A 75-year-old man was admitted complaining of sudden bilateral foot coldness and numbness. The patient had undergone endovascular repair for abdominal aortic aneurysm (AAA) 5 years previously. Abdominal X-ray showed a highly kinked endovascular stent-graft, and aortography revealed occlusion of the stent-graft and infrarenal aorta. Emergency axillo-bifemoral bypass was performed to restore the blood flow of the lower extremities, and he recovered uneventfully. Endovascular repair for AAA can be performed with low mortality and morbidity, and is accepted worldwide as a minimally invasive treatment. However, there are several late complications, such as newly developed endoleak, graft migration, graft occlusion, AAA expansion, and AAA rupture. Therefore, great attention should be paid to following patients treated with endovascular procedures for abdominal aortic aneurysm.

Left ventricular (LV) thrombus is an uncommon primary disease, but following acute myocardial infarction (AMI) it is a common complication associated with a risk of systemic embolism. Especially if the thrombus is ball-shaped, there is a higher risk of systemic embolism. We reviewed 4 cases of thrombectomy including 1 with the acute phase of AMI and another with Takotsubo disease. Between January 2000 and August 2005, 4 consecutive patients underwent thrombectomy for ball-like thrombus in the left ventricle (all men, mean age 53.5 years). We performed thrombectomy through left ventriculotomy. In 3 patients ventriculotomy was repaired with direct closure with double PTFE felt reinforcement, and in the other large acute AMI with the infarction exclusion technique (Komeda-David) because the LV wall was remarkably fragile. All thrombi were ball-like and fresh (mean size 15.8mm). Concomitant coronary artery bypass grafting was performed in 3 cases, the Maze procedure in 2, and mitral annuloplasty (MAP) in 1. All patients survived and have been doing well without any major complications. Surgical thrombectomy is safe and can improve prognosis without systemic embolism. In the acute phase of AMI, the infarction exclusion technique is excellent to prevent bleeding and postoperative remodeling of the left ventricular wall.

Between January and December 2006, 3 patients with aortic abdominal aneurysm (AAA) receiving home oxygen therapy (HOT) and 20 patients without HOT were studied. The 3 patients with HOT were all men, the mean age was 72 years (range, 69-74), and they had been treated with HOT for 37.3 months (1-102) due to chronic obstructive pulmonary disease (COPD) with a mean %VC of 96.9% and FEV1.0% of 42.8%. Only the FEV1.0% value in the preoperative data was significantly lower than in patients without HOT. In the 3 patients with HOT, extubation was performed immediately after operation, and minitracheotomy tubes (Mini-trach^®) to control sputum were inserted in the operation room. The minitracheotomy tubes were removed 5 or 6 days after operation. Postoperatively, no one with HOT had any major complications, while in those without HOT one patient had ileus and another had prolonged intubation. There were no significant differences between the 2 groups in operative time, blood loss, blood transfusion, or hospital stay. In conclusion, based on detached preoperative close estimation and careful postoperative supervision, patients receiving HOT can undergo AAA operations as safely as those not receiving HOT.