Particularly in patients with hemodialysis, cardiovascular mortality rate is extremely high. Polyvascular diseases develop at an early stage of CKD. Pathophysiology includes insulin resistance and/or imbalance between nitric oxide (NO) and endothelin bioavailability as well as oxidative stress. The understanding in pathophysiology of vascular calcification and strategic treatment is a critical issue to achieve favorable outcome for the patients with CKD. In this article, we aim to review the cardiovascular disease for the patients with CKD with a particular emphasis on the clinical aspects of polyvascular disease. Finally, we address to detect microcirculatory impairment and eradicate vascular calcification as early as possible prior to renal replacement therapy.

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Objectives: The optimal surgical management for secondary aortoenteric fistula (sAEF) is controversial. Here, we report the long-term outcomes of a surgical treatment with in situ graft reconstruction for sAEF that was performed at our hospital. Methods: Between 2009 and 2012, 10 consecutive patients (8 males, 2 females, mean age 75.9 years) with sAEF were surgically treated with in situ graft reconstruction. Perioperative and long-term outcomes were reviewed retrospectively by medical records. Results: Clinical manifestations, including gastrointestinal bleeding, shock, sepsis, and back and abdominal pain, were observed during the treatment of the patients. In all the cases, fistula was found between the duodenum or small intestine and the graft anastomosis, the graft itself, or pseudoaneurysm. Total graft excision and in situ graft reconstruction with omental coverage and digestive tract reconstruction was performed for all cases. There were two operative deaths because of multiple organ dysfunction syndrome and sepsis. The other patients showed no sAEF related complications, such as graft infection, and were alive during the 54-month mean follow-up period (33–76 months). Conclusion: According to our study, the long-term outcomes of surgical treatment with in situ graft reconstruction for sAEF were considered satisfactory.

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Background: Although the surgical technique for ruptured abdominal aortic aneurysm (rAAA) and its perioperative management have improved, concern regarding the high mortality and morbidity rates after surgery remain. Recently, it has been reported that endovascular aneurysm repair (EVAR) provides favorable results in patients with rAAA. In this study, we assessed the treatment of rAAA at our center. Methods: We evaluated 25 patients who underwent surgery for rAAA between January 2008 and June 2015. Nine patients underwent EVAR (group E) and 16 underwent open repair (group O). The outcomes between the two groups were compared. Results: Preoperative data showed no significant differences between the two groups. There was no significant difference in hospital death (E, 1 patient; O, 6 patients; p=0.355). Causes of death were peritonitis (one patient), bowel necrosis (two patients), sepsis (two patients), bleeding (one patient), and ischemic heart disease (one patient). Regarding perioperative data, significant differences in operation time (E, 128±28 min; O, 320±176 min; p<0.001) and perioperative transfusion volume (red blood cells: E, 10.7±9.8 versus O, 24.3±18.4 units, p=0.027; fresh frozen plasma: E, 5.6±4.7 versus O, 19.5±15.0 units, p=0.002) were identified, although there were no significant differences in hospital morbidity (five patients in group E versus 10 in group B; p=1.000) and hospital stay (E, 12.7±8.0 days; O, 14.3±8.2 days; p=0.487) between the two groups. Conclusions: This study suggests that as a treatment of rAAA, EVAR is at least the equal of open repair and perhaps is superior, as evidenced by the decreases in operation time and perioperative transfusion volume.

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The present study evaluated the effectiveness of our strategies for renal protection during endovascular aortic aneurysm repair in patients with chronic kidney disease (CKD) at our institution. The protective methods of, preoperative isotonic fluid infusion, osmotic contrast media use, and reduced contrast media dosage through intraoperative intravascular ultrasonographic assistance, were introduced at our institution in March 2013. The study included 24 patients with preoperative serum creatinine (Cr) levels >1.5 mg/dl or preoperative estimated glomerular filtration rates (eGFRs) <45 ml/min/1.73 m², who underwent endovascular aortic aneurysm repair with stent grafts (SGs). The patients were divided into the following two groups according to the use of renal protection: group A (received renal protection: n=12) and group B (did not receive renal protection: n=12). The finding in the two groups, particularly those related to postoperative renal function, were compared. The intraoperative contrast media volumes were 43.8 ml in group A and 125.1 ml in group B (P<0.001), and the incidence rates of contrast-induced nephropathy were 0% in group A and 41.6% in group B (P=0.01). In group A, the Cr level and eGFR did not change before and after the procedure: however, in group B, the Cr level was higher and the eGFR was lower after the procedure than before the procedure. In conclusion, our renal protective methods effectively protected and maintained renal function in CKD patients who underwent endovascular aortic aneurysm repair with SG.

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Objective: Many patients with ruptured abdominal aortic aneurysm (rAAA) will die before arriving at a hospital where operation is possible. Therefore, preoperative patient transfer is an important factor for the survival of those with rAAA. We studied the effect of improvement in transfer for patients with rAAA that occurred at the time of consolidation of a cardiovascular center and a municipal hospital. Methods: Aichi Prefectural Cardiovascular Center and Ichinomiya Municipal Hospital were consolidated in 2010. Around the consolidation of the two hospitals, the same vascular team treated the patients with abdominal aortic aneurysm (AAA) in the same fashion. The patients with AAA who underwent operation before consolidation of the two hospitals (CV group) were compared with those after consolidation (MU group). Results: The number and the results of the AAA elective surgery were similar in the two groups. The number of rAAA patients was 5.9/year in the CV group, and 10.5/year in the MU group. All rAAA patients of CV group were transferred from other hospitals, while 42% of MU group patients visited our institution directly. Hardmen index was ≥3 in 14% of CV group and 39% of MU group. Only in MU group, 5 patients were inoperable and started operation was not completed in the other 4 patients. The mortality rate of the whole rAAA patients were 14% in CV group and 42% in MU group (P=0.0410). On the other hand, the number of patients who survived after rAAA operation was 5.0/year in CV group and 6.2 /year in MU group. Conclusion: After partial improvement in preoperative transfer for patients with rAAA, the rate of critical patients and mortality were increased. On the other hand, the number of patients who survived operation after rAAA was also increased.

