Indication of endovascular surgery for chronic venous insufficiency and varicose veins are decided by precise clinical information and duplex findings. Even though presence of primary varicose vein or partial reflux of saphenous vein are diagnosed, it does not mean indication of endovascular surgery. Because endothermal ablation of varicose veins is less invasive surgery, it tends to overused.

For infectious abdominal aortic aneurysm, complete surgical removal of the infected lesion and appropriate antimicrobial treatment are important. A 67-year-old male was referred to our hospital because of fever and low back pain. The presence of fatty weave opacities around the abdominal aorta, 26mm in diameter, on contrast CT seemed to be the finding of an infected abdominal aortic legion. No bacteria were detected in the blood culture test. We started conservative treatment with antibiotics (VCM, MEPM). A follow-up CT showed rapid enlargement of the abdominal aorta to 44mm in diameter, so surgery was performed. He underwent infrarenal abdominal aortic replacement with an antibiotic-impregnated prosthesis, complete resection of all the infected tissues, and omentopexy. The postoperative course was uneventful. Bacterial culture tests of the tissue were negative, so VCM and MEPM were continued. However, antibiotics were de-escalated to AMPC and MINO on Day 13 postoperatively because 16S rRNA genetic analysis of the aortic wall detected Helicobacter cinaedi. Postoperative contrast CT showed no abnormal findings, and he was discharged from the hospital on the 22^th postoperative day.

Pancreaticoduodenal artery aneurysms (PDAA) are quite rare and account for only 2% of all visceral artery aneurysms. Since the risk of rupture is reportedly independent of the aneurysmal diameter and the mortality rate after the rupture reaches over 50%, therefore, aggressive surgical treatment should be considered. Trans-catheter arterial embolization (TAE) seems to be a first-line treatment for PDAA in most institutions because of its less invasiveness. However, some PDAA are poor candidate for TAE due to anatomical reasons. The hybrid treatment could be a choice for some PDAA, a combination of TAE and open surgery such as bypass grafting or aneurysmectomy with arterial reconstruction.-Here, we report two cases of successful hybrid treatment. The first case was that of a patient with a double aneurysm, one of which was treated by TAE in a first stage and the other treated by open surgery, aneurysmectomy with arterial reconstruction, under real-time guide of angiography. The second case was that of a patient with PDAA, which were treated by TAE and a surgical bypass to celiac artery simultaneously in a hybrid theater. Both cases showed positive early results. Although we achieved excellent early outcomes, long-term outcomes of the hybrid treatment for this aortic pathology remain undefined. Careful follow-up is mandatory.

External iliac arterial aneurysm is an extremely rare condition; only a few cases have been reported worldwide. A 58-year-old man was admitted for vital shock. He had poliomyelitis and paralysis in the right leg and previously underwent arteriovenous fistula procedure during childhood for the treatment of leg length discrepancy caused by poliomyelitis. He also underwent ligation of the right superficial femoral artery 13 years ago, as treatment for the right leg ulcer. We performed emergent surgery. First, embolized the right external iliac artery using vascular plug. And then, ligated right common femoral artery and bypass from left common femoral artery to right deep femoral artery using ePTFE graft. Although this is a rare case, several studies have reported the association between poliomyelitis and arterial aneurysms. Here, we report a case of ruptured external iliac arterial aneurysm in a patient with poliomyelitis who had arteriovenous fistula procedure during childhood.

A 68-year-old man was treated for bladder cancer with transurethral resection, followed by adjuvant Bacillus Calmette-Guérin (BCG) therapy 2 years ago. Computed tomography (CT) revealed an abnormal shadow around the left common iliac artery. As positron emission tomography-computed tomography (PET-CT) showed an abnormal uptake in the mediastinal lymph nodes and common iliac artery, among other sites, malignant lymphoma was suspected. The patient was referred to another hospital with sudden left lower abdominal pain. CT revealed impending rupture of a left common iliac artery aneurysm. He was thus transferred to our hospital. Emergency aorto-iliac reconstruction was performed with a prosthetic graft. The pathological findings of aortic wall revealed epithelioid cell granuloma, and he was diagnosed with tuberculous mycotic aneurysm. Although he received anti-tuberculosis therapy after the operation, magnetic resonance imaging four months later showed an aneurysm in the aortic arch. We diagnosed him with recurrence of tuberculous mycotic aneurysm and performed total arch replacement. The pathological findings of the resected aortic wall revealed epithelioid cell granuloma, just as at the initial operation. Tuberculous mycotic aneurysm after BCG therapy can recur even during anti-tuberculosis therapy.

