The purpose of this study was evaluate the operative procedures and outcomes of abdominal aortic aneurysm (AAA) patients and iliac artery injury with aortocaval fistula (ACF) and iliac vein fistula. From 1990 through 2018, we experienced seven AAA patients associated with spontaneous aortocaval and aortoiliac venous fistula and iatrogenic iliac A-V fistula who underwent repair of AAA and iliac artery injury. Three patients were in hypovolemic shock, including one patient with cardiopulmonary arrest on admission required cardiopulmonary resuscitation before surgery who underwent emergency open AAA repair (AAAR) using prosthesis and two patients with stable hemodynamic state underwent urgent AAAR. All surgical treatment of the fistula included direct closure within the aorta under digital compression in four patients and inferior vena cava clamp in one. The mortality rate was 25%. One ACF patient with retroperitoneal hematoma died of bleeding. Two patients with iliac artery-vein fistula during and after disc surgery successfully treated with stent-graft. Survival for ACF depends on early diagnosis and prompt surgical repair. In indication for endovascular aneurysm repair for the AAA patients with ACF controversial issues still remain.

A 78-year-old man with abdominal aortic aneurysm (AAA) had been performed open AAA repair with expanded polytetrafluoroethylene graft. Two years later, re-do open graft replacement with polyester knitted graft was performed due to increasing perigraft seroma (PGS). Then, EVAR using Excluder was performed for recurrent PGS, and there was no sign of recurrence. EVAR is one of the choices of treatment for PGS.

An 80-year-old man visited our hospital for the treatment of bilateral common iliac aneurysms. Endovascular aneurysm repair (EVAR) was selected. After embolization of the bilateral internal iliac arteries, proximal deployment of the Excluder main body and constraining dial was turned for the proximal side of the main body. The inflated balloon in the contralateral gate and main body were pulled down simultaneously to bail out the inferior mesenteric artery (IMA). Using this Excluder repositioning function enabled the main body to be implanted to preserve the IMA. The patient has achieved good progress without complications such as intestinal bowel necrosis.

Here, we report the case of a solitary left internal iliac artery aneurysm that compressed the rectum, resulting in obstructive necrotizing colitis in the sigmoid colon. A 91-year-old male patient presented with diarrhea and abdominal pain. On computed tomography imaging, a left internal iliac artery aneurysm that was 9 cm in size was observed, and it was compressing the rectum. The sigmoid colon on the oral side of the compressed rectum was markedly dilated, and a colonoscopy showed signs of obstructive colitis. Endovascular treatment of the left internal iliac artery aneurysm and laparoscopic sigmoidectomy were performed. The resected sigmoid colon exhibited necrosis. We deemed this as a rare case of obstructive necrotizing colitis because, to the best of our knowledge, no such cases have been reported to occur due to the compression of the rectum by an iliac artery aneurysm.

Aneurysm of the reversed saphenous vein bypass graft for arteriosclerosis obliterans is a rare condition. We report the case of an autologous saphenous vein graft (SVG) pseudoaneurysm following peroneal bypass in the late stage. An 85-year-old man complained of a painless pulsatile mass in the middle of the lower leg. He had undergone a peroneal bypass with reversed autologous SVG for occlusion of the popliteal artery for arteriosclerosis obliterans 14 years ago. He was admitted to the hospital because of the possibility of an anastomotic pseudoaneurysm. Computed tomography (CT) showed that the proximal and distal sites of anastomosis were intact, and part of the aneurysm was the autologous SVG itself. The size of the aneurysm was 8×9.5 cm in diameter. We resected the aneurysm of the reversed SVG and replaced it using the left SVG. Pathological findings revealed graft sclerosis in the aneurysmal orifice, loss of normal vascular wall structure and elastic elements in the aneurysmal wall, and absence of venous sclerosis in the normal portion of the SVG. Thus, we concluded that the expanded portion was the pseudoaneurysm. Postoperative CT revealed that the reconstruction site was patent. Postoperative course was uneventful, and the patient was discharged without complications.

