Department of Vascular Surgery, San Raffaele Scientific Institute, Università Vita-Salute, Milan, Italy.
J Endovasc Ther. 2010 Feb;17(1):126-30. doi: 10.1583/09-2900.1.
To describe perforation of a Dacron aortic graft due to a post-thoracotomy dislocated rib fracture in a young Marfan patient.
Six months after a successful open repair of a type II dissecting thoracoabdominal aortic aneurysm (TAAA), a 40-year-old woman with Marfan syndrome underwent elective repair of a post-thoracotomy dislocated rib fracture. During the procedure, the graft ruptured; 2 TAG stent-grafts were emergently implanted to reline the existing aortic graft. The fractured rib was then resected. The postoperative course was uneventful, without residual leak at computed tomography at 3 days. At 18 months, the patient is well, without need of further operations.
Early correction of any dislocated rib fracture close to a thoracic aortic graft should be considered, especially if the graft is not wrapped by the aneurysm sac. In these patients, in-graft endovascular relining associated with repair of the rib fracture may be a feasible and effective alternative to redo thoracotomy and surgical graft repair. Prior to attempting rib resection, appropriate thoracic endografts should be on hand in case an endovascular bailout is needed.
描述一位马凡综合征年轻患者因开胸术后肋骨错位骨折导致涤纶主动脉移植物穿孔。
一位 40 岁的马凡综合征女性患者，在成功进行了 II 型胸腹主动脉夹层动脉瘤（TAAA）开放修复术后 6 个月，因开胸术后肋骨错位而行择期肋骨骨折复位术。手术过程中，移植物破裂；紧急植入 2 个 TAG 支架移植物以重新衬里现有的主动脉移植物。随后切除了骨折肋骨。术后过程顺利，3 天时 CT 无残余漏。18 个月时，患者恢复良好，无需进一步手术。
对于靠近胸主动脉移植物的任何错位肋骨骨折，应考虑早期矫正，尤其是移植物未被动脉瘤囊包裹时。对于这些患者，血管内植入物内修复联合肋骨骨折修复可能是再次开胸和外科移植物修复的可行且有效的替代方法。在尝试切除肋骨之前，应准备好适当的胸主动脉内移植物，以防需要血管内紧急救援。
