Endovascular Stent Grafting of a Perforated Descending Aorta Caused by Empyema
10.4326/jjcvs.34.25
- VernacularTitle:膿胸に合併した胸部下行大動脈穿孔にステントグラフト内挿術を施行した１例
- Author:
Koji Dairaku
;
Akira Furutani
;
Satoshi Saito
;
Norio Akiyama
;
Kouichi Yoshimura
;
Hiroaki Takenaka
;
Kimikazu Hamano
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
2005;34(1):25-28
- CountryJapan
- Language:Japanese
-
Abstract:
We performed endovascular stent grafting of a perforated descending aorta, caused by empyema after surgery for lung cancer, in a 75-year-old man. After diagnosing hemorrhage from a perforation of the proximal descending aorta, caused by left empyema, the perforation was repaired with a saphenous vein patch and a pectoralis major muscle flap. However, re-hemorrhage from the same lesion occurred 2 months postoperatively. Temporary hemostasis was achieved with gauze packing and he was transferred to our hospital for endovascular stent grafting. The infection did not resolve after fenestration, so the descending aorta was cropped out to the fenestration lesion. Therefore, endovascular stent grafting was performed on the same day. Postoperatively the bleeding stopped completely without any signs of graft infection, and he was transferred to another hospital on postoperative day 9. No re-hemorrhage or graft infection of the aortic perforative lesion occurred in the early postoperative period. However, the patient died of massive bleeding from the aorta wall of the proximal stump of the stent graft, caused by recurrence of the infection 2 months after the 2nd operation. In this situation, endovascular scent grafting provides the only chance of saving the patient's life. If endovascular stent grafting is performed as a lifesaving procedure, meticulous operative technique is imperative.
