Surgical Management of Abdominal Aortic Aneurysm Complicated with Ischemic Heart Disease / 日本心臓血管外科学会雑誌

We studied the incidence of associated ischemic heart disease (IHD) among 143 consecutive patients (male 118, female 25, mean age 68.5±6.9 years) operated upon for abdominal aortic aneurysm (AAA), excluding ruptured aneurysms. The screening of IHD was routinely performed by using dipyridamole thallium scintigraphy, and when it was positive, the lesion was further confirmed by selective coronary angiography. More than 50% luminal stenosis of the major coronary arteries was judged positive for IHD. Sixty-two patients (43%) with AAA were simultaneously afflicated with IHD. We also compared the 62 AAA patients with IHD with the remaining 81 AAA patients in this series. The patients with IHD had higher incidences of risk factors such as diabetes mellitus (<i>p</i>=0.0031) and hyperlipidemia (<i>p</i>=0.0029) than those without IHD. Five patients were operated on for AAA after coronary artery bypass grafting (CABG), 11 were operated on for AAA and IHD (CABG) simultaneously, 10 were operated on after PTCA, thirty-two patients underwent elective surgery for AAA and four had emergency procedures due to impending rupture of AAA with continuous infusion of nitroglycerin with or without diltiazem. There was no significant difference in surgical mortality between AAA patients with IHD and those without IHD (3%vs2%), and no cardiac death in this series. When both AAA and IHD are severe enough to warrant surgical treatments at the earliest opportunity, we recommend concomitant operations for AAA and IHD (CABG) since these have been performed quite successfully in our series.

Surgical Management for Arteriosclerosis Obliterans Complicated with Ischemic Heart Disease / 日本心臓血管外科学会雑誌

We studied the incidence of associated ischemic heart disease (IHD) among 110 consecutive patients (males 99, females 11, mean age 66.0±8.8 years) operated upon for arteriosclerosis obliterans (ASO). The screening of IHD was routinely conducted by using dipyridamole thallium scintigraphy, and when results were positive, the lesion was further confirmed by selective coronary angiography. More than 50% luminal stenosis of the major coronary arteries was judged as positive for IHD. Forty-eight patients (44%) of ASO were simultaneously afflicted with IHD. Ten patients were operated on for ASO after coronary artery bypass grafting (CABG), five for ASO and IHD (CABG) simultaneously, eight for ASO after PTCA. Twenty-five patients underwent surgery for ASO only with infusion of nitroglycerin, with or without diltiazem. We also compared 15 patients with thrombotic obliteration at the end of the abdominal aorta o: Leriche's syndrome with the remaining 95 patients in this series. The patients with Leriche's syndrome were younger and had higher incidences of hyperlipidemia (<i>p</i>=0.0254) and IHD (<i>p</i>=0.0225) than those without Leriche's syndrome. In surgical treatment for ASO, particularly for Leriche's syndrome, meticulous attention to complications is needed due to the frequent association of IHD. When both ASO and IHD are severe enough to warrant surgical treatment at the earliest opportunity, we recommend concomitant operations for ASO and IHD (CABG).

Anuria Resulting from the Non-Inflammatory (Atherosclerotic) Large Abdominal Aortic Aneurysm. A Successful Surgical Case with Recovery of Renal Function / 日本心臓血管外科学会雑誌

The sudden onset of anuria in a 71-year-old man was found to be caused by the non-inflammatory (atherosclerotic) large abdominal aortic aneurysm compressing the bilateral ureters. A computed tomography scan demonstrated the bilateral extrinsic ureteral obstructions due to the large aneurysm of 13cm in diameter, left hydronephrosis and no thick layer of perianeurysmal fibrotic tissue. On the 9th day from the onset of anuria, an emergency operation was performed. There was no fibrotic adhesions around the aneurysm and mobilization of the aorta was easy. A straight Dacron prosthesis was inserted between the infrarenal aorta and the bifurcation of the abdominal aorta following resection of the aneurysm of the atherosclerotic origin. Soon after the operation, the patient had very good urinary output with adequate recovery of renal function. This case seems to be very uncommon, but very important in the surgical management of abdominal aortic aneurysm complicated by oliguria or anuria.

Reversible Cerebral Damage Following Bilateral Ascending Aorta-Internal Carotid Artery Bypass Operation for Aortitis Syndrome: A Case Report / 日本心臓血管外科学会雑誌

Aortitis is an inflammatory arteriopathy that often progresses to obliteration of multiple large arteries. Surgical treatment for obstructive lesions due to aortitis syndrome therefore is difficult in many cases. The patient was a 23-year-old female who at the age of 19 had been diagnosed as aortitis syndrome with cerebral vessel involvement, and she subsequently received steroids. She increasingly experienced syncopal attacks, and was indicated for surgical treatment. Angiography revealed obstruction of the left common carotid and left subclavian arteries, and severe stenosis of the right common carotid and right vertebral arteries. She underwent bilateral ascending aorta-carotid artery bypass operation with 7mm ring-supported EPTFE grafts. After the operation she developed clinical signs of temporary brain damage due to hyperperfusion syndrome, but she now completely recovered and maintains a good clinical condition.