RESUMO
A 78-year-old man underwent replacement of a descending thoracic aorta in 1980 using a Cooley double velour knitted Dacron (CDVKD) following a diagnosis of DeBakey type III b aortic dissection. He had back pain and bloody sputum from around January 2012, and so the patient was referred to our department. Upon multi-detector computed tomography (MDCT), we diagnosed a graft aneurysm caused by the prosthetic graft carried out 32 years previously that had expanded to a maximum of greater than 80 mm. An emergency operation was considered due to the continuing back pain and bloody sputum. As a strategy for treatment, low invasive treatment by thoracic endovascular aortic repair (TEVAR) was initially planned. However, due to the large size of the aneurysm relative to the surrounding vessels and severe aortic calcification of the landing zone, complications of endoleak and migration were considered possible upon TEVAR. Instead, we selected total aortic arch replacement with extracorporeal circulation upon median sternotomy, even though this required increased surgical invasion. Postoperative prognosis was good and the patient was discharged from hospital 5 weeks following surgery. There are few reports on the failure of a prosthetic graft causing a graft aneurysm, particularly involving an aging CDVKD graft, but it is possible that deterioration of a prosthetic graft may cause a graft aneurysm. Therefore, postoperative follow-up must be carried out with care.
RESUMO
We experienced unusual dilatation of gelatin-impregnated knitted Dacron prostheses after abdominal aortic aneurysm surgery. Therefore, we investigated dilatation of gelatin impregnated knitted Dacron grafts compared with other types of Dacron grafts after abdominal aortic aneurysm surgery. Eighteen grafts inserted after abdominal aortic aneurysm surgery were studied for to evaluate dilatation. Enhance CT was used to determine the external diameter of the most dilated portion of the abdominal aortic grafts and high speed plain CT was used to determine the most dilated internal diameter. The gelatin-impregnated knitted Dacron grafts dilated from 25% to 43.8% (mean 31.8±7.2%), significantly more than collagen impregnated woven Dacron grafts (<i>p</i>=0.0003). Moreover, high fever was frequently noticed after these grafts implantation (66.7%). Therefore, caution must be used concerning these implantation in aortic lesions and careful follow-up study should be performed after implantation.
RESUMO
A 67-year-old man suffered acute arterial occlusion caused by emboli from aneurysms in a right axillo-bifemoral graft using Cooley double velour knitted Dacron, which was inplanted 10 years and 10 months before the admission. The patient underwent urgent redo surgery; left axillobifemoral bypass with 6mm ringed PTFE graft and right femoropopliteal bypass with <i>in situ</i> saphenous vein were performed successfully. Several clinical experiences by others demonstrated that Cooley double velour knitted Dacron graft, manufactured before June, 1981, might have possible aneurysmogenic factors, therefore cases in which it has been employed should be followed up carefully.
RESUMO
A case of a 77-year-old man is reported, who developed late rupture of the knitted Darcon velour graft by blunt trauma 8 years after implantation for axillo-femoral bypass. Dacron fiber deterioration, which led the graft to fragility, might have played a main role in the clinical setting. This case clearly emphasizes that with its possibility to be deteriorated life-long care and follow up should be taken for the patients who undergo arterial reconstructive surgery using Dacron prostheses.