The purpose of this case report was to discuss the efficacy of The Amplatzer Vascular Plug (AVP) in endovascular aneurysm repair (EVAR) for ruptured aortoiliac aneurysm. A 73-year-old man was referred to our institution with a diagnosis of ruptured abdominal aortic aneurysm (rAAA) by CT scan. The CT scan showed an rAAA of 70 mm (Fitzgerald classification 3) and a right common iliac aneurysm of 30 mm. The patient was immediately transferred from the ER to the OR and treated with EVAR in combination with occlusion of the right internal iliac artery (IIA) using AVP. The total procedural time was 138 min. The patient recovered uneventfully after the operation with an ICU stay of 2 days and was discharged 9 days after the onset. EVAR has been recognized as a therapeutic option for rAAA in Japan. However, it is not yet been generally adopted as a first-line therapy for rAAA accompanied with iliac aneurysm because of the necessity to occlude IIA. The conventional method with coils to induce thrombosis of IIA is unsuitable for patients in a critical situation for the time required and the difficulty in precise placement. AVP is a nitinol-based self-expanding cylindrical device that is used for arterial embolization. AVP allows assured embolization of IIA in a shorter procedural time, which is essential in an urgent situation. Although AVP is still under post-market surveillance in Japan and only available in limited institutions, the usage of AVP should be considered as an adjunctive procedure in EVAR for rAAA and may expand the limits of endovascular treatment for rAAA.

A 27-year-old man who presented with worsening dyspnea was transferred to our hospital due to congestive heart failure with multiple organ dysfunction. Echocardiogram showed severe left ventricular systolic dysfunction and a huge thrombus in the left ventricle. An urgent operation was performed to remove the thrombus simultaneously with the placement of bilateral extracorporeal ventricular assist devices. After the operation, despite a rapid improvement in the liver function, renal dysfunction persisted and he remained anuric for nearly a month. We continued maximal circulatory support with biventricular assist device to optimize his end-organ function. His renal function gradually improved, allowing him to be registered as a heart transplant candidate on the 140th postoperative day. On the 146th postoperative day, the patient underwent successful removal of the right ventricular assist device, and the left extracorporeal device was replaced by an implantable device (HeartMate II). He was discharged 78 days after the implantation. We present here a case where adequate support with biventricular assist device enabled a successful bridge to transplantation even in a patient with end-stage heart failure having end-organ dysfunction.

We report a case of minimally invasive cardiac surgery (MICS) for partial anomalous pulmonary venous return (PAPVR) to the high portion of the superior vena cava. A 34-year-old female was referred to our hospital for exertional chest oppression, and was diagnosed with PAPVR and a sinus venosus atrial septal defect. Two pulmonary veins were connected to the superior vena cava (SVC) : one to the SVC-atrial junction and the other to the high SVC adjacent to the azygos connection. We performed an intracardiac repair through a small right axillary incision. The postoperative course was uneventful. MICS may become a useful option for PAPVR repair.

Spinal cord ischemia (SCI), a complication of acute aortic dissection, has no established treatment. Here, we report the successful management of three cases of acute type A aortic dissection (ATAAD) with SCI using a multidisciplinary approach. Case 1: A 55-year-old man presented with paraparesis due to ATAAD (non-communicating type), cardiac tamponade, and no loss of consciousness. He underwent emergency surgery for ascending aortic replacement. He awoke 3 h after the surgery; however, as his paralysis was not improved, we initiated multidisciplinary treatment with cerebrospinal drainage, continuous infusion of naloxone, and steroid pulse therapy. These treatments led to the complete resolution of his symptom; he was discharged on Day 32, with no neurological deficits. Case 2: A 50-year-old woman presented with complete paralysis of the left lower limb due to ATAAD (communicating type) but no loss of consciousness. She underwent emergency surgery for ascending aortic replacement. She awoke 2 h after the surgery; however, as her paralysis was not improved, multidisciplinary treatment with cerebrospinal drainage, continuous infusion of naloxone, and steroid pulse therapy were initiated, which led to partial resolution of the symptoms. She could walk with orthotics and was discharged on Day 57. Case 3: A 43-year-old man presented with paraparesis of the left lower limb due to ATAAD (non-communicating type). He was hemodynamically stable, with no loss of consciousness. The ATAAD was conservatively managed, and multidisciplinary treatment with cerebrospinal drainage, continuous infusion of naloxone, and steroid pulse therapy was administered. These therapies led to the complete resolution of his symptoms; he was discharged on Day 46, with no neurological deficits. Hence, for ATAAD with SCI, multidisciplinary treatment, including emergency surgery, is an important therapeutic strategy.

Abdominal compartment syndrome (ACS) is an important postoperative complication of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysms (rAAA). Open abdominal management (OAM) has been reported to be effective in EVAR ; however, only a limited number of reports are available on when and how to close the abdomen. Here we report a case of early abdominal wall closure achieved through the combined use of retroperitoneal hematoma evacuation after EVAR and OAM for rAAA. The patient was a 79-year-old woman who underwent EVAR for rAAA on an emergency basis. She developed ACS after EVAR and underwent OAM. Four days after surgery, a decrease in intraabdominal pressure was confirmed, and subsequent contrast-enhanced computed tomography revealed the absence of an endoleak ; retroperitoneal hematoma evacuation was performed, during which the abdominal wall was closed. The postoperative course was good, and the patient was discharged. Early closure of the abdomen may be possible by concomitant retroperitoneal hematoma evacuation after EVAR and OAM for rAAA.

A 48-year-old woman was scheduled to undergo wrist surgery at the orthopedic surgery clinic. She was adventitiously diagnosed with miliary tuberculosis and saccular-type aneurysms in the suprarenal abdominal aorta and descending thoracic aorta during preoperative examination. Consequently, she received antituberculosis medications. However, the abdominal aortic aneurysm had enlarged rapidly 2 months later. Accordingly, we used an artificial graft patch bonded with rifampicin for the abdominal aortic aneurysm and resected the aneurysm and reconstructed the aorta through partial extracorporeal circulation by clamping the descending thoracic aorta and infrarenal abdominal aorta. Finally, we performed a thoracic endovascular aortic repair of the thoracic aortic aneurysm. Culture of the samples from the wall of the abdominal aortic aneurysm indicated Mycobacterium tuberculosis; therefore, the patient was diagnosed with a tuberculous aneurysm of the aorta. Her postoperative course was good, and she was discharged on day 36. At postoperative month 7, the patient is still on antituberculosis medications and has not experienced a recurrence.