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Objective: To evaluate operative methods of late open surgical conversion for endoleaks (EL) following endovascular aneurysm repair (EVAR). Methods: Between June 2008 and May 2015, 306 EVARs were performed. During the same time interval, 11 patients required late open surgical conversion because of sac expansion due to EL. Our operative methods are preparing for endovascular surgery: transperitoneal approach, inserting a wire or occlusion balloon into the vessel prior to open the sac, and doing surgical procedures in addition to endovascular treatment as necessary. Clinical outcomes are reported. Results: Data was reviewed for 11 patients with a mean age of 77±9 years old. The median interval from the initial implantation was 3.7 years (range, 4 months–4.1 years). Two patients were presented with proximal type I EL, seven patients were presented with type II EL and two patients were presented with type IIIb EL. Three patients (27%) required an endovascular procedure: two for an endovascular balloon occlusion and one for EVAR. In type I EL, a stent graft was partially explanted in one patient and proximal neck banding was performed on one patient. A stent graft preservation was used for type II and type III EL in all. The 30-day mortality rate was 9% and the mean hospital stay was 14.8±7 days. There was no aneurys—related death during median follow up period of 6.9 months. Conclusion: Our operative methods of late open conversion are of safety and efficacy. But it is necessary to do long-term surveys of post-open surgical conversions for EL following EVAR.

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Objectives: The present study aimed to investigate our treatment strategies for acute deep venous thrombosis (DVT), and to evaluate the treatment outcomes. Methods: We retrospectively reviewed the charts of patients who underwent surgical thrombectomy (ST) and/or catheter-directed thrombolysis (CDT). Furthermore, we added endovascular treatment (EVT) to these procedures. The treatment strategies were divided to three groups: in the Early period group, we performed simultaneous ST and EVT; in the Middle period group, we performed simultaneous ST and EVT, then CDT; in the Latter period group, we performed CDT then ST and/or EVT. Results: 20 patients were treated in this study period. The Early period, Middle period and Latter period groups included 13, 2 and 5 patients, respectively. In the Early period group, the patency of the affected venous lesions was maintained in 9 of 13 patients (69%). In contrast, with the exception of one case, the patency of the affected venous lesions was maintained in all of the patients in the Middle period and Latter period groups and all of the patients have been free from symptoms of venous insufficiency. Conclusion: Our treatment strategy using the hybrid ST and CDT procedure might be a safe and feasible treatment for acute DVT.

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Objective: This report investigates the efficacy and limitations of carbon dioxide (CO₂) angiography for endovascular aortic aneurysm repair (EVAR) in a group of patients with renal insufficiency. Methods: Four patients with abdominal aortic aneurysm (AAA) and concomitant renal dysfunction were selected. Their ages range was 75–87 years and preoperative serum creatinine values were 1.51–1.86 mg/dl. Sizing for EVAR was done using plain computed tomography. Three patients with common iliac artery aneurysm underwent preliminary coil embolization of the internal iliac artery. EVAR was done under general anesthesia using CO₂ angiography; the volume of CO₂ injected was 30 ml in aorta and 20 ml in the iliac artery. Angiography with diluted iodinated media was used in the case of poor visualization of the arteries and at the completion of the procedure in all patients. Results: CO₂ angiography was able to show both renal arteries (RAs) in two patients and a unilateral RA in one patient, but did not show the RAs in one patient. The iliac arteries were well visualized in all patients. Though CO₂ angiography did not detect any endoleaks in any patients, iodinated contrast angiography detected a type Ia endoleak in one patient. For EVAR, the total volume of CO₂ was 180–235 ml and the total volume of iodinated media was 8.0–33.5 ml. There were no complications related to CO₂ administration and the postoperative serum creatinine values were unchanged in all patients. Conclusion: EVAR under CO₂ angiographic control is technically feasible and safe. It still requires the utilization of a small amount of iodinated media that does not appear to worsen renal function.

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Objective: To analyze the long-term result of above-knee femoro-popliteal artery bypass (AKFP) with Distaflo. Methods: In last 11 years, 83 patients underwent AKFP with Distaflo in 107 limbs (88 men, mean age 70.5 year-old) for claudication in 86 limbs, ischemic rest pain in 5 and ulceration in 16. Results: No operative death was encountered but graft occlusion in one patient and wound complications in 13 were observed. During the follow up time (mean 1667days), primary patency rate at 2 years and 5 years were 88.2% and 70.6% and secondary patency rate were 94.0% and 77.1%. Among 24 patients complicated with graft occlusion, thrombus inside the cuff at distal anastomosis was found in 2 patients. Conclusions: The long-term results with Distaflo were acceptable. Distal cuff might be a cause of thrombosis.

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We examined the outcomes of aortic remodeling for chronic type B aortic dissection (cTBD) after thoracic endovascular aneurysm repair (TEVAR). Objective & Methods: Thirty-eight patients underwent TEVAR for cTBD at our institution. We classified cTBD patients into the early cTBD group (16 cases, 2 weeks-4 months from onset) and late cTBD group (22 cases, >4 months from onset). Results: There were no cases of paraplegia, stroke, and hospital death in both groups. There was no worsening of complicated cases. We achieved false lumen thrombosis in cases with a double-barreled thoracic aorta. The early cTBD group had more complete shrinkage cases (60%) than the late cTBD group (11%). Conclusion: We obtained favorable mid-term outcomes after TEVAR for cTBD patients. Early cTBD patients obtained good aortic remodeling with TEVAR.

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Objective: Patients of aorto-iliac aneurysms who undergo endovascular aortic repair (EVAR) require internal iliac artery (IIA) occlusion with coil embolization and its coverage with the stentgraft to prevent type 2 endoleak after extending the endograft into the external iliac artery. However, it has become well recognized that IIA occlusion cause buttock claudication and other various sequelae due to pelvic ischemia. We retrospectively analyzed IIA occlusion outcomes. Methods: From October 2008 to February 2015, 71 patients with aorto-iliac aneurysms underwent IIA occlusion prior to EVAR. The relationship between pelvic circulation and symptom of pelvic ischemia was studied. Results: Buttock claudication occurred in 17 patients (22.9%) of all. Eight patients (14.8%) in unilateral IIA occlusion group (54 patients) and nine patients (52.9%) in bilateral IIA group (17 patients) had sequelae of claudication. The sacrifice of the communication of superior gluteal artery (SGA) and inferior gluteal artery (IGA) led to buttock claudication in 18 (64.3%) of 28 limbs. Instead, only 4 of 60 limbs had buttock claudication, when we preserved the communication between SGA and IGA. In all patients, staged treatment of aorto-iliac aneurysms with IIA occlusion and EVAR were done successfully without pelvic ischemic complications except for buttock claudication, and postoperative CT scanning showed no endoleakage. Conclusion: IIA occlusion prior to EVAR is recognized as a safe and reasonable strategy. It is emphasized that preservation of the communication of SGA and IGA is important to prevent buttock claudication.

