Efficacy of non-obstructive aortic angioscopy for detecting a thoracic aortic graft rupture: a case report.
Aortic angioscopy
Contrast-enhanced computed tomography
Non-anastomotic rupture
Vascular prosthesis graft
Journal
Surgical case reports
ISSN: 2198-7793
Titre abrégé: Surg Case Rep
Pays: Germany
ID NLM: 101662125
Informations de publication
Date de publication:
14 Mar 2022
14 Mar 2022
Historique:
received:
05
01
2022
accepted:
01
03
2022
entrez:
14
3
2022
pubmed:
15
3
2022
medline:
15
3
2022
Statut:
epublish
Résumé
Non-anastomotic thoracic aortic graft rupture is extremely rare and difficult to diagnose. Non-obstructive general angioscopy can help monitor the aortic intima and detect the locations of abnormal findings, while aortic angioscopy can detect vulnerable plaques in the aorta, which are difficult to visualize using conventional diagnostic methods. Herein, we report the case of a patient with non-anastomotic thoracic aortic graft rupture diagnosed using non-obstructive aortic angioscopy. An 85-year-old man who had undergone total arch replacement 5 years prior complained of chest pain. Emergent contrast-enhanced computed tomography (CT) revealed an intra-mediastinal hematoma around the vascular graft of the ascending aorta and angiography revealed pooling of contrast medium on the dorsal side of the vascular graft. We suspected extravasation of the thoracic vascular graft. Aortic angioscopic examination revealed a red vascular graft defect that matched extravasation at the contralateral level of the prosthetic left common carotid artery branch. Subsequently, non-anastomotic thoracic aortic graft rupture was diagnosed. The patient underwent a two-debranching thoracic endovascular aortic repair (Zone 0) with a right subclavian artery-left common carotid artery-left subclavian artery bypass. Postoperative angiography revealed disappearance of the extravasation from the graft rupture site, patent grafted vessels with flow, and no endoleak. Follow-up CT at 6 months postoperatively showed no extravasation. To our knowledge, this is the first report of non-anastomotic thoracic aortic graft rupture detected using non-obstructive aortic angioscopy. Aortic angioscopy can help establish a definitive diagnosis in patients with aortic graft rupture.
Sections du résumé
BACKGROUND
BACKGROUND
Non-anastomotic thoracic aortic graft rupture is extremely rare and difficult to diagnose. Non-obstructive general angioscopy can help monitor the aortic intima and detect the locations of abnormal findings, while aortic angioscopy can detect vulnerable plaques in the aorta, which are difficult to visualize using conventional diagnostic methods. Herein, we report the case of a patient with non-anastomotic thoracic aortic graft rupture diagnosed using non-obstructive aortic angioscopy.
CASE PRESENTATION
METHODS
An 85-year-old man who had undergone total arch replacement 5 years prior complained of chest pain. Emergent contrast-enhanced computed tomography (CT) revealed an intra-mediastinal hematoma around the vascular graft of the ascending aorta and angiography revealed pooling of contrast medium on the dorsal side of the vascular graft. We suspected extravasation of the thoracic vascular graft. Aortic angioscopic examination revealed a red vascular graft defect that matched extravasation at the contralateral level of the prosthetic left common carotid artery branch. Subsequently, non-anastomotic thoracic aortic graft rupture was diagnosed. The patient underwent a two-debranching thoracic endovascular aortic repair (Zone 0) with a right subclavian artery-left common carotid artery-left subclavian artery bypass. Postoperative angiography revealed disappearance of the extravasation from the graft rupture site, patent grafted vessels with flow, and no endoleak. Follow-up CT at 6 months postoperatively showed no extravasation.
CONCLUSIONS
CONCLUSIONS
To our knowledge, this is the first report of non-anastomotic thoracic aortic graft rupture detected using non-obstructive aortic angioscopy. Aortic angioscopy can help establish a definitive diagnosis in patients with aortic graft rupture.
Identifiants
pubmed: 35286489
doi: 10.1186/s40792-022-01394-w
pii: 10.1186/s40792-022-01394-w
pmc: PMC8921450
doi:
Types de publication
Journal Article
Langues
eng
Pagination
41Informations de copyright
© 2022. The Author(s).
Références
Ann Thorac Surg. 2006 Sep;82(3):1097-9
pubmed: 16928549
Ann Vasc Surg. 1997 Jul;11(4):383-6
pubmed: 9236995
Circ J. 2015;79(4):742-50
pubmed: 25766407
J Vasc Surg. 2007 Oct;46(4):636-41
pubmed: 17764881
J Vasc Surg. 2005 Sep;42(3):573
pubmed: 16171611
Interact Cardiovasc Thorac Surg. 2016 Oct;23(4):668-70
pubmed: 27324732
Ann Thorac Surg. 2011 Mar;91(3):899-902
pubmed: 21353023
J Cardiol. 2020 Jul;76(1):60-65
pubmed: 32173185
Ann Thorac Surg. 2015 Dec;100(6):2370
pubmed: 26652541
J Atheroscler Thromb. 2019 Nov 1;26(11):997-1006
pubmed: 30918164
Ann Thorac Cardiovasc Surg. 2005 Oct;11(5):343-5
pubmed: 16299465