Genitourinary anomalies can present a formidable challenge to the vascular surgeon at abdominal aortic reconstruction. We saw a case of crossed renal ectopia without fusion, a rare anomaly, associated with abdominal aortic aneurysm. Because of risk for injury to the kidney during surgery, preoperative evaluation of this anomaly must include computed tomography, angiography, and intravenous pyelography. Preoperative placement of a ureteral catheter may prevent injury to the anomalous ureter. Renal failure of the ectopic kidney during aortic reconstruction can be a serious problem. We used in situ hypothermic perfusion with cold (4 degrees C) Ringer solution for renal protection, and reimplanted the aberrant renal artery. The postoperative course was good, without major complications. The procedure for renal preservation must be selected on the basis of anatomic findings. We review the literature and present the first case of crossed renal ectopia.

We report a case of left atrial myxoma associated with acute myocardial infarction (AMI) in a 63-year-old man. Percutaneous coronary intervention was performed immediately, and we removed white intracoronary particles by using a thrombectomy catheter. The postinterventional course was uneventful; however, on hospital day 5, pathological examination revealed platelet thrombus and myxomatous tissue from the particles aspirated by thrombectomy catheter, and transesophageal echocardiography showed a gelatinous mass in the left atrium. Based on these findings, we diagnosed AMI caused by coronary embolization from a left atrial myxoma, and excision of the myxoma was scheduled. However, preoperative magnetic resonance imaging revealed multiple subacute cerebral infarctions, and the tumor was successfully excised on hospital day 13. Although coronary embolization induced by cardiac myxoma is rare, it should be considered in a young to middle-aged patient presenting with signs of AMI without coronary risk factors.

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During a 9-year period from January 1991 through December 2000, 30 patients underwent surgical interventions for peripheral vascular injuries associated with catheterizations. Pseudoaneurysm, the most frequent complication, was seen in 19 patients (63.3%). This was followed by arteriovenous fistula in 6 patients (20%), uncontrolled hemorrhage in three (10%), arterial thrombosis in one (3.3%), and pseudoaneurysm complicated with arteriovenous fistula in one patient (3.3%). We performed repair of the puncture site in 26 patients (86.6%), followed by arterial ligation in two (6.6%), thrombectomy combined with percutaneous transluminal angioplasty and aneurysmectomy in one patient (3.3%) respectively. There was a tendency for patients to have diabetes mellitus or hypertension. Though secondary suture had to be performed in two patients with wound infection postoperatively, there was no other complication. In pseudoaneurysmal patients proximal arterial control followed by direct incision into the aneurysm cavity and tangential finger pressure over the hole in the artery was a safe method to control bleeding. In arteriovenous fistula patients aggressive repair resulted in good outcome. In uncontrolled hemorrhage and arterial thrombosis patients prompt intervention is essential. By using accurate techniques in arterial puncture and adequate arterial compression following removal of the catheter, the incidence of vascular injuries can be reduced.

The patient was a 75‐year‐old female who had received medical treatment for effort angina. Recently, she noticed a left breast tumor, which was diagnosed as breast cancer with axillary lymph node swelling. Coronary angiography performed prior to the surgery for the breast cancer showed 90% stenosis in segment 6 of the left anterior descending artery (LAD). Coronary intervention was not possible due to anatomical reasons, so she was admitted for simultaneous surgery for the breast cancer and angina. The chest was opened through a median sternotomy and the full‐skeletonized right internal thoracic artery was grafted on the LAD without cardiopulmonary bypass. A transverse elliptical incision was made after the median sternotomy was closed, and the breast tumor and lymph nodes around the subclavian and axillary vessels were completely dissected. Even in the case of multiple vessel coronary disease, simultaneous surgery may be possible, but indications should be carefully assessed considering the cardiac function and general condition of the patient.