Two-Staged Operation for Multiple Aortic Aneurysm
Etsuro Suenaga Hisao Suda Yuji Katayama
Manabu Sato Noriko Yamada Tsuyoshi Itoh*

(Department of Cardiovascular Surgery, Nagasaki Kouseikai Hospital, Nagasaki, Japan and Department of Thoracic and Cardiovascular Surgery, Saga Medical School*, Saga, Japan)

A 69-year-old man was admitted for treatment of thoracic aneurysm. DSA revealed multiple aortic aneurysms: three true aneurysms which were located at the distal arch, the thoracoabdominal aorta at the diaphragm level and the infrarenal abdominal aorta, 60 mm, 55 mm and 55 mm in diameter, respectively and two pseudo-aneurysms which were located in the abdominal aorta just below the right renal artery and the right common iliac artery. We decided to perform a two-staged operation. Before the first operation, 1,200 ml of autologous blood was stored for perioperative blood transfusion. Initially, total arch replacement was performed using deep hypothermic circulatory arrest and antegrade selective cerebral perfusion. One month after the first operation, total thoraco-abdominal aorta replacement was performed by a retroperitoneal approach with mild hypothermia. The Th 9, 10 and 11 intercostal arteries were reconstructed. Distal anastomosis was performed at both common iliac arteries. Blood transfusion was not reqired for blood pooling and reduction of primig volume in the cardiopulmonary bypass system.
@Jpn. J. Cardiovasc. Surg. 29: 396-399 (2000)