Cherniavskiĭ A M, Al'sov S A, Tsirikhov V R, Kliver E N
Department of Aorta and Coronary Arteries Surgery, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia.
Angiol Sosud Khir. 2019;25(1):169-174. doi: 10.33529/angio2019123.
Presented herein is the remote (more than 15-year follow up) result of successful surgical treatment of aortic coarctation complicated by septic aortitis and a false aneurysm of the anastomosis between the graft and the aortic arch. In 2002, after correction of aortic coarctation the woman was admitted to our Clinic with an incompetent proximal anastomosis and an infected aortic pseudoaneurysm. Taking into consideration the general and local septic process, repeat reconstruction of the thoracic aorta was impossible due to the risk for generalization of the infectious process and fatal complications. Therefore, the woman was subjected to extra-anatomical bypass grafting of the thoracic aorta with a synthetic graft from the ascending aorta to the infrarenal portion of the abdominal aorta in order to isolate the infection focus to be followed by removal thereof. The postoperative period turned out uneventful, with no complications. After 15 years, the woman was examined again, with her condition being stable. The findings of contrast-enhanced magnetic resonance imaging demonstrated complete patency of the extra-anatomical bypass graft. The carotid-subclavian anastomosis functioned well, without narrowed portions. No infectious complications after the carried out operations were observed. Using extra-anatomical bypass grafting with exclusion from circulation and removal of the infected portion of the aorta along with the graft is one of reliable variants of treatment for such a severe complication as an infected false aneurysm.
本文介绍了主动脉缩窄合并感染性主动脉炎及移植物与主动脉弓吻合处假性动脉瘤的成功手术治疗的远期（超过15年随访）结果。2002年，在矫正主动脉缩窄后，该女性因近端吻合口功能不全及感染性主动脉假性动脉瘤入住我院。考虑到全身和局部的感染过程，由于感染扩散和致命并发症的风险，无法再次重建胸主动脉。因此，该女性接受了胸主动脉解剖外旁路移植术，使用合成移植物从升主动脉至腹主动脉肾下段，以隔离感染灶并随后切除。术后恢复顺利，无并发症。15年后，该女性再次接受检查，病情稳定。对比增强磁共振成像结果显示解剖外旁路移植物完全通畅。颈动脉-锁骨下动脉吻合功能良好，无狭窄部位。术后未观察到感染并发症。采用解剖外旁路移植术，排除循环并切除主动脉感染部分及移植物，是治疗感染性假性动脉瘤这种严重并发症的可靠方法之一。
