Yamana Fumio, Maeda Koichi, Hamanaka Yuma, Kodani Noriko, Domae Keitaro, Hata Masatoshi, Higuchi Yoshiharu, Shirakawa Yukitoshi, Masai Takafumi
Department of Cardiovascular Surgery, Osaka Police Hospital, 2 Chome-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Surg Case Rep. 2022 Mar 14;8(1):41. doi: 10.1186/s40792-022-01394-w.
Non-anastomotic thoracic aortic graft rupture is extremely rare and difficult to diagnose. Non-obstructive general angioscopy can help monitor the aortic intima and detect the locations of abnormal findings, while aortic angioscopy can detect vulnerable plaques in the aorta, which are difficult to visualize using conventional diagnostic methods. Herein, we report the case of a patient with non-anastomotic thoracic aortic graft rupture diagnosed using non-obstructive aortic angioscopy.
An 85-year-old man who had undergone total arch replacement 5 years prior complained of chest pain. Emergent contrast-enhanced computed tomography (CT) revealed an intra-mediastinal hematoma around the vascular graft of the ascending aorta and angiography revealed pooling of contrast medium on the dorsal side of the vascular graft. We suspected extravasation of the thoracic vascular graft. Aortic angioscopic examination revealed a red vascular graft defect that matched extravasation at the contralateral level of the prosthetic left common carotid artery branch. Subsequently, non-anastomotic thoracic aortic graft rupture was diagnosed. The patient underwent a two-debranching thoracic endovascular aortic repair (Zone 0) with a right subclavian artery-left common carotid artery-left subclavian artery bypass. Postoperative angiography revealed disappearance of the extravasation from the graft rupture site, patent grafted vessels with flow, and no endoleak. Follow-up CT at 6 months postoperatively showed no extravasation.
To our knowledge, this is the first report of non-anastomotic thoracic aortic graft rupture detected using non-obstructive aortic angioscopy. Aortic angioscopy can help establish a definitive diagnosis in patients with aortic graft rupture.
非吻合口胸主动脉移植物破裂极为罕见且难以诊断。非阻塞性普通血管内镜有助于监测主动脉内膜并检测异常发现的部位，而主动脉血管内镜可检测主动脉中难以用传统诊断方法可视化的易损斑块。在此，我们报告一例使用非阻塞性主动脉血管内镜诊断非吻合口胸主动脉移植物破裂的病例。
一名85岁男性，5年前接受了全主动脉弓置换术，现主诉胸痛。急诊增强计算机断层扫描（CT）显示升主动脉血管移植物周围纵隔内血肿，血管造影显示血管移植物背侧有造影剂聚集。我们怀疑胸血管移植物渗漏。主动脉血管内镜检查发现一个红色血管移植物缺损，与人工左颈总动脉分支对侧水平的渗漏部位相符。随后，诊断为非吻合口胸主动脉移植物破裂。患者接受了带右锁骨下动脉 - 左颈总动脉 - 左锁骨下动脉旁路的双分支胸主动脉腔内修复术（0区）。术后血管造影显示移植物破裂部位的渗漏消失，移植血管通畅且有血流，无内漏。术后6个月的随访CT显示无渗漏。
据我们所知，这是首例使用非阻塞性主动脉血管内镜检测到的非吻合口胸主动脉移植物破裂的报告。主动脉血管内镜有助于对主动脉移植物破裂患者做出明确诊断。
