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.

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). 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. 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). 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.

Venous adventitial cystic disease (VACD) is a rare vascular disorder characterized by mucin-filled cysts in the venous adventitia. We encountered five patients who presented to our vascular clinic with an initial diagnosis of deep vein thrombosis (DVT) but were later diagnosed with VACD on imaging. The patients were aged 64-81 years; lesion locations included the common femoral vein (n=3), external iliac vein (n=1), and popliteal vein (n=1). Four patients underwent surgical intervention, and one patient received conservative management with medical therapy. All surgically treated patients demonstrated improvement in leg swelling after complete cyst excision. One of the two patients with concomitant thrombus developed a massive pulmonary embolism with hemodynamic instability following catheter-directed mechanical thrombectomy. VACD can mimic DVT; however, computed tomography together with duplex ultrasonography is usually sufficient for differentiation. Thrombosis may occur secondary to outflow obstruction, and complete cyst excision remains the treatment of choice.

Left atrial intramural hematoma (LAIH) is a rare complication related to various cardiac interventions, including cardiac surgery, catheter-based arrhythmia ablation, and percutaneous coronary intervention (PCI), all of which may involve manipulation of the left atrium (LA). Here, we describe the challenging management of a patient who developed LAIH after PCI. A 72-year-old male patient was transferred to our hospital for the management of LAIH after PCI. Owing to cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (ECMO) was initiated. Repeat coronary angiography confirmed perforation of the left circumflex coronary artery; thus, coil embolization was performed. Subsequently, emergency surgical evacuation of the LA hematoma was performed to relieve the hemodynamic instability and impaired intracavitary flow. ECMO was weaned the day after surgery, and the patient made a full recovery. Even in critically ill patients, staged management with ECMO support should be considered to facilitate recovery.

Radial arteriovenous fistulas (AVFs), although rare and usually trauma-related, are being observed more frequently due to the growing popularity of transradial catheterization. Treatment options include physical compression, surgical repair, or endovascular intervention. While surgical ligation remains the standard treatment for most extremity AVFs, treatment failure and recurrence have been reported. Endovascular embolization with N-butyl cyanoacrylate (NBCA) is well established in neurovascular and visceral interventions; however, its application in extremity AVFs has rarely been documented. We present a case of recurrent post-traumatic radial AVF successfully treated using NBCA as the sole embolic agent in a single session following failed surgical ligation. This case highlights a technically simple and cost-effective approach using microcatheter-based glue embolization and blood pressure cuff-assisted flow control. A brief literature review is also provided, comparing this technique with other endovascular treatment options, including stent graft placement and balloon-assisted glue embolization.

These clinical practice guidelines (CPG) were developed by the Korean Society for Vascular Surgery to provide evidence-based recommendations for the management and post-treatment surveillance of abdominal aortic aneurysms (AAAs). The guidelines were developed by a multidisciplinary guideline working committee of 19 members, including vascular surgeons and methodological experts. A total of 18 key clinical questions focusing on AAA management and surveillance after treatment were selected. Based on systematic reviews and meta-analyses of the available literature, literature searches were performed in MEDLINE (via PubMed), EMBASE, Cochrane Central, and KoreaMed up to February 3, 2022. Additional searches for two questions were conducted in September 2022 and December 2023. Recommendations were formulated through structured evidence review and consensus, following a Cochrane-based grading system with modifications in terminology and structure. Eighteen recommendations were made, covering surgical indications, comparison of open surgical repair and endovascular aneurysm repair, postoperative complication management, and surveillance strategies. Each recommendation was assigned a strength (strong or conditional) and direction (do or do not), along with an evidence level (high, moderate, low, or very low). These CPGs provide a structured, evidence-based framework to guide clinical decision-making in the management of AAAs.

PurposeBehçet disease can cause aortitis and aortic aneurysms. Although open surgery has been a standard treatment, endovascular repair may be beneficial when combined with immunosuppressive therapies. This study assessed the outcome of endovascular stent-graft placement with adjuvant immunosuppressive therapy in aortic aneurysms and pseudoaneurysms associated with Behçet disease.Materials and MethodsNine patients with Behçet disease were diagnosed with 10 aortic aneurysms between February 2018 and August 2023. Immunosuppressive medication was administered to all patients prior to intervention to achieve remission. We reviewed procedural details and follow-up imaging to assess technical success, complications, and reinterventions. After discharge, patients received routine follow-up at 3-month intervals.ResultsAll patients were male, with a mean age of 42.1 years. Tube stent-grafts were used in all patients; one patient additionally underwent endovascular aneurysm repair with a bifurcated graft. Three patients underwent debranching procedures prior to endovascular stent-graft placement. Technical success was achieved in all procedures. During follow-up, two patients died (one on postoperative day 6 due to myocardial infarction and another on postoperative day 40 due to mediastinitis). Two patients developed access-site pseudoaneurysms, and one patient required secondary intervention for stent-graft migration with a type Ib endoleak. No graft infection, sac expansion, or attachment-site pseudoaneurysm was identified.ConclusionIn patients with Behçet disease, endovascular stent-graft repair combined with immunosuppressive therapy appears to be safe and effective treatments for aortic aneurysms or pseudoaneurysms.

Patients with chronic limb-threatening ischemia (CLTI) are typically older adults with multiple comorbidities, placing them at high risk for major amputation and mortality. As CLTI frequently occurs in patients with diabetes or end-stage renal disease, it often presents as stenosis or occlusion with calcification of the infrapopliteal (IP) arteries. Endovascular therapy (EVT) has become widely adopted as a first-line treatment and an alternative to surgical bypass in the management of CLTI, owing to its high technical success rate and favorable limb salvage rate. However, IP lesions in patients with CLTI are often long, diffuse, heavily calcified, and totally occluded and may extend below the ankle, making it challenging to achieve optimal procedural success and long-term durability. This review aimed to explore current treatment strategies for CLTI associated with IP artery disease and discuss practical techniques for achieving successful EVT.

Severe aortoiliac occlusive disease (AIOD), particularly TransAtlantic Inter-Society Consensus (TASC) II C/D lesions, presents a therapeutic challenge and has traditionally been managed with aortobifemoral bypass, which offers durable patency but carries substantial perioperative morbidity and mortality. Endovascular approaches, including bifurcated endografts, have emerged as less invasive alternatives, demonstrating favorable patency outcomes, technical advantages, and reduced hospital stays. We present the case of a 49-year-old male with complex TASC II D lesions who was successfully treated with a bifurcated endograft. The procedure achieved complete revascularization without perioperative complications, and one-year follow-up confirmed durable patency. This case highlights the feasibility of bifurcated endografts in selected high-risk patients with advanced AIOD. Although encouraging, their application in non-aneurysmal disease remains off-label, underscoring the need for long-term and comparative studies to validate outcomes and guide patient selection.