RESUMEN
A 70-year-old man with no outpatient history visited the local doctor with complaints of weakness of the limbs and abdominal pain on the following day after vomiting on the previous night. He was suspected to have a ruptured abdominal aortic aneurysm from a simple CT scan of the abdomen, and was transported to our hospital for emergency treatment. After a contrast-enhanced CT scan at our hospital, a thrombosed type B aortic dissection and ruptured abdominal aortic aneurysm were diagnosed, and emergency surgery was performed on the same day. Although the dissection had extended to the abdominal aortic aneurysm, abdominal aortic endovascular repair (EVAR) was performed because it was a thrombosed type B aortic dissection. After admission to the intensive care unit (ICU), the patient showed intra-abdominal hypertension and oliguria. So, we performed an emergency decompressive laparotomy against abdominal compartment syndrome (ACS). He was discharged from the ICU on the 8th day and transferred to rehabilitation on the 38th day. We report a case of a ruptured abdominal aortic aneurysm associated with thrombosed acute type B aortic dissection that was successfully treated.
RESUMEN
A 52-year-old man presented himself to his family doctor for uremia associated with prerenal acute renal failure. A 12 Fr vascular access catheter was inserted via the right internal jugular vein for emergency dialysis. A contrast-enhanced computed tomography (CT) scan revealed that the catheter had penetrated the right internal jugular vein, perforated the right subclavian artery, and reached the ascending aorta. Under general anesthesia, we completed the procedure with a pull-through technique between the bilateral brachial arteries. A vascular occlusion balloon was inserted from the left brachial artery and a GORE VIABAHN stent graft was inserted from the right brachial artery. The postoperative course was good and he has been free from hemorrhagic episodes. He was transferred to the referring hospital on postoperative day 2.
RESUMEN
A-75-year-old man had refractory late cardiac tamponade after an off-pump coronary artery bypass grafting. He was initially treated by pericardiocentesis with oral nonsteroidal anti-inflammatory drugs, but the treatment failed. Pericardial fenestration was conducted twice for refractory pericardial effusion during his hospitalization. He presented again with recurrence of cardiac tamponade 2 months after the last pericardial fenestration. Therefore, a pleuroperitoneal shunt system was implanted. He recovered well and was discharged without reaccumulation of pericardial effusion.