DOI QR코드

DOI QR Code

고위험군 대동맥궁 동맥류에 대동맥 상부 혈관 우회술과 스텐트 그라프트 치료 2예

A Hybrid Approach for Thoracic Aortic Arch Aneurysms in Two Patients at High Operative Risk

  • 장세원 (좋은삼선병원 내과) ;
  • 고우석 (좋은삼선병원 내과) ;
  • 김민정 (좋은삼선병원 내과) ;
  • 최정천 (부산대학교 의학전문대학원 부산대학교병원 순환기내과) ;
  • 안진희 (부산대학교 의학전문대학원 부산대학교병원 순환기내과) ;
  • 송승환 (부산대학교 의학전문대학원 부산대학교병원 흉부외과) ;
  • 이한철 (부산대학교 의학전문대학원 부산대학교병원 순환기내과)
  • Jang, Se Won (Department of Internal Medicine, Good Samsun Hospital) ;
  • Ko, Woo Seok (Department of Internal Medicine, Good Samsun Hospital) ;
  • Kim, Min Jeong (Department of Internal Medicine, Good Samsun Hospital) ;
  • Choi, Jung Cheon (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Ahn, Jin Hee (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Song, Seung Hwan (Department of Thoracic & Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Lee, Han Cheol (Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine)
  • 투고 : 2012.11.27
  • 심사 : 2013.03.18
  • 발행 : 2014.02.01

초록

연령이 높고 수술 고위험군인 대동맥궁의 대동맥류에 대해 대동맥궁 상부동맥 우회술과 스텐트 이식편(stent-graft) 삽입을 같이 시행하는 Hybrid 수술을 시행하여 좋은 결과를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

A large aortic aneurysm invading the aortic arch can be catastrophic if rupture occurs. In the past, the standard treatment was an open thoracotomy followed by total aortic arch replacement. However, open surgery is difficult in patients at high operative risk. Consequently, thoracic endovascular aortic repair (TEVAR) is preferred in high-risk patients. In patients with a short proximal landing whose aortic aneurysm invades the aortic arch, TEVAR is not available because of innominate, left carotid, and left subclavian artery occlusion. We report two cases in which aortic aneurysms invaded the aortic arch, and who were treated with TEVAR after a supra-aortic artery bypass operation.

키워드

참고문헌

  1. Clouse WD, Hallett JW Jr, Schaff HV, Gayari MM, Ilstrup DM, Melton LJ 3rd. Improved prognosis of thoracic aortic aneurysms: a population-based study. JAMA 1998;280:1926-1929. https://doi.org/10.1001/jama.280.22.1926
  2. Okada K, Omura A, Kano H, et al. Effect of atherothrombotic aorta on outcomes of total aortic arch replacement. J Thorac Cardiovasc Surg 2013;145:984-991. https://doi.org/10.1016/j.jtcvs.2012.03.048
  3. Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 1994;331:1729-1734. https://doi.org/10.1056/NEJM199412293312601
  4. Schoder M, Grabenwoger M, Holzenbein T, et al. Endovascular repair of the thoracic aorta necessitating anchoring of the stent graft across the arch vessels. J Thorac Cardiovasc Surg 2006;131:380-387. https://doi.org/10.1016/j.jtcvs.2005.11.009
  5. Hughes GC, Nienaber JJ, Bush EL, Daneshmand MA, McCann RL. Use of custom Dacron branch grafts for "hybrid" aortic debranching during endovascular repair of thoracic and thoracoabdominal aortic aneurysms. J Thorac Cardiovasc Surg 2008;136:21-28. https://doi.org/10.1016/j.jtcvs.2008.02.051
  6. Mitchell RS, Ishimaru S, Ehrlich MP, et al. First International Summit on Thoracic Aortic Endografting: roundtable on thoracic aortic dissection as an indication for endografting. J Endovasc Ther 2002;9(Suppl 2):II98-105. https://doi.org/10.1583/1545-1550(2002)009<0098:RIFEAA>2.0.CO;2
  7. Melissano G, Civilini E, Bertoglio L, Setacci F, Chiesa R. Endovascular treatment of aortic arch aneurysms. Eur J Vasc Endovasc Surg 2005;29:131-138. https://doi.org/10.1016/j.ejvs.2004.12.005
  8. Bhamidipati CM, Irvine JN, Hagspiel KD, Matsumoto AH, Tracci MC, Kern JA. Hybrid repair of aortic arch aneurysm. Ann Vasc Surg 2012;26:420.e1-4.
  9. Shimizu H, Hachiya T, Yamabe K, Yozu R. Hybrid arch repair including supra-aortic debranching on the descending aorta. Ann Thorac Surg 2011;92:2266-2268. https://doi.org/10.1016/j.athoracsur.2011.05.045
  10. Vallejo N, Rodriguez-Lopez JA, Heidari P, et al. Hybrid repair of thoracic aortic lesions for zone 0 and 1 in high-risk patients. J Vasc Surg 2012;55:318-325. https://doi.org/10.1016/j.jvs.2011.08.042
  11. Melissano G, Civilini E, Bertoglio L, et al. Results of endografting of the aortic arch in different landing zones. Eur J Vasc Endovasc Surg 2007;33:561-566. https://doi.org/10.1016/j.ejvs.2006.11.019
  12. Legras A, Bruzzi M, Nakashima K, Hillion ML, Loisance D, Kirsch M. Risk factors for hospital death after surgery for type A aortic dissection. Asian Cardiovasc Thorac Ann 2012;20:269-274. https://doi.org/10.1177/0218492311435423
  13. Iida Y, Kawaguchi S, Koizumi N, Komai H, Obitsu Y, Shigematsu H. Thoracic endovascular aortic repair with aortic arch vessel revascularization. Ann Vasc Surg 2011;25:748-751. https://doi.org/10.1016/j.avsg.2010.12.018
  14. Murphy EH, Stanley GA, Ilves M, et al. Thoracic endovascular repair (TEVAR) in the management of aortic arch pathology. Ann Vasc Surg 2012;26:55-66. https://doi.org/10.1016/j.avsg.2011.08.009
  15. Cooper DG, Walsh SR, Sadat U, Noorani A, Hayes PD, Boyle JR. Neurological complications after left subclavian artery coverage during thoracic endovascular aortic repair: a systematic review and meta-analysis. J Vasc Surg 2009;49:1594-1601. https://doi.org/10.1016/j.jvs.2008.12.075
  16. Woo EY, Carpenter JP, Jackson BM, et al. Left subclavian artery coverage during thoracic endovascular aortic repair: a single-center experience. J Vasc Surg 2008;48:555-560. https://doi.org/10.1016/j.jvs.2008.03.060