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Objective: Maintenance of adequate blood flow in hemodialysis (HD) access (AVF; arteriovenous fistula and AVG; arteriovenous graft) is critical in patients with end-stage renal disease. This study was performed to evaluate the results of a rescue therapy for failing/thrombosed HD access. Methods: From April 2007 to July 2015, 1421 and 1022 operations were performed for failing and thrombosed HD access respectively. Among these operations, 1230 (611 for AVG, 619 for AVF) percutaneous balloon angioplasty (PTA) and 650 (434 for AVG, 216 for AVF) surgical thrombectomy with/without balloon angioplasty (ST (+BA)) were included. Initial success rate, morbidity, and procedure time were evaluated. Results: Procedure time of PTA and ST (+BA) were shorter in AVG compared to those in AVF (23 min vs 29 min, 52 min vs 66 min, respectively). Initial success rate of PTA and ST (+BA) were 99% and 96% in AVG, 99% and 90% in AVF. Success rate of ST (+BA) in AVF were statistically inferior to that in AVG (p<0.001). Morbidity of PTA and ST (+BA) were 0.5% and 1.9% in AVG, 0.5% and 5% in AVF. Most observed morbidity was perforation of blood vessels (0.5% in PTA, 3.2% in ST (+BA)). Vascular injury caused by guide-wires or balloon were initially rescued surgically but recently managed with prolonged balloon inflation. Conclusion: Resluts of PTA for failing AVG and AVF were excellent. Mean procedure time was 20–30 min and success rate were more than 99% in both group. Although results of ST (+BA) were still acceptable (mean procedure time was within 1 hour and success rate was more than 90% in both group), those in AVF were statistically inferior to those in AVG.

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A heparin-bonded expanded polytetrafluoroethylene (ePTFE) vascular graft (GORE PROPATEN Vascular Graft, W.L. GORE & ASSOCIATES, Flagstaff, Ariz) has been commercially available for clinical use in Japan since 2014. Several good results of PROPATEN have been reported in Europe and the United States, however there is no report of the experience in Japan. So we retrospectively investigated 19 consecutive patients who performed femoropopliteal (FP) bypass using the PROPATEN (P group) at our institute between January of 2014 and November of 2015, compared with prior 19 FP bypasses using autologous saphenous vein graft (V group) and 45 FP bypasses using other prosthetic graft, including ePTFE graft without heparin and dacron graft (G group). The primary patency rates at 1.5-year for the PROPATEN were 84.9%, and the secondary patency rates were 90.9%. In the autologous saphenous vein graft group, the primary patency rates were 68.6% (1.5-year, 3-year) and secondary patency rates were 100% (1.5-year), 91.7% (3-year). In the other prosthetic graft group, the primary patency rates were 85.8% (1.5-year), 78.8% (3-year) and the secondary patency rates were 91.7% (1.5-year), 86.4% (3-year), respectively. Although these results were convincing, long-term results were needed for the PROPATEN to be the first choice of the prosthetic graft for FP bypass.

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Objectives: Aneurysm shrinkage after EVAR is the strong factor of favorable outcomes after endovascular abdominal aortic aneurysm repair (EVAR), and type II endoleaks is the risk factor of no aneurysm shrinkage or aneurysm enlargement in the long term. In this study, we evaluate the aortic side branches relate to early postoperative type II endoleak, and performed coil embolization for those vessels for prevention of type II endoleak. Methods: Patency and diameter of aortic side branches including inferior mesenteric artery (IMA) and lumbar artery (LA) were evaluated in 56 consecutive patients with abdominal aortic aneurysm who were scheduled for EVAR. Coil embolization with Interlock was performed in 24 patients during EVAR for all patent IMA and LA with maximal diameter more than 2.0 mm. Computed tomography was performed one week after EVAR for evaluation of endoleak. Results: In patients with IMA more than 2.5 mm in diameter, the frequency of type II endoleak was approximately 90% regardless of the number of patent LA. In case with patent IMA less than 2.5 mm or with 2 or more patent LA larger than 2.0 mm, the frequency of type II endoleak was 46 to 67%. Coil embolization for IMA was successfully performed in 15/16 patients (94%). Coil embolization of LA was performed for patent LA larger than 2.0 mm and 29 out of 45 Las (64%) was successfully occluded. There was no perioperative complication associated with coil embolization. The frequency of type II endoleak was significantly lower in patients with coil embolization than those without coil embolization (4.2% vs 58.9%, p<0.0001). Conclusion: Patent IMA and LA in diameter larger than 2.0 mm were associated with type II endoleak one week after EVAR, and coil embolization with Interlock during EVAR is safe and effective procedure to prevent type II endoleak.

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Objective: To elucidate the occurrence rate, timing and risk factors of endovenous heat induced thrombosis (EHIT) after radiofrequency ablation for varicose veins of lower extremities. Methods: Ninety-nine patients (110 legs) with varicose veins of great saphenous vein (GSV) were underwent radiofrequency ablation therapy using ClosureFAST catheters. Postoperative assessment with duplex ultrasound was conducted for all of the patients after radiofrequency ablation on Day 1, 7, 30 and 90. The occurrence rate, timing and risk factors of EHIT were analyzed retrospectively. Results: The EHIT occurred in 32 legs (29%) (EHIT class1: 24%, ≧class2: 5%). EHIT was found in 11%, 24%, 8% and 1% of legs on Day 1, 7, 30 and 90, respectively. The strong risk factor of EHIT after radiofrequency ablation was the diameter of GSV more than 7.5 mm on multivariate analysis. Conclusion: EHIT was found mostly on Day 7 after radiofrequency ablation for GSV. Postoperative surveillance with duplex ultrasound is really important to prevent thromboembolism for the patients, especially with GSV more than 7.5 mm in diameter after radiofrequency ablation.

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Coral reef aorta is an uncommon variant of atherosclerotic disease that affects the paravisceral and pararenal aorta and its branches. Herein, we describe a 64-year-old man presented to the emergency room with progressive dyspnea and was initially diagnosed as congestive heart failure. CT-scan revealed an irregular, extensive, subtotal occlusive lesion of the visceral aorta and he was finally diagnosed as heart failure secondary to coral reef aorta. Surgical thromboendarterectomy was performed via left thoracoabdominal approach. Partial cardiopulmonary bypass with selective visceral artery perfusion allowed enough time to manage this deteriorated aorta.

