A 75-year-old man underwent endovascular repair of the abdominal aortic aneurysm. The procedure was aorto-uni-femoral endograft and femorofemoral crossover bypass using PTFE graft. The postoperative course was satisfactory, but 4 years after operation, he was admitted complaining of abdominal fullness. CT scan showed significant increase of aneurysm diameter to 13cm without evidence of endoleak. Endograft replacement with a new Dacron graft was carried out. Intraoperative findings suggested perigraft seroma related to the use of PTFE, and there was no endoleak. The postoperative course was uneventful. Pathological finding of aneurysm showed a lack of hemocytes and thrombocytes.

A 53-year-old man presented with a painful, non-healing ischemic ulcer of the left fifth toe. The patient was initially treated conservatively for 4 months with local debridement and medication with antiplatelet therapy but his symptoms and the ulcer was refractory. A computed tomography revealed a bulky, irregular, gritty, localized calcification of the infra-renal aorta and was compatible with the so-called “coral reef aorta”. Angiography confirmed the findings of the CT scan, and there was no evidence of occlusive lesions in the distal runoff vessels. A diagnosis of blue toe syndrome secondary to infra-renal coral reef aorta was made. In order to prevent further embolization, the patient underwent aortic excision with PTFE grafting via a retroperitoneal incision. In order to increase the microcirculation of the toe and to aid in the healing of the ulcer, a lumbar sympathectomy was performed simultaneously. The ulcer healed completely on postoperative day 47. The treatment method for coral reef aorta depends on the presence or absence of global ischemia of the lower extremity and embolic complications.

A 73-year-old woman suffered from ruptured aortic arch aneurysm into mediastinum. The patient was treated by thoracic endovascular aortic repair with the double-chimney graft technique. Three days later, computed tomography (CT) revealed type 1a endoleak (EL) between the chimney grafts. Ten days later, the patient was treated by coil embolization of the aneurysm from the left subclavian artery. The patient recovered, and was without aortic aneurysm events during six months of follow up.