A case is presented of a 18-year-old male patient, in whom an abnormal distension of the distal aortic arch was pointed out on chest X-ray. Angiography and computed tomography revealed distal arch aneurysm, obstruction of the left subclavian artery, and abdominal aortic aneurysm, including the celiac, superior mesenteric, and bilateral renal arteries. Oral administration of prednisolone (15mg/day) was initiated to control systemic inflammation before surgery. First, the distal arch aneurysm was resected with total cardiopulmonary bypass, selective cerebral perfusion and hypothermia. Approximately 1 month later, the abdominal aortic aneurysm was resected with partial cardiopulmonary bypass with selective visceral perfusion of the celiac and left renal arteries. The celiac, superior mesenteric, bilateral renal arteries were reconstructed with a dacron prosthesis (6mm in diameter). The postoperative course was uneventful and he is being followed up as an outpatient.

Fifty consecutive patients who underwent elective repair for abdominal aortic aneurysms were preoperatively evaluated on blood coagulation tests and retrospectively classified into three groups. Class I had a normal profile on the tests. Class II had either high FDP (≥20ng/ml), TAT (≥20ng/ml), or positive results on the FM test. Class III had either thrombocytopenia (≤120/μl) or bleeding symptoms with Class II conditions. Operative mortality was 0% (0/26) in Class I, 13% (2/15) in Class II, and 22% (2/9) in Class III patients. This classification is considered to be simple and useful to assess specific coagulopathy for aortic aneurysms.