[Hybrid Treatment for Thoracoabdominal Aortic Aneurysm by Combined Graft Replacement and Stent-graft].

Graft replacement for thoracoabdominal aortic aneurysm(TAAA) is still an important technique, yet it has high risks of mortality, spinal cord ischemia, and pulmonary complications. In our hospital, thoracoabdominal aneurysm repair with grafting and endovascular treatment (TARGET) method was performed in patients with severe chronic obstructive pulmonary disease( COPD), severe pulmonary adhesions after descending aortic replacement, or those considered high risk from general condition to undergo a wide range replacement. In this method, thoracoabdominal aortic replacement near the diaphragm was followed by stent graft treatment of the residual proximal or distal lesions. Here the usefulness of this technique was reported.

[Hybrid Treatment for Aortic Arch Aneurysm Concomitant with Right Subclavian Artery Aneurysm].

A 78-year-old man was hospitalized for aortic arch aneurysm concomitant with right subclavian artery aneurysm. Maximum diameter of each aneurysm was 65 mm and 40 mm, respectively. Both aneurysms clearly needed to be treated. However, simultaneous surgery of total arch replacement (TAR) and right subclavian artery grafting carries both technical difficulty of surgical exposure and considerable risk of bilateral recurrent nerve palsy. Thus, to avoid these serious problems, we chose hybrid treatment. TAR was performed as the 1st procedure, followed by stent graft placement to right subclavian artery aneurysm. At the 1st procedure, an 8 mm graft was anastomosed to right common carotid artery in end to side fashion. This was used for cerebral perfusion, and after that, another end of this graft was anastomosed to a branch of quadrant graft which was anastomosed to brachiocephalic artery. Then, right common carotid artery was ligated at proximal portion to create a proximal landing zone. As the 2nd procedure, excluder leg was deployed via right axillary artery without difficulty. He was discharged with uneventful postoperative course.

[Closure of Ascending Aortic Entry by Debranching Endovascular Management in an Elderly Patient with Acute Stanford Type A Dissection].

An 85-year-old woman was hospitalized by emergency for an acute Stanford type A aortic dissection. Computed tomography showed a primary entry on the ascending aorta and pericardial effusion. Although her hemodynamics was unstable due to cardiac shock, her family wished no open surgery considering her age and frailty. A couple of days later, her condition became stabilized with antihypertensive therapy. Since the dissection was limited within the ascending aorta, closure of the entry with the stentgraft was considered appropriate and much less invasive as compared with an open surgery. After obtaining informed consent with her family, thoracic endovascular aortic repair was performed with Gore C-TAG with 2-debranch. The procedure was completed without complications and the entry closure was confirmed by aortography. Her postoperative course was uneventful. Her physical activity restored to the preoperative level and she was discharged.

[Mediastinal abdominal wall fistula due to ePTFE membrane].

A 78-year-old woman who had undergone double valve replacement 13 years before was referred to our department because of postoperative wound dehiscence and exudate. Although the result of exudate culture was negative, the wound was disinfected continuously for 4 weeks and showed a transient remission. However, the exudate was observed again 3 weeks later. By chest computed tomography (CT), a highly bright shadow was revealed in the mediastinum, which was suspected to be a foreign body and, therefore, the cause of the exudate. Considering the possibility of infection, the patient underwent an operation. Following incision of the epigastric region and the resection of the xiphoid process, ePTFE membrane with poor granulation tissue was found. The membrane was removed, the lesion was washed with warm saline, and then the wound was closed. The postoperative course was uneventful without recurrence. This complication was considered to be caused by biological reaction to a foreign body.

Saphenous vein graft aneurysm after coronary artery bypass grafting.

Saphenous vein graft (SVG) aneurysms are an unusual but potentially fatal complication after coronary artery bypass grafting (CABG). We report a case of multiple SVG aneurysms 23 years following CABG. Although the patient was on dialysis and had a poor left ventricular function, the aneurysms were successfully excised, and the ascending aorta was uneventfully replaced to be possible for percutaneous coronary intervention in the near future.