Abdominal aortic injury caused by blunt trauma is rare. We examined a 69-year-old-male with acute abdominal aortic occlusion due to a steering wheel injury in an automobile accident. At the time of the emergency operation, the infra-renal abdominal aorta was occluded with a complete transection of the intima and media, resulting in a flap formation and thrombosis. Aortoiliac arterial replacement was performed with a bifurcated Dacron graft. The postoperative course was complicated and included acute cardiac failure, respiratory distress, and myonephropathic metabolic syndrome. The patient gradually recovered, and to date remains well, 6 months after surgery.

A 74-year-old male was admitted to our hospital with a complaint of high fever, abdominal pain, and increasing anemia. Abdominal CT and angiography revealed a ruptured abdominal aneurysm. In an emergency operation the aneurysm was located between the superior mesentemic artery and the renal amtery. Aneurysmectomy and graft interposition were done. Bacteriological examinations of the exudate in retroperitoneal space confirmed the positive diagnosis of aneurysm due to Salmonella choleraesuis infection. The patient continues to remain well 10 months after the operation.

A 80-year-old woman was referred to our hospital for coagulation abnormality and huge abdominal aortic aneurysm (AAA). She had persistent hemorrhage from the surgical wound after the operation for her cubital tunnel syndrome 5 days before. Enhanced computed tomography image revealed AAA with a maximum diameter of 91 mm. Laboratory data were compatible with disseminated intravascular coagulation (DIC). Due to the marked hemorrhagic status, we thought the open repair of AAA was an extremely risky procedure. We initiated the medical treatment with gabexate mesilate. However, the hemorrhage continued after 2 weeks of medical therapy. We performed endovascular aneurysm repair (EVAR). DIC improved after the procedure. Postoperative enhanced computed tomography image showed regression of the aneurysm with no endoleak. EVAR might be an acceptable procedure for AAA with DIC.

The surgical results of 9 patients (group II) who were treated for thoracoabdominal aneurysm using left heart bypass combined with oxygenation were compared to those of 16 patients (group I) using left heart bypass without oxygenation. The left heart bypass time in group II was longer than that in group I, and the operations performed in group II were more extensive with more intercostal and lumbar arteries being reconstructed than those in group I. Nevertheless, bleeding associated with transfusion was less in group II than in group I. Intraoperatively, hypothermia and hypoxemia developed in 44% and 31%, respectively of group I, whereas neither of these conditions occurred in group II. There were three operative deaths in group I, compared with one in group II. Paraplegia was encountered in one patient of group I, but in none of the patients in group II. There were a few patients with respiratory failure or other organ failures in both groups. Our results showed that left heart bypass combined with oxygenation offered more stable and effective respiratory as well as circulatory support for a long duration compared to conventional left heart bypass without oxygenation in the surgical treatment of thoracoabdominal aortic aneurysm.