A 58-year-old male was unable to walk because of progressive pain in both lower extremities that rapidly became cold and clammy. Femoral, popliteal and ankle pulses ware absent, and there was a pulsatile tumor in the abdomen. Abdominal CT showed an abdominal aortic aneurysm that measured 50mm in diameter. Aortogram revealed total infrarenal aortic occlusion. The patient underwent emergency aorto-bifemoral bypass with a bifurcated artificial graft. Several days after the operation, renal failure appeared because of MNMS. He was weaned from hemodialysis at one month and was discharged from hospital about 1 year after the operation.

We report a case of a dissecting brachiocephalic artery aneurysm that developed at the anastomotic site following surgery for acute aortic dissection ; and which was successfully treated by stent grafting. The patient, a 62-year-old man, had undergone total arch replacement for an acute Stanford type A aortic dissection that accompanied dissection of the brachiocephalic artery. In the early postoperative period, he complained of dull pain in the right arm and fatigue on exertion. The blood pressure in the patient's right arm was found to be significantly lower than in the left. Enhanced computed tomography (CT) performed 1 month postoperatively revealed leakage at the anastomotic site of the brachiocephalic artery, leading to the formation of a false lumen and the creation of a dissecting aneurysm with a maximum short diameter of 30 mm. No re-entry was seen, and the greatly expanded false lumen was exerting pressure on the true lumen, causing ischemia of the arm. Enhanced CT performed 3 months postoperatively showed that the maximum short diameter of the aneurysm had increased to 35 mm. Because ischemic symptoms of the arm were also present, surgery was considered to be indicated, and stent grafting was performed. A stent graft was inserted via the right axillary artery and positioned to close the entry to the false lumen of the dissecting aneurysm. Symptoms resolved without any complications, and the patient was discharged 7 days after the surgery. The false lumen of the dissecting aneurysm completely disappeared, and no complications have developed during the 3-year interval since stent grafting. In this patient, stent grafting enabled minimally invasive closure of the entry to the dissecting aneurysm that had developed at the anastomosis site. We conclude that stent grafting is very useful for treating dissecting aneurysms caused by anastomotic leakage and without re-entry, as seen in this case.

From January 1979 through May 1982, 36 premature infants less than 2.5kg and less than 35 weeks of gestation, including 24 patients with respiratory distress syndrome, underwent ligation of patent ductus arteriosus (PDA) due to being unresponsive to medical treatment. Ten patients died postoperatively mainly from intracranial hemorrhage and necrotizing enterocolitis. Surviving 26 patients were examined for developmental sequelae based on questionnaire survey. One infant died of respiratory failure secondary to severe bronchopulmonary dysplasia 28th month after operation. We found no evidence of recurrent ductal patency following ligation during the follow-up period. Twenty four patients exhibited normal motor and mental development to attend the ordinary elementary school everyday, but one patient shows mental retardation. Most of patients suffered from the frequent upper respiratory infection in childhood to require rehospitalization. There are no patients with hoarseness, but 2 patients developed funnel chest and one required the operation. One third of the patients had ophthalmological handicap (myopia or strabismus). Surgical ligation of PDA in premature infants seems to reduce the duration of postoperative mechanical ventilation and the incidence of bronchopulmonary dysplasia. Analyzing long-term follow-up indicates that infants who undergo PDA ligation grow almost normally and do not appear to be at increased risk for sensorineural handicaps. Therefore we emphasize that surgical ligation of PDA is an effective and appropriate treatment of choice for significant PDA in premature infants.

A 63-year-old woman who was diagnosed a having impending rupture of abdominal aortic aneurysm underwent urgent anatomic reconstruction. Histopathological findings revealed abscess formation around the aneurysmal wall, and a definitive diagnosis of mycotic aneurysm was established. Successful management of this rare aortic disease depends on early accurate diagnosis, control of infection and careful surgical management.