We report a case of chronic localized thoracoabdominal aortic dissection with an entry located just above the celiac artery which was successfully treated by patch aortoplasty. The patient was a 55-year-old man who complained of abdominal and back pain. CT scan and angiography showed a localized thoracoabdominal aortic dissection the entry of which was located just above the celiac artery. The patient underwent resection of the aneurysm and patch aortoplasty with the aid of a femoro-femoral bypass. The postoperative course was uneventful. Localized thoracoabdominal aortic dissection has been reported in only 5 cases, including our case, in the Japanese literature.

The possibility of anastomotic pseudoaneurysms as a life-threatening complication following prosthetic graft replacement for an aneurysmal disease or an arterial occlusive disease is well known. However the pseudoaneurysm at an anastomosis between two prostheses is rarely reported. We present a successful surgical treatment for an anstomotic pseudoaneurysm between two prostheses. A 75-year-old man underwent total arch replacement for a true aortic arch aneurysm with the aid of selective cerebral perfusion five years previously. The graft used was a composite prosthesis consisting of 26mm woven Dacron graft for the aortic arch to which a hand-made three-tributary graft was sutured for major three arch vessels. An anastomotic pseudoaneurysm at an anastomotic site between the 26mm graft and a tributary graft was suspected on a chest CT and then differentially diagnosed by aortography. The anastomotic pseudoaneurysm was surgically resected and the anastomosis was repaired with 3-0 polypropylene continuous sutures with the aid of hypothermic circulatory arrest. Anastomotic aneurysm can occur only between a native vessel and a prosthesis but also between two prostheses. Therefore we should make periodical examinations such as CT after prosthetic graft replacement.