Forty-four cases of ruptured abdominal aortic aneurysm were treated between January 1980 and December 1995. We classified the cases into three groups: Group I, 1980-1984; Group II, 1985-1989; and Group III, 1990-1995 and evaluated the surgical results, the preoperative states, the bleeding and blood transfusion volume and so on. The surgical results have improved every year and there were no surgical deaths during the past seven years. Most of the causes of previous surgical deaths were DIC (4 cases) and renal failure (3 cases). The volume of intraoperative bleeding was 7227.3±3293.4ml in Group I, 4176.0±2577.9ml in Group II and 1781.9±1877.0ml in Group III. The volume of intraoperative blood transfusion was 6975.5±2711.6ml in Group I, 4826.7±2596.6ml in Group II and 3542.4±1561.5ml in Group III. We decreased the volume of intraoperative blood transfusion significantly in Group III by using a Cell Saver. The surgical results have improved significantly due to the decrease of bleeding and blood transfusion under the rapid control of bleeding and the autotransfusion of shed blood using the Cell Saver. The technique of postoperative care also contributed to the more satisfactory results.

Ruptured vertebral artery dissecting aneurysm is more prone to re-bleeding and thus needs immediate surgical management. We present a case of 47 years old male with ruptured vertebral artery dissecting aneurysm which was immediately treated by endovascular surgery. Coil occlusion of the vertebral artery at the aneurysm site was performed. As emergency open surgery is often not possible, this case shows that endovascular surgery is an effective and helpful alternative.

We describe a case of successful open-cell stent deployment across the wide neck of a large middle cerebral artery aneurysm using the stent anchor technique. A microcatheter was looped through the aneurysm and navigated into a distal vessel across the aneurysm neck. Although the loop of the microcatheter in the aneurysm straightened as it was gently withdrawn, the microcatheter again protruded into the aneurysm by open-cell stent navigation. The stent was partially deployed in a vessel distal to the aneurysm neck, withdrawn slowly to straighten the loop of the microcatheter in the aneurysm, and completely deployed across the aneurysm neck. After successful stent deployment, stent-assisted coil embolization was performed without complications. The stent anchor technique was successfully used to deploy an open-cell stent across the aneurysm neck in this case of microcatheter protrusion into the aneurysm during stent navigation.
Aneurysm ; Embolization, Therapeutic ; Endovascular Procedures ; Intracranial Aneurysm* ; Neck* ; Stents* ; Subarachnoid Hemorrhage

Coronary-subclavian steal (CSS) can occur after coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA). Subclavian artery (SA) stenosis proximal to the ITA graft causes CSS. We describe a technique for cardiac and cerebral protection during endovascular stenting for CSS due to right SA origin stenosis after CABG. A 64-year-old man with a history of CABG using the right ITA presented with exertional right arm claudication. Angiogram showed a CSS and retrograde blood flow in the right vertebral artery (VA) due to severe stenosis of the right SA origin. Endovascular treatment of the right SA stenosis was planned. For cardiac and cerebral protection, distal balloon protection by inflating a 5.2-F occlusion balloon catheter in the SA proximal to the origin of the right VA and ITA through the right brachial artery approach and distal filter protection of the right internal carotid artery (ICA) through the left femoral artery (FA) approach were performed. Endovascular stenting for SA stenosis from the right FA approach was performed under cardiac and cerebral protection by filter-protection of the ICA and balloon-protection of the VA and ITA. Successful treatment of SA severe stenosis was achieved with no complications.
Arm ; Brachial Artery ; Carotid Artery, Internal ; Catheters ; Constriction, Pathologic* ; Coronary Artery Bypass* ; Endovascular Procedures ; Femoral Artery ; Humans ; Mammary Arteries ; Middle Aged ; Stents* ; Subclavian Artery* ; Subclavian Steal Syndrome* ; Transplants ; Vertebral Artery