Chang Heepeel, Hadro Neal C, Norris Marc A, Rhee Sang Won, Morris Marvin E
Baystate Medical Center, University of Massachusetts School of Medicine, Springfield, MA.
Baystate Medical Center, University of Massachusetts School of Medicine, Springfield, MA.
Ann Vasc Surg. 2019 Jan;54:335.e11-335.e14. doi: 10.1016/j.avsg.2018.06.019. Epub 2018 Aug 13.
Despite recent publications indicating billowing (aneurysmal degeneration of the outer fabric material manifesting as a bulging sac of contained contrast due to weakening of the fabric material between the metal struts) as a benign finding, we present a unique case of billowing that resulted in aneurysmal rupture with the AFX2 stent graft (Endologix, Inc., Irvine, CA). AFX2 consists of an inner metallic endoskeleton with multiple metallic struts covered by a polytetrafluoroethylene graft fabric. It allows the flow of blood or contrast beyond the border of the metallic endoskeleton without evidence of endoleak or rupture secondary to the outer cover being anchored to the endoskeleton with polypropylene sutures only at the proximal and distal ends. Our report raises the concern that although billowing may be a relatively common manifestation with Endologix stent grafts, clinicians have to be diligent as the phenomenon may progress to abdominal aortic aneurysm rupture.
尽管近期有文献表明，膨出（外覆材料的动脉瘤样退变，表现为由于金属支架间的材料薄弱导致含有造影剂的囊袋膨出）是一种良性表现，但我们报告了一例独特的AFX2支架型人工血管（美国加利福尼亚州尔湾市Endologix公司）膨出导致动脉瘤破裂的病例。AFX2由一个内部金属内骨骼和多个被聚四氟乙烯移植织物覆盖的金属支架组成。它允许血液或造影剂在金属内骨骼边界之外流动，且不会因外覆层仅在近端和远端用聚丙烯缝线固定在内骨骼上而出现内漏或破裂。我们的报告引发了这样的担忧：尽管膨出可能是Endologix支架型人工血管相对常见的表现，但临床医生仍需保持警惕，因为这种现象可能进展为腹主动脉瘤破裂。
