We successfully treated a case of extra-anatomical revascularization using an extrathoracic approach for what is called subclavian steal syndrome, and we describe the operative method. A 65-year-old man with dizziness was examined by digital subtraction assessment and given a diagnosis of subclavian steal syndrome by occlusion of left subclavian artery. He was relatively young for his age with good general condition, and no lesion were detected in aortic arch branches and cerebral arteries except for left subclavian artery. Therefore we performed left common carotid artery-subclavian artery bypass using a prosthetic graft. The preoperative symptoms and difference in blood pressure among arteries of the upper limbs disappeared, and he was discharged 15 days after surgery.

A case of successful surgical revascularization for mid-aortic syndrome is reported, with discussion of the operative method. A 10-year-old boy with headache and vomiting was admitted to our hospital for excessive hypertension. A diagnosis of mid-aortic syndrome with severe stenosis of abdominal aorta and stenosis or occlusion of bilateral renal arteries was made. His hypertension did not respond to conservative treatment. Therefore we performed aorto-aorta bypass using a prosthetic graft and revascularization of the bilateral renal arteries. The preoperative symptoms disappeared, his blood pressure became controllable, and he was discharged on the 21st day after surgery. At present, he attends school and has a normal blood pressure without hypotensive medication.

We encountered a case of ruptured penetrating atherosclerotic ulcer (PAU) that previously had focal ulceration. A 82-year-old man was followed on a diagnosis of distal arch true aneurysm with a diameter of 4.5cm on CT examination. He was admitted with sudden onset of back pain, but he had experienced no previous symptom. CT scan showed a ruptured penetrating atherosclerotic ulcer, therefore we performed emergency replacement of the thoracic descending aorta. The postoperative course was good. CT scan showed the thoracic descending aorta had focal ulceration with a width of 11mm and depth of 7mm at 6 months, however the width was 11mm and the depth was 11mm 1 month before rupture of the PAU. This suggested progression of the focal ulceration caused the PAU rupture.

Acute aortic dissection is a formidable disease because of complications such as rupture or visceral ischemia. Early diagnosis of these conditions is essential. The patient was a 40-year-old woman with acute type B aortic dissection, suspected to have Marfan syndrome. We first treated her with medical therapy, but 5 days later she suffered from repeated abdominal angina. This was thought to be probably predictive of malperfusion, so we decided to perform an operation. We maintained an elevated blood pressure (about 140mmHg), used heparin and Prostaglandin E₁ for the prevention of angina, until total aortic arch replacement and open stent grafting was performed. She has been doing well since.