| Two Cases of Stent-Grafting for
Ruptured Aneurysms |
(First Department of Surgery, Hirosaki University
School of Medicine, Hirosaki, Japan)
| Ikkoh Ichinoseki |
Kazuo Itoh |
Mamoru Munakata |
| Masayuki Koyama |
Yasuyuki Suzuki |
Kozo Fukui |
| Shunichi Takaya |
Ikuo Fukuda |
|
|
In cases of stent-grafting for ruptured
aneurysm, endoleak is a serious problem. We report 2 cases of
ruptured aneurysms that were treated with endovascular stent-graft
placement. Case 1: A 79-year-old woman had a ruptured thoracic
aortic aneurysm that was treated with endovascular stent-grafting
from the distal arch to the descending aorta. Although her intra-operative
course was uneventful, she died suddenly the day after operation.
Autopsy revealed re-rupture of the aneurysm due to endoleak from
the proximal site. Case 2: An 84-year-old woman was treated with
endovascular stent-grafting for ruptured abdominal aortic aneurysm.
The stent-graft was inserted from the infra-renal abdominal aorta
to the right common iliac artery with femoro-femoral crossover
bypass placement. There was evidence of type II endoleak that
occurred via the left internal iliac artery（IIA）and inferior
mesenteric artery（IMA）16 days after surgery. A CT scan performed
6 months after surgery revealed an increase in aneurysm size
and persistent type II endoleak. Both embolization of the aneurysmal
sac through the IMA and surgical ligation of the IMA failed,
and endoleak from the IMA persisted. Re-rupture of the aneurysm
occurred 10 months after initial surgery and emergency open surgery
was performed. In stent-grafting for ruptured aneurysms, only
the thrombus outside the graft resists the pressure caused by
the endoleak. We conclude that endoleak after stent-grafting
for ruptured aneurysm should be treated completely as soon as
possible because of the risk of re-rupture.
Jpn. J. Cardiovasc. Surg. 33: 34 -37 (2004) |
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