A 16-year-old girl with aortitis syndrome under treatment with a low dose of prednisolone was admitted because of severe headache and intermittent claudication. Angiography revealed diffuse stenosis of the thoracoabdominal aorta and the bilateral renal arteries. Extra-anatomical bypass grafting from the ascending to the abdominal aorta was first made with a 14mm woven Dacron graft through a midline sternolaparotomy. Bilateral renal arteries were difficult to dissect due to periarterial adhesion. Bypass grafting for the left renal artery could be performed with a 5mm external velour wrap-knit Dacron graft (Sauvage, Bionit); however, the right renal artery was so thin that bypass was made with a 4mm EPTFE graft which was demonstrated to be occluded by follow-up angiography 3 years after surgery. The postoperative course has been uneventful and she has been free from symptoms up to now. The good long-term function of the bypass graft from the ascending aorta holds promise for diffuse coarctation of the thoracoabdominal aorta due to aortitis syndrome.

The earlier the diagnosis of acute type A aortic dissection is made, the more frequent the complications of aortic root destruction and/or a compromised coronary artery are encountered. Only aortography is diagnostic in these lesions, however, recently this modality tends to be avoided in order to try to improve the survival rate of the patients by obtaining diagnosis by noninvasive modalities. Therefore, contrast-enhanced CT scans in 49 patients with aortic dissection were analyzed in order to detect the slightest signs suggesting aortic root lesions. In 4 of the 6 cases in which intimal flap was detected in the aortic root by CT and in 2 of the 14 cases with an aortic root more than 35mm in diameter, aortic root reconstruction and/or concomitant CABG were neccessary for the repair of the destroyed aortic root. The aortic root diameter was more than 40mm in 8 of 9 patients with aortic root destruction, with a mean value of 45.6±3.6mm (p<0.01). In summary, detection of a septum in the aortic root and/or an aortic root dilated more than 40mm on CT were important signs suggesting the dissection extending to the aortic sinus combined with aortic root destruction. In such cases aortic root reconstruction and/or concomitant CABG may be necessary.

Prosthetic grafts have been employed in a limited number of pediatric patients with peripheral vascular lesions. We treated an iatrogenic obstruction of bilateral external iliac arteries in a child. The patient was a six-year-old girl whose chief complaints were intermittent claudication, and lower limb pain when exposed to cold. She had a history of coarctation complex for which she had undergone repeated catheterizations by puncture of both femoral arteries in her infancy. At the age of four, two-stage operation was performed: resection of the coarctation and end-to-end anastomosis, and direct closure of ventricular septal defect. Angiography performed through the brachial artery demonstrated obstruction of the bilateral external iliac arteries. Both right and left femoral artery were visualized through the collateral artery from the ipsilateral internal iliac artery. Because she became afflicted with lower limb ischemia a revascularization procedure was indicated. A 6mm expanded polytetrafluoroethylene (ePTFE) bypass graft was implanted bilaterally between the internal iliac artery and the common femoral artery with end-to-side anastomosis. Ischemic symptoms disappeared postoperatively and MR-angiogram performed nine days after surgery also showed the patency of the graft. It is a great concern, however, that the length of the graft may become relatively shorter with the growth of the patient. It is also anticipated that the lower limbs may suffer relatively insufficient blood flow in the future.