Nogami Eijiro, Takeuchi Yuki, Koga Yuichi, Kitsuka Takahiro, Amamoto Sojiro, Takahashi Baku, Uchino Motonori, Yoshitake Shuichiro, Takamatsu Masanori, Itoh Manabu, Yunoki Junji, Tanaka Atsuhisa, Kamohara Keiji
Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Saga, Japan.
EJVES Vasc Forum. 2020 May 29;48:1-4. doi: 10.1016/j.ejvsvf.2020.05.006. eCollection 2020.
The efficacy of endovascular treatment for complicated Stanford type B acute aortic dissection is being established. However, aortic events sometimes occur, and some cases require surgical intervention.
A 52 year old man underwent ascending aorta replacement for Stanford type A acute aortic dissection in August 2016. Post-operative computed tomography (CT) showed residual dissection from the aortic arch to the right common iliac artery and a large re-entry in the right common iliac artery (RCIA). Two months after the operation, CT revealed enlargement of the false lumen of the thoracic aorta and the thoracic aortic diameter. Aiming to reduce the false lumen and remodel the aorta, a three stage operation was performed, as described below. Four months after the dissection, total aortic arch replacement and a frozen elephant trunk insertion were performed as the first stage. Subsequently, as a second stage operation, thoracic endovascular repair (TEVAR) was performed using a Zenith® Dissection Endovascular System (Cook Japan Co., Ltd, Tokyo, Japan), with the aim of expanding the true aortic lumen. The implanted devices were a stent graft for the proximal part and two bare stents for the middle and distal part. As a third stage operation, abdominal aortic endovascular treatment was performed with the purpose of closing the re-entry from the RCIA. However, two years after the three stage operation, CT showed that the thoracic aorta was over 60 mm in diameter. Graft replacement of the thoraco-abdominal aorta was performed. The bare stents were expected to be easily removable from the aorta, but unexpectedly, they were strongly attached to the intima, which made it extremely difficult to perform surgical and aortic operations.
Surgical operations for the aorta can become more difficult after bare stent placement in the aorta.
血管内治疗复杂Stanford B型急性主动脉夹层的疗效正在确立。然而，主动脉事件有时会发生，有些病例需要手术干预。
一名52岁男性于2016年8月因Stanford A型急性主动脉夹层接受升主动脉置换术。术后计算机断层扫描（CT）显示从主动脉弓至右髂总动脉存在残余夹层，且右髂总动脉（RCIA）有一个大的再入口。术后两个月，CT显示胸主动脉假腔及胸主动脉直径增大。为了减小假腔并重塑主动脉，进行了如下所述的三阶段手术。夹层发生四个月后，作为第一阶段进行了全主动脉弓置换及植入“冰冻象鼻”。随后，作为第二阶段手术，使用Zenith®夹层血管内系统（日本东京Cook Japan有限公司）进行胸主动脉腔内修复（TEVAR），目的是扩大主动脉真腔。植入装置近端为覆膜支架，中远端为两个裸支架。作为第三阶段手术，进行腹主动脉腔内治疗以封闭RCIA的再入口。然而，三阶段手术后两年，CT显示胸主动脉直径超过60 mm。遂进行胸腹主动脉移植物置换。预计裸支架可轻松从主动脉移除，但出乎意料的是，它们与内膜紧密附着，这使得进行外科手术和主动脉操作极为困难。
在主动脉内放置裸支架后，主动脉手术可能会变得更加困难。
