Arai Yoshio, Marui Akira, Wada Yuki, Ohno Nobuhisa
Department of Cardiovascular Surgery, Kokura Kinen Hospital, Kitakyushu, Japan.
Kyobu Geka. 2022 Jun;75(6):418-421.
A 85-year old male with hoarseness due to distal aortic arch aneurysm underwent zone 1 thoracic endovascular aortic repair( TEVAR) with two-debranching at our hospital. Five years after the TEVAR (90 years old), computed tomography( CT) revealed typeⅠa endoleak due to migration of proximal end of the graft. Anatomically, additional TEVAR was impossible. To minimize the invasiveness, a two-stage surgery was planned. First, under deep hypothermic circulatory arrest, the ascending aorta was replaced with the brachiocephalic artery reconstruction and insertion of a stented vascular prosthesis distally through partial sternotomy to preserve the debranching bypass. Six days after the surgery, a transcatheter stent graft was placed from the stented vascular prosthesis to the native descending aorta. Postoperative course was uneventful, and CT scan showed no endoleak.
一名85岁男性因远端主动脉弓动脉瘤导致声音嘶哑，在我院接受了1区胸主动脉腔内修复术（TEVAR）及双分支手术。TEVAR术后5年（90岁），计算机断层扫描（CT）显示由于移植物近端移位导致Ⅰa型内漏。从解剖学角度来看，再次进行TEVAR手术是不可能的。为了将侵袭性降至最低，计划进行两阶段手术。首先，在深低温停循环下，通过部分胸骨切开术置换升主动脉，重建头臂动脉，并在远端插入带支架的血管假体，以保留分支旁路。术后6天，从带支架的血管假体至降主动脉置入经导管支架移植物。术后病程平稳，CT扫描显示无内漏。
