During past 15 years 78 patients were operated for thoracic aortic aneurysm. Patients operated in emergency or dead within 24 hours after operation or with preoperative renal failure were excluded and remaining 65 patients were studied for factors affecting postoperative renal dysfunction. Postoperative renal dysfunction was based on the serum creatinine value which was within normal limit before operation and exceeded 1.5mg/dl after operation, or which increased by 1mg/dl and more from preoperative value. 23 patiens developed postoperative renal dysfunction and the incidence was 35.4%. As preoperative factors, old age, male and high value of preoperative serum creatinine were significantly (p<0.01) related with postoperative renal dysfunction. As intraoperative factor, decreased urine output per operative hour was significantly (0.01<p<0.05) related. Other preoperative factors; hypertension, diabetes, location of aneurysm, dissecting and nondissecting, intraoperative factors; operation time, volume of operative bleeding, minimum systolic blood pressure during operation, clamping time of aorta, minimum temperature of rectum, difference of adjuncts (temporary shunt or extracorporeal circulation), postoperative factors; systolic blood pressure at arriving ICU, urine output of first postoperative day were not significantly related. Between the operative procedures of graft replacement and extraanatomic bypass, no significant difference was recognized in occurrence of postoperative renal dysfunction, but patients with patch angioplasty etc. developed no renal dysfunction. In the complications within one week after operation, central nervous system dysfunction, infection and hemorrhage had a tendency to occur together with renal dysfunction. For prevention of postoperative renal dysfunction it is important to minimize the renal ischemia, to protect the kidney and to maintain urine output during operation, particularly in patients of preoperative decreased function of kidney and of old male with advanced arteriosclerosis. Also it is necessary to choose the less invasive procedure of operation for patients of severely decreased function of kidney and to consider about organ system relations in patients of postoperative renal dysfunction.

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Total correction for a chronic aortic dissection, producing progressive enlargement of the false lumen of the aorta involving wide range of aorta and aortic manifestation of Marfan's syndrome is a very difficult procedure. However, with the recent development in surgical techniques and management, it became possible to replace total or subtotal aorta with the prosthetic graft. Recently, we treated a 24 y/o male patient with annuloaortic ectasia, DeBakey type II+IIIb aortic dissection, and obstruction of right common iliac artery, associated with Marfan's syndrome with a two-staged operation. For the first stage, we performed Cabrol's procedure on his lesions in ascending aorta. About 2 years after that, for the second stage, replacement of total descending and abdominal aorta was pertformed.

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[in Japanese]

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