The Japanese Journal of Thoracic Surgery Volume 71, Issue 13 (December 2018)

Open Stent Graft Stenosis after Total Arch Replacement for Acute Aortic Dissection in a Patient with Right-sided Aortic Arch Ryo Taguchi 1 , Ryosuke Kowatari 1 , Masahito Minakawa 1 , Kazuyuki Daitoku 1 , Yasuyuki Suzuki 1 , Ikuo Fukuda 1 1Department of Thoracic and Cardiovascular Surgery, Hirosaki University Keyword: right-sided aortic arch , open stent graft , stenosis pp.1068-1072
Published Date 2018/12/1
  • Abstract
  • Look Inside
  • Reference

We describe a patient with stenosis of an open stent graft during total arch replacement of a right-sided aortic arch. A 67-year-old man was transferred to our hospital with a diagnosis of acute type A (DeBakey type Ⅱ) aortic dissection. Computed tomography (CT) imaging revealed concomitant right-sided aortic arch (RAA) and Kommerell diverticulum at the descending thoracic aorta. Total arch replacement was performed using an open stent graft over the Kommerell diverticulum. While closing the sternum, blood pressure of the femoral artery dropped to a level much lower than that of radial artery. Transesophageal echocardiography revealed an apparently new intimal flap in the descending thoracic aorta. Therefore, an axilla-femoral artery bypass and a femoro-femoral artery crossover bypass were performed to improve malperfusion of the visceral organs and lower extremities. CT imaging immediately after these procedures revealed stenosis at the non-stented portion of the open stent graft, which was located at the steep-angled site of the RAA. The pressure gradient between the upper and lower extremities was around 100 mmHg on the day of surgery, but it disappeared on postoperative day 4. Improved graft stenosis was confirmed by CT before discharge.

© Nankodo Co., Ltd., 2018


71巻13号 (2018年12月)
電子版ISSN 2432-9436 印刷版ISSN 0021-5252 南江堂