A Case of Vascular Graft Infection Caused by Staphylococcus lugdunensis after Femoropopliteal Bypass Operation

A 79-year-old man who had undergone a right femoropopliteal (FP) bypass operation 6 weeks previously was diagnosed with vascular graft infection caused by Staphylococcus lugdunensis. Another FP bypass operation was performed, with long-term administration of antibiotics, and the patient eventually recovered well without any recurrences for over 2 years. Although S. lugdunens is classified as coagulase-negative Staphylococcus, its pathogenicity has been reported to be equal to that of S. aureus. Based on the literature review, the organism characteristically colonizes the inguinal area of human skin;thus, operations such as FP bypass grafting may place patients at a relatively high risk for infection by S. lugdunensis, a potentially high-pathogenicity organism

2つの瘤を形成した冠動脈-肺動脈瘻に対する1手術例

症例は77歳男性.2ヶ月前より夜間の息苦しさと胸の締め付けを感じていた.冠動脈CTを施行したところ主肺動脈前面及び上行大動脈と主肺動脈の間に冠動脈・肺動脈瘻を伴った2個の瘤を認め,右冠動脈#2に90%狭窄を認めた.On pump beating下に瘤を切開し,冠動脈側からの入口部及び肺動脈瘻を閉鎖した.また,右冠動脈の狭窄病変に対して大伏在静脈をグラフトとして用い冠動脈バイパス術を行った.術後経過良好にて退院となった.今回我々は瘤を形成した冠動脈-肺動脈瘻に対して人工心肺下に手術を施行した1手術例を経験したので報告する.We will report on one surgically treated case of coronary-pulmonary artery fistula with two aneurysms. A 77-year-old male suffering from chest pain and respiratory discomfort underwent coronary CT and angiography. Both revealed a fistula between the coronary artery and the pulmonary artery along with two aneurysms. Surgery was performed utilizing the on-pump beating heart technique. We extracted all fistulous vessels and performed a coronary bypass to #3 segment using the great saphenous vein grafting. We believe, that for complete treatment in such a case direct inspection of the internal wall of the aneurysm through incision is necessary, as opposed to simple ligation of the feeding vessel

Use of the Outback re-entry device for occluded abdominal aortic aneurysms with bilateral common iliac artery aneurysms

Background: Extensive juxtarenal aortoiliac occlusion (JRO) is difficult to treat and has severe outcomes. However, recent treatments have involved endovascular approaches. We encountered a rare case of successful occlusion penetration using the Outback Elite Re-entry Catheter (Cordis, Miami, FL, USA). Case presentation: A 75-year-old man was referred to our department for treatment of an enlarged aneurysm. The patient presented with intermittent claudication and underwent computed tomography, which revealed thoracic aortic, abdominal aortic (AAA), bilateral common iliac artery (CIAA), and right external iliac artery (EIAA) aneurysms of 51.8, 47.4, 71.5/31.9 (right/left), and 26.3 mm in diameter, respectively. The AAA, bilateral CIAA, and right EIAA were extensively occluded and treated with a re-entry device (outback® Elite Re-entry Catheter). The patient's symptoms improved significantly, and he was discharged with no serious complications. Conclusion: The Outback Elite Re-entry Catheter may be a promising endovascular treatment option for patients with extensive JRO