A 76-year-old man underwent the aorto-femoral bypass with prosthetic graft at other hospital. Prosthetic graft infection with abcess at inguinal wound occurred 4 months later. A obturator foramen bypass was performed and the infected graft and the inguinal vessels were removed. The obturator foramen bypass is useful extra-antomical bypass.

No case of graft replacement for abdominal aortic aneurysm in a case of congenital deficiency of coagulation factor X III has yet been reported. Recently we performed graft replacement of 66-year-old man with congenital deficiency of coagulation factor X III. Concentrated factor X III separated from human placenta (Fibrogamin^®) was used during, before and after the operation. We measured factor X III activity, and when the activity was so low that replacement therapy was necessary, we administered Fibrogamin immediately. We maintained coagulation factor X III activity at over 70%. No adverse reaction of factor X III replacement therapy was observed. The postoperative course was uneventful and the patient did not have delayed wound healing.

Fifteen consecutive patients with true or dissecting aneurysms of the thoracic descending aorta, and thoraco-abdominal aorta were operated upon under left thoracotomy with the support of partial cardiopulmonary bypass, equipment composed of a membrane oxygenator, centrifugal pump, and percutaneous thin wall cannulae which were all coated with covalently bonded heparin. The polyvinyl tube was coated with Biomate. The administration of systemic heparin was determined by an ACT of around 200 seconds. One perioperative death in a case treated by emergency operation for a ruptured descending aortic aneurysm occurred due to acute myocardial infarction. Other patients tolerated their operation well and are alive. No thromboembolic accident, bleeding tendency, nor organ failure were observed postoperatively in any other patients. In conclusion, the cardiopulmonary bypass using an antithrombotic circuit is safe and recommendable for thoracic descending or thoraco-abdominal aneurysm operations.