It is presumed that visceral ischemia is caused as a result of fighting between the lower limb and intraperitoneal organs to steal blood in aortoiliac occlusive disease (AIOD). Accordingly, an investigation has been made of this “aortoiliac steal” phenomenon. Out of 65 AIOD patients, the case in whom the main collateral circulation to the lower limb was found to originate in the intraperitoneal visceral arteries by angiography were only 2 (3%), both of which showed, however, no visceral ischemic symptom. Intraoperative changes in pelvic visceral hemodynamics were observed in 19 cases undergone either aorto-bifemoral or axillo-bifemoral bypass operation (AFB) using Doppler's ultrasonic trans-anal method. As a result, visceral circulation was maintained favorably even after AFB, further suggesting the possibility that not only the circulation of the inferior limb but the visceral circulation is improved directly by AFB. Visceral ischemia is considered to occur in the patient in whom concomitant stenotic lesion is present in the celiac artery or superior mesenteric artery, for which full attention should be paid to visceral circulation also in the patients with ischemia in the lower limb.

View full abstract

This report documents a case of three-channeled aortic dissection. The diagnosis of dissecting aneurysm was made by chest X-P and CT to 70-year-old man, with a chief complaint of back pain. Aortogram showed aortic aneurysm (DeBakey type IIIb), which had an entry at distal of the beginning of the left subclavian artery. Though we had given a pressure control therapy, the patient died on the 5th day of the admission. At autopsy, a new dissection was found in the chronic dissecting outer wall, forming three channeled dissection and rupture was there. Three-channeled dissection is very rare, only 8 cases including ours have been reported so far. From this case, we learned it very difficult to diagnose and treat it.

View full abstract

A 49-year-old man who had had severe tripple vessel coronary disease and low left ventricular function (EF=29%) underwent coronary artery bypass grafting. Following the procedure he could not be weaned from cardiopulmonary bypass (CPB) even with an intra-aortic balloon pumping (IABP). Left ventricular assist using a centrifugal pump (CFP) together with IABP was then utilized with a dramatic recovery from profound postcardiotomy cardiogenic shock, and the CPB was successfully terminated. The left ventricular function recovered gradually from intraoperative myocardial damage. The CFP was successfully removed at 86 LHB hour and the IABP at 9th postoperative day. At present 12 months after LHB, he reveals no angina. Settting up the left ventricular support using a CFP is simple and not-time-consuming, so this system with IABP is of practical use in the case of unpredicted postcardiotomy cardiogenic shock.

View full abstract