Ulnar artery aneurysms (UAAs) are rare vascular lesions, most commonly associated with repetitive hand trauma and hypothenar hammer syndrome. Simultaneous involvement of both the ulnar and radial arteries is exceptionally uncommon. We report the case of a 61-year-old female patient with a true distal UAA in the dominant hand and concomitant ipsilateral radial artery occlusion, possibly associated with prolonged occupational repetitive trauma from sewing machine use. The patient presented with a progressively enlarging pulsatile wrist mass and sensory symptoms in the ulnar nerve distribution. Computed tomography angiography demonstrated a fusiform UAA and complete radial artery occlusion. Because the ulnar artery represented the only patent major arterial inflow to the hand, aneurysm excision and direct end-to-end spatulated reconstruction were performed under local anesthesia. At 2-year follow-up, the patient remained asymptomatic, with a patent reconstruction and preserved hand perfusion. This case highlights the importance of arterial reconstruction in dual-vessel disease.
Intentional celiac artery (CA) coverage during thoracic endovascular aortic repair (TEVAR) may be required to achieve an adequate distal landing zone; however, this strategy remains controversial owing to concerns regarding visceral ischemia, particularly in patients with infective native aortic aneurysms with compromised physiology and hostile anatomy. We retrospectively reviewed three patients who underwent TEVAR with planned CA coverage after angiographic assessment of collateral circulation using balloon occlusion testing and selective superior mesenteric artery angiography, with CA embolization. All patients demonstrated robust collateral perfusion, underwent CA embolization, and subsequently TEVAR with intentional CA coverage. One patient developed a type Ib endoleak on surveillance imaging without sac expansion. No hepatic, gastric, or splenic ischemic events occurred during follow-up. This case series suggests that intentional CA coverage may be feasible in carefully selected patients when guided by meticulous collateral assessment, offering a pragmatic option in urgent or anatomically constrained settings.
Complete endograft occlusion involving the main body and both limbs after endovascular aneurysm repair (EVAR) is rare, and the optimal treatment remains unclear. We report an 85-year-old male with late complete endograft occlusion after EVAR for an abdominal aortic aneurysm. Computed tomography (CT) showed complete thrombotic occlusion extending from just below the renal arteries to both iliac limbs and distally to the level of the external iliac arteries. A hybrid procedure was performed. After proximal recanalization under right renal artery protection, thrombectomy was performed through the left groin. Next, unilateral endograft relining was carried out using Ovation iX limbs, followed by femoro-femoral bypass. Postoperative CT confirmed patency of the relined limb, femoro-femoral bypass, and left external iliac artery reconstruction, with preserved bilateral renal perfusion. The ankle-brachial index improved from 0.58/0.49 to 0.95/0.88. Hybrid revascularization based on unilateral inflow reconstruction may be an effective option for selected patients with this rare complication.
Chronic peri-aortic inflammation after endovascular aneurysm repair (EVAR) is rare and may reflect sterile postoperative inflammation, immune-mediated periaortitis, or graft-associated infection. Differentiating between these entities is challenging but essential for appropriate management. An 84-year-old male with prior infrarenal EVAR in 2005 presented with persistent inflammation and peri-aortic fluid collection, initially considered immune-mediated periaortitis based on a partial response to corticosteroids. Computed tomography (CT) showed progressive enlargement of the lesion, and contrast-enhanced ultrasound demonstrated early arterial enhancement within it, supporting an active inflammatory process. Two CT-guided peri-aortic sampling yielded Listeria monocytogenes, confirming localized graft-associated infection despite negative blood cultures. The patient was treated with intravenous ampicillin for 6 weeks, followed by oral trimethoprim-sulfamethoxazole for 2 months, which led to clinical and radiological improvement. This case highlights the diagnostic value of invasive sampling and the potential role of targeted antimicrobial therapy with close imaging surveillance in selected high-risk patients with localized infection.
Chronic mesenteric ischemia (CMI) with multivessel occlusive disease remains challenging when endovascular therapy fails. We describe sequential antegrade reconstruction of the superior mesenteric artery (SMA) and celiac artery using a single 8-mm Dacron conduit originating from the supraceliac aorta. A 59-year-old man with severe malnutrition presented with progressive postprandial abdominal pain and substantial weight loss. Computed tomography angiography revealed flush occlusion of the celiac trunk, heavily calcified chronic total occlusion of the proximal SMA, patent distal target vessels, and limited collateralization through a diminutive inferior mesenteric artery. After two unsuccessful endovascular attempts, open revascularization was performed. The distal SMA was selected beyond the occluded segment, and the celiac trunk was reimplanted onto the same graft to preserve antegrade physiologic inflow while avoiding additional conduits. The patient recovered uneventfully and remained asymptomatic with patent graft at 3 months. This report outlines considerations for conduit configuration in CMI after failed endovascular therapy.
