In vascular surgery, thrombo-embolism and hemorrhage are major noisome complications. We report a case of cholesterol emboli which came from atheromatous aortic wall during the thoracoabdominal aortic aneurysm operation. Micro-emboli were migrated into the capillary in the liver, kidney and small bowels, and the patient died of multiple organ failure. The histological examination showed the cholesterol emboli in micro-circulations. The other is a case of in situ thrombus formation in the posterior tibial artery during aortic surgery. The patient with combined (iliac and femoral) lesion had aorto-bifemoral bypass to get better proximal inflow. Just after the operation, we noticed his right lower extremity was pale and cold. Angiography revealed the thrombus distal to the occluded superficial femoral artery. Since the thrombus was too large to pass through any collateral vessels, it should be formed in situ. Femoro-popliteal bypass was added to the primary procedure with success.

We report an 81-year-old woman with giant left atrial myxoma who had been admitted with congestive heart failure. Diagnosis was established by echocardiography and a moderate degree of tricuspid valve regurgitation was also found. The tumor was extensively attached to the atrial septum, and was excised completely including endocardium. She had concomitant tricuspid annuloplasty. Atrial fibrillation occurred on postoperative day 10, but conversion to a sinus rhythm was seen on postoperative day 19. She was discharged in good condition on postoperative day 36. Even in a patient over 80 years old with congestive heart failure, aggressive surgical treatment of left atrial myxoma should be performed.

We report a 66-year-old woman with circulatory collapse due to acute pulmonary thromboembolism, in whom a left nephrectomy for a renal tumor was scheduled. Following preoperative renal angiography. The patient suffered sudden shock resulting from pulmonary thromboembolism (PTE) following release of compression of the puncture site. The patient was transported to the ICU, and percutaneous cardiopulmonary support (PCPS) was instituted immediately for resuscitation. Hemodynamics were stabilized by PCPS and percutaneous thrombectomy was attempted. However, perforation by a catheter inverted to the extracardiac space occurred, which neccesitated emergency surgical hemostasis. PCPS was converted to cardiopulmonary bypass (CPB). The injured right ventricle and right atrial walls were repaired, and pulmonary thrombectomy was performed via the pulmonary trunk. CPB was easily terminated and her postoperative course was uneventful with anticoagulant therapy. Left nephrectomy was performed two months later. PTE recurred due to the interruption of anticoagulation for surgical treatment of a renal tumor. Percutaneous pulmonary thrombectomy and thrombolysis therapy were effective and a Greenfield filter was inserted into the inferior vena cava to prevent recurrence.

A 58-year-old man underwent aortic root replacement for annuloaortic ectasia (AAE) and aortic regurgitation (AR). The patient was readmitted because of chest discomfort 3 months after the first operation. Computed tomography showed a pseudoaneurysm of the ascending aorta. Re-aortic root replacement was done on an emergency basis. However, 16 days after the second operation, a pseudoaneurysm was revealed by computed tomography. The third operation was successfully performed using a rif ampicin-bonded gelatin-sealed Dacron graft (GELSEAL^®; Sulzer Vascutek, Glasgow, UK). The postoperative course was uneventful.