Davidsonmikkelsen5460

Recently, it has been reported that a fenestrated stent graft is an effective option in the treatment of pararenal artery abdominal aortic aneurysm. We report the case of a 72-year-old male patient with multiple aortic aneurysms in the distal arch, thoracoabdominal aorta, right common iliac artery, as well as a pararenal abdominal aortic aneurysm. The patient was found to have a mass with a tendency of rapid expansion within a month from its discovery. Because it was a saccular aneurysm with a tendency of rapid expansion and wide spread, the risk of rupture was judged to be high, and surgical treatment became necessary. One-stage treatment was desirable; therefore, endovascular treatment with a fenestrated stent graft was selected. Four fenestrations were made to a stent graft for the celiac artery, superior mesenteric artery, and bilateral renal arteries. The postoperative computed tomography (CT) showed no branch occlusion or endoleak, and the 2-year postoperative CT showed the shrinkage and subsequent disappearance of the aortic aneurysm at the treatment site. For extensive aortic aneurysm, including pararenal artery abdominal aortic aneurysms, one-stage treatment with fenestrated stent graft was considered to be effective as a treatment strategy. (This is a translation of Jpn J Vasc Surg 2020; 29 9-13.).Venous aneurysm (VA) is an uncommon vascular disease; however, VA, especially in the lower extremities, can lead to critical complications, such as pulmonary embolism (PE). We report a case with a VA located in the sural vein (SV), which did not lead to PE; however, it had the potential to cause PE. Therefore, we treated this VA by total excision. The popliteal vein (PV) is the most common VA location in the lower extremities, but SV is extremely rare. We should always be aware that, in addition to the PV, VAs may also occur in the SV.The effectiveness of endovascular aneurysm repair (EVAR) has been proven, but anatomical limitations, including narrow access route, may obstruct procedure of EVAR and cause serious complications. Parallel placement of Excluder legs (W. L. Gore & Associates, Inc., Newark, DE, USA) was established to treat patients with type IIIb endoleak or those with a narrow aorta, who could not be treated using a standard main body. In this report, we applied this technique in two patients with aortoiliac aneurysms with occlusive lesion.Aneurysmal change of reconstructed intercostal arteries is believed to be a rare complication after thoracoabdominal aortic repair. To our knowledge, there is no guideline or randomized controlled trials regarding intercostal patch aneurysm management. Therefore, the optimal treatment is still controversial. We describe a successful case of emergent thoracic endovascular aortic repair for ruptured intercostal patch aneurysm in an 83-year-old man following thoracoabdominal aortic aneurysm repair. Our experience illustrated that gradual expansion of large blocks of aortic wall reconstruction should be closely monitored after primary thoracoabdominal aortic replacement.We report a case of periaortic lymphoma mimicking Stanford type B acute aortic dissection treated for impending rupture by thoracic endovascular aortic repair. Although no endoleak was detected, the aneurysm enlarged continuously. Repeat computed tomography scans showed that an aortic aneurysm-like structure around the stent graft had enlarged irregularly. Histopathological examination revealed diffuse large B-cell malignant lymphoma. Post-chemotherapy, the aneurysm-like structure disappeared without any fistula or rupture. In open surgery, differentiating between aneurysms and malignancy is easy under direct vision; however, in the endovascular surgery era, this is a pitfall because no surgical specimen of the lesion can be obtained.We report a case of stent graft occlusion, severe lower extremity ischemia, and ruptured abdominal aortic aneurysm due to type B acute aortic dissection 3 years after endovascular aneurysm repair. He admitted our hospital because of abrupt back pain and dysesthesia of bilateral lower limb. Contrast-enhanced computed tomography (CT) scan showed type B acute aortic dissection and occlusion of the stent graft due to dynamic compression by the false lumen. Emergent right axillo-bifemoral bypass operation was done for his critical limb ischemia. Immediately after the successful operation, he fell into shock vital and dissecting abdominal aortic aneurysm rupture was revealed by CT scan. We performed the stump occlusion of the infrarenal abdominal aorta and the bilateral common iliac arteries by abdominal midline incision. Postoperative myonephropathicmetabolic syndrome due to the left ischemia resulted in amputation of his left lower leg for lifesaving. While EVAR cases are increasing, various its complications come to be reported. We consider that this case report might be cautious about the indication of EVAR for the younger generation. (This is a translation of Jpn J Vasc Surg 2019; 28 367-371.).Aim Critical limb ischemia (CLI) has a wide age distribution. We aimed here to reveal age-associated clinical features in CLI patients. Materials and Methods We analyzed 531 Japanese CLI patients referred to vascular centers. The three-year mortality risk by age was compared to that for the Japanese nationals, derived from Japan's national life table data. learn more Clinical characteristics associated with age in CLI patients were also explored. Results Mean age was 73±10 years. Whereas 27.9% were aged ≥80 years, 19.2% were aged less then 65 years. Mortality risk was increased with age, but its risk ratio relative to the same-aged nationals was higher in younger patients. Incidence of major amputation was higher in a younger population. Receiving welfare, smoking, increased body mass index, diabetes with hemoglobin A1c ≥7.0%, non-high density lipoprotein cholesterol ≥190 mg/dL, renal failure, and the Wound, Ischemia, and foot Infection classification stage 4 were associated with younger age, whereas non-ambulation and institutionalization were associated with older age. Conclusion Patients aged less then 65 years, belonging to the working-age population, reached almost one fifth of the CLI population. Younger patients had a lower mortality risk in the population, but had a higher risk ratio relative to the same-aged nationals. Socioeconomic disadvantage, poor cardiovascular risk control, and wound severity were associated with younger age.