Purpose: Abdominal aortoiliac aneurysms (AAIAs) in pediatric patients are very rare, but rupture is often fatal. This study aimed to analyze causes, surgical management strategies, and clinical outcomes in pediatric patients with AAIAs who underwent surgical treatment. We also performed a systematic literature review of previously reported cases to inform diagnostic and therapeutic approaches. Materials and Methods : A retrospective case series analysis was conducted of consecutive pediatric patients (age <20 years) diagnosed with abdominal aortic or iliac artery aneurysms who underwent surgical treatment at Seoul National University Hospital from 1997 through 2025. A systematic literature review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and Web of Science were searched for publications from 1913 through 2025 using search terms including “child”, “pediatric”, “abdominal aortic aneurysm” and “iliac artery aneurysm”. Results : Surgical treatment was successfully performed in five patients, with no perioperative mortality. During a median follow-up of 5 years, four patients were alive with stable outcomes and no aneurysm recurrence or ischemic complications. One patient with tuberous sclerosis complex died 5 years after surgery from seizure-related complications. One patient developed early graft thrombosis but remained asymptomatic due to good collateral circulation. The systematic literature review summarized 96 reported cases of pediatric AAIAs, showing diverse etiologies and surgical approaches and generally favorable long-term outcomes when appropriately managed. Conclusion : Although rare, pediatric AAIAs carry a significant risk of rupture and death, requiring prompt diagnosis and surgical treatment. Experience from pediatric vascular reconstruction suggests that appropriate graft selection and anticipation of somatic growth are key for durable outcomes. Preservation of collateral circulation is crucial, as children demonstrate remarkable tolerance to graft occlusion. Further multicenter studies are needed to establish standardized management protocols for this rare condition.
Purpose: Peripheral artery disease (PAD) and aortic aneurysm (AA) are major manifestations of systemic atherosclerosis. Although they differ in pathophysiology and clinical presentation, they share common risk factors and overlapping biological pathways. However, long-term integrated data encompassing both conditions remain limited in Korea, constraining real-world evidence generation and outcome evaluation. Materials and Methods : To address this gap, the Vascular disease Prospective-Retrospective Observational Registry (VAPOR) was established as a mixed retrospective- prospective registry. VAPOR was initially implemented at a single coordinating center and was designed for stepwise expansion to multiple institutions. The registry systematically collects clinical, imaging, and procedural data from patients with AA and PAD. It aims to identify shared and disease-specific risk factors, evaluate outcomes, and apply established risk-stratification frameworks, thereby supporting the development of an interoperable vascular data infrastructure for precision medicine, quality benchmarking, and policy development. Results : As of April 15, 2026, VAPOR included 5,249 unique patients, comprising 4,438 patients in the retrospective cohort and 811 patients in the prospective cohort. The registry included 2,193 patients with AA and 3,287 patients with PAD; 231 patients had both AA and PAD. The primary outcomes are the incidence of major adverse cardiovascular events, major adverse limb events, and aneurysm- or procedure-related adverse events. Secondary outcomes include technical success, hemodynamic and imaging parameters, safety outcomes, and patient-centered endpoints. Conclusion : VAPOR provides a comprehensive real-world dataset for evaluating treatment outcomes and long-term prognoses in patients with AA or PAD. By integrating retrospective and prospective cohorts and establishing an infrastructure for multicenter expansion, VAPOR represents an important initiative in Korean vascular surgery and has the potential to enhance evidence-based management and advance precision vascular care.
Coral reef aorta (CRA) is characterized by dense, rock-hard intraluminal calcified plaques that can cause critical aortic stenosis or occlusion. We report the case of a 59-year-old man who presented with accelerated hypertension, acute decompensated heart failure, bilateral pleural effusions, acute kidney injury, adrenal insufficiency, and progressive inability to ambulate. Computed tomography angiography demonstrated a near-occlusive supraceliac CRA lesion with markedly reduced infraceliac aortic flow. The lesion was successfully treated with intravascular lithotripsy-assisted stenting, During the procedure, a partially deployed WALLSTENT (Boston Scientific) was used for temporary distal embolic protection. The postoperative course was uneventful, with resolution of heart failure, normalization of renal function, improvement in adrenal function, and reduction in antihypertensive requirements from four to two agents. The patient remained asymptomatic at the 6-month follow-up. This case suggests that endovascular management using intravascular lithotripsy-assisted stenting with temporary WALLSTENT-based embolic protection may be feasible for selected patients with complex supraceliac CRA.
