[Aortic arch replacement performed in emergency in a short-term after grafting for abdominal aortic aneurysm]

Two cases of successful staged replacement of multiple aortic aneurysms are reported. Case 1: A 65-year-old man was found to have abdominal aortic and aortic arch aneurysms. He underwent abdominal aneurysmectomy and Y-grafting in the first stage. A month after his discharge, he was transferred to our hospital because of abrupt chest pain. Two days later, he fell into shock and emergent aortic arch replacement was performed successfully. Case 2: A 46-year-old man was transferred to our hospital because of abrupt abdominal pain and shock. CT scan revealed the rupture of the abdominal aneurysm. He received emergent abdominal aneurysmectomy and Y-grafting successfully. Three months later, he was readmitted because of back pain. CT scan revealed DeBakey Type I dissecting aneurysm. After three days, PaO2 of blood gas analysis fell to 46 mmHg, and absent femoral pulsation and oliguria were also observed. Therefore, aortic arch replacement was performed in emergency. The intimal tear was found in the distal aortic arch. The both of cases are doing well 24 months and 10 months after surgery respectively. It is important to scrutinize the order of surgery for multiple aortic aneurysms and to control blood pressure properly after aneurysmectomy.