A 71-year-old man was admitted to our emergency center complaining of severe pain and cyanosis in both legs. No arterial pulses were palpable in either foot, and emergency aortography revealed thromboembolism of the right knee and left common iliac artery. Thromboembolectomy via a Fogarty catheterTM was performed on both sides and cyanosis disappeared, but swelling developed in the lower leg and pulsation in the right foot was weak even after embolectomy. Angiography 30 days later revealed a peroneal arteriovenous (AV) fistula on the right side. Transarterial embolization (TAE) with a MDC coilTM was performed, and the swelling resolved and the pulsation in the right foot improved soon after the TAE. Peroneal AV fistula is an unusual complication of Fogarty catheterTM embolectomy, often detected only after postoperative follow-up angiography. We emphasize the importance of angiography following embolectomy and the effectiveness of TAE in treating AV fistula.
We report the case of a 64-year-old housewife with a diagnosis of acute traumatic aortic dissection associated with left pericardial rupture. The patient suffered multiple left rib fractures, a right wrist fracture, fracture of the right ankle and open fracture of the left ankle. She was transferred to our hospital complaining of severe back pain and increasing blueness of the right leg, which suggested cyanosis due to advancing dissection of the aorta. Enhanced CT and intra-arterial DSA confirmed dissection of the descending aorta from the distal portion of the left subclavian artery to the right iliac artery. Standard left thoracotomy revealed pulsatile patent ductus arteriosus (PDA) and traumatic rupture of the left pericardium. The PDA was divided first. Because of the multiple injuries, a heparin-coated cardiopulmonary bypass system was used to reduce the dose of heparin. Dissection was noted around the proximal descending aorta, with the point of entry observed above and below the PDA. This finding supports the observation that traumatic rupture of the thoracic aorta occurs most frequently in the area of the ligamentum arteriosum, because the aorta is fixed at that point. The descending aorta was successfully replaced with an artificial vascular graft. Three traumatic dissections have been reported, including our case, in Japan. In our patient surgery was performed 10 hours after the injury. This may represent the earliest operative treatment of traumatic aortic dissection in Japan thus far.
We reported successful reconstruction by omental graft in a case of reccurent traumatic CSF rhinorrhea. A 21-year-old male was brought to our hospital by traffic accident in coma state. Skull X-ray showed left frontal depressed fracture extending to the superior orbital rim. CT scan revealed traumatic subarachnoid hemorrhage, left cerebral contusional hemorrhage and severe brain swelling, so we carried out removal of the hematoma and external decompression. After that CSF rhinorrhea appeared, but disappeared before long, and after five months he discharged. After one year he returned to our hospital because of meningitis by CSF rhinorrhea. We confirmed the point of leakage from frontal skull base to ethmoid sinus by MRI and metrizamide CT, and we carried out repairment to frontal skull base with temporal muscle and periosteum. After three months he recurred CSF rhinorrhea and this time we carried out reconstruction to frontal skull base used by omental graft separated from abdomen. Since then CSF rhinorrhea has not reccured. Omentum possesses various functions such as protection against infection, ability of various shapes, absorption of CSF and adhesion to the surrounding tissue, so we regards it as very useful material to reconstruction of skull base.