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Thoracic endovascular aortic repair for complicated chronic type B aortic dissection in a patient on hemodialysis with recurrent ischemic colitis.

Miyazaki Y, Furuyama T, Matsubara Y, Yoshiya K, Yoshiga R, Inoue K, Matsuda D, Aoyagi Y, Kato M, Matsumoto T, Maehara Y - Surg Case Rep (2016)

Bottom Line: The celiac artery and superior mesenteric artery (SMA) arose from the true lumen, and these were compressed by the expanded false lumen.Seven days after this operation, enhanced computed tomography showed that the patient's true lumen was expanded and her blood flow to the true lumen and SMA was improved.We believe that TEVAR supplemented by a noncovered aortic stent is an effective treatment, even for highly chronic B-AD in dialysis patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Fukuoka, Japan.

ABSTRACT
We present a successful case of thoracic endovascular aortic repair (TEVAR) for chronic Stanford type B aortic dissection (B-AD) with recurrent ischemic colitis. The patient was a 56-year-old woman with abdominal pain as the main complaint who had two operations previously: the total arch replacement 8 years ago and the Bentall 7 years ago for acute Stanford type A aortic dissection. Her abdominal pain worsened as her blood pressure became low during her hemodialysis treatment. An enhanced computed tomography scan was performed on the patient and showed chronic B-AD that occurred from the distal anastomotic part of the total arch graft to the bilateral common iliac arteries. The celiac artery and superior mesenteric artery (SMA) arose from the true lumen, and these were compressed by the expanded false lumen. Her complicated chronic B-AD was treated with the Zenith Dissection Endovascular System, and its procedure was performed as her proximal entry tear was covered by a proximal tapered Zenith TX2 stent graft, supplemented by a noncovered aortic stent extending across both renal arteries, the SMA, and the celiac artery. Seven days after this operation, enhanced computed tomography showed that the patient's true lumen was expanded and her blood flow to the true lumen and SMA was improved. On the other hand, her false lumen tended to be thrombosed. Consequently, she was discharged 10 days after the operation without any postoperative complications as she had no abdominal complaints even though she underwent hemodialysis three times per week after the operation. We believe that TEVAR supplemented by a noncovered aortic stent is an effective treatment, even for highly chronic B-AD in dialysis patients.

No MeSH data available.


Related in: MedlinePlus

a The TX2 was deployed just distal to the left subclavian branch to seal the entry of the false lumen. b The TXD was deployed at the SMA to expand the true lumen and improve blood flow of the SMA
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Fig3: a The TX2 was deployed just distal to the left subclavian branch to seal the entry of the false lumen. b The TXD was deployed at the SMA to expand the true lumen and improve blood flow of the SMA

Mentions: Based on these clinical findings, we considered that this recurrent ischemic colitis was a result of diminished blood flow to the SMA due to the compressed true lumen combined with hypotension due to hemodialysis. We then determined that therapeutic enlargement of the true lumen would improve blood flow to the SMA and reduce the risk of ischemic colitis. For treatment, we decided to perform TEVAR because open surgical repair can be risky for the patient considering the history of previous Bentall operation and comorbid ESRF. Because the patient’s quality of life was adversely affected by recurrent ischemic colitis, she agreed to undergo the procedure we suggested, and informed consent was obtained. The operation was performed under general anesthesia. An incision was made in the right groin to expose the right femoral artery. A 6Fr sheath introducer was inserted percutaneously from the left common femoral artery for aortography. A 8Fr sheath introducer was inserted from the right exposed common femoral artery, and we delivered a guidewire and catheter with contrast radiography to pass into the compressed true lumen. The proximal entry tear in the patient was covered by a Zenith TX2 stent graft (diameter, 32–28 mm; mean length, 200 mm; Cook Medical, Bloomington, IN), supplemented by a noncovered aortic stent (TXD; diameter, 36 mm; length, 164 mm; Cook Medical) around both renal arteries, the SMA, and the celiac artery (CA). The TX2 was deployed just distal to the left subclavian branch to seal the entry tear (Fig. 3a). The noncovered aortic stent (TXD) was deployed from above the CA to under both renal arteries to expand the true lumen and to improve blood flow of the CA and SMA (Fig. 3b). The operation time was 2 h and 33 min, and blood loss was 150 cc. The patient tolerated these procedures well and was transferred to the postoperative care unit in a hemodynamically stable condition. Her bowel condition improved just after the operation.Fig. 3


Thoracic endovascular aortic repair for complicated chronic type B aortic dissection in a patient on hemodialysis with recurrent ischemic colitis.

