1.A Case Report of Endovascular Repair by a Pull-through Technique for Iatrogenic Right Subclavian Artery Injury
Hironori BABA ; Ayaka IWASAKI ; Eisaku NAKAMURA
Japanese Journal of Cardiovascular Surgery 2023;52(5):349-349
A 52-year-old man presented himself to his family doctor for uremia associated with prerenal acute renal failure. A 12 Fr vascular access catheter was inserted via the right internal jugular vein for emergency dialysis. A contrast-enhanced computed tomography (CT) scan revealed that the catheter had penetrated the right internal jugular vein, perforated the right subclavian artery, and reached the ascending aorta. Under general anesthesia, we completed the procedure with a pull-through technique between the bilateral brachial arteries. A vascular occlusion balloon was inserted from the left brachial artery and a GORE VIABAHN stent graft was inserted from the right brachial artery. The postoperative course was good and he has been free from hemorrhagic episodes. He was transferred to the referring hospital on postoperative day 2.
2.A Case Report of a Ruptured Abdominal Aortic Aneurysm Associated with Thrombosed Acute Type B Aortic Dissection
Hironori BABA ; Ayaka IWASAKI ; Kosuke MORI ; Eisaku NAKAMURA
Japanese Journal of Cardiovascular Surgery 2024;53(2):87-90
A 70-year-old man with no outpatient history visited the local doctor with complaints of weakness of the limbs and abdominal pain on the following day after vomiting on the previous night. He was suspected to have a ruptured abdominal aortic aneurysm from a simple CT scan of the abdomen, and was transported to our hospital for emergency treatment. After a contrast-enhanced CT scan at our hospital, a thrombosed type B aortic dissection and ruptured abdominal aortic aneurysm were diagnosed, and emergency surgery was performed on the same day. Although the dissection had extended to the abdominal aortic aneurysm, abdominal aortic endovascular repair (EVAR) was performed because it was a thrombosed type B aortic dissection. After admission to the intensive care unit (ICU), the patient showed intra-abdominal hypertension and oliguria. So, we performed an emergency decompressive laparotomy against abdominal compartment syndrome (ACS). He was discharged from the ICU on the 8th day and transferred to rehabilitation on the 38th day. We report a case of a ruptured abdominal aortic aneurysm associated with thrombosed acute type B aortic dissection that was successfully treated.
3.A Case of Aortic and Mitral Stenoses Recovered from Thrombocytopenia after Double Valve Replacement
Kousuke MORI ; Mitsuhiro YANO ; Masakazu MATSUYAMA ; Masanori NISHIMURA ; Katsuya KAWAGOE ; Ayaka IWASAKI
Japanese Journal of Cardiovascular Surgery 2018;47(5):220-223
A 77-year-old-woman was hospitalized at our institution following the diagnosis of severe aortic and mitral stenoses. Although she had thrombocytopenia before surgery, bone marrow examination revealed no abnormality. Thrombocytopenia was thought to be caused by shear stress accompanying valvular diseases. She underwent surgery for the replacement of aortic and mitral valves and the resection of left ventricular outflow tract myocardium. Because the mitral valve involved the calcification of the annulus the valve replacement was performed after decalcification using CUSA. After surgery, she experienced a transient sick sinus syndrome ; however, the overall course was good, and the platelet counts spontaneously recovered. More than 12 months have passed since surgery, but the platelet counts remains around 110,000.