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A 72-year-old male with hemodialysis 3 times a week was admitted to the clinic because of a pulsatile abdominal tumor, which was diagnosed as infrarenal abdominal aortic aneurysm (AAA). On admission, with cough and fever, pneumonitis and systemic erythema with severe itching were noted. Hemoglobin level was 8.3g/dl, White cell count was 5300/mm3, with 36% neutrophils, 8% lymphocytes, 50% eosinophils, 1% basophils, and 5% monocytes. From the clinical picture and laboratory data, hypereosinophilic syndrome (HES) was diagnosed. We preferred the medical treatment for HES to the surgical treatment for AAA. Six months after admission, he died of the rupture of AAA. In this paper Operative indication and its timing for AAA associated with grave diseases such as HES were discussed.

A 27-year-old male with Marfan's syndrome was admitted because of abdominal and back pains, and a pulsatile abdominal mass. Emergency operation was performed under a diagnosis of ruptured isolated abdominal aortic aneurysm. There was irregular tears in the aneurysmal lumen. Cystic medical necrosis was microscopically observed. No cardiovascular abnormality except for abdominal aortic aneurysm was demonstrated by postoperative examinations. This case is of ruptured isolated abdominal aortic aneurysm caused by a relatively rare Marfan's syndrome. Another 13 cases were seen in the literature.

A retrospective review of 108 patients who underwent infrarenal abdominal aortic ancurysm (AAA) repair during the recent 9 years was designed to investigate whether an association of coronary artery disease (CAD) influenced the operative results and long-term survival. Patients associated with CAD was defined as those having a medical history of angina or myocardial infarction, or those presenting ST·T abnormality or abnormal Q wave in ECG. CAD was clinically found in 57 (53%) operations. Coronary angiography (CAG) was performed in only 2 patients with CAD. Two patients died of multi-organ failure due to massive bleeding. There was no cardiac death during the perioperative period. Two patients in CAD group had angina attack during postoperative period, but patients without CAD had no cardiac complication. One patient with unstable angina in history, whose preoperative CAG showed less than 50 percent of stenotic lesion in right and left coronary arteries, suddenly died of coronary spasm 65 days after successful AAA repair. In 26 late deaths, 6 died of cardiac events. There was no significant difference in perioperative cardiac mortality, morbidity and long-term survival rate between CAD group and non-CAD group. The results show that AAA repair can be performed at low risk by intra- and postoperative intensive cardiac care. CAG should be selectively performed only in patients with unstable angina, and if there is reasonable indication of CABG, coronary revasuralization must be done prior to AAA repair.