Płoński Adam, Płoński Adam Filip, Chlabicz Michał, Głowiński Jerzy
Department of Vascular Surgery and Transplantation, Medical University of Bialystok, 15-276 Bialystok, Poland.
J Clin Med. 2024 Dec 17;13(24):7687. doi: 10.3390/jcm13247687.
Stent-graft implantation is a widely recognized method for endovascular treatment of aortic aneurysms. In cases where the aneurysm involves the thoracic and abdominal aorta, repair including fenestrated and branched stent grafts provides a viable alternative. This approach, initially reserved for patients unsuitable for open surgery, has become preferred for anatomically appropriate thoracoabdominal aortic aneurysms. The Zenith t-Branch system has been extensively studied, demonstrating high technical success rates and acceptable mortality and morbidity. However, complications such as endoleaks, kinking, and stent-graft branch rupture remain significant challenges. We present the case of an 82-year-old male with a thoracoabdominal aortic aneurysm treated with endovascular aneurysm repair using the Zenith t-Branch. Four years post-implantation, he developed a spontaneous rupture of the stent-graft branch, leading to dangerous leakage and aneurysm sac enlargement. An urgent surgical intervention was performed, implanting additional Be-Graft into the damaged branch, restoring stent-graft continuity and revascularizing the superior mesenteric artery. The procedure was completed successfully. We conducted a review of the latest literature on endovascular treatment of thoracoabdominal aortic aneurysms with particular emphasis on the possibility of repairing postoperative complications, especially endoleaks. While modern technologies have significantly improved outcomes, serious complications persist. Studies emphasize the importance of regular imaging follow-up for early complication detection and management. Continuous advancements in stent-graft technology aim to reduce complications further and improve outcomes. This case underscores the necessity of experienced operators in managing complex and rare complications and highlights the promising future of endovascular techniques in treating thoracoabdominal aortic aneurysms.
支架型人工血管植入术是一种广泛认可的主动脉瘤腔内治疗方法。对于累及胸主动脉和腹主动脉的动脉瘤病例，包括开窗和分支型支架型人工血管的修复提供了一种可行的替代方案。这种方法最初是为不适用于开放手术的患者保留的，现在已成为解剖结构合适的胸腹主动脉瘤的首选方法。Zenith t-Branch系统已得到广泛研究，显示出较高的技术成功率以及可接受的死亡率和发病率。然而，诸如内漏、扭结和支架型人工血管分支破裂等并发症仍然是重大挑战。我们报告一例82岁男性胸腹主动脉瘤患者，采用Zenith t-Branch进行腔内动脉瘤修复治疗。植入四年后，他发生了支架型人工血管分支的自发性破裂，导致危险的渗漏和动脉瘤囊扩大。进行了紧急手术干预，在受损分支中植入额外的Be-Graft，恢复了支架型人工血管的连续性并使肠系膜上动脉再血管化。手术成功完成。我们对胸腹主动脉瘤腔内治疗的最新文献进行了综述，特别强调了修复术后并发症尤其是内漏的可能性。虽然现代技术显著改善了治疗效果，但严重并发症仍然存在。研究强调定期影像学随访对于早期并发症检测和管理的重要性。支架型人工血管技术的不断进步旨在进一步减少并发症并改善治疗效果。该病例强调了经验丰富的操作者在处理复杂罕见并发症方面的必要性，并突出了腔内技术在治疗胸腹主动脉瘤方面的光明前景。
