A 66-year-old woman attended our hospital for ascending aortic aneurysm. She was admitted with sudden back pain and acute aortic dissection of Stanford type B was revealed by computed tomography. We performed replacement of the ascending aorta and aortic arch with the frozen elephant trunk technique. The left pleural drainage fluid turned cloudy white after diet initiation on postoperative day 2. We diagnosed chylothorax with biochemical analysis and stopped oral intake completely, but the drainage increased to 3,700 ml/day. On postoperative day 8, completely thoracoscopic ligation of thoracic duct was performed. The drainage decreased immediately after the procedure. She could start meals on postoperative day 12 and was discharged on postoperative day 22. We conclude that a completely thoracoscopic ligation of thoracic duct for persistent chylothorax after aortic surgery can lead to early resolution.

A 74-year-old male who had a medical history of thoracic endovascular aortic repair (TEVAR) was referred to us for endoleakage. A total of 21 years ago, he underwent emergent descending aortic grafting for aortic aneurysm rupture at his age of 53. After that, 19 years ago, he underwent TEVAR with Matsui-Kitamura stent graft (MKSG) due to pseudoaneurysm formation at the proximal anastomotic site at the age of 55. CT revealed type III endoleakage due to fracture of MKSG and graft. We proceeded to perform TEVAR with Relay Plus successfully, and his endoleakage disappeared. His postoperative course was uneventful. He was discharged from our hospital on the 9th day after the operation, and is now doing well.

This study reports a 38-year-old man who suffered traumatic thoracic aorta injury due to a fall accident during mountain climbing, and was saved by swift helicopter transport and emergency surgery. Approximately 2 h after the accident, the subject was brought to the hospital by the emergency helicopter transport service. Contrast-enhanced CT of the thorax and abdomen revealed leakage of the contrast medium from the aortic isthmus and a hematoma in the surrounding area. Thus, traumatic thoracic aorta injury was diagnosed and emergency surgery was performed. The patient went into a state of shock after being given anesthesia. Further rupture was diagnosed and a left fourth intercostal thoracotomy was performed immediately in order to control the hemorrhage. Concurrently, a partial cardio-pulmonary bypass was used. A lacerated foramen was observed across 1/3 of the lesser curvature of the aortic isthmus ; the affected site was replaced by a prosthetic graft. The postoperative recovery was generally uneventful, and the patient was discharged from the hospital 30 days after the operation.