A 68-year-old woman with hoarseness was referred to our hospital because of abnormal findings on chest computed tomography (CT), and esophageal compression on gastrointestinal endoscopy. She was diagnosed with Kommerell’s diverticulum with right-sided aortic arch and aberrant left subclavian artery by contrast enhanced CT. The diameter of the origin of the diverticulum was 30 mm and the distance from the tip of the diverticulum to the opposite aortic wall was 52 mm. We performed thoracic endovascular aortic repair (TEVAR) because of the hoarseness and large diverticulum. Following the left carotid-axillary bypass, a Gore TAG Conformable active control system 37 mm–150 mm was inserted covering the right subclavian artery. The angulation control was used to adapt the stent graft to the steep aortic arch before deployment, and the right subclavian artery was stented (chimney technique) for preservation of the blood flow. After that, coil embolization of the left subclavian artery was performed. Postoperative contrast enhanced CT showed no endoleak, and the hoarseness disappeared. For the two years since the surgery, the diverticulum has not enlarged and she has been doing well.

The patient was a 52-year-old man diagnosed with diabetes but had not received medical care. Blood tests indicated leukocytosis and elevated HbA1c levels. Contrast-enhanced computed tomography (CT) revealed abnormal soft tissue shadows surrounding the right common femoral artery. The patient was then diagnosed with right femoral cellulitis and an infected femoral aneurysm. Antibiotic therapy and diabetic treatment were initiated accordingly. On the eighth day of hospitalization, edema appeared in the right lower extremity, and CT demonstrated femoral artery transformation into a pseudoaneurysm with an associated flattened femoral vein. Given the inadequate glycemic control and active infection, the decision was to defer surgery until euglycemia was achieved. After the cellulitis resolved, a dermatologist identified scabies in the right inguinal region, necessitating further surgery postponement due to the required isolation period. Following the isolation period, a preoperative CT scan revealed a thrombus in the right femoral vein. On the 35th day of hospitalization, the patient underwent an aneurysmectomy and a bypass procedure involving the right external iliac artery and superficial femoral artery, accompanied by venous ligation. The patient experienced a favorable postoperative recovery and was discharged on the 28th day to continue recuperation at home.

Bronchial artery aneurysms are rare, presenting in less than 1% of selective bronchial arteriography. The risk of rupture is high regardless of the size of the aneurysm, and treatment is necessary as soon as it is diagnosed, even if the patient is asymptomatic. A 78-year-old woman presented with chief complain of coughing. Computed tomography (CT) showed a bronchial artery aneurysm with a diameter of 25 mm, so we opted for treatment with thoracic endovascular aneurysm repair (TEVAR). Although we attempted to embolize the outflow vessel, the inflow vessel was too thin to cannulate, so we decided to close the inflow vessel with TEVAR alone. The postoperative course was uneventful. Enhanced CT on postoperative day 7 showed no endoleak, and the aneurysm was thrombosed. Follow-up CT showed that the aneurysm gradually shrank to 14 mm in diameter at 4 years postoperatively and had remained at the same diameter at 11 years. In the endovascular treatment of bronchial artery aneurysms, a combination of embolization of the outflow vessel and closure of the inflow vessel with TEVAR can be a more reliable strategy. Even when embolization of the outflow vessel is difficult, TEVAR alone may provide a good long-term outcome.

An 88-year-old patient underwent thoracic endovascular aortic repair for an incidentally discovered thoracic aortic aneurysm. Access was attempted via the femoral and external iliac artery approaches; however, insertion was not possible, and the procedure was completed via an open trans-aortic approach. Postoperatively, the patient developed acute lymphangitis and lymphedema in the inguinal region, resulting in extensive skin and subcutaneous tissue necrosis requiring debridement and skin grafting. Two incisions in the femoral and external iliac arteries were considered to be the cause of sudden lymphedema. This extremely rare case is reported in detail, with a discussion of the potential mechanism.

