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Successful Echo-guided Deployment of Stent Graft for Intraoperative Retrograde Aortic Dissection and Rupture;Report of a Case Naoki Kanemitsu 1 , Takehiko Matsuo 1 , Hiroaki Osada 2 , Kazuo Yamanaka 3 , Junichi Tazaki 4 1Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital Keyword: intraoperative aortic dissection , rupture of thoracic aortic aneurysm , echo-guided stent-graft insertion pp.351-355
Published Date 2018/5/1
DOI https://doi.org/10.15106/j_kyobu71_351
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We report a case of chronic dissecting thoracoabdominal aneurysm with intraoperative retrograde aortic dissection and rupture at proximal descending aorta, which was successfully treated by echo-guided stent-graft insertion. An 82-year old male underwent thoracoabdominal aortic replacement for dilatation of infra-diaphragmatic aorta. Under F-F bypass, his thoracoabdominal aorta was replaced by a Dacron graft with 4-branches. After he weaned from F-F bypass, we found massive bleeding from proximal descending aorta. Trans-esophageal echocardiography (TEE) showed aortic dissection from the clamp site to the distal anastomotic site of the former total arch replacement. We temporary got hemostasis by suture and surgical glue, and anastomosed a 10 mm-graft to the thoracoabdominal main graft as conduit, then inserted and deployed 2 pieces of stent-graft. Direct echo and TEE contributed to the accurate positioning of them. Bleeding was completely controlled. He well recovered without paraplegia. Post-operative computed tomography (CT) showed good positioning and dilatation of the stent-graft and the perfect reverse remodeling of thoracic aorta.


© Nankodo Co., Ltd., 2018

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電子版ISSN 2432-9436 印刷版ISSN 0021-5252 南江堂

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