Subfascial endoscopic perforator surgery (SEPS) for the incompetent perforator veins (IPVs), which is the cause of stasis skin lesion on the lower leg, was performed in Europe and America as the minimally invasive method instead of Linton’s operation. Good results were shown, but were not enforced too much when they entered the 21st century. We surfaced two points, insufficiency of the maneuver maturity and the big difference in medical system with Japan when we examined the background. Japanese SEPS is simpler and easier than that in Europe and America, and it is performed by a high-quality method and the treatment result is better than Europe and America, as a result, SEPS was accepted as a medical service under national health insurance in April 2014. Japanese modern style SEPS is hopeful as a treatment choice which can be performed in the outpatient clinic by a laborer.

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A 76-year-old female was referred to our hospital with a giant splenic artery aneurysm (58 mm in diameter) which happened to be detected by an abdominal computed tomography scan. The aneurysm was fusiform and located at the middle third of the splenic artery. We performed laparotomy and interposed auto saphenous vein between the proximal and distal splenic arteries. Later, mural thrombus was removed after opening the aneurysm. Postoperative course was fair with no complication. Histological examination on the wall of the aneurysm showed sclerotic changes.

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