Stent-Graft Re-expansion Following Axillo-Bifemoral Bypass : A Case of Stent Graft Collapse due to Acute Type B Aortic Dissection / 日本心臓血管外科学会雑誌

We describe a rare complication and treatment progression that occurred in a 64-year-old man with an aortic abdominal aneurysm (AAA) that had been treated by endovascular aneurysm repair (EVAR). He had undergone EVAR to treat an infra-renal type AAA 21 months previously and returned to the emergency department with back pain. Contrast-enhanced computed tomography (CT) revealed acute type B aortic dissection, so he was admitted and conservative medical management was started. Acute stomachache and limb pain appeared on hospital day 7, which prevented him from moving his lower limbs. The main body of the stent graft had collapsed, blocking blood flow, and contrast was not found in arteries from the collapsed stent graft portion to the knee level on emergency contrast CT images of the leg. His legs were revascularized by an extra-anatomical right axial-bilateral external iliac bypass. His symptoms disappeared and reperfusion injury was avoided. The collapsed stent graft had retained its original shape at 11 and 18 days after surgery. Furthermore, follow-up CT 4.5 years later showed that the stent graft retained its original form.

Type A Aortic Dissection during the Treatment of Tuberculous Pericarditis / 日本心臓血管外科学会雑誌

A 69-year-old woman, who had undergone a right nephrectomy for renal tuberculosis in her teens, was admitted with a low grade fever, anorexia and progressive dyspnea. Transthoracic echocardiography showed cardiac tamponade and chest CT revealed an enlarged ascending aorta. She was treated with pericardiocentesis. Specimens of pericardial effusion failed to demonstrate any acid-fast bacilli, but they did reveal a high level of adnosine deaminase (72 IU/<i>l</i>). A diagnosis of tuberculous pericarditis was considered, and antituberculous chemotherapy was started. However, he presented with severe back pain 32 days later and CT revealed type A acute aortic dissection. We therefore replaced the ascending aorta and aortic root. A histopathological examination of the ascending aorta revealed evidence of a granulomatous inflammatory reaction with Langhans giant cells. She thereafter received antituberculous chemotherapy with 4 drugs for 2 months, with continued rifampicin and isoniazid treatment. There was no evidence of any graft infection after 70 days.