Nakao Yoshihisa, Mitsuoka Hiroshi, Furuya Hidekazu, Shintani Tsunehiro, Higashi Shigeki
Department of Cardiovascular Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
Kyobu Geka. 2011 Dec;64(13):1163-7.
A 79-year-old woman presented with sustained thoracolumbar back pain. Contrasted computed tomography (CT) showed a thoracoabdominal aortic aneurysm (TAAA: type I of Crawford classification) and an abdominal aortic aneurysm (AAA) that were not ruptured. Considering her age, the placement of an endovascular stent graft was performed for TAAA at the possible sacrifice of the celiac (CA) and superior mesenteric arteries (SMA). In order to prevent ischemic events, it was necessary that blood supply to the CA and SMA was maintained by placing a graft to each artery from the Y-shaped graft for replacement of AAA. Actually, only CA was sacrificed and coil embolization of CA was needed because of type 2 endoleak. The patient was discharged 17 days after surgery. A hybrid technique, endovascular repair with reconstruction of abdominal branches for TAAA and AAA, can be an alternative procedure for such high-risk operation with multiple aortic aneurysms including TAAA.
一名79岁女性因持续性胸腰背部疼痛就诊。增强计算机断层扫描(CT)显示为胸腹主动脉瘤(TAAA:Crawford分类I型)和未破裂的腹主动脉瘤(AAA)。考虑到患者年龄,对TAAA进行了血管内支架植入术,可能牺牲腹腔干(CA)和肠系膜上动脉(SMA)。为预防缺血事件,有必要通过从用于置换AAA的Y形移植物向各动脉植入移植物来维持对CA和SMA的血液供应。实际上,由于2型内漏仅牺牲了CA且需要对CA进行弹簧圈栓塞。患者术后17天出院。对于包括TAAA在内的多发性主动脉瘤的此类高风险手术,一种混合技术,即对TAAA和AAA进行血管内修复并重建腹部分支,可能是一种替代手术方法。