Kawahara Yu, Omine Kaito, Kutsuzawa Rieko, Otake Satoshi, Konaka Miku, Kobayashi Junichi, Yamashita Atsushi, Abe Kazuo, Konno Masahiko, Araki Takahiro
Department of Cardiovascular Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
Kyobu Geka. 2023 Aug;76(8):597-601.
An 88-year-old male underwent thoracic endovascular aortic repair (TEVAR) with the double-debranching and chimney technique for arch aortic aneurysm. When the aforementioned procedure was performed, the left common carotid artery was closed and transected, and the left subclavian artery was embolized and bypassed, respectively. However, postoperatively, the gutter endoleak persisted, and the aneurysm enlarged;therefore, requiring additional surgery. A skin incision was made on the left side of the neck, and the closed and dissected left common carotid artery stump was detected. A sheath was placed at the stump and an angiographic catheter and guidewire were used to retrograde cannulate the gutter beside the chimney graft, and coil embolization was performed. No endoleak was observed at postoperatively and 6-month follow up computed tomography( CT). We believe that embolization from a deblanched left common carotid artery stump is useful for endoleaks after TEVAR employing the chimney and debranching technique.
一名88岁男性因主动脉弓动脉瘤接受了采用双分支和烟囱技术的胸主动脉腔内修复术（TEVAR）。在进行上述手术时，左颈总动脉被闭合并横断，左锁骨下动脉分别进行了栓塞和旁路移植。然而，术后，烟囱旁内漏持续存在，动脉瘤增大；因此，需要再次手术。在颈部左侧做皮肤切口，发现了闭合并解剖的左颈总动脉残端。在残端放置鞘管，使用血管造影导管和导丝逆行插入烟囱移植物旁的烟囱旁间隙，并进行弹簧圈栓塞。术后及6个月随访计算机断层扫描（CT）均未观察到内漏。我们认为，来自去分支的左颈总动脉残端的栓塞对于采用烟囱和去分支技术的TEVAR术后内漏是有用的。
