Ng Alvin Yuan Liang, Gale Michael, Renwick Bryce, Bachoo Paul
Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
Department of Vascular Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
J Surg Case Rep. 2020 Mar 24;2020(3):rjaa046. doi: 10.1093/jscr/rjaa046. eCollection 2020 Mar.
Anatomical variation may result in unexpected complications after fenestrated endovascular aneurysm repair (FEVAR). We report a 78-year-old gentleman who was admitted for elective FEVAR procedure for a juxtarenal abdominal aortic aneurysm. Three days post-operatively, he deteriorated clinically. Computed tomography (CT) angiogram showed small bowel ischaemia and a replaced right hepatic artery originating from superior mesenteric artery. A necrotic gallbladder found during laparotomy required cholecystectomy following small bowel resection that required a relook for anastomosis and drainage of bile collection. He had prolonged ICU stay requiring treatment for multiple organ dysfunction then spent 4 weeks in hospital. Following multidisciplinary team approach in management of his complications during post-operative phase, he recovered well enough for rehabilitation and discharge home. Surveillance CT aorta at 1 month and 6 months post FEVAR showed satisfactory FEVAR appearance with no endoleak.
解剖变异可能导致开窗式血管腔内动脉瘤修复术（FEVAR）后出现意外并发症。我们报告一位78岁男性，因择期行FEVAR治疗近肾腹主动脉瘤入院。术后三天，他的临床状况恶化。计算机断层扫描（CT）血管造影显示小肠缺血，右肝动脉由肠系膜上动脉发出替代正常走行。剖腹手术中发现坏死胆囊，在小肠切除术后需要行胆囊切除术，术后还需要再次探查以吻合和引流胆汁积聚。他在重症监护病房（ICU）住院时间延长，需要治疗多器官功能障碍，随后在医院住了4周。在术后阶段采用多学科团队方法管理其并发症后，他恢复良好，足以进行康复并出院回家。FEVAR术后1个月和6个月的主动脉CT监测显示FEVAR外观满意，无内漏。
