A 73-year-old man complained of pain in the right lower abdomen with hypotension. The result of abdominal computed tomography (CT) suggested a rupture of an abdominal aortic aneurysm. Emergency Y graft replacement was performed. During surgery, a perforation of about 1cm in diameter was found in the posterior wall of the abdominal aorta just above the iliac bifurcation. The patient developed postoperative complication of retroperitonitis. The cultures of blood clots collected during surgery grew Bacteroides fragilis, as did postoperative drainage fluid from the retroperitoneum. On the 10th day of illness, axillo-bifemoral bypass was performed and the Y graft was removed. Although continuous lavage of the retroperitoneum was performed, he did not recover from retroperitonitis and died of sepsis 2 months after surgery. Infected abdominal aneurysm is rarely caused by Bacteroides. We discussed the infectious route and treatment of this rare condition with a review of the literature.

We report an extremely rare case of leiomyosarcoma originating from the abdominal aorta. The patient was a 57-year-old man who had palpable abdominal mass with pain. The symptoms were consistent, and urgent operation was done due to impending rupture of the abdominal aortic aneurysm. The intraoperative findings showed that the mass was a primary tumor of the abdominal aorta, and the histological diagnosis was leiomyosarcoma. It is reported that its prognosis is very poor, but he survived 7.5 years after diagnosis by reason of aggressive management including surgical treatment, chemotherapy and radiotherapy.

We report a 30-year-old patient with von Willebrand disease who received AVR under cardio-pulmonary bypass. AR was diagnosed at the age of 13, and von Willebrand disease was revealed after cardiac catheterization because of a bleeding episode. His von Willebrand factor (vWF) activity was significantly low, 43% of normal. Infusion of vWF concentrates (Confact F^®) was administered before surgery. AVR was safely performed and no bleeding complications occurred during the perioperative period. Blood transfusion was unnecessary, vWF infusion was considered to be very useful.

A 53-year-old man who had angina pectoris and juxtarenal aortic abdominal aneurysm was referred to our department. Because the coronary angiography showed severe triple vessel disease, coronary bypass grafting was performed prior to aneurysmectomy. Contrast enhanced computed tomography revealed a retroaortic left renal vein located behind the posterior wall of the aneurysm. The postoperative course was uneventful. Because of its complicated embryological development, the anatomy of the renal veins shows extensive variability. The incidence of retroaortic left renal vein was 2%. Large lumbar and retroperitoneal veins often joined it to form a complex retroaortic venous system. These veins are particularly vulnerable to injury during circumferential dissection of the proximal parts of the aorta. Unawareness of this anomaly and vigorous attempts at encircling the aorta with clamps can result in laceration of the vein. Subsequent catastrophic hemorrhage may lead to unfavorable results, nephrectomy or death. Therefore, preoperative evaluation by a contrast enhanced CT scan and adequate intraoperative management based on a understanding of the potential anatomical variations are imperative. We recommend crossclamp of the aorta proximally with a vertical clamp to avoid circumferential dissection with possible injury to a retroaortic left renal vein. Injury may necessitate division of the aorta to obtain exposure for venous repair. In addition, this anomaly may be related to aorto-left renal vein fistula syndrome and left renal vein entrapment syndrome.