Aneurysm of the external jugular vein is rare, and a traumatic case with a documented mechanism and pathological findings is exceptional. A woman in her 50s sustained a blunt injury to the left anterior neck from a kendo thrust (tsuki). One month later she developed a left cervical swelling. Ultrasound study and computed tomography showed a 2-cm saccular dilatation with a cranial filling defect, indicating partial thrombosis. After 4 months of observation, the aneurysm was resected at the patient's request. Histopathology showed segmental loss of elastic fibers and adventitial rupture without organized thrombus. Recognizing venous injury after a kendo thrust enables timely diagnosis.

Flow diverter (FD) technology has provided a new concept for the treatment of intracranial aneurysms: reconstruction of the parent artery by covering the neck with a braided mesh stent. It has enabled us to treat not only saccular aneurysms but also complex aneurysms that were previously considered difficult or impossible to treat. Despite its clinical impact, FD remains associated with thromboembolic and hemorrhagic complications, both of which are closely related to perioperative antiplatelet therapy. Dual antiplatelet therapy (DAPT), consisting of aspirin combined with a P2Y12 inhibitor, has traditionally been adopted as the standard strategy to reduce thromboembolic risk. However, the optimal regimen remains poorly defined, and substantial variability exists in clinical practice. Recent evidence suggests that the risk of thromboembolism is highest in the early perioperative period, while prolonged antiplatelet therapy may expose patients to unnecessary bleeding risks without clear additional benefits. In parallel, advances in platelet function testing, the availability of potent P2Y12 inhibitors, and the development of surface-modified FD devices are prompting reconsideration of the conventional paradigm of prolonged DAPT. This review provides a comprehensive synthesis of current evidence on perioperative antiplatelet therapy in the context of flow diversion and proposes a contemporary framework that emphasizes temporal risk stratification and individualized treatment strategies.

A 55-year-old man with serologically confirmed tertiary syphilis had an asymptomatic 70 mm bilobed thoracoabdominal aortic aneurysm with two contiguous saccular components, severe T11 to T12 vertebral body erosion, complete celiac artery occlusion, and critical ostial stenosis of the superior mesenteric and right renal arteries, with mature collateral perfusion from the inferior mesenteric artery. After preoperative penicillin therapy, open repair with selective left renal artery reimplantation and intentional nonreconstruction of the chronically occluded visceral branches was completed without paraplegia or mesenteric ischemia.

Coronary artery aneurysm is a rare condition commonly treated with conventional surgery under cardiopulmonary bypass because of its complexity. Here, we present a patient who underwent minimally invasive off-pump coronary surgery via left mini-thoracotomy for a left anterior descending artery saccular aneurysm. A Japanese woman in her late 40s, who had been treated with beta-blocker therapy for hypertrophic cardiomyopathy, and steroid and immunosuppressive therapies after renal transplantation, developed chest discomfort on effort recently. Digital Holter electrocardiography showed ST-segment depression associated with exertional dyspnea, suggesting ischemic heart disease. Coronary angiography revealed a saccular aneurysm of the left anterior descending artery that had caused ischemia due to turbulence. This patient was diagnosed with a left coronary artery aneurysm causing ischemic symptoms, which indicated surgical intervention, whereas we judged that the mild to moderate mitral valve regurgitation and mild left ventricular outflow stenosis, caused by hypertrophic cardiomyopathy, did not require surgical interventions. Then, we performed aneurysmal plication after bypass grafting to the left anterior descending by the left internal thoracic artery via left mini-thoracotomy under off-pump guidance. The patient recovered well, and the symptoms disappeared. Postoperative computed tomography angiography showed good patency of the internal thoracic artery and complete disappearance of the aneurysm. This case demonstrates the potential utility of minimally invasive off-pump coronary surgery via left mini-thoracotomy as a useful alternative for patients with simple left coronary artery aneurysms.

Submucosal pseudoaneurysms located within the uterine wall can be particularly challenging to diagnose due to their atypical location and nonspecific clinical presentation. We report the case of a 32-year-old woman presenting with heavy postoperative uterine bleeding following robotic myomectomy and endometriosis resection. Contrast-enhanced computed tomography angiography revealed an 8-mm left intracavitary pseudoaneurysm arising from the arcuate artery within the submucosal layer. Diagnosis was confirmed with catheter-directed angiography, and the patient was successfully treated with selective embolization of the left uterine artery. This case highlights the importance of advanced imaging in identifying uterine pseudoaneurysms and guiding timely intervention.

Mycotic abdominal aortic aneurysms are rare but life-threatening vascular infections. We report a 71-year-old woman with metastatic small-cell lung cancer receiving immunotherapy. She presented with Salmonella bacteremia and was found to have a 5.4-cm eccentric saccular infrarenal abdominal aortic aneurysm with periaortic gas, inflammatory soft tissue, and a large retroperitoneal hematoma consistent with a contained rupture. Emergent endovascular aneurysm repair (EVAR) was performed. She completed six weeks of intravenous ceftriaxone followed by lifelong suppressive antimicrobial therapy. Follow-up imaging demonstrated a patent graft without endoleak. This case highlights the association between non-typhoidal Salmonella bacteremia and infectious aortitis and illustrates the role of EVAR, combined with prolonged antimicrobial therapy, in the management of mycotic abdominal aortic aneurysm with contained rupture.

Rupture of intracranial aneurysms leads to aneurysmal subarachnoid hemorrhage with severe adverse outcomes. Current retrospective imaging studies merely differentiate existing ruptured and unruptured aneurysms instead of forecasting prospective rupture risk. To address this limitation, we constructed a multimodal fusion model combining handcrafted radiomics and deep learning embeddings from routine CTA/MRA for aneurysm rupture discrimination and performed internal validation.