Hayashi Nagi, Yoshikai Masaru, Sato Hisashi, Shimauchi Kota, Kuwano Akito
Department of Cardiovascular Surgery, Shin-Koga Hospital, Kurume, Japan.
Kyobu Geka. 2023 May;76(5):343-346.
We report a case of pseudoaneurysms at the anastomotic sites after prosthetic graft replacement for Immunogloblin G4 (IgG4)-related thoracic aortic aneurysm. A 69-year-old male patient underwent ascending and aortic arch replacement and open stent graft insertion. Five months after the surgery, pseudoaneurysms at the anastomosis to the brachiocephalic artery and to the left common carotid artery developed, and urgency surgery was performed. The right common carotid artery, the right subclavian artery, and the left common carotid artery were individually reconstructed with grafts, and the anastomoses were wrapped with grafts. In IgG4-related aneurysms, complete resection of the diseased tissue and reinforcement of the anastomosis, such as anastomotic wrapping, are important to prevent anastomotic site failure. While serum IgG4 had normalized after the first surgery, C-reactive protein (CRP) remained elevated until the reoperation. Thus, CRP is considered one of the biomarkers for disease activity in IgG4-related vascular disease.
我们报告一例在免疫球蛋白G4（IgG4）相关胸主动脉瘤人工血管置换术后吻合口处发生假性动脉瘤的病例。一名69岁男性患者接受了升主动脉和主动脉弓置换及开放式支架植入术。术后5个月，在与头臂动脉和左颈总动脉的吻合处出现假性动脉瘤，并进行了急诊手术。分别用移植物重建右颈总动脉、右锁骨下动脉和左颈总动脉，并用移植物包裹吻合口。在IgG4相关动脉瘤中，彻底切除病变组织并加强吻合（如吻合口包裹）对于预防吻合口失败很重要。虽然第一次手术后血清IgG4已恢复正常，但直到再次手术时C反应蛋白（CRP）仍保持升高。因此，CRP被认为是IgG4相关血管疾病疾病活动的生物标志物之一。
