This article provides a comprehensive overview of the treatment of chronic limb threatening ischemia (CLTI). In order to understand the optimal treatment strategy for CLTI, the following six essential aspects are discussed: (1) the PLAN concept, (2) wound treatment, (3) nutritional intervention, (4) rehabilitation, (5) drug and adjuvant therapy, and (6) major amputation. In recent years, a new comprehensive concept called CLTI has been introduced internationally, focusing not only on ischemia but also on factors such as tissue loss and infection, leading to a restructuring of treatment strategies. The goal of treatment for CLTI is not simply to save the limb, but to save the limb functionally with an emphasis on quality of life (QOL). In CLTI, which requires a multidisciplinary approach and individualized assessment and treatment strategies, clinical decisions based on the latest guidelines and evidence from Japan and overseas are important.

Based on the JCS/JSCVS/JATS/JSVS 2020 Guideline on the Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection, and also referring to the 2018 revision of The Society for Vascular Surgery practice guidelines for patients with an abdominal aortic aneurysm, as well as the 2024 revision of the European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms, provide an overview of the diagnosis and treatment of abdominal aortic aneurysms and iliac artery aneurysms.

We report a case in which chimney endovascular aneurysm repair (chEVAR) was performed for a ruptured abdominal aortic aneurysm, in which the patient’s life was saved after preoperative shock vital signs. The patient was a 70-year-old man who had sudden abdominal pain and underwent a detailed examination. Contrast computed tomography (CT) revealed a ruptured abdominal aortic aneurysm. The patient was transported to our department via ambulance for surgical treatment. During transport, the patient was administered norepinephrine 0.08 γ, had a systolic blood pressure of 70 mmHg, and was in shock. Before transport, we planned to use CT images from the previous hospital and decided to perform chEVAR. It took 5 min after arrival at our hospital to enter the operating room, 16 min to start the surgery, 23 min to insert the aortic occlusion balloon, and 97 min to complete stent graft. The postoperative course was uneventful, and the patient was discharged home on postoperative day 16. After six months postoperatively, there has been no obvious endoleak, enlargement of the aneurysm diameter, or increase in retroperitoneal hematoma. Currently, the patient is undergoing outpatient follow-up.

Blunt axillo-subclavian arterial injuries are typically associated with high-energy trauma. However, we encountered two cases of such arterial injuries resulting from relatively low-energy mechanisms. Patient 1 presented occlusion and extravasation of the right subclavian artery, concomitant with a clavicular fracture sustained in a bicycle accident. Patient 2 revealed occlusion of the left axillary artery, accompanied by a humeral fracture, after falling while attempting to sit on a chair at home. Endovascular repair was performed in both cases using a VIABAHN stent graft via the ipsilateral brachial approach. The postoperative courses were uneventful. Endovascular stent grafting is probably a valuable therapeutic option in emergency settings.