A 57-year-old man with cerebral infarction who was treated at another hospital with 24 million IU of recombinant tissue Plasminogen Activator was referred to our hospital after he was found to have acute type A aortic dissection. His primary complaint at presentation was partial paralysis of the left upper limb. Contrast-enhanced computed tomography scan revealed dissection of the three branches of the neck, a narrowed true lumen in the right common carotid artery, and an opening in the aortic root. Echocardiography revealed severe aortic regurgitation. We urgently performed total arch aortic replacement with the frozen elephant trunk technique and aortic valvuloplasty. We administered high doses of tranexamic acid in the perioperative period and applied intraoperative maneuvers. The patient was discharged without complications. Our results suggest that perioperative preventive measures against hemorrhage, such as reconstruction of the dissected neck branch as early as possible and resumption of blood flow even when recombinant tissue Plasminogen Activator has been administered, can lead to neurological improvement and ultimately save the patient’s life.

Persistent sciatic artery is a very uncommon congenital malformation. Its incidence is estimated to be 0.025–0.05% of all births. This case report describes the improvement of a patient after optimal medical treatment for acute exacerbation on persistent sciatic artery occlusion. A 72-year-old woman was admitted because of hypothermia and hypoesthesia of her right leg. Her right leg did not presented cyanosis. Physical examination revealed easily palpable pulses of femoral arteries, but more distally her right lower limb was pulseless. There was no cyanosis. The ankle brachial index was 0.58 on the right side and 1.17 on the left side, respectively. Computed Tomography (CT) scan showed bilateral persistent sciatic arteries separated from the internal iliac arteries, respectively. The right persistent sciatic artery was completely occluded. The persistent sciatic artery had no aneurysmal changes. Each superficial femoral artery was hypoplastic and did not anastomose to the each popliteal artery. The right popliteal artery and the anterior tibial artery were both occluded. Blood supply to the right posterior and peroneal arteries was detected through collateral arteries. Right leg ischemia was diagnosed due to acute exacerbation on chronic occlusion of a persistent sciatic artery. This patient experienced no rest pain, and therefore we commenced optimal medical treatment and physiotherapy. Her ischemic symptoms improved gradually. CT scanning showed improvement of blood supply in the affected leg.

A 75-year-old woman, who had underwent total knee replacement for osteoarthritis of the knee, and percutaneous transluminal angioplasty for arteriosclerosis obliterans, had popliteal pseudoaneurysm (25 mm×29mm in diameter). We conducted endovascular treatment (EVT) for this pseudoaneurysm in consideration of her left lower limb strongly swollen after orthopedics surgery, high-risk patient with severe obesity, diabetes, hypertension, etc. and the risk of open repair regarding the difficulty for approach to arteries. The device of EVT was VIABAHN stent graft (W. L. Gore & Associates, Flagstaff, AZ, USA) , which was composed of expanded polytetrafluoroethylene graft and self-expanding nitinol stent, could exclude the popliteal pseudoaneurysm. EVT with VIABAHN stent graft is an excellent alternative of open repair for patients with PAA with obesity and multiple complications without any fear of difficulty for approach to arteries and post surgical complications on open repair.

Although popliteal venous aneurysms are rare diseases, they can cause pulmonary embolism and deep vein thrombosis. We report a case of popliteal venous aneurysm discovered after pulmonary embolism and treated with venous patch plasty to prevent a recurrence. A patient is 62-year-old man. He became aware of the pain in his left popliteal region. A few days later, he became aware of dyspnea and severe chest pain on exertion, and called for emergency medical assistance, and was transported to our emergency center. CT scan of the chest revealed pulmonary embolism, and thrombolysis started. CT scan of the lower extremities showed a popliteal venous aneurysm in the left popliteal fossa, so he was refered to our department for surgical treatment. The patient underwent surgery using a posterior approach to the left popliteal fossa under general anesthesia. A large amount of obsolete thrombus was found in the venous aneurysm. After we rescected the aneurysm, harvested a small saphenous vein from the peripheral leg, and repaired popliteal vein with venous patch because there was little normal tissue remaining. No recurrence of intravenous thrombus was observed after the surgery and obtained good results.

False lumen rupture in acute type B aortic dissection is fatal, and preserving life is the priority during treatment. However, when paraplegia develops, it leads to a decrease in activities of daily living and affects outcomes. We report a case in which intraoperative monitoring of motor-evoked potentials (MEPs) helped respond to changes in MEPs, thus avoiding paraplegia development. A 60-year-old man presented with chest and back pain, and computed tomography revealed acute type B dissection and extravasation in the mediastinum from the false lumen near the entry of the proximal descending aorta. Thoracic endovascular aortic repair (TEVAR) was performed from Zone 2; no MEP changes were observed immediately after the stent graft was placed. While controlling pseudo luminal blood flow, MEPs started decreasing 51 min after stent graft placement and disappeared 78 min later. Although MEPs did not recover by increasing mean blood pressure, they recovered when a bare stent was placed in the left subclavian artery to secure antegrade blood flow. In conclusion, the patient did not develop paraplegia after TEVAR. Monitoring MEP is important even in emergencies to prevent paraplegia.

A 39-year-old man had weakness and numbness in his left upper limb. A CT scan revealed arterial thoracic outlet syndrome with anomalous left first rib adhered to left second rib. Left subclavian artery was pinched by left first rib and left clavicle, got stenosis and aneurysmal degeneration. In addition, thromboembolism of left brachial artery was detected. Thrombectomy successfully improved blood flow, however, first rib could not be resected due to adhesion with surrounding tissues. So, we performed route change operation by interposition with expanded polytetrafluoroethylene graft. Traditional first rib resection can cause complications such as nerve injury or pleural injury or, thus this method can be effective and safe operation in some cases.

