McCallum John C, Limmer Karl K, Perricone Anthony, Bandyk Dennis, Kansal Nikhil
Department of Surgery, Division of Vascular Surgery, University of California San Diego, San Diego, CA, USA.
Vasc Endovascular Surg. 2013 Jul;47(5):374-8. doi: 10.1177/1538574413486838. Epub 2013 May 22.
Thoracic aortic endografting has been successfully implemented to treat aneurysmal disease of the distal aortic arch and descending thoracic aorta. Although there are reports of ascending aortic endovascular interventions, the total endovascular repair of a ruptured ascending aorta secondary to a Type A dissection has not been described. We report the case of a 77-year-old patient who presented with a ruptured ascending aortic aneurysm secondary to degeneration of a Stanford type A aortic dissection. His surgical history was significant for orthotropic heart transplant 19 years prior. The dissection, aneurysm, and rupture occurred in the native aorta distal to the ascending aortic suture line. At presentation, he was hemodynamically unstable with a right hemothorax. We placed 3 Medtronic Talent Thoracic Stent Graft devices (Medtronic Inc, Minneapolis, MN) across the suture line in the ascending aorta, excluding the rupture. The patient survived and has been followed to 25 months.
胸主动脉腔内修复术已成功应用于治疗主动脉弓远端和降主动脉的动脉瘤性疾病。虽然有关于升主动脉血管内介入治疗的报道，但尚未描述过对A型夹层继发的升主动脉破裂进行完全血管内修复的情况。我们报告了一例77岁患者，其因斯坦福A型主动脉夹层退变继发升主动脉瘤破裂。他有重要的手术史，19年前接受过原位心脏移植。夹层、动脉瘤和破裂发生在升主动脉缝线远端的天然主动脉。就诊时，他血流动力学不稳定，伴有右侧血胸。我们在升主动脉的缝线处植入了3个美敦力Talent胸主动脉覆膜支架装置（美敦力公司，明尼阿波利斯，明尼苏达州），覆盖破裂部位。患者存活，已随访25个月。
