Two hundred fourteen cases treated surgically for aortic aneurysms between Jan. 1986 and Dec. 1991 at our hospital. Among them, 15 cases (7.0%) had multiple aortic aneurysms. In 10 cases, aneurysms were resected completely: 9 simultaneously (one-stage operation) and 1 separately (two-stage operation), although in 5 cases there remained another aneurysm left even after operation. In all cases who had one-stage operation, the combination of sites of aneurysms were descending thoracic aorta and infra-renal abdominal aorta. Temporary bypass (n=4), centrifugal pump (n=4) or cardiopulmonary bypass (n=1) were employed as supportive methods during aortic cross-clamp. There were neither operative nor late death in one-stage operation group, although one patient died due to rupture residual aneurysm 1.2 years after the first operation. In these patients, vascular disease are expected to be present systemically, so that operative method should be determined carefully under consideration of poor general condition and another risk factors. We recommend, however, that simultaneous one-stage operation for multiple aortic aneurysm might be safe and fully acceptable procedure, especially in case of those whose aneurysms exist in descending thoracic and infra-renal abdominal aorta.

Marfan's syndrome associated with multiple arterial aneurysms of the abodominal aortic branches in a pair of identical twins is described. The first case, a 21-year-old male, visited our affiliated hospital because of severe upper abdominal pain. Computed tomography (CT) and aortography (AOG) demonstrated multiple abdominal aneurysms, i.e., celiac artery, bilateral renal arteries and superior mesenteric artery, but there were no findings of dissecting aneurysm of the aorta. The aneurysm of the superior mesenteric artery, which had ruptured, was replaced with a greater saphenous vein graft. The postoperative course was uneventful until sudden cardiac arrest occurred on the 5th POD. An autopsy revealed a dissecting aortic aneurysm (DeBakey type I), massive intrathoracic hemorrhage, and subarachnoidal hemorrhage. Two years later, the second case, the 23-year-old twin brother of the prior case, visited our hospital because of upper abdominal pain similar to that of his brother. The clinical course bore a close resemblance to his brother's. CT and AOG revealed the intact aorta and aneurysms of the celiac artery and right renal artery. The ruptured aneurysm of the celiac artery was ligated. Immediately after his returning to the ICU, he developed sudden massive intrathoracic bleeding and cardiac arrest. This is the fourth report of identical twins with Marfan's syndrome in Japan. It is also noteworthy that in both cases rupture of the extra-aortic aneurysm occurred prior to the aortic dissection or aneurysmal formation.