Dialysis treatment was first introduced in the convalescent rehabilitation ward after the medical fee revision in April 2012 in Japan. In this study, we examined 4 stroke patients who underwent rehabilitation in the convalescent rehabilitation ward while receiving dialysis. We collected information on the patients' age, sex, disease, dialysis period, duration of hospitalization during the acute and recovery phases, the number of units of exercise, discharge destination after hospital, complications, and their Functional Independence Measure (FIM) scores. The average age of the subjects( 2 men and 2 women) was 71.0±9.5 years. Two of the 4 patients had cerebral hemorrhage and the other 2 had cerebral infarction. The dialysis period was 16.8±21.7 months. The duration of hospitalization during the acute phase was 50.0±20.3 days, while that in the convalescent rehabilitation ward was 120.0±28.2 days. The average exercise amount per day was 6.01±1.17 units in the convalescent rehabilitation ward. The total FIM score was 59.3±19.2 at admission and 94.5±27.0 at discharge. The FIM efficiency was 0.29±0.16. In all cases, the discharge destination was home. Three of the subjects showed progression of their renal anemia. One subject developed shunt vessel stenosis and one developed delirium as complications. We conclude that rehabilitation in the convalescent rehabilitation ward for dialysis is beneficial to patients due to the increased amount of exercise that they receive. In addition, such rehabilitation enables the patients to return home in good health, similar to the case of non-dialysis patients.

We describe a rare case of sacral epidural arteriovenous fistulas (edAVFs) with atypical clinical course of treatment. A 78-year-old man with a history of spinal surgery presented progressive gait disturbance and urinary incontinence. Spinal angiography demonstrated a sacral spinal AVF fed by bilateral lateral sacral arteries, draining to the venous pouch with subdural drainage. The first treatment by direct interruption of a subdural drainer was incompletely finished. Postoperative reassessment by 3D imaging analysis led to the diagnosis of sacral edAVF and 3D understanding of its angioarchitecture. The second treatment by transarterial embolization (TAE) resulted in complete occlusion of a sacral edAVF. However, spinal venous congestion didn’t improve, because the recruitment of occult edAVFs at the multiple lumbar levels and complex-shaped sacral ventral epidural venous plexus (VEP) were involved in the remnant of prior subdural drainage. The third treatment was performed by TAE for three occult edAVFs and the VEP compartment connecting between a patent edAVF and subdural drainage, which resulted in complete disappearance of spinal cord edema. Endovascular embolization of VEP compartment connecting to subdural drainage in addition to fistulous occlusion may be one of the treatment options for several edAVFs at the multiple spinal levels.