Pitfalls in Open Stent Grafting for Distal Aortic Arch Aneurysm

Kentaro Tamura Fumikazu Nomura Shogo Mukai
Katsuhiko Ihara

(Cardiovascular Surgery, National Hospital Kure Medical Center, Hiroshima, Japan)

A 72-year-old woman underwent surgical stent graft implantation for a huge distal arch aneurysm(12×11cm). Axillo-bifemoral bypass was added in order to restore visceral perfusion. Severe metabolic acidosis developed after the operation, and the patient died 6 hours after surgery. Autopsy showed thromboembolism of the superior mesenteric artery and aortic dissection in the descending thoracic aorta because of stent graft insertion into a false lumen. To reduce complications like this case, we should consider the peculiar anatomic features and thoroughly evaluate atheromatous changes in the aortic wall with improvement of the shape of the sheath and delivery system. 
  Jpn. J. Cardiovasc. Surg. 31:139-142(2002)