In two cases of thromboangitis obliterans (TAO) a popliteal-posterior tibial-peroneal artery sequential bypass was attempted through a median approach. The 1st case underwent the operation successfully with non-reversed saphenous vein graft. However, only popliteal-peroneal bypass was carried out in the 2nd patient because the posterior tibial artery was severely affected. In surgery of TAO patients, careful assessment of preoperative angiographic findings is important to select the site of distal anastomosis. We found that the posterior tibial artery and the peroneal artery are easily accessible through the medial route in the proximal half of the lower leg and that peroneal artery revascularization was effective for limb salvage.

A 67-year-old man suffered acute arterial occlusion caused by emboli from aneurysms in a right axillo-bifemoral graft using Cooley double velour knitted Dacron, which was inplanted 10 years and 10 months before the admission. The patient underwent urgent redo surgery; left axillobifemoral bypass with 6mm ringed PTFE graft and right femoropopliteal bypass with in situ saphenous vein were performed successfully. Several clinical experiences by others demonstrated that Cooley double velour knitted Dacron graft, manufactured before June, 1981, might have possible aneurysmogenic factors, therefore cases in which it has been employed should be followed up carefully.

We reviewed the results of 14 patients who underwent the operation of thoracic aneurysms using a centrifugal pump. Nine patients had atherosclerotic aneurysms and 5 had aortic dissections. The autotransfusion system (ATS) was used to keep hemodynamic stability by rapid transfusion. The ATS consisted of a roller pump, a 2, 000ml reservoir and a heat exchanger. Two mg/kg of heparin was given to the patients to keep ACT over 400 seconds. All patients survived. Body temperature increased 0.08±0.59°C during bypass with the ATS, and no patients showed hemodynamic instability after aneurysmotomy under the help of the ATS. We conclude that 1) the centrifugal pump is a useful and safe assisting means for the surgery of thoracic aneurysms, 2) the autotransfusion system has advantages as follows: keeping stable circulation and preventing loss of body temperature during bypass.