Yamashita S, Dohi T, Shimizu Y, Momomura S
Cardiovascular Center, Toranomon Hospital, Tokyo, Japan.
Drug Discov Ther. 2012 Oct;6(5):278-82.
We report a case of 74-year-old man presenting with a rupture of a thoracic aortic false aneurysm after undergoing conventional total arch replacement for aortic arch aneurysm (62 mm) and endovascular stent placement for descending aortic aneurysm (70 mm). His chief complaints at the present admission were fever and sensation of dyspnea and we put him on a course of antibiotics for stent graft infection. However he died of massive hemoptysis. From a standpoint of autopsy findings, a thoracic aortic false aneurysm formed at the just proximal landing zone owing to type Ia endoleak, and simultaneously stent graft infection lead to make fistula formation between the false aneurysm and the lung. We examined ourselves that stent graft infection and aortopulmonary fistula caused by an infected thoracic aortic false aneurysm rupturing into the lung should be promptly treated such as complete removal of the stent and another revascularization in a reasonable period of time except if there are complications such as comorbid1ities or withholding of consent. We experienced and reported one rare case associated with a rupture of thoracic aortic false aneurysm caused by stent graft infection and the fistulization between the lung and the stent graft.
我们报告了一例74岁男性病例，该患者在接受主动脉弓动脉瘤（62毫米）的传统全弓置换术及降主动脉动脉瘤（70毫米）的血管内支架置入术后，出现了胸主动脉假性动脉瘤破裂。他此次入院的主要症状为发热和呼吸困难，我们给予他抗生素疗程以治疗支架移植物感染。然而，他死于大量咯血。从尸检结果来看，由于Ia型内漏，在近端着陆区刚形成了一个胸主动脉假性动脉瘤，同时支架移植物感染导致假性动脉瘤与肺部之间形成瘘管。我们自我检查发现，由感染性胸主动脉假性动脉瘤破裂入肺引起的支架移植物感染和主动脉肺瘘应及时治疗，例如在合理时间内彻底移除支架并进行再次血管重建，除非存在合并症或患者拒绝同意等并发症。我们经历并报告了一例罕见病例，该病例与支架移植物感染导致的胸主动脉假性动脉瘤破裂以及肺部与支架移植物之间的瘘管形成有关。
