초록접수 현황
| 16F-217 | 포스터 발표 |
Total Arch Replacement of Retrograde type A Aortic Dissection after TEVAR
김관욱¹, 하승일¹, 이상빈¹, 장병철², 이건¹
¹Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University College of Medicine, Gyeonggi-do, Korea, ²Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
Background : Retrograde Stanford type A aortic dissection is one of the most serious complications of thoracic endovascular aortic repair (TEVAR). It has a low incidence but high mortality. We report here a case of retrograde Stanford type A aortic dissection in a 48-year-old woman after TEVAR.
Methods : A 48-year-old woman underwent TEVAR for acute type B aortic dissection. About 6 weeks after procedure, she suddenly developed a severe back pain. Enhanced computed tomography (CT) of the thoracoabdominal aorta disclosed retrograde type A aortic dissection with an intimal tear at the tip of the proximal bare spring. Furthermore, the position of stent graft proximal tip was very close to the origin of left subclavian artery.
Results : The patient was taken to the operating room. After sternotomy, cardiopulmonary bypass (CPB) was instituted by means of axillary and femoral artery perfusion and double staged right atrial drainage. The body's temperature falls below 28°C. During circulatory arrest, the ascending aorta was transected. And then anterograde cerebral perfusion was achieved through the cannula introduced via the axillary and left common carotid artery. About 4cm length of proximal portion of the TEVAR stent graft was resected. The distal part of the 4-branched 30mm graft was sutured to the proximal end of the stent-graft including aorta wall. The side branch of graft was cannulated, allowing distal perfusion and global warming. The head vessels were anastomosed to 3 side branches of graft respectively. Afterwards, the proximal aortic anastomosis was performed. The patient suffered left flank pain that was diagnosed with left renal infarction on postoperative day 9. After systemic heparinization, she recovered from left flank pain shortly. She was discharged from the hospital on postoperative day 25. She was followed up at an outpatient clinic for 2 months.
Conclusion : The stent grafts with proximal bare stent seem to favor the occurrence of retrograde Stanford type A aortic dissection. Moreover, about two-thirds of retrograde Stanford type A aortic dissection occurs in the immediate postoperative period and first postoperative month. So, accurate diagnosis with short-term follow up and prompt surgical intervention if needed are essential.
Methods : A 48-year-old woman underwent TEVAR for acute type B aortic dissection. About 6 weeks after procedure, she suddenly developed a severe back pain. Enhanced computed tomography (CT) of the thoracoabdominal aorta disclosed retrograde type A aortic dissection with an intimal tear at the tip of the proximal bare spring. Furthermore, the position of stent graft proximal tip was very close to the origin of left subclavian artery.
Results : The patient was taken to the operating room. After sternotomy, cardiopulmonary bypass (CPB) was instituted by means of axillary and femoral artery perfusion and double staged right atrial drainage. The body's temperature falls below 28°C. During circulatory arrest, the ascending aorta was transected. And then anterograde cerebral perfusion was achieved through the cannula introduced via the axillary and left common carotid artery. About 4cm length of proximal portion of the TEVAR stent graft was resected. The distal part of the 4-branched 30mm graft was sutured to the proximal end of the stent-graft including aorta wall. The side branch of graft was cannulated, allowing distal perfusion and global warming. The head vessels were anastomosed to 3 side branches of graft respectively. Afterwards, the proximal aortic anastomosis was performed. The patient suffered left flank pain that was diagnosed with left renal infarction on postoperative day 9. After systemic heparinization, she recovered from left flank pain shortly. She was discharged from the hospital on postoperative day 25. She was followed up at an outpatient clinic for 2 months.
Conclusion : The stent grafts with proximal bare stent seem to favor the occurrence of retrograde Stanford type A aortic dissection. Moreover, about two-thirds of retrograde Stanford type A aortic dissection occurs in the immediate postoperative period and first postoperative month. So, accurate diagnosis with short-term follow up and prompt surgical intervention if needed are essential.
책임저자: 이건
Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University College of Medicine, Gyeonggi-do, Korea
발표자: 김관욱, E-mail : mujin10km@chamc.co.kr