초록접수 현황
| 15F-055 | 포스터 발표 |
Successful Rescue of the Ruptured Chronic B Dissecting Aneurysm After Endovascular Stentgraft with Carotid Artery Graft Cannulation
So Young Lee, Ji Sung Kim, Kuk Hui Son, Kun-Woo Kim, Chang Hu Choi, Kook Yang Park, Jae-Ik Lee, Chul Hyun Park
Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University, Incheon, Republic of Korea
Background : The thoracic endovascular repair (TEVAR) has been developed to cover the primary entry in the chronic dissecting aneurysm. TEVAR is useful in the life-threatening condition of type B dissection with rupture or malperfusion.
The complications after failed endovascular repair, are rare but fatal, should require surgical conversion. We report the case that the prepared carotid cannulation saved the ruptured chronic dissecting aneurysm.
Methods : A 44-year-old patient underwent TEVAR with chimney technique of left subclavian artery in the life-threatening situation of type B chronic dissecting aneurysm with rupture. A follow-up CT scan showed the proximal type I endoleak with high pressurized aneurysm 5 days later. The graft explanation and open repair were performed emergently. Via a left supraclavicular incision, the end-to side graft in left carotid artery and the carotid-to-subclavian bypass were performed for the proximal antegrade perfusion and a salvage of left subclavian artery. The femoro-femoral bypass was prepared in the left inguinal area. As soon as the left thoracotomy was performed, the stented descending aorta was ruptured. CPB was instituted with the left common carotid artery and the femoro-femoral bypass. The operative fields were secured with digital compression and a cross-clamping on the mid-thoracic aorta. The proximal perfusion was achieved fortunately with digital compression, balloon occlusion and aortic clamping on the distal arch after the thoracic stent-graft and chimney graft were explanted. The ruptured dissecting aneurysm was reconstructed using an interposition of graft.
Results : The postoperative course was uneventful without a mental change or spinal injury. The survived patient was in good condition during a follow-up of 7 months.
Conclusion : The additional cannulation of end-to side graft in left carotid artery would be a life-saving rescue tool in the complicated condition like impending rupture of descending thoracic aortic aneurysm.
The complications after failed endovascular repair, are rare but fatal, should require surgical conversion. We report the case that the prepared carotid cannulation saved the ruptured chronic dissecting aneurysm.
Methods : A 44-year-old patient underwent TEVAR with chimney technique of left subclavian artery in the life-threatening situation of type B chronic dissecting aneurysm with rupture. A follow-up CT scan showed the proximal type I endoleak with high pressurized aneurysm 5 days later. The graft explanation and open repair were performed emergently. Via a left supraclavicular incision, the end-to side graft in left carotid artery and the carotid-to-subclavian bypass were performed for the proximal antegrade perfusion and a salvage of left subclavian artery. The femoro-femoral bypass was prepared in the left inguinal area. As soon as the left thoracotomy was performed, the stented descending aorta was ruptured. CPB was instituted with the left common carotid artery and the femoro-femoral bypass. The operative fields were secured with digital compression and a cross-clamping on the mid-thoracic aorta. The proximal perfusion was achieved fortunately with digital compression, balloon occlusion and aortic clamping on the distal arch after the thoracic stent-graft and chimney graft were explanted. The ruptured dissecting aneurysm was reconstructed using an interposition of graft.
Results : The postoperative course was uneventful without a mental change or spinal injury. The survived patient was in good condition during a follow-up of 7 months.
Conclusion : The additional cannulation of end-to side graft in left carotid artery would be a life-saving rescue tool in the complicated condition like impending rupture of descending thoracic aortic aneurysm.
책임저자: Chul Hyun Park
Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University, Incheon, Republic of Korea
연락처 : So Young Lee, Tel: 032-460-3666 , E-mail : faustina117@gmail.com
