RESUMO
We present herein the case of a 45-year-old man with a coronary artery aneurysm (diameter 19 mm) in the proximal part of the left anterior descending branch associated with eosinophilic granulomatosis with polyangiitis (EGPA). As coronary angiography showed #6 : 100% and #12-2 : 90%, and Tc-99 m myocardial scintigraphy showed exertional ischemia in the anterior septum, revascularization was considered to be indicated. Prednisolone and mepolizumab were administered preoperatively to suppress the activity of vasculitis due to eosinophilia, and surgery was performed when the eosinophil count normalized. The patient underwent off-pump coronary artery bypass grafting (LITA-LAD, SVG-OM2). The patient was discharged, and the postoperative course was uneventful. In coronary artery bypass grafting for EGPA, eosinophils may infiltrate the internal thoracic artery and result in vasculitis, which may affect the patency rate. Perioperative management of vasculitis may thus be important.
RESUMO
A 64-year-old man under dialysis was referred for surgical treatment of Crawford type I thoracoabdominal aortic aneurysm. He had a history of idiopathic portal hypertension and chronic total occulusion of supra-renal abdominal aorta and appeared to have massive development of collateral arteries and veins in the abdomen. We chose endovascular repair with debranching of visceral arteries and bypass grafting to bilateral superficial femoral artery considering bleeding from collateral arteries and veins by conventional open surgery. Postoperative CT scan revealed no endoleak and all debranched and bypass grafts were patent. He was discharged with no postoperative complications including paraplegia.