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Endovascular Rescue of a Narrowed Aorto-Aortic Bypass Graft in a Patient with Takayasu's Arteritis.

Son KH, Kim JS, Kim JH, Chung WJ, Ahn S, Park CH - Korean J Thorac Cardiovasc Surg (2014)

Bottom Line: We report a case of successful endovascular treatment of a pseudoaneurysm and the obstruction of an aorto-aortic bypass graft, which had been performed to treat Takayasu's arteritis fifteen years prior, at the thoracic aorta.Along with the immediate relief of proximal hypertension that had caused severe heart failure, the successful exclusion of the pseudoaneurysm and the patency of the stem graft were maintained three years after the procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Heart Center, Gachon University Gil Medical Center, Gachon University.

ABSTRACT
We report a case of successful endovascular treatment of a pseudoaneurysm and the obstruction of an aorto-aortic bypass graft, which had been performed to treat Takayasu's arteritis fifteen years prior, at the thoracic aorta. Along with the immediate relief of proximal hypertension that had caused severe heart failure, the successful exclusion of the pseudoaneurysm and the patency of the stem graft were maintained three years after the procedure.

No MeSH data available.


Related in: MedlinePlus

Chest radiograph and computed tomography scan before the stent graft procedure. (A) Chest radiograph taken in the emergency room showing cardiomegaly and pulmonary edema. The aortic notch was prominent. (B) Computed tomography image showing severe stenosis in the descending thoracic aorta and diffuse circumferential wall calcification. Vascular wall thickening was observed in the distal portion of the aortic arch and in the left common carotid artery. The bypass graft was from the distal aortic arch to the abdominal aorta above the celiac trunk. There was a 3-cm pseudoaneurysm (arrowhead) and severe luminal stenosis in the proximal segment of the bypass graft (arrow).
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f1-kjtcvs-47-556: Chest radiograph and computed tomography scan before the stent graft procedure. (A) Chest radiograph taken in the emergency room showing cardiomegaly and pulmonary edema. The aortic notch was prominent. (B) Computed tomography image showing severe stenosis in the descending thoracic aorta and diffuse circumferential wall calcification. Vascular wall thickening was observed in the distal portion of the aortic arch and in the left common carotid artery. The bypass graft was from the distal aortic arch to the abdominal aorta above the celiac trunk. There was a 3-cm pseudoaneurysm (arrowhead) and severe luminal stenosis in the proximal segment of the bypass graft (arrow).

Mentions: A 59-year-old female visited an emergency room of Gachon University Gil Medical Center due to dyspnea that had lasted for five days. The initial blood pressure in her right arm was 220/100 mmHg, and her respiration rate was 40 breaths per minute. Chest radiography revealed cardiomegaly, a prominent aortic notch, and pulmonary edema, which explained her tachypnea and arterial hypoxemia (Fig. 1A). The laboratory data was as follows: creatine kinase-MB, 1.20 ng/mL; troponin I, 0.08 ng/mL; brain natriuretic peptide, 5,850 pg/mL; creatinine, 1.3 mg/dL; C-reactive protein, 12.30 mg/L; and an erythrocyte sedimentation rate of 1.1 mm/hr. An electrocardiogram showed sinus tachycardia with a Q wave on V1, ST segment elevation from V1 to V3, and T wave inversion on anterior precordial and inferior limb leads. Echocardiography showed akinesia of the anterior wall anteroseptum, and inferoseptum from the low middle left ventricle to the apex with thinning and a preserved ejection fraction of 50% with left ventricular hypertrophy. The medical history taken from the patient’s family revealed that she had been diagnosed with hypertension, Takayasu’s arteritis, and cerebral infarction at another hospital fifteen years ago. In addition, an aortic bypass graft procedure carried out to treat thoracic aortic stenosis 15 years ago. When the patient presented to an emergency room of Gachon University Gil Medical Center she had left hemiparesis as the sequel of her previous stroke.


