The fistula between the aorta and the digestive tract is a rare and highly fatal condition. Aorto-enteric fistula (AEF) often develops after operation for abdominal aortic aneurysm, and it’s in hospital mortality and long-term results are not satisfied. Even now, AEF is a major challenge in vascular surgery. Therefore, it is necessary to know the most effective strategy for AEF in present Japan.

Objectives: The purpose of this study was to compare the medical expenses between open (OR) and stent graft (SG) repair for ruptured abdominal aortic aneurysm (AAA). Method: Ruptured AAA patients were divided into 2 groups (21 cases of OR, 14 cases of SG) according to the instruction for use of stent grafts. Preoperative, intraoperative, postoperative findings and medical costs were compared between the 2 groups. Results: Preoperative and postoperative findings did not show differences between the 2 groups. Anesthesia and operation times were significantly longer in OR than SG. Total material cost was significantly higher in SG than OR. Conclusion: Stent graft repair required expensive material cost. Although total medical cost was more expensive and the length of the first hospital stay was longer, anesthesia and operation times were significantly shorter in SG than OR for ruptured AAA.

Popliteal venous aneurysm (PVA) is often associated with pulmonary embolism and can be fatal, so early surgery and postoperative anticoagulation therapy are the current standard therapies. The patient was a 75-year-old woman who was examined by a local physician after experiencing a sudden chest discomfort and dyspnea. She was diagnosed as having an acute pulmonary embolism and admitted to our hospital. Contrast computed tomography (CT) revealed a 23×37 mm left PVA with internal thrombus, and anticoagulation therapy using rivaroxaban was initiated. Dyspnea gradually disappeared, and contrast CT revealed that the thrombi in the pulmonary arteries and the PVA have disappeared. In the perioperative period, an inferior vena cava filter was placed and tangential aneurysmectomy with lateral venorrhaphy was performed. Rivaroxaban was administered for 1 year as postoperative anticoagulant therapy, which yielded positive short-term results. Only a few cases have been reported on the efficacy and duration of postoperative anticoagulant therapy using direct oral Xa inhibitors because of its short history. Hence, we believe further examination is necessary.

An 87-year-old man, who had undergone descending aorta replacement because of aneurysm rupture, required emergent surgery for a pseudoaneurysm at the proximal anastomosis of the graft. The preoperative computed tomography scan revealed that the existing graft was severely kinked, and that additional aortic aneurysms were present at the distal sites. We judged it difficult to perform thoracic endovascular aortic replacement approaching from a peripheral artery, such as the iliac or femoral artery, because of these lesions, and selected total aortic arch replacement using an open stent graft method. Although we attempted to use the transesophagus echocardiography as the intraoperative guidance of the distal end of the stent graft, we were unable to insert the echo probe through the esophagus. We accomplished the effective deployment of the open stent graft after confirmation of its distal end and determination of satisfactory expansion using angioscopy as an alternative guidance mechanism.

Persistent sciatic artery is relatively rare congenital variant of the lower limb vasculature left by the sciatic artery forming the dominant supply to the leg during early embryonic development and extremely rare complicated with abdominal aortic aneurysm. A 65-year-old man was referred to our hospital with abdominal aortic aneurysm pointed out by a previous doctor. The enhanced CT scan showed abdominal aortic aneurysm measuring 53 mm and complete left persistent sciatic artery. Left external iliac and femoral arteries were hypoplastic. In addition to abdominal aortic aneurysm, we plan to treat left persistent artery which have a propensity toward aneurysmal or occlusive degeneration. We performed abdominal aortic aneurysm graft replacement, ligation of left persistent sciatic artery, and left femoropopliteal bypass. Postoperative CT scan showed complete thrombosis of the left persistent sciatic artery.

A 58-year-old man was referred to our hospital for treatment of hemolytic anemia with jaundice (Hb 6.9 g/dL, LDH 2684 IU/L, T-Bil 6.9 mg/dL) 7 years after ascending aortic replacement for acute type A aortic dissection. The cause of hemolysis was confirmed to be mechanical damage by the kinked graft. Distal anastomotic line was angulated because of the dilatation on the aortic arch with residual false lumen. We performed total arch replacement with open stent grafting and resected the kinked graft. His postoperative course was uneventful and hemolysis resolved soon after the operation.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeon in Japan in 2015, 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 124,073 vascular treatments were registered by 1,038 institutions in 2015. 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 22,041, 15,671, 4,779, 2,313, 631, 48,837, and 29,801, respectively. In the field of aneurysm treatment, 18,907 cases of abdominal aortic aneurysm (AAA) including common iliac aneurysm were registered, and 57.6% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,850 (9.8%) cases were registered as ruptured AAA. The operative mortality of ruptured and un-ruptured AAA was 16.0%, and 0.6%, respectively. 33.6% 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 16.6%, and 14.5%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 8,230 cases, including 1,194 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) were performed in 7,441 cases. The EVT ratio was gradually increased at 47.4%. Venous treatment including 47,046 cases with varicose vein treatments and 531 cases with lower limb deep vein thrombosis were registered. Regarding other vascular operations, 29,801 cases of vascular access operations and 1,511 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.