Impending rupture of the descending aorta by enlargement of the false lumen after graft replacement with the elephant trunk technique: report of a case

• Published in: Surgery today (Tokyo, Japan) Vol. 29; no. 11; pp. 1213 - 1217
• Main Authors: Koshino, T, Kazui, T, Tamiya, Y, Fukada, J, Koushima, R, Morishita, K, Abe, T
• Format: Journal Article
• Language: English
• Published: Japan 01-01-1999
• Subjects: Aneurysm, Dissecting - diagnosis; Aneurysm, Dissecting - surgery; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - diagnosis; Aortic Aneurysm, Thoracic - surgery; Aortic Rupture - diagnosis; Aortic Rupture - etiology; Aortic Rupture - surgery; Blood Vessel Prosthesis - adverse effects; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - methods; Female; Follow-Up Studies; Humans; Middle Aged; Radiography; Treatment Outcome
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/BF02482276

We report herein a case of an impending rupture of the descending aorta caused by an enlargement of the false lumen after a graft replacement using the elephant trunk technique. The patient was a 51-year-old woman who had received a graft replacement of the ascending aorta for an acute Stanford type A aortic dissection 6 years previously. An enhanced computed tomographic scan and digital subtraction angiography revealed pseudoaneurysms at the proximal and distal anastomotic site, and a residual dissection of the aortic arch. A graft replacement of the ascending aorta to the aortic arch was performed with the distal site using the elephant trunk technique. Five days after the operation, massive bleeding from the drainage tube occurred. A chest enhanced computed tomographic scan suggested an impending rupture of the descending aorta caused by an enlargement of the false lumen. A graft replacement of the descending aorta was carried out. Postoperatively she had no complications, and digital subtraction angiography showed an excellent reconstruction of the thoracic aorta. One month after the second operation, she was discharged from hospital.