Résumé
A 77-year-old man with an abdominal aortic aneurysm, detected by abdominal ultrasonography, was referred to our hospital. Multi-detector computed tomography (MDCT) revealed an intrathoracic left subclavian artery aneurysm 30 mm in diameter and a small distal arch aortic aneurysm as well as an abdominal aortic aneurysm 40 mm in diameter. Surgery was indicated for the subclavian artery aneurysm considering the risks of rupture and distal embolism. Our choice for treatment was endovascular repair ; thoracic endovascular aortic repair (TEVAR) and coil embolism. The operation was performed successfully. Orifices of the left subclavian artery and the distal arch aneurysm were covered with a stent graft and the left subclavian artery was occluded with coils distal to the aneurysm. The operation time was 1 h and 44 min. He was extubated in the operation theater. A follow-up CT scan performed at 1 week showed the correct position of the TEVAR device, patency of the common trunk of the brachiocephalic and right common carotid arteries, and complete exclusion of the aneurysms. He was discharged on the 12th postoperative day without complication. Subclavian artery aneurysms, in particular in the intrathoracic location, are rare. Conventional surgery for this entity tends to require arch replacement to be unreasonably invasive as a therapy for peripheral artery disease. We believe this endovascular therapy can be a useful, less-invasive alternative to conventional open surgery.
Résumé
A 64-year-old woman, with no findings of Marfan's syndrome, was addmited with dyspnea on exsertion. She had a family history of thoracic aortic disease. Moderate aortic regurgitation was diagnosed due to mild annulo-aortic ectasia (AAE) limited in the sinuses of Valsalva with moderately impaired left ventricular function. The aortography showed that the diameters of the ascending aorta, the aortic root, and the aortic ring were 38mm, 48mm, and 23.5mm. We planned aortic valve replacement, as the AAE was small and was limited in the sinuses of Valsalva, but she sufferd from A type acute dissection combined with AAE, while waiting for operation. As she fell into deep shock and cardiac arrest caused by cardiac tamponade, an emergency operation was done. The intimal tear was found in the ascending aorta, but no organic change was seen on the three cusps of the aortic valve. Total aortic root replacement with Cabrol's procedure was performed successfully. We recommend that AR with AAE should be performed with aortic root reconstruction in such cases because AAE is often combined with aortic root dissection, even if the aortic root size is small.