The patient was a 63-year-old man. He underwent total arch replacement for Stanford type A acute aortic dissection. Eleven years after surgery, blood tests showed anemia, elevated LDH and direct bilirubin levels, and a visual blood test detected crushed red blood cells, leading to a diagnosis of hemolytic anemia. The Computed tomography showed a highly kinked graft, and the catheter test showed an increase in the pressure gradient before and after the kinked graft, suggesting that the patient had hemolytic anemia caused by the kinked graft. Because he also had moderate aortic regurgitation and a patent foramen ovale, he underwent resection of the kinked graft, ascending aortic replacement, aortic valve replacement, and closure of the foramen ovale. The postoperative course was good, and hemolytic anemia was not observed.

We report a case of a 53-year-old woman, who was transported as an emergency case to our institution because of type A acute aortic dissection. Total arch replacement and coronary artery bypass grafting (CABG) with open stent graft was performed. After the operation, during rehabilitation for discharge (33 and 38 days after the surgery), she developed acute arterial occlusion of the right lower limb, and we performed thrombectomy. Both thrombi extracted from the right common femoral artery were organized clots. No perioperative arrhythmia was observed, and no obvious left atrial appendage thrombus was observed on CT. We performed angiography to diagnose the cause of the spread of organized clots, and an entry was detected at the distal tip of the open stent graft, and antegrade blood flow in a false lumen was observed. We considered that the thrombus was caused by the antegrade blood flow in a false lumen, TEVAR (c-TAG) was performed to seal the entry 48 days after the surgery. Embolism did not occur afterward, and the patient was discharged for rehabilitation.