Graft perforation by a dislocated rib fracture after open thoracoabdominal aortic repair: emergent endovascular and open repair.
OBJECTIVE
To describe perforation of a Dacron aortic graft due to a post-thoracotomy dislocated rib fracture in a young Marfan patient.


METHODS
Six months after a successful open repair of a type II dissecting thoracoabdominal aortic aneurysm (TAAA), a 40-year-old woman with Marfan syndrome underwent elective repair of a post-thoracotomy dislocated rib fracture. During the procedure, the graft ruptured; 2 TAG stent-grafts were emergently implanted to reline the existing aortic graft. The fractured rib was then resected. The postoperative course was uneventful, without residual leak at computed tomography at 3 days. At 18 months, the patient is well, without need of further operations.


CONCLUSIONS
Early correction of any dislocated rib fracture close to a thoracic aortic graft should be considered, especially if the graft is not wrapped by the aneurysm sac. In these patients, in-graft endovascular relining associated with repair of the rib fracture may be a feasible and effective alternative to redo thoracotomy and surgical graft repair. Prior to attempting rib resection, appropriate thoracic endografts should be on hand in case an endovascular bailout is needed.
Tshomba
Yamume
Y
Department of Vascular Surgery, San Raffaele Scientific Institute, Università Vita-Salute, Milan, Italy. y.tshomba@hsr.it
Bertoglio
Luca
L
Marone
Enrico Maria
EM
Psacharopulo
Daniele
D
Iob
Gianluca
G
Chiesa
Roberto
R
D000328:Adult; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects*; D006801:Humans; D008382:Marfan Syndrome / Q000150:complications*; D011093:Polyethylene Terephthalates; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012253:Rib Fractures / Q000209:etiology / Q000601:surgery*; D013908:Thoracotomy / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D011093:Polyethylene Terephthalates