Spontaneous Thrombosis of a Ruptured Deep Femoral Artery Aneurysm / 日本心臓血管外科学会雑誌

We report a rare case of spontaneous thrombosis of a ruptured deep femoral artery aneurysm. An 85-year-old man presented two days after onset of acute swelling and pain in the left groin. Computed tomography demonstrated rupture of a deep femoral artery aneurysm and thrombosis of the aneurysm. After 1 month of observation, surgical intervention was performed as the local pain persisted. Opening of the aneurysm sac confirmed that thrombosis was complete. Simple ligation and drainage of the aneurysmal sac was performed. His postoperative course was uneventful.

Mesenteric Ischemia Complicated with Acute Aortic Dissection: Report of a Case with Successful Surgical Management / 日本心臓血管外科学会雑誌

An emergency saphenous vein bypass was performed from the right internal iliac artery to the superior mesenteric artery for ischemia due to occlusion of the superior mesenteric artery complicated with acute DeBakey type I aortic dissection. A 68-year-old woman underwent ascending aortic graft replacement for acute aortic dissection as emergency procedure. On postoperative day 4, signs and symptoms of acute mesenteric ischemia clearly developed. Laparotomy was performed and the saphenous vein graft was used to bypass the right internal iliac artery and the superior mesenteric artery at the orifice of the ileocolic artery where it was free from dissection. Because of persistent diarrhea and cramping abdominal pain, second- and third-look operations were necessary in order to confirm the recovery of intestinal viability. The patient was discharged from hospital with complete relief of abdominal symptoms 110 days after the first operation.

Surgical Treatment of a Patient with Aorto-pulmonary Fistula due to Thoracic Aortic Aneurysm Rupture Associated with Gastric Carcinoma / 日本心臓血管外科学会雑誌

A 57-year-old man suffered hemoptysis during an examination for gastric carcinoma. Enhanced computed tomography demonstrated rupture of a thoracic aortic aneurysm to the left pulmonary lower lobe. The lateral segment of the liver was atrophic due to intrahepatic cholelithiasis. Emergency operation was performed after he was transferred to our hospital. The thoracic aorta was reconstructed using a temporary bypass and the pulmonary left lower lobe was resected. The omentum was mobilized and used to cover the prosthesis and bronchial stump. The gastric carcinoma and intrahepatic cholelithiasis with biliary stones in the common bile duct were treated in the next procedure. The pathologic examination revealed lymph node metastasis; thus this operation was recognized to be absolutely noncurative. The treatment of cardiovascular disease concomitant with malignancy remains controversial. The strategy to treat such patients is discussed in this report.