Coronary artery disease (CAD) is common in patients with abdominal aortic aneurysms (AAA). Myocardial infarction is the leading cause of postoperative death and late death after AAA repair. In an attempt to reduce the incidence of perioperative myocardial infarction, routine coronary angiography has been recommended in all patients scheduled for elective AAA repair, and staged myocardial revasculization has been performed using percutaneous transluminal coronary angioplasty (PTCA), if indicated. From March 1987 to February 1995, 40 consecutive patients receiving elective repair of AAA underwent preoperatively coronary angiography. Twenty-one of the 40 patients (53%) had CAD, and in 9 coronary revasculization was indicated. Seven of those patients underwent successful PTCA prior to surgery. One patient had PTCA following surgery for AAA because of technical difficulties in advancing a catheter due to the elongated abdominal aorta. The other patient with triple vessel disease was considered to be unsuitable for PTCA in those days and underwent coronary bypass grafting before AAA repair. There was no operative mortality or perioperative myocardial infarction during and after the repair of AAA. Our results suggest that PTCA should be considered one of the best treatment strategy options for patients with coexistent AAA and CAD.

IABP has been widely used as a circulatory assist device since introduction of the percutaneous insertion method. However, vascular complications associated with IABP have remained a high incidence. We developed a new sheath for IABP insertion to maintain the lower limb perfusion in the patients with tortuous or stenotic iliofemoral arteries. The new sheath has an internal diameter of 12Fr, an outer diameter of 14Fr and has 10 side holes which serve as an internal shunt. The new sheath used for IABP presented good lower limb perfusion in three patients with tortuous or stenotic iliac arteries who presented limb ischemia with an ordinary IABP sheath. The internal shunt sheath may also be useful for diagnosis of lower limb perfusion by injection of contrast medium into a side port of the sheath in cases of leg ischemia suspected after insertion of IABP.

Six patients with malignant retroperitoneal tumor extending into the inferior vena cava (VCI) were surgically treated with use of a normothermic extracorporeal circulation (ECC). Origin of malignant tumor was renal cancer in four, adrenal cancer in one and seminoma in one. Four patients excluding two of renal cancer had metastasis to the lung or bone preoperatively. One of renal cancer with lung metastasis and invasion to the colon died six months after surgery. The remaining five patients have been alive and well with follow up of 1 year to 7 years (mean 3 years 3 months). Cytological examination of an arterial filter of ECC and intra-circuit blood was made and negative in two patients. Long term results and cytology revealed a rare chance of intraoperative dissemination of malignant cells. These results suggested feasibility of surgery using normothermic ECC for the treatment of malignant retroperitoneal tumor with extension into VCI.