Successful Endovascular Stent-graft Treatment of a Ruptured Thoracoabdominal Aortic Aneurysm with Coverage of the Celiac Axis / 日本心臓血管外科学会雑誌

A 73-year-old woman was referred to our hospital for treatment of a ruptured thoracoabdominal aortic aneurysm (TAAA). Computed tomography (CT) showed a ruptured saccular TAAA (maximum diameter, 70 mm) located just above the celiac trunk. The patient chose to undergo endovascular repair because of the high risk associated with conventional repair, so an emergency endovascular stent-graft treatment was performed. The collateral pathway from the superior mesenteric artery (SMA) to the celiac branches via the pancreaticoduodenal arcades was confirmed by selective angiography of the SMA before stent-grafting. The stent-graft was successfully deployed just proximal to the origin of the SMA with intentional coverage of the celiac axis to achieve sealing. Postoperatively, the patient was free from abdominal organ disorder or paraplegia/paraparesis and was discharged from the hospital after 36 days procedure. Follow-up CT scans performed at 1 week, month and 6 months showed patency in the SMA and the celiac branches, and there was no evidence of an endoleak. A less invasive endovascular repair procedure such as this can be an alternative treatment of a ruptured TAAA.

Successful Endovascular Stent-graft Treatment of a Ruptured Isolated Internal Iliac Artery Aneurysm / 日本心臓血管外科学会雑誌

A 90-year-old man was referred to our hospital for lower abdominal pain and ecchymotic discoloration around the anus. A laboratory test revealed severe anemia (hemoglobin level, 5.7 g/dl), and computed tomography (CT) showed a ruptured left internal iliac artery aneurysm (diameter, 60×44 mm). Consequently, emergency endovascular stent-grafting treatment was performed. Under local anesthesia, the stent-graft was successfully inserted in the left common and external iliac arteries, covering the ostia of the internal iliac artery. A follow-up CT scan showed complete thrombosis of the left internal iliac artery aneurysm and no evidence of an endoleak. After the procedure, the patient was treated with hemodialysis for acute-on-chronic renal failure and was discharged after 2 months.

In Situ Replacement with Rifampicin-Soaked Vascular Prosthesis in a Patient with Abdominal Aortic Aneurysm Infected by Listeria monocytogenes and Presenting with Symptoms of Leriche Syndrome / 日本心臓血管外科学会雑誌

A 72-year-old man presented with low back pain, intermittent claudication, atrophy of the muscle of the lower extremities, and impotence. Laboratory tests revealed inflammation, and computed tomography showed an abdominal aortic aneurysm with severe stenosis of the terminal aorta. Consequently, we diagnosed an infected aortic aneurysm and antibiotics were administered intravenously. Bacterial culture of the blood on admission demonstrated <i>Listeria monocytogenes</i>. On day 27 after admission, <i>in situ </i>replacement with a rifampicin-soaked vascular prosthesis and omentopexy were performed. After the surgery, intermittent claudication, atrophy of the muscles of the lower extremities, and impotence improved dramatically. The postoperative course was uneventful. Antibiotics were administered for a long period, and the C-reactive protein levels decreased to a normal range. For 18 months thereafter, the patient has been doing well without any sign of infection.

<i>In Situ </i>Replacement with Rifampicin-Soaked Vascular Prosthesis in a Patient with Abdominal Aortic Aneurysm Infected by <i>Listeria monocytogenes </i>and Presenting with Symptoms of Leriche Syndrome / 日本心臓血管外科学会雑誌

A 72-year-old man presented with low back pain, intermittent claudication, atrophy of the muscle of the lower extremities, and impotence. Laboratory tests revealed inflammation, and computed tomography showed an abdominal aortic aneurysm with severe stenosis of the terminal aorta. Consequently, we diagnosed an infected aortic aneurysm and antibiotics were administered intravenously. Bacterial culture of the blood on admission demonstrated <i>Listeria monocytogenes</i>. On day 27 after admission, <i>in situ </i>replacement with a rifampicin-soaked vascular prosthesis and omentopexy were performed. After the surgery, intermittent claudication, atrophy of the muscles of the lower extremities, and impotence improved dramatically. The postoperative course was uneventful. Antibiotics were administered for a long period, and the C-reactive protein levels decreased to a normal range. For 18 months thereafter, the patient has been doing well without any sign of infection.

