Oshima Rika, Sato Tetsuya, Yamada Ryotaro, Kawahara Takuya, Sumiyoshi Riki, Miyoshi Kosuke, Hashimoto Kazunori, Hashizume Kenichi, Itoh Satoshi
Center for Medical Education and Training, Yokohama City Minato Red Cross Hospital, Yokohama, Japan.
Department of Cardiovascular Surgery, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita, Naka-Ku, Yokohama, Kanagawa, Japan.
Gen Thorac Cardiovasc Surg Cases. 2025 Jul 28;4(1):34. doi: 10.1186/s44215-025-00195-5.
Cold agglutinin disease (CAD) is sometimes incidentally detected before cardiovascular surgery. Several methods to prevent complications associated with CAD after cardiac surgery have been reported, but there are no reports of the use of physician-modified TEVAR to date.
A 76-year-old man with an arch aortic saccular aneurysm was scheduled to undergo arch aortic replacement. However, cold agglutinin syndrome was incidentally detected before open heart surgery. The safety of cardiopulmonary surgery under hypothermia for patients with cold agglutinin disease is unknown, as intravascular hemolysis is a source of concern for patients sensitive to cold stimulation. Instead, we performed physician-modified thoracic endovascular aortic repair (3 fenestrations and 1 branch), as the aneurysm in this case was suitable for thoracic endovascular aortic repair (TEVAR). As a result, the patient recovered well without any complication.
The long-term prognosis of physician-modified thoracic endovascular aortic repair remains unclear, and its use is limited to high-risk patients who require open chest surgery. Also, the impact of cold agglutination on stent grafts in CAD patients has not been reported. Despite that situation, this case illustrated that physician-modified TEVAR can be safely performed without significant postoperative complications, such as coagulation-fibrinolytic abnormalities or embolic events. Further studies are needed to establish the indications for this procedure in CAD patients.
冷凝集素病（CAD）有时在心血管手术前被偶然发现。已有多种预防心脏手术后与CAD相关并发症的方法被报道，但迄今为止尚无使用医生改良型胸主动脉腔内修复术（TEVAR）的报道。
一名76岁患有主动脉弓部囊状动脉瘤的男性计划接受主动脉弓置换术。然而，在心脏直视手术前偶然发现了冷凝集素综合征。由于血管内溶血是对冷刺激敏感患者的一个担忧来源，因此低温下心肺手术对冷凝集素病患者的安全性尚不清楚。相反，由于该病例中的动脉瘤适合胸主动脉腔内修复术（TEVAR），我们实施了医生改良型胸主动脉腔内修复术（3个开窗和1个分支）。结果，患者恢复良好，未出现任何并发症。
医生改良型胸主动脉腔内修复术的长期预后尚不清楚，其应用仅限于需要开胸手术的高危患者。此外，冷凝集对CAD患者支架移植物的影响尚未见报道。尽管如此，该病例表明医生改良型TEVAR可以安全实施，且无明显术后并发症，如凝血 - 纤溶异常或栓塞事件。需要进一步研究以确定该手术在CAD患者中的适应证。
