Hattori Shigeru, Noguchi Kenichiro, Gunji Yusuke, Nagatsuka Motoki, Yamabe Tsuyoshi, Ogino Hidemitsu, Katayama Ikuo
Department of Cardiovascular Surgery, Aortic Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
Gen Thorac Cardiovasc Surg. 2020 Jan;68(1):70-73. doi: 10.1007/s11748-018-1016-9. Epub 2018 Sep 22.
Conversion to open repair after thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection is rare, but inevitable. We present a case of an 86-year-old man with ruptured type B aortic dissection after TEVAR. He received a successful stent-graft implantation of the descending aorta without any type of endoleak. After the patient was transferred to the intensive care unit, he went into a shock state. Contrast-enhanced CT revealed a re-rupture of acute retrograde type B aortic dissection. The false lumen was patent and perforated to the left thorax. Left thoracotomy and descending aortic banding was performed. Descending aorta was encircled with a woven Dacron graft at the distal part of the rupture site to compress the patent false lumen. The bleeding was stopped, and the follow-up CT showed false lumen thrombosis. Descending aortic banding is one of the quick and effective open conversion techniques.
对于急性B型主动脉夹层，经胸主动脉腔内修复术（TEVAR）后转为开放修复术的情况罕见，但不可避免。我们报告一例86岁男性患者，在TEVAR术后发生B型主动脉夹层破裂。他成功接受了降主动脉支架移植物植入术，未出现任何类型的内漏。患者转入重症监护病房后，进入休克状态。增强CT显示急性逆行性B型主动脉夹层再次破裂。假腔通畅并向左胸穿孔。进行了左胸开胸和降主动脉束带术。在破裂部位远端用编织涤纶移植物环绕降主动脉，以压迫通畅的假腔。出血停止，随访CT显示假腔血栓形成。降主动脉束带术是快速有效的开放转换技术之一。
