Department of Cardiovascular Surgery, Tokyo Dental College Ichikawa General Hospital, Sugano 5-11-13, Ichikawa, Chiba, 272-8513, Japan.
J Cardiothorac Surg. 2023 Nov 9;18(1):306. doi: 10.1186/s13019-023-02436-6.
The development of fenestrated endograft, Najuta endograft Kawasumi Laboratories, Inc, Tokyo, Japan) in thoracic endovascular aortic repair (TEVAR) has enabled the treatment of aortic arch aneurysms approaching zone 0 without the need of supra-aortic vessel branch reconstruction. However, the indications of Najuta remain controversial due to complications such as endograft collapse, which is rare and lethal.
We here report a 75-year-old male patient with arch saccular aneurysm. Because of his liver cirrhosis, 2 debranching TEVAR has chosen as a treatment using Najuta. After extrathoracic bypass was performed, a CTAG stent graft was implanted distal to the LSCA in order to deliver Najuta stent graft steadily. Najuta stent graft was successfully positioned in zone 0. However, he was suffered from stent-graft collapse. After additional TEVAR to salvage stent-graft collapse to zone 0, he complicated type A dissection, which was treated by ascending aorta replacement. After salvage operation complicated multiorgan failure and he died.
fenestrated 血管内移植物（Najuta 血管内移植物，Kawasumi Laboratories，Inc，东京，日本）在胸主动脉腔内修复术（TEVAR）中的发展，使得治疗接近零区的主动脉弓动脉瘤无需进行主动脉上血管分支重建成为可能。然而，由于内漏等并发症的存在，Najuta 的适应证仍存在争议，这种并发症非常罕见，但却具有致命性。
我们报告了一例 75 岁男性患者，患有弓部囊状动脉瘤。由于其肝硬化，选择了 2 分支 TEVAR 治疗，使用 Najuta。体外循环完成后，将 CTAG 支架移植物植入到 LSCA 远端，以稳定地输送 Najuta 支架移植物。Najuta 支架移植物成功定位于零区。然而，他出现了支架移植物塌陷。在进行附加的 TEVAR 以挽救零区的支架移植物塌陷后，他并发了 A 型夹层，采用升主动脉置换术进行了治疗。挽救手术后，他并发多器官功能衰竭，最终死亡。
