Objective: Persistent endoleak (EL) is a major cause of aneurysmal enlargement or rupture after endovascular aneurysm repair (EVAR). Treatment strategy for type II EL (T2EL) remains controversial. Methods: From February 2012 to August 2022, we performed 151 EVARs using Excluder (WL Gore and Associates, Flagstaff, AZ, USA). Patients with increased aneurysm diameter of ≥5 mm post-EVAR were considered for retreatment. Aortic branches artery closure and aneurysmorrhaphy (BACA) through laparotomy was performed in 11 patients (11 men, mean age 75.6±4.4 years). We retrospectively reviewed the BACA outcomes. Results: The overall retreatment rate was 8.6%. The interval from the primary EVAR was 49.7±16.2 months. The operation time was 183±37 min and postoperative hospital stay was 14.6±2.6 days. Aneurysm shrank gradually in all patients. No surgical or aneurysm-related deaths were observed during the observation period of 19.2±9.5 months. Conclusion: Early BACA results were favorable, although long-term results require further investigation. Although aneurysmal re-enlargement after BACA may occur, aneurysm-related event would be delayed because the BACA shrank sac diameter. Therefore, BACA is an acceptable procedure, considering the patients’ backgrounds.

Objective: Thromboangiitis obliterans (Buerger disease) is known as an intractable vascular disease that has been reported as thrombosis in distal arteries and occasional venous occlusion, as well as inflammatory changes in the thrombus and vascular wall. Patients often require limb amputation due to limb necrosis. Corkscrew (CS), a small arterial coiling, is an important diagnostic finding that was mainly found with angiography. Recently, however, it can also be identified using a modern ultrasonographic technique. Methods: In thease 22 cases, in 48 areas of study, we used the ultrasonographic technique to identify the CS, which allowed us to observe its relationship with the surrounding nerves and arteries. Results: In all cases, it was possible to identify the CS easily and it was confirmed that the CS and the nerve were carried down in their sheath. The sites of the CS existed in areas other than the area around the occluded main arteries and some CS that ran inside the nerve (16 areas) and some CS that accompanied the outside of the nerve (10 areas) were confirmed, suggesting the CS work as collateral blood supply vessels, with well-developed normal vessel-like anatomy. Conclusion: When we observe the CS, it is important to observe not only around the main trunk artery, but also areas where nerves mainly run, even if they do not accompany the main trunk artery.

Objective: To evaluate the mid-term outcomes following TEVAR for chronic type B aortic dissection (TBD), especially to know which re-entry closure affecting on the thoracic false lumen remodeling in the late chronic TBD. Methods: From April 2017 to April 2022, 25 patients with chronic TBD underwent TEVAR. The late chronic TBD received the re-entry closure including stent-graft deployment in renal artery, infrarenal aorta and unilateral or bilateral iliac artery. Results: Complete shrinkage of the thoracic false lumen were accomplished in 67% of the early chronic cases, but in only 13% of the late chronic cases. The thoracic false lumen shrinkage over 5 mm in diameter were obtained in 78% of the early chronic cases and in 69% of the late chronic cases. Univariate and multiple logistic regression analyses revealed the re-entry closure of common or external iliac artery affected on the thoracic false lumen remodeling. Conclusion: The re-entry closure in common or external iliac artery could affected on the thoracic false lumen remodeling following TEVAR for the late chronic TBD.