A 67-year-old man suffered sudden chest pain. Computed tomography with contrast medium revealed dissection from the ascending aorta to the bilateral iliac arteries and hematoma around the left external iliac artery. Type A acute aortic dissection complicated with rupture of the left external iliac artery was diagnosed. Urgent endovascular repair (stent-graft implantation) was first performed for the arterial rupture more critical than the aortic dissection. On the next day after satisfactory hemostasis and hemodynamical stabilization, semi-urgent ascending aortic replacement was achieved, and the patient survived. Acute aortic dissection complicated with rupture of the aortic branch was extremely rare, and only 5 cases have been reported in the English literature.

We report a 49-year-old man with retrograde type A acute aortic dissection with patent false lumen in the ascending aorta. The patient successfully underwent urgent thoracic endovascular repair (TEVAR) to cover the primary entry on the onset (admission) day. The false lumen from the ascending aorta to the proximal descending thoracic aorta was completely thrombosed, gradually shrank, and finally disappeared. In conclusion, TEVAR for retrograde type A acute aortic dissection with a patent ascending false lumen is far less invasive than aortic replacement (with cardiopulmonary bypass, cardiac arrest, and circulatory arrest) and may be useful in selected patients with a primary entry located at least approximately 2 cm distal to the origin of the left subclavian artery.

Primary cardiac synovial sarcoma is extremely rare, and approximately100 cases had been reported according to a literature review in 2019. We herein reported a case of primary pericardial synovial sarcoma originating from the epicardium with cardiac tamponade. Pericardiocentesis, subsequent complete tumorectomy under cardiopulmonary bypass and cardiac arrest, and adjuvant chemoradiotherapy was performed, and the patient survived for 3 years with neither recurrence nor metastasis.

A 63-year-old female suddenly suffered right hemiplegia. Multiple cerebral infarctions in the nucleus basalis and the frontal and temporal lobes perfused by the left middle cerebral artery were diagnosed. A left atrial myxoma probably causing the cerebral infarctions was identified. The patient underwent anticoagulation therapy with heparin to prevent recurrent cerebral infarctions while waiting for surgical resection of the myxoma. Motor aphasia, however, occurred on the 8th day after the onset of the cerebral infarctions. Extensive hemorrhagic cerebral infarctions involving the left temporal and frontal lobes with a midline shift occurred, and accordingly the anticoagulation therapy was discontinued. After a 6-week interval from the hemorrhagic cerebral infarctions, the left atrial myxoma was successfully resected, and the patient was discharged from the hospital without any new neurological complications. Even if left atrial myxoma complicates extensive hemorrhagic cerebral infarctions, surgical resection may be safely performed allowing a sufficient interval. Anticoagulation therapy to prevent recurrent cerebral infarctions while waiting for surgery after cerebral infarctions should be avoided because of the risk of hemorrhagic cerebral infarctions, and early surgery should be considered.

We report a case of semi-urgent infected endograft explanation following thoracic endovascular aortic repair (TEVAR) for distal anastomotic (DA) infectious pseudoaneurysm after total arch replacement (TAR). A 70-year-old male underwent TAR for distal arch saccular aneurysm 10 years before and open bifurcated graft replacement for an abdominal aortic aneurysm 5 years before. The patient was admitted 3 years before because of repeated pyrexia of 40°C. Contrast-enhanced CT scans revealed suspected vegetation and infectious pseudoaneurysm at the DA of the TAR, and semi-urgent TEVAR was performed on the next day. Antibiotic therapy was initiated for Staphylococcus capitis detected in a blood culture, and the patient was discharged after a negative blood culture. At this time, he was admitted owing to face and below-knee edema and dyspnea. Because a blood culture identified Methicillin-resistant Staphylococcus capitis and antibiotic therapy uncontrolled infection, we performed explanation of the infected endograft and distal end of the TAR graft and replacement of the descending thoracic aorta with a rifampicin-bonded graft under moderate hypothermic circulatory arrest with retrograde cerebral perfusion via the 4th intercostal posterolateral thoracotomy. Postoperative 6-week antibiotic therapy was continued and the patient was discharged in good condition after a negative blood culture on postoperative day 46.

Leg malperfusion accompanied with type B acute aortic dissection (AAD) is reported to be an independent predictor for mortality. In such a case, though aortic replacement, extra anatomical arterial bypass or endovascular aortic repair (EVAR) can be selected, an appropriate treatment strategy has not been established yet. A 53-year-old woman was urgently hospitalized with sudden low back pain and right leg weakness, despite the right popliteal and anterior tibial arteries being palpable. Computed tomography (CT) revealed a type B AAD, and antihypertensive therapy was initiated. She complained of intermittent claudication during rehabilitation, and right leg ischemia with decreased ankle brachial pressure index (ABPI) was detected. The follow-up CT revealed the narrow true lumen of the right common iliac artery compressed by the thrombosed false lumen and the large entry of the aortic dissection in the terminal aorta. At the subacute phase of the aortic dissection, EVAR was performed. To expand the true lumen and exclude the entry, Y-shaped stent-grafts were implanted in the infra-renal aorta and the bilateral common iliac arteries. The postoperative course was uneventful. Postoperative ABPI returned to the normal range, and the intermittent claudication disappeared. In conclusion, EVAR should be considered in patients with type B AAD complicated with leg malperfusion.

We report a case of endovascular aneurysm repair (EVAR) in a patient with an aortocaval fistula (ACF) who presented with congestive heart failure due to left-to-right shunting. The patient was an 80-year-old man who complained of sudden respiratory discomfort and lower leg edema, and was admitted to the emergency department. The initial diagnosis on admission was acute heart failure. Because the inferior vena cava was visualized by angiography in the arterial phase due to the fistula from the abdominal aorta, after admission, we rediagnosed this case as ACF. As medical treatment did not improve the patient's symptoms, emergency surgery was decided upon. Because preoperative evaluation was able to rule out the existence of an aortic aneurysm, ACF closure was performed by EVAR. The postoperative course was uneventful and the patient was discharged 15 days after surgery. ACF without aortic aneurysm is uncommon and is not easily diagnosed. This case demonstrated that EVAR can be an effective treatment option for ACF.