Acute High Aortic Occlusion with Aplastic Anemia / 日本心臓血管外科学会雑誌

A 67-year-old man had been diagnosed as having aplastic anemia three years ago. He had taken anabolic steroids continuously. He suddenly complained of the ischemic signs of the lower extremities. Aortography showed the total occlusion of the abdominal aorta with encroachment upon the left renal artery. The right renal artery and superior mesenteric artery were intact. Laboratory data showed acute renal failure. We selected an axillo-femoral bypass because of aplastic anemia and acute renal failure. Throughout the intraoperative and post-operative periods the patient showed a bleeding tendency, then disseminated intravascular coagulation (DIC) has occurred. He required much blood transfusion, anti-coagulant drugs and hemodialysis post-operatively and finally recovered from acute renal failure and DIC.

Clinical Experiences of Dissecting Aortic Aneurysm with Organ Ischemia / 日本心臓血管外科学会雑誌

We studied 6 surgical cases of dissecting aortic aneurysm with organ ischemia, consisting of 4 cases of DeBakey type I dissection and 2 cases of DeBakey type III b dissection and the average age was 62 years old. The ischemic organs were, the brain and upper extremities, intestine and kidney, kidney, kidney and lower extremity, and bilateral lower extremities, respectively. We performed the graft replacements of the ascending aorta or ascending aorta and arch for DeBakey type I dissection, and bypass or Y-graft replacement for DeBakey type III b dissection. In one case of DeBakey type I dissection we performed a second Y-graft replacement two days after the first operation. MNMS (myonephropathic metabolic syndrome) developed in two cases of 3 lower extremity ischemia. The results were unsatisfactory because 3 patients died. To improve of the outcome of surgical treatment in case of dissecting aortic aneurysm with organ ischemia, preoperative appropriate diagnosis and appropriate surgical planning are necessary.

Three Operations Following Conservative Therapy in Patients with Stanford A Type Acute Thrombosed Aortic Dissection / 日本心臓血管外科学会雑誌

We performed 3 operations for Stanford A type aortic dissections which were confirmed as acute thrombosed type by contrast chest CT. Initially conservative therapy was chosen in all patients. In case 1, a 64-year-old woman received ascending aortic replacement with a Hemashield^® vascular prosthesis 3 days after admission, because of increasing diameter of the ascending aorta and sustained back pain. In case 2, a 54-year-old woman, we replaced the total aortic arch with Hemashield^® graft, on an emergency basis since recanalization of the false lumen was revealed by contrast CT and D.S.A. 3 days after admission. In case 3, a 52-year-old woman, cardiac tamponade occured on the 30th admission day even though anti-hypertensive treatment had been effectively performed immediately after onset. Emergency D.S.A. revealed an“ulcer like projection” in the ascending aorta, so following pericardiocentesis, we resected and directly anastomosed the ascending aorta at the entry site 34 days after onset. Generally, acute thrombosed aortic dissections should be treated conservatively. Here we reported 3 operations for acute thrombosed Stanford A type aortic dissections even under good B.P. control, suggesting the importance of careful and long term observation for acute thrombosed aortic dissections.