|We report a case of localized abdominal aortic dissecting aneurysm, diagnosed in association with an intractable ulcer on the right leg. The patient, a 62-year-old man, with a history of hypertension and hyperlipidemia, was admitted to another hospital for hematemesis and phlegmon of the left lower leg. He subsequently needed intensive care, including mechanical ventilation, because of loss of consciousness and extreme leucocytosis caused by meningitis. The skin ulcer that developed on his right leg leaked gabexate mesilate, which had been administered to treat disseminated intravascular coagulation. The ulcer was resistant to several surgical treatments, including skin graft implantation. As he complained of intermittent claudication, ischemia of the right lower limb was suspected. Angiography and computed tomography revealed infrarenal abdominal aortic dissecting aneurysm and occlusion of the right common iliac artery. He was referred to us for surgery. After performing a median laparotomy, we resected the aneurysm and implanted a Y-shaped prosthetic graft. The postoperative course was uneventful, and the patient was discharged 4 weeks after operation. The surgical indications of infrarenal abdominal aortic dissecting aneurysm are the same as those for abdominal aortic aneurysm.
Jpn. J. Cardiovasc. Surg. 34: 350-353 (2005)