus (Ep, kPa), one-point PWV (PWV β, m/s), and arterial compliance (AC, mm²/kPa⁻¹), were assessed using 2-dimensional automated tissue tracking (2DTT) ultrasonography. Patients were divided into two groups: high PWV (≥1800) and low PWV (<1800).

Results: Patients with high PWV showed significantly higher β and PWV β (30.6 ± 10.1 vs. 25.2 ± 6.3, p = 0.047; 11.6 ± 2.3 vs. 10.5 ± 1.5, p = 0.048) and significantly lower AC in the aneurysmal sac (10.6 ± 5.3 vs. 14.7 ± 8.1, p = 0.045) than those with low PWV. AC was negatively correlated with PWV (r = −0.361, p = 0.011).

Conclusions: Brachial-ankle PWV can reflect arterial stiffness and distensibility, as measured by 2DTT ultrasonography, in the aneurysmal sac of AAA, suggesting its potential as an elasticity index for assessing regional arterial stiffness and distensibility in AAA.

Objectives: The objective of this research was to examine the occurrence, clinical features, treatment approaches, and results associated with a rare complication of thrombosis of the popliteal artery after total knee arthroplasty (TKA), leading to acute limb ischemia (ALI).

Methods: A retrospective study on 1020 TKA procedures spanning 5 years. Cases of ALI were identified through clinical evaluation and arterial Doppler studies. Peripheral angioplasty was done to recanalize the popliteal artery. Manifestations, complications, and management strategies were evaluated.

Results: Among the 1020 TKA cases, 5 cases of ALI were identified which accounts for 0.49% of all TKA cases. Female predominance and left-sided presentations are notable observations. Most patients presented within 8 hours of symptom onset with diverse complications ranging from foot drop to compartment syndrome. Except for 1 case, all patients recovered with thrombosuction and balloon dilatation.

Conclusions: A rare but potentially fatal complication of TKA is popliteal artery thrombosis leading to ALI so it becomes important for early recognition and intervention to mitigate the adverse outcomes. In our study, endovascular treatment has emerged as the preferred modality in terms of effective management and reducing complications and morbidity from surgical procedures.

A 56-year-old woman with recurrent acute pulmonary embolism was diagnosed with a left popliteal venous aneurysm (PVA) by venous echocardiography. During anticoagulation therapy with heparin for acute pulmonary embolism, she was found to be positive for heparin-induced thrombocytopenia (HIT) antibodies. Surgery was performed with argatroban for anticoagulation, removal of the thrombus in the PVA, and suturing of the vein. Postoperatively, the popliteal vein showed shrinkage, and no recurrence of thromboembolism was observed. We report a case in which a patient with a PVA positive for HIT antibodies was successfully treated with PVA resection and anticoagulation therapy with argatroban.

A 78-year-old male presented with progressive enlargement of a pararenal abdominal aortic aneurysm following chimney endovascular aneurysm repair. The aneurysmal expansion was attributed to an endoleak secondary to migration of the left renal artery chimney stent graft, resulting in a 5-mm increase in aneurysm diameter over 6 months. Endovascular reintervention successfully induced aneurysm regression, with no recurrence of endoleak on annual imaging follow-up. While chimney endovascular aneurysm repair presents a minimally invasive alternative for managing complex aortic pathologies, including pararenal abdominal aortic aneurysms, vigilance regarding potential stent graft migration is essential.

Late postoperative type 3 endoleaks associated with the AFX (Endologix, Irvine, CA, USA) stent-graft are commonly reported. The AFX’s endoskeletal design raises concerns about wire entrapment between its frame and fabric, as well as a risk of type 1a endoleak. An 84-year-old man with prior EVAR using the AFX presented with a type 3b endoleak 4 years postoperatively. He underwent relining with the TREO stent-graft (Terumo Aortic, Sunrise, FL, USA), which enabled easy contralateral gate cannulation and secured a long proximal landing zone. The TREO appears to be a viable option for relining the AFX in type 3b endoleak cases.

