Late leakage from four-branch prosthetic graft after total aortic arch repair.
We present two cases with late graft leakage of unknown aetiology after open total aortic arch repair (TAR). Case 1: a 73-year-old woman underwent TAR for arch aneurysm with 24-mm four-branch graft. She had a previous history of pacemaker implantation for sick sinus syndrome and warfarin therapy for atrial fibrillation. Follow-up computed tomography (CT) revealed increased low-density area around the graft 4 years after surgery and blood leakage was shown in delayed-phase CT. Thoracic endovascular aortic repair (TEVAR) was performed to cover the haematic leakage, and shrinkage of the lesion was achieved 1 month after TEVAR. Case 2: a 72-year-old man with diabetes mellitus, hypertension and hyperlipidaemia was admitted to our institute for treatment of aortic arch aneurysm. TAR was successfully performed; however, leakage from the prosthetic graft was noticed by expert radiologists in follow-up delayed-phase CT scan 6 years after surgery. The leakage was resolved 1 month after TEVAR. Although the cause of late leakage was not determined, the slowly expanding haematoma proved to be treatable by additional TEVAR.
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan bassbord1028@yahoo.co.jp.
Arudo
A
Hiraoka
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Genta
G
Chikazawa
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Taichi
T
Sakaguchi
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Hidenori
H
Yoshitaka
D000368:Aged; D057868:Anastomotic Leak / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012086:Reoperation / Q000379:methods; D012494:Sampling Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Haematic graft leakage; Prosthetic graft; Thoracic endovascular aortic repair; Total aortic arch repair