In thoracic endovascular aneurysm repair (TEVAR), the common femoral artery is typically used as the standard vascular access. However, in some cases, alternative vascular accesses must be considered, or endovascular treatment may need to be abandoned due to vascular diameter or characteristics. A female in her 70 s presented with saccular aortic aneurysms located at the distal arch and descending aorta, possibly secondary to bacteremia. She had a history of partial arch replacement and ascending aorto-bi-iliac artery bypass for ascending aortic aneurysm, as well as calcified abdominal aortic stenosis, performed five years prior. In this case, we successfully treated the aneurysms with antegrade TEVAR, accessing through the extra-anatomical bypass graft, which was exposed in the epigastric preperitoneal space. This is the first case report of TEVAR using access from an extra-anatomical bypass graft connecting the ascending aorta to the lower extremity.

In the present study, acupuncture treatment has performed in a patient with spondylosis deformans combined piriformis syndrome, and applied to relief the hypertonus of the piriformis in the right buttock. As a result, the mitigation of right buttock pain and subsequent improvement in the range of the hip joint motion were observed from the early stage of treatment. These acupuncture effects are probably due to pain relief that resulted from increased local muscle blood flow following acupuncture stimulation. In addition, the present patient was suspected of double lesion neuropathy consisting of spondylosis deformans complicated by piriformis syndrome. From the present study, acupuncture therapy is thought to be useful method of enhancing the decompression of an entrapped nerve and vessels by increasing blood flow in the affected muscle in entrapment neuropathy such as thoracic outlet syndrome or piriformis syndrome.