Sakai Kenji, Okumura Yushi, Yoshida Tetsuya
Department of Cardiovascular Surgery, Hokushin General Hospital, Nakano City, JPN.
Cureus. 2025 Jul 2;17(7):e87195. doi: 10.7759/cureus.87195. eCollection 2025 Jul.
Simultaneous repair of extensive aortic aneurysms carries a high risk of spinal cord ischemia. Staged repair is one strategy to reduce this risk; however, aneurysm rupture during the interval is a concern. A 74-year-old man presented with a ruptured juxtarenal abdominal aortic aneurysm (AAA). A CT scan revealed a large (87 mm) ruptured AAA, a 95-mm descending thoracic aortic aneurysm (TAA), and an 80-mm saccular aneurysm in the aortic arch. Emergency EVAR (endovascular aneurysm repair) and right renal artery embolization were performed. Two weeks later, TEVAR (thoracic endovascular aortic repair) was completed for the descending TAA. At six weeks post-initial intervention, open arch replacement with open stent graft technique was performed. The patient had no neurologic or renal complications. Staged repair, prioritizing rupture risk, can allow the complete and safe treatment of extensive aortic disease without major complications.
同时修复广泛的主动脉瘤会带来较高的脊髓缺血风险。分期修复是降低这种风险的一种策略；然而，在此间隔期动脉瘤破裂是一个令人担忧的问题。一名74岁男性因肾旁腹主动脉瘤（AAA）破裂就诊。CT扫描显示一个大的（87毫米）破裂AAA、一个95毫米的降主动脉瘤（TAA）和主动脉弓处一个80毫米的囊状动脉瘤。进行了急诊血管内动脉瘤修复术（EVAR）和右肾动脉栓塞术。两周后，对降主动脉瘤完成了胸段血管内主动脉修复术（TEVAR）。在首次干预后六周，采用开放支架移植物技术进行了主动脉弓置换术。患者未出现神经或肾脏并发症。根据破裂风险进行分期修复，可以实现对广泛主动脉疾病的完整且安全的治疗，而不会出现重大并发症。
