A 76-year-old man had increasing thoracic and abdominal aortic aneurysms. First, endovascular repair was performed on the thoracic descending aorta, but type Ib endoleak persisted due to severe aortic calcification. Additional treatment was planned since the maximum diameter of the thoracic and abdominal aortic aneurysms had increased to 75 and 70 mm, respectively. Due to the fact that aortic calcification was present from the aortic arch to the bilateral iliac arteries, which is sometimes referred to as porcelain aorta, conventional open thoracoabdominal aortic repair or hybrid repair using retrograde debranching seemed impossible. Therefore we performed antegrade visceral debranching from the ascending aorta followed by endovascular thoracoabdominal aortic repair successfully. For the thoracoabdominal aortic aneurysms which present difficulty in performing conventional open surgical repair or hybrid repair with retrograde debranching from the iliac artery. This technique can be an effective alternative strategy, but still needs further investigation, including its indications, due to the high surgical stress associated with the procedure.

Recently, the palliative care team (PCT) at our hospital has included dentists. Among a total of 127 cancer patientsand required PCT intervention from 2009 to 2014, 17 patients (13.3%) had oral symptoms. Therefore, the PCT held discussions in order to determine the optimal way to treat each patient. Various symptoms, including oral pain, dry mouth, taste disturbance, furred tongue, excessive amounts of saliva, appetite loss, and trismus were treated by the dentists. As a result, the oral findings improved in all patients, while the oral symptoms improved in 16 of the 17 patients (94%). Thanks to the fact that dentists have joined the PCT, oral symptoms are effectively relieved, and PCT members now have an increased interest in oral cavity complications. Furthermore, conducting thorough examinations of the oral cavity by the PCT not only results in an improved QOL, but it has also increased the interest in the oral cavity on the part of the PCT. Therefore, more effective palliative care is expected to be achieved by promoting increased cooperation with more clinical departments.