Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan.
Surg Today. 2012 May;42(5):493-6. doi: 10.1007/s00595-011-0050-3. Epub 2011 Nov 18.
We experienced a serious complication of proximal stent strut penetration (PSSP) during thoracic endovascular aortic repair in a 74-year-old man who underwent two-stage hybrid treatment for a distal arch thoracic aortic aneurysm. First, a debranching right common carotid-left common carotid-left subclavian artery bypass was performed. Second, a TALENT Thoracic Stent Graft (Medtronic, Tokyo, Japan) was inserted at Zone 1 (Ishimaru). At deployment, a proximal bare strut accidentally everted and penetrated the aortic wall vertically. Postoperative computed tomography revealed that one crown of the proximal strut had penetrated the aortic wall vertically and had produced an intramural hematoma around the strut. The patient was observed carefully and discharged from the hospital without any sequelae. Seven months after the procedure, there was no remarkable change and his aneurysm was well excluded. PSSP can cause retrograde type-A aortic dissections. A bare strut tends to cause proximal strut penetration more frequently than a covered strut. More caution should be taken in the deployment of a stent graft with a bare strut.
我们在一位 74 岁男性患者的胸主动脉腔内修复术中遇到了严重的近端支架支柱穿透（PSSP）并发症，该患者因远端主动脉弓胸主动脉瘤而行两阶段杂交治疗。首先，进行了去分支右颈总动脉-左颈总动脉-左锁骨下动脉旁路手术。其次，在 1 区（石丸）置入 TALENT 胸主动脉支架移植物（美敦力，东京，日本）。在展开时，一个近端裸支架意外外翻并垂直穿透主动脉壁。术后计算机断层扫描显示，一个近端支架支柱的冠穿透主动脉壁，支架周围形成了壁内血肿。患者得到了仔细观察，无任何后遗症出院。术后 7 个月，无明显变化，其动脉瘤得到了很好的隔绝。PSSP 可导致逆行型 A 型主动脉夹层。裸支架比覆盖支架更容易导致近端支架穿透。在置入带裸支架的支架移植物时应更加小心。
