A 77-year-old man with an abdominal aortic aneurysm, detected by abdominal ultrasonography, was referred to our hospital. Multi-detector computed tomography (MDCT) revealed an intrathoracic left subclavian artery aneurysm 30 mm in diameter and a small distal arch aortic aneurysm as well as an abdominal aortic aneurysm 40 mm in diameter. Surgery was indicated for the subclavian artery aneurysm considering the risks of rupture and distal embolism. Our choice for treatment was endovascular repair ; thoracic endovascular aortic repair (TEVAR) and coil embolism. The operation was performed successfully. Orifices of the left subclavian artery and the distal arch aneurysm were covered with a stent graft and the left subclavian artery was occluded with coils distal to the aneurysm. The operation time was 1 h and 44 min. He was extubated in the operation theater. A follow-up CT scan performed at 1 week showed the correct position of the TEVAR device, patency of the common trunk of the brachiocephalic and right common carotid arteries, and complete exclusion of the aneurysms. He was discharged on the 12th postoperative day without complication. Subclavian artery aneurysms, in particular in the intrathoracic location, are rare. Conventional surgery for this entity tends to require arch replacement to be unreasonably invasive as a therapy for peripheral artery disease. We believe this endovascular therapy can be a useful, less-invasive alternative to conventional open surgery.

The long-term efficacy of various treatments for intermittent claudication was studied to determine which regimen should be selected. Two hundred and nineteen patients with arteriosclerosis obliterans (ASO) and intermittent claudication of the extremities were divided into two groups based upon the type of treatment: 1) 170 patients who underwent arterial reconstruction and 2) 49 receiving conservative treatment. Fifty-five patients with Buerger's disease (TAO) with intermittent claudication were divided into three groups: 1) 17 patients who underwent arterial reconstruction, 2) 15 with lumbar sympathectomy, and 3) 23 receiving conservative treatment. The background factors of both disease groups were analyzed, and the changes in claudication, the quality of life, and the survival rate were followed up. Among ASO patients, the improvement of intermittent claudication was significantly better in the arterial reconstruction group (p<0.001) than in the conservative treatment group. The quality of life and 5-year surival rate were also superior in the arterial reconstruction group (p<0.01), and they were closely related to the improvement of intermittent claudication. On the other hand, there was no significant difference in any of these parameters between the three groups of TAO patients. This discrepancy in outcome was concluded to be due to differences in the background factors of the two diseases. Accordingly, the treatment for intermittent claudication should be discussed making a clear distinction between ASO and TAO. In conclusion, the treatment of choice for intermittent claudication is arterial reconstruction in ASO patients, whereas surgical treatment should only be considered for TAO patients when conservative therapy is ineffective.

[Objectives]We investigated the behaviour factors in Hiesho (excessive sensitivity to cold symptoms), a summary score of Health-related QOL (SF-8) and Body Mass Index (BMI) in subjects who feel Hiesho (hereinafter referred to as Hiesho Subjects), in relation to sex, and showed the future direction of acupuncture therapy on Hiesho.
[Methods]After approval by the Ethics Committee, we obtained written informed consent from the participants in this study. Participants were 753students in a vocational college. The study was performed with questionnaires, which were delivered by hand to the participants in September, 2008. We analyzed 629 subjects (538 males and 91 females, mean age of 27.4 ± 6.8) whose responses were valid. The questionnaire consisted of age, sex, height, weight, subjective Hiesho, 24 behaviour patterns of Hiesho according to a previous study, and Health-related QOL (SF-8, Japanese version). We used two summaries -physical component summary (PCS) and mental component summary (MCS) -which are derived from standard values (scores) in the nation on eight scales of SF-8 calculated using the special scoring software. Total scores of behaviour patterns of Hiesho subjects (HIE Scores) and summary scores and BMI in male and female subjects were statistically analyzed using covariance structure analysis technique in multiple populations (Amos Ver. 7).
[Results]In our model, the Comparative Fit Index (CFI), Akaike's Information Criterion (AIC) and Root Mean Squares Error of Approximation were 1.00, 75.886 and 0.00, respectively, which showed a high degree of compatibility. We found the relations from Hiesho Scores to PCS (β=-0.175, p < 0.01) and MCS (β=-0.179, p < 0.001) and from PCS to MCS (β=-0.089, p=0.038) in male Hiesho subjects. In contrast, in female Hiesho subjects, there were relations from Hiesho scores to MCS (β=-0.601, p < 0.001) and from PCS to MCS (β=-0.244, p < 0.05).
[Discussion]From the results of our investigation, Hiesho was considered not to be associated with Health-related QOL in male Hiesho subjects but to be associated with mental factors in female Hiesho subjects.
[Conclusions]It was shown that we should consider the patient's sex in acupuncture therapy on Hiesho.

Objective
 We examined the effects of acupuncture electrotherapy in young women with hie symptoms (excessive sensitivity to cold), presented in conjunction with vasomotor dysfunction as determined by the postural change test.
Subjects and Methods
 Subjects comprised 20 women (mean age, 20.6 years; range, 18-26 years) who exhibited symptoms of hie, evaluated as toe skin temperature after standing for 5 mins or a temperature difference between the right and left toes as compared to before standing. A stainless steel acupuncture needle (length, 40 mm; diameter, 0.2 mm) was inserted approximately 15 mm in SP6 (Shangqui). Acupuncture electrotherapy connected an acupuncture electrode to SP6 and a non-feeling electrode to lateral of the tibial tuberosity, and was undertaken at a frequency of 1 Hz for 20 mins. Therapy was provided as a total of 5 sessions, with 1 session each week, and the postural change test was performed before and after therapy. Thermal images from the medial aspect of the foot to the tibial aspect of the lower leg were captured using a medical thermography device, and mean skin temperature was calculated in selected regions of the toes, metatarsals, ankle, and tibial aspect of the lower leg. Therapy was evaluated using a questionnaire with two originally designed scales: a categorical scale of 14 symptoms including hie; and degree of hie on a visual analogue scale (VAS). Subjects completed the questionnaire every day during a period from 1 week before therapy sessions began until 1 week after completion of all 5 sessions. Scores for hie symptoms were calculated as mean values from the total score of the 14 symptoms and VAS each week. Changes in health-related quality of life with acupuncture were evaluated using the SF-8 Standard Edition.
Results
 Toe skin temperature just after standing was not significantly increased by therapy as compared to before standing. Skin temperature on the tibial aspect of the lower leg 20 mins after standing was significantly increased as compared to the adaptation period. In terms of hie, VAS and SF-8, no significant changes were seen before and after therapy, but total score for the 14 symptoms decreased significantly.
Conclusions
 Acupuncture electrotherapy to SP 6 did not appear to exacerbate hie symptoms after reductions in air temperature, while normalizing the postural vascular reflex and improving hie-related symptoms.