A 53-year-old man who complained of chest pain was admitted. He had been on hemodialysis for chronic renal failure since age 34 and suffered from painful abdominal skin ulcer of unknown etiology when he was 49 years old. His coronary angiography showed severe coronary stenosis on the left main trunk and triple vessels. Preoperative CT revealed severe systemic vascular calcification. He underwent coronary artery bypass grafting using the left internal thoracic artery and saphenous vein grafts. Postoperatively, his left anterior chest wall changed into the painful necrosis. On the 43rd postoperative day, VAC therapy was started after the debridement of necrotizing tissue. Histological examination confirmed that it was ischemic necrosis due to stenosis of the vascular lumen with medial calcification and intimal hyperplasia resembling “calciphylaxis”. Performing the sternal excision and skin grafting for the sternal dehiscence, he was discharged on the 148th postoperative day with perfect healing of the chest wall. The calciphylaxis was suspected to be the cause of this rare complication. Therefore, we should consider this matter carefully whenever we harvest the internal thoracic artery for patients who undergo coronary bypass grafting and who require hemodialysis for chronic renal failure.

A 79-year-old woman complained of chest pain during hemodialysis. At 65 years of age, she underwent total arch replacement for acute aortic dissection. The following year, she underwent thoracic endovascular aortic repair and Y-graft replacement of a thoracoabdominal aortic aneurysm. Since the age of 73 years, she has been on hemodialysis for chronic renal failure. At 77 years of age, she underwent a modified Bentall procedure and mitral valve annuloplasty for a huge pseudoaneurysm at the aortic root and for mitral regurgitation. One year after the surgery, computed tomography (CT) showed a pseudoaneurysm around the aortic root. Although asymptomatic at the time of her follow-up visit, she developed chest pain during hemodialysis 20 months following the Bentall procedure. CT revealed progressive dilatation of the aortic root pseudoaneurysm. Coronary angiography showed severe stenosis of the right coronary artery. During the redo operation, findings indicated the presence of oozing type of bleeding from the needle hole from the previous artificial graft. We experienced a rare case of a huge aortic root pseudoaneurysm due to oozing from the needle hole at the artificial graft.