Journal of Chest Surgery

  • 제43권6호
  • /
  • Pages.729-733
  • /
  • 2010
  • /
  • 2765-1606(pISSN)
  • /
  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
권호 표지
DOI QR코드

DOI QR Code

Type I 급성 대동맥 박리 수술 후 진행하는 원위부 박리성 동맥류에 대한 대동맥궁 탈분지술과 전향적 대동맥궁 스텐트 그라프트의 설치

Aortic Arch Debranching and Antegrade Stent Graft Placement in an Expanding Distal Dissecting Aneurysm after Repair of an Acute Type I Aortic Dissection

  • 백완기 (인하대학교병원 흉부외과) ;
  • 김영삼 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 임현경 (인하대학교병원 마취통증의학과) ;
  • 윤용한 (인하대학교병원 흉부외과) ;
  • 김정택 (인하대학교병원 흉부외과) ;
  • 김광호 (인하대학교병원 흉부외과)
  • Baek, Wan-Ki (Department of Thoracic and Cardiovascular Surgery, Inha University Hospital) ;
  • Kim, Young-Sam (Department of Thoracic and Cardiovascular Surgery, Samsung Seoul Hospital, Sungkyunkwan University School of Medicine) ;
  • Lim, Hyun-Kyoung (Department of Anesthesiology, Inha University Hospital) ;
  • Yoon, Yang-Han (Department of Thoracic and Cardiovascular Surgery, Inha University Hospital) ;
  • Kim, Joung-Taek (Department of Thoracic and Cardiovascular Surgery, Inha University Hospital) ;
  • Kim, Kwang-Ho (Department of Thoracic and Cardiovascular Surgery, Inha University Hospital)
  • 투고 : 2010.05.06
  • 심사 : 2010.09.29
  • 발행 : 2010.12.05
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

스텐트 그라프트를 이용한 대동맥류에 대한 혈관내 치료는 급격히 발전하고 있다. 저자들은 대동맥궁 탈분지술 후 스텐트 그라프트를 설치한 hybrid TEVAR (thoracic endovascular aortic repair) 1예에 대해 보고하고자 한다. 환자는 2년 반 전 Type I 급성 대동맥 박리로 상행 대동맥 치환술을 시행하였다. 수술 후 박리 원위부의 동맥류성 변화가 점차 진행하여 이에 대한 치료로 먼저 상행 대동맥으로 부터 무명동맥과 좌경동맥으로 향하는 우회로를 만든 다음 전향적으로 대동맥궁 전체 및 근위부 하행 흉부 대동맥에 걸쳐 스텐트 그라프트를 설치하였다.

Endovascular treatment of the aortic aneurysm with a stent graft is rapidly evolving. We describe here a case of hybrid TEVAR (thoracic endovascular aortic repair) in which the stent grafts were placed in the aortic arch after debranching of the arch vessels. The patient had undergone ascending aorta replacement for acute type I aortic dissection 2.5 years earlier. The aneurysmal change of the distal dissection progressed with time. A provisional bypass surgery from the ascending aorta to the innominate artery and left carotid artery was performed and then stent grafts were inserted via an antegrade route that covered the whole aortic arch and proximal descending thoracic aorta.

키워드

참고문헌

  1. Bachet JE, Termignon JL, Dreyfus G, et al. Aortic dissection. Prevalence, cause, and results of late reoperations. J Thorac Cardiovasc Surg 1994;108:199-205.
  2. Halstead JC, Meier M, Etz C, et al. The fate of the distal aorta after repair of acute type A aortic dissection. J Thorac Cardiovasc Surg 2007;133:127-35. https://doi.org/10.1016/j.jtcvs.2006.07.043
  3. Kazui T, Yamashita K, Washiyama N, et al. Impact of an aggressive surgical approach on surgical outcome in type A aortic dissection. Ann Thorac Surg 2002;74:S1844-7. https://doi.org/10.1016/S0003-4975(02)04155-3
  4. Panos A, Kalangos A, Christofilopoulos P, Khatchatourian G. Combined surgical and endovascular treatment of aortic Type A dissection. Ann Thorac Surg 2005;80:1087-90. https://doi.org/10.1016/j.athoracsur.2004.09.056
  5. Dake MD, Miller DC, Sempa CP, et al. Transluminal placement of endovascular stent graft for the treatment of descending thoracic aortic aneurysms. N Engl J Med 1994; 331:1729-34. https://doi.org/10.1056/NEJM199412293312601
  6. Desai ND, Szeto WY. Complex aortic arch aneurysm and dissections: hybrid techniques for surgical and endovascular therapy. Curr Opin Cardiol 2009;24:521-7. https://doi.org/10.1097/HCO.0b013e3283317c91
  7. Kim U, Hong SJ, Kim J, et al. Intermediate to long term outcomes of endoluminal stent-graft repair in patients with chronic type B aortic dissection. J Endovasc Ther 2009;16: 42-7. https://doi.org/10.1583/08-2563.1
  8. Huptas S, Mehta RH, Kühl H, et al. Aortic remodeling in type B aortic dissection: effects of endovascular stent-graft repair and medical treatment on true and false lumen volumes. J Endovasc Ther 2009;16:28-38. https://doi.org/10.1583/08-2497.1