Endoleak after use of the fenestrated frozen elephant trunk technique to treat acute type A aortic dissection.

Several studies have indicated that the fenestrated frozen elephant trunk (FET) technique enhances early outcomes in cases of acute aortic dissection, although long-term outcomes remain unclear. A case involving a 62-year-old male who experienced endoleak from a fenestration site following total arch replacement using the fenestrated FET technique for a DeBakey type I aortic dissection is reported. The patient underwent successful reoperation involving total arch replacement and reinsertion of the FET. Postoperatively, there was an absence of endoleak from the fenestration, and a noteworthy reduction in the diameter of the aortic arch was observed. It is imperative to recognize that endoleak from a fenestration poses a risk for prompt aortic expansion, thus necessitating vigilant postoperative monitoring. Furthermore, when adopting fenestrated FET, it is crucial to ensure firm fixation around the fenestration to prevent endoleak.

Sutureless Repair for Iliac Vein Bleeding Using an Elastomeric Sealant.

Addressing venous bleeding is a frequent complication of vascular and abdominopelvic surgeries. We present a novel sutureless repair technique using HydrofitⓇ (Terumo, Tokyo, Japan), an elastomeric sealant. In a patient experiencing common iliac vein bleeding during abdominal aortic aneurysm surgery, this technique successfully achieved complete hemostasis. By applying the elastomeric sealant with an autologous arterial patch to the bleeding site, we demonstrate the simplicity and effectiveness of sutureless hemostasis for venous bleeding.

Embolization of left anterior descending artery due to pledget after a redo surgery.

A 53-year-old man underwent aortic root replacement for acute aortic dissection. Following this procedure, the patient developed a pseudoaneurysm at the aortic root, necessitating reoperation. The subsequent surgery was performed routinely, allowing the patient to be weaned from mechanical ventilation on the same day. Postoperative electrocardiography revealed ST-segment elevation, suggesting myocardial ischaemia. Coronary angiography identified 90% stenosis in the left anterior descending artery, and computed tomography revealed a high-density mass. These findings suggested an embolus from a previous surgery. A snare catheter was successfully employed to extract the embolic material, which was identified as a pledget used for aortic valve replacement in the initial operation. This case underscores the potential for complications associated with pledgets used in valve surgeries, illustrating the risk of embolization when the valve is subsequently removed.

Severe right ventricular infarction due to iatrogenic aortocoronary dissection successfully treated by surgical repair and extracorporeal membrane oxygenation.

Iatrogenic aortocoronary dissection (IACD) is a rare but potentially fatal complication of percutaneous coronary intervention or coronary angiography (CAG). In particular, if the condition of the patient is complicated by cardiogenic shock and right ventricular (RV) dysfunction, the mortality rate is high. Herein, we report the case of an 85-year-old woman with IACD who underwent elective CAG of the right coronary artery complicated with cardiogenic shock due to RV infarction. After prompt surgical repair and postoperative extracorporeal membrane oxygenation, the postoperative course was uneventful and the patient was discharged to a rehabilitation facility.

[A Case of Laparoscopic Total Gastrectomy for Juvenile Polyposis of Stomach with Synchronous Multiple Intramucosal Carcinomas].

The patient was a 57-year-old woman. She was referred to our hospital because severe anemia. Upper gastrointestinal endoscopy revealed polyposis throughout the stomach and lobulated polyps in cardia, greater curve of middle body of the stomach, and angulus. Colonoscopy and small bowel endoscopy showed no obvious abnormal findings. Based on these findings, a laparoscopic total gastrectomy with D1 lymph node dissection was performed for suspected juvenile polyposis of stomach with severe anemia. The gross examination of the resection specimen revealed diffuse polyposis throughout the stomach, and histopathological examination revealed hyperplasia of the orbital epithelium throughout the stomach and lack of edema in lamina propria of mucous and eosinophil leukocytic infiltration, leading to the diagnosis of juvenile polyposis of stomach. Two well differentiated adenocarcinomas were found in 2 locations, which remained within the mucosa. We report a case of laparoscopic total gastrectomy for juvenile polyposis of the stomach with gastric cancer, with some discussion of the literature.