An 80-year-old man had high serum immunoglobulin G4 (IgG4) concentration and fibrous thickening of the soft tissue mass surrounding the region from the abdominal aorta to the bilateral iliac arteries, suggestive of IgG4-related periaortitis. He presented to our emergency department with sudden-onset abdominal pain and lumbago. Computed tomography revealed a ruptured abdominal aorta. He was a poor candidate for open surgery due to his hostile abdomen. Therefore, endovascular aneurysm repair was performed. No consensus about the surgical indication for IgG4-related arterial disease has been reached yet. We believe that a novel indicator is needed for this disease.
The descending aortic coarctation is often difficult to anatomically reconstruct. We report two cases of ascending aorta to abdominal aorta bypass without laparotomy or thoracotomy. This approach enabled us to avoid anastomosis close to the inflammatory lesion and left thoracotomy causing bleeding from the collateral vessels, and to allow concomitant cardiac procedures to be performed. The graft contact with the intestines can be preventable by the retroperitoneal approach. This technique is useful for the selective patients.
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