A 75-year-old man was admitted to our hospital due to sudden onset of chest pain. Computerized tomography showed penetrating atherosclerotic ulcer at the distal arch and hematoma around the aortic arch, therefore we diagnosed spontaneous rupture of the aortic arch. He had a history of previous CABG and multiple cerebral infarction with diffuse cerebral arteries. Open surgery under deep hypothermia, circulatory arrest and cerebral perfusion was considered to be difficult and too invasive, therefore we performed debranching TEVAR. Postoperative cerebellar infarction occurred, but he was discharged 29 days after surgery. TEVAR is especially useful for treatment of spontaneous rupture of the aorta in high-risk patients.

Endovascular aneurysm repair (EVAR) of pararenal abdominal aortic aneurysm (pararenal AAA) includes fenestrated or branched endografts, and the chimney technique. However, fenestrated and branched endografts are not currently available. An 82-year-old man, who underwent EVAR two years previously, was admitted to our hospital because of pararenal AAA measuring 56 mm. He underwent endovascular treatment with the chimney technique for bilateral renal arteries. We used a self-expanding and balloon-expandable uncovered-stent in renal arteries. Postoperatively he had slight renal dysfunction and acute pancreatitis, but was discharged 14 days after surgery. EVAR with the chimney technique for bilateral renal arteries was thought to be useful in high risk patients with pararenal AAA.

Mediastinitis caused by methicillin-resistant Staphylococcus aureus (MRSA) is a severe complication after coronary artery bypass grafting (CABG). Vacuum-Assisted Closure (VAC) therapy is a technical innovation in wound care. The advantage of VAC is the application of negative pressure to sternal wounds. A 73-year-old man was admitted to our hospital because of operation for triple vessel disease including left main coronary artery lesion. Off-pump CABG was performed using the bilateral internal thoracic arteries and right gastroepiploic artery. The postoperative course was uneventful. However, purulent discharge from a median sternostomy wound appeared on the 11th postoperative day. MRSA was identified by the culture of the wound exudate. On operation, the necrotic tissue was removed, and continuous irrigation and drainage were performed. Conventional technique was not effective. VAC therapy was applied on the 35th postoperative day. During VAC therapy, the wound became smaller and granulation tissue proliferated. VAC therapy was discontinued on the 208th postoperative day. Finally, the wound was naturally closed. He was discharged in good condition on the 213th postoperative day. VAC therapy was an effective treatment for MRSA mediastinitis after cardiac surgery.