Transesophageal pacing (TEP) was performed in 54 patients with atheroscrelotic vascular disease to detect ischemic heart disease (IHD). Thirty patients had arteriosclerosis obliterans of the lower extremities (ASO) and 24 patients aortic aneurysm (AA). All patients underwent coronary arteriography. Sensitivity for the diagnosis of IHD was 90% and the specificity 67%, accuracy 83% in ASO and sensitivity 80%, specificity 93%, accuracy 88% in AA. In both vascular diseases the sensitivity was 87%, the specificity was 83%, and the accuracy was 85%. These results suggest that TEP is a useful screening test to detect IHD in patients with atheroscrelotic vascular disease who are candidates for surgery.

Lipoprotein(a) [Lp(a)] has been considered as an independent risk factor for arteriosclerotic diseases. With an anticipation that Lp(a) would also serve as a risk factor for abdominal aortic aneurysms (AAA), we analyzed serum and tissue Lp(a) levels of patients with AAA in relation to those in healthy individuals. Serum Lp(a) levels were significantly higher in the AAA group (53.2±60.8mg/dl) than in the healthy controls (14.6±13.6mg/d) (p<0.001). The Lp(a) level in the aneurysmal wall of patients with AAA was 49.8±38.2ng/mg. There was a significant correlation between serum and aneurysmal wall Lp(a) levels in AAA patients (r²=0.79, p<0.01). Immunohistochemical examination revealed Lp(a) in the extracellular matrix of the middle layer of the tunica intima, but not in the tunica media or externa.

We reviewed our experience with 4 cases of chronic dissecting aortic aneurysm (DeBakey IIIb) with the false lumen extending into the abdominal aorta and major branches being perfused from the false lumen. In such cases, resection of the intrathoracic portion of the aneurysm and closing of the distral false lumen may exclude visceral perfusion from the false lumen. In order to ensure continued perfusion of true and false lumens after repair, we performed “double barrel” anastomosis for distal anastomosis in graft replacement of the descending aorta. Follow-up periods ranged from 8 to 21 months, 17 months on average. Postoperatively, neither apparent expansion of the false lumen nor compression of the true lumen was found in these cases. The advantage of this procedure is the effective restoration of visceral perfusion. We emphasize that this procedure is one of the choices of procedures, as a two-staged approach for chronic aortic dissection presenting with visceral perfusion from the false lumen and without an enlarged abdominal aorta, though more patients and longer follow-up are required to fully evaluate this procedure.