A 71-year-old man underwent thoracic endovascular aortic repair (TEVAR). His postoperative course was uneventful, with no endoleak by enhanced computed tomography (CT). CT performed 3 months postoperatively showed stent graft stenosis. The patient was readmitted to the hospital, and balloon dilation was performed for stent graft stenosis. During the procedure, obstruction of abdominal aorta and left renal artery developed secondary to thrombus expressed from the aneurysm in response to balloon dilation. The patient subsequently underwent immediate thrombectomy using a Fogarty catheter. While reperfusion was obtained, partial thrombus remained in the right common iliac artery. After thrombectomy, additional TEVAR was performed to prevent further thromboembolic events. Bare stent was placed in the right iliac artery on postoperative day 15, and the patient discharged on postoperative day 20 with no symptoms. We conclude that treatment for stent graft stenosis should be considered carefully prior to surgery.

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Limb occlusion after endovascular repair of abdominal aortic aneurysm is a serious treatment-related complication. We report two cases of limb occlusion after endovascular repair of abdominal aortic aneurysm with ENDURANT^® AAA stent graft. One case was a 62-year-old man. One year after surgery, the patient suffered from an acute ischemia of a right leg in the hospital with a bladder cancer. The CT revealed limb occlusion and stenosis of the right iliac leg of endovascular graft. The patient was treated with thrombolytic therapy and E-LUMINEXX stent placement. The second case was a 64-year-old man. Three months after surgery, the patient referred to our clinic due to an acute ischemia of a right leg. The CT revealed limb occlusion and stenosis of the right iliac leg of endovascular graft. The patient was treated with thrombectomy and E-LUMINEXX stent placement. The condition of their right legs improved after treatment.

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A 72-year-old man entered our hospital and was diagnosed with Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia, mediastinitis and sepsis. An enhanced computed tomography (CT) scan revealed a pseudoanuerysm of the right subclavian artery, which was considered to be a mycotic aneurysm. It required surgical treatment, but his general condition was serious, so emergency endovascular treatment, considering phased open surgery, was performed. In the operation, Gore excluder leg (16×10×70 mm) was detached from the brachiocephalic artery and attached to the right common carotid artery, while the right subclavian artery was performing coil embolization. Long term antibiotics therapy was done, and he was discharged 153 days after surgery. Endovascular treatment for mycotic aneurysm is controversial, but it could be a choice especially with patients in poor condition.

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We report a rare case of an infected brachiocephalic arterial aneurysm associated with tracheal obstruction. A 59-year-old diabetic man was referred to our hospital because of a rapidly growing brachiocephalic aneurysm. He developed acute respiratory failure, and chest computed tomography showed a large brachiocephalic arterial aneurysm causing severe tracheal stenosis. Extra-anatomical grafting between the right and left common carotid arteries was performed with a prosthetic vascular graft. The brachiocephalic aneurysm was excised, followed by omentopexy. Sixty-seven days later, the patient successfully underwent an additional endovascular coiling for a pseudoaneurysm of the distal stump of the brachiocephalic artery.

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In recent years, arterial closure devices have been developed and are now used after catheter intervention. These devices may however induce complications, such as infections and pseudoaneurysms. We report two cases with an infected femoral pseudoaneurysm caused by an arterial closure device (ACD). Case 1, an 83-year-old man, underwent percutaneous coronary intervention (PCI) and arterial puncture closing devices were used. Erythema and swelling appeared at the puncture lesion. He was diagnosed as having an infected pseudoaneurysm by echography and was referred to our hospital. The infection was extensive, and the vessel wall had been destroyed, making it difficult to perform treatment using a vein patch. We thus performed debridement of the infected site, and ilio-femoral bypass using a saphenous vein graft away from the infected lesion. The postoperative course was uneventful. Case 2 was a 60-year-old man with a history of diabetes mellitus and polio. An ACD was used for hemostasis after PCI in a previous hospital. An infectious response was observed at the puncture site. He received antibiotic therapy, but showed no improvement. He was therefore referred to our hospital. Because the infection was more extensive than in Case 1, we chose ilio-femoral bypass using expanded polytetrafluoroethylene in the retroperitoneal space in order to obtain a long root graft. The infected area was debrided and the wound was left open to allow washing irrigation during the postoperative course. Wound healing was prolonged, but he was ultimately discharged in good condition. We conclude that debridement and bypass surgery are satisfactory treatment methods for infected pseudoaneurysms caused by ACD.

