Zusammenfassung
Eine 60-jährige Frau wurde notfallmäßig mit plötzlich auftretenden interskapulären Schmerzen stechenden Charakters aufgenommen. An kardiovaskulären Risikofaktoren waren ein arterieller Hypertonus, eine Hyperlipidämie und Nikotinkonsum bekannt. In der präoperativen Diagnostik mittels Angio-CT zeigte sich eine retrograde Typ-A-Dissektion mit einem Entry distal des Abgangs der A. subclavia sinistra, die sich retrograd bis zum Abgang der A. coronaria sinistra und antegrad bis in die Aorta abdominalis erstreckte. Die chirurgische Behandlung dieser komplexen Aortenerkrankung erfolgte als einzeitige Therapie durch Stenting der Aorta descendens sowie durch den Ersatz der Aorta ascendens und des Aortenbogens mittels einer Hybrid-Endo-Prothese (E-VITA open®), die aus einem Stentgraft mit integrierter Dacron-Gefäß-Prothese besteht.
Summary
A 60-year-old woman presented with sudden severe pain in the interscapular region and a feeling of impending death in the emergency room. She had a medical history of hypertension, hypercholesterolemia and strong tobacco abuse. The results of the CT-scan showed an extensive thoracic aortic dissection with an entry distal to the origin of the left subclavian artery reaching retrograde to the left coronary ostia as well as antegrade into the upper abdomen aorta. Here, we describe the surgical treatment of this retrograde Type A dissection combining an open ascending tube graft and aortic arch replacement with simultaneous antegrade deployment of an endoluminal graft (E-VITA open®) into the descending thoracic aorta as an one-stage repair.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Borst HG, Walterbusch G, Schaps D (1983) Extensive aortic replacement using elephant trunk prosthesis. Thorac Cardiovasc Surg 31:37–40
Clouse WD, Hallett JW, Schaff HV, Gayari MM, Ilstrup DM, Melton LJ (1998) Improved prognosis of thoracic aortic aneurysm. A population-based study. JAMA 280:1926–1929
Dietrich EB, Ghazoul M, Wheatley GH, Alpern JA, Rodriquez-Lopez J, Ramaiah V, Williams J (2005) Surgical correction of ascending type A thoracic aortic dissection: simultaneous endoluminal exclusion of the arch and distal aorta. J Endovasc Ther 12:660–666
Fann JI, Smith JA, Miller DC, Mitchell RS, Moore KA, Grunkemeier G, Stinson EB, Oyer PE, Reitz BA, Shumway NE (1995) Surgical management of aortic dissection during a 30-year period. Circulation 92(Suppl II):II113–121
Ishihara H, Uchida N, Yamasaki O, Sakashita M, Kanou M (2002) Extensive primary repair of the thoracic aorta Stanford type A acute dissection by means of a synthetic vascular graft with self-expandable stent. J Thorac Cardiovasc Surg 123:1035–1040
Jakob H, Tsagakis K, Leyh R, Buck T, Herold U (2005) Development of an integrated stent graft-Dacron prosthesis for intended one-stage repair in complex thoracic aortic disease. Herz 30:766–768
Kato M, Ohnishi K, Kaneko M, Ueda T, Kishi D, Mizushima T, Matsuda H (1996) New graft-implanting method for thoracic aortic dissection with a stented graft. Circulation 94(Suppl II):II188–193
Kato M, Kuratani T, Kaneko M, Kyo S, Ohnishi K (2002) The results of total arch graft implantation with open stentgraft placement for type A aortic dissection. J Thorac Cardiovasc Surg 124:531–540
Svensson LG, Kyung-Hwan K, Blackstone EH, Alster JM, McCarthy PM, Greenberg RK, Sabik JF, D'Agostino RS, Lytle BW, Cosgrove DM (2004) Elephant trunk procedure: newer indications and uses. Ann Thorac Surg 78:109–116
Wheatley GH (2006) A new surgical paradigm: hybrid open and endovascular repair of the ascending aorta and aortic arch for acute type A dissection. J Thorac Cardiovasc Surg 132(3):734–735
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Blehm, A., Meinhardt, G., Schölz, C. et al. Operative Versorgung einer retrograden Typ-A-Dissektion mittels Hybrid-Endo-Prothese. Z Herz- Thorax- Gefäßchir 20, 236–240 (2006). https://doi.org/10.1007/s00398-006-0558-9
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00398-006-0558-9