Miyazaki Y, Furuyama T, Matsubara Y, Yoshiya K, Yoshiga R, Inoue K, Matsuda D, Aoyagi Y, Kato M, Matsumoto T, Maehara Y - Surg Case Rep (2016)

a The TX2 was deployed just distal to the left subclavian branch to seal the entry of the false lumen. b The TXD was deployed at the SMA to expand the true lumen and improve blood flow of the SMA
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835411&req=5

Fig3: a The TX2 was deployed just distal to the left subclavian branch to seal the entry of the false lumen. b The TXD was deployed at the SMA to expand the true lumen and improve blood flow of the SMA
Mentions: Based on these clinical findings, we considered that this recurrent ischemic colitis was a result of diminished blood flow to the SMA due to the compressed true lumen combined with hypotension due to hemodialysis. We then determined that therapeutic enlargement of the true lumen would improve blood flow to the SMA and reduce the risk of ischemic colitis. For treatment, we decided to perform TEVAR because open surgical repair can be risky for the patient considering the history of previous Bentall operation and comorbid ESRF. Because the patient’s quality of life was adversely affected by recurrent ischemic colitis, she agreed to undergo the procedure we suggested, and informed consent was obtained. The operation was performed under general anesthesia. An incision was made in the right groin to expose the right femoral artery. A 6Fr sheath introducer was inserted percutaneously from the left common femoral artery for aortography. A 8Fr sheath introducer was inserted from the right exposed common femoral artery, and we delivered a guidewire and catheter with contrast radiography to pass into the compressed true lumen. The proximal entry tear in the patient was covered by a Zenith TX2 stent graft (diameter, 32–28 mm; mean length, 200 mm; Cook Medical, Bloomington, IN), supplemented by a noncovered aortic stent (TXD; diameter, 36 mm; length, 164 mm; Cook Medical) around both renal arteries, the SMA, and the celiac artery (CA). The TX2 was deployed just distal to the left subclavian branch to seal the entry tear (Fig. 3a). The noncovered aortic stent (TXD) was deployed from above the CA to under both renal arteries to expand the true lumen and to improve blood flow of the CA and SMA (Fig. 3b). The operation time was 2 h and 33 min, and blood loss was 150 cc. The patient tolerated these procedures well and was transferred to the postoperative care unit in a hemodynamically stable condition. Her bowel condition improved just after the operation.Fig. 3

Bottom Line: The celiac artery and superior mesenteric artery (SMA) arose from the true lumen, and these were compressed by the expanded false lumen.Seven days after this operation, enhanced computed tomography showed that the patient's true lumen was expanded and her blood flow to the true lumen and SMA was improved.We believe that TEVAR supplemented by a noncovered aortic stent is an effective treatment, even for highly chronic B-AD in dialysis patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Fukuoka, Japan.

ABSTRACT
We present a successful case of thoracic endovascular aortic repair (TEVAR) for chronic Stanford type B aortic dissection (B-AD) with recurrent ischemic colitis. The patient was a 56-year-old woman with abdominal pain as the main complaint who had two operations previously: the total arch replacement 8 years ago and the Bentall 7 years ago for acute Stanford type A aortic dissection. Her abdominal pain worsened as her blood pressure became low during her hemodialysis treatment. An enhanced computed tomography scan was performed on the patient and showed chronic B-AD that occurred from the distal anastomotic part of the total arch graft to the bilateral common iliac arteries. The celiac artery and superior mesenteric artery (SMA) arose from the true lumen, and these were compressed by the expanded false lumen. Her complicated chronic B-AD was treated with the Zenith Dissection Endovascular System, and its procedure was performed as her proximal entry tear was covered by a proximal tapered Zenith TX2 stent graft, supplemented by a noncovered aortic stent extending across both renal arteries, the SMA, and the celiac artery. Seven days after this operation, enhanced computed tomography showed that the patient's true lumen was expanded and her blood flow to the true lumen and SMA was improved. On the other hand, her false lumen tended to be thrombosed. Consequently, she was discharged 10 days after the operation without any postoperative complications as she had no abdominal complaints even though she underwent hemodialysis three times per week after the operation. We believe that TEVAR supplemented by a noncovered aortic stent is an effective treatment, even for highly chronic B-AD in dialysis patients.

No MeSH data available.


Related in: MedlinePlus