Surgical repair of distal arch psendoaneurysm from ruptured penetrating aortic ulcer with the frozen elephant trunk technique

Journal of Cardiothoracic Surgery

Thanos Athanasiou²  Stratos Anagnostou¹  Theodore Kratimenos¹  Konstantinos Velissarios¹  Hutan Ashrafian²  Leanne Harling²  Jacob Ttofi¹  Dimitrios Tassopoulos¹  John Kokotsakis¹ 

[1] Department of Cardiac Surgery Evangelismos Hospital, Athens, Greece;Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St Mary’s Hospital Praed Street, London W2 1NY, UK

关键词: Frozen elephant trunk;    Stented graft;    Aortic arch;    Pseudoaneurysm;   

Others  :  810709
DOI  :  10.1186/1749-8090-9-68

 received in 2014-01-16, accepted in 2014-03-31,  发布年份 2014

【 摘 要 】

Ruptured Penetrating Ulcer and aortic arch pseudo-aneurysm is a rare condition but one which carries a high risk of rupture. We report the case of a 74-year-old man with aortic arch pseudo-aneurysm, in which a Frozen Elephant Trunk procedure was successfully performed. There were no postoperative complications at 6 months follow-up. The Computed Tomography Angiogram demonstrated thrombus formation in the pseudo-aneurysm lumen, with no endoleak on the stented part of the descending thoracic aorta and complete patency of all branches of aortic arch. This case demonstrates that the Frozen Elephant Trunk technique may be the treatment of choice when treating such complex aortic arch lesions provided there is no absolute contraindication to radical surgical intervention. However, long-term clinical efficacy and safety have yet to be confirmed.

【 授权许可】

   
2014 Kokotsakis et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Coady MA, Rizzo JA, Hammond GL, Pierce JG, Kopf GS, Elefteriades JA: Penetrating ulcer of the thoracic aorta: what is it? How do we recognize it? How do we manage it? J Vasc Surg 1998, 27(6):1006-1015. discussion 15–6
• [2]Botta L, Buttazzi K, Russo V, Parlapiano M, Gostoli V, Di Bartolomeo R, Fattori R: Endovascular repair for penetrating atherosclerotic ulcers of the descending thoracic aorta: early and mid-term results. Ann Thorac Surg 2008, 85(3):987-992.
• [3]Gottardi R, Zimpfer D, Funovics M, Schoder M, Lammer J, Wolner E, Czerny M, Grimm M: Mid-term results after endovascular stent-graft placement due to penetrating atherosclerotic ulcers of the thoracic aorta. Eur J Cardiothorac Surg 2008, 33(6):1019-1024.
• [4]Di Bartolomeo R, Di Marco L, Armaro A, Marsilli D, Leone A, Pilato E, Pacini D: Treatment of complex disease of the thoracic aorta: the frozen elephant trunk technique with the E-vita open prosthesis. Eur J Cardiothorac Surg 2009, 35(4):671-675. discussion 5–6
• [5]Ius F, Fleissner F, Pichlmaier M, Karck M, Martens A, Haverich A, Shrestha M: Total aortic arch replacement with the frozen elephant trunk technique: 10-year follow-up single-centre experience. Eur J Cardiothorac Surg 2013, 44(5):949-957.
• [6]Kourliouros A, Vecht J, Kakouros N, Grapsa J, Nihoyannopoulos P, Kokotsakis J, Athanasiou T: Frozen elephant trunk as an effective alternative to open and hybrid two-stage procedures for complex aortic disease. Hellenic J Cardiol 2011, 52(4):337-344.
• [7]Tsagakis K, Pacini D, Di Bartolomeo R, Benedik J, Cerny S, Gorlitzer M, Grabenwoger M, Mestres CA, Jakob H: Arch replacement and downstream stent grafting in complex aortic dissection: first results of an international registry. Eur J Cardiothorac Surg 2011, 39(1):87-93. discussion -4
• [8]Karck M, Kamiya H: Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch? Eur J Cardiothorac Surg 2008, 33(6):1007-1013.
• [9]Eggebrecht H, Herold U, Schmermund A, Lind AY, Kuhnt O, Martini S, Kuhl H, Kienbaum P, Peters J, Jakob H, Erbel R, Baumgart D: Endovascular stent-graft treatment of penetrating aortic ulcer: results over a median follow-up of 27 months. Am Heart J 2006, 151(2):530-536.
• [10]Demers P, Miller DC, Mitchell RS, Kee ST, Chagonjian L, Dake MD: Stent-graft repair of penetrating atherosclerotic ulcers in the descending thoracic aorta: mid-term results. Ann Thorac Surg 2004, 77(1):81-86.
• [11]Cho KR, Stanson AW, Potter DD, Cherry KJ, Schaff HV, Sundt TM 3rd: Penetrating atherosclerotic ulcer of the descending thoracic aorta and arch. J Thorac Cardiovasc Surg 2004, 127(5):1393-1399. discussion 9–401