Impending Rupture of a Dissecting Aortic Aneurysm in the Acute Phase after Entry Closure

Hiroshi Mitsuo＊	Takashi Matsumoto＊	Sho Takemoto＊
Takayuki Uchida＊

（Department of Cardiovascular Surgery, Izuka Hospital＊, Fukuoka, Japan）

The patient was a 41-year-old man with Marfan syndrome. At 36 years of age, he underwent aortic root replacement and arch replacement for acute aortic dissection（DeBakey type I). Five years later, his dissecting aortic aneurysm began to expand, and he was referred to our department for treatment. We performed thoracic endovascular aortic repair to close the entry of the descending aorta. However, sudden back pain appeared 15 days after surgery, and computed tomography（CT）revealed false lumen enlargement. We diagnosed the patient with impending rupture of a descending aortic aneurysm, and we performed urgent thoracoabdominal aortic replacement. The postoperative course was good without paralysis. Subsequent CT revealed enlargement of the aneurysm owing to type II endoleak from the intercostal artery. We performed coil embolization of the intercostal artery and inserted NBCA into the aneurysm, eventually achieving complete aneurysm thrombosis. The ideal treatment for residual dissecting aortic aneurysms after surgery for type A dissection or chronic type B dissection is unclear, and it is necessary to examine the optimal surgical strategy in each case. As in this case, the aneurysm diameter may expand rapidly owing to an increase in blood flow from the residually patent false lumen. This case highlights the need for close follow-up and early secondary operative intervention if the aneurysm enlarges or if residual entries are detected below the stent level.

 

Jpn. J. Cardiovasc. Surg. 50:415-419（2021）

Keywords：impending rupture;chronic aortic dissection;endovascular repair