A girl was given a diagnosis of Takayasu arteritis (TA) with thoracic aortic aneurysm (TAA) at 11 years old, and began receiving medical treatment using steroids. At age 19, her biological inflammation markers were within normal limit ; however, contrast-enhanced CT showed the enlargement of the TAA to 60 mm in diameter. The risks and benefits of traditional revascularization vs endovascular procedures were carefully considered. The presence of suitable anatomical conditions, including adequate 20-mm-long landing zones, led us to select an endovascular approach. We exposed the right common iliac artery via a retroperitoneal approach, then, original stent grafts, using Z stents covered with thin-wall polytetrafluoroethylene, were positioned in the descending aorta from the level of the left subclavian artery to the level of the celiac artery. Intraoperative arteriography showed a patent stent graft without endoleaks or enlargement of the TAA. The postoperative course was uneventful, and follow-up CT scan performed 4 years after the repair showed shrinkage of the aneurysm diameter, and no evidence of any endoleaks. We concluded that endovascular treatment for TA-related aneurysm can be useful and safe, but further follow-up is needed in this case.

We have studied post tetanic count (PTC) and single twitch height at the onset of reflex movement to carinal stimulation after administration of vecronium to 10 female patients under total intravenous anesthesia. During spontaneous recovery from vecronium-induced neuromuscular block, the carina was stimulated at every 120s. It took 18.7±5.5 minutes before reflex movement started, T1% was 1.9±2.2%, and PTC was 11.59±5.3 counts. In 5 cases, T1% did not appear at the onset of reflex movement.