Purpose: This study aimed to quantify the real-world availability of a single-segment great saphenous vein (GSV) in a nonselective Korean cohort with peripheral arterial disease and to identify patient-level predictors that may limit the adoption of a vein-first strategy. Materials and Methods : This retrospective analysis of prospectively collected data included 115 consecutive patients admitted for evaluation and planning of lower-extremity revascularization (53 with claudication and 62 with chronic limb-threatening ischemia [CLTI]) from 2023 to 2024. All patients underwent mandatory bilateral duplex mapping before treatment by registered vascular technologists under a standardized protocol (reverse Trendelenburg position, temperature 25°C-26°C, inner-to-inner measurements). A suitable single-segment conduit was defined as a continuous, thrombus-free GSV from the saphenofemoral junction to the proximal calf without duplex-detected reflux and was categorized by minimum diameter as ideal (≥3.0 mm), acceptable (≥2.5 mm), or borderline (≥2.0 mm). Results : In the ipsilateral limb, the GSV met the ideal, acceptable, and borderline thresholds in 23/115 (20.0%), 39/115 (33.9%), and 57/115 (49.6%) patients, respectively. When the contralateral limb was included, overall availability (either limb) increased to 28/115 (24.3%), 58/115 (50.4%), and 75/115 (65.2%), corresponding to absolute gains of 4.3, 16.5, and 15.6 percentage points, respectively. Ipsilateral and overall ideal availability tended to be lower in CLTI than in claudication (14.5% vs. 26.4%, P=0.112 for ipsilateral; 17.7% vs. 32.1%, P=0.074 for overall). On multivariable analysis, older age and female sex were independently associated with reduced overall ideal availability (adjusted odds ratio [aOR] per year, 0.932; 95% confidence interval [CI], 0.887-0.979; female sex: aOR, 0.201; 95% CI, 0.046-0.869). Conclusion : In this consecutive real-world cohort, ideal single-segment GSV availability (≥3.0 mm) was low and was further limited by older age and female sex. These findings highlight an important limitation of a vein-first strategy in routine practice and support standardized bilateral mapping to clarify conduit availability and guide individualized revascularization planning.
Purpose: This study aimed to evaluate the feasibility and safety of balloon-assisted selective renal protection during endovascular treatment of juxtarenal aortoiliac occlusive disease (AIOD) and to present a preoperative computed tomography angiography (CTA)-based morphological framework for procedural planning and standardized reporting. Materials and Methods : This single-center retrospective study, conducted between 2017 and 2022, included patients with juxtarenal AIOD treated with kissing covered self-expanding stents. Renal protection balloons were applied selectively based on preoperative CTA findings and the anticipated proximal stent extension. Renal reconstruction was performed selectively for planned proximal stent extension above the renal ostium, significant ostial disease, or bailout in cases of embolization or flow limitation. The primary outcomes were acute kidney injury (AKI; Kidney Disease: Improving Global Outcomes creatinine criteria, patient level) and renal embolic events (REEs, renal artery level), defined as angiographic embolization requiring intervention or clinically silent renal infarction on postoperative CTA. Patency and follow-up estimated glomerular filtration rates were also assessed. Results : Eleven patients (21 renal arteries, excluding 1 preexisting renal artery occlusion) were treated with 100% technical success. AKI occurred in 2/11 patients (18.2%), both stage 1. REEs occurred in 3/21 renal arteries: one symptomatic embolization required stenting, and two showed clinically silent partial renal infarction on postoperative CTA. Six renal stents were implanted, with a primary patency rate of 83.3% (5/6). One patient developed acute in-hospital thrombosis requiring thrombolysis, and the same stent became permanently occluded at the 2-year follow-up and was managed conservatively. Aortoiliac primary patency was 95.5% (21/22 limbs), and secondary patency was 100%. No late reinterventions were observed during a mean follow-up of 24.4 months. Conclusion : Balloon-assisted selective renal protection is feasible in juxtarenal AIOD. However, REEs, including clinically silent infarctions, may still occur, and selective renal reconstruction remains necessary in a subset of patients. The CTA-based morphological framework may facilitate preprocedural planning and standardized reporting of renal outcomes alongside traditional aortoiliac endpoints.
