An 89-year-old woman was followed with a diagnosis of thoracoabdominal aortic aneurysm (TAAA) with a diameter of 40 mm. Computed tomography (CT) scans revealed that the TAAA had rapidly expanded to 55 mm in diameter in just two years. She was admitted to our hospital. Considering her advanced age, conventional graft replacement was thought to be quite a high risk. Thus, we selected endovascular treatment. As the TAAA was located just above the celiac artery, it was necessary to deploy the stent-graft just proximal to the origin of the superior mesenteric artery in order to secure a sufficient distal landing zone. In this case, we could secure the maximum landing zone by using the endowedge technique with the staged deployment of the conformable TAG with ACTIVE CONTROL System. The postoperative course was uneventful, and CT disclosed complete occlusion of the aneurysm.

An 89-year-old man complained of pulsatile masses in his right groin. Computed tomography (CT) scans revealed an aneurysm of the right deep femoral artery. He was admitted to our hospital with a diagnosis of deep femoral artery aneurysm (DFAA). The clinical frailty scale score was 6 (moderately frail), and he also suffered chronic obstructive pulmonary disease (COPD). Considering his complicated frail and impaired pulmonary function, conventional graft replacement and aneurysmectomy were thought to be quite a high risk. Thus, we selected endovascular treatment. It was not possible to secure a sufficient proximal landing zone for measurement, we did not select a stent-graft treatment. Therefore, we performed hybrid therapy with proximal neck ligation and distal outflow coil embolization. The postoperative course was uneventful, and CT disclosed complete occlusion of the aneurysm.

An 81-year-old man who had a saccular abdominal aortic aneurysm (AAA) with a narrow terminal aorta underwent endovascular aortic aneurysm repair (EVAR) with the Medtronic Endurant^® stent graft system. After 4 days, computed tomography (CT) showed stenosis of the stent graft left limb, which was pressed flat against the right limb at the narrow terminal aorta. We performed re-intervention to dilate the narrow terminal aorta and bilateral limbs with kissing stenting using Express Vascular LD^® (Boston Scientific). After operation his ankle brachial pressure index rose from 0.88 to 0.99 and there was no evidence of stenotic limbs at CT image. We need to be careful about the stenotic limb after EVAR with Medtronic Endurant stentgraft system for AAA with a narrow terminal aorta.

A 76-year-old woman, suffering from rapidly worsening dyspnea, and general fatigue was referred for evaluation and treatment of cardiac tumor. Echocardiography and computed tomography revealed a large tumor occupying the right atrium and inferior vena cava. We performed partial resection with cardiopulmonary bypass, in order to improve hemodynamics. The pathological examination suggested malignant lymphoma, diffuse large B-cell type. The patient was treated with cyclophosphamide, cyosine, arabinoside, etoposide, dexamethasone and rituximab (CHASER) postoperatively and gained complete response.