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Pseudoaneurysm of graft-graft anastomosis of a hand-sewn branched graft: a case report.

Gomibuchi T, Takano T, Wada Y, Terasaki T, Seto T, Fukui D - J Cardiothorac Surg (2015)

Bottom Line: Surgical repair involved direct suture of multiple bleeding points which were found at the sites of the hand-sewn branches anastomosis.The postoperative course was uneventful, and no signs of bleeding were observed by CT after the reoperation.Long-term follow-up is essential to detect late complications at the site of hand-sewn anastomosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan. gomit@shinshu-u.ac.jp.

ABSTRACT

Background: Pseudoaneurysm of graft-graft anastomosis is an extremely rare but potentially fatal complication after thoracic aorta replacement with a prosthetic graft. We report a case of pseudoaneurysm at the graft-graft anastomosis of a hand-sewn branched graft.

Case presentation: A 65-year-old man underwent total arch replacement with a hand-sewn branched graft for Stanford type A acute aortic dissection 22 years ago. During follow-up, serial CT scans showed a pseudoaneurysm on the branched graft which warranted reintervention. Surgical repair involved direct suture of multiple bleeding points which were found at the sites of the hand-sewn branches anastomosis. The postoperative course was uneventful, and no signs of bleeding were observed by CT after the reoperation.

Conclusions: Long-term follow-up is essential to detect late complications at the site of hand-sewn anastomosis.

No MeSH data available.


Related in: MedlinePlus

Intraoperative view
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Fig2: Intraoperative view

Mentions: We performed median resternotomy after exposing the left femoral and right axillary arteries. Cardiopulmonary bypass (CPB) was established with cannulation of the right axillary artery, the left femoral artery, and the right atrium under normothermia. The pseudoaneurysm was opened and a thrombus inside the aneurysm was removed. Small bleedings were found on the anastomosis of the arch graft–brachiocephalic branch graft (Fig. 2), arch graft–left subclavian branch graft, and ascending graft–arch graft. The bleedings were repaired with interrupted pledget-supported sutures. CPB was weaned off after the other anastomoses including native artery–graft anastomoses were carefully examined. CPB time was 89 min, and total operation time was 427 min.Fig. 2


Pseudoaneurysm of graft-graft anastomosis of a hand-sewn branched graft: a case report.

Gomibuchi T, Takano T, Wada Y, Terasaki T, Seto T, Fukui D - J Cardiothorac Surg (2015)

Intraoperative view
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4635580&req=5

Fig2: Intraoperative view
Mentions: We performed median resternotomy after exposing the left femoral and right axillary arteries. Cardiopulmonary bypass (CPB) was established with cannulation of the right axillary artery, the left femoral artery, and the right atrium under normothermia. The pseudoaneurysm was opened and a thrombus inside the aneurysm was removed. Small bleedings were found on the anastomosis of the arch graft–brachiocephalic branch graft (Fig. 2), arch graft–left subclavian branch graft, and ascending graft–arch graft. The bleedings were repaired with interrupted pledget-supported sutures. CPB was weaned off after the other anastomoses including native artery–graft anastomoses were carefully examined. CPB time was 89 min, and total operation time was 427 min.Fig. 2

Bottom Line: Surgical repair involved direct suture of multiple bleeding points which were found at the sites of the hand-sewn branches anastomosis.The postoperative course was uneventful, and no signs of bleeding were observed by CT after the reoperation.Long-term follow-up is essential to detect late complications at the site of hand-sewn anastomosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan. gomit@shinshu-u.ac.jp.

ABSTRACT

Background: Pseudoaneurysm of graft-graft anastomosis is an extremely rare but potentially fatal complication after thoracic aorta replacement with a prosthetic graft. We report a case of pseudoaneurysm at the graft-graft anastomosis of a hand-sewn branched graft.

Case presentation: A 65-year-old man underwent total arch replacement with a hand-sewn branched graft for Stanford type A acute aortic dissection 22 years ago. During follow-up, serial CT scans showed a pseudoaneurysm on the branched graft which warranted reintervention. Surgical repair involved direct suture of multiple bleeding points which were found at the sites of the hand-sewn branches anastomosis. The postoperative course was uneventful, and no signs of bleeding were observed by CT after the reoperation.

Conclusions: Long-term follow-up is essential to detect late complications at the site of hand-sewn anastomosis.

No MeSH data available.


Related in: MedlinePlus