A 57-year-old man with extensive-stage small cell lung cancer presented with superior vena cava (SVC) syndrome caused by a right upper lobe mass and underwent stenting from the SVC to the left brachiocephalic vein. Because ongoing chemotherapy required durable central venous access, chest port placement was subsequently attempted after stent placement. However, advancing a conventional peel-away sheath across the recently placed stent was considered undesirable because of the risk of stent deformation or displacement. A chest wall port was successfully placed by advancing only the guidewire and catheter through the stent interstices using an 8-Fr hemostatic vascular sheath instead of a peel-away sheath. Imaging confirmed appropriate catheter course and tip position within the stented segment. This case illustrates a feasible and practical alternative for central venous access following malignant SVC stenting.
Venous aneurysms of the upper extremities are uncommon and may be traumatic, iatrogenic, or idiopathic. Herein, we report the case of a 72-year-old female with a cephalic venous aneurysm of the wrist that was closely associated with the superficial radial nerve. To minimize the risk of nerve injury, tangential aneurysmectomy with lateral venorrhaphy was performed. However, early postoperative occlusion occurred despite preserved collateral venous flow, and no neurological deficits were observed. This case highlights the importance of meticulous identification and preservation of adjacent nerves and suggests that vein-preserving repair may have limited durability in superficial venous aneurysms. When adequate collateral circulation is present, aneurysmectomy with ligation may be a safer and more practical option after careful identification and preservation of the superficial radial nerve.
Few cases have reported the use of a transapical approach for thoracic endovascular aortic repair (TEVAR) when standard retrograde device delivery is not feasible. We present the unique case of a 74-year-old female with a history of descending thoracic TEVAR, a physician-modified fenestrated endograft, and ascending aortic repair who presented with an enlarging aortic arch aneurysm requiring intervention. Her native aorta was notably tortuous, and a patient-centered decision was made to proceed with transapical access via a mini-thoracotomy after unsuccessful retrograde endovascular attempts due to severe tortuosity and prior endografts. The stent graft was successfully deployed without type I or III endoleak. The patient recovered without neurologic deficits and was discharged on postoperative day 7. This case highlights transapical access as a feasible alternative route for TEVAR in selected patients with prohibitive anatomy and underscores the importance of multidisciplinary collaboration and timely management of proximal aortic pathology.
Purpose: The aim of this study was to present the mid-term outcomes of patients undergoing treatment for atherosclerotic stenosis or occlusion of the supra-aortic arch vessels using covered stents. Materials and Methods : We conducted a retrospective, single-center analysis of patients treated for supra-aortic arch vessel atherosclerotic occlusive disease (AOD) at our institution between 2015 and 2024. The study included symptomatic patients who received endovascular treatment with covered stents for lesions involving the subclavian artery, proximal common carotid artery (pCCA), or the brachiocephalic trunk (BT). All patients underwent preprocedural computed tomography angiography within 6 months and color duplex ultrasonography before and after the intervention. Results : A total of 20 patients (8 male; mean age, 69.5±14.3 years) underwent primary covered stent implantation for supra-aortic arch vessel AOD, with 21 vessels treated (11 [52.4%], 6 [28.6%], and 4 [19.0%] in the subclavian artery, pCCA, and BT respectively). The main presenting symptoms were related to cerebrovascular insufficiency. Two patients presented with ischemic finger lesions due to subclavian artery occlusion. Technical success rate was 100% (21/21), and no intraoperative complications were recorded. Perioperative mortality was 0%. Two patients developed transient cerebral hyperperfusion syndrome after pCCA recanalization, one required temporary hemodialysis, and one underwent wound revision for access-site hematoma. Sixteen patients reported postoperative symptom resolution. Mean follow-up was 47.9±33.1 months (median, 40 months; interquartile range, 32 months). Mortality during follow-up was 30% (6/20), with no AOD-related deaths. During follow-up, no duplex ultrasound findings suggestive of >50% in-stent restenosis were detected, and no reinterventions were required. Conclusion : Covered stent implantation for supra-aortic arch vessel atherosclerotic lesions appears to be associated with acceptable mid-term outcomes.
Blunt trauma caused by bicycle or motor-scooter handlebars is a rare mechanism of femoral artery injury. Three-wheelers, commonly operated with handlebars, are a frequent mode of transportation in Sri Lanka. This case report describes a 22-year-old male driver of a three-wheeler who presented with acute occlusion of the common femoral artery (CFA) after blunt handlebar trauma to the groin during a collision. Intraoperatively, the intimal injury extended from the CFA to the external iliac artery, necessitating iliac exposure and reconstruction with a reversed great saphenous vein interposition graft. Arterial perfusion was successfully restored. Although the postoperative course was complicated by iliofemoral deep vein thrombosis, limb salvage was achieved. This case highlights that handlebar trauma to the groin can result in arterial injury extending beyond the site of impact. Clinicians managing such injuries should be prepared to extend exposure to the iliac vessels and perform appropriate reconstruction when needed.
