Objective: To evaluate the relationship between surgical outcomes with the subacute pre-emptive thoracic endovascular aortic repair (PTEVAR) and the factors related to a change in aneurysm diameters for uncomplicated acute type B aortic dissection (UATBAD). Methods: From December 2008 to January 2020, total 38 patients (shrinkage(S) group; 32, non-shrinkage(N) group; 6) were followed up one year after pre-emptive TEVAR for UATBAD. Their relationship with preoperative, postoperative factors and computed tomography findings (Parsa classification) was analyzed retrospectively. Results: Factors for the statistically significant changes in aneurysm diameters were, with or without preoperative reentry, loss of false lumen within 6 months after surgery, and attribution to Parsa classification 3 in the S group, and preoperative iliac region reentry, full false lumen patency, central landings in zone 2, postoperative type Ia EL, type V EL, and Parsa classification 0 for in the N group.For additional treatments, two patients in the N group underwent open repair, chimney TEVAR and one patient in each group required re-entry closure with re-intervention. Conclusions: Subacute PTEVAR was effective for uncomplicated acute type B aortic dissection (UATBAD), but the cases showing extensive dissection, zone 2 landing, and a postoperative extensive residual false lumen had a tendency not to reduce the aneurysm diameter.

Dorsalis pedis artery aneurysms represent an extremely rare type of peripheral aneurysm, and there is a lack of consensus regarding the necessity of revascularization after aneurysm excision. We report two cases of dorsalis pedis artery aneurysms treated surgically at our hospital, together with a literature review. Case 1: The patient presented with a saccular aneurysm; we performed end-to-end anastomosis for revascularization after aneurysm excision. Contrast-enhanced computed tomography (CT) performed 4 years postoperatively revealed occlusion of reconstructed vessels and the development of collateral circulation. Case 2: The patient presented with a fusiform aneurysm; we did not perform reconstruction using end-to-end anastomosis after aneurysm excision. Preoperative contrast-enhanced CT confirmed adequate blood circulation to the plantar arch via the arcuate artery, and intraoperative findings indicated that revascularization was not necessary. The patient did not show any postoperative peripheral blood flow abnormalities. We report two surgical cases of dorsalis pedis artery aneurysms, which represent an extremely rare type of peripheral aneurysm.

Thromboembolism caused by an occluded vessel has been reported in stump syndromes, such as axillofemoral stump syndrome, carotid stump syndrome, and vertebral stump syndrome. However, it was unclear whether thromboembolism caused by an occluded vein graft actually occurred during lower extremity revascularization. A 41-year-old man was admitted for anastomotic stenosis with thrombosis that occurred during lower extremity revascularization. Seven years earlier, the patient had undergone bypass grafting, using an autogenous saphenous vein, from the femoral artery to the tibioperoneal trunk. Three years after the initial operation, he developed thrombosis at the distal site of the autogenous vein graft and underwent an additional bypass grafting with a veno-venous anastomosis, using another autogenous saphenous vein from the saphenous vein graft to the anterior tibial artery. Thrombosis in the vein graft, between the femoral artery and the tibioperoneal trunk, gradually collected from the distal anastomosis, and a stenosis finally developed in the veno-venous anastomosis. We closed the stump of the vein graft using patch angioplasty after thrombectomy. We then performed patch angioplasty with an autogenous vein for anastomotic stenosis. Because the thrombus was fresh and unstable at the site of the veno-venous anastomosis, it may have embolized the distal vessel. Herein, we report that an occluded vein graft can cause thromboembolism during lower extremity revascularization in patients with stump syndrome.

A 60-year-old female smoker presented our hospital with complaints of back pain, fever, and increased inflammatory findings. Contrast-enhanced computed tomography (CT) revealed an errant denture, but there were no findings suggestive of intestinal perforation or peritonitis. Considering the risk of rupture, the patient underwent thoracoabdominal aortic replacement under partial cardiopulmonary bypass. The peri-aneurysm and around adventitia of the aorta were dissected as much as possible. On the eighth postoperative day, the patient developed peritonitis and underwent jejunectomy due to perforation of the jejunum by the denture. Blood culture and para-aortic abscess revealed Streptococcus intermedius, a commensal oral bacterium. Dentures, especially hook-type dentures, cause not only gastrointestinal disorders but also infected aortic aneurysm, and therefore, it is necessary to remove the dentures as soon as possible or, in patients undergoing extracorporeal circulation surgery, to be under close observation postoperatively for the possibility of peritonitis caused by dentures.

