It is internationally called REVAS (recurrent varices after surgery) regarding recurrent varicose veins. A consensus meeting on the topic decided to adopt a clinical definition: the presence of varicose veins in a lower limb previously operated on the varices. Causes of REVAS include inappropriate surgery based on inadequate preoperative evaluation (tactical error), inappropriate or incomplete surgical procedure (technical error), regurgitation due to neovascularization at the blood flow blockage site, and varicose vein progression including residual varicose veins at a site different from the surgical site (disease progression). In some cases, REVAS could be avoided by treatment strategies, such as improper surgical procedure selection based on incorrect diagnosis and poor surgical procedures. In addition, when REVAS is diagnosed, each case shows a unique venous regurgitation, and many cases cannot be dealt with by routine standard surgery. More detailed examination, surgical procedure selection, and prominent surgical technique are required for these reasons than in the initial surgery.

Popliteal artery entrapment syndrome (PAES) and adventitial cystic disease (ACD) should be considered as nonatherosclerotic lesions in young patients with popliteal artery stenosis or occlusion without risk factors for arteriosclerosis obliterans. PAES is due to a congenital abnormality of the popliteal artery running to the medial gastrocnemius, and the popliteal artery is entrapped by the medial gastrocnemius or abnormal fiber bundle. Surgery is the first choice for types with anatomical abnormalities. The exact cause of ACD is unknown, and the cyst is filled with a gelatinous mucoid substance. Popliteal artery stenosis rather than occlusion is often indicated, but resectional treatment is preferred for patients with popliteal arterial thrombotic occlusion or extensive arterial lesion.

Endovascular therapy for femoropopliteal lesions has been accepted in the real world clinical settings, due to development of devices and establishment of procedures. The author herein described the current situation focusing on the latest devices.

The cardiovascular complication caused by long-term hemodialysis for end-stage renal disease, especially due to diabetic nephropathy is well known. This review is focusing on the histopathology of peripheral arteries among autopsied patients underwent hemodialysis during several years. The well-known term of “Moencheberg Medial Calcification” has been considered as a representative vascular lesion of patients with hemodialysis. However, vascular calcification in hemodialysis patients usually occurs in intima and media, classified as atherosclerosis Type V lesion of the classification by the American Heart Association.

We report a rare case of tuberculous pseudoaneurysm after COVID-19 that was difficult to diagnose. A 73-year-old man was hospitalized for 4 weeks with COVID-19. Four weeks after discharge from the hospital, he developed a fever, followed by redness, swelling, and pain in the left elbow. CT showed suspected cellulitis. MRI showed suspected cellulitis, abscess, and aneurysm. Ultrasonography of the swollen area of the left elbow revealed a 37 mm pseudoaneurysm that was partially thrombosed and originated from the brachial artery. The patient was admitted to hospital, and underwent thrombus removal and fistula closure under local anesthesia. Postoperatively, the fever persisted, and a CT scan performed on the 8th postoperative day showed diffuse granular shadows in both lung fields, suggesting miliary tuberculosis. PCR tests of sputum and the excised thrombus were positive for Mycobacterium tuberculosis, leading to a diagnosis of miliary tuberculosis and tuberculous pseudoaneurysm. Pathological examination of the excised thrombus confirmed the presence of acid-fast bacilli. The patient was transferred to another hospital for tuberculosis treatment, which resolved his symptoms and he was discharged.

A 51-year-old man complained of intermittent claudication and fatigue in the right lower leg while he was playing tennis. Physical exam revealed normal pulsation at the popliteal and dorsalis pedis artery and ABI (ankle-brachial pressure index) was normal at the first visit. Duplex doppler ultrasound exam showed semi-circumferential cystic lesion without arterial stenosis in the popliteal artery. A month later, postexercise ABI reduced to 0.27 and duplex doppler ultrasound demonstrated arterial stenosis at the cystic lesion in the popliteal artery. The patient was diagnosed with cystic adventitial disease of the popliteal artery and underwent cyst wall resection under general anesthesia. Postoperative course was uneventful, and the symptom improved. Over three-year follow-up period, there has been no recurrence of the symptom and the adventitial cyst. The diagnosis by postexercise ABI was appropriate, and the surgery was effective treatment.

We experienced a case in which a huge right saphenous venous aneurysm with a size of 50 mm appeared after blood was collected from the right inguinal region. We performed surgery, and intraoperative findings revealed a 2 cm laceration in the right great saphenous vein, which was thought to be caused by vascular injury during inguinal blood sampling. There are few reports of iatrogenic venous aneurysm in Japan, and this is a very rare case. Based on the precautions when collecting blood in the inguinal region, we report this case with some literature discussion.

