Huber Florian, Schachner Bruno, Hagleitner Georg, Binder Ronald K, Pichler Peter, Zierer Andreas
Department of Thoracic and Cardiovascular Surgery, Kepler University Hospital, JKU, Linz, Austria.
Central Institute of Radiology, Kepler University Hospital, JKU, Linz, Austria.
SAGE Open Med Case Rep. 2024 Jan 18;12:2050313X231225867. doi: 10.1177/2050313X231225867. eCollection 2024.
Treatment of post-dissection arch and thoracoabdominal aortic aneurysms presents significant therapeutic challenges. True lumen collapse or take off of aortic branches from the false lumen makes endograft alignment difficult, if not impossible. We present herein the first successful case of an extensive thoracoabdominal electro aortic septotomy of the entire dissection membrane from the aortic arch down to the aortic bifurcation during an open redo aortic arch replacement employing the frozen elephant trunk technique. The procedure was performed on a 59 years old female patient presenting with a progressive post-dissection aortic aneurysm during follow-up with a maximum diameter of 6 cm 11 years after operating on an acute type A aortic dissection. Due to the extensive longitudinal aortic electric septotomy, we created a new "common lumen" for subsequent endovascular completion of the repair.
治疗夹层分离后的主动脉弓及胸腹主动脉瘤面临着重大的治疗挑战。真腔塌陷或主动脉分支从假腔发出会使腔内移植物的定位变得困难，甚至无法定位。在此，我们介绍首例成功的广泛胸腹主动脉电切内膜剥脱术，该手术在采用冰冻象鼻技术进行再次主动脉弓置换手术时，将整个夹层分离膜从主动脉弓直至主动脉分叉进行了切开。该手术针对一名59岁女性患者，她在急性A型主动脉夹层手术后11年的随访中出现了进行性夹层分离后主动脉瘤，最大直径为6厘米。由于进行了广泛的主动脉纵向电切内膜剥脱术，我们为后续的血管腔内修复创造了一个新的“共同管腔 ”。
