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[Successful Echo-guided Deployment of Stent Graft for Intraoperative Retrograde Aortic Dissection and Rupture;Report

Naoki Kanemitsu1, Takehiko Matsuo, Hiroaki Osada

  • 1Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|May 15, 2018
PubMed

Insights

This case study details a successful endovascular repair of a complex thoracoabdominal aortic aneurysm rupture using echoguided stent-grafts. The innovative technique achieved complete hemostasis and excellent patient recovery without complications.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Endovascular Therapy
  • Medical Imaging in Interventions

Background:

  • Chronic dissecting thoracoabdominal aneurysms present significant surgical challenges.
  • Intraoperative complications like retrograde aortic dissection require immediate and effective management strategies.

Observation:

  • An 82-year-old male experienced massive bleeding from the proximal descending aorta post-thoracoabdominal aortic replacement.
  • Trans-esophageal echocardiography (TEE) revealed extensive aortic dissection from the clamp site.

Findings:

  • Successful hemostasis was achieved using a combination of suture, surgical glue, and a novel echoguided stent-graft insertion.
  • Two stent-grafts were accurately positioned using direct echocardiography and TEE, controlling the bleeding.
  • Post-operative CT confirmed optimal stent-graft placement and thoracic aorta remodeling.

Implications:

  • Echoguided stent-graft insertion offers a viable and effective solution for managing intraoperative aortic rupture during complex aortic repairs.
  • This approach minimizes the risk of paraplegia and promotes favorable long-term aortic remodeling.
  • The study highlights the critical role of intraoperative imaging in guiding complex endovascular interventions.

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