Stent graft-induced new entry tear (SINE) is one of a significant complication after thoracic endovascular aortic repair (TEVAR) for aortic dissection. Reported incidence of SINE is 4.8–25%, and it is more frequently observed in chronic aortic dissection. Excessive oversizing of the stent graft relative to the true lumen and the sprig back force of the stent graft would contribute to SINE formation. Therefore, it is important to select an appropriate stent graft size based on strict CT measurement of both proximal and distal landing zone, and to place the stent grafts in a way to reduce the aortic wall stress related to spring back force. Using two or more devices in distal to proximal implantation sequence, that usually use distal device with minimal oversizing of the true lumen in descending aorta and proximal device which is selected according to the non-dissected arch diameter, is a useful technique not only to avoid excessive oversizing but also to control the aortic wall stress from the spring back force of the proximal device.

A 72-year-old woman with a 50 mm infrarenal abdominal aortic aneurysm was performed aortic repair. After the procedure, she complained lower limb motor disorders. We suspected paraplegia, so we performed cerebrospinal fluid drainage, mean blood pressure maintenance, unfractionated heparin administration, naloxone administration, and edaravone administration urgently. But her symptom was not improved. Paraplegia after infrarenal abdominal aortic aneurysm repair is a rare but catastrophic event for patient’s life prognosis and quality of life. So it is necessary to consider preventive interventions for cases with a high risk of developing paraplegia.

We report a case of 81 year-old man with sudden enlargement of wrapping aneurysm sac 10 years after vascular graft replacement for an abdominal aortic aneurysm (AAA). A 71-year-old man had undergone replacement of an AAA with a quadrifurcated knitted Dacron graft (16×8×7 mm). The size of the wrapping aneurysm wall was 51 mm in diameter and was filled with hematoma three weeks after the operation. It seemed to be responsible for inadequate resection of aneurysm wall, but computed tomography revealed no contrast effect in the hematoma and ultrasonography detected no blood flow into the aneurysm. One year later, most hematoma disappeared and the wrapping aneurysm shrinked, and it kept the size of 35 mm in diameter for a long period. Ten years after the initial operation, it showed sudden expansion to 61 mm in diameter. Intraoperatively, relatively fresh thrombus was observed in the aneurysm sac, and it was removed. The cause of the back-bleeding was found to be reflux from inferior mesenteric artery. After hemostasis, the aneurysm wall was resected as much as possible, and the remaining wall was plicated. It should be kept in mind that wrapping aneurysm sac enlargement can occur even in the distant period, even with proper initial surgery.

The patient was a 28-year-old male. After he developed a bruise on his left back of thigh that hit a corner of his desk at home, for which he consulted a local clinic and was diagnosed as having a contusion. Thereafter, his symptoms spontaneously improved and disappeared. One month after injury, he consulted our hospital because he suddenly developed severe pain and swelling in his left thigh while walking, which resulted in walking difficulty. Contrast-enhanced computed tomography (CT) led to a diagnosis of ruptured pseudoaneurysm of the left deep femoral artery; hence, embolization was performed by endovascular treatment using a metal coil and gelatin sponge. He had an uneventful course after the surgery, and at 2 weeks after surgery, the swelling completely disappeared. Contrast-enhanced CT performed 6 months after the surgery revealed good progress, with no detectable pseudoaneurysm and complete resolution of the hematoma. Although pseudoaneurysm formation following blunt trauma without a fracture is rare, we recommend a close examination of the possibility of pseudoaneurysm formation by contrast-enhanced CT when swelling and pain persist after injury. Although it is necessary to select and use embolus materials according to the patient's condition, transcatheter embolization by endovascular treatment is minimally invasive and effective as a treatment.

Persistent sciatic artery (PSA) is a rare congenital malformation and often result in aneurysmal or occlusive changes. This case report described a patient who underwent angioplasty for persistent sciatic artery occlusion. A 66-year-old man was referred with right leg claudication. The ankle brachial index (ABI) was reduced to 0.63 on the right side. Computed tomography showed a right PSA was occluded. The right superficial femoral artery was hypoplastic. Blood supply to the right popliteal artery by the collateral arteries was detected from right superficial femoral artery. Angioplasty of collateral artery was performed. Postoperatively, ABI improved to 0.88 on the right side. After follow-up, ABI reached 1.01 and claudication was disappeared.

A 70-year-old man who had undergone tumor resection and artificial anus preparation for the treatment of rectal cancer as well as lung resection due to lung metastasis suddenly developed dyspnea in 2018, and when he presented to a nearby hospital, a thrombus was found in the pulmonary artery and right atrium on contrast computed tomography, along with a thrombus in the femoral vein by lower-extremities venous ultrasound. He was diagnosed with pulmonary thromboembolism due to deep-vein thrombosis and transferred to our hospital. At admission, echocardiography revealed right ventricular strain and floating thrombi in the right atrium. Therefore, we performed surgical embolectomy. The operation was performed through a median sternotomy with cardiopulmonary bypass. We removed the thrombi in the right atrium and main pulmonary artery. Warfarin was started a few days after the operation. Contrast computed tomography showed no thrombus in the pulmonary artery, and the patient was discharged 24 days after surgery. Six months after discharge, he underwent partial lung resection due to the onset of new lung metastases. We herein report a cancer-bearing patient who developed pulmonary thromboembolism that was successfully treated by surgical embolectomy.

We performed staged endovascular treatment for a rare case with comorbid peripheral arterial disease, arteriovenous fistula, and venous insufficiency in the leg. A 79-year-old man presented with pain, bulging veins, and skin pigmentation in the left leg. Computed tomography revealed a long occlusion of the left femoral artery and arteriovenous fistulas between the peroneal artery and the great saphenous vein. Although the ankle brachial pressure index was normalized, the left leg symptoms and skin perfusion pressure did not improve after endovascular treatment for the femoral artery due to blood stealing to the great saphenous vein and venous insufficiency through micro arteriovenous fistulas. Therefore, we underwent full length closure of the great saphenous vein using cyanoacrylate closure (CAC) and coil embolization for the residual arteriovenous fistula. Subsequently, the patient’s symptoms rapidly disappeared and the circulation in the leg improved. Staged arteriovenous endovascular treatment may be effective in cases of complex vascular disease, as in this case. In particular, CAC may be a useful treatment for micro arteriovenous fistulas that mainly return to the saphenous vein.