Objective: We report the early and long-term results of hybrid endovascular repair of a thoracoabdominal aortic aneurysm (TAAA), perioperative disseminated intravascular coagulation (DIC), and hemorrhagic complications associated with postoperative DIC. Methods: We evaluated 15 patients (10 males and 5 females; median age 74.6 years) who underwent hybrid endovascular repair for TAAA and chronic thoracoabdominal aortic dissection between January 2011 and September 2022. Postoperative complications, survival, incidence of DIC, and risk factors for hemorrhagic complications associated with postoperative DIC were evaluated. DIC was diagnosed using the scoring system established by the Japanese Association for Acute Medicine. Results: Only one patient (6.7%) died within 30 days of treatment due to cerebral hemorrhage. The 5-year survival rate was 64.6% and aneurysm-related deaths were not detected. The 5-year rate of freedom from aneurysm-related complications is 70%. Preoperative DIC occurred in five patients (33%), while postoperative DIC increased in 11 patients (73%), and hemorrhagic complications were detected in 3 patients (20%). A univariate analysis identified preoperative FDP value, thrombus volume, and stent-graft treatment length as risk factors for bleeding complications. Conclusion: Hybrid endovascular repair for TAAA may be a good option for high-risk patients who are ill suited to conventional open repair. Postoperative DIC and hemorrhagic complications associated with extensive stent grafting occur with relatively high frequency and can be fatal. Therefore, risk assessments and appropriate therapeutic interventions for perioperative DIC are necessary.

Objective: Thromboangiitis obliterans (Buerger disease) is known as an intractable vascular disease that has been reported as thrombosis in distal arteries and occasional venous occlusion, as well as inflammatory changes in the thrombus and vascular wall. Patients often require limb amputation due to limb necrosis. Corkscrew (CS), a small arterial coiling, is an important diagnostic finding that was mainly found with angiography. Recently, however, it can also be identified using a modern ultrasonographic technique. Methods: In thease 22 cases, in 48 areas of study, we used the ultrasonographic technique to identify the CS, which allowed us to observe its relationship with the surrounding nerves and arteries. Results: In all cases, it was possible to identify the CS easily and it was confirmed that the CS and the nerve were carried down in their sheath. The sites of the CS existed in areas other than the area around the occluded main arteries and some CS that ran inside the nerve (16 areas) and some CS that accompanied the outside of the nerve (10 areas) were confirmed, suggesting the CS work as collateral blood supply vessels, with well-developed normal vessel-like anatomy. Conclusion: When we observe the CS, it is important to observe not only around the main trunk artery, but also areas where nerves mainly run, even if they do not accompany the main trunk artery.

Objective: To evaluate the mid-term outcomes following TEVAR for chronic type B aortic dissection (TBD), especially to know which re-entry closure affecting on the thoracic false lumen remodeling in the late chronic TBD. Methods: From April 2017 to April 2022, 25 patients with chronic TBD underwent TEVAR. The late chronic TBD received the re-entry closure including stent-graft deployment in renal artery, infrarenal aorta and unilateral or bilateral iliac artery. Results: Complete shrinkage of the thoracic false lumen were accomplished in 67% of the early chronic cases, but in only 13% of the late chronic cases. The thoracic false lumen shrinkage over 5 mm in diameter were obtained in 78% of the early chronic cases and in 69% of the late chronic cases. Univariate and multiple logistic regression analyses revealed the re-entry closure of common or external iliac artery affected on the thoracic false lumen remodeling. Conclusion: The re-entry closure in common or external iliac artery could affected on the thoracic false lumen remodeling following TEVAR for the late chronic TBD.