The case was a 79-year-old woman. She fell on the street in February 2020 and was taken to a nearby doctor complaining of cold numbness in her right hand. She had right humerus proximal fracture and contrast-enhanced CT showed right axillary artery occlusion. She was transferred to our hospital on the third day of her injury. On the 6th day, she underwent open reduction and fixation of the right humerus and revascularization of the right axillary artery. The intraoperative findings showed that the axillary artery was accompanied by thrombotic obstruction in the lumen and damage to the adventitia, but fortunately there was no massive hematoma around the injury. We ligated both the proximal and the distal sides of the adventitial rupture and performed an axillary brachial artery bypass surgery with an autologous great saphenous vein graft. There are two types of reports of arterial injury associated with proximal humerus fractures: thrombotic obstruction due to intimal injury of the artery, bleeding and pseudoaneurysm formation caused by adventitial injury due to bone fragments, In this case, thrombotic obstruction due to intimal injury and adventitial injury were complicated.

Venous aneurysm (VA) is a rare entity and etiology has not been clarified. VA involving the popliteal vein can cause the potentially fatal pulmonary thromboembolism (PTE). In this paper, we present our experience with a case of a popliteal venous aneurysm (PVA). PVA should be treated surgically because only anticoagulation treatment is not sufficient to prevent recurrent of PTE. A 21-year-old woman presented with a loss of consciousness. Contrast-enhanced computed tomography (CT) demonstrated PTE and right PVA with thrombi. After successful cardiopulmonary resuscitation (CPR), anticoagulation therapy was started and a retrievable inferior vena cava filter was placed. Thereafter plication suture of PVA was performed. Urgent surgical treatment of PVA should be considered to prevent severe PTE.

Diagnosing type IIIb endoleak (EL) following endovascular aortic repair is difficult via both contrast-enhanced computed tomography (eCT) and intraoperative angiography. Here, we report a case of type IIIb EL that was successfully treated using the relining technique (RT).The patient was a 68-year-old male who underwent urgent endovascular aortic repair using AFX2 for an impending rupture of an abdominal aortic aneurysm. Postoperative eCT demonstrated type Ib EL at the right leg. Leg extension with right internal iliac artery embolization was performed. Although the aneurysm shrunk after the repeat surgery, eCT taken 14 months after the first surgery revealed re-enlargement of the aneurysm, migration of AFX2, and accumulation of the contrast medium in two places (the proximal side of AFX2 and around the bifurcation). With the diagnosis of type Ia EL and suspicion of IIIb EL, a second repeat surgery was performed. After proximal cuff placement, type Ia EL disappeared. After confirming that the residual distal EL was a type IIIb, RT was performed using the ENDURANT IIs bifurcated main body and the EXCLUDER leg. Intraoperative completion aortography and postoperative eCT confirmed the disappearance of all ELs, and outpatient follow-up was continued. With AFX2, once a diagnosis of type IIIb EL is made, relining can be easily performed using various devices by paying attention to the endoskeleton.

The case was a 16-year-old man. At the time of surgery on the 6th day of hospitalization for a left tibial fracture, a fasciotomy was performed because of acute arterial occlusion of the left lower limb due to exacerbation of the left lower leg compartment syndrome, which was thought to have occurred before the operation. However, the operation was stopped and he was transferred to our department as an emergency. Revascularization was performed by thrombectomy and endovascular treatment, and the blood flow in the tibialis anterior artery was successfully resumed within the Golden Time. However, the compartment syndrome that had occurred before the operation did not improve the peripheral circulatory insufficiency of the muscle, leading to widespread muscle necrosis. After that, he persistently performed orthopedics and multidisciplinary treatment, and succeeded in saving his limbs.

A 69-year-old man who was due to undergo carotid artery stenting in our hospital’s Department of Neurosurgery was referred to our department for treatment of a saccular aneurysm of the left common iliac artery that was identified preoperatively. Due to the risk of complications from comorbidities, endovascular treatment was considered, and coil embolization by the stent-assisted technique using a bare metal stent was conducted under local anesthesia. Postoperative angiography showed that the signs of contrast within the aneurysm had disappeared, and the patient was discharged without complications on postoperative Day 2. Stent-assisted intra-aneurysmal coil filling is mainly used to treat intracranial aneurysms, and there has been no previous report of its use for a saccular aneurysm in the common iliac artery region. Endovascular treatment using stent grafts is the usual choice, but limitations may be imposed by factors such as device indications and effects on collateral circulation. This case demonstrates that procedures using a bare metal stent can provide a useful method of preserving the circulation of the internal iliac artery.

Herein, we report an extremely rare case of dorsalis pedis artery aneurysm, which developed after sepsis. A 48-year-old male with untreated atopic dermatitis was presented to our facility suffering from sepsis caused by methicillin-resistant Staphylococcus aureus and further complicated by a spinal epidural abscess and an infected spondylitis. Although some time was required, the infection was successfully treated by draining the abscess and having the patient complete a two-month course of antibiotics. Two months later, the patient noticed a pulsatile tumor on the dorsal part of his left foot. Ultrasound sonography revealed a saccular aneurysm on the dorsalis pedis artery prompting the aneurysm’s resection, and the dorsalis artery’s reconstruction by direct anastomosis. A pathologic examination of the aneurysmal wall confirmed that the aneurysm had been a pseudoaneurysm and that there had been no inflammation or infection. As the patient had no history of trauma or injury to the dorsalis pedis artery, we concluded that the aneurysm had been an infective aneurysm that had developed due to sepsis.