Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Sapporo, Japan.
Department of Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki, Japan.
Eur J Cardiothorac Surg. 2022 Mar 24;61(4):952-954. doi: 10.1093/ejcts/ezab543.
Thoracoabdominal aortic aneurysm (TAAA) repair remains challenging in patients with high surgical risk. We report a case of TAAA in an 84-year-old woman with type Ib endoleak after thoracic endovascular aortic repair with coeliac artery coverage due to impending ruptured TAAA. A stent graft was assembled to create 3 fenestrations and sew 3 inner grafts for the superior mesenteric artery (SMA) and bilateral renal arteries. This stent graft system was inserted into the thoraco-abdominal aorta and partially unsheathed until the first inner branch endograft fully expanded. The wire was used to catheterize the stent graft, inner branch, and SMA from the left upper limb, and a bridge stent was deployed from the inner branch to the SMA. A similar procedure was performed for bilateral renal arteries. The stent graft system was fully unsheathed. Postoperative computed tomography angiography revealed no endoleak and good flow of the visceral artery. The use of the physician-modified inner branched endograft system described is feasible and can make TAAA endovascular repair simpler and safer.
胸主动脉腹主动脉瘤（TAAA）修复对于高手术风险的患者仍然具有挑战性。我们报告了一例 TAAA 病例，该患者为 84 岁女性，因 TAAA 即将破裂而行胸主动脉腔内修复术（TEVAR）时覆盖腹腔动脉，术后出现 Ib 型内漏。组装了一个支架移植物，以创建 3 个窗孔，并缝合 3 个用于肠系膜上动脉（SMA）和双侧肾动脉的内移植物。该支架移植物系统被插入胸主动脉腹主动脉，并部分展开，直到第一个内分支移植物完全扩张。使用导丝从左上臂将支架移植物、内分支和 SMA 进行导管插入，并从内分支向 SMA 部署桥接支架。对双侧肾动脉进行了类似的操作。支架移植物系统完全展开。术后计算机断层血管造影术（CTA）显示无内漏，内脏动脉血流良好。使用医生改良的分支内移植物系统是可行的，可以使 TAAA 血管内修复更简单、更安全。