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Surgical treatment of an aortic aneurysm in vasculo–Behcet disease is difficult, because of the high incidence of perioperative complications. A 38-year-old man who was diagnosed with Behcet disease 4 years ago, complained of sudden abdominal pain. Computed tomography revealed a ruptured abdominal aortic aneurysm, and we performed emergent open graft replacement. The anastomosis site was wrapped with a prosthetic graft to prevent anastomotic aneurysm formation. The patient is now well, with no complications.

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Tracheoinnominate artery fistula (TIF) is a relatively rare but often life-threatening complication of tracheostomy. Although controlling the lethal hemorrhage and prompt surgery are indispensable, massive bleeding leads to deterioration of the patient’s respiratory or systemic condition and often prevents early definitive surgical management. We successfully treated a 25-year-old man presenting with TIF 3 years after tracheostomy by performing temporary coil embolization of the innominate artery followed by curative surgery. Massive hemorrhage occurred spontaneously through the tracheostoma while at home. After immediately controlling the hemorrhage using an orotracheal cannula and a hyperinflated cuff, he was transported to our institute by air ambulance. Because he was intolerant to general anesthesia as a result of severe pulmonary insufficiency and general deterioration, he underwent coil embolization of the brachiocephalic artery under local anesthesia. After his general condition had improved a week later, definitive surgical treatment consistings of resection of the erosive innominate artery and repair of the injured trachea was performed. Therefore, palliative coil embolization of the innominate artery followed by curative surgery should be considered in the treatment of TIF.

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Type Ia endoleak after endovascular aneurysm repair (EVAR) needs immediate treatment for the risk of rupture by enlargement of aneurysms. An 85-year-old woman with type Ia endoleak 5 years after EVAR was treated with embolization using NBCA and coil. But, 5 months after embolization, the patient showed imminent aneurysm rupture with back pain and recurrence of type Ia endoleak. Additional endovascular treatment was unsuitable, because endoleak was caused by proximal neck enlargement. And it was indication for aortic banding. Type Ia endoleak disappeared after banding, and she discharged 9 days after operation. Aortic banding may be effective for type Ia endoleak caused by proximal neck enlargement after EVAR.

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We report a case of acute type B dissection in a patient with paraplegia that improved after emergent thoracic endovascular stent graft repair (TEVAR). A 62-year-old man was admitted to our hospital because of acute onset of abdominal pain and paraplegia. Computed tomography scan revealed type B aortic dissection with complete thrombosis of the false lumen and a severely collapsed true lumen. The patient's right and left femoral arteries were weakly palpable. Emergent TEVAR was performed to close the entry site. After TEVAR, femoral arteries on both sides were well palpable, and the neurological deficit resolved immediately. Entry closure with TEVAR can maintain the collateral supply of the spinal cord that is important for treating spinal cord injury due to acute aortic dissection.

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We report a case of an 84-year-old woman who underwent graft replacement of the abdominal aorta for an infected aneurysm caused by Listeria monocytogenes. She had suffered from spike fever for 2 weeks. Computed tomography showed an aneurysm at the infra-renal abdominal aorta with perianeurysmal inflammation. She was treated by urgent surgery which consisted of complete resection of the aneurysmal sac, prosthetic graft replacement. Listeria monocytogenes was isolated from bacterial culture of the blood. Antibiotics were administrated for 4 weeks. She had drastic recovery and uneventful postoperative course 1 year after surgery.

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An 85-year-old man with ischemic ulcer on the left fifth toe burned his left foot with a portable body warmer. The angiography showed occlusion of infrapopliteal arteries with patent dorsalis pedis and posterior tibial arteries at the ankle. Because the skin on bypass target artery was blistered, we performed endovascular treatment for the occluded peroneal artery preceding a bypass surgery. After the skin on the dorsum of the foot healed, we constructed a superficial femoral artery-to-dorsalis pedis artery bypass and salvaged his foot.

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