An 86-year-old woman was hospitalized because of a thoracic aortic aneurysm. Computed tomography (CT) revealed an arch aortic aneurysm with an abnormality of the right subclavian artery. The origin of the right subclavian artery was cystically dilated and was considered to be Kommerell’s diverticulum. The aneurysm was located in Zone 3 of the arch aorta, it was 58 mm in diameter and enlarged by 3 mm in about 6 months. 2-debranching thoracic endovascular aortic repair (TEVAR) was perfomed with bypass from the ascending aorta to bilateral axillary arteries without surgical intervention of the common carotid arteries. The patient had a good progress without cerebral infarction.

The Arc of Bühler (AOB) is considered a remnant anastomotic vessel between the superior mesenteric artery and the celiac artery (CA) during the embryonic period, it is a rare anatomical variation and its frequency is 1–4%. AOB aneurysm by stenosis or occlusion of the CA with median arcuate ligament syndrome occasionally requires treatment. A 77-year-old woman was incidentally found to have a visceral artery aneurysm at another hospital and was referred to our hospital. We diagnosed a 20 mm saccular AOB aneurysm by contrast-enhanced computed tomography (CT) and performed endovascular treatment. During the initial treatment, we embolized two outflow arteries with coils. After that, the blood flow to AOB aneurysm and the inflow artery was lost, we concluded the procedure. One week later, the contrast-enhance CT showed that a part of the aneurysm and the inflow artery were recanalized, therefore we performed the second treatment. We performed coil embolization of a part of the aneurysm and the inflow artery. Three months after the procedure, the contrast-enhanced CT showed the aneurysm was completely embolized. It was considered that the endovascular treatment with coil embolization was a safe and effective treatment for AOB aneurysm.

Acute limb ischemia not only leads to lower extremity amputation, but also has a high mortality rate. It is due to ischemia-reperfusion injury which can affect the entire body. We experienced a case of acute abdominal aortic occlusion with ischemia in both lower extremities triggered by infection. A 64-year-old man suddenly developed acute abdominal aortic occlusion during receiving antibiotic treatment for Lemierre syndrome. Thrombectomy was performed and stent graft was used to ensure vascular lumen. In addition, we performed controlled limb reperfusion to avoid ischemia-reperfusion injury. After the operation, he developed compartment syndrome and acute kidney injury, but recovered immediately. Controlled limb reperfusion is effective technique to avoid ischemia-reperfusion injury such as hyperkalemia, lethal arrhythmia or metabolic acidosis, and can improve outcome.

A 65-year-old male was admitted with worsening chest and abdominal pain. Enhanced computed tomography (CT) showed retrograde type A aortic dissection (RTAD) with an entry in the distal left subclavian artery, which had extended itself across the pre-existing 70 mm abdominal aortic aneurysm, resulting in rupture with retroperitoneal hematoma. We considered performing simultaneous graft replacement of total arch aorta and abdominal aorta, but due to the high invasiveness and potential life-threatening risks involved, we performed emergency simultaneous thoracic endovascular aortic repair (TEVAR) and endovascular aneurysm repair (EVAR). When we observed progression of the aortic dissection, expansion of the retroperitoneal hematoma and the aortic diameter, we also planned surgical additional treatment. We controlled blood pressure strictly and followed up CT scans frequently. Fortunately, the patient’s postoperative course was uneventful, with remodeling of the ascending aorta, thrombosis of the false lumen in the abdominal aortic aneurysm and disappearing of the retroperitoneal hematoma. He was discharged home without any additional treatments.

In cases of iliac artery aneurysm, the stent graft limb, a component of the endovascular aneurysm repair device, can be used individually for endovascular treatment (EVT). In cases where the proximal landing zone diameter exceeds that of the limb, an upside-down limb implantation is necessary. This is because the proximal diameter is generally uniform for each device. In the presented case, EVT was successfully performed using an upside-down Ovation iX iliac limb for a left internal iliac artery aneurysm. The Ovation iX iliac limb has a sinusoidal stent, is more flexible than the Excluder limb, which has a similar structure, and may be useful for EVT in the iliac artery region considering patency and conformability. The limb was deployed within a sheath (Check-Flo) extracorporeally by inserting it from the sheath’s front side first. Subsequently, the limb was introduced into the artery by inserting it into another sheath (DrySeal), which had been placed previously, and pushed up with the modified terminal end of the inner sheath. For deployment, the outer sheath was pulled while providing support to the limb using the terminal end of the inner sheath. This technique may broaden the surgical indications and strategies for iliac artery aneurysms.

A 31-year-old male right-handed professional baseball pitcher visited his previous doctor complaining of coldness in his right index and middle fingers and fatigue in his right upper limb after pitching. He was referred to our hospital because of a suspected upper limb ischemia. CT and ultrasound examinations revealed intimal thickening and thrombus occlusion of the axillary artery. Angiography also revealed occlusion of the axillary artery, and abundant collateral circulation to the periphery was visualized. Considering the future of his career as a baseball player, the decision was made to perform surgical revascularization. Surgical findings showed intimal thickening of the axillary artery and occlusion of the vascular lumen due to a thrombus. After removal of the thrombus and endarterectomy, angioplasty was performed using a bovine pericardial patch. The postoperative course was uneventful, and the patient returned to pitching in a game 6 months after being discharged from the hospital. Axillary artery occlusion in athletes is rare and can be difficult to diagnose, but with appropriate treatment the prognosis is relatively good.

Edwardsiella tarda is a bacterium belonging to the family Enterobacteriaceae that is widely distributed in nature and rarely infects humans through ingestion of infected fish, shellfish, or aquatic animals. In humans, Edwardsiella tarda mainly causes intestinal infections, but serious extraintestinal infections have also been reported. In this report, we describe a case of an infected abdominal aortic aneurysm caused by Edwardsiella tarda that presented to our hospital with fever and lower back pain, and successfully underwent in situ prosthetic graft replacement and omental coverage.

Objectives: This is an annual report indicating the number and early clinical results of annual vascular treatment performed by vascular surgeon in Japan in 2019, 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 154,460 vascular treatments were registered by 1,082 institutions in 2019. 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 23,826, 17,100, 4,947, 2,369, 674, 54,023 and 51,521, respectively. In the field of aneurysm treatment, 20,369 cases of abdominal aortic aneurysm (AAA) including common iliac aneurysm were registered, and 63.3% were treated by endovascular aneurysm repair (EVAR). Among AAA cases, 1,739 (8.5%) cases were registered as ruptured AAA. The operative mortality of ruptured and un-ruptured AAA was 15.0%, and 0.6%, respectively. 43.8% 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 12.6%, and 15.4%, respectively. Regarding chronic arterial occlusive disease, open repair was performed in 8,026 cases, including 1,250 distal bypasses to the crural or pedal artery, whereas endovascular treatment (EVT) were performed in 8,879 cases. The EVT ratio was gradually increased at 51.9%. Varicose vein treatment was decreased in 42,313 cases (1.9% less than in 2018), and 79.8% of the cases were treated by endovenous thermal ablation (ETA) including endovenous laser ablation (EVLA) and radio-frequency ablation (RFA). Regarding other vascular operations, 47,605 cases of vascular access operations and 1,703 lower limb amputation surgeries were included. Conclusions: The number of vascular treatments increased since 2011, 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.