Rationale: Thoracic endovascular aneurysm repair (TEVAR) is commonly used to treat Stanford type B aortic dissections. However, coexistence of aortic dissection and patent ductus arteriosus (PDA) is an extremely rare phenomenon, and TEVAR alone is insufficient for treatment. Herein, a case of endovascular treatment in a patient with both aortic dissection and PDA is reported. Patient concerns: A 31-year-old woman presented to the authors’ hospital with chest pain extending to the back. At presentation, her blood pressure was 130/70 mm Hg. Her father, brother, and uncle were all diagnosed with aortic dissection. Diagnoses: Computed tomography (CT) revealed Stanford type B aortic dissection from the aortic arch to the infrarenal abdominal aorta; however, PDA was incidentally identified. Interventions: TEVAR was immediately performed. Follow-up CT scan performed 2 months later did not reveal any thrombosis or remodeling of the false lumen, and the PDA remained open. Therefore, an additional PDA embolization procedure was performed using the Amplatzer Vascular Plug II via the transvenous route. Outcomes: On follow-up CT performed 6 months after PDA embolization, successful remodeling, and shrinkage of the false lumen were observed, and PDA closure was confirmed. Lessons: If Stanford type B aortic dissection and PDA coexist, TEVAR alone may not be a sufficient treatment and additional PDA embolization may be required. In the present case, transvenous embolization of PDA using an Amplatzer Vascular Plug II was safe and effective.

Rationale: Vascular involvement manifests as aneurysms, stenosis, and arteriovenous malformations in patients with type I neurofibromatosis (NF-I). Aneurysms are rare; however, the renal artery is the most common site. Herein, we report a rare case of stent graft placement in an anterior tibial artery (ATA) pseudoaneurysm in a patient with NF-I. Patient concerns: A 52-year-old woman with NF-1 was admitted to the emergency room with painful swelling in the left lower leg. At presentation, the patient’s blood pressure was 100/60 mmHg and the hemoglobin level was 9 g/dL. Diagnoses: Computed tomography scan revealed a small aneurysm arising from the left ATA and an adjacent large hematoma. Intervention: Stent graft placement was performed to treat ATA pseudoaneurysm. Outcomes: After stent graft placement, the aneurysm disappeared and the distal flow was patent through the ATA. Lessons: Stent graft placement should be considered as another option for endovascular treatment in patients in whom coil embolization or surgery cannot be performed.

Rationale: Plug-assisted retrograde transvenous obliteration (PARTO) or coil-assisted retrograde transvenous obliteration (CARTO) are alternative treatments for gastric variceal bleeding and hepatic encephalopathy. Both procedures have fewer complications related to balloon rupture or sclerosing agents and are shorter than balloon-occluded retrograde transvenous obliteration. Herein, we report a case of PARTO and CARTO was performed simultaneously to treat refractory hepatic encephalopathy in a patient with 2 portosystemic shunts. Patient concerns: A 59-year-old man with alcoholic liver cirrhosis presented to the emergency room with mental change. At presentation, the patient’s plasma ammonia level was 340 μg/dL. Diagnoses: A computed tomography scan revealed perisplenic collateral vessels and 2 splenorenal shunts. Intervention: PARTO and CARTO were performed to treat hepatic encephalopathy via the 2 splenorenal shunts. Outcomes: A follow-up computed tomography scan showed the splenorenal shunt was successfully embolized using a vascular plug and coil. After 3 weeks, the patient’s plasma ammonia level decreased to 80 μg/dL, and repeated hospitalizations due to hepatic encephalopathy ceased. Lessons: Depending on the patient’s anatomy, PARTO and CARTO can be performed simultaneously and, similar to balloon-occluded retrograde transvenous obliteration, are useful for treating hepatic encephalopathy.