We report a case of isolated celiac artery dissection that was successfully treated with surgery. A 48-year-old man was referred to our hospital due to sudden upper abdominal pain. The patient was diagnosed with the celiac artery dissection by contrast-enhanced computed tomography (CT) and was followed with conservative observation. Follow up CT at three months after the onset revealed saccular aneurysmal formation and enlargement of the celiac trunk. We therefor decided to perform surgery. Laparotomy was perfomed with a median incision. A bypass using the saphenous vein was made from the infra-renal abdominal aorta to the splenic artery and the common hepatic artery. Then the dissecting aneurysm of the celiac trunk was resected. The postoperative course was uneventful, and the patient was discharged 15 days after surgery. Postoperative contrast-enhanced CT showed a patent bypass graft and sufficient arterial perfusion to the visceral organs. The patient is currently doing well with no problems. Isolated visceral artery dissection, including celiac artery dissection, is relatively rare. Most cases are treated conservatively, however, invasive therapy may be indicated in some cases. If invasive therapy is required, it is important to choose the optimal method for each case.

The radial artery aneurysm in the anatomical snuff box is very rare. A 70-year-old male was referred to our department with a complain of a painless pulsatile mass in his right wrist. Ultrasonography and angiography confirmed a 13 mm sized saccular shaped radial artery aneurysm in the anatomical snuff box. The operation was successfully performed with resection of the aneurysm and reconstruction of the radial artery by end-to-end anastomosis. The histopathological examination identified it as a true aneurysm.

A 58-year-old woman was referred to our hospital emergently for abdominal aortic rupture with acute type B aortic dissection. Computed tomography revealed descending abdominal aortic dissection with retroperitoneal hematoma. Infrarenal abdominal aortic replacement was performed using a transabdominal approach. The site of the rupture was identified as a defect in the external membrane at the bifurcation of the left ovarian artery and aortic false lumen. After releasing the aortic cross-clamp, the distal perfusion was found to be severely disturbed with intestinal shrinkage. The aortic malperfusion was thought to arise from severe compression of the proximal true lumen by an extended false lumen. To alleviate the compression and obtain sufficient blood perfusion through the true lumen, thoracic endovascular aortic repair (TEVAR) was immediately performed to close the primary entry tear that was located distal from the left subclavian artery. Intraoperative angiography revealed evidence of a successful TEVAR, given that abdominal and distal perfusion was improved. Although the patient required both partial resection of her intestine and hemodialysis postoperatively, her condition improved gradually, and she was discharged home 6 months after surgery.

An 82-year-old man presented with a history of intravesical administration of bacillus Calmette-Guérin (BCG) therapy using an Immunobladder (Japan BCG Laboratory, Tokyo, Japan) for urinary bladder cancer 10 years prior. The patient was referred to our hospital with low back pain. Computed tomography (CT) revealed third and fourth level lumbar spinal fractures due to pyogenic spondylitis, paravertebral abscess, and a saccular-type infectious infrarenal abdominal aortic aneurysm (AAA). A CT-guided abscess biopsy was performed and BCG was detected. Medical therapy for tuberculosis (TB), that is, HRE+LVFX (isoniazid, rifampicin, ethambutol, and levofloxacin), was started, and treatment was continued for six weeks. With the TB infection controlled, we performed endovascular aneurysm repair (EVAR) for the infectious AAA. The patient’s postoperative course was good, and a CT scan eight months later showed a reduction in the abscess and the AAA. He continued to undergo anti-tuberculosis therapy for twelve months without graft infection. Polymerase chain reactions (PCRs) analysis using the biopsy sample led to the definitive identification of Tokyo strain of BCG vaccine.

We present the case of a 58-year-old man with a history of total arch repair (TAR). Computed tomography revealed a right subclavian artery aneurysm (30 mm), which was connected to the right vertebral artery. Revascularization of the left subclavian artery was not conducted during TAR, and retrograde blood flow in the left vertebral artery was confirmed. The circle of Willis was poorly developed, and we believed that the patient was at high risk of interruption of the right vertebral artery. A two-stage procedure was conducted for treatment: left common carotid artery–vertebral artery bypass was performed using saphenous vein graft and antegrade blood flow in the left vertebral artery was identified. After 1 month, coil embolization of the branch of the right subclavian artery aneurysm and stent graft were used in the right subclavian artery. Postoperative complications were not observed, and the patient was discharged on the 7th hospitalization day.

