Nakamura Eiji, Takagi Kazuyoshi, Otsuka Hiroyuki, Hiromatsu Shinichi, Tayama Eiki
Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, JPN.
Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of medicine, Kurume, JPN.
Cureus. 2024 Oct 15;16(10):e71559. doi: 10.7759/cureus.71559. eCollection 2024 Oct.
Ulcer-like projections (ULPs) with a tendency to enlarge are at risk of aortic events such as new dissection, aneurysmal formation, or rupture and require therapeutic intervention. However, what should be done after open chest surgery when standard thoracic endovascular aortic repair (TEVAR) cannot be performed is debatable. Here, we present a case of coil embolization of a newly enlarged ULP that was not amenable to TEVAR following a hemiarch aortic arch repair. A 68-year-old male with a history of ascending and hemiaortic arch repair for acute type A aortic dissection presented with a chief complaint of chest pain three months prior to presentation. A post-type A dissection ULP remained in the aortic arch but had enlarged over the three months. Therapeutic intervention was planned to avoid aortic events; however, standard and fenestrated TEVAR were going to be anatomically challenging. Since the patient was in poor general condition after diverticulitis and stroke, reopened total arch replacement and total debranching TEVAR were avoided. The neck of the ULP was narrow and had a small volume; therefore, we assessed that the coil-packing method could embolize the ULP. Coil embolization was successful, and the patient had no postoperative complications. A computed tomography scan at the remote stage showed no recanalization or enlargement, and the patient was stable. Coil embolization may be attempted for arch ULP that can enlarge if the ULP can be embolized with intra-aneurysmal packing when it is difficult to perform a reopen surgery or TEVAR, including standard zone II, total debranching, and fenestrated TEVAR.
具有扩大倾向的溃疡样突出（ULP）有发生主动脉事件的风险，如新发夹层、动脉瘤形成或破裂，需要进行治疗干预。然而，在开胸手术后无法进行标准胸主动脉腔内修复术（TEVAR）时应采取何种措施仍存在争议。在此，我们报告一例在半弓主动脉弓修复术后，对一个新增大的、无法进行TEVAR的ULP进行弹簧圈栓塞的病例。一名68岁男性，有因急性A型主动脉夹层进行升主动脉和半弓主动脉弓修复的病史，在就诊前三个月因胸痛为主诉前来就诊。A型夹层后残留的ULP位于主动脉弓，但在三个月内有所增大。计划进行治疗干预以避免主动脉事件；然而，标准和开窗TEVAR在解剖学上具有挑战性。由于患者在患憩室炎和中风后全身状况较差，避免了再次进行全弓置换和全去分支TEVAR。ULP的颈部狭窄且体积小；因此，我们评估弹簧圈填充法可栓塞ULP。弹簧圈栓塞成功，患者术后无并发症。远期计算机断层扫描显示无再通或增大，患者情况稳定。对于难以进行再次手术或TEVAR（包括标准II区、全去分支和开窗TEVAR）的、如果ULP可通过瘤内填充进行栓塞且可能增大的弓部ULP，可尝试弹簧圈栓塞。
