[Separate operation for extensive aneurysm (mega-aorta) complicated with ischemic heart disease].

A seventy one year-old woman, who had an arch and thoracoabdominal aortic aneurysm (type II according to Crawford classification) with ischemic heart disease, underwent a separate operation using the elephant trunk method. At first, she underwent the ascending aorta and arch replacement the with elephant trunk technique, and, underwent CABG simulutaneously utilizing the separate extra corporeal circulation and hypothermic circulatory arrest. The Chest and abdominal CT revealed the enlargement of abdominal aortic aneurysm 5 months after operation. The second operation was performed using Stoney's spiral opening method and the revasculization of spinal arteries (Th6, 7 and Th9) underwent the segmental aortic clamping to prevent spinal cord ischemia. Furthermore, the second operation was performed using selective perfusion to visceral arteries and F-F bypass for the prevention of visceral ischemia. Each flow rate by selective perfusion in major abdominal blanches was from 50 to 100 ml/min. Therefore, hepatorenal dysfunction and paraparesis did not occur after the second operation. It was suggested that the segmental aortic clamping and the selective perfusion to visceral arteries with F-F bypass may be effective to prevent the ischemia of the spinal cord and abdominal organs.