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1 Marfan Marfan 4 10 Marfan 1 44Marfan II + IIIb Bentall Björk-Sheily 25mm + Hemashield 28mm graft Tel: Hemashield 28mm graftth mm warfarin potassium 12 5 warfarin potassium aspirin cm 72kg 80 / 110 / 68mmHg 37.7 C WBC / l Hb 12.8g / dl HCT 38.5CRP 5.94mg / dl CRP BUN 10mg / dl Cre 0.78mg / dl GOT 20IU / L GPT 20IU / L LDH 363mg / dl PT 12.0s 29
2 15 1 SMA SVG to CHA SVG to SMA A B Fig. 1 A) Retrograde mesenteric and celiac bypass by saphenous vein graft (SVG) was performed. SMA: superior mesenteric artery, CHA: common hepatic artery. B) Schema of bypass procedure. APTT 28.2s Fib 386mg / dl TOT 77 BE 0.4mmol / L Lactete 3.16mmol / L X 58 CT computed tomography celiac artery; CA superior mesenteric artery; SMA CT CA SMA SMAcommon hepatic artery; CHA 2 Fig. 1 SMA 850ml / min CHA 75ml / min SMA SMA 30ml / min ICU intensive care unit
3 SMA CA Fig event warfarin potassium Aspirin 200mg / day Hepatic artery SVG SMA Beebe ml / min SMA 850ml / min SMA CA Fig. 2 Postoperative digital subtraction angiography revealed thrombotic occlusion of celiac and superior mesenteric arteries, and its were demonstrated by bypass graft only. 5, 8 6, 7, 10 in flow SMA CA 31
4 15 1 warfarin potassium CT warfarin potassium aspirin 200mg / day 2 event CT SMA CA SMA / 1 Cambria, R. P., Brewster, D. C., Moncure, A. C., et al.: Recent experience with thoracoabdominal aneurysm repair. Arch. Surg., 124: , Hollier, L. H., Symmonds, J. B., Parolero, P. C., et al.: Thoracoabdominal aortic aneurysm repair: Anarysis of postoperative morbidity. Arch. Surg., 123: , Schepens, M. A. A. M., Defauw, J. J. A. M., Hamerlijnck, R. P. H. M., et al.: Surgical treatment of thoracoabdominal aortic aneurysms by simple crossclamping: Risk factors and late results. J. Thorac. Cardiovasc. Surg., 107: , Schepens, M. A. A. M., Dekker, E., Hamerlijnck, R. P. H. M., et al.: Survival and aortic events after graft replacement for thoracoabdominal aortic aneurysm. Cardiovasc. Surg., 4: , Yamashiro, S., Kuniyoshi, Y., Miyagi, K., et al.: Successful management in the case of mesenteric ischemia complicated with acute type A dissection. Ann. Thorac. Cardiovasc. Surg., 8: , Cambria, R. P.: Management of thoracoabdominal aortic aneurysms. Surgery of the Aorta and Its Branches, Gewertz, B. L. and Schwartz, L. B. eds., Philadelphia, 2000, W. B. Saunders Co., pp Gewertz, B. L.: Surgical treatment of chronic mesenteric ischemia: Bypass procedures. Surgery of the Aorta and Its Branches, Gewertz, B. L. and Schwartz, L. B. eds., Philadelphia, 2000, W. B. Saunders Co., pp Yamashiro, S., Kuniyoshi, Y., Miyagi, K., et al.: Type B dissection complicated with subacute visceral ischemia. Asian Cardiovasc. Thorac. Ann., 12: , Beebe, H. G., MacFarlane, S. and Raker, E. J.: Supraceliac aortomesenteric bypass for internal ischemia. J. Vasc. Surg., 5: , Moawad, J., McKinsey, J. F., Wyble, C. W., et al.: Current results of surgical therapy for chronic mesenteric ischemia. Arch. Surg., 132: ,
5 Visceral Ischemia on 10 Years after Total Aortic Replacement Include Reconstruction of Mesenteric and Celiac Arterial Branch Case Satoshi Yamashiro, Yukio Kuniyoshi, Kazuhumi Miyagi, Toru Uezu, Katsuya Arakaki and Kageharu Koja Second Department of Surgery, School of Medicine, University of the Ryukyus Key words: Total aortic replacement, Visceral ischemia, Bypass of visceral arteries A 44-year-old man with Marfan syndrome underwent total aortic graft replacement including Bentall s procedure and reconstruction of the visceral branches 10 years previously. He was brought by ambulance because of abdominal pain high fever with diarrhea and tarry stool. We performed emergency laparotomy on the suspicion of intestinal ischemia. Intestinal necrosis with perforation was recognized, from the ascending colon to the transverse colon. We diagnosed ischemic necrotic colitis due to arterial thrombosis because pulsation of the superior mesenteric artery and celiac artery was not clear. We performed right hemicolectomy and splenectomy, plus retrograde mesenteric and celiac bypass by a saphenous vein graft. The patient s postoperative course was uneventful. Postoperative angiography revealed thrombotic occlusion of the celiac and superior mesenteric arteries. Jpn. J. Vasc. Surg., 15: 29-33,
CT computed tomography
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