Since April 2000, we have applied a preoperative special skin preparation in order to prevent surgical site infection (SSI) for cardiovascular surgery patients. After skin preparation with popidone iodine painting, patients take a shower and scrub using the same disinfectant 3 to 1 days before surgery. In the morning of operative day, patients take a shower and scrub using disinfectant, and then received skin painting on their beds. After induction of anesthesia, skin was scrubbed with iodine soap, then painted 3 times. 378 patients had undergone operations until December 2007. No SSI had occurred, except 1 case of inguinal graft infection who had not received the routine preparation at that site. However, this program is complicated, and so we are planning to change for a 1 day program from 3 days program.

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Infrarenal abdominal aortic occlusive disease has traditionally been treated with aorto bifemoral bypass or axillo-femoral bypass. It is also associated with high mortality rate and major early complication rates. An endovascular approach has the advantages of lower mortality and morbidity and better hemodynamics. We reported three cases of high aortic occlusion (one with severe claudication and two with critical limb ischemia) those were managed by an endovascular approach. Endovascular treatment should be considered as an alternative to laparotomy or axillo-femoral bypass in selected patients with total juxtarenal aortic occlusions.

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We report a case of superficial femoral artery pseudoaneurysm due to methicillin-resistant Staphylococcus aureus (MRSA). An 81-year-old man had suffered from MRSA pneumonia and had been treated by antibiotics, respiratory care, and tube feeding. Three months later, he had fever of 38℃ was present. The left thigh was swollen and a pulsatile mass was palpated. Multislice computed tomography revealed left superficial femoral artery aneurysm with a lobulated contour. The aneurysm was 50 mm in diameter. We performed resection and extensive debridement of the aneurysm and the surrounding tissues, followed by femorotibial bypass with an autologous vein which was placed laterally. The patient achieved excellent wound healing and granulation tissue formation with vacuum-assisted closure treatment. Tissue culture of the aneurysm wall revealed MRSA.

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A 59-years-old man was admitted to our hospital because of aneurysmal enlargement around a graft. Two months earlier he had undergone surgical repair of abdominal aortic aneurysm and coronary artery bypass. The patient was operated because of a diagnosis of seroma. The seroma sac was excised for drainage and a pedicled omentum was used to cover the aortic graft to promote healing the interstices of the graft and preventing aortoenteric fistula. The postoperative course was uneventful and the patient is doing well 8 months after the operation. We think this procedure is simple and useful for high risk patients in order to control perigraft seroma.

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We report a case of traumatic popliteal arteriovenous fistula diagnosed 50 years after injury. A 73-year-old man was referred to our hospital complaining of left leg edema. He presented with a tender pulsatile mass posterior to his left knee, popliteal bruit and a thrill at the popliteal fossa. Computed tomography (CT) scan revealed dilated artery and vein from iliac bifurcation to popliteal fossa. Arteriography showed popliteal arteriovenous fitula. With the patient in the prone position, the left popliteal artery and vein were exposed. A 5-mm communication discovered between the popliteal atery and vein was closed with 5-0 polypropylene running sutures. The patient’s postoperative course was uneventful and postoperative arteriography revealed no fistula and narrowing of the artery. He was slapped with a stick in the back of the knee when he was aged 20 years old. This was the longest interval between cause and diagnosis of traumatic popliteal arteriovenous fistula in the Japanese literature.

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A 74-year-old woman had undergone graft replacement for abdominal aortic aneurysm and 3 years later she presented with signs of graft infection. Because the suspected cause was perforation of the third portion of the duodenum, we performed omentopexy. The infection did not recur. She was discharged on the 65th postoperative day. No sign of infection was detected 16 months after the operation. Graft infection following abdominal aortic aneurysmectomy is considered a very serious complication, as it is associated with high mortality and morbidity. Autologous tissue transposition coverage of a graft should confer the advantage of fewer stressors and improve the control of graft infection. Our findings from this patient indicate that this method could be useful in treating such types of mild graft infection.

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Persistent sciatic artery (PSA) is a rare congenital anomaly. We present a case of a 75-year-old woman who complained of right buttock pain with right PSA aneurysm and hypoplastic external iliac and femoral arteries. The PSA was ligated at the pelvis and the adductor magnus canal, and bypass between the internal iliac artery and the popliteal artery was performed. Postoperatively, the PSA including the aneurysm was completely thrombosed and the symptoms disappeared.

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Infrarenal abdominal aortic dissection is a rare disease that has traditionally been treated with graft replacement under general anesthesia. We report a case of isolated dissection of the abdominal aorta that was managed by an endovascular approach. The patient was 81-year-old with intermittent claudication. Computed tomographic angiography (CTA) showed isolated dissection of the abdominal aorta and both iliac arteries. A stent was placed in the abdominal aorta and it closed the pseudolumen. It restored the blood flow to the lower leg, and the intermittent claudicantion disappeared.

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Superficial temporal artery (STA) pseudoaneurysm is a very rare disease. We report the treatment of an STA aneurysm by ultrasound-guided thrombin injection (UGTI). The patient was an 85-year-old woman, who had hit her temple 3 weeks ago. Subsequently, a pulsating mass formed at the site of injury, and she developed a throbbing pain. STA pseudoaneurysm was diagnosed by ultrasonography and CT angiography, and UGTI was performed. The aneurysm was successfully occluded by injection of 1,200 units of thrombin into the aneurysm sac. There were no complications or side effects, and she did not require hospitalization.

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Heparin-induced thrombocytopenia (HIT) is classified into type I and type II. In type II HIT, the main presentation is repeated thrombosis, and in some cases it can be life-threatening. A successful case of reconstruction in a 68-year-old female with an arterio-venous fistula and type II HIT is reported. Her arteriovenous fistula (AVF) was occluded one day after the AVF formation, and the circuit of hemodialysis was completely coagulated. She also had thrombi around the hemodialysis catheter. After the diagnosis was made, we started to administrate Argatroban. After two weeks from the last heparin administration, the second AVF was reconstructed successfully.

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