Purpose: We clinically performed a hybrid procedure of aortic replacement with transluminally placed endovascular grafting (TPEG) and evaluated the operative results.
Materials and Methods: Since April 1995, 14 patients underwent the hybrid procedure of conventional aortic replacement with TPEG. Their age was 62 to 78 years, 10 were men and 4 women. The lesions were atherosclerotic aneurysm in 10 patients, atherosclerotic aneurysm with chronic dissection in 3, chronic dissection in 1. We simultaneously performed abdominal aortic replacement with TPEG into the descending thoracic aorta in 6 of 14 patients, while we performed this procedure sequentially in 8. Five of these 8 patients underwent graft replacement of total aortic with secondary TPEG using the elephant trunk for the landing zone.
Results: One patient died of MRSA pneumonia three months after the simultaneous procedure, while the rest of the patients survive without any complications in the follow-up period (range, 1 to 88 months, mean 42 months).
Conclusion: Hybrid procedure of aortic replacement with TPEG was minimally invasive yet effective even for high-risk patients with multiple aortic aneurysms.

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Venous thromboembolism (VTE) can cause serious perioperative pulmonary embolism (PE) which requires an evidence-based treatment strategy. Although inferior vena cava (IVC) filtration is a recent treatment of choice, it remains unclear whether the filters have a prophylactic effect on PE for patients with VTE. This study reviewed 32 patients with active VTE at surgery, out of 187 patients with VTE who received treatment in our department from January 1, 2003 to December 31, 2005. There were 7 men and 25 women with an average age of 58.5-years-old. Underlying diseases included gynecologic (n=11) and urologic diseases (n=2), deseases treated by general surgery (n=9), orthopedics (n=6), neurosurgery (n=2) and plastic surgery (n=2). Nineteen patients received an IVC filter (Group F; permanent n=9, temporary n=10) before surgery and 13 patients underwent surgery without filtration of IVC (Group N). Two groups had similar levels of d-dimer values and distribution of VTE. The operative burden, evaluated by operative time, blood loss and first ambulation day revealed no difference between F and N groups. Both groups had neither fatal nor anticoagulant-related complications. However, group N had no recurrent PE after surgery, whereas group F had one recurrent PE just after placement of the filter. Furthermore, group F included acute IVC thrombosis, filter migration, and filter connection trouble in one case each during the hospitalized period. Longterm follow-up (mean, 13 months) showed that group F experienced one PE and two IVC occlusions, while group N had no such complications associated with VTE. The present study indicated that IVC filter placement for the patients with active VTE prior to surgery has no benefit for recurrent PE either in the short and long-term period.

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