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Acute thrombotic occlusion of left internal jugular vein compressed by bypass graft for thoracic endovascular aortic repair debranching procedure.

Sim HT, Beom MS, Kim SR, Ryu SW - Korean J Thorac Cardiovasc Surg (2014)

Bottom Line: Thoracic endovascular aortic repair has become a widespread alternative treatment option for thoracic aortic aneurysm.The debranching of arch vessels may be required to provide an acceptable landing zone for an endovascular stent graft.We report a case where the bypass graft used in the thoracic endovascular aortic repair procedure compressed the left internal jugular vein, causing acute thrombotic occlusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital.

ABSTRACT
Thoracic endovascular aortic repair has become a widespread alternative treatment option for thoracic aortic aneurysm. The debranching of arch vessels may be required to provide an acceptable landing zone for an endovascular stent graft. We report a case where the bypass graft used in the thoracic endovascular aortic repair procedure compressed the left internal jugular vein, causing acute thrombotic occlusion.

No MeSH data available.


Related in: MedlinePlus

After a thrombectomy was performed, the left internal jugular vein was transected and repositioned above the bypass graft. An intervenous bypass (end-to-end anastomosis with an 8-mm ringed vascular graft) was carried out.
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f3-kjtcvs-47-552: After a thrombectomy was performed, the left internal jugular vein was transected and repositioned above the bypass graft. An intervenous bypass (end-to-end anastomosis with an 8-mm ringed vascular graft) was carried out.

Mentions: Postoperatively, the patient twice failed to be weaned off the ventilator because of intractable stridor and desaturation immediately after extubation. He underwent reoperation on postoperative day four due to suspected airway edema caused by the obstruction of venous return. When neck ultrasonography was performed in the operating room, a large amount of thrombi was found in the left internal jugular vein and no flow was found through the left internal jugular vein. In the operative theater, the left internal jugular vein was found to be totally obstructed by thrombosis (Fig. 2), which might have been caused by compression from the bypass graft. The reoperation was done by thrombectomy and left internal jugular vein intervenous bypass using an 8-mm ringed graft (EXXCELL SOFT ePTFE vascular graft; MAQUET cardiovascular LLC, San Jose, CA, USA) (Fig. 3). After reoperation, the patient’s upper airway symptoms improved, but he still displayed delirium and poor spatial orientation. He was weaned off the ventilator five days after the second operation and transferred to a general ward on postoperative day eight. He was readmitted to the intensive care unit because of stridor and delirium on postoperative day nine. On an upper airway exam, bilateral vocal cord palsy was noted. Thereafter, he was given steroid medications and was weaned off the ventilator four days later. On postoperative cardiac computed tomography, a patent debranching graft was noted and the thoracic stent graft was well positioned with no evidence of endoleak (Fig. 4). On a follow-up vocal cord exam, his bilateral vocal cord palsy had improved. He was discharged from hospital on postoperative day 30, but was prescribed oral aspirin for anticoagulation to maintain the patency of the intervenous graft.


Acute thrombotic occlusion of left internal jugular vein compressed by bypass graft for thoracic endovascular aortic repair debranching procedure.

Sim HT, Beom MS, Kim SR, Ryu SW - Korean J Thorac Cardiovasc Surg (2014)

After a thrombectomy was performed, the left internal jugular vein was transected and repositioned above the bypass graft. An intervenous bypass (end-to-end anastomosis with an 8-mm ringed vascular graft) was carried out.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4279840&req=5

f3-kjtcvs-47-552: After a thrombectomy was performed, the left internal jugular vein was transected and repositioned above the bypass graft. An intervenous bypass (end-to-end anastomosis with an 8-mm ringed vascular graft) was carried out.
Mentions: Postoperatively, the patient twice failed to be weaned off the ventilator because of intractable stridor and desaturation immediately after extubation. He underwent reoperation on postoperative day four due to suspected airway edema caused by the obstruction of venous return. When neck ultrasonography was performed in the operating room, a large amount of thrombi was found in the left internal jugular vein and no flow was found through the left internal jugular vein. In the operative theater, the left internal jugular vein was found to be totally obstructed by thrombosis (Fig. 2), which might have been caused by compression from the bypass graft. The reoperation was done by thrombectomy and left internal jugular vein intervenous bypass using an 8-mm ringed graft (EXXCELL SOFT ePTFE vascular graft; MAQUET cardiovascular LLC, San Jose, CA, USA) (Fig. 3). After reoperation, the patient’s upper airway symptoms improved, but he still displayed delirium and poor spatial orientation. He was weaned off the ventilator five days after the second operation and transferred to a general ward on postoperative day eight. He was readmitted to the intensive care unit because of stridor and delirium on postoperative day nine. On an upper airway exam, bilateral vocal cord palsy was noted. Thereafter, he was given steroid medications and was weaned off the ventilator four days later. On postoperative cardiac computed tomography, a patent debranching graft was noted and the thoracic stent graft was well positioned with no evidence of endoleak (Fig. 4). On a follow-up vocal cord exam, his bilateral vocal cord palsy had improved. He was discharged from hospital on postoperative day 30, but was prescribed oral aspirin for anticoagulation to maintain the patency of the intervenous graft.

Bottom Line: Thoracic endovascular aortic repair has become a widespread alternative treatment option for thoracic aortic aneurysm.The debranching of arch vessels may be required to provide an acceptable landing zone for an endovascular stent graft.We report a case where the bypass graft used in the thoracic endovascular aortic repair procedure compressed the left internal jugular vein, causing acute thrombotic occlusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital.

ABSTRACT
Thoracic endovascular aortic repair has become a widespread alternative treatment option for thoracic aortic aneurysm. The debranching of arch vessels may be required to provide an acceptable landing zone for an endovascular stent graft. We report a case where the bypass graft used in the thoracic endovascular aortic repair procedure compressed the left internal jugular vein, causing acute thrombotic occlusion.

No MeSH data available.


Related in: MedlinePlus