Endovascular relining of a Dacron graft for refractory perigraft seroma.

Although perigraft seroma (PGS) is a well-known complication of vascular surgery, optimal therapy has not yet been established. A 90-year-old patient underwent a bypass from the right subclavian artery to the left carotid and subclavian arteries for debranching thoracic endovascular aortic repair. Four years post-surgery, computed tomography revealed PGS at the anastomosis site. Percutaneous needle aspiration and surgical drainage were ineffective in treating PGS. We performed a relining procedure using covered stents for the bypass graft that resolved the PGS. This procedure is minimally invasive, avoids graft excision, and can be especially valuable for elderly patients.

[Treatment of Hemothorax with Bronchial Artery Embolization Combined with Video-assisted Thoracic Surgery Following Hemi-arch Replacement for Stanford Type A Acute Aortic Dissection].

A 51-year-old male arrived at our hospital by ambulance, presenting with a sudden onset of chest pain. Computed tomography (CT) revealed Stanford type A acute aortic dissection. Although emergency hemi-arch replacement was successfully performed, the blood pressure decreased and anemia acutely progressed. As chest X-ray revealed right lung opacity, a chest drain was inserted and 3,000 ml of bloody effusion was drawn over a period of 2 hours. Enhanced CT revealed hemothorax and extravasation of the right lung. Since the preoperative CT showed an abnormally dilated right bronchial artery, the branch vessels of the bronchial artery were considered to be the source of hemorrhage. Bronchial artery coil embolization was first performed, which decreased the bronchial artery flow, stabilizing the hemodynamics. Video-assisted thoracic surgery (VATS) was then performed, and the bleeding site at the surface of the lung was electrocauterized. Finally, the hemorrhage was controlled. This case suggests that the combination of coil embolization and VATS is an effective procedure.

[Redo Off-pump Coronary Artery Bypass for Postoperative Vein Graft Stenosis of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery;Report of a Case].

Bland-White-Garland (BWG) syndrome (anomalous origin of the left coronary artery from the pulmonary artery) is a rare disease which may result in myocardial infarction, congestive heart failure or sometimes death during the early infantile period. We present a 57-year-old female with BWG syndrome. At the age of 20, she was diagnosed with BWG syndrome and underwent coronary artery bypass grafting of a saphenous vein to the proximal portion of the anterior descending branch of the left coronary artery and ligation of the anomalous artery. Thirty-seven years later, she presented with symptoms of angina pectoris and congestive heart failure. Coronary angiography (CAG) revealed stenosis of the saphenous vein graft. Bare metal stent implantation for the saphenous vein graft was performed, but at the 6 months' follow-up CAG revealed restenosis. Drug-eluting stent was then implanted, but in-stent restenosis recurred 4 months later. We performed off-pump coronary artery bypass grafting to the left anterior descending artery using the left internal thoracic artery. The postoperative course was uneventful.

[Ruptured descending aortic aneurysm in a young woman with systemic lupus erythematosus].

We report here a case of ruptured descending aortic aneurysm in a 35-year-old woman with systemic lupus erythematosus (SLE). She was diagnosed with SLE in 1985, and had been receiving steroid therapy for 23 years. In February 2009, she presented with sudden back pain. Computed tomography (CT) scan showed the presence of descending aortic aneurysm, 50 mm in maximum diameter, and a hematoma in the posterior mediastinum. Emergency of the replacement descending aorta was performed. She was discharged from our hospital 69 days after the operation without significant postoperative complications. It is concluded that early operation should be performed for aortic aneurysm in the patients using steroids.