Ito Taiki, Suno Kenichiro, Kamikubo Yasuhiro
Cardiovascular Surgery, Kushiro City General Hospital, Kushiro, JPN.
Cureus. 2025 Jul 30;17(7):e89094. doi: 10.7759/cureus.89094. eCollection 2025 Jul.
A 65-year-old man presented with Stanford type B aortic dissection complicated by rupture of the distal aortic arch, originating from the false lumen. Due to the short distance between the supra-aortic branches, the lack of peripheral access from malperfusion, and the invasiveness of combined arch and descending aortic replacement via left thoracotomy, emergency total arch replacement with a frozen elephant trunk was chosen to close the primary entry and control the rupture. However, intraoperative deployment of the prosthesis into the false lumen was suspected due to increasing bleeding and transesophageal echocardiographic findings. Seamless endovascular fenestration of the dissection flap was performed intraoperatively using the tail of a stiff wire under fluoroscopic guidance. By adding stent grafts to the distal true lumen, bleeding from the ruptured aorta was successfully controlled. This case highlights the feasibility and utility of a rapid, simplified intraoperative endovascular fenestration technique in a critical emergency time setting, demonstrating a life-saving strategy when the device is inadvertently deployed into the false lumen.
一名65岁男性，患有斯坦福B型主动脉夹层，并伴有远端主动脉弓破裂，破口源自假腔。由于主动脉弓上分支之间距离短，因灌注不良导致外周入路不佳，且经左胸行全弓及降主动脉置换术具有侵入性，故选择采用带“象鼻”技术的急诊全弓置换术来封闭原发破口并控制破裂。然而，术中因出血增多及经食管超声心动图检查结果，怀疑人工血管被置入假腔。术中在透视引导下，使用硬导丝的尾部对夹层瓣进行了无缝血管腔内开窗术。通过在远端真腔添加覆膜支架，成功控制了破裂主动脉的出血。该病例凸显了在危急紧急情况下快速、简化的术中血管腔内开窗技术的可行性和实用性，展示了在设备意外置入假腔时的一种挽救生命的策略。
