A Case of Graft Aneurysm due to Deterioration of a Cooley Double Velour Knitted Dacron Prosthesis / 日本心臓血管外科学会雑誌

ABSTRACT

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.