Takayama Shoryu, Ishikawa Ken, Kani Hisanori, Takayama Satoru, Sakamoto Masaki
Surgery, Nagoya Tokushukai General Hospital, Kasugai, JPN.
Digestive Surgery, Nagoya Tokushukai General Hospital, Kasugai, JPN.
Cureus. 2022 Feb 13;14(2):e22184. doi: 10.7759/cureus.22184. eCollection 2022 Feb.
An 85-year-old man underwent thoracic endovascular aortic repair (TEVAR) for a thoracic aortic aneurysm (TAA). The day after TEVAR, the patient complained of abdominal pain. Blood tests showed lactic acidosis. Contrast-enhanced CT of the abdomen showed emphysema and poor contrast areas in the lower esophagus, total stomach, and duodenum. The left lobe of the liver also showed a poorly contrasted area. Indocyanine green (ICG) intraoperative blood flow evaluation was performed by laparoscopy to evaluate how organ ischemia is and whether resection of necrotic organs is possible. It was judged that resection of the poor perfusion area would not improve prognosis because of the extensive area of poor perfusion in the ICG intraoperative perfusion evaluation. In TEVAR for TAA, embolization of the celiac artery (CA) can be performed if collateral blood flow is demonstrated. However, in this case, extensive organ necrosis happened. We discuss the cause of this case and the usefulness of ICG intraoperative blood flow assessment when ischemia is suspected.
一名85岁男性因胸主动脉瘤（TAA）接受了胸主动脉腔内修复术（TEVAR）。TEVAR术后第二天，患者主诉腹痛。血液检查显示乳酸酸中毒。腹部增强CT显示下食管、全胃和十二指肠有气肿及造影剂充盈不佳区域。肝脏左叶也显示出造影剂充盈不佳区域。通过腹腔镜进行吲哚菁绿（ICG）术中血流评估，以评估器官缺血情况以及是否可行坏死器官切除术。根据ICG术中灌注评估中灌注不良区域广泛，判断切除灌注不良区域并不能改善预后。在TAA的TEVAR中，如果证实有侧支血流，则可进行腹腔干动脉（CA）栓塞。然而，在本病例中发生了广泛的器官坏死。我们讨论了该病例的病因以及怀疑有缺血时ICG术中血流评估的实用性。