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An 81-year old male with right lower abdominal pain was admitted to our hospital. Computed tomography showed inflammatory abdominal aortic aneurysm and bilateral common iliac artery aneurysms associated with bilateral hydronephrosis. Preoperatively, he underwent right percutaneous nephrostomy, and serum creatinine level decreased from 2.4 mg/dl to 1.0 mg/dl. We performed coil embolization of bilateral internal iliac arteries and endovascular repair for abdominal aortic and bilateral common iliac aneurysms. Postoperative course was uneventful and the improvement of right hydronephrosis was recognized. He discharged on postoperative day 29 without any complications. Six months later, computed tomography showed that bilateral hydronephrosis had improved.

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Femoral artery injury can be caused by endovascular interventions or surgical procedure. There have been a few reports of trauma to the femoral artery caused by animal bites. To our knowledge, trauma of the femoral artery caused by deer antlers is rare. We herein report a case of successfully treated traumatic superficial femoral artery (SFA) injury caused by deer antlers. A 74-year old female encountered a male deer while taking a walk in the woods. The deer gored her in the left thigh and she was taken to a nearby hospital. Computed tomography (CT) angiography showed left SFA occlusion and she was transferred to our hospital for treatment. Physical examination on admission showed 4 puncture wounds in her left thigh, which have already stopped bleeding. Although her left femoral pulse was present, no pulses were palpable in the left posterior tibial artery and dorsalis pedis artery. An emergency operation was performed. The antelope’s horn had penetrated the SFA but the hemostasis was achieved. After segmental resection of an injured femoral artery, end-to-end anastomosis was performed. There were no signs of local infection. However, postoperative lymphorrhea lead to prolonged hospital stay. The patient was discharged to home on postoperative day 22. Follow-up CT confirmed patency of the left SFA.

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We report a successful case of thoracic endovascular aortic repair for an acute type B aortic dissection with an atherosclerotic thoracic aortic aneurysm. An 80-year-old man was admitted with acute back pain. Computed tomography showed the type B aortic dissection and the distal aortic arch aneurysm which was 75 mm in diameter. The dissection extended from the distal portion of the aneurysm and the false lumen was totally thrombosed. His symptom persisted though he was treated with antihypertensive medical therapy. Furthermore, computed tomography on 7^th hospital day and 22^nd hospital day were revealed the false lumen was gradually expanded. We carried out the thoracic endovascular aortic repair for the treatment of the aortic dissection and the aortic aneurysm. First, to ensure the proximal landing zone, surgical debranching was performed from the right axillary artery to the left common carotid artery and the left axillary artery. The chimney graft was inserted via the right common carotid artery. Second, to exclude the aneurysm and close the primary entry, the stent grafts were deployed from the ascending aorta to the proximal descending aorta. After deployment of proximal stent graft, the chimney graft was deployed. The postoperative course was uneventful and his symptom was disappeared. Postoperative computed tomography showed no endoleaks and expansion of the true lumen. He was discharged on the postoperative day 14.

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A 63-year-old woman who had been treated for systemic sclerosis for four years developed synchronous stasis ulcers on both lower legs due to varicose veins. The ulcers appeared within nine months of each other. She had worked in a restaurant for more than 12 hours per day for 45 years. The great saphenous veins had been stripped and incompetent perforating veins in each leg had been directly transected or treated by sub-fascial endoscopic perforator surgery using a two-port system. The ulcers completely healed about 10 weeks after surgery without worsening the systemic sclerosis. However, the skin and subcutaneous areas around the left knee became inflamed where the varicose veins had been removed using stab avulsion, and required several weeks to heal. The inflammation may have developed due to the fragility of the skin associated with systemic sclerosis.

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Distal revascularization-interval ligation (DRIL) for dialysis access-associated steal syndrome (DASS) may be performed to improve ischemic symptoms while preserving the vascular access. We herein report a case in which the outcome of DRIL was evaluated with indocyanine green angiography (ICGA). The case was a 75-year-old male. Even though a vascular access was created at the patient's elbow, left finger pain during dialysis appeared after the surgery. In addition, gangrene of the left middle finger tip appeared 12 months later. DRIL was performed in the diagnosis of DASS and his symptoms thereafter improved. Based on the findings of ICGA, it was noted that the time elapsed from ICG onset to half the maximum intensity improved from 56.6 seconds to 48.4 seconds. ICGA may therefore be a useful modality to evaluate ischemia of upper limb extremities.

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Trauma, iatrogenic effects, arteriosclerosis, and infection may cause spontaneous rupture of the posterior tibial artery. If the patient with such a rupture is young and does not have a traumatic history, an inherited connective tissue disorders must be considereds. We present a case of a patient with rupture of the right posterior tibial artery caused by preexisting diagnosed vascular Ehlers-Danlos syndrome. A 38-year-old woman with swelling of the right-lower leg was admitted to our hospital. A CT revealed a rupture of the right posterior tibial artery. We decided the rupture could not be repaired by endovascular treatment, because the rupture site was large. We therefore performed a surgical repair. Following a postoperative examination the patient was diagnosed with vascular Ehlers-Danlos syndrome. In cases of vascular Ehlers-Danlos syndrome, surgical repair should be avoided if possible because of the friability of the vessels. If patients with ruptures of the peripheral arteries do not have a traumatic history, arteriosclerosis, or infection, it is necessary to consider the possibility of an inherited connective tissue disorders.

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After treatment of stent graft for chronic aortic dissection, there are patients who can't obtain aortic remodeling because persistent flow in the false lumen. We underwent the false lumen embolization with Candy plug technique for the purpose of controlling perfusion in the false lumen remaining after TEVAR. 49-year-old woman. She was treated with TEVAR that covered the entry in the distal arch aorta for chronic type B aortic dissection which had passed 10 years from the onset. The false lumen was not thrombosed because a lot of blood flow to the false lumen from the re-entry of the abdominal aorta had remained. We added the embolization of false lumen by Candy plug technique after two months from first TEVAR. Her postoperative course was good, and the false lumen was quickly thrombosed. At six months after the operation, computed tomography revealed that the diameter of thoracic aorta and the false lumen was regressed. We think that Candy plug technique might be one of the good treatments for chronic aortic dissection.

