Endovascular abdominal aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) has been an alternative surgical treatment due to its low perioperative mortality and morbidity rates. However, mid- and long-term follow-up results of randomized, controlled trials have shown that the early survival advantage of EVAR is lost by four years, and open surgery has a survival benefit at between 8 and 15 years. These results indicate an increase in aneurysm-related mortality and complications in the EVAR group. Concerns about the long-term durability of EVAR have become a significant issue worldwide in recent years. Meanwhile, with the evolution of devices, there is also a trend to expand the use of EVAR in patients with more complex anatomical structures. What should clinicians do to stabilize the durability of EVAR? First, we need to identify the risk factors that affect the durability of EVAR based on published data. Second, we should consider appropriate patient selection, device selection, and perform surgical procedures.

View full abstract

In the era of widespread use of endovascular treatment (EVAR/TEVAR) for aortic aneurysms, the trend toward less invasive treatment has been accelerating. In Europe and the United States, vascular closure devices are covered by insurance, and percutaneous EVAR (pEVAR) accounts for the majority. Abbott’s Perclose PROGLIDE/PROSTYLE has been covered for EVAR/TEVAR in Japan since January 2021, and most EVARs with open surgical femoral access will likely be replaced with pEVAR in the near future. This manuscript presents an overview of pEVAR, focusing on tips for the procedure.

View full abstract

With the current development of endovascular techniques, stent-grafting for aortic arch aneurysms is still a challenging procedure, and arch replacement is the first choice. In this article, the evidence from the Japanese guidelines and the European expert consensus is reviewed, and surgical, hybrid-TEVAR, and total endovascular treatments, including the latest developing devices and techniques, are outlined.

View full abstract

Widespread use of thoracic aortic stent-graft placement as treatment for aortic aneurysms has recently been started, and its indication has expanded to include treatment of aortic dissection after the efficacy of TEVAR was proven. Furthermore, domestic approval and health insurance coverage have increased the use of TEVAR for aortic dissection. The indications for TEVAR do not classically include complicated type B aortic dissection, but they do include uncomplicated cases with a high risk of aneurysmal formation or other aortic events. Technical development of TEVAR including PETTICOAT technique etc. has also occurred. The basics and an update about TEVAR for acute or subacute aortic dissection are presented.

View full abstract

This report describes the evidence and clinical outcomes of TEVAR for aneurysmal dilatation in chronic type B aortic dissection (CTBAD).
The issues of TEVAR for CTBAD include aortic-related events such as rupture or false lumen growth due to persistent retrograde false lumen flow through the re-entry site or involved branch vessels. Various techniques for false lumen thrombosis and clinical outcomes of TEVAR with re-entry closure at our institution are presented.

View full abstract

A woman in her 60s with idiopathic bleeding from the left lower abdominal wall underwent emergent transcatheter arterial embolization (TAE) with a right femoral and left brachial approach. She had anemia and a prolonged activated partial thromboplastin time (APTT). Even after 2 sessions of TAE and subsequent surgical hemostasis, rebleeding developed. In addition, a hematoma due to a pseudoaneurysm of the puncture site in the left arm resulted in compartment syndrome. Later, inactivation of factor VIII activity and the presence of factor VIII inhibitor were demonstrated. The patient was diagnosed with acquired hemophilia A. The hemorrhage was controlled using recombinant activated factor VII (rFVIIa) and immunosuppressive therapy. In this case report, the difficulty in diagnosis of acquired hemophilia A and the importance of early diagnosis and appropriate therapy are discussed.

View full abstract