Infectious aortic pseudoaneurysm secondary to disseminated tuberculosis is rare and potentially fatal, particularly in immunocompromised patients. We report a 37-year-old female patient with systemic lupus erythematosus and end-stage renal disease on immunosuppressive therapy and hemodialysis who presented with post-dialysis fever. Computed tomography angiography (CTA) revealed a descending thoracic aortic pseudoaneurysm. During hospitalization, she developed persistent fever, abdominal pain, and lower-extremity purpura. Urgent thoracic endovascular aortic repair (TEVAR) was performed using a 24×100 mm single thoracic stent-graft. Post-TEVAR CTA demonstrated a persistent endoleak, raising concern for a distal type Ib versus type III endoleak; therefore, left thoracotomy was performed, and a type III endoleak was confirmed intraoperatively. Tuberculous aortitis was confirmed by GeneXpert (Cepheid) analysis of the aortic tissue. Renal-adjusted antitubercular therapy was administered with favorable clinical and imaging outcomes. This case highlights the importance of early recognition and multidisciplinary management of tuberculous aortitis in high-risk patients.
Thoracic endovascular aortic repair (TEVAR) and the frozen elephant trunk (FET) are well-established treatment options for aortic dissection (AD). Inadvertent misdeployment of a TEVAR stent graft or FET into the false lumen (FL) can lead to serious complications. We report two cases of FL misdeployment. First, a 68-year-old female with acute Stanford type B AD underwent TEVAR; follow-up computed tomography angiography (CTA) revealed stent-graft misdeployment into the FL. Second, a 44-year-old female with Marfan syndrome, who had undergone supracoronary ascending aortic grafting for type A AD at 25 years of age, underwent urgent FET 19 years later for a symptomatic dissecting arch aneurysm; follow-up CTA confirmed misdeployment into the FL. In both cases, endovascular rescue was performed with fenestration of the intimal flap and additional stent-graft deployment to reroute flow into the true lumen. Misdeployment of TEVAR or FET into the FL is catastrophic but treatable with rapid diagnosis and timely intervention.
Purpose: This study aimed to investigate the relationship between the two biomarkers, von Willebrand factor (VWF) and ADAMTS13, and major adverse limb events (MALE) in patients with peripheral artery disease (PAD). Materials and Methods : After obtaining informed consent, baseline blood samples were collected from 48 PAD patients aged 60-75 years who were undergoing assessment, surveillance, medical management, or consideration for surgical intervention. VWF and ADAMTS13 antigen levels were measured by enzyme-linked immunosorbent assay (ELISA). Patients were monitored prospectively for subsequent MALE, defined as lower-limb revascularization or major amputation. Biomarker levels were compared between patients who did and did not experience subsequent MALE using Mann-Whitney U-tests, and time to MALE was evaluated using Kaplan-Meier analyses. This study was approved by the Unity Health Toronto Research Ethics Board. Results : Twenty-four patients (50%) experienced MALE after baseline blood sampling. These patients had significantly lower VWF antigen levels (median [interquartile range]: 17,817.18 [32,339.16] ng/mL vs. 46,175.95 [75,284.64] ng/mL, P=0.026) and lower VWF/ADAMTS13 ratios (P=0.008) than those without MALE. Kaplan-Meier analyses comparing biomarker values above versus below the cohort median showed non-significant trends toward a higher cumulative incidence of MALE during follow-up for lower VWF, higher ADAMTS13, and lower VWF/ADAMTS13 ratios. In an exploratory analysis excluding patients with baseline chronic limb-threatening ischemia, below-median VWF/ADAMTS13 ratios were associated with a higher cumulative incidence of MALE during follow-up (log-rank P=0.018). Conclusion : Contrary to our original hypothesis, lower baseline VWF levels and VWF/ADAMTS13 ratios were associated with subsequent MALE in this high-risk PAD cohort, which may reflect increased VWF consumption in severe, diffuse atherosclerosis. This study contributes to the limited literature on VWF and ADAMTS13 in PAD in relation to MALE, as previous research has largely focused on major adverse cardiovascular events. Larger studies in patients with similar risk profiles are required to validate these findings.
