Horseshoe kidney is an unusual abnormality occurring in 0.25% of the population. In surgery for AAA with horseshoe kidney, reconstruction of aberrant renal and preservation of renal isthmus is important. We report 3 cases of AAA with horseshoe kidney treated successfully without division of the isthmus.

A 15-year-old boy who had been treated for TOF (tetralogy of Fallot) at 3 years of age was admitted with dysphagia due to esophageal stenosis. He also suffered from malrotation of the intestine. The esophageal stenosis was caused by recurrent cyclic vomiting and subsequent esophagitis. Three years earlier, he had received an implantation of a totally implantable central venous access device via the right cephalic vein. Echocardiography revealed a floating mass in his right atrium, which was assumed to be a thrombus at the catheter tip of the central venous access device. We suspected that the cause of atrial thrombus in this case was complicated by the long-term (3 years) use of the venous central port. He was suspected to have a pulmonary embolism. A perfusion lung scan (99mTc-MAA) revealed multiple diminished uptake in both lungs. The thrombus was removed successfully under partial cardiopulmonary bypass. The postoperative course was uneventful.

A 53-year-old woman was admitted because of cardiac failure caused by mitral valve stenosis and regurgitation. She had been treated by an aortic valve replacement with a Björk-Shiley convexo-concave valve (21mm) 22 years previously in our institute. Her clinical symptoms and the histological findings of the lung specimen from the operation led to a diagnosis of Swyer-James syndrome. The diagnosis was confirmed by pulmonary blood flow scintigraphy on the present admission. With her informed consent, we treated her cardiac disease by mitral valve replacement and a second aortic valve replacement was carried out because of the structural brittleness of the Björk-Shiley convexo-concave valve. She was discharged from our institute after the operation without any complications.

We have long advocated the usefulness, accuracy and safety of carbon dioxide angiogrphy for patients with iodine allergy and renal dysfunction. In addition to its utility, no specialized apparatus is necessary for carbon dioxide angiography. Carbon dioxide as a contrast material has been adopted by consensus for use in endovascular revascularization. Here we report 4 cases of endovascular revascularization using carbon dioxide angiography. Two of the four patients had an iodine allergy, one had renal dysfunction, and the remaining one was complicated by diabetes mellitus. All patients exhibited intermittent claudication and were treated for iliac arterial stenotic lesions with percutaneous angioplasty and sequential endovascular stenting using carbon dioxide gas as a negative contrast material. All cases demonstrated improvement of the chief complaint. There were no direct or indirect complications of carbon dioxide angiography and endovascular intervention after the procedures. All 4 patients were discharged without event within 1 week after the endovascular intervention. Carbon dioxide is useful not only as an angiographic contrast material but also for endovascular intervention in patients with iodine allergy or renal dysfunction.

We experienced the usefulness of the superficial femoral vein as an autogenous graft replacement of an infected prosthetic graft. Case 1: A 75-year-old man complained of right leg intermittent claudication due to arteriosclerosis. Prosthetic femoro-femoral crossover bypass was performed. Three months after the operation, prosthetic bypass graft infection was diagnosed. Case 2: A 72-year-old man underwent an aortobifemoral graft surgery for an abdominal aortic aneurysm (5cm in diameter) . Ten days after the operation, the patient suddenly had a high fever and bacterial culture of the blood demonstrated Gram-negative bacilli. Prosthetic bypass graft infection was diagnosed. Both cases were resistant to conservative therapies including antibiotics. The infected prosthetic grafts were removed and autogenous reconstructions were performed extra-anatomically using the superficial femoral vein: in Case 1, with femoro-femoral crossover bypass, and in Case 2, with axillo-unifemoral bypass with anastomosis of bilateral common iliac arteries. Both infections eventually resolved. Since the deep femoral vein had been preserved during harvesting of the superficial femoral vein, no problems, such as venous congestion of the leg, occurred in either of the two cases. Their postoperative courses were uneventful and the patients were given ambulatory their own feet. We reviewed the literature about the utility of superficial femoral veins as arterial substitutes.

Abdominal aortic aneurysm and cystic kidneys are both common diseases that have been increasingly detected due to the development of medical screening instruments, such as computed tomography and ultrasonography. We occasionally intraoperatively encounter abdominal aortic aneurysms accompanying cystic renal lesions. However, there have been extremely few reports about abdominal aortic aneurysms complicated by cystic renal disease. Large renal cysts or polycystic kidneys are at risk of rupture or intraoperative hemorrhage, and can hinder the surgical treatment of abdominal aortic aneurysm. Therefore, there is a significant need for surgeons to be able to preoperatively determine the potential of an interruption of the procedure, for example, due to a cystic lesion. In this paper, we report a case of a 77-year-old man with abdominal aortic aneurysm who complained of abdominal fullness due to the presence of large cystic lesions in both kidneys. Preoperatively we aspirated 1, 550ml percutaneously from bilateral renal cysts under ultrasonographic guidance, but did not instill sclerosing agents, such as ethanol. Three days after the percutaneous aspiration, surgical treatment of the abdominal aortic aneurysm (5.2cm in diameter), the left common iliac arterial aneurysm and the right common iliac arterial aneurysm (3.0 and 2.6cm in diameter) was performed through a median abdominal incision with a retroperitoneal approach. The arterial prosthesis used was a Y-shaped woven double velour vascular graft. The postoperative course was uneventful and the patient was discharged 14 days after the vascular reconstruction procedure. Our experience suggests that percutaneous aspiration of large renal cysts that might hinder the surgical procedure for abdominal aortic aneurysm is useful.