A 75-year-old woman was referred to our hospital with sudden onset of chest and back pain. She showed ventricular fibrillation during transportation and shock vitals on arrival at the hospital. An electrocardiogram (ECG) showed ST segment elevation in aVR, and emergency coronary angiography (CAG) was performed. CAG revealed malperfusion of the left main coronary artery (LMT) due to type A aortic dissection. Emergency percutaneous coronary intervention (PCI) was performed and coronary revascularization was achieved. Strict blood pressure management was performed in the intensive care unit. She underwent ascending aortic replacement two days after onset of the disease. Although she required long-term postoperative ventilator management, she did not develop low output syndrome (LOS). In this case, emergency PCI minimized myocardial ischemia, and LOS could have been avoided by waiting for circulation to recover and then performing surgery.

A 67-year-old man underwent endovascular aneurysmal repair for an abdominal aneurysm at another hospital about a year earlier. He presented to us with complaints of abdominal pain with an accompanying fever. Contrast-enhanced CT revealed a stent graft thrombus, with discontinuity of the aneurysmal wall, and a mass in the left retroperitoneal space, suggesting stent graft infection. The patient's fever initially subsided with antibiotic treatment, but soon recurred. Plain CT revealed an enlarged left retroperitoneal mass, which was determined to be a contained aneurysmal rupture. The stent graft was surgically removed urgently without incident and, upon examination of the removed stent graft, it was noted that there was a section of yellowish-white tissue attached to the stent graft and definitive evidence of infection was apparent. Thorough debridement of the aneurysmal wall was performed, leaving a segment of the posterior wall intact. In-situ reconstruction was carried out using a Gelsoft graft soaked in rifampicin. There was evidence of purulent pus outflow and cholecystitis during the ablation procedure of the hepatic flexure for omental filling. Post cholecystectomy, the reconstructed vascular graft was covered with omentum. A bacterium, Bacteroides thetaiotaomicron, was detected in the pus, bile, and on the stent graft removed during the surgical procedure. Subsequently, a diagnosis of hematogenous stent graft infection during the course of acute cholecystitis was made. The postoperative course of the patient was uneventful, with no recurrence of infection observed in the 3 months following surgical intervention.