Endovascular Stent Graft Infection due to Esophageal Perforation after Surgical Treatment for Type II Endoleak

Yosuke Motoharu	Haruo Aramoto	Togo Norimatsu
Minoru Tabata	Toshihiro Fukui	Shuichiro Takanashi

（Cardiovascular Surgery, Sakakibara Heart Institute＊, Tokyo, Japan, and Cardiovascular Surgery, Fukuoka Wajiro Hospital＊＊, Fukuoka, Japan）

An 80-year-old man was admitted to our hospital with a diagnosis of distal aortic arch aneurysm. A preoperative chest CT demonstrated a 54mm in diameter distal aortic arch and coronary angiography revealed stenosis of LAD and the diagonal branch. We planned a thoracic endovascular repair after total arch replacement with a coronary artery bypass graft. A ZTEG-2P-30-200-JP was deployed at the proximal side of the elephant trunk, and a ZTEG-2P-34-152-JP was deployed. About 10 months later, a chest CT demonstrated a 90mm in diameter distal native aortic arch, and anemia had increased to Hb 7.7g/dl. A CT and angiography revealed a type II endoleak and so we tried to close the endoleak through a left thoracotomy approach. Twenty-eight months after the TEVAR, the patient had esophageal perforation and stent graft infection. At first, we resected the esophagus and reconstructed it with a gastric tube. Secondly, a descending thoracic aorta replacement was performed. The patient suffered from a cerebral infarction. However, infection was controlled successfully and he was transferred to another hospital for rehabilitation 69 days after the descending aorta replacement.

 

Jpn. J. Cardiovasc. Surg. 45:94-99（2016）

Keywords：aortic aneurysm;TEVAR;endoleak;AEF;graft infection