Rapid Expansion of the Descending Thoracic Aortic Aneurysm and Aneurysm-Induced DIC Following Total Arch Replacement with a Long Elephant Trunk

Ken-ichiro Takahashi	Yuji Maruyama	Takahide Yoshio
Motoko Morishima	Takashi Nitta

（Department of Cardiovascular Surgery, Nippon Medical School＊, Tokyo, Japan）

A 74-year-old woman presented to our hospital with complaints of dysphagia. On examination, we diagnosed extensive thoracic aortic aneurysm and esophageal compression due to a descending thoracic aortic aneurysm. We planned a two-stage approach for repairing the extensive thoracic aortic aneurysm;the first stage involving the repair of the ascending and arch segments, and the second stage involving the repair of the descending aorta. In the first stage, we performed the Bentall procedure and total arch replacement with a long elephant trunk. Following this, her dysphagia resolved, although the size of the descending aortic aneurysm was the same as that before the procedure（49mm in diameter). We decided to treat her conservatively in the outpatient clinic without the second stage, because the descending aorta was asymptomatic and not sufficiently large. One year later, she presented with a sudden recurrence of dysphagia and swelling of buttocks. She was diagnosed with an expansion of the descending aortic aneurysm（62mm in diameter）and a hematoma in the gluteal muscle due to aneurysm-induced disseminated intravascular coagulation（DIC). After emergency admission, she underwent a successful thoracic endovascular aortic repair and was discharged following a smooth recovery from dysphagia and aneurysm-induced DIC. We report this case along with a review of the literature.

 

Jpn. J. Cardiovasc. Surg. 46:130-133（2017）

Keywords：thoracic aortic aneurysm;two-stage repair;elephant trunk;DIC;TEVAR