Here we describe a case involving an elderly man with Citrobacter freundii-associated infectious rupture of a dissecting thoracoabdominal aortic aneurysm. We performed emergency thoracoabdominal aortic replacement using a rifampicin-soaked prosthetic graft and omental flap wrapping. The patient was discharged on postoperative day 255, although he experienced pseudomembranous enteritis and paraplegia.
Simultaneous thoracic and abdominal aneurysms comprise approximately 10–20% of all cases of aortic aneurysms. Whether simultaneous or staged therapy can be used to treat multilevel aortic aneurysms remains controversial. Herein, we report the case of a 79-year-old woman with both huge abdominal and saccular thoracic aortic aneurysms who was referred to our hospital. Multiple stenotic lesions were observed in the major cerebral arteries; moreover, triple-vessel disease was observed on the coronary angiogram. Although this case required immediate primary surgery, cardiopulmonary bypass was difficult due to multiple stenoses in the cerebral arteries. We performed simultaneous surgery with total debranching thoracic endovascular aortic repair, endovascular aortic repair, and off-pump coronary artery grafting. Total debranching thoracic endovascular aortic repair is useful for avoiding neurological complications in cases where cardiopulmonary bypass is difficult. Furthermore, it helps devise an intraoperative cervical branch reconstruction method.
A 77-year-old man with diabetes, dyslipidemia, and a smoking history presented with asymptomatic gross hematuria and left hydronephrosis. Computed tomography (CT) angiography revealed a left ureteral tumor and abdominal aortic aneurysm. Cardiac catheterization revealed right coronary artery (RCA) stenosis. First, a left nephroureterectomy was performed via a midline abdominal incision. To achieve minimal invasiveness, a median sternotomy was avoided, and off-pump coronary artery bypass grafting of the RCA was performed with the great saphenous vein graft, using the left renal artery as the graft inflow. Y-grafting was subsequently performed. Without any postoperative complications, CT angiography confirmed graft patency. This procedure has potential use for removing ureteral tumors by surgeons and clinicians in clinical settings.