Thakkar Rajiv N, Thomaier Lauren, Qazi Umair, Verde Franco, Malas Mahmoud B
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Ann Vasc Surg. 2015 Apr;29(3):594.e11-6. doi: 10.1016/j.avsg.2014.10.044. Epub 2015 Jan 28.
A 21-year-old male suffered blunt trauma from a motor vehicle accident causing thoracic aorta tear. The smallest available stent graft was deployed. Definitive repair was later performed using a 22 × 22 × 116 mm Talent Thoracic Stent Graft. The postoperative course was uneventful. Seventeen months later, he presented with dizziness, chest pain, acute renal failure, malignant hypertension, and troponin elevation. Computed tomography (CT) angiogram and transesophageal echocardiogram did not reveal any dissection, stent stenosis or collapse. Cardiac catheterization showed normal coronary arteries but a 117 mm Hg gradient across the stent graft. Iatrogenic coarctation of the aorta was confirmed with a second measurement during arch angiogram. A Palmaz stent was deployed over the distal end of the previous stent graft with complete resolution of symptoms and gradual normalization of kidney function. This case report demonstrates a need for wider availability and selecting appropriate stent graft in treating traumatic aortic injuries in young patients. It is the first case report of the inability of current imaging modalities in confirming stent collapse. Pressure gradient is a useful tool in confirming stent collapse when clinical scenario does not match CT findings.
一名21岁男性因机动车事故遭受钝性创伤，导致胸主动脉撕裂。使用了最小可用的覆膜支架。随后使用22×22×116mm的Talent胸主动脉覆膜支架进行了确定性修复。术后过程顺利。17个月后，他出现头晕、胸痛、急性肾衰竭、恶性高血压和肌钙蛋白升高。计算机断层扫描（CT）血管造影和经食管超声心动图未发现任何夹层、支架狭窄或塌陷。心导管检查显示冠状动脉正常，但覆膜支架两端存在117mmHg的压差。在主动脉弓血管造影期间再次测量证实了医源性主动脉缩窄。在先前覆膜支架的远端置入一个Palmaz支架，症状完全缓解，肾功能逐渐恢复正常。本病例报告表明，在治疗年轻患者的创伤性主动脉损伤时，需要更广泛地提供并选择合适的覆膜支架。这是首例当前影像学检查无法证实支架塌陷的病例报告。当临床情况与CT结果不符时，压力梯度是确认支架塌陷的有用工具。
