Bai Jun, Liu Yandong, Jin Jie, Li Jun, Ji Xiangguo, Qu Lefeng
Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
J Thorac Dis. 2018 Apr;10(4):2474-2480. doi: 10.21037/jtd.2018.03.162.
To present a case with aorta coarctation complicated by aortic arch aneurysm which is clinical rare and entails a high risk of rupture. Here we reported a 46-year-old female patient diagnosed with aortic arch aneurysm combined with coarctation. The computed tomography angiography shows that an irregular aneurysm was located at the aortic arch site with its maximal diameter 86.55 mm and the right end of aneurysm was located 10 mm away from the ostium of left common carotid artery (LCCA). The aneurysm body invaded the left subclavian artery, and at the distal end of aneurysm a coarctation had been observed with a minimum diameter reaching 2.7 mm. We performed percutaneous balloon angioplasty, thoracic endovascular aortic repair to exclude the aneurysm, and simultaneously used a novel fenestration device (Quick-Fenestrater) to revascularize the covered LCCA. This is first case of using a novel fenestration device single-stage endovascular treatment of complicated thoracic aorta coarctation concurrent with aortic arch aneurysm. Combined endovascular techniques can elevate the success rate of reconstruct complicated aorta aneurysm concurrent with coarctation and reduce complications. Under the guidance of Quick-Fenestrater, fenestration could be performed with safety and a high success frequency.
报道一例主动脉缩窄合并主动脉弓动脉瘤的病例,该病例临床罕见且破裂风险高。在此,我们报告一名46岁女性患者,诊断为主动脉弓动脉瘤合并缩窄。计算机断层血管造影显示,一个不规则动脉瘤位于主动脉弓部位,最大直径86.55毫米,动脉瘤右端距左颈总动脉开口10毫米。瘤体侵犯左锁骨下动脉,在动脉瘤远端观察到缩窄,最小直径达2.7毫米。我们进行了经皮球囊血管成形术、胸主动脉腔内修复术以排除动脉瘤,同时使用一种新型开窗装置(Quick - Fenestrater)对被覆盖的左颈总动脉进行血管重建。这是首例使用新型开窗装置单阶段腔内治疗复杂胸主动脉缩窄并发主动脉弓动脉瘤的病例。联合腔内技术可提高重建复杂主动脉瘤合并缩窄的成功率并减少并发症。在Quick - Fenestrater的引导下,开窗操作安全且成功率高。