Riesenman Paul J, Reeves James G, Kasirajan Karthikeshwar
Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University, Atlanta, GA, USA.
Ann Vasc Surg. 2011 May;25(4):555.e5-9. doi: 10.1016/j.avsg.2010.12.028.
We report a case of a large ruptured thoracoabdominal aortic aneurysm, which was stabilized with endovascular aortic exclusion and snorkel bypass of the superior mesenteric artery (SMA). An 80-year-old African American woman with multiple medical comorbidities and previous open infrarenal abdominal aortic aneurysm repair presented with a ruptured 10.7 × 7.3 cm thoracoabdominal aortic aneurysm involving the origins of the renal and mesenteric vessels. The patient underwent emergent endovascular aortic repair with placement of a covered stent into the SMA coursing parallel to the aortic endograft. This technique was initially successful in clinically stabilizing the patient; however; 3 weeks after the initial procedure, she presented with recurrent rupture necessitating proximal extension of her snorkeled SMA bypass and aortic endograft into the mid-descending thoracic aorta. The patient stabilized and was successfully discharged home.
我们报告一例巨大破裂性胸腹主动脉瘤病例，该病例通过血管腔内主动脉隔绝术及肠系膜上动脉（SMA）的“通气管”旁路移植术得以稳定病情。一名80岁的非裔美国女性，有多种内科合并症，既往曾行开放性肾下腹主动脉瘤修复术，此次因一个10.7×7.3 cm的破裂性胸腹主动脉瘤就诊，该动脉瘤累及肾血管和肠系膜血管的起始部。患者接受了紧急血管腔内主动脉修复术，将覆膜支架置入与主动脉腔内移植物平行走行的SMA。该技术最初成功地使患者临床病情稳定；然而，在初次手术后3周，她再次出现破裂，需要将其“通气管”式SMA旁路移植术及主动脉腔内移植物近端延伸至胸主动脉降部中段。患者病情稳定，随后成功出院回家。
