Key result
The frozen elephant trunk technique combined with thoracic endovascular aortic repair was successfully performed without thromboembolic complications in a patient with a shaggy aorta.
Why the study?
In extensive aortic surgery complicated by shaggy aorta, case-specific surgical strategies to avoid embolism are important.
Does staged hybrid repair with frozen elephant trunk and TEVAR prevent thromboembolism in a patient with subacute Type B aortic dissection and shaggy aorta?
Case Report (n=1)
No
Does staged hybrid repair with frozen elephant trunk and TEVAR prevent thromboembolism in a patient with subacute Type B aortic dissection and shaggy aorta?
Staged hybrid repair combining the frozen elephant trunk technique and TEVAR with balloon protection may be an effective strategy to prevent thromboembolism in patients with subacute Type B aortic dissection complicated by a shaggy aorta.
Hybrid strategies may aid embolization avoidance in shaggy aorta; leaves open efficacy in larger cohorts.
症例は79歳男性．急性B型大動脈解離で保存加療していたが，発症3週目に遠位弓部大動脈と下行大動脈の2カ所が急速拡大をきたした．遠位弓部大動脈から胸部下行大動脈がshaggy aortaであったため，弓部置換術を先行後に胸部ステントグラフト（TEVAR）を行う二期的手術を予定した．一期目手術時にFrozen elephant trunkを用い，遠位弓部の血栓性アテロームによる塞栓症を予防した．二期目手術時にはあらかじめ上腸間膜動脈，腎動脈をバルーンカテーテルで保護した．術後経過は良好で，懸念すべき重篤な塞栓症を発症せず，初回手術から23日目に独歩退院された．Shaggy aortaを合併した広範な大動脈手術においては，塞栓症を回避するための症例ごとの手術戦略を計画することが重要である．本症例においてはFrozen elephant trunkにTEVARを組み合わせた二期的ハイブリッド治療が有効であった可能性が推察されたため，文献的考察を加えて報告する.
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Watanabe et al. (2021) conducted a case report in Subacute Type B Aortic Dissection with Shaggy Aorta (n=1). Staged hybrid repair (frozen elephant trunk technique and TEVAR) was evaluated on Postoperative thromboembolism. The frozen elephant trunk technique combined with thoracic endovascular aortic repair was successfully performed without thromboembolic complications in a patient with a shaggy aorta.
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