We report a case of an abdominal aortic rupture without aneurysm associated with giant cell arteritis. A 67-year-old woman presented with lower back pain. Contrast-enhanced computed tomography revealed a massive retroperitoneal hematoma with contrast leakage from the abdominal aorta, suggestive of abdominal aortic rupture. During emergency surgery, a rupture site was identified on the anterior wall of the abdominal aorta, while no aneurysmal changes or dilatation of the abdominal aorta were observed. Histopathological examination of the resected aortic wall revealed infiltration of giant cells positive for CD68, leading to the diagnosis of giant cell arteritis.

Herein, we describe the case of a 72-year-old man who presented with a residual inferior pancreaticoduodenal artery aneurysm following the rupture and treatment of a superior pancreaticoduodenal artery aneurysm. Open surgery for pancreaticoduodenal artery aneurysms requires carefully planned vascular reconstruction to prevent organ ischemia and minimize pressure changes caused by fluctuations in mechanical stress. Additionally, in cases of rupture, factors such as the patient’s condition, presence of hematoma and adhesions, and pressure changes resulting from prior transarterial embolization must be considered. This case report outlines the surgical strategy employed for managing the residual inferior pancreaticoduodenal artery aneurysm.

Subclavian artery aneurysms are rare and challenging to treat owing to their anatomical location and proximity to critical branches, including the vertebral artery. We report the case of a 78-year-old man with a left subclavian artery aneurysm. The aneurysm was located in the mediastinum and measured 31 mm in diameter. The proximal side of the aneurysm was sealed with a stent graft, while the distal side was accessed through a supraclavicular incision and directly ligated. Postoperative imaging confirmed complete exclusion. This hybrid approach avoided invasive open surgery and provided a favorable outcome.

We present a case of a common femoral artery aneurysm as an extremely rare manifestation of immunoglobulin G4-related disease (IgG4-RD). A 79-year-old male, who underwent emergency abdominal aortic aneurysm repair at age 60 due to rupture, developed enlarging aneurysms of the right internal iliac artery, the right common femoral artery, and the left common femoral artery. Consequently, the right iliac artery was replaced with a graft extending to the right deep femoral artery, also reconstructing the right internal iliac artery. Histopathological examination of the resected common femoral artery wall confirmed the diagnosis of IgG4-RD.

A 76-year-old male patient, who had undergone right axillary artery bypass and arch replacement surgery for retrograde type A aortic dissection after thoracic endovascular aortic repair 2 years ago, was referred to our department with complaints of swelling and pain in the right subclavian region. A computed tomography scan suspected an abscess around the bypass graft; however, the culture was negative. Pathological examination indicated a diffuse large B-cell lymphoma (DLBCL) diagnosis. Chemotherapy was not indicated due to the patient’s condition, and he passed away after 3 months. DLBCL originating around a graft is extremely rare but crucial for differential diagnosis.

We experienced a case in which a myxoma in the inferior vena cava (IVC) was surgically removed along with the IVC using deep hypothermic circulatory arrest. A 42-year-old female with no subjective symptoms was incidentally found to have a mass in the IVC at the junction of the hepatic veins on contrast-enhanced computed tomography. Ultrasonography revealed a mobile tumor attached to the junction of the hepatic veins. Surgery was performed via median sternotomy and laparotomy. Cardiopulmonary bypass and deep hypothermic circulatory arrest were utilized to safely operate.

Persistent sciatic artery (PSA) is an exceptionally rare vascular condition that occurs in approximately 0.025%–0.04% of the general population. We describe the case of a 51-year-old man who presented with acute left lower limb pain and high fever. He was diagnosed with COVID-19 and isolated, and conservative treatment was performed for toe pain, resulting in left toe necrosis. Computed tomography revealed PSA occlusion in the left lower extremity. We diagnosed the patient with acute occlusion of the PSA due to COVID-19. The complicated disease was successfully treated using distal artery bypass.

We report a case of a 68-year-old female patient with an 8-mm right gastric artery aneurysm. The attempt at endovascular treatment was unsuccessful and therefore the patient underwent laparoscopic surgery for the resection of the unruptured right gastric artery aneurysm. The postoperative course was uneventful, and the patient is currently under observation as an outpatient. Although endovascular treatment is the first choice for treatment of unruptured right gastric aneurysms, laparoscopic surgery offers advantages such as less invasiveness, anatomical accessibility, and the ability to perform histopathological examination, making it an effective treatment option when endovascular treatment is difficult.

