Redo Total Arch Replacement for a Patient with Pseudoaneurysm of the Thoracic Aortic Graft
10.4326/jjcvs.41.29
- VernacularTitle:弓部大動脈人工血管置換術後仮性動脈瘤に対して再弓部置換術を行った1例
- Author:
Satoshi Kimura
;
Yasutaka Ueno
- Publication Type:Journal Article
- Keywords:
graft replacement of thoracic aorta;
pseudoaneurysm;
reoperation
- From:Japanese Journal of Cardiovascular Surgery
2012;41(1):29-32
- CountryJapan
- Language:Japanese
-
Abstract:
Aortic pseudoaneurysm is a rare but life-threatening complication after graft replacement. One of the main challenges of surgery is the appropriate and safe method of re-entering the chest cavity. Therefore, it is necessary to consider a strategy which includes cardiopulmonary bypass. The patient was a 64-year-old man who had undergone hemi-arch replacement for pseudoaneurysm of the native thoracic aorta 17 years previously. The exact surgical details of the previous operation were unknown. He experienced progressive chest pain for 1 month, and noticed a parasternal pulsatile mass. An enhanced computed tomographic scan revealed a pseudoaneurysm originating from the thoracic aortic artificial graft itself, which had eroded the left parasternum and which would possibly rupture out of the skin. Preoperative examinations suggested a high risk of bleeding if redo sternotomy was performed. Therefore, we decided to perform open surgical repair with a cardiopulmonary bypass with cannulation through the femoral artery and vein before resternotomy. In addition, we performed a transthoracic left ventricular venting and selective cerebral perfusion using bilateral axillary arteries, which enabled core cooling in case of uncontrollable hemorrhage. He successfully underwent redo graft replacement of the thoracic aorta, and his postoperative course was uneventful.
