A case of Budd-Chiari syndrome in which direct surgical intervention was successfully performed is reported. A 43-year-old female who had had a history of hepatic coma was pointed out complete obstruction of inferior vena cava (IVC) between the right atrium and diaphragma, associated with hepatic dysfunction and esophageal varices. At operation, the IVC lesion was visualized directly by thoracotomy through midsternal incision and by laparotomy through right hypochondrial oblique incision, with the liver retracted. Under partial extracorporeal circulation with suction of blood from hepatic vein, the IVC was incised, 3cm in length, and membranous tissue causing obstruction was resected. The defect of the IVC wall was repaired with ringed EPTFE patch. Postoperatively, both central venous and portal pressure were decreased, 21 mmHg to 10mmHg and 26cm H₂O to 21cm H₂O, respectively, with good patency of the IVC on venogram. Now the patient is up and well, 11 months after operation. Thus, complete removal of obstruction under direct vision is thought to be important for surgical treatment of Budd-Chiari syndrome.

A case of non-anastomotic aneurysms of a knitted Dacron graft is reported. The patient, a 35-year-old female, had had a bypass operation with a Cooley double velour knitted Dacron graft 11 years previously for stenosis of the descending thoracic aorta caused by aortitis syndrome, was admitted complaining of a painful pulsating tumor of the left hypochondral region. We diagnosed multiple aneurysms of Dacron graft with computerized tomography and aortography. The dilated Dacron graft was resected and replaced by a woven polyester graft. The resected specimen showed longitudinal ruptures macroscopically and a decrease of the number of Dacron fibers at the dilated portion was detected microscopically. The nonuniformity of the diameter of Dacron fibers and cracks in the fibers were observed with a scanning electron microscope. Thus, for patients implanted with a knitted Dacron graft, periodical careful follow-up is required for early detection of aneurysmal changes of the graft.