Cystic adventitial disease (CAD) is a relatively rare condition that primarily occurs in the popliteal artery. We report a case of CAD in the common femoral artery. A 46-year-old woman presented to a local clinic with intermittent claudication in her left lower limb. Ultrasound examination revealed a hypoechoic area without blood flow in the left common femoral artery, with luminal narrowing due to compression. The patient was referred to our department with a diagnosis of femoral artery dissection. However, based on contrast-enhanced CT and lower limb MRI findings, femoral artery CAD was suspected. Surgery was performed to excise the cyst along with the vessel wall, followed by vascular reconstruction using a prosthetic graft. The patient’s symptoms resolved postoperatively, and she has shown good progress with no recurrence at the 3-month follow-up. Understanding the pathophysiology and imaging findings of adventitial cystic disease is crucial for accurate diagnosis. We report this case as we achieved favorable treatment results through surgery.

Internal iliac artery aneurysms are often asymptomatic and may be detected through urinary or neurological symptoms depending on their size and location. However, unilateral internal iliac artery aneurysms rarely cause acute postrenal failure, even if they lead to unilateral hydronephrosis. Here, we report the case of a 76-year-old male who presented to our hospital with complaints of urinary dysfunction. A computed tomography (CT) scan revealed a giant left-sided internal iliac artery aneurysm measuring 100 mm in diameter, compressing the bladder and resulting in bilateral hydronephrosis. The patient exhibited severe renal impairment, with a serum creatinine (Cr) level of 6.16 mg/dL, and was diagnosed with acute postrenal failure due to the left internal iliac artery aneurysm. Emergency endovascular intervention was performed, including distal embolization of the left internal iliac artery and stent-graft placement within the iliac artery. Postoperative renal function improved, with serum Cr decreasing to 1.46 mg/dL, and the patient was discharged on day 10. While endovascular treatment for internal iliac artery aneurysms effectively prevents rupture, it may not always restore renal function due to the potential persistence of the aneurysm. In this case, however, the reduction in aneurysmal pressure alleviated compression on the bladder and ureters, leading to improved renal function. This suggests that endovascular treatment of internal iliac artery aneurysms may be beneficial not only for rupture prevention but also for resolving aneurysm-induced postrenal failure.

A 76-year-old man with multiple comorbidities including pulmonary dysfunction and chronic kidney disease was admitted to our hospital with acute aortic dissection associated with a thoracic aortic aneurysm. He had undergone axillary-bifemoral bypass surgery for infrarenal occlusive disease 4 years prior to presentation. During hospitalization, the dissecting thoracic aortic aneurysm rapidly dilated and surgical intervention was considered. Because of the high surgical risk of open thoracic graft replacement, we performed an endovascular repair of this aortic pathology. An antegrade approach through the ascending aorta was chosen due to the difficulty of a conventional retrograde approach and other inadequate peripheral access. A median full-sternotomy was performed and after careful assessment of the ascending aorta using epi-aortic scan echo, a 22 Fr. sheath was cannulated into the ascending aorta using a 3-0 Ethibond purse-string suture. Three pieces of aortic endograft (c-TAG, W. L. Gore & Associates) were then placed from the level of Th6 to Th12. Completion angiography showed no endoleak. Although the patient required temporary hemodialysis, he recovered well with no neurological deficit and no aortic events at 6 months follow-up. This report highlights the potential efficacy of thoracic endovascular aortic repair via the ascending aorta as an alternative to conventional access or the cervical vessels.

Pseudoaneurysms reportedly have traumatic, bacterial, or inflammatory causes. Of these, those involving the radial artery are most often due to catheterization or perforating trauma. The delayed occurrence of radial artery pseudoaneurysms has been reported; however, cases of delayed occurrence due to blunt trauma are rare. Herein, we describe a case of delayed radial artery pseudoaneurysm due to blunt trauma. The patient was a 25-year-old man who fell and bruised his right wrist. One month later, he came to our hospital with a complaint of a gradually enlarging mass on the radial side of the right wrist. The mass was pulsatile, and an aneurysm of the right radial artery was confirmed by ultrasonography, and the artery in question was ligated. After the operation, the mass shrank and the pulsation disappeared. Radial artery pseudoaneurysms have also been reported to occur in the dorsum of the hand and in the tobacco orifice, where the artery runs close to the body surface, making it susceptible to trauma. The distal radial artery may be affected by the same mechanism.