A 77-year-old woman noticed a pulsatile mass on her right lower leg 2 months previously. Computed tomography revealed the presence of a right anterior tibial artery aneurysm. We performed resection of the aneurysm surgically. Histological analysis revealed that it was a true aneurysm. After the surgery, deep peroneal nerve dysfunction occurred. For the treatment of peripheral artery aneurysms, we must try to avoid nerve complications and we must have a choice of endovascular therapy.
An 82-year-old woman suspected of thoracoabdominal aortic aneurysm impending rupture was admitted for an emergency. The aorta was sharply bent just below the renal arteries. A hybrid thoracic endovascular aortic repair (TEVAR) was performed. On the first day after transecting the aorta just below the renal arteries, a straight graft was interposed between the proximal aorta and the left common iliac artery, the distal aorta was anastomosed to a bifurcated graft and its legs were used for debranching four visceral arteries. Next day, TEVAR was executed via the femoral artery. The postoperative course was uneventful without paraplegia. As a result, she was discharged on foot on 19th postoperative day.
A 63-year-old man on hemodialysis with diabetic nephropathy had ischemic necrosis of both lower limbs (Rutherford 6 on right, 5 on left). Preoperative angiography revealed occlusive lesions of all peripheral arteries below trifurcation. Bilateral distal dual bypasses were performed and all wounds were completely healed. If the vascular network of foot is poor for the lesions of pedal arch and perforator, and the necrosis was wide or on two areas, dual bypass seems effective.