A 71-year-old female patient was transferred to our hospital complaining of left leg swelling and pain with suspected of DVT. CT showed sequential venous thrombus from peripheral tibial veins to IVC. We performed emergent temporary IVC filter implacement, transvenous thrombolytic therapy, and intensive oral rivaroxaban treatment for severe venous thrombus. One month after treatment, CT revealed venous thrombus disappeared from popliteal vein to IVC, but residual thrombus in left external iliac vein. Two month after treatment, the thrombus in left iliac vein was disappeared, and we could retrieve IVC filter safely.
An 84-year-old female underwent coil embolization for a 22 mm aneurysm of the common hepatic artery (CHA) and felt severe abdominal pain at a day after the treatment. Contrast-enhanced CT revealed intra-abdominal hemorrhage due to a ruptured aneurysm of the right gastric artery (RGA). A microcatheter was successfully advanced near it via the left gastric artery. We successfully embolized it using 0.4 mL of 25% n-butyl-2-cyanoacrylate mixed with Lipiodol. This case report suggests that hemodynamic shear stress change to the fragile vascular wall stimulated by increased RGA flow after occlusion of the CHA causes aneurysmal formation and rupture of the RGA.
A-70-year old woman presented hypertensive heart failure, steal phenomenon and syncope owing to Takayasu's arteritis . At the standpoint of heart failure therapy, we should use hypotensive drugs. But reduced blood pressure can lead to syncope. So we operated right illaic artery-biaxillary artery bypass. The post-operative course was good. We could use hypotensive drugs safely, and could treat her heart failure without occurrence of syncope. Then gradually she recoverd her activities of daily living.
Microscopic polyangiitis (MPA) is characterized by the inflammation of small-sized vessels. We describe a patient with MPA who had suffered large vessel arteritis. A 94-year-old woman who had been given a diagnosis of MPA suffered abdominal aortic aneurysm. This case presented with prolonged fever and aggressive inflammatory reaction and the diagnosis was made during the early phase. An autopsy revealed the systemic vasculitis.