Wada Kenji, Shimamoto Takeshi, Komiya Tatsuhiko, Tsuneyoshi Hiroshi
Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan.
Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan
J Endovasc Ther. 2016 Jun;23(3):489-92. doi: 10.1177/1526602816644913. Epub 2016 Apr 20.
To report initial use of a physician-modified Gore TAG Thoracic Endoprosthesis for the treatment of pseudoaneurysm in the ascending aorta.
This technique is demonstrated in a 42-year-old man with a pseudoaneurysm of the ascending aorta after a Bentall operation. The treatable length extending from the sinotubular junction to the anastomotic aneurysm edge was only 5 cm. A 45×100-mm TAG endograft for the pseudoaneurysm was modified on a back table to shorten its length. The delivery shaft was incised, and the 2 threads that fasten the top and bottom portions of the stent-graft to the sleeve were pulled out. The unfolded half of the stent-graft was cut back after pulling out the strand for the back half. Next, this custom-made graft was deployed via a transcarotid approach with cardiopulmonary bypass; no endoleak was observed. Postoperative computed tomography showed a minute type Ib endoleak. The patient was doing well at postoperative month 6.
Physician modification of a TAG endograft facilitated effective management of this ascending aortic lesion by shortening the length of aortic coverage.
报告首次使用经医生改良的戈尔TAG胸段血管内假体治疗升主动脉假性动脉瘤。
在一名42岁行Bentall手术后发生升主动脉假性动脉瘤的男性患者身上展示了该技术。从窦管交界至吻合口动脉瘤边缘的可治疗长度仅为5厘米。在手术台上对用于假性动脉瘤的45×100毫米TAG血管内移植物进行改良以缩短其长度。切开输送轴，拔出将支架移植物顶部和底部固定至套管的2根线。拔出后半部分的线后，将支架移植物未展开的一半进行裁剪。接下来，通过经颈动脉途径在体外循环下植入这个定制的移植物；未观察到内漏。术后计算机断层扫描显示有微小的Ib型内漏。患者在术后6个月情况良好。
医生对TAG血管内移植物的改良通过缩短主动脉覆盖长度，有助于有效处理这种升主动脉病变。