In the case of surgical intervention for short-necked abdominal aortic aneurysms, operative procedures should be considered, taking into account the characteristics of those aneurysms. A 78-year-old male had presented with back pain and right thigh pain beginning three months prior. CT scan revealed a pseudoaneurysm of 90 mm in diameter located in the abdominal aorta below the right renal artery and expanded to the right and dorsal side, eroding lumber vertebras. He was diagnosed with chronic contained rupture due to his stable hemodynamics. As he had a history of laparotomy and there was no evidence of infection to the aneurysm, endovascular aneurysm repair (EVAR) was performed. We reconstructed the left renal artery using chimney technique and the right renal artery with branched and fenestrated endovascular aneurysm repair, because the aneurysm was pararenal. Renal dysfunction did not occur after these procedures. Back pain and right thigh pain immediately disappeared during the postoperative course. EVAR with multiple methods to reconstruct vessels is thought to be useful in short-necked AAA patients with history of laparotomy.

Background: Venous aneurysms are rare. Herein, we report a case of popliteal venous aneurysm (PVA) detected in a patient with pulmonary thromboembolism. Case presentation: The patient is a 68-year-old woman with no relevant medical, miscarriage, or medication history who presented with the chief complaints of palpitations and shortness of breath. Upon admission, she showed a blood pressure level of 79/54 mmHg, heart rate of 129/min, SpO₂ level of 85% (room air), respiratory rate of 28/min, and body temperature of 36.6°C. No leg edema was observed. Contrast-enhanced computed tomography revealed bilateral pulmonary artery emboli and a saccular venous aneurysm (30-mm diameter) with thrombus in the right popliteal vein. Pulmonary thromboembolisms resolved and the respiratory symptoms improved after 2 weeks of anticoagulation therapy. Subsequently, the patient underwent tangential aneurysmectomy with lateral venorrhaphy for PVA, followed by postoperative anticoagulation therapy for 6 months. No recurrence was observed after 2 years. Conclusion: PVAs cause pulmonary thromboembolisms. PVAs should be treated surgically as early as possible and monitored via follow-up.

Vascular leiomyosarcoma is rare disorder and its prognosis is considered to be poor. Particularly, only a few reports have been published regarding primary leiomyosarcoma of the femoral vein. In the current study, we reported a case of primary leiomyosarcoma of the femoral vein, accompanied with a literature review. A 74-year-old woman was referred to our department with suspected deep vein thrombosis due to the swelling of her right lower extremity. A Hen’s egg-sized and non-pulsatile mass was palsated in the right inguinal region. Vascular ultrasonography revealed a 35×31×51 mm-sized mass, and a femoral venous aneurysm with thrombosis in the lumen was suspected. Furthermore, a tumor of the right femoral vein was suspected based on CT and MRI findings, and primary neurogenic tumor was listed in the differential diagnosis. The operative finding revealed that the mass was connected to the femoral vein, and a primary neurogenic tumor was ruled out. The mass was diagnosed as a tumor of the femoral vein, and complete resection was performed. Moreover, pathological examination of the mass revealed a primary leiomyosarcoma of the femoral vein. After the patient was discharged, she was observed by our department along with the hematology-oncology department at our hospital. Multiple metastases of the lung and liver were confirmed 4 months after the operation, and chemotherapy was initiated. She remains alive 2 years after the operation.

Popliteal artery cystic adventitial disease (PACAD) is an uncommon nonatherosclerotic arterial occlusive disease. We describe three cases of PACAD that spontaneously remitted. The three patients included a 56-year-old man, 34-year-old man, and 72-year-old man who presented at our hospital with intermittent claudication of the extremities. Diagnostic imaging, such as enhanced computed tomography (CT) or magnetic resonance imaging (MRI), showed scimitar-shaped cystic lesions with severe narrowing or obstruction of the affected popliteal artery. In two of the cases, enhanced CT revealed that multilocular cysts of the arterial wall had connected to the knee joint. Therefore, the patients were diagnosed with PACAD and scheduled for surgical repair. Subsequently, claudication or calf pain improved awhile. The intervals from onset to remission of the symptoms were three months, 34 days, and 13 days, respectively. Examinations showed normal distal pulses; duplex or contrast-enhanced CT revealed that the diameters of the cystic lesions were decreased and that the blood flow in the popliteal arteries was normalized. Accordingly, the operations were cancelled, patients underwent conservative therapies, and they were followed up as outpatients. Exacerbation after remission of calf pain was observed in one case, the 72-year-old man. One week later, however, this symptom due to leg ischemia improved under conservative treatment. The three patients have remained asymptomatic with normal ankle pressure up until the present. Although spontaneous regression of PACAD is rare, our cases demonstrated the possibility of permanent remission of PACAD. There may be justified conservative therapies for non-limb-threatening cases of PACAD before surgery.