Hata Yosuke, Iida Osamu, Asai Mitsuyoshi, Masuda Masaharu, Okamoto Shin, Ishihara Takayuki, Nanto Kiyonori, Kanda Takashi, Tsujimura Takuya, Okuno Shota, Matsuda Yasuhiro, Mano Toshiaki
Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan.
J Cardiol Cases. 2017 Dec 9;17(4):111-115. doi: 10.1016/j.jccase.2017.11.004. eCollection 2018 Apr.
Enlargement due to residual dissection after surgical ascending aortic replacement is technically challenging to treat. Endovascular entry closure using an Amplatzer vascular plug 2 (AVP2) in the sub-acute phase has not been reported. A 75-year-old female underwent emergent ascending aorta replacement for Stanford type A aortic dissection. Postoperative computed tomography angiography (CTA) showed a distal aortic arch diameter of 41 mm and a patent false lumen. CTA one month after the operation revealed distal aortic arch enlargement to 52 mm, which is considered high-risk for rupture. Repeat open surgery was considered but carried a high risk of perioperative complications. Therefore, we performed endovascular closure for the entry at the proximal descending aorta using an AVP2 and stent graft coverage and coil embolization for the re-entries at the bilateral iliac arteries. CTA one month after the procedure revealed that the false lumen of the aortic arch was thrombosed and that the distal aortic arch had shrunk to 38 mm, indicating the efficacy of endovascular entry closure with the AVP2 after aortic dissection. < Endovascular entry closure for residual dissection more than 2 years after ascending aorta replacement has already been reported. We conducted this procedure in the sub-acute phase and induced favorable aortic remodeling. The endovascular entry closure was successfully conducted for a patient presenting residual tears after emergent ascending aorta replacement, considering a treatment option with high risk for repeat open surgery.>.
手术升主动脉置换术后因残留夹层导致的扩张在治疗上具有技术挑战性。在亚急性期使用Amplatzer血管封堵器2（AVP2）进行血管腔内入口闭合术尚未见报道。一名75岁女性因斯坦福A型主动脉夹层接受了急诊升主动脉置换术。术后计算机断层扫描血管造影（CTA）显示主动脉弓远端直径为41毫米，假腔通畅。术后1个月的CTA显示主动脉弓远端扩大至52毫米，这被认为有较高的破裂风险。考虑过再次进行开放手术，但围手术期并发症风险较高。因此，我们使用AVP2对降主动脉近端的入口进行了血管腔内闭合，并对双侧髂动脉的再入口进行了支架移植物覆盖和弹簧圈栓塞。术后1个月的CTA显示主动脉弓假腔血栓形成，主动脉弓远端缩小至38毫米，表明主动脉夹层后使用AVP2进行血管腔内入口闭合的有效性。<已有报道在升主动脉置换术后2年以上对残留夹层进行血管腔内入口闭合。我们在亚急性期进行了该手术，并诱导了良好的主动脉重塑。对于一名在急诊升主动脉置换术后出现残留撕裂的患者，考虑到再次开放手术风险较高的治疗选择，成功进行了血管腔内入口闭合术。>
