Department of Cardiothoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
Eur J Cardiothorac Surg. 2012 Nov;42(5):894-6. doi: 10.1093/ejcts/ezs384. Epub 2012 Aug 3.
Endovascular treatment has emerged as a less traumatic alternative treatment for several diseases of the thoracic aorta. However, the complications of the endovascular management of ascending aortic dissections are still high. We present a case of two iatrogenic complications after endovascular repair (EVAR) of type A (ascending) aortic dissection. Retrograde aortic dissection at the proximal part of the aortic endovascular graft and a guidewire-induced iatrogenic left ventricular pseudoaneurysm were presented in this patient after the stent-grafting procedure. Fourteen months later, surgical replacement of the ascending aorta and proximal arch was performed and the left ventricular pseudoaneurysm was treated successfully by linear closure. The patient recovered uneventfully. Although aortic endovascular grafting is apparently less traumatic, indications and potential complications related to the stent graft should be considered with great care.
血管内治疗已成为治疗胸主动脉多种疾病的一种创伤较小的替代治疗方法。然而，血管内处理升主动脉夹层的并发症仍然很高。我们报告了一例主动脉夹层腔内修复（EVAR）后发生的两种医源性并发症。在支架置入术后，该患者出现近端主动脉腔内移植物逆行主动脉夹层和导丝引起的左心室假性动脉瘤。14 个月后，行升主动脉及近端弓置换术，成功采用线性缝合治疗左心室假性动脉瘤。患者恢复顺利。尽管主动脉腔内移植物植入术明显创伤较小，但应慎重考虑支架移植物的适应证和潜在并发症。
