Kuntz Salomé, Thaveau Fabien, Ohana Michaël, Pasquinelli Gianandrea, Chakfé Nabil, Lejay Anne
Department of Vascular Surgery and Kidney Transplantation, University of Strasbourg, Strasbourg, France.
GEPROMED, Strasbourg, France.
EJVES Vasc Forum. 2023 Sep 19;60:64-67. doi: 10.1016/j.ejvsvf.2023.09.006. eCollection 2023.
Calcification of a vascular endograft and adjacent tissues (adventitia, media, and neointima) can result in graft failure. This report shows a rare case of intraluminal calcifications in the distal end of a thoracic endovascular aortic repair (TEVAR) endograft implanted 11 years previously for grade IV blunt traumatic aortic injury (BTAI) in a young patient.
A 24 year old man required TEVAR for a BTAI caused by a motorcycle accident. The procedure consisted of TEVAR and an emergency left carotid subclavian venous bypass. Eleven years after the procedure, he had severe hypertension. Intra-TEVAR calcifications appeared, gradually increasing on computed tomography angiography (CTA). Calcifications in the distal luminal end of the TEVAR were responsible for a 60% stenosis on CTA. An open approach was indicated after multidisciplinary discussion, based on the gradient value. The patient underwent explantation, with total replacement of the aortic arch and descending thoracic aorta with re-implantation of the supra-aortic vessels, under extracorporeal circulation. Macroscopic analysis showed no device degeneration but revealed a solid mass at the distal end of the TEVAR. Both microcomputed tomography and histopathology confirmed the calcific nature of the lesions.
This case highlights a rare long term graft failure due to calcified neo-atherosclerosis in a TEVAR.
血管内移植物及相邻组织（外膜、中膜和新生内膜）的钙化可导致移植物失败。本报告展示了一例罕见病例，一名年轻患者11年前因IV级钝性创伤性主动脉损伤（BTAI）植入胸主动脉腔内修复术（TEVAR）移植物，其远端腔内出现钙化。
一名24岁男性因摩托车事故导致BTAI而需要进行TEVAR手术。该手术包括TEVAR和紧急左颈总动脉-锁骨下静脉旁路术。术后11年，他出现严重高血压。TEVAR内出现钙化，在计算机断层血管造影（CTA）上逐渐增多。TEVAR远端腔内钙化在CTA上造成了60%的狭窄。基于梯度值，多学科讨论后建议采用开放手术方法。患者在体外循环下接受了移植物取出术，同时用重新植入主动脉弓上血管的方式对主动脉弓和胸降主动脉进行了全置换。宏观分析显示移植物无退变，但在TEVAR远端发现一个实性肿块。微型计算机断层扫描和组织病理学均证实了病变的钙化性质。
本病例突出了TEVAR中因钙化性新动脉粥样硬化导致的罕见长期移植物失败。
