Those cases in which a dissected lumen closes early in the onset of acute aortic dissection and produce a“dissected lumen with no blood flow”are regarded as a clinico-pathological entity and are called a“closing aortic dissection”, and the clinical picture and clinical course of 14 cases in which the clinical course could be observed from early onset were reported. Although 13 cases resulted in complete closure of the dissected lumen, one case initially showed incomplete closure, but subsequently closed completely. Two cases resulted in reopening of the blood flow, but the disease recurred, and by four and six weeks each had incompletely or completely reclosed. Consequently, there were three cases of entry observed and scars of entry were found in three other cases. And in eight cases, there was nothing observed at all. Although one patient died because of complications of secondary type I acute dissection, all the others survived. All told, the developmental mechanism of this disease was alluded to.

Two hundred fourteen cases treated surgically for aortic aneurysms between Jan. 1986 and Dec. 1991 at our hospital. Among them, 15 cases (7.0%) had multiple aortic aneurysms. In 10 cases, aneurysms were resected completely: 9 simultaneously (one-stage operation) and 1 separately (two-stage operation), although in 5 cases there remained another aneurysm left even after operation. In all cases who had one-stage operation, the combination of sites of aneurysms were descending thoracic aorta and infra-renal abdominal aorta. Temporary bypass (n=4), centrifugal pump (n=4) or cardiopulmonary bypass (n=1) were employed as supportive methods during aortic cross-clamp. There were neither operative nor late death in one-stage operation group, although one patient died due to rupture residual aneurysm 1.2 years after the first operation. In these patients, vascular disease are expected to be present systemically, so that operative method should be determined carefully under consideration of poor general condition and another risk factors. We recommend, however, that simultaneous one-stage operation for multiple aortic aneurysm might be safe and fully acceptable procedure, especially in case of those whose aneurysms exist in descending thoracic and infra-renal abdominal aorta.