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We herein report a rare case of an acute superior mesenteric vein (SMV) occlusion caused by a tumor thrombus from colon cancer, resulting in massive bowel infarction. A 60-year-old woman was referred to our hospital for evaluation of abdominal pain. Enhanced computed tomography (CT) showed an intraluminal filling defect in the SMV and an ascending colon tumor. We immediately began anticoagulant therapy and planned a colonoscopy. On the third day after admission, the patient went into shock. Emergency enhanced CT showed that the filling defect in the SMV had progressed to the portal vein (PV), and the small bowel was not extensively enhanced. Emergency surgery revealed that the small bowel was extensively necrosed (the non-necrosed portion was 40 cm in length) and that ascending colon cancer was present. The SMV and PV were occluded by the tumor thrombus. We performed massive small bowel resection, right colectomy, and thrombectomy with a Fogarty catheter. Both the colon cancer and the tumor thrombus in the SMV and PV were pathologically diagnosed as adenocarcinoma. Thus, we concluded the massive congestive bowel infarction was caused by the rapid progression of the tumor thrombus from the SMV to the PV. We continued the anticoagulant therapy postoperatively, and the SMV and PV were recanalized without residual bowel infarction or acute liver failure. The patient was discharged on postoperative day 47 with the assistance of intravenous hyperalimentation. She received chemotherapy, but died of multiple liver metastases and peritoneal dissemination 21 months postoperatively. SMV tumor thrombosis secondary to colon cancer can cause bowel infarction in patients undergoing anticoagulant therapy. In such cases, thrombectomy with a Fogarty catheter can effectively prevent bowel infarction and acute liver failure.

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A 47-year-old man underwent graft replacement of the abdominal aorta and iliac arteries. On postoperative day 17, he developed a high fever and abdominal pain. Laboratory evaluations revealed a high C reactive protein level (13.5 mg/dl). Computed tomography (CT) identified fluid retention and inflammatory changes of the soft tissue around the prosthetic graft. We suspected an abdominal aortic graft infection and initiated antibiotics treatment, but the inflammatory reactions and CT findings worsened. The antibiotics regimen was changed to meropenem and metronidazole, because Bacteroides fragilis was identified from the patient's blood culture. The inflammatory reactions markedly improved and his general condition stabilized. On day 37 after re-admission, he was discharged. The patient is now asymptomatic, 32 months after the operation.

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A 62-year-old man was admitted with left shoulder pain and high fever. Enhanced computed tomography (CT) showed a lobular dilatation of distal aortic arch, descending thoracic aorta and left common iliac artery. The diagnosis was infected multiple aortic aneurysms. Following to antibiotic therapy for 11 weeks, the patient was underwent the operation. Aortic arch was reconstructed with 4-branched graft, thoracic endovascular stent grafts were deployed at distal arch, descending thoracic aorta, and iliac stent graft was also deployed to left common iliac artery (hybrid-procedure). Postoperative CT revealed no endoleakage in aneurysms. Intravenous antibiotic therapy was continued for a month. Hybrid-procedure for infected aneurysm may be an alternative to standard open procedures in high-risk cases.

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We surgically treated a patient with large abdominal aortic aneurysm (AAA), which was gradually enlarged due to type II endoleak after endovascular aneurysm repair (EVAR). The catheter intervention was unsuccessful. To prevent migration and deforming of the stent, the large aneurysm was directly opened with minimum manipulation of the stent and surgical hemostasis was achieved by primary clipping of lumbar arteries. This approach would be safe and useful for such patients with large AAA caused by type II endoleak after EVAR.

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Cystic adventitial disease of the popliteal artery is a rare disease, leading to narrowing of the arterial lumen and causing symptoms of lower limb ischemia. In this report, we describe a case of cystic adventitial disease of the popliteal artery, which was connecting to the knee joint. A 71-year-old man presented to our hospital with a complaint of intermittent claudication of the right lower limb. In the right limb, the ankle brachial pressure index was 0.80. Contrast-enhanced computed tomography indicated stenosis of the right popliteal artery. Cyst formation around the stenotic artery was also found. Thus, cystic adventitial disease of the popliteal artery was suspected, and surgical treatment was performed. Intraoperatively, we observed that adventitial cyst had a stalk connecting with the knee joint. The treatment consisted of resection of the popliteal artery and the cyst, and revascularization using the great saphenous vein. The stalk was ligated and devided. After operation, symptoms totally disappeared. The cause of this disease has not been revealed and various theories have been proposed for its etiology. In this case, the cyst was connected with the knee joint. We consider this finding to support the developmental theory.

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The patient was 50s woman who was treated with norgestrel drug for bleeding from the uterus due to adenomyosis. She complicated with deep vein thrombosis and thromboembolism of the pulmonary artery. After a retrievable inferior vena cava (IVC) filter (Cordis OptEase^TM) was implanted, she was performed hysterectomy. Because the thrombus had disappeared due to anticoagulant therapy with warfarin, we attempted to retrieve of the IVC filter via femoral vein. However, during the procedure, the IVC filter was markedly deformed and it became impossible to retrieve transvenously. A computed tomographic scan revealed that the strut of the IVC filer markedly oppressed the duodenum from the back side. However the patient complained no abdominal pain and had no gastrointestinal bleeding, we were afraid of the duodenal perforation in the future. After the discussion about the indication of the operation, we performed surgically removal of the IVC filter to prevent the duodenal perforation 39 days after implant of the IVC filter. The post-operative course was uneventful.

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Penetrating neck injuries (PNIs) are rare, but may be potentially lethal. The management of PNIs remains controversial. We report a case of surgical repair of the left carotid arteriovenous fistula after penetrating injury of the neck. A 34-year-old woman, who stabbed herself in the neck was admitted to the emergency medical center. She did not have active bleeding or hemodynamic instability, then had the stab wound just closed. On the following day, continuous murmur was audible at the left neck and contrast CT scan revealed a pseudoaneurysm of the left common carotid artery. The patient was referred to our hospital, and had an emergency operation. The operation was performed through a left cervical incision and median full sternotomy to control bleeding at the take off of the left common carotid artery. We used topical head cooling and continuous intravenous injection of thiopental to protect the brain. Both the left carotid artery and the internal jugular vein were repaired by direct suture closure. Clamp time of the left common carotid artery was 30 minutes. No postoperative neurologic deficit occurred and her postoperative course was uneventful.