Several studies of the covered endovascular reconstruction of the aortic bifurcation (CERAB) technique for aortoiliac occlusive disease have recently been reported. We treated a patient with Leriche syndrome who presented with 20-m severe intermittent claudication. Computed tomography showed that the left renal artery was located 20 mm caudal to the right renal artery. Eighty percent stenosis of the aorta at the right renal artery and aortic occlusion at the left renal artery were also depicted. The aortoiliac occlusion extended to both distal external iliac arteries. It was assumed that a height mismatch between the right and left stents into the juxta-renal abdominal aorta would occur if treated using the kissing stent technique. In this case, the CERAB technique was successfully implemented. We performed CERAB using the double D technique with only stent grafts and bare metal stents for peripheral artery use. The patient did not exhibit any symptoms for 1.5 years after undergoing the procedure, and the stent grafts and bare metal stents were patent without any reintervention.

We here report of a rare case of true aneurysm of the dorsalis pedis artery. A 68-year-old male patient presented with a pulsatile mass on the dorsal part of his right foot. Clinical and ultrasound examinations confirmed a diagnosis of aneurysm. The diameter was 15×15×20 mm. Intraoperative angiography revealed a patent plantar arch. The aneurysm was resected after dissection, exposure and isolation of the proximal and distal stumps of the dorsalis pedis artery. Pathologic analysis showed true aneurysm due to atheosclerosis. He recovered well after surgery and remained free of symptoms 18 months postoperatively. A brief review of the Japanese literature of this entity has been discussed.

An 80-year-old man who had been stepped on his lower abdomen by a cow, showing paleness, coldness, and pain on his right leg was delivered to nearby hospital. He was transported to our hospital and arrived at 6 hours after the injury. No pulse was palpable on the right femoral and peripheral arteries and the right lower limb was paralyzed. CTA revealed obstructions from the right common iliac artery to the external iliac artery and the superficial femoral artery. A femoro–femoral bypass and thrombectomy for the right superficial femoral artery were performed immediately. Dorsal and posterior tibial arteries become palpable after surgery. Obvious swelling of the right lower leg appeared 6 hours after surgery and fasciotomy was performed. The urine volume was 1600 mL/day on the 1st postoperative day, but myonephritic metabolic syndrome (MNMS) was diagnosed on the 3rd postoperative day based on the depleted urine (400 mL/day) and the lab data (BUN 87.7 mg/dL, Cr 7.8 mg/dL, K 5.9 mEq/L), and hemodialysis (HD) was begun. The patient could leave HD 5 weeks later. The wounds of fasciotomy were treated with vacuum assisted closure therapy and skin grafting. He recovered to walk and discharged at 6 weeks after the operation. Iliac artery obstruction due to blunt trauma is relatively rare. It is not rare to be able to save a limb which is classified the Rutherford category III, however special attention is required to predict the onset of MNMS in such cases.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeon in Japan in 2016, 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 136,164 vascular treatments were registered by 1,070 institutions in 2016. 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 21,653, 17,560, 4,983, 2,557, 596, 54,462 and 34,353, respectively. In the field of aneurysm treatment, 19,144 cases of abdominal aortic aneurysm (AAA) including common iliac aneurysm were registered, and 60.3% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,714 (9.4%) cases were registered as ruptured AAA. The operative mortality of ruptured and un-ruptured AAA was 15.7%, and 0.6%, respectively. 35.9% 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 15.8%, and 15.3%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 9,303 cases, including 1,329 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) were performed in 8,257 cases. The EVT ratio was gradually increased at 47.0%. Varicose vein treatments tremendously increased in 52,639 cases, and 68.5% of the cases were treated by endovenous laser ablations (EVLA). Regarding other vascular operations, 32,779 cases of vascular access operations and 1,411 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 EVLA for varicose veins.