Penetrating atherosclerotic ulcer in the juxtarenal abdominal aorta and coronary artery disease: emergency one-stage repair with off-pump coronary surgery.

An 82 year-old woman suddenly developed severe back pain. Enhanced computed tomography and aortography revealed penetrating atherosclerotic ulcer (PAU), that was a localized contrast-filled outpouching in the juxtarenal abdominal aorta and intramural hematoma within the aortic wall. Coronary angiography revealed significant stenosis in the left anterior descending artery and right coronary artery. Urgent aortic repair was required; therefore we performed the combined operations of coronary artery bypass grafting and aortic repair. PAUs typically occur in elderly patients with a history of hypertension, and are frequently complicated by coronary artery disease. However, few cases have been reported in the literature, such as cases involving combined operations. In this study, we report on a successful case of emergency repair involving concomitant juxtarenal abdominal aortic replacement for PAU and off-pump coronary artery bypass grafting.