Ariya Takumi, Koide Masaaki, Kunii Yoshifumi, Tateishi Minori, Okugi Satoshi, Sakurai Yousuke, Cao Yuchen
Department of Cardiovascular Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
Kyobu Geka. 2020 May;73(5):375-379.
Thoracic endovascular aortic repair (TEVAR) has become a major procedure for thoracic aortic aneurysm and its indication is expanding. On the other hand, TEVAR specific complication is rather critical and its treatment is of increasing interest. Especially, open repair after TEVAR is sometimes demanding and case based strategy is mandatory. We experienced a case of open repair for aneurysm infection and endoleak after fenestrated TEVAR in 76-year-old man. He underwent initial aneurysmal repair using fenestrated graft 2 years ago. Five months later, debridment of infected tissue was performed because of aneurysmal infection. Type Ⅰ endoleak appeared after the surgery and expansion of the aneurysm made us decide extensive open repair. The operation was done under hypothermic circulatory arrest and selective cerebral perfusion. Partial removal of stent-graft and insertion of the open stent-graft, replacement of ascending aorta and reconstruction of neck vessels were done. Postoperative course was smooth. Open repair after TEVAR is often demanding. Sophisticated strategy for each case has to be planned.
胸主动脉腔内修复术（TEVAR）已成为治疗胸主动脉瘤的主要手术方法，其适应症也在不断扩大。另一方面，TEVAR特有的并发症相当严重，对其治疗的关注度日益增加。特别是，TEVAR术后的开放修复有时要求很高，基于病例的策略必不可少。我们遇到一例76岁男性在开窗TEVAR术后因动脉瘤感染和内漏进行开放修复的病例。他两年前接受了开窗移植物的初次动脉瘤修复术。五个月后，由于动脉瘤感染进行了感染组织清创术。术后出现Ⅰ型内漏，动脉瘤扩大促使我们决定进行广泛的开放修复。手术在低温循环停止和选择性脑灌注下进行。部分移除支架移植物并插入开放支架移植物，置换升主动脉并重建颈部血管。术后过程顺利。TEVAR术后的开放修复往往要求很高。必须针对每个病例制定精细的策略。
