The standard procedure for aortic aneurysm is still total arch replacement even stentgraft or frozen elephant trunk procedure becomming common. However, the distal anastomosis in the total arch replacement, is often difficult with limited surgical view. And bleeding from it requires sugical hemostasis with cardiopulmonary bypass and left thoracotomy, resulting in severe invasive. We report a case of 82-year-old woman, who had an distal anastomotic bleeding, successfully treated by endovascular aortic repair with antegrade stent-graft insertion via the branch of total arch graft. It is rare to report that hemostasis was performed with stent graft for bleeding at the anastomotic site during sugery, and this could be alternative technique.

The Nutcracker syndrome is a rare condition that the left renal vein becomes compressed most commonly between the aorta and the superior mesenteric artery. We report here a case of Nutcracker syndrome due to a huge abdominal aortic aneurysm. A 77-years old man with protein and blood in his urine, presented to our hospital. Computed tomography(CT) image demonstrated the abdominal aortic aneurysm measuring 93 mm×82 mm, the Nutcracker phenomenon and the left testicular varicose veins. We performed Y-grafting following resection of the abdominal aortic aneurysm. When the aneurysm was resected, the compression of the left renal vein was released. CT image after the operation revealed that the testicular varicose veins were disappeared and the compression of the left renal vein was reduced. He was discharged on postoperative day 22. Now his hematuria is changing for the better at his follow-up.

Recently, it has been reported that a fenestrated stent graft is an effective option in the treatment of pararenal artery abdominal aortic aneurysm.We report the case of a 72-year-old male patient with multiple aortic aneurysms in the distal arch, thoracoabdominal aorta, right common iliac artery, as well as a pararenal abdominal aortic aneurysm. The patient was found to have a mass with a tendency of rapid expansion within a month from its discovery. Because it was a saccular aneurysm with a tendency of rapid expansion and wide spread, the risk of rupture was judged to be high, and surgical treatment became necessary. One-stage treatment was desirable; therefore, endovascular treatment with a fenestrated stent graft was selected.Four fenestrations were made to a stent graft for the celiac artery, superior mesenteric artery, and bilateral renal arteries.The postoperative computed tomography (CT) showed no branch occlusion or endoleak, and the 2-year postoperative CT showed the shrinkage and subsequent disappearance of the aortic aneurysm at the treatment site.For extensive aortic aneurysm, including pararenal artery abdominal aortic aneurysms, one-stage treatment with fenestrated stent graft was considered to be effective as a treatment strategy.

Persistent type 2 endoleak (T2EL) after endovascular repair (EVAR) of abdominal aortic aneurysm (AAA) has remained a significant clinical concern. Additionally, the effects of anticoagulation therapy on the incidence of T2EL and aneurysm sac enlargement after EVAR are unclear. We report a case of 77-year-old man with a state of shock due to ruptured AAA secondary to T2EL. He underwent EVAR at age 74 and was performed the embolization of the inferior mesenteric artery at age 76 because of a persistent T2EL and enlargement of AAA. He was admitted to our hospital due to sudden abdominal pain and was diagnosed with Fitzgerald grade 3 ruptured AAA. Because he was too frail to undergo surgical repair, we treated him with discontinuation of oral anticoagulant. A computed tomography revealed shrinkage of AAA and retroperitoneal hematoma. He attained remission after the treatment. This case suggests that the anticoagulant administration can be associated with an increased risk for persistent T2EL after EVAR. Therefore, a critical and balanced decision-making approach should be applied when treating AAA with EVAR in patients with anticoagulantion therapy.

We report a 34-year-old man, who was diagnosed Stanford type A acute aortic dissection with polycystic kidney disease (PKD) and had received Bentall’s Operation (using SJM 25 mm and Carboseal 28 mm). The postoperative course was good and he left the hospital without renal dysfunction. Pathological finding revealed cystic medial necrosis at aorta. PKD caused cysts to grow inside the kidneys and the complications of PKD are cerebral aneurysm and acute aortic dissection, which could develop sudden death. It is considered, appropriate preventive methods and treatment strategies are required considering acute aortic dissection as a complication of PKD.

