ABSTRACT
We report a case of a 65-year-old man, who was transported as an emergency case to our institution because of Stanford type B dissection. He received conservative therapy, but follow-up computed tomography(CT) revealed dilatation of descending aorta and low-enhanced range from abdominal aorta to right common iliac artery due to the expansion of the false lumen on day 11 of hospitalization. So, we attempted to perform debranch thoracic endovascular aortic repair (TEVAR), but we could not delivery the stentgraft through occluded right iliac artery. Four days later, we performed hybrid surgery of TEVAR and Y-graft replacement with reconstruction of the left renal artery. Postoperative CT showed no endoleak of TEVAR and ankle brachial pressure index (