A 65-year old unconscious man with left hemiplegia was found to have acute Stanford type A aortic dissection (AAD) and occlusion of the brachiocephalic and right carotid artery. He underwent emergency surgery. Before midline sternotomy, arterial cannulas were inserted into the femoral artery and the true lumen of the right carotid artery and were connected thorough a Y-shaped extracorporeal circulation circuit to restore the cerebral perfusion. During the aortic procedure, both arteries were used as arterial inflow sites.The patient regained consciousness 6 h later and was extubated on the next day. He suffered infarction of the right cerebral hemisphere, but neurologic deficits were totally resolved. He was given an ambulatory discharged 46 days later and has been reinstated in his former job 6 months after the operation. The indications for emergency surgery for AAD complicated by stroke or coma remains controversial. Especially soon after the onset, surgery may be applicable for such AAD patients if neurological deficits are not obviously irreversible.

A 61-year-old man fell into out-of hospital cardiopulmonary arrest due to rupture of an abdominal aortic aneurysm, and was resuscitated onsite. On arrival at the emergency room, a fusiform type abdominal aortic aneurysm and massive hematoma in the retro-peritoneal space were detected by ultrasonography. Quickly, an aortic occlusion balloon catheter was placed at the proximal site of abdominal aorta through the left brachial artery, and then graft replacement of the aneurysm was carried out. The inferior mesenteric artery was occluded, and was not reconstructed. Five hours after the operation, left hemi-colectomy was carried out for ischemic necrosis of the descending to sigmoid colon. Although he was complicated by multiple organ failure; renal failure, liver dysfunction, severe infection, and brain infarction, he survived without a fatal disability. A rare case with ruptured abdominal aortic aneurysm who fell into cardiopulmonary arrest outside the hospital but survived after bowel necrosis and multiple organ failure is reported.

A 34-year-old female with a gestational age of 38 weeks developed acute type A aortic dissection. Appearance of this patient was typical for Marfan's syndrome, and echocardiography revealed annulo-aortic ectasia with mild aortic regurgitation, but pericardial effusion was absent. As her hemodynamic condition was stable, an emergency Caesarean section was carried out first. After careful observation in the ICU for half a day, she successfully underwent aortic valve reimplantation and replacement of the ascending aorta under deep hypothermic circulatory arrest. Intraoperative heparin use minimally impacted uterine bleeding. Both the mother and the neonate were discharged home 16 days later. We believe a two-stage strategy should be adopted whenever possible.