Toyama Masahiro, Higa Shotaro, Ando Mizuki, Maeda Tatsuya, Kise Yuya, Inafuku Hitoshi, Nakaema Moriyasu, Nagano Takaaki, Furukawa Kojiro
Department of Thoracic and Cardiovascular Surgery, University of the Ryukyus, Okinawa, Japan.
Kyobu Geka. 2024 Mar;77(3):213-216.
Formation of a pseudoaneurysm due to blood leakage from the anastomotic site of the vascular graft in large-diameter vessels is often seen, but formation of a pseudoaneurysm from the non-anastomotic site is extremely rare. A 68-year-old woman presented with a history of double valve replacement for combined valvular disease at 37 years old and hemiarch replacement for thoracic aortic dilatation at 65 years old. She visited the emergency room with a 2-week history of chest pain. Contrast-enhanced computed tomography (CT) revealed a 5-cm-diameter pseudoaneurysm and extravasation from the ascending aorta, so emergency surgery was performed. Around the ascending aorta area, we confirmed bleeding from a 5-mm dehiscence in the non-anastomotic part of the graft prosthesis, so hemostasis was performed with a cross-stitch mattress suture over a felt strip. Initially, the cause of the pseudoaneurysm was unknown, but re-examination of CT images from after the previous hemiarch replacement confirmed contact between the sternal wire and graft prosthesis. The wire was thus considered to have caused damage and bleeding. The patient was discharged from the hospital with a good postoperative course and is being followed-up in the outpatient department.
大口径血管中血管移植物吻合部位血液渗漏导致假性动脉瘤形成较为常见，但非吻合部位形成假性动脉瘤极为罕见。一名68岁女性，37岁时因联合瓣膜病接受双瓣膜置换术，65岁时因胸主动脉扩张接受半弓置换术。她因胸痛2周就诊于急诊室。增强计算机断层扫描（CT）显示一个直径5厘米的假性动脉瘤及升主动脉渗漏，遂行急诊手术。在升主动脉区域周围，我们确认移植物假体非吻合部位有一处5毫米的裂开出血，于是在毡条上用十字褥式缝合进行止血。起初，假性动脉瘤的病因不明，但重新检查上次半弓置换术后的CT图像证实胸骨钢丝与移植物假体有接触。因此认为钢丝造成了损伤和出血。患者术后恢复良好出院，目前在门诊接受随访。
