[Ruptured non-dissection thoracic aortic aneurysms]

The number of patients with thoracic aortic aneurysm has been increasing in Japan. The annual report by the Japanese Association for Thoracic Surgery 2001 demonstrated that 4,133 patients underwent surgery for thoracic aortic aneurysm. Among them, ruptured cases consisted of 11% (460 patients) and its early mortality was 32%. At the emergency room, initial accurate diagnosis, using echocardiography and computed tomography (CT), is mandatory for the next step and catastrophic shock status should be corrected if possible, such as pericardiocentesis or transfusion. For patients with ruptured descending or thoracoabdominal aortic aneurysms, the endovascular stent-grafting should be first choice of treatment. Otherwise, patients should be sent for the operation room as quickly as possible for initialing cardiopulmonary bypass and for controlling bleeding. Special attention should be paid for not injuring the left lung after left thoracotomy. Mycotic false aneurysms, including the aorto-esophageal fistula and prosthetic graft infection, remained as one of challenging entities in aortic emergency. The standard treatment for this fatal disease resection of the infected both aneurysm and esophagus, and has been reconstruction with an extra-anatomical bypass, however, recent advancement of technologies, including allograft and tissue engineering might enable to have in situ reconstruction of the aorta.