White R A, Donayre C E, Walot I, Wilson E, Jackson G, Kopchok G
Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance 90509, USA.
J Endovasc Surg. 1997 Feb;4(1):88-94. doi: 10.1583/1074-6218(1997)004<0088:EGEOAP>2.0.CO;2.
To describe a case of endoluminal graft exclusion of a proximal para-anastomotic pseudoaneurysm that occurred 17 years following aortobifemoral bypass for occlusive disease.
The lesion was found on abdominal ultrasound examination as part of a work-up for acute abdominal pain and upper gastrointestinal bleeding in a 67-year-old male. A 5-cm saccular pseudoaneurysm was confirmed by preintervention aortography and spiral computed tomography (CT) scanning. Because of the patient's acute symptoms and high-risk medical condition (cardiomyopathy), he was deemed a candidate for endoluminal bypass. At the time of intervention, intravascular ultrasound (IVUS) interrogation identified a 3.5-cm-long separation of the existing aortic graft from the proximal aortic stump with a large pseudoaneurysm. The lesion was isolated and repaired by placement of an aortic-to-right iliac endoluminal bypass, ligation of the left limb of the aortofemoral graft, and femorofemoral bypass to restore blood flow to the lower extremities. Spiral CT scans at 48 hours and 3 months following the procedure confirmed complete isolation of the lesion.
This case illustrates the feasibility of endografting for repair of aortic para-anastomotic pseudoaneurysms, and it also highlights the potential role of IVUS imaging in endoluminal graft deployment.
描述1例因闭塞性疾病行主动脉双股动脉搭桥术后17年发生的近端吻合口旁假性动脉瘤经腔内移植物封堵的病例。
在对一名67岁男性急性腹痛和上消化道出血进行检查时，通过腹部超声检查发现了该病变。术前主动脉造影和螺旋计算机断层扫描（CT）证实为一个5厘米的囊状假性动脉瘤。由于患者有急性症状且存在高危医疗状况（心肌病），他被认为是腔内搭桥手术的候选人。在干预时，血管内超声（IVUS）检查发现现有主动脉移植物与近端主动脉残端分离3.5厘米，伴有一个大的假性动脉瘤。通过置入主动脉至右髂总动脉腔内搭桥、结扎主动脉双股动脉移植物的左支以及股股动脉搭桥以恢复下肢血流，对病变进行了隔离和修复。术后48小时和3个月的螺旋CT扫描证实病变已完全隔离。
本病例说明了腔内移植物修复主动脉吻合口旁假性动脉瘤的可行性，同时也突出了IVUS成像在腔内移植物置入中的潜在作用。
