AAAD (Acute type A aortic dissection) may cause trauma, due to a fall down with LOC (loss of consciousness), which can be missed when the disturbance of consciousness is prolonged. Intraoperative heparinization may result in persistent bleeding, and trauma due to a fall with LOC associated with acute aortic dissection should always be kept in mind. An 81-year-old woman underwent emergency surgery for ruptured AAAD with LOC. Preoperative hemodynamics were unstable and low blood pressure persistent even after release of the cardiac tamponade. The partial arch replacement with brachiocephalic artery reconstruction was performed. Before the chest was closed, a large amount of bloody ascites was noted in abdomen and multiple traumas of the liver were found, resulting in a diagnosis of traumatic liver injury due to a fall with LOC. The patient had liver cirrhosis and coagulation abnormality, and hemostasis was difficult to achieve. The operation was finished with gauze packing and placed ABTHERA® was placed for open abdominal wounds. The abdomen was closed in the second stages. The patient's postoperative course was good, and the patient was transferred for continued rehabilitation.

A 45-year-old man with no history developed pain and paralysis in his left lower extremity. When he visited his previous physician, CT was performed, which showed Stanford type A aortic dissection with an aberrant right subclavian artery and Kommerell's diverticulum and narrowing of the true lumen of the left common iliac artery. He was accompanied by lower limb symptoms. He was then rushed to our hospital for emergency surgery. The operation was planned and performed in two stages. A median sternotomy was conducted, and cardiopulmonary bypass using the right common femoral artery, left axillary artery, and right atrium was initiated. Deep hypothermic circulatory arrest and antegrade selective cerebral perfusion were performed. The tear's entry was located in the distal arch of the aorta. The aortic arch was transected between the left common carotid and left subclavian arteries. We inserted an open stent graft to cover the diverticulated origin of the right subclavian artery. The left subclavian artery was reconstructed using a fenestration technique. The ascending aorta, aortic arch, and right and left common carotid arteries were reconstructed using a 4-branch prosthesis graft. The right subclavian artery was reconstructed through the thoracic cavity. On the day after the surgery, we performed percutaneous embolization of the right subclavian artery distal to the Kommerell's diverticulum. Postoperative CT showed no endoleakage or blood flow to the Kommerell's diverticulum. The patient's postoperative course was uneventful.