Inflammatory aneurysms of the thoracic aorta are extremely uncommon. We present a 58 year-old man with an inflammatory aneurysm of the aortic arch. He was admitted because of chest pain. Coronary angiographies showed severe stenosis of the left anterior descending artery and computed tomography revealed an aneurysm of the distal aortic arch. We conducted combined graft replacement of the aortic arch and coronary artery bypass grafting. During the operation, the patient was noted to have extensive peri-aneurysmal fibrosis and inflammation with a thick aneurysmal wall. To avoid excessive hemorrhage, distal anastomosis was performed using the graft inclusion technique. He was discharged 35 days after operation without any major complication. Pathological evaluation of the aneurysmal wall revealed destruction of the mural structure and inflammatory cell infiltration in the adventitia.

A 70-year-old man with severe chest pain was transferred to our hospital by ambulance. Computed tomography revealed a ruptured thoracic aortic aneurysm and massive bleeding into the posterior mediastinum. Emergency total aortic arch replacement was performed through median sternotomy. However sternal closure induced severe hypotension because the heart was elevated anteriorly by the posterior mediastinal hematoma. The hematoma could not be eliminated fully so the sternum was kept open at the first operation followed by delayed sternal closure 3 days after the operation. After that, the postoperative course was uneventful and the patient was discharged on postoperative day 43.

BACKGROUND: Lymphaticovenous anastomosis is an important surgical treatment for lymphedema, with lymphaticovenous side-to-end anastomosis (LVSEA) and lymphaticovenous end-to-end anastomosis being the most frequently performed procedures. However, LVSEA can cause lymphatic flow obstruction because of regurgitation and tension in the anastomosis. In this study, we introduce a novel and simple procedure to overcome this problem. METHODS: Thirty-five female patients with lower extremity lymphedema who underwent lymphaticovenous anastomosis at our hospital were included in this study. Eighty-five LVSEA procedures were performed, of which 12 resulted in insufficient venous blood flow. For these 12 anastomoses, the proximal lymphatic vessel underwent clipping after the anastomotic procedure and the venous inflow was monitored. Subsequently, the proximal ligation after side-to-end anastomosis recovery (PLASTER) technique, which involves ligating the proximal side of the lymphatic vessel, was applied. A postoperative evaluation was performed using indocyanine green 6 months after surgery. RESULTS: Despite the clipping procedure, three of the 12 anastomoses still showed poor venous inflow. Therefore, it was not possible to apply the PLASTER technique in those cases. Among the nine remaining anastomoses in which the PLASTER technique was applied, three (33%) were patent. CONCLUSIONS: Our findings show that achieving patent anastomosis is challenging when postoperative venous inflow is poor. We achieved good results by performing proximal ligation after LVSEA. Thus, the PLASTER technique is a particularly useful recovery technique when LVSEA does not result in good run-off.
Edema ; Female ; Humans ; Indocyanine Green ; Ligation ; Lower Extremity ; Lymphatic Diseases ; Lymphatic Vessels ; Lymphedema ; Microsurgery