M Malina, J Brunkwall, K Ivancev, B Lindblad, J Malina, U Nyman, B Risberg
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引用次数: 14
摘要
目的:报告一例晚期主动脉穿孔的致命病例。方法和结果:一名69岁的女性在胸腹动脉瘤修复后2年,在常规主动脉瓣近端扩张了9厘米的胸降主动脉。一个38毫米的涤纶移植物内缝合多个Gianturco z -支架,穿过主动脉弓,使近端支架的部分未覆盖部分部分穿过左锁骨下口。四个月后,病人死于大出血。尸检显示近端支架未覆盖部分已穿孔主动脉弓。结论:本病例强调了低轮廓支架移植物和更小、更灵活的引入系统的必要性。锚定支架必须灵活,创伤小,并且足够坚固,即使在曲折的血管中也能形成水密密封。为避免胸椎支架移植物损伤主动脉弓,近端支架应被织物完全覆盖。
Late aortic arch perforation by graft-anchoring stent: complication of endovascular thoracic aneurysm exclusion.
Purpose: To describe a fatal case of late aortic perforation by an endograft-anchoring stent.
Methods and results: 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.
Conclusions: 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.