Massive thrombi are sometimes present in aortic aneurysms, which cause severe complication such as distal arterial thromboembolism, and greatly influence the prognosis. Such thrombi can be easily detected by CT scan and ultrasound. However these imaging techniques can only demonstrate the presence of thrombi, and are not able to indicate these activity. We performed ¹¹¹In-labeled-platelet scintigraphy (platelet scinti.) in 27 cases of aortic aneurysms (13 true aneurysms and 14 dissecting aneurysms) and 13 postoperative cases of dissecting aneurysms, and compared the findings of CT scan. In some cases, the findings of platelet scinti. were markedly different from the findings CT scan. And our results suggested that the radioisotope deposit revealed by platelet scinti. was reflected thrombotic activity. In one case of dissecting aneurysm, marked RI deposit was revealed by platelet scinti., and subsequently the false lumen was occluded. One postoperative case of dissecting aneurysm showed marked RI deposit and, distal arterial thromboembolism developed. ¹¹¹In-labeled-platelet scintigraphy is thought to be useful to estimate thrombotic activity in aortic aneurysm, and to predict complications and the prognosis.

View full abstract

In vascular surgery, thrombo-embolism and hemorrhage are major noisome complications. We report a case of cholesterol emboli which came from atheromatous aortic wall during the thoracoabdominal aortic aneurysm operation. Micro-emboli were migrated into the capillary in the liver, kidney and small bowels, and the patient died of multiple organ failure. The histological examination showed the cholesterol emboli in micro-circulations. The other is a case of in situ thrombus formation in the posterior tibial artery during aortic surgery. The patient with combined (iliac and femoral) lesion had aorto-bifemoral bypass to get better proximal inflow. Just after the operation, we noticed his right lower extremity was pale and cold. Angiography revealed the thrombus distal to the occluded superficial femoral artery. Since the thrombus was too large to pass through any collateral vessels, it should be formed in situ. Femoro-popliteal bypass was added to the primary procedure with success.

View full abstract

The left IMA graft to the LAD showed a string sign with no antegrade flow in an asymptomatic 67-year-old man 3 years after the operation. The LAD lesion had regressed from 95% stenosis to less than 50% during this period. Exercise electrocardiographic and thallium 201 myocardial scintigraphic examinations revealed no ischemia in the LAD region. When the LAD was temporarily occluded by a PICA balloon, the anterograde flow from the IMA to the LAD could be demonstrated by angiography. The IMA graft in no flow situation has maintained anatomical patency for 3 years after the operation.

View full abstract