Malina M, Brunkwall J, Ivancev K, Lindblad B, Malina J, Nyman U, Risberg B
Department of Vascular Surgery, Malmö University Hospital, Lund University, Sweden.
J Endovasc Surg. 1998 Aug;5(3):274-7. doi: 10.1177/152660289800500317.
To describe a fatal case of late aortic perforation by an endograft-anchoring stent.
A 69-year-old woman presented 2 years after thoracoabdominal aneurysm repair with a 9-cm dilatation of the descending thoracic aorta proximal to the conventional aortic graft. A 38-mm Dacron graft with multiple Gianturco Z-stents sutured inside was placed transluminally across the aortic arch such that part of the uncovered portion of the proximal stent was partially across the left subclavian orifice. Four months later, the patient died from massive hemorrhage. Autopsy showed that the uncovered portion of the proximal stent had perforated the aortic arch.
This case stresses the need for low-profile stent-grafts and smaller, more flexible introducer systems. Anchoring stents must be flexible, less traumatic, and strong enough to create a watertight seal even in tortuous vessels. To avoid aortic arch damage by thoracic stent-grafts, the proximal stent should be fully covered by the fabric.
描述一例因腔内移植物锚定支架导致晚期主动脉穿孔的致死病例。
一名69岁女性在胸腹主动脉瘤修复术后2年就诊，其降主动脉在传统主动脉移植物近端扩张了9厘米。将一个内部缝合有多根Gianturco Z型支架的38毫米涤纶移植物经腔内置入，跨越主动脉弓，使近端支架未覆盖部分的一部分部分跨过左锁骨下动脉开口。四个月后，患者死于大出血。尸检显示近端支架未覆盖部分已穿透主动脉弓。
该病例强调了对低轮廓支架移植物以及更小、更灵活的导入系统的需求。锚定支架必须灵活、创伤性小且足够坚固，即使在血管迂曲的情况下也能形成水密密封。为避免胸段支架移植物损伤主动脉弓，近端支架应由织物完全覆盖。