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A 32-years-old man had undergone ventricular septal defect patch closure and patent ductus arteriosus ligation for a ventricular septal defect, patent ductus arteriosus, coarctation of the aorta, and pulmonary hypertension at the age of one year. He was then followed up for aortic coarctation under a presumed diagnosis of pseudocoarctation of the aorta because the pressure gradient was mild (≤10 mmHg) postoperatively. Furthermore, he had required aortic valve commissurotomy for aortic stenosis due to a bicuspid aortic valve at 17-years of age. Subsequently, aortic stenosis and insufficiency had gradually worsened and a chest computerized tomography scan revealed an ascending aortic aneurysm. We performed the modified Bentall procedure using a mechanical heart valve and a Dacron graft, and total arch replacement including resection of the aortic coarctation using a 4-branched Dacron graft. Surgical treatment for the aortic aneurysm with pseudocoarctation is rare, and the surgical approach varies according to the position of the aortic aneurysm. We examined the surgical strategy for aortic aneurysm treatment with pseudocoarctation by referring to reported cases.

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Cystic adventitial disease of the popliteal artery is a rare vascular disease which is characterized by the formation of mucin-filled cysts within the adventitia of the popliteal artery. These cysts may result in the obstruction of blood flow. We herein report a case of a cystic adventitial disease of the popliteal artery that was successfully treated by percutaneous needle aspiration. The patient was a 74-year-old male who presented with a chief complaint of intermittent claudication of the left lower limb. Contrast-enhanced computed tomography revealed severe stenosis of the left popliteal artery compressed by cystic masses, which supported a diagnosis of cystic adventitial disease. We decided to perform less-invasive percutaneous needle aspiration because the patient’s respiratory function was impaired due to interstitial pneumonia. Ultrasound-guided percutaneous cyst aspiration was performed using a 14-gauge needle and jelly-like substance was aspirated. About four weeks later, residual cysts were detected and aspiration was performed again. The cysts were reduced in size and the patient’s stenosis resolved. The patient remained asymptomatic during a 6-month follow-up period. Ultrasound-guided percutaneous needle aspiration is an effective method for treating cystic adventitial disease, and should therefore be considered as a treatment option.

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A brachiocephalic artery aneurysm is rare, with cases of a brachiocephalic artery aneurysm along with a distal arch aneurysm being rarer. Herein, we report a rare case of a brachiocephalic artery aneurysm with a distal arch aneurysm in a 50-year-old man who was treated with two-stage repair surgery. The patient was diagnosed with sigmoid colon carcinoma on computed tomography. The sigmoid colon carcinoma was resected. Because of suspected gastrointestinal bleeding associated with systemic heparinization at the time of aneurysm treatment, open surgery was performed for treating the brachiocephalic aneurysm, and thoracic endovascular aortic repair (TEVAR) was performed for treating the distal arch aneurysm. It is a common policy to perform two-stage repair surgery for treating arch aneurysms, while median sternotomy is performed for treating brachiocephalic artery aneurysms. We clamped the innominate artery by using an external shunt, to avoid cerebral ischemia; the surgery was completed safely. After sigmoid colon carcinoma resection, TEVAR, a non-invasive procedure, was used to avoid extracorporeal circulation, and the distal arch aortic aneurysm was treated with a non-invasive procedure; all the procedures showed good results.

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Venous aneurysms are local vessel knobs of the veins. However, the frequency with which superficial venous aneurysms are associated with thromboembolisms remains unclear. We experienced a case of venous aneurysm of the great saphenous vein with a thrombus that extended rapidly into the common femoral vein. A 70-year-old woman noticed a subcutaneous mass in her right thigh. Echography revealed a vessel knob in the great saphenous vein with a thrombus extending adjacent to the sapheno-femoral junction. Retrospective analysis of previous computed tomography images showed that the thrombus location and range had not changed in the previous month. Four days after her diagnosis, the patient underwent surgery. Echography performed just before the operation revealed that the thrombus had extended into the common femoral vein by 2 cm. Thrombectomy and vessel knob resection were performed. Because the vessel knob in the great saphenous vein was localized as a saclike widening, it was diagnosed as a venous aneurysm. It is important to appropriately address superficial venous aneurysms containing thrombi near the sapheno-femoral junction, including evaluation of thrombotic diathesis and anticoagulant therapy. Because thrombi may develop rapidly, early venous aneurysm resection is recommended.

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An 84 year-old female patient with a gradually expanding aneurysm in the infrarenal abdominal aorta was referred to our department. Although she had two previous laparotomies for uterine cancer, open repair was chosen because of inappropriate configuration for endovascular repair. Despite marked adhesions, we managed to complete aortic repair with infrarenal aortic cross-clamp. However, she unexpectedly developed liver dysfunction with marked elevations of creatine kinase and lactate. Computed tomography revealed diffuse liver necrosis, white blood test results indicated disseminated intravascular coagulation, the patients was thus diagnosed with acute liver failure. Since infrarenal aortic cross-clamping is unlikely to cause liver ischemia, repeated laparotomy with underlying adhesions might have been related to this event. This paper reports this unusual case with bibliographical considerations, focusing especially on the mechanism and measures for prevention.

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An 88-year-old male was treated with endovascular repair of an abdominal aortic aneurysm using Gore Excluder stent-graft. Two years after the procedure, the patient was referred to our emergency room due to abdominal pain. Computed tomography revealed an enlargement of the abdominal aortic aneurysm and a type Ia endoleak located left posteriorly on the bifurcated stent-graft. The patient was diagnosed with impending rupture of aneurysm, and underwent delayed open surgical conversion. The proximal and distal component of the stent-graft was preserved with stent-graft cross-clamping and partial stent-graft removal. Aortic reconstruction was performed with an end-to-end anastomosis between a bifurcated graft and the preserved stent-graft. Computed tomography after the delayed open surgical conversion demonstrated neither disruption nor collapse of the preserved stent-graft. The partial removal of the stent-graft avoiding suprarenal aortic cross clamping appears to be safe and effective.

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An infected aortic aneurysm after thoracic endovascular aneurysm repair is a dire, life-threatening condition. We report the case of an infected thoracic aortic aneurysm successfully treated by wrapping the pedicled latissimus dorsi muscle flap. The patient was a massively obese 62-year-old man who had been undergoing maintenance hemodialysis and had undergone thoracic endovascular aneurysm repair 8 months previously. He became febrile and was diagnosed with an infected thoracic aortic aneurysm and mediastinitis. After the mediastinitis was treated with a vacuum-assisted closure device, an operation was performed for the infected thoracic aortic aneurysm. Fistulous communication between the aorta and the pulmonary parenchyma was found. There was purulent collection inside the aneurysm, and aortotomy and left upper lobectomy (LUL) were performed. The stent graft was wrapped with the pedicled latissimus dorsi (PLD) muscle flap. The mediastinal wound was closed by a rectus abdominis muscle flap. Postoperative infection remained well controlled even 5 months after the operation, and the patient was able to live a comfortable life in the hospital. The PLD muscle flap is considered to be reliable and useful.

