Tilea Ioan, Hadadi Laszlo, Serban Razvan C, Tilea Brindusa
University of Medicine and Pharmacy of Targu Mures, 38 Gheorghe Marinescu St, Targu Mures 540139, Romania.
J Med Case Rep. 2012 Aug 30;6:255. doi: 10.1186/1752-1947-6-255.
Local aneurysms after surgical repair of coarctation of the aorta occur mainly in patients surgically treated by Dacron patch plasty during adulthood. The management of these patients is always problematic, with frequent complications and increased mortality rates. Percutaneous stent-graft implantation avoids the need for surgical reintervention.
We report a case involving the hybrid treatment by stent-graft implantation and transposition of the left subclavian artery to the left common carotid artery of an aneurysmal dilatation of the thoracic aorta that occurred in a 64-year-old Caucasian man, operated on almost 40 years earlier with a Dacron patch plasty for aortic coarctation. Our patient presented to our facility for evaluation with back pain and shortness of breath after minimal physical effort. A physical examination revealed stony dullness to percussion of the left posterior thorax, with no other abnormalities. The results of chest radiography, followed by contrast-enhanced computed tomography and aortography, led to a diagnosis of giant aortic thoracic aneurysm. Successful treatment of the aneurysm was achieved by percutaneous stent-graft implantation combined with transposition of the left subclavian artery to the left common carotid artery. His post-procedural recovery was uneventful. Three months after the procedure, computed tomography showed complete thrombosis of the excluded aneurysm, without any clinical signs of left lower limb ischemia or new onset neurological abnormalities.
Our patient's case illustrates the clinical outcomes of surgical interventions for aortic coarctation. However, the very late appearance of a local aneurysm is rather unusual. Management of such cases is always difficult. The decision-making should be multidisciplinary. A hybrid approach was considered the best solution for our patient.
主动脉缩窄手术修复后发生的局部动脉瘤主要见于成年期接受涤纶补片修补术治疗的患者。这些患者的治疗一直存在问题，并发症频繁且死亡率增加。经皮支架移植物植入术避免了再次手术干预的需要。
我们报告一例64岁白种男性患者，其在近40年前因主动脉缩窄接受涤纶补片修补术，现发生胸主动脉瘤样扩张，采用支架移植物植入术和左锁骨下动脉转位至左颈总动脉的杂交治疗。我们的患者因轻微体力活动后出现背痛和呼吸急促前来我院评估。体格检查发现左后胸部叩诊呈实音，无其他异常。胸部X线检查结果，随后的增强计算机断层扫描和主动脉造影检查，诊断为巨大胸主动脉瘤。通过经皮支架移植物植入术联合左锁骨下动脉转位至左颈总动脉成功治疗了该动脉瘤。术后恢复顺利。术后三个月，计算机断层扫描显示被隔绝的动脉瘤完全血栓形成，无左下肢缺血或新发神经异常的任何临床体征。
我们患者的病例说明了主动脉缩窄手术干预的临床结果。然而，局部动脉瘤的极晚期出现相当罕见。此类病例的治疗总是困难的。决策应是多学科的。杂交方法被认为是我们患者的最佳解决方案。
