Routine completion angiography and intraoperative stent placement for the management of distal intimal flap during eversion carotid endarterectomy

Although eversion carotid endarterectomy (CEA) has gained popularity, there are some concerns, including difficulties in handling the distal intimal flap, especially in those patients with a high lesion. Therefore, intraoperative angiography is routinely performed during CEA to check for intimal flaps and to assess the need for adjunctive maneuvers such as stent placement. We describe our adjunctive intraoperative carotid artery stenting after eversion CEA for unsatisfactory distal internal carotid artery end points detected by routine completion angiography. By conducting completion angiography when in doubt and adjunctive carotid artery stenting if indicated, the potential disadvantage of eversion CEA can be minimized

Immunoglobulin G4-related hepatic artery aneurysm

A 49-year-old man who was a current smoker with a history of hypertension, dyslipidemia, and coronary artery disease after coronary stent placement presented because of abdominal and back pain. Contrast-enhanced computed tomography showed a 30-mm, large hepatic artery aneurysm. Resection of the aneurysm and autogenous vein bypass grafting was performed, which resulted in a successful outcome without any complications. Pathologic examination of the aneurysm confirmed that it was related to immunoglobulin G4 (IgG4). The patient's serum IgG4 level was within the normal range, and no other signs of IgG4-related organ lesions were observed

Fenestrated endovascular repair of aortic arch aneurysm in patients with bovine arch using the Najuta stent graft

We describe the case of a 74-year-old man with a thoracic aortic aneurysm with a bovine arch who underwent fenestrated endovascular repair of aortic arch aneurysm using the Najuta stent graft (Kawasumi Laboratories, Inc, Tokyo, Japan). He has had a previous endovascular aneurysm repair and femoropopliteal bypass for abdominal aortic aneurysm combined with peripheral arterial disease. The Najuta stent graft was inserted and deployed at zone 0 with delicate positional adjustment of the fenestration of the stent graft to the brachiocephalic trunk. There was no endoleak or complication. His postoperative course was uneventful. At 7-month follow-up, complete exclusion of the aneurysm was noted. The Najuta stent graft repair of aortic arch aneurysms is a safe and effective treatment option for patients with a bovine arch