We report a case of endovascular surgery in a patient of common iliac artery aneurysm with arteriovenous (A-V) fistula. A 60-year-old woman was admitted because of dyspnea. She had a clinical history of lumbar disk surgery at age of 40. On physical examination, we detected a pulsatile mass and pansystolic murmurs in her left lower abdomen. A chest X-ray film demonstrated severe cardiomegaly with 70% of cardiothoracic ratio. Contrast-enhanced CT revealed left common artery aneurysm with A-V fistula between the left common iliac artery and the left common iliac vein. Three-dimensional CT showed hyper-vascularity in the region from the pelvic vein to IVC. We considered that she had high risk of intraoperative massive bleeding for open abdominal surgery. We conducted endovascular repair for this iliac artery aneurysm with A-V fistula by the GORE EXCLUDER C3^® stent graft system. Postoperative contrast-enhanced CT showed complete exclusion of both left common iliac artery aneurysm and A-V fistula. After surgery, her symptoms improved significantly.

A 70-years-old woman who had been on hemodialysis for 8 years was referred to our institution to undergo mitral surgery for mitral valve stenosis. Intraoperative investigations confirmed severe calcification of the posterior mitral leaflet and all-around mitral annulus. We excised the mitral leaflet using the Ultrasonic Surgical System and preserved the calcified annulus to prevent a fatal complication such as left ventricular rupture. We passed 2-0 polyester mattress sutures through the calcified annulus from the left ventricle to the left atrium, and mitral valve replacement was performed using a reversed 19 mm On-X mechanical heart valve for the aortic valve. The postoperative course was uneventful. Mitral annular calcification is a factor of fatal complications such as left ventricle rupture and coronary artery injury. We succeeded in preserving the calcified annulus and using a small diameter mechanical heart valve.

Cerebral malperfusion is a serious complication of acute aortic dissection type A(AADA), and the best strategy for its management remains unclear. A 71-year-old woman was brought to our hospital because of consciousness disorder and right hemiplegia. Contrast-enhanced CT showed AADA and occlusion of the left common carotid artery. As the symptoms gradually improved and CT showed flow in the left distal carotid artery, we prioritized central repair by total arch replacement and Frozen Elephant Trunk with deep hypothermia and antegrade cerebral perfusion (ACP). Although the ACP cannula did not go into the left common carotid artery and we eventually had to do a left intra-carotid bypass, she was discharged home without any symptoms. It is acceptable that we give the priority to central repair over direct carotid artery re-perfusion when her symptoms improve. Besides we have to perform carotid bypass if the malperfusion is remains.