The spur occasionally seen in a left common iliac vein was investigated by anatomical and histological examination of cadavers so the occurrence mechanism could be discussed. Spurs were found in 6 cases of the 28 cadavers (21.4%) and they were classified a few different kinds of composition of endosporia, tunica media and adventitia. It is considered that there may be different formation mechanisms and stages even in cases of similar anatomical finding.

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The patient was a 60-year-old woman. Intraoperative use of the toe blood pressure (TBP) is considered to be useful, as it allows the operator to identify the site of anastomosis and to confirm the peripheral microcirculation during re-operation in cases with severe left lower limb ischemia associated with bilateral obstructive lesions.

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We report the case of 79-year-old man who had an anastomotic pseudoaneurysm in the ascending aorta, successfully treated by endovascular stent-graft with periscope graft technique. We selected endovascular treatment because there was a high risk with resternotomy. Then, we adopted the periscope graft technique because the orifice of the left subclavian artery had to be covered to take enough length of distal landing zone and the left subclavian artery was relatively large. The patient tolerated this procedure well. His postoperative course was uneventful. The size of his pseudoaneurysm had not dilated at the sixth month visit after operation.

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