Intravenous leiomyomatosis (IVL) remains scarcely reported, and complete tumor resection is the recommended treatment. Herein, we present a comprehensive review of the case of a 52-year-old woman who suffered from recurrent syncope episodes due to IVL with intracardiac extension to the right atrium. Partial tumor resection and postoperative hormone therapy were conducted first. However, the 6-month postoperative follow-up computed tomography scan revealed a tendency for the IVL to increase in size, and complete resection was conducted. In this article, we would like to emphasize that partial resection followed by hormone therapy is insufficient for IVL, and complete resection should be chosen.

Cold agglutinin disease (CAD) is a rare and autoimmune hemolytic disorder caused by the presence of cold-reacting autoantibodies against red blood cells. An abdominal aortic aneurysm (AAA) is a potentially life-threatening condition. This report describes an 83-year-old man with AAA who was diagnosed with primary CAD 9 years before undergoing AAA surgery. The patient underwent successful endovascular aortic repair. Temporary hemolytic anemia and exacerbation of jaundice were observed postoperatively despite strict temperature control. Red blood cell and haptoglobin transfusions may prevent fatal hemolytic anemia, renal disorders, embolism, and systemic complications.

In the treatment of saphenous varicose veins with endovenous laser ablation, simultaneous treatment of varicose tributaries using stab avulsion or sclerotherapy is commonly performed. To address the limitations of these conventional treatments, laser ablation for varicose tributaries has recently gained widespread acceptance. This guideline, developed by the Japanese Society of Phlebology, outlines appropriate treatment protocols for laser ablation of varicose tributaries. Indications include primary varicose veins requiring concurrent treatment of the saphenous trunk and varicose tributaries. The procedure utilizes slim radial fibers, with puncture and ablation performed using either short- or long-axis approaches. Although rare, adverse events such as skin burns, nerve injury, and fiber breakage have been reported. A learning curve is necessary to ensure the safe execution of the procedure. Further clinical studies are essential to enhance the safety and efficacy of laser ablation for varicose tributaries. (This is a secondary publication from Jpn J Phlebol 2025; 36: 51–58.)

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeons in Japan in 2019, as analyzed by database management committee (DBC) members of the JSVS.

Materials and Methods: To survey the current status of vascular treatments performed by vascular surgeons in Japan, the DBC members of the JSVS analyzed the vascular treatment data provided by the National Clinical Database (NCD), including the number of treatments and early results such as operative and hospital mortality.

Results: In total 154,460 vascular treatments were registered by 1,082 institutions in 2019. This database is composed of 7 fields including treatment of aneurysms, chronic arterial occlusive disease, acute arterial occlusive disease, vascular injury, complication of previous vascular reconstruction, venous diseases, and other vascular treatments. The number of vascular treatments in each field was 23,826, 17,100, 4,947, 2,369, 674, 54,023, and 51,521, respectively. In the field of aneurysm treatment, 20,369 cases of abdominal aortic aneurysm (AAA) including common iliac aneurysm were registered, and 63.3% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,739 (8.5%) cases were registered as ruptured AAA. The operative mortality rates of ruptured and un-ruptured AAA were 15.0%, and 0.6%, respectively. 43.8% of ruptured AAA were treated by EVAR, and the EVAR ratio was gradually increasing, but the operative mortality rates of open repair and EVAR for ruptured AAA were 12.6%, and 15.4%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 8,026 cases, including 1,250 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) was performed in 8,879 cases. The EVT ratio was gradually increased at 51.9%. Varicose vein treatment was decreased in 42,313 cases (1.9% less than in 2018), and 79.8% of the cases were treated by endovenous thermal ablation (ETA) including endovenous laser ablation (EVLA) and radio-frequency ablation (RFA). Regarding other vascular operations, 47,605 cases of vascular access operations and 1,703 lower limb amputation surgeries were included.

Conclusions: The number of vascular treatments increased since 2011, and the proportion of endovascular procedures increased in almost all fields of vascular diseases, especially EVAR for AAA, EVT for chronic arterial occlusive disease, and ETA for varicose veins. (This is a translation of Jpn J Vasc Surg 2024; 33: 307–335.)