ABSTRACT
We report a case of thoracic endovascular aortic repair (TEVAR) with a fenestrated stent graft for ulcer-like projection (ULP) of the proximal anastomosis after total arch replacement (TAR) for acute type A aortic dissection (DAA). A 73-year-old woman with a history of surgical resection of a left atrial myxoma in January 2009 underwent TAR for DAA in November 2011. The contrast enhanced CT (CE-CT) 72 days after TAR revealed two ULPs anterior and posterior to the proximal anastomosis. Surgical repair would be difficult because of the history of cardiac and aortic surgery, therefore TEVAR with a fenestrated stent graft was performed. The postoperative course was uneventful and she was discharged on the 8th postoperative day. The CE-CT 3 months after TEVAR showed almost completely thrombosed ULPs. Endovascular repair with fenestrated stent graft for the proximal anastomotic ULP can be a useful and effective treatment.
ABSTRACT
Six surgical cases of localized abdominal aortic dissections experienced from 1977 to August, 1992 comprised 1.1% of all true aneurysms of the abdominal aorta (563 cases) and 2.5% of all aortic dissections (242 cases) for the same period. The mean age of the 6 patients at operation was 70 years (range from 62 to 74 years, 2 males, 4 females). All dissections were localized at the infrarenal abdominal aorta and one case showed three-channeled dissection. All cases were diagnosed preoperatively and prosthetic graft replacement was performed. Localized abdominal aortic dissection was reported in only 30 cases, including our cases, in the Japanese literature. Compared to thoracic aortic dissection, the development of symptoms is slow, age is high and the condition is often accompanied by hypertension and atherosclerosis.