An 84-year-old man developed right cerebral infarction recently twice a year. Enhanced computed tomography revealed innominate artery stenosis with irregular atheroma and diameter of innominate artery was expanded to 17 mm. The atheroma was considered to be the cause of cerebral infarction, and the patient was referred to our hospital for treatment. Endovascular therapy was thougut to be inadequate due to vascular diameter and the difficulty of brain protection. The operation was performed by direct ligation of innominate artery and revascularization by axillo-axillary artery crossover bypass. The postoperative course was uneventful, and the patient was discharged on 6th postoprerative day. One year after the operation, no new symptoms have been observed. The ligation of innominate artery and axillo-axillary artery crossover bypass were effective and less invasive strategy for innominate artery stenosis with irregular atheroma.
We report a rare case of left persistent sciatic artery (LPSA) in a patient with an abdominal aortic aneurysm (AAA) and a left internal iliac aneurysm (LIIA). The AAA and LIIA were first identified on computed tomography (CT) after orthopedic surgery in a 74-year-old man. The LPSA had to be preserved because it provided the major blood supply to the lower limbs. Endovascular aortic repair (EVAR) with an iliac branch system (Gore Excluder iliac branch endoprosthesis [IBE]) was performed to preserve the LPSA and repair the aneurysm. We performed a coil embolization before placement of the IBE because branches from the internal iliac aneurysm can cause type II endoleak. The surgical procedure was completed without any complications, and no endoleak was observed on the final angiography. Postoperative CT revealed optimal flow in the LPSA after 1 year 6 months, and no aneurysm or thrombosis was observed. Placement of an IBE can be effective for preserving LPSA.
A 72-year-old man was referred to our hospital because of left upper limb pain. Contrast-enhanced computed tomography showed occlusion of the left brachial artery and the masses in the aortic arch, which were suspected to be thoracic aortic thrombi. We performed emergency thrombectomy of the left brachial artery. On the following day, the patient developed a walking disorder and dysarthria. Head magnetic resonance imaging (MRI) showed cerebral infarction in the cerebellum and occipital lobe. We administered anticoagulation therapy as treatment of cerebral infarction. One-hundred four days after operation, the patient developed higher cortical dysfunction. Head MRI showed brain tumors and an abscess in the left cerebrum and cerebral ventricle. Contrast-enhanced computed tomography showed the rapid growth of the masses in the aortic arch, and infarct regions in the left adrenal gland, spleen, and kidneys. Systemic metastasis of an intraluminal tumor was suspected. The patient was received palliative care and died 111 days after the surgery. An autopsy was performed. The white tumor had grown into the aortic lumen, like a polypoid lesion. The pathological diagnosis was intimal sarcoma of the aorta, and there were multiple metastatic lesions in the brain, spleen, kidneys, and adrenal gland. Aortic intimal sarcoma is a very rare disease. However, we should not exclude the possibility that acute arterial occlusive disease can be caused by an intraluminal tumor.