[Anastomotic Pseudoaneurysms after Graft Replacement for IgG4-related Thoracic Aortic Aneurysm].

We report a case of pseudoaneurysms at the anastomotic sites after prosthetic graft replacement for Immunogloblin G4 (IgG4)-related thoracic aortic aneurysm. A 69-year-old male patient underwent ascending and aortic arch replacement and open stent graft insertion. Five months after the surgery, pseudoaneurysms at the anastomosis to the brachiocephalic artery and to the left common carotid artery developed, and urgency surgery was performed. The right common carotid artery, the right subclavian artery, and the left common carotid artery were individually reconstructed with grafts, and the anastomoses were wrapped with grafts. In IgG4-related aneurysms, complete resection of the diseased tissue and reinforcement of the anastomosis, such as anastomotic wrapping, are important to prevent anastomotic site failure. While serum IgG4 had normalized after the first surgery, C-reactive protein (CRP) remained elevated until the reoperation. Thus, CRP is considered one of the biomarkers for disease activity in IgG4-related vascular disease.

Acute Dissection of the Middle Colic Artery Immediately after Endovascular Abdominal Aortic Aneurysm Repair: A Case Report.

A 78-year-old man underwent endovascular abdominal aortic aneurysm repair (EVAR) for a true aortic aneurysm. He developed sudden abdominal pain 4 hr after EVAR. Angiography revealed a dissected aneurysm of the middle colic artery (MCA). Despite conservative treatment, follow-up computed tomography revealed an expanded aneurysm of the MCA. We therefore performed coil embolization of the dissected MCA to prevent a rupture of the aneurysm. There has never been a reported case of acute dissection of the MCA immediately after EVAR that was not caused by catheters. In this report, we discuss the possible underlying mechanisms and the optimal therapeutic strategy for this rare complication.