A 70-year-old woman was referred to our hospital because of an abdominal aortic aneurysm. She was on maintenance dialysis for chronic renal failure, had calcification of the aorta, and had undergone abdominal surgery, so we decided to perform stent grafting. Since the aorta was not bent at all, we decided to use an Excluder. After deployment of the proximal side of the main body, cannulation of the contralateral gate, and placement of the contralateral leg, we attempted to remove the constraining system, but it was difficult because the proximal side of the main body was constrained. The wire was replaced, the constraining system was manually removed while capturing the proximal side of the main body with a balloon, and the entire system was removed. The lock pin of the constraining system was bent in the removed device. So, it was considered that the wire had entered into the anchor of the constraining loop and the lock pin.

A 57-year-old female developed type B acute aortic dissection 13 years ago and had been observed without complications. Two years ago, she developed type A acute aortic dissection, and underwent ascending aortic replacement and thoracic endovascular aortic repair (TEVAR) for the ulcer-like projection (ULP) lesion that appeared in the descending thoracic aorta. One year ago, multiple peripheral embolisms derived from a false lumen occurred in the left limb and buttocks, and the dissecting aortic aneurysm was also enlarged. The dissection extended from the descending thoracic aorta to the left external iliac artery, and visceral arteries were perfused in the true lumen. The residual entry was located at the proximal of where the celiac artery branches and the re-entry was located before the bifurcation of the internal iliac artery of the left common iliac artery. The left internal iliac artery was perfused from the false lumen. The left femoral artery was punctured, the left internal iliac artery was embolized via the re-entry of the left common iliac artery, and the entry and re-entry were closed by stent grafts. After the operation, the false lumen became complete thrombosis, and one year has passed since the operation, but no enlargement of the aortic diameter has been observed.

A 67-year-old woman was referred to the department of orthopedic surgery with a chief complaint of sciatica on the lateral side of the right thigh. An abnormal vessel was pointed out and she was referred to our department. Enhanced CT showed the right persistent sciatic artery, type 2a of the Pillet-Gauffre classification, and its outer diameter was enlarged to 2.0 cm. The persistent sciatic artery communicated to the popliteal artery. The superficial femoral artery was hypoplastic and the profunda femoral artery was normal. VIABAHN was deployed into the persistent sciatic artery aneurysm from the right internal iliac artery to the upper third of the right thigh. The superior gluteal artery was preserved. After the procedure, she complained no sciatica. VIABAHN was patent and the aneurysm regressed without type II endoleak four years postoperatively.

Popliteal venous aneurysms (PVAs) are rare, but potentially life-threatening disease as they could lead to the deep vein thrombosis followed by the pulmonary thromboembolism (PTE). We herein report a case of duplicated PVAs complicated with PTE. A 79-year-old female was referred to our hospital because of exertional dyspnea. She was diagnosed with acute PTE by contrast-enhanced computed tomography, which also detected two venous aneurysms on her right popliteal vein. One of the PVAs was saccular shaped, 30 mm in diameter and fully thrombosed, which supposed to be the source of pulmonary embolism. Surgical resection of both PVAs were performed simultaneously after the treatment for PTE. There has been no recurrence of PVA and PTE for six months.

The common femoral artery is frequently used as a puncture site during catheterization or as an anastomosis site during revascularization. Therefore, although rare, infection can occur at this site and its treatment might be intractable. We experienced two cases of infection of the common femoral artery: the first after common femoral artery patch plasty for arteriosclerosis obliterans and the second following rupture of an infected pseudoaneurysm at the puncture site for percutaneous coronary intervention. In both cases, bleeding occurred, which required emergency surgery. However, the infected arterial wall was fragile, and reconstruction of the common femoral artery was impossible. In both cases, the femoral artery was sutured closed and revascularization was performed by external iliac–superficial femoral artery bypass surgery with a great saphenous vein graft. The graft was passed through the inguinal or lateral femoral subcutaneous tunnel, and not through the obturator foramen. Although wound dehiscence occurred in both cases, it healed with antibiotic therapy and wound care. External iliac–superficial femoral artery bypass is useful as an emergency surgery for femoral artery infection with bleeding.

