A Case of Recurrent Acute Inferior Limb Arterial Occlusion Seemingly Caused by Antegrade False Lumen Blood Flow due to Stent Graft-Induced New Entry（SINE）

Jun Takaki＊	Keiji Kamohara＊	Shugo Koga＊
Nozomi Yoshida＊

（Department of Cardiovascular Surgery, Kouseikai Hospital＊, Nagasaki, Japan）

We report a case of a 53-year-old woman, who was transported as an emergency case to our institution because of type A acute aortic dissection. Total arch replacement and coronary artery bypass grafting（CABG）with open stent graft was performed. After the operation, during rehabilitation for discharge（33 and 38 days after the surgery), she developed acute arterial occlusion of the right lower limb, and we performed thrombectomy. Both thrombi extracted from the right common femoral artery were organized clots. No perioperative arrhythmia was observed, and no obvious left atrial appendage thrombus was observed on CT. We performed angiography to diagnose the cause of the spread of organized clots, and an entry was detected at the distal tip of the open stent graft, and antegrade blood flow in a false lumen was observed. We considered that the thrombus was caused by the antegrade blood flow in a false lumen, TEVAR（c-TAG）was performed to seal the entry 48 days after the surgery. Embolism did not occur afterward, and the patient was discharged for rehabilitation.

 

Jpn. J. Cardiovasc. Surg. 48:65-68（2019）

Keywords：stent graft-induced new entry