Kasemi Holta, Marino Mario, Di Angelo Costantino Luca, Fadda Gian Franco, Speziale Francesco
Vascular Surgery Unit, Department of Surgery, "San Francesco" Hospital, Nuoro, Italy; Vascular Surgery Unit, Department "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Vascular Surgery Unit, Department of Surgery, "San Francesco" Hospital, Nuoro, Italy; Vascular Surgery Unit, Department "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Ann Vasc Surg. 2015 Jan;29(1):126.e15-9. doi: 10.1016/j.avsg.2014.08.014. Epub 2014 Oct 7.
We report the case of a 76-year-old man presented with three saccular aneurysms at the aortic arch and descending thoracic aorta. A two-staged hybrid approach was performed. A left common carotid-to-left subclavian artery bypass and a custom-made fenestrated endograft were used for the two proximal aneurysms. The endograft deployment was complicated by the unadverted coverage of the left common carotid artery ostium, promptly corrected with the chimney technique. The endovascular treatment was completed with the third endovascular aneurysm exclusion 5 months after the first procedure to reduce the risk of spinal cord ischemia. Yearly follow-up computed tomography scan confirmed aortic arch and descending thoracic aorta aneurysms exclusion with supra-aortic vessels, bypass, and stent patency. Endovascular repair of the aortic arch aneurysm with a fenestrated endograft is safe and feasible in selected patients. Complications may be solved with total endovascular approach. Long term follow-up remains mandatory.
我们报告了一例76岁男性患者，其主动脉弓和胸降主动脉出现三个囊状动脉瘤。采用了两阶段的杂交手术方法。对于两个近端动脉瘤，进行了左颈总动脉至左锁骨下动脉搭桥术，并使用了定制的开窗型覆膜支架。覆膜支架植入过程中出现了意外覆盖左颈总动脉开口的情况，随即采用烟囱技术迅速纠正。在首次手术后5个月，通过第三次血管内动脉瘤隔绝术完成了血管内治疗，以降低脊髓缺血风险。每年的随访计算机断层扫描证实了主动脉弓和胸降主动脉动脉瘤被隔绝，主动脉弓上血管、搭桥血管和支架通畅。对于选定的患者，使用开窗型覆膜支架进行血管内修复主动脉弓动脉瘤是安全可行的。并发症可通过完全血管内方法解决。长期随访仍然是必要的。
