Bertoglio Luca, Marone Enrico M, Civilini Efrem, Cambiaghi Tommaso, Mascia Daniele, Chiesa Roberto
Department of Vascular Surgery, Scientific Institute San Raffaele Hospital, Vita Salute San Raffaele University, Milan, Italy -
J Cardiovasc Surg (Torino). 2016 Oct;57(5):646-52. Epub 2015 Sep 3.
The aim of this case report was to present an endovascular treatment of a residual post-dissection Crawford type III thoracoabdominal aneurysm (TAA). A 60-year-old man, who had suffered from acute type B aortic dissection (TBAD) 8 years ago and had already been treated for both descending thoracic and infrarenal aortic aneurysm with open repair, presented with a 61mm post-dissection TAA. The aneurysm was successfully excluded with a staged fully endovascular procedure by employing two multibranched custom-made stent grafts deployed into the false lumen. The first stent-graft with a proximal monobranch was created to perfuse the right renal artery via the true lumen. The latter, with a triple branch design, was meant to perfuse the visceral arteries and left renal artery arising from the false lumen. Available branched custom-made stent-grafts for the treatment of degenerative TAA can be employed also in post TBAD aneurysms so as to simplify the procedure. The branched stent-grafts could be deployed within an enlarged false lumen provided that a suitable distal landing zone is available as well as that the visceral vessels can be perfused from the false lumen. A proximal branch for perfusing one of the lumens of the dissection from the proximal tear can be an alternative solution to creating neofenestrations.
本病例报告的目的是介绍1例采用血管腔内治疗方法处理的Crawford III型胸主动脉瘤（TAA）夹层残留病变。1例60岁男性患者，8年前曾患急性B型主动脉夹层（TBAD），已接受降主动脉和肾下腹主动脉瘤开放修复术，现发现有1个61mm的夹层后TAA。通过将2个定制多分支支架型人工血管置入假腔，采用分期完全血管腔内手术成功隔绝了动脉瘤。第一个带有近端单分支的支架型人工血管用于经真腔灌注右肾动脉。第二个采用三分支设计，用于灌注发自假腔的内脏动脉和左肾动脉。用于治疗退行性TAA的现有分支定制支架型人工血管也可用于TBAD后动脉瘤，以简化手术。只要有合适的远端锚定区且内脏血管可从假腔灌注，分支支架型人工血管即可置入扩大的假腔内。从近端破口灌注夹层其中一个腔的近端分支可作为创建新开窗的替代解决方案。
