Immunoglobulin G4-related diseases (IgG4-RD) are systemic inflammatory conditions, characterized by high serum IgG4 concentrations, and pathologically IgG4-positive plasmacytes infiltrations and storiform fibrosis. We described IgG4-related inflammatory abdominal aortic aneurysm in 2008, and revealed the existence of vascular lesions. IgG4-related vascular lesions frequently occur in the aorta and branching medium-sized arteries with or without aneurysmal change. The inflammatory lesion mainly involves in the adventitia, indicating remarkable adventitial fibrous thickening with infiltration of inflammatory cells. Clinical symptoms associated with IgG4-related vascular lesions might be fever, abdominal pain, hydronephrosis, or few subjective symptoms. Comprehensive diagnostic criteria is applied according to image findings of thickening lesions, high serum IgG4 levels, and histopathological findings. As a treatment, open surgical repair or endovascular aneurysm repair is performed for the aneurysmal cases, and steroid administration is used for the cases with strong inflammation. This disease can lead to a lethal situation due to the rupture following aneurysmal formation, thus special attention is needed unlike IgG4-RD occupying in the other organs.

A localized abdominal aortic dissection complicated by an abdominal aortic aneurysm is a rare disease, and there are few reported cases. For communicating aortic dissection, it’s common to reduce the false lumen internal pressure by implanting stent grafts in the true lumen. However, in this case, the false lumen had enlarged in diameter, and the true lumen was narrowed. Judging from the disorder in the true lumen, there was no commercial stent graft fitting the blood vessel diameter of the true lumen. Therefore, as a method of revascularization, we chose to implant the stent graft in the false lumen, ensuring a sufficient landing zone in a portion with good vascular properties. The patient has had a favorable post-surgery course, and no complications such as graft limb occlusion have been observed.

We report our good outcome of a staged angioplasty for an 18-year-old woman with vasculo-Behçet disease complicated with severe cerebral ischemia. Although she had undergone medical therapy for 12 months, her cerebral ischemic symptoms caused by bilateral common carotid artery (CCA) and left subclavian artery (SCA) occlusions developed gradually. Finally, a cerebral infarction occurred, and she suffered from prolonged symptoms involving higher brain dysfunction, fatigability, and articulation disorder. On admission, computed tomography revealed bilateral CCA and left SCA occlusions. Furthermore, the right SCA, which was the only source of cerebral blood flow, was severely stenotic. Therefore, an endovascular treatment (EVT) was performed to treat the severe cerebral ischemia. At first, percutaneous balloon angioplasty for the left CCA was performed to prevent cerebral hyperperfusion syndrome. Subsequently stentgraft implantation into left CCA and balloon angioplasty for the right CCA and SCA were performed 3 days after first EVT. There were no incidences of brain infarction or hyperperfusion after EVT, and the preoperative symptoms of high brain dysfunction disappeared. No recurrence has been observed over the last 3 years following EVT.

Endograft failure, especially type 1 endoleak, has remained a significant clinical concern and its treatment is often challenging. We report a case of type 1 endoleak after TEVAR using the Najuta prototype, which is a semi-custom-made pre-curved fenestrated device. The endoleak was successfully repaired by additional TEVAR using VALIANT Captivia. An 85-year old man with 70% of Japan Score (estimated early mortality rate) was admitted to our hospital owing to type 1 endoleak and enlargement of a distal arch aneurysm. He underwent zone 0 TEVAR using the Najuta prototype for the treatment of distal arch aneurysm at age 80. Computed tomography showed type 1 endoleak through a fenestration on the stent graft (SG) at age 83. So we performed re-intervention using VALIANT Captivia. This SG has proximal bare stent and strong radial force that may be effective for adequate seal of a space around a fenestration of the Najuta endograft. After this procedure, the endoleak disappeared.

TypeII endoleak after endovascular aneurysm repair (EVAR) is one of most frequent complications. Some cases require additional treatment because of the aneurysm enlargement due to endoleaks. However, management of TypeII endoleaks, the indication of secondary treatment and prophylactic treatment are controversial. Herein, we have devised a method of coverage the IMA using the Aorta Extender for prevention of TypeII endoleak prior to EVAR. We carried out this method for two cases with good results. Postoperative CT showed no endoleak and no aneurysm enlargement 1 year after EVAR.

Popliteal venous aneurysm (PVA) is a rare disease that may lead to the potentially fetal pulmonary thromboembolism (PTE). PVA should be treated surgically because only anticoagulation treatment is not sufficient to prevent the recurrence of PTE. A 62-year-old woman presented with a sudden onset of dyspnea. Contrast-enhanced computed tomography (CT) demonstrated multiple bilateral PTE, and the CT venogram showed a right PVA. We initiated anticoagulation therapy, and performed retrievable inferior vena cava filter insertion. She subsequently underwent aneurysmectomy of the PVA and patch plasty with the small saphenous vein. She has been doing well, without recurrence of PVA and PTE, on warfarin for more than half a year postoperatively. Urgent surgical treatment of PVA should be considered to prevent severe PTE.