Endovascular Rescue of a Narrowed Aorto-Aortic Bypass Graft in a Patient with Takayasu's Arteritis.

Son KH, Kim JS, Kim JH, Chung WJ, Ahn S, Park CH - Korean J Thorac Cardiovasc Surg (2014)

Chest radiograph and computed tomography scan before the stent graft procedure. (A) Chest radiograph taken in the emergency room showing cardiomegaly and pulmonary edema. The aortic notch was prominent. (B) Computed tomography image showing severe stenosis in the descending thoracic aorta and diffuse circumferential wall calcification. Vascular wall thickening was observed in the distal portion of the aortic arch and in the left common carotid artery. The bypass graft was from the distal aortic arch to the abdominal aorta above the celiac trunk. There was a 3-cm pseudoaneurysm (arrowhead) and severe luminal stenosis in the proximal segment of the bypass graft (arrow).
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Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4279845&req=5

f1-kjtcvs-47-556: Chest radiograph and computed tomography scan before the stent graft procedure. (A) Chest radiograph taken in the emergency room showing cardiomegaly and pulmonary edema. The aortic notch was prominent. (B) Computed tomography image showing severe stenosis in the descending thoracic aorta and diffuse circumferential wall calcification. Vascular wall thickening was observed in the distal portion of the aortic arch and in the left common carotid artery. The bypass graft was from the distal aortic arch to the abdominal aorta above the celiac trunk. There was a 3-cm pseudoaneurysm (arrowhead) and severe luminal stenosis in the proximal segment of the bypass graft (arrow).
Mentions: A 59-year-old female visited an emergency room of Gachon University Gil Medical Center due to dyspnea that had lasted for five days. The initial blood pressure in her right arm was 220/100 mmHg, and her respiration rate was 40 breaths per minute. Chest radiography revealed cardiomegaly, a prominent aortic notch, and pulmonary edema, which explained her tachypnea and arterial hypoxemia (Fig. 1A). The laboratory data was as follows: creatine kinase-MB, 1.20 ng/mL; troponin I, 0.08 ng/mL; brain natriuretic peptide, 5,850 pg/mL; creatinine, 1.3 mg/dL; C-reactive protein, 12.30 mg/L; and an erythrocyte sedimentation rate of 1.1 mm/hr. An electrocardiogram showed sinus tachycardia with a Q wave on V1, ST segment elevation from V1 to V3, and T wave inversion on anterior precordial and inferior limb leads. Echocardiography showed akinesia of the anterior wall anteroseptum, and inferoseptum from the low middle left ventricle to the apex with thinning and a preserved ejection fraction of 50% with left ventricular hypertrophy. The medical history taken from the patient’s family revealed that she had been diagnosed with hypertension, Takayasu’s arteritis, and cerebral infarction at another hospital fifteen years ago. In addition, an aortic bypass graft procedure carried out to treat thoracic aortic stenosis 15 years ago. When the patient presented to an emergency room of Gachon University Gil Medical Center she had left hemiparesis as the sequel of her previous stroke.

Bottom Line: We report a case of successful endovascular treatment of a pseudoaneurysm and the obstruction of an aorto-aortic bypass graft, which had been performed to treat Takayasu's arteritis fifteen years prior, at the thoracic aorta.Along with the immediate relief of proximal hypertension that had caused severe heart failure, the successful exclusion of the pseudoaneurysm and the patency of the stem graft were maintained three years after the procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Heart Center, Gachon University Gil Medical Center, Gachon University.

ABSTRACT
We report a case of successful endovascular treatment of a pseudoaneurysm and the obstruction of an aorto-aortic bypass graft, which had been performed to treat Takayasu's arteritis fifteen years prior, at the thoracic aorta. Along with the immediate relief of proximal hypertension that had caused severe heart failure, the successful exclusion of the pseudoaneurysm and the patency of the stem graft were maintained three years after the procedure.

No MeSH data available.


Related in: MedlinePlus