A 52-year-old male was admitted to our hospital through the emergency room due to dyspnea and hypertensive heart failure. Computer tomography revealed atypical aortic coarctation with stenosis and calcification just above the superior mesenteric artery. Calcium channel blocker significantly reduced hypertension and improved heart failure, while his creatine elevated rapidly, and he presented acute renal failure. Endovascular self-expanding stent implantation in the aorta was performed in order to restore renal blood flow. The postoperative course was uneventful, and the patient was discharged on the third day after the procedure. The cardiac function recovered immediately, and the patient no longer required antihypertensive agents. There have been many reported cases of endovascular correction of atypical aortic coarctation overseas. Nevertheless, due to reimbursement issue in the health care system, the majority of atypical aortic coarctation cases in Japan are treated with open surgery. Endovascular treatment should be endorsed as an option for its short procedural time, minimal invasiveness and brief hospital stay.

Many aspiring surgeons under 40 years of age feel uneasy because surgical opportunities are rare. Under such circumstances, vascular surgery may provide operating opportunities relatively early. Here we used a questionnaire to clarify what opportunities young surgeons are seeking in the field of vascular surgery.

Basic procedures that cardiovascular surgeons routinely perform are rarely discussed, despite the great variability among facilities. We conducted a questionnaire survey on Extracorporeal Membrane Oxygenation (ECMO) targeting under-forty cardiovascular surgeons and obtained responses from 53 surgeons. We report the questionnaire results.

We conducted a questionnaire survey on shift and on-call system targeting under-forty cardiovascular surgeons and obtained responses from 35 surgeons. We report the questionnaire results.

1)The Keio ACLS Popularizing and Promoting Association (KAPPA) is an official student organization that promotes advanced life support techniques.
2)KAPPA has provided 29 advanced cardiac life support courses, including 20 official ICLS (immediate cardiac life support) courses of the Japanese Association for Acute Medicine, which have trained 314 ICLS providers and 61 ICLS instructors during the past 8 years.
3)Peer–led training among students to maintain the quality of the courses has contributed to the activities of KAPPA.

Along with clinical practice and education, research is among the most important activities for medical doctors. The same is true in cardiovascular surgery: Young cardiovascular surgeons are expected to improve their surgical techniques and prioritize their clinical practice. However, their perspective on the role of research in their field of expertise is unknown. Therefore, we conducted a survey of and discussion with young cardiovascular surgeons to clarify their thoughts and concerns about performing research. Here we review and report the survey and discussion results.

Popliteal artery entrapment syndrome (PAES) is a rare cause of intermittent claudication. Optimal strategies and management have been debated. We report two cases of PAES that were treated with respective different procedures. Case 1 : A 53-year-old male with intermittent claudication was referred to our department with PAES with a decrease in the ankle brachial index (ABI) with plantar flexion. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) showed medial deviation and compression of the popliteal artery by the medial head of the gastrocnemius muscle. The patient received excision of the medial head of the gastrocnemius muscle and thrombectomy of the popliteal artery. The diagnosis was confirmed as PAES type 2 during the procedure. Case 2 : A 37-year-old male presenting intermittent claudication and declining ABI in his left lower extremity was diagnosed with PAES by contrast CT. MRI and CT indicated that a fibrous band was compressing the popliteal artery. The findings of the imaging studies were confirmed during the subsequent surgical procedure and it was diagnosed as PAES type 4. In addition to removal of the band, popliteal artery interposition using a saphenous vein graft was performed due to severe stenosis with intimal hyperplasia. Pathological findings of the excised artery showed intimal hyperplasia and degeneration of elastic fibers in the media due to chronic compression. Although a large volume of retrospective data exists on PAES, recommendation of a particular operative procedure has not yet been derived. Thus, the treatment for PAES should be individually determined based on etiology and status of affected vessels.