Axillo-bilateral Iliac Artery Bypass for Atypical Coarctation of the Aorta with Severe Calcification / 日本心臓血管外科学会雑誌

A 66-year-old woman had hypertensive heart failure and intermittent claudication due to coarctation of the aorta with severe calcification. Consequently, axillo-bilateral iliac artery bypass was performed. Postoperatively, the difference in blood pressure between the upper and lower limbs decreased, the heart failure improved, and the intermittent claudication disappeared. The postoperative course was uneventful and the patient was discharged without complication 15 days after surgery. There are many case reports of aorto-aortic bypass for this disease ; however, axillo-bilateral iliac artery bypass is an effective and less-invasive procedure. On the other hand, from the perspectives of long-term graft patency and abdominal visceral perfusion, careful postoperative follow-up of upper and lower limb blood pressure and renal perfusion is necessary.

Prognosis of Aortic Dissection (Type A) with a Thrombosed False Lumen. CT Findings and Operative Timing / 日本心臓血管外科学会雑誌

Several investigators have reported that aortic dissections with thrombosed false lumens has a better prognosis than those with open false lumens. However, the method of treating dissecting aorta with a thrombosed false lumen has not yet been clearly determined. The purpose of the present study is to determine the factors that would indicate surgical treatment for dissecting aorta with thrombosed lumen. Sixteen consecutive cases of type A dissecting aorta with a thrombosed lumen were classified into two groups: event-free group (group R, <i>n</i>=10), recanalization or ulcer-like projection group (group P, <i>n</i>=6). The maximum aortic diameter and thrombosed lumen diameter in group P were significantly greater than in group R (45.00±1.78 <i>vs</i>. 36.00±2.16mm: <i>p</i>=0.0182, 8.00±0.00 <i>vs</i>. 4.00±0.40mm: <i>p</i>=0.0004). In group P, the thrombosed lumen diameter significantly decreased after 1 month. In conclusion, the maximum aortic diameter (>45mm), the maximum lumen diameter (>8mm), and no decrease of the thrombosed lumen diameter are useful predictors for the risk of recanalization or ulcer-like projection. These cases would require surgical treatment.

Anigioplasty of Isolated Left Coronary Ostial Stenosis-A Case Report / 日本心臓血管外科学会雑誌

A case of isolated left coronary artery ostial stenosis treated successfully by the saphenous vein patch plasty is reported. A 49-year-old woman was referred for surgery because of unstable angina with subendcardial infarction on ECG. Coronary angiogram showed isolated severe stenosis of left coronary artery ostium without stenotic lesion in the periphery and right coronary artery. At surgery, the aorta was incised obliquely downward to the left coronary ostium and this incision was further extended 8mm distally in the main trunk. Atheromatous left coronary ostium was enlarged with the saphenous vein patch. Postoperatively, angina disappeared and aortic root angioram revealed a well dilated ostium. At 1 year follow-up, the patient remains asymptomatic.

Coronary artery bypass grafting in a patient with hypertrophic non-obstructive cardiomyopathy. A case report / 日本心臓血管外科学会雑誌

Preoperatively, hypertrophic non-obstructive cardiomyopathy with asymmetrical septal hypertrophy was found in a 66-year-old man with a chief complain of effort angina whose CAG showed stenosis of 70% in LCA (seg 5) and 100% in RCA (seg 1) with collaterals from LAD. Although graft flows, 240ml to LAD and 28ml/min to RCA, were obtained, it was necessary to place the patient on the assisted circulation and catecholamines when the weaning from CPB was being tried due to “stone heart” despite patient had been on IABP during surgery and short anoxic arrest time of 44min. Postoperative hemodynamic recovery was slow with low cardiac output improved lately by the continuous use of IABP and DBcAMP. Catecholamines and vasodilators often cause disturbance of hemodynamics in hypertrophic obstructive type but seem to be effective in non-obstructive type. Importance of myocardial protection, use of IABP, careful administration of β-stimulants and DBcAMP are discussed in surgery of patients with cardiomyopathy.