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An 87-year-old man developed a multilocular saccular aneurysm of the descending thoracic aorta and experienced extensive inflammatory reaction; he was administered antibiotic therapy because infectious aortic aneurysm was suspected. Throughout the course, however, no fever was noted, and the results of blood culture and procalcitonin test were negative. Computed tomography scans showed minor changes in the aneurysm shape and few shadows surrounding soft tissue. Based on these findings, we ruled out infectious aneurysm and performed thoracic endovascular aneurysm repair (TEVAR) with the emphasis on the risk of aneurysm rupture. One day after the surgery, leukemoid reaction with an abnormally high white blood cell count up to 112800/μl was noted, and the patient developed rapidly progressive pyoderma gangrenosum in the bilateral groin. He showed no response to antibiotic therapy during the course and died of multi-organ failure 21 days after the surgery. The results of the autopsy showed marrow hyperplasia and increased immature leukocytes, which suggested surgery-induced blast crisis that resulted from the underlying chronic myelomonocytic leukemia. Although TEVAR was less invasive, it is important to fully evaluate the reasons for preoperative inflammation and its indications for surgery.

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A 55-years old man was referred to our hospital due to chest and back pain. He was managed conservatively with antihypertensive therapy because of acute uncomplicated type B aortic dissection. After six months, his dissecting aortic aneurysm had enlarged to 45 mm in diameter and the true lumen had been narrow. To achieve aortic reconstruction, thoracic endovascular aortic repair (TEVAR) of combined covered stent graft and metal bare stent with Zenith Endovascular Graft (Cook Inc., Bloomington, IN) was performed from Zone-2 to terminal aorta. Three and six months after TEVAR, the true lumen was normalized in consequence of remodeling. This procedure has a beneficial effect on aortic remodeling of dissecting aneurismal aorta in the short term.

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A 75-year-old male was transferred to a local hospital due to loss of consciousness (LOC). Contrasted computer tomography (CT) revealed the ruptured abdominal aortic aneurysm and retroperitoneal hematoma with the severity of Type 3 in Fitzgerald’s classification. He was transferred to our hospital, and presented with hemorrhagic shock upon the arrival. A low level of prognosis was predicted by the presence of two Hardman’s factors (Hgb<7.7 g/dl and LOC). Suprarenal balloon aortic occlusion (BAO) was set up urgently, emergency EVAR was performed using Excluder (W. L. Gore & Associates, Az). The hemodynamics was stabilized temporarily, but an hour later, he went into shock again presenting with abdominal compartment syndrome (ACS). Contrasted CT showed further extension of retroperitoneal hematoma and exudation of contrast agent into the abdominal cavity in the early arterial phase. Resetting BAO, abdominal incision was performed urgently to drain the large volume of hemorrhagic ascites. After fastening a banding tape around the proximal landing zone of the stent graft, we incised into the aneurysm, and stopped back-bleeding of lumber arteries surgically. The right contralateral leg was removed, and lumber and sacral arteries originated from the right common iliac artery (RCIA) were sewn closed. A bypass from the contralateral gate of the stent-graft to the RCIA was constructed using a Dacron graft. He survived postoperative multi organ dysfunction and was discharged after 36 postoperative days without complication.

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We reported a debranching TEVAR for a descending thoracic aortic aneurysm with localized dissection complicated by disseminated intravascular coagulation (DIC). A 76-year-old man was admitted to our hospital due to acute kidney dysfunction, anemia and thrombocytopenia. A computed tomographic scan revealed a descending thoracic aortic aneurysm with localized dissection. The maximum aneurysm diameter was 51 mm. He was also diagnosed as DIC due to the aneurysm with dissection. Because he was too frail to undergo open repair of the aneurysm, we decided to perform a debranching TEVAR. Recombinant thrombomodulin was administered preoperatively to alleviate DIC. An axillary-axillary-carotid bypass with a T-shaped GoreTex graft^® was followed by endografting with TX2 thoracic stent grafts (34 mm, 38 mm). The disseminated intravascular coagulation was improved after surgery. Postoperative enhanced computed tomography showed shrinkage of the aneurysm sac with no endoleak. We believe that debranching TEVAR is one of the useful strategies for a descending thoracic aortic aneurysm with DIC.

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We encountered a 77-year-old man who developed wrapping sac enlargement and rupture 10 years after vascular graft replacement for an abdominal aortic aneurysm. He had undergone aortic replacement with a bifurcated woven Dacron graft (20×10 mm). The wrapping aneurysm sac began to enlarge 1 year after surgery. Although computed tomography (CT) suggested a high-density hematoma, the exact source of bleeding could not be identified by CT, magnetic resonance imaging, or abdominal ultrasonography. The wrapping aneurysm sac enlarged by approximately 4 mm per year, and ruptured 10 years after the initial surgery. No hypotension or abdominal pain occurred at the time of rupture, which was incidentally detected by CT during a detailed evaluation of other diseases. Intraoperatively, a hematoma was observed in the left retroperitoneal space, and the wrapping aneurysm sac contained a small amount of old thrombus and a large amount of fresh thrombus. No anastomotic aneurysm or damage to the vascular graft was observed, and no backflow of blood occurred from the inferior mesenteric or lumbar artery. There was only diffuse oozing from the entire aneurysm sac. The oozing was arrested, and, after the resection of as much of the aneurysm sac as possible, the surgery was completed by plicating the remaining aneurysm sac. Herein, we report this very rare case of wrapping aneurysm sac enlargement and rupture due to oozing.

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An aneurysm of the brachiocephalic artery belongs to peripheral vascular disease. When planning surgery, it is important to consider the anatomical characteristic of the brachiocephalic artery which is vital to cerebral circulation. We report that an infected aneurysm of the brachiocephalic artery with bilateral carotid stenosis was successfully treated with a deliberate surgical strategy described here.

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Endovascular aortic repair (EVAR) has been proposed as an alternative to open surgery for the treatment of Behcet’s disease. However, some patients experience aneurysm recurrence during the postoperative period. A 56-year-old man was diagnosed with Behcet’s disease and had been receiving medical treatment for 26 years. We detected a 60-mm abdominal aortic aneurysm. We performed EVAR using a Power Link (Endologix, Inc.: Irvine) device after preoperative immunosuppressant therapy. The postoperative course was uneventful, and there has been no recurrence during 34 months after operation. The Power Link device has a one-piece bifurcated design, and fully supports polytetrafluoroethylene grafts, which may reduce stress to the aortic intima and the risk of arterial occlusions in the legs in cases of saccular aneurysms with normal terminal aortic diameters. Therefore, Power Link may be a more durable device than the other available options after EVAR in this case of Behcet’s Disease.

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Surgical treatment of intrathoracic subclavian artery (SCA) aneurysm often requiresis median sternotomy approach and it is challenging especially in patients after cardiac surgery. Here, we presented a successful surgical case underwent hybrid treatment which consisted of t endovascular therapy and crossover axillary bypass. A 77-years-old man was referred to our institution for the treatment of SCA aneurysm. He previously underwent coronary artery bypass graft via median sternotomy approach. Preoperative computed tomography revealed a 32 mm sized SCA aneurysm. An aneurysm was located at the proximal portion of the right SCA and extended to the bifurcation of brachiocephalic artery (BCA). Coronary angiography also showed patent internal mammary artery (IMA). Therefore, we employed hybrid approach in order not to injure the IMA by resternotomy procedure. After construction of axillo-axillar crossover bypass, covered stent graft was inserted from BCA to right common carotid artery and coil embolized into aneurysm. Postoperative course was uneventful and postoperative examination confirmed complete exclusion of the aneurysm and patency of the extra-anatomical bypass graft. Hybrid approach not necessitating stenotomy should be considered as a less invasive alternative to conventional surgical procedure in this particular circumstance.

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Cystic adventitial disease (CAD) of the popliteal artery is a rare pathology which causes intermittent claudication. A 68-year-old man presented to our hospital complaining of intermittent claudication of the right lower extremity. Ankle-brachial pressure index (ABI) was 0.47 on the right side. By contrast computed tomography, the right popliteal artery was found to be occluded while the angiography showed stenosis of the artery with typical ‘hourglass appearance’. Based on the findings of magnetic resonance imaging and intravascular ultrasonography, CAD of the right popliteal artery was diagnosed. He underwent removal of the diseased segment and replacement with an autologous great saphenous vein. No recurrence was observed over 6 months postoperatively. Surgical resection for arterial CAD is effective and curative. Appropriate procedure should be selected considering the severity and location of the affected lesion.

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A female patient who had cerebral palsied and tracheomalacia because of hypoxic-ischemic encephalopathy. She also had total laryngectomess and tracheotomy when she was 7 years old. She had bleeding from where she had the tracheotomy and came into emergency when she was 11 years old. We have observed massive bleeding by re-locating the trachea cannula however arrest of hemorrhage was succeeded by cuss expansion. After detailed examination which include bronchoscope and CT scan, we diagnosed tracheo-innominate artery fistula and perfomed the brachiocephalic artery transection. Bypass surgery wasn’t provided since her blood pressure of the distal stump of innominate artery was more than 50 mmHg after tracheo-innominate artery fistula. Tracheo innominate artery is fatal disease however we believe that quick response and appropriate surgery led us to good results.

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Aneurysm and rupture of visceral artery are rare, but they are life-threatening and important diseases. An arc of Riolan connecting between superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) is one of the collateral artery of splanchnic artery. Among the aneurysms of visceral artery, an aneurysm of IMA is few, and there has never been reported a case of ruptured of an arc of Riolan. We experienced a case of intraperitoneal bleeding due to a rupture of the arc of Riolan with a stenosis of SMA. When the 73-years-old female attended to our department, her vital signs were stable and active bleeding and intestinal infarction were not considered, so we chose medically treating for her. Collapsed arc of Riolan was to be thrombotic occluded and spontaneously disappeared, and she didn’t complain of symptoms of abdominal angina after starting oral ingestion. After her general condition became stable, we performed revascularization of the SMA via a common iliac to SMA vein bypass. We could successfully medically treat intraperitoneal bleeding due to collapse of small vessels, as the bleeding spontaneously stopped and an intestinal infarction didn’t occur for abundant collateral artery between splanchnic arteries.

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The patient, a 70-year-old man who underwent thoracic endovascular aortic repair and total aortic arch replacement for descending aortic aneurysm, presented our hospital with chief complaints of hemoptysis and fever. Computed tomography showed air entrapment around the stent-graft. Esophagoscopy showed a mucosal elevation due to extrinsic compression by the descending aorta, an inflammatory polyp, and an orifice-like lesion on the lower esophageal lumen adjacent to the aortic aneurysm. Suspecting an aortoesophageal fistula, the operation was performed. Intraoperative findings revealed an aortopulmonary fistula in the left lower lobe; however, an aortoesophageal fistula was not found. Thus, resection of the whole infected stent-graft, graft replacement of the descending aorta, and omental wrapping were performed. Postoperative esophagoscopy showed disappearance of the inflammatory polyp and the presence of a scar tissue at the same site. The disappearance of the inflammatory polyp on the lower esophageal lumen adjacent to the aortic aneurysm after the operation indicated that the inflammatory polyp was caused by the aneurysm. These results suspect that we encountered a rare case of an inflammatory polyp in the course of aortoesophageal fistula formation.

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A 67 year-old woman was admitted to our institution with pyloric stenosis, but could not take oral medication because of the presence of advanced gastric cancer. A central venous catheter (CVC) was inserted via the right subclavian vein prior to the operation. However, contrast computed tomography (CT) scanning performed 1 week later revealed superior vena caval thrombosis around the tip of the CVC. Despite anticoagulant therapy with unfractionated heparin, thrombus in the superior vena cava (SVC) continued to grow. To prevent a perioperative pulmonary embolism, an SVC filter was placed in the SVC safely and without complications. A gastrectomy was performed and the postoperative course was uneventful, with no pulmonary embolism development during the perioperative period. Some reports have noted that the incidence of pulmonary embolism is high in cases of catheter-induced deep vein thrombosis in an upper extremity. Anticoagulant therapy with heparin is the first choice for treatment of deep venous thrombosis in an upper extremity. However, in selected patients who are unable to receive such therapy, SVC filter placement may be an effective option for prevention of pulmonary embolism. An SVC filter is considered to be useful for prevention of pulmonary embolism and its placement can be safely performed.

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