A 58-year-old man was admitted with a diagnosis of an acute Stanford type A aortic dissection after 20-year-long steroid therapy for hypopituitarism. The graft replacement of the ascending aorta was performed as an emergency procedure under deep hypothermic selective cerebral perfusion. We administered 1, 000mg of methylprednisolone during cardiopulmonary bypass, injected 500mg/day of hydrocortisone during postoperative day 1 to 4, and then administered orally 40mg/day of hydrocortisone. Then 200μg of levothyroxine sodium was given orally from postoperative day 6. There are some reports about acute aortic dissection associated with long-term steroid therapy in SLE or aortitis syndrome, but reports involving hypopituitarism are very rare.

A 85-year-old man was admitted to our hospital with a right iliac artery anastomotic pseudoaneurysm after aorto-biiliac Y-shaped graft replacement for the treatment of abdominal aortic and biiliac aneurysms. We performed an endovascular intervention of this anastomotic pseudoaneurysm with an ePTFE-covered stent-graft. This method seemed to be very useful even in such a high-risk patient, because it can be done under local anesthesia.