D'Ancona Giuseppe, Bauset Richard, Normand Jean-Pierre, Turcotte Roc, Dagenais François
Department of Cardiovascular Surgery, Quebec Heart Institute, Sainte-Foy, Canada.
J Endovasc Ther. 2003 Oct;10(5):928-31. doi: 10.1177/152660280301000513.
To report a pitfall encountered during stenting of a complicated penetrating ulcer of the descending thoracic aorta.
A 65-year-old man was diagnosed with a complicated penetrating ulcer of the thoracic aorta. A 38-mm Talent endograft was implanted. On balloon dilation of the distal end of the endoprosthesis, the terminal bare stent became distorted and penetrated the aortic wall. A 42-mm endoprosthesis was immediately placed to exclude the aortic perforation. Control aortography demonstrated exclusion of the original proximal aortic ulcer and the distal iatrogenic aortic tear.
Endoprostheses may present some drawbacks in terms of elasticity and adaptability to tortuous and angulated diseased aortas. Caution is advised in the treatment of penetrating aortic ulcers where the aortic wall is diffusely friable. In this condition, balloon dilation should be limited to the covered portion of the stent-graft to prevent stent distortion and erosion through the aortic wall.
报告在降主动脉复杂穿透性溃疡支架置入过程中遇到的一个陷阱。
一名65岁男性被诊断为胸主动脉复杂穿透性溃疡。植入了一个38毫米的Talent血管内移植物。在内假体远端进行球囊扩张时，末端裸支架变形并穿透主动脉壁。立即置入一个42毫米的内假体以排除主动脉穿孔。控制性主动脉造影显示原近端主动脉溃疡和远端医源性主动脉撕裂被排除。
血管内移植物在弹性以及对迂曲和成角病变主动脉的适应性方面可能存在一些缺点。对于主动脉壁弥漫性脆弱的穿透性主动脉溃疡的治疗，建议谨慎操作。在这种情况下，球囊扩张应仅限于支架移植物的覆盖部分，以防止支架变形和穿透主动脉壁。
