Maldonado Fernández Nicolás, López Espada Cristina, Linares Palomino Jose Patricio, Pérez Vallecillos Pablo, García Róspide Vicente
Department of Vascular Surgery, Vascular Surgery Unit, University Hospital Virgen de las Nieves of Granada, Spain.
Department of Vascular Surgery, Vascular Surgery Unit, University Hospital Virgen de las Nieves of Granada, Spain.
Ann Vasc Surg. 2020 Nov;69:449.e11-449.e16. doi: 10.1016/j.avsg.2020.05.047. Epub 2020 Jun 3.
Structural heart defects, secondary to congenital malformations, have been commonly repaired by open cardiac surgery. Endovascular technology enables these repairs to be performed with fewer complications and better recovery. However, endovascular therapy can be associated with major complications as device dislocation or embolization. We present the case of migration of an Amplatzer occluder device into the abdominal aorta and its surgical retrieval.
A 10-year-old child with ostium secundum-type interatrial communication underwent endovascular repair in our center. Cardiologists sorted out the atrial communication by endovascular deployment of an Amplatzer device. The 24-h ultrasound control study showed the loss of the occluder. An angio-CT scan showed the migration of the Amplatzer into the juxtarenal abdominal aorta. Initially, an endovascular rescue was attempted but was not effective. Our vascular team performed a median laparotomy, control of the abdominal aorta proximal to the renal arteries, and control of the renal arteries and the infrarenal aorta. We performed a transverse arteriotomy, and the material was removed. Subsequently, the arteriotomy was closed directly without any patch. Postoperative evolution was uneventful.
Most of the migrations and embolizations of the devices to close interatrial communications remain intracardiac. Although embolization of the abdominal aorta is only reported sporadically, it could cause a major vascular complication. Percutaneous retrieval of the device is currently recommended, with conventional surgery being the efficient treatment in case of endovascular failure or severe damage to the aorta.
继发于先天性畸形的结构性心脏缺陷通常通过心脏直视手术进行修复。血管内技术使这些修复手术的并发症更少，恢复更好。然而，血管内治疗可能会出现诸如装置移位或栓塞等严重并发症。我们报告了一例Amplatzer封堵器移位至腹主动脉并通过手术取出的病例。
一名10岁继发孔型房间隔缺损患儿在我们中心接受了血管内修复手术。心脏病专家通过血管内植入Amplatzer装置对房间隔缺损进行了封堵。术后24小时的超声检查显示封堵器消失。血管CT扫描显示Amplatzer封堵器移位至肾动脉水平的腹主动脉。最初尝试了血管内取出，但未成功。我们的血管外科团队进行了正中剖腹手术，控制了肾动脉近端的腹主动脉、肾动脉及肾动脉以下的腹主动脉。我们进行了横行动脉切开，取出了封堵器。随后，直接缝合动脉切口，未使用补片。术后恢复顺利。
大多数用于封堵房间隔缺损的装置移位和栓塞仍发生在心脏内。虽然腹主动脉栓塞仅偶尔有报道，但可能会导致严重的血管并发症。目前推荐经皮取出装置，若血管内取出失败或主动脉严重受损，传统手术是有效的治疗方法。
