Japanese Board of medical specialties (JMSB) has been established to certify specialist physicians in 2014 based on the report of the committee on Japanese medical specialties set in 2013 by Ministry of Health, Labour and Welfare (MHLW). The primary operation concepts of JMSB are as follows, ① to be an independent certification organization, ② to adopt two-step system, primary specialty training first then subspecialty training, ③ to establish the General Medicine as a primary specialty, ④ to operate according to the concept of Professional Autonomy. JMSB made great efforts to establish the training system according to the guidelines set by JMSB during first 2 years. However, apprehension about mal-distribution of senior residents was pointed out by the subcommittee of Medical Ethics Council (MEC) set in MHLW. To resolve the problems, number limit of senior residents, so-called ceiling system, was introduced. Since the ceiling system was not satisfied by both the subcommittee and JMSB, it is now under repeated discussions. Another problem at issue is subspecialty training. Training in some subspecialty areas can exceptionally be started in coordination with that in primary specialties, Internal Medicine, Surgery and Radiology. JMSB is now blushing up our subspecialty training systems for better understandings by the subcommittee members, related specialty organizations and public.

An adolescent was referred to our hospital with intermittent claudication. The right popliteal artery was extrinsically compressed by the gastrocnemius muscle and was occluded by a thrombus, as shown by computed tomography angiography. The patient was diagnosed with popliteal artery entrapment syndrome. The patient was successfully treated with popliteal artery release and myotomy of the aberrant medial head of the gastrocnemius muscle, thrombectomy, and endarterectomy. In cases where the fibrotic change in the popliteal artery is not severe, whether popliteal artery reconstruction or bypass surgery with musculotendinous sectioning should be performed is controversial.

An 85-year-old woman presented with abnormality on lung cancer screening. The distal arch and descending thoracic aortic aneurysm were surgically repaired using a woven dacron graft (Gelweave™, Vascutec) at 73 years old. Computed tomography showed a proximal anastomotic false aneurysm that expanded to 110 mm in diameter. At the reoperation, the dacron graft showed 2 holes measuring 5 mm in size, apart from the anastomosis that had dehisced without signs of infection. Graft perforation potentially caused by densely calcified foci in the aneurysm cuff was suspected as the primary cause of false aneurysm resulting in dehiscence of the proximal anastomosis.

IMPEDE using Shape memory polymer was approved as a new embolic material in Japan, February 2020. We report a case of an 82-year-old man who was performed the superior and inferior gluteal arteries embolization with IMPEDE (IMP-10) prior to EVAR. Although it is necessary to examine the timing and frequency of contrast for confirming embolism in order to prevent the delay of thrombus formation, post-operative CT has few artifacts and it is easy to evaluate endoleak. We considered that IMPEDE is useful embolic material.