Simonte Gioele, Isernia Giacomo, Fiorucci Beatrice, Paciaroni Elisa, Cieri Enrico, Rebonato Alberto, Lenti Massimo
Unit of Vascular Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy.
Unit of Vascular Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy.
Ann Vasc Surg. 2018 Jul;50:298.e7-298.e11. doi: 10.1016/j.avsg.2018.01.079. Epub 2018 Mar 5.
During implantation of an Ovation endograft for abdominal aortic aneurysm (AAA) correction, a patient experienced anaphylactic reaction after polymer leakage outside the device circuit. Procedure was completed after hemodynamic stabilization. Since postoperative day 2, patient complained of loss of legs strength. Medullar injury was excluded by electromyography test, and the clinical signs attributed to muscular necrosis and peripheral nerve involvement after arterial embolization. Furthermore, immediately after surgery, a wide erythematous area appeared in the lumbar region. During the next few days, the lesion developed from extensive blisters and necrosis to deep loss of substance. The wound needed to be medicated 2 or 3 times per week. One year after surgery, the patient still needs crutches for deambulation, and the back injury is currently under treatment. In conclusion, surgeons performing aortic endovascular repair with the Ovation endograft, as well as anesthesiologists participating in the procedure, should be aware of the possibility of embolization and ready to promptly treat possible complications.
在植入用于治疗腹主动脉瘤(AAA)的Ovation血管内移植物过程中,一名患者在装置回路外聚合物泄漏后发生过敏反应。在血流动力学稳定后手术完成。自术后第2天起,患者抱怨腿部力量丧失。通过肌电图检查排除了脊髓损伤,临床体征归因于动脉栓塞后的肌肉坏死和周围神经受累。此外,手术后立即在腰部出现大片红斑区域。在接下来的几天里,病变从广泛的水泡和坏死发展为深部组织缺失。伤口每周需要换药2至3次。手术后一年,患者仍需要拐杖行走,背部损伤目前正在治疗中。总之,使用Ovation血管内移植物进行主动脉血管内修复的外科医生以及参与该手术的麻醉医生应意识到栓塞的可能性,并准备好及时治疗可能出现的并发症。