Sueyoshi Eijun, Koike Hirofumi, Sakamoto Ichiro, Uetani Masataka
1Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan.
2Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
CVIR Endovasc. 2018;1(1):10. doi: 10.1186/s42155-018-0019-z. Epub 2018 Oct 22.
Massive hemoptysis is a life-threatening condition and can arise as a complication of conditions. Conversely, hemoptysis rarely occurs as a complication of a ruptured thoracic aortic aneurysm (TAA).
A 76-year-old male had a history of surgical replacement of the whole aortic arch due to a TAA. Three years after the surgery, severe hemoptysis occurred, which resulted in the patient's emergency hospitalization at our hospital. The patient was diagnosed with ruptured pseudoaneurysms of the aortic arch. Emergency thoracic endovascular aortic repair (TEVAR) was performed. .After that, the hemoptysis stopped, and the patient was discharged. Two months later, the hemoptysis reccurred so the patient was re-admitted to our hospital. CT showed a type 2 endoleak from the bronchial artery. The anastomotic pseudoaneurysms remained. As re-rupturing of the anastomotic aneurysms due to a type 2 endoleak was suspected, transcatheter arterial embolization was performed to treat the type 2 endoleak. The patient's hemoptysis stopped, and he was discharged.One year later, CT showed that the anastomotic pseudoaneurysms had disappeared, and the diameter of the aorta had also reduced.
We present a case of hemoptysis caused by a type 2 endoleak that occurred after TEVAR for a ruptured TAA. The hemoptysis was secondary to aortobronchial fistulas caused by anastomotic aortic pseudoaneurysms. Transcatheter arterial embolization of the type 2 endoleak was very effective against the hemoptysis, and the pseudoaneurysms also disappeared. No such cases have been reported previously.
大量咯血是一种危及生命的状况，可作为多种疾病的并发症出现。相反，咯血很少作为胸主动脉瘤（TAA）破裂的并发症发生。
一名76岁男性因TAA接受了全主动脉弓手术置换。术后三年，发生严重咯血，导致患者紧急入住我院。患者被诊断为主动脉弓假性动脉瘤破裂。进行了急诊胸主动脉腔内修复术（TEVAR）。之后，咯血停止，患者出院。两个月后，咯血复发，患者再次入院。CT显示来自支气管动脉的2型内漏。吻合口假性动脉瘤仍然存在。由于怀疑2型内漏导致吻合口动脉瘤再次破裂，进行了经导管动脉栓塞术以治疗2型内漏。患者的咯血停止，随后出院。一年后，CT显示吻合口假性动脉瘤消失，主动脉直径也缩小了。
我们报告了一例TEVAR治疗破裂TAA后由2型内漏引起咯血的病例。咯血继发于吻合口主动脉假性动脉瘤导致的主动脉支气管瘘。对2型内漏进行经导管动脉栓塞术对咯血非常有效，假性动脉瘤也消失了。此前未见此类病例报道。
