Percutaneous subclavian vein catheter hemodialysis has been accepted as a convienient method in acute need of hemodialysis, but recently, as a serious complication, not a few cases of venous obliterations were reported. Patients on hemodialysis with a functioning arteriovenous fistula become symptomatic with venous hypertension and painful edema. As fistula ligation renders the arm unsuitable for future blood access, venous reconstruction should be considered. In our series, two patients with right subclavian vein obstruction and innominate vein stenosis were treated by polytetrafluoroethylene bypass graft and by angioplasty, respectively. Their symptoms disappeared, and fistulas were preserved for 6 and 25 months.

A 59-year-old man has had a heart murmur for a long time. Four years previously coronary artery-pulmonary artery fistula was diagnosed as the cause of arrhythmia, by coronary angiogram. Despite two coil embolizations some fistulae recanalized and dilated. The coronary artery connected with the main pulmonary trunk and a part of plexiform angioma on the right ventricule outflow tract. Under heart beating, we ligated the origin of each fistulae with direct closure of the ostia from inside pulmonary artery. His symptoms finally improved.

We performed a modified Bentall operation and aortic arch replacement simultaneously in three cases of chronic type A aortic dissection with connective tissue disease. Two of the subjects were men. Ages ranged from 37 to 48 years. There were two cases of Marfan's syndrome, and one case of cystic medial necrosis. All patients had annuloaortic ectasia (AAE), severe aortic regurgitation (AR) and marked dilatation at the base and arch of the aorta with extensive dissecting lesions. Widespread, progressive vascular lesions are often seen, especially among cases of dissecting aneurysm of the aorta with connective tissue disease, and there is a high probability that new vascular lesions and valvular diseases will result after surgery. Therefore, cases must be followed, keeping in mind the possibility of early extended aortic operation and secondary surgery.