In this study, we encountered a case in which phlebitis developed at an untreated superficial tributary due to glue inflow during the course of cyanoacrylate closure for varicose veins of lower extremities, which was eventually removed as it could not be relieved with oral treatment. The patient was a 75-year-old male who undervent cyanoacrylate closure for right great saphenous vein(GSV) trunk. Time passed without significant inflammation at the GSV trunk, however redness and induration with pain developed at an untreated tributary in the first week postoperatively, which was diagnosed as phlebitis. There were no general symptons or skin lesions in other parts, and the patient was followed up with NSAIDs administration. However the inflammation did not subside after treatment, and the pain persisted. Thus, operation was performed to remove the induration. Histopathological examination confirmed glue in the blood vessels and inflammation associated with a foreign-body reaction. There was no recurrence of inflammation at the GSV trunk, but long-term follow-up is recommended.

Minimally invasive and effective endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) is widely used and has become effective in this field. However, endoleak-related with enlargement of the aneurysmal sac in the long-term period is expected to increase in the future. We report herein a case of significantly increased aneurysmal sac of unknown cause 14 years after initial EVAR. After plication of the aneurysmal sac, CT showed abnormal heterogenous enhancement, and maximum shortest diameter was enlarged to 106 mm. The cause was speculated to be type IV or V endoleaks. We decided to apply a relining technique with a stent graft. Postoperatively, the aneurysmal sac was not enhanced and reduction in diameter was observed.

We report a case of an 80-year-old man who presented with chest pain at rest and was diagnosed with a saccular aortic arch aneurysm. His history included non-gallstone pancreatitis and cholangitis. He underwent total arch replacement. Although he was stable after surgery, on day 3 after surgery he suffered sudden hemoptysis, and a chest X-ray showed consolidation shadow in his right lung field. Although we began giving broad antibiotics, the CT finding did not clearly indicate bacterial pneumonia. We conducted COVID-19 PCR and triple sputum examination for tuberculosis, and neither result was positive. On day 15 he went into shock due to severe hemothorax, and IgG4-related arteritis was diagnosed from the heavy infiltration of IgG4 positive plasma cells in the aortic wall. Preoperative CT finding did not clearly indicate bleeding points, so we suspected alveolar hemorrhage. As soon as corticosteroid treatment began, at 30 mg/day, the consolidation shadow improved. It was uncertain that lung complication was associated with IgG4-RD, because we could not do lung biopsy considering his general condition. We switched corticosteroid administration from IV to oral without hemothorax recurrence, and he was referred on postoperative day 99. Erythrocyte sedimentation rate (ESR) is known to be a marker of IgG4-RD, and in this case ESR was the key to successful corticosteroid treatment.

The patient was a 41-year-old woman who presented to our hospital with persistent left inguinal pain that had not been diagnosed for >2 years. Diagnostic work-up (including ultrasonography and computed tomography) revealed a left inguinal mass, which appeared to be the cause of her symptom. As definitive diagnosis and treatment, she underwent surgical resection. Under general anesthesia, the left groin was opened and the mass was found in the common femoral vein. En bloc resection of the mass and a part of the common femoral vein was performed, and the greater saphenous vein was mobilized and transposed onto the distal femoral vein using the modified May-Husni technique. Histologically, the tumor originated from the common femoral vein, and consisted of the tumor cells with some epithelioid morphologies. Immunohistological staining demonstrated that the tumor cells were positive for several endothelial markers (such as CD31, CD34 and ERG) and negative for other types of tumor markers. Moreover, the cells were positive for CAMTA1, which strongly suggested the presence of the WWTR1-CAMTA1 fusion gene. These microscopical findings were characteristic of epithelioid hemangioendothelioma. Postoperatively, the patient has been doing well for a year without obvious signs of tumor recurrence.