Cardiovascular diagnosis and therapy · 2022
Kinking of frozen elephant trunk: reality versus myth-a case report and literature reported.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Okita Yutaka
Аннотация
BACKGROUND: Kinking or iatrogenic stenosis in the frozen elephant trunk (FET) is a possible complication, however, there have been few cases reported.
CASE DESCRIPTION: A 43-year-old male with acute type A aortic dissection (ATAAD) underwent total arch replacement and FET installation. After weaning from the cardiopulmonary bypass, both femoral pulses were absent. A right axillo-bifemoral bypass using 8 mm graft was performed. Postoperative aortography showed a 100 mmHg-stenosis at the FET and 28 mm stent-graft was inserted to relieve stenosis. Eleven cases of postoperative FET stenosis have been reported from 2007 to 2019. The ages ranged from 30 to 72 years and 6 patients had ATAAD, 4 had chronic type A dissection, and 1 had non-dissection. They all underwent total arch replacement. To correct the iatrogenic stenosis of the FET, additional TEVAR was done in 8 patients, 2 had axillo-femoral bypass, 1 had a bare stent graft, and one required re-anastomosis.
CONCLUSIONS: To prevent the FET kinking, surgeons should place the stented portion of the FET in the aortic arch angle. Also, we should make the non-stented portion as short as possible at the distal anastomosis. The DANE (distal anastomosis new entry) should be avoided by the secure anastomosis. Over-sizing or under-sizing of the FET should be minimized.
CASE DESCRIPTION: A 43-year-old male with acute type A aortic dissection (ATAAD) underwent total arch replacement and FET installation. After weaning from the cardiopulmonary bypass, both femoral pulses were absent. A right axillo-bifemoral bypass using 8 mm graft was performed. Postoperative aortography showed a 100 mmHg-stenosis at the FET and 28 mm stent-graft was inserted to relieve stenosis. Eleven cases of postoperative FET stenosis have been reported from 2007 to 2019. The ages ranged from 30 to 72 years and 6 patients had ATAAD, 4 had chronic type A dissection, and 1 had non-dissection. They all underwent total arch replacement. To correct the iatrogenic stenosis of the FET, additional TEVAR was done in 8 patients, 2 had axillo-femoral bypass, 1 had a bare stent graft, and one required re-anastomosis.
CONCLUSIONS: To prevent the FET kinking, surgeons should place the stented portion of the FET in the aortic arch angle. Also, we should make the non-stented portion as short as possible at the distal anastomosis. The DANE (distal anastomosis new entry) should be avoided by the secure anastomosis. Over-sizing or under-sizing of the FET should be minimized.