A Case of External Iliac Artery Occlusion after Total Hip Arthroplasty / 日本心臓血管外科学会雑誌

A case of external iliac artery occlusion after total hip arthroplasty (THA) is reported. A 65-year-old man had undergone a left THA 8 years previously. He had intermittent claudication involving his left calf, and the ankle pressure index (API) of the left leg was 0.56. Digital subtraction angiography revealed local occlusion of the left external iliac artery, which was consistent with the surgical field of THA. A left external ilio-common femoral bypass was performed without incident. The risk of vascular complication associated with THA is low, and especially so in cases with iliac arterial occlusion. However, adequate and prompt diagnosis is required in such cases.

A Case of Iliac Artery Occlusion due to Abdominal Blunt Trauma / 日本心臓血管外科学会雑誌

A 54-year-old male driver suffered abdominal injuries from the steering wheel in a collection and was admitted. Twelve days later, contrast CT demonstrated stenosis of the abdominal aorta and occlusion of the left common iliac artery. Aorto-biiliac bypass, using a bifurcated knitted Dacron graft, was performed without incident. The left common iliac artery was completely occluded by a thrombus. The case of an iliac arterial occlusion due to blunt abdominal trauma is rare. Adequate and prompt diagnosis is thus required in such cases of blunt abdominal trauma.

Two Cases of Small Aorta Syndrome with Arterial Occlusion of the Lower Extremities / 日本心臓血管外科学会雑誌

We operated on two cases of small aorta syndrome (SAS). Case 1 was a 43-year-old man who complained of pain and cyanosis of the left first and second toes and was admitted to our department. Angiography showed narrowing of the infra-renal aorta, 11mm in diameter just above the bifurcation. It also showed stenosis of the right external iliac artery and occlusion of the left external iliac artery. Aorto-bifemoral bypass, using a 12×6mm bifurcated knitted Dacron graft, was performed without incident. Case 2 was a 21-year-old man. He was admitted with a chief complaint of intermittent claudication of his left calf. Angiography showed narrowing of the infra-renal aorta, 12mm in diameter just above the bifurcation. It also showed occlusion of the left superficial femoral artery. A femoro-popliteal bypass, using a 6mm knitted Dacron graft, was successfully performed. Both cases were diagnosed as SAS. In the literature, SAS is characterized by narrowing of the infra-renal aorta and is frequently accompanied by hypoplasia of the iliac arteries. Although SAS is not uncommon in Western countries, there are only a few reports in Japan. SAS has been reported more frequently in women with a relatively early age of onset. The graft patency rate in these patients is observed to be much less than that in the general population of patients who require aortoiliac reconstruction. Therefore, long-term follow-up is important to observe possible deterioration of ischemic symptoms and signs in SAS patients even after apparently curative operations.