강동경희대병원 대동맥수술 증례 - 대동맥궁 치환술 (1)

전 흉부대동맥 인조혈관치환술 (상행대동맥, 대동맥궁, 하행대동맥)


감염성 대동맥궁 대동맥류 대동맥-기관지루 가 발생하여 다량의 객혈로 입원한 환자의 증례입니다. 

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Aortobronchial fistula (ABF) induced by a mycotic aortic aneurysm is life-threatening. Although early open thoracic surgery under cardiopulmonary bypass (CPB) is essential, graft replacement is invasive and the results can be disastrous. Recently, endovascular therapy without CPB has been considered as treatment for thoracic aortic aneurysm including mycotic aortic aneurysm. We report a case of recurrent aortobronchial fistula after stent grafting as early procedure for distal aortic arch mycotic aneurysm.

A 59-year-old man was admitted to emergency room following the occurrence of massive hemoptysis. About 1 month earlier, he had presented to the outpatient clinic to investigate the origin of the fever and antibiotics had been administered under a diagnosis of UTI. Enhanced computed tomography (CT) of the chest revealed the saccular aortic aneurysm on the distal aortic arch. Emergency stent grafting of the aneurysm was performed to control the hemoptysis caused by aortobronchial fistula. About 5 months after the stent grafting, the patient was readmitted with a recurrent massive hemoptysis. Thus, we performed exclusion of the previous stent graft and graft replacement of distal ascending aorta, aortic arch, and proximal descending aorta under CPB and total circulatory arrest.

The patient had an uneventful postoperative course and recovered without any neurological complications. There has been no evidence of complication in the 4 months since his last operation.

It is still controversial whether stent grafting is effective for a patient with an mycotic aortic aneurysm. In our opinion, endovascular repair has the high risks of recurrent inflammation and complication even though it might have a role as a bridge therapy to open surgery. Ultimately, a complicated aortic arch mycotic aneurysm should be treated by open thoracic surgery.

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