Berczeli Márton, Oláh Zoltán, Szatai Lilla, Daróczi László, Sótonyi Péter
Érsebészeti és Endovaszkuláris Tanszék,Semmelweis Egyetem, Általános Orvostudományi KarBudapest, Városmajor u. 68., 1122.
Szívsebészeti Tanszéki Csoport,Semmelweis Egyetem, Általános Orvostudományi KarBudapest.
Orv Hetil. 2020 Feb;161(7):269-274. doi: 10.1556/650.2020.31676.
Treatment of thoracoabdominal aortic aneurysms is one of the most difficult challenges of vascular surgery. Endovascular options for complex aneurysms in urgent situation are limited. Thoracoabdominal giant aortic aneurysms are especially rare phenomena, each of them requires patient-specific treatment. Staged-fashion reconstructions may offer lower rate, especially for spinal cord injury. In our case report, we present a male patient, who had a 19.2 cm maximum diameter modified Crawford type V thoracoabdominal aortic aneurysm with contained rupture. The patient underwent an acute open repair and later a staged endovascular repair successfully. A 64-year-old male patient was admitted to our institution with complaints of chest and lower back pain in stable hemodynamic state. After evaluation, computer tomography angiography revealed a 19.2 cm maximum diameter thoracoabdominal aortic aneurysm, compression signs and hemothorax. Based on the anatomy, the serious compression symptoms and hemothorax associated with the gigantic aneurysm, we decided to perform open aortic repair. To reduce risk of spinal cord ischemia, intraoperatively we chose finishing the full reconstruction in a staged fashion. First, we performed an open repair with a Dacron interpositum distally using an oblique patch involving the visceral orifices. Later we implanted a thoracic endograft. At one-year follow-up, the patient was symptom-free, with no sign of endoleak. Giant aortic aneurysms are rare conditions, especially in the thoracoabdominal region. In the presence of compression symptoms, hemothorax and unsuitable aneurysm anatomy, open repair should be done. Staged repair offers a less invasive approach decreasing the risk of spinal cord ischemia. Orv Hetil. 2020; 161(7): 269-274.
胸腹主动脉瘤的治疗是血管外科最具挑战性的难题之一。在紧急情况下，针对复杂动脉瘤的血管内治疗选择有限。胸腹巨大主动脉瘤尤为罕见，每个病例都需要个体化治疗。分期重建的发生率可能较低，尤其是对于脊髓损伤而言。在我们的病例报告中，我们介绍了一名男性患者，他患有最大直径为19.2 cm的改良Crawford V型胸腹主动脉瘤并伴有局限性破裂。该患者先接受了急诊开放修复，随后成功进行了分期血管内修复。一名64岁男性患者因胸部和下背部疼痛入院，血流动力学状态稳定。经评估，计算机断层血管造影显示最大直径为19.2 cm的胸腹主动脉瘤、压迫体征和血胸。基于解剖结构、与巨大动脉瘤相关的严重压迫症状和血胸，我们决定进行主动脉开放修复。为降低脊髓缺血风险，术中我们选择分期完成全重建。首先，我们使用一个涉及内脏孔口的斜形补片进行远端涤纶补片开放修复。随后我们植入了一个胸段血管内移植物。在一年的随访中，患者无症状，无内漏迹象。巨大主动脉瘤较为罕见，尤其是在胸腹区域。在存在压迫症状、血胸且动脉瘤解剖结构不适合的情况下，应进行开放修复。分期修复提供了一种侵入性较小的方法，可降低脊髓缺血风险。《匈牙利医学周报》。2020年；161(7):269 - 274。
