Abstract
A 67-year-old woman underwent simultaneous surgical treatment of aneurysms in the descending thoracic and abdominal aorta. The aneurysm in the descending thoracic aorta was 5.0cm in diameter. The abdominal lesion which was accompanied by closed partial dissection was located below the renal arteries and its diameter was 7.8cm. First, the patient was positioned in right decubitus position and left thoracotomy was made. The descending thoracic aorta was replaced with an artificial graft under partial cardiopulmonary bypass through the left femoral vein and artery. Thoracotomy was closed after removal of cardiopulmonary bypass and neutralization of heparin with protamine sulfate. The patient's position was then changed to supine, and following median laparotomy, her abdominal aorta was replaced with an artificial graft. Her postoperative course was entirely uneventful except for slight hoarseness and transient urine disorder. Although simultaneous operation for multiple aneurysms may give more surgical stress to patients, it can reduce the risk of rupture of the remaining aneurysm as compared with surgical treatment in two stages. The order in which aneurysms are operated on should be considered well in simultaneous operation. It was considered in this case that the thoracic lesion should be treated first because crossclamping of the abdominal aorta may increase cardiac afterloads and result in rise of intraluminal pressure and rupture of the thoracic aortic aneurysm.