We describe an extremely rare case of primary myxoma of the descending aorta. 62-year-old woman was hospitalized for ischemia of her left toe. Contrast-enhanced computed tomography detected a low-density giant mass in the descending aorta that was presumed to be the source of the embolism. Despite further examination, we could not make a definitive diagnosis of the mass. Subsequently, the aortic mass was resected in an en-bloc manner with limited graft replacement of the descending aorta to prevent recurrent embolism. Histologically, the resected mass was diagnosed as primary aortic myxoma.

Tuberculous aortic aneurysm is a rare and potentially fatal condition. A 54-year-old woman who had no medical history was diagnosed as having miliary tuberculosis and received antituberculosis medications in another hospital. Computed tomography revealed a thoracic aortic aneurysm, which rapidly enlarged within 2 months despite improvement of lung lesions. She was referred to our hospital to undergo surgical intervention. As the tuberculous infection was controlled with medications, thoracic endovascular aortic repair was performed. The postoperative course was uneventful, and follow-up computed tomography revealed a significant shrinkage of the aneurysm. The endovascular approach in combination with antituberculosis medications could be a useful treatment option for tuberculous aortic aneurysms.

A 66-year-old man underwent endovascular treatment (EVT) for acute occlusion of the right femoropopliteal (FP) bypass graft 1 year after bilateral FP bypass surgery for arteriosclerosis obliterans. Endovascular recanalization for the occluded graft failed; therefore, stent implantation for the right superficial femoral artery (SFA) was performed. Moreover, because a floating thrombus was observed in the right common femoral artery (CFA), an additional stent was implanted from the proximal SFA to the CFA, covering the deep femoral artery (DFA) orifice. Although the limb ischemia was relieved, dissection of the SFA also occurred during this procedure. Four months later, acute thrombosis of all the stents occurred, resulting in the right SFA occlusion. At the same time, it turned out that the proximal end of the additional stent had been positioned in the false lumen of the right CFA. For the occluded SFA, endovascular recanalization was tried but unsuccessful. Although EVT for the right DFA was added, the limb ischemia worsened after these interventions. As pharmacological therapy did not improve the ischemia, the patient was transferred to our hospital. We performed sequential aorto-DFA and DFA-above knee popliteal bypass grafting. The postoperative course was uneventful. The most appropriate and effective strategy for revascularization, including EVT or surgical bypass, should be considered on each occasion.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeon in Japan in 2013, as analyzed by database management committee (DBC) members of the JSVS. Materials and Methods: To survey the current status of vascular treatments performed by vascular surgeons in Japan, the DBC members of the JSVS analyzed the vascular treatment data provided by the National Clinical Database (NCD), including the number of treatments and early results such as operative and in-hospital mortality. Results: In total 100,470 vascular treatments were registered by 1,045 institutions in 2013. This database is composed of 7 fields including treatment of aneurysms, chronic arterial occlusive disease, acute arterial occlusive disease, vascular injury, complication of previous vascular reconstruction, venous diseases, and other vascular treatments. The number of vascular treatments in each field was 19,439, 13,276, 4,688, 1,563, 1,777, 37,643, and 23,971, respectively. In the field of aneurysm treatment, 16,694 cases of abdominal aortic aneurysm (AAA) including common iliac aneurysm were registered, and 52.9% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,598 (9.6%) cases were registered as ruptured AAA. The operative mortality of ruptured and un-ruptured AAA was 17.9%, and 1.0%, respectively. 25.5% of ruptured AAA were treated by EVAR, and the EVAR ratio was gradually increasing, but the operative mortality of open repair and EVAR for ruptured AAA was 16.1%, and 15.8%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 7,437 cases, including 1,121 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) were performed in 5,839 cases. The EVT ratio was gradually increased at 44.0%. Venous treatment including 35,986 cases with varicose vein treatments and 506 cases with lower limb deep vein thrombosis were registered. Regarding other vascular operations, 22,572 cases of vascular access operations and 1,185 amputation surgeries were included. Conclusions: The number of vascular treatments increased since 2011, and the proportion of endovascular procedures increased in almost all field of vascular diseases, especially EVAR for AAA, EVT for chronic arterial occlusive disease, and endovenous laser ablation (EVLA) for varicose veins.