초록접수 현황
| 20F-130 | Video session발표 |
The posterior pericardial approach to treat proximal SINE and aortic rupture caused by previous thoracic endovascular aortic repair (TEVAR)
Hong Rae Kim, Suk Jung Choo
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
Purpose : A long elephant trunk procedure was used to treat proximal stent graft-induced new entry (SINE) and aortic rupture caused by a previously deployed TEVAR stent graft
Methods : A 78-year-old man presented with chest pain and hemoptysis. His past medical history was remarkable for a zone 2 TEVAR that was performed at our institution in 2014 to treat a proximal descending aortic aneurysm. The last follow up CT performed in 2017 showed good remodeling without complications. He continued to do well until 4 months earlier when he first presented with chest discomfort and recent symptomatic aggravation. The CT showed proximal SINE at the tip of the bare metal portion with a newly developed large surrounding periaortic hematoma suggestive of aortic rupture.
After a median sternotomy, the mid DTA approached through the posterior pericardium was opened below the hilum. A 30mm 1-br Dacron graft tied to a silk suture was pulled from the aortic opening and passed through the previously deployed stent graft. The distal graft end was sutured inside the descending aorta with continuous 3-0 prolene suture. Proximally, an ascending and total arch graft replacement was performed which was then anastomosed with the proximal stump of the descending aorta graft.
Results : There was no major postoperative morbidity including neurologic, cardiovascular, or renal complication, but the patient was discharged on postoperative day 28 due to pneumonia.
Conclusion : A long elephant trunk procedure through the median sternotomy may be useful to treat SINE induced aortic rupture caused by previous TEVAR
Methods : A 78-year-old man presented with chest pain and hemoptysis. His past medical history was remarkable for a zone 2 TEVAR that was performed at our institution in 2014 to treat a proximal descending aortic aneurysm. The last follow up CT performed in 2017 showed good remodeling without complications. He continued to do well until 4 months earlier when he first presented with chest discomfort and recent symptomatic aggravation. The CT showed proximal SINE at the tip of the bare metal portion with a newly developed large surrounding periaortic hematoma suggestive of aortic rupture.
After a median sternotomy, the mid DTA approached through the posterior pericardium was opened below the hilum. A 30mm 1-br Dacron graft tied to a silk suture was pulled from the aortic opening and passed through the previously deployed stent graft. The distal graft end was sutured inside the descending aorta with continuous 3-0 prolene suture. Proximally, an ascending and total arch graft replacement was performed which was then anastomosed with the proximal stump of the descending aorta graft.
Results : There was no major postoperative morbidity including neurologic, cardiovascular, or renal complication, but the patient was discharged on postoperative day 28 due to pneumonia.
Conclusion : A long elephant trunk procedure through the median sternotomy may be useful to treat SINE induced aortic rupture caused by previous TEVAR
책임저자: Suk Jung Choo
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
발표자: Hong Rae Kim, E-mail : khrjsk@gmail.com