A 75-year-old man with underlying arteriosclerosis obliterans presented with acute heart failure secondary to rest pain of the right lower extremity. Echocardiogram showed severe mitral regurgitation, moderate tricuspid regurgitation and a low cardiac function (ejection fraction : 27%). Right toe gangrene developed in association with continuous acute heart failure. He underwent mitral valve replacement, tricuspid annuloplasty, right common femoral artery-posterior tibial artery bypass and amputation of the right toes in single-stage surgery. There were no major complications during his hospital stay. After surgery, his symptoms significantly improved.

An 80-year-old male patient underwent endovascular aneurysm repair (EVAR) for a 60 mm infrarenal abdominal aortic aneurysm (AAA) at the age of 78. Intraoperative angiography detected an endoleak of indeterminate origin, leading to a decision for postoperative surveillance. Follow-up contrast-enhanced CT imaging revealed proximal main body infolding and a Type 1a endoleak. Despite these findings, the patient declined further intervention at that time, necessitating continued conservative management. Eighteen months postoperatively, the aneurysm diameter had increased from 60 to 63 mm, warranting additional endovascular intervention. Initial attempts to correct the infolding with balloon angioplasty were unsuccessful in eliminating the endoleak. Consequently, a secondary stent graft was deployed within the initial stent graft, successfully resolving the endoleak. At the four-month postoperative follow-up, there was no evidence of recurrent stent graft infolding.