[Surgery of thoracoabdominal aortic aneurysm associated with coronary artery disease].

A 67-year-old man underwent combined surgery for thoracoabdominal aortic aneurysm and coronary artery disease. Preoperative computed tomographic scan and aortography showed a large aneurysm in diameter of 7 cm locating from lower half of the descending thoracic aorta to just above the celiac artery. Coronary arteriography revealed severe stenosis (99%) of the proximal left anterior descending artery (LAD). The patient was operated on in October 1994, via a thoracoabdominal approach by entering the thorax in the 8th intercostal space and the retroperitoneal space through a paramedian incision after division of the costal arch. An additional standard thoracotomy was performed in the 5th intercostal space, through which a left internal thoracic artery (LITA) was mobilized. After the proximal descending thoracic aorta as well as the right femoral artery was cannulated for arterial perfusion, and the main pulmonary artery as well as the right femoral vein for venous return, total cardiopulmonary bypass was established and a LITA graft was anastomosed to the LAD under cardioplegic arrest. Thereafter the aneurysm was replaced with an 18 mm dacron prosthesis while the LITA graft and coronary arteries were reperfused and cardiac beating was resumed. His postoperative course was uncomplicated. Postoperative angiography demonstrated satisfactory repair of the aorta and a fully patent LITA graft.