We present a case of uretero-arterial fistula with successful management of artery embolism and femoral-femoral artery bypass. A 76-year-old woman had undergone total cystectomy with ileal conduit construction for bladder cancer, and after that she underwent antibiotic therapy for intra-abdominal infection and sepsis by anastomotic leakage. Five months after operation, she complicated with gross hematuria and shock condition. A computed tomography scan revealed a saccular right external iliac artery aneurysm with inflammation. Expecting an Adhesion after operation and intra-abdominal infection, so we performed arterial embolization and femoral-femoral artery bypass. She recovered and discharged without recurrent gross hematuria, lower limb ischemia and intestinal ischemia. There is no golden standard in the treatment of uretero-arterial fistula. Recently, endovascular procedures containing endovascular stent graft have been recognized as an effective and less invasive treatments. It is important to develop treatment strategy incorporating endovascular procedures according to the situation.

This 85 year-old male complaining of left leg pain was referred to our clinic for evaluation of varicose vein with great saphenous vein (GSV) reflux in left lower extremity. Contrast-enhanced CT revealed that left external iliac artery was completely occluded and we suspect that the left leg pain was attributed to this occlusion. Consequently, femoro–femoral artery bypass surgery was performed and the left leg pain disappeared. However, 2 months after the surgery severe edema showed up in his left lower extremity and ultrasound detected increased diameter of the GSV. Hence, the left GSV stripping surgery was performed. Three months after the stripping procedure, edema in left lower extremity completely disappeared. Among the patients with varicose vein, some of them might also has arteriosclerosis obliterans (ASO). For those patients both diseases should be cared and appropriate treatment strategies are warranted.

The patient was a 60-year-old man, who had undergone dialysis using a vascular access (VA) created at the left wrist with the radial artery and the cephalic vein, was referred to our hospital with VA occlusion in the forearm and difficult dialysis. Urgent vascular access intervention therapy (VAIVT) was performed on the same day. A puncture was performed in the vein near the elbow and an attempt was made to pass the guide wire in a direction retrograde to the blood flow, but the guide wire could not pass through the calcified occluded site close to the anastomosis. Here we report a case where VAIVT was completed by puncturing the anastomosis and a pull-through procedure.

We describe a rare case of a 52-year-old man with spontaneous rupture of the ascending aorta. The patient was transferred to our hospital complaining of severe thoracoabdominal pain. Contrasted CT showed ulcer-like projection in the ascending aortic wall, mediastinal hematoma and pericardial effusion. There was, however, no evidence of intimal flap. Graft replacement of the ascending aorta was emergently performed. Inspection from inside of the aorta after aortotomy revealed transmural perforation. There was no specific evidence of aortic aneurysm or dissection, therefore he was diagnosed with spontaneous aortic rupture. The pathological findings indicated perforation, extramural hematoma and cystic medial degeneration. When acute intrapericardial bleeding or mediastinal hematoma develops with no evidence of aortic aneurysm or dissection, spontaneous aortic rupture should be taken into consideration.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeon in Japan in 2014, 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 hospital mortality. Results: In total 113,296 vascular treatments were registered by 1,002 institutions in 2014. 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 21,085, 14,344, 4,799, 2,088, 1,598, 42,864, and 26,518, respectively. In the field of aneurysm treatment, 17,973 cases of abdominal aortic aneurysm (AAA) including common iliac aneurysm were registered, and 55.7% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,824 (10.1%) cases were registered as ruptured AAA. The operative mortality of ruptured and un-ruptured AAA was 16.1%, and 0.6%, respectively. 32.1% 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 15.7%, and 18.0%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 8,020 cases, including 1,210 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) were performed in 6,324 cases. The EVT ratio was gradually increased at 44.1%. Venous treatment including 41,246 cases with varicose vein treatments and 520 cases with lower limb deep vein thrombosis were registered. Regarding other vascular operations, 25,024 cases of vascular access operations and 1,322 lower limb 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.