A 71-year-old male patient was transferred to the authors’ hospital with Stanford type A acute aortic dissection (TAAD) as diagnosed by his previous physician, which extended into the arch branch. Although there were no problems such as consciousness disorder, or paralysis of the left upper and lower limbs, previous computed tomography (CT) scan revealed occlusion from the brachiocephalic artery (BCA) to the proximal side of the right common carotid artery (RCCA). Preoperative carotid ultrasonography showed thrombus on the distal side of the RCCA. In order to avoid arteriogenic cerebral embolism, selective cerebral perfusion was initiated from the left subclavian artery and left common carotid artery after circulatory arrest, and the distal RCCA thrombus was removed by cross flow from the left cerebral perfusion. End-to-end anastomosis of the RCCA and artificial blood vessel was then performed, and RCCA antegrade cerebral perfusion was initiated. A preoperative diagnosis of distal RCCA thrombus was made on the basis of total occlusion of the central part of the RCCA, and a selective cerebral perfusion sequence was devised, as a result of which extensive cerebral embolism was avoided.

Persistent sciatic artery is a rare congenital vascular anomaly but could be associated with leg ischemia due to aneurysmal degeneration. An 84-year-old woman presented right leg pain and CT showed a right persistent sciatic artery aneurysm with an intramural thrombosis and occlusion of the distal popliteal artery. Initial thrombolytic therapy was effective but right leg pain recurred and amputation of toes were performed for ulcer formation. To prevent recurrence of thromboembolism, resection of the aneurysm was successfully performed through buttock approach after femoro-popliteal bypass.

Inferior mesenteric artery aneurysm (IMAA) is the rarest among visceral artery aneurysms with a relatively high risk of life-threatening rupture. We report the case of a 72-year-old female presenting with asymptomatic IMAA measuring 25 mm in diameter, associated with occlusion of the celiac artery and severe stenosis of the superior mesenteric artery, who underwent endovascular treatment. Since the splanchnic circulation was dependent on the IMA flow, revascularization of the SMA, in addition to exclusion of the IMAA was required in order to prevent jet disorder phenomenon and mesenteric ischemia. Thus, the patient was treated by placing a bare metal stent in the ostium of the SMA and VIABAHN stent-grafts in the IMA. Post-operative course was uneventful, and the patient was discharged from the hospital on post-operative day nine. Patient is doing well 3 years post intervention without restenosis of both the SMA stent and the IMA VIABAHN.

A difficult-to-treat case was experienced in which a patient’s left first toe necrotized after the phenol procedure for ingrown nails. The patient was a 59-year-old male. As for his past medical history, dialysis was instituted due to glomerulonephritis in1996 and a left femoral-right femoral artery bypass was created for peripheral arterial disease (PAD) in 2015. There was nothing special about his family history, and he did not drink or smoke. In March 2020, the patient underwent the phenol cauterization for his ingrown nail on the left first toe. In May, he visited our hospital due to delayed healing. In July, his left first toe was amputated resulting from infection and necrosis. Six days later, he was discharged from the hospital after receiving endovascular treatment of the left lower extremity artery, but was readmitted to the hospital in late September due to incompetent healing. The patient underwent valve replacement surgery for aortic stenosis at another hospital and was hospitalized for the third time in late October. He lost consciousness on the day of hospitalization. After the implantation of a pacemaker, a left femoral artery-dorsal foot artery bypass was created. In mid-November, bone sequestrum of the left first toe was removed. During the hospitalization, the patient experienced bleeding from a rectal ulcer, which was treated with a hemostatic method. In mid-December, nine months after the procedure for ingrown nails, he was discharged from the hospital because of healing. Although the treatment of ingrown nails with the phenol procedure has been widely used since it is simple and minimally invasive, this procedure should be performed with caution in cases of suspected ischemia.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeon in Japan in 2018, 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 143,745 vascular treatments were registered by 1,090 institutions in 2018. 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 24,495, 18,700, 4,813, 2,363, 694, 45,088 and 47,592, respectively. In the field of aneurysm treatment, 20,160 cases of abdominal aortic aneurysm (AAA) including common iliac aneurysm were registered, and 61.6% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,794 (8.9%) cases were registered as ruptured AAA. The operative mortality of ruptured and un-ruptured AAA was 15.7%, and 0.6%, respectively. 43.3% 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 14.0%, and 14.6%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 8,336 cases, including 1,348 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) were performed in 9,710 cases. The EVT ratio was gradually increased at 51.9%. Varicose vein treatment was decreased in 43,133 cases (7.7% less than in 2017), and 77.3% of the cases were treated by endovenous thermal ablation (ETA) including endovenous laser ablation (EVLA) and radio-frequency ablation (RFA). Regarding other vascular operations, 44,003 cases of vascular access operations and 1,631 lower limb amputation surgeries were included. Conclusions: The number of vascular treatments increased since 2017, 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 ETA for varicose veins.