Emergency Total Arch Replacement with J-Graft Open Stent Graft for Acute Type A Aortic Dissection, Requiring TEVAR for Stent Graft Stenosis

Hidetaka Wakiyama	Hidefumi Obo	Sou Izumi
Kyouzou Inoue	Noboru Wakita

（Department of Cardiovascular Surgery, Kakogawa East Hospital＊, Kakogawa, Japan, and Department of Cardiovascular Surgery, Kobe Rousai Hospital＊＊, Kobe, Japan）

A 76-year-old man was admitted to our hospital to receive optimal medical therapy for acute type B aortic dissection with a thrombosed false lumen. Eighteen days after admission, computed tomography（CT）was performed because of back pain and showed new retrograde acute type A aortic dissection. Emergency total arch replacement was performed with the aid of a J-graft open stent graft（JOSG). Postoperatively, the blood pressure in the lower extremities decreased to 70% of systemic blood pressure without symptoms. Enhanced CT showed severe stenosis from the non-stent part of the aorta to the proximal part of the JOSG. On postoperative day 2, thoracic endovascular aortic repair（TEVAR）was performed for stent graft stenosis. The blood pressure of the lower extremities promptly recovered after the procedure, and the patient was extubated without any neurologic deficits on the next day. Postoperative CT demonstrated that the stent graft stenosis had been effectively alleviated. The patient’s subsequent course was uneventful and he was discharged on postoperative day 24. A JOSG should only be deployed after precise evaluation of the anatomy of the target aorta and careful attention should be paid to the length of the non-stent part of the graft in order to prevent unpredictable graft retraction that could cause stent graft stenosis. TEVAR is considered to be a good option to treat complications related to open stent grafts.

 

Jpn. J. Cardiovasc. Surg. 46:39-44（2017）

Keywords：J-graft open stent graft（JOSG）;acute type A aortic dissection;total arch replacement;stenosis of JOSG;TEVAR