Cystic adventitial disease is a rare cause of arterial insufficiency. It usually affects the popliteal artery and its etiology is obsure. It has also been detected in the radial, ulnar, external iliac and common femoral vessels. Here, we describe a case of cystic compression of the common femoral artery from a ganglion arising from the hip joint. A 50-year-old healthy man presented with claudication for several years, rapid left leg cool feeling and numbness. In the left lower limb, the ankle brachial pressure index was as low as 0.31, and three-dimentional computed tomography showed occlusion of the left femoral artery. Left femoral arterial echocardiography suspected thrombosis at the same site. Primary diagnosis was left femoral arterial thrombosis and thrombectomy was performed. However, there was no thrombus and also blood flow was normal. About fifty days later, same symptoms recurred and re-stenosis was occurred. The findings of magnetic resonance imaging suggested the presence of cyst formation of the femoral arterial wall. We performed resection of the left common femoral artery and graft replacement. Arterial compression due to external cystic lesions, this case caused by Ganglion, although rare, was recognized. This case serves as a reminder that the causes of rapid ischemic symptoms, and cystic adventitial disease should be considered in the diagnosis of all patients.

An 83-year-old male was treated with endovascular repair of an abdominal aortic aneurysm using Gore Excluder stent-graft. Eighteen months after the procedure, the patient was referred to our outpatient department due to gluteal and thigh pain for several days. Computed tomography revealed an enlargement of the abdominal aortic aneurysm without any endoleaks. A large hematoma was located left posteriorly on the aneurysm and the third lumbar vertebra was destructed. The patient was diagnosed with chronic contained aneurysm rupture because of stable hemodynamics and no evidence of anemia, and underwent delayed open surgical conversion. After a thrombus in the aneurysm sack was completely removed, aortic reconstruction was performed using a bifurcated prosthetic graft. The radicular pain was improved immediately after the operation.

In patients with false aneurysms after fracture of the femoral neck, it is sometimes difficult to evaluate whether or not protracted pain is related to the fracture, requiring a specific period until a definitive diagnosis can be made. The patient was an 85-year-old male. He underwent intramedullary nailing for right trochanteric fracture. However, right inguinal pain persisted, and a gradually enlarging mass involving the right inguinal to femoral regions was noted 6 months after injury. Contrast-enhanced CT led to a diagnosis of a false aneurysm in which a free bone fragment was present, and repair was performed. After surgery, the pain disappeared, and the patient was discharged. In patients with protracted pain persisting for 6 months or more after surgery for fracture of the femoral neck, a diagnosis must be made, considering the presence of a false aneurysm.

Popliteal arterial aneurysms (PAAs) carry a high risk of a major amputation when they develop into acute ischemia or rupture. Surgical treatment of PAAs involve revascularization using primarily saphenous vein grafts or prosthetic grafts. Here, we used a superficial femoral vein graft for a case of PAA surgery. An 82-year-old woman with diagnoses of PAA and varicose veins underwent an operation involving left popliteal artery replacement with a left superficial femoral vein graft using the posterior approach. We avoided to use a saphenous vein graft because they had some dilated changes broadly. Postoperative swelling of the left lower leg occurred, but improved uneventfully. Enhanced computed tomography revealed patency of the graft with a size equal to the native popliteal artery. The superficial femoral vein is suggested to be a feasible and useful graft for PAA surgery.

A 78-year-old man underwent Y-grafting for an infrarenal abdominal aortic aneurysm. The next evening, he suddenly went into shock. Contrast computed tomography (CT) revealed a hemoperitoneum located immediately dorsal to the transverse colon. Angiography showed dilatation and stenosis of the middle colic artery with no contrast medium extravasation. Although the hemodynamics was temporarily stabilized, he went into shock again the next day. Laparotomy was urgently performed. The middle colic artery was dilated and had a 3 cm longitudinal tear. We repaired the tear with a 5-0 polypropylene running suture. The postoperative course was uneventful. He was discharged without complications after 18 postoperative days. Contrast CT and angiography suggested that rupture of middle colic artery was associated with segmental arterial mediolysis (SAM). Preceding Y-grafting might have led to SAM, even though the middle colic artery was anatomically remote.

We report a successful case of endovascular aneurysm repair and abscess drainage for rapidly expanding infectious abdominal aortic aneurysm associated with psoas abscess. A 62-year-old woman who had experienced left lumboinguinal pain for 1 month was referred to our hospital. Computed tomography (CT) showed an infrarenal abdominal aortic aneurysm that was poorly marginated with psoas muscle, so she was admitted to our hospital and fully examined. We recognized an increasing inflammatory reaction after her admission, and CT showed a psoas abscess with an irregular infrarenal aortic aneurysm adjacent to it. We suspected an infectious abdominal aortic aneurysm associated with psoas abscess and initiated antibiotic therapy. Yersinia enterocolitica was detected in the psoas abscess drainage. One month after the antibiotic therapy was completed, she presented with left lumboinguinal pain again. CT showed that the aneurysm was close to rupturing, so we perfumed emergency surgery with endovascular aneurysm repair. The postoperative course was uneventful, and postoperative CT showed no endoleak of the abdominal aorta and a decreasing psoas abscess. Seven months after the surgery, CT revealed the disappearance of the aneurysm and an abscess cavity. No infection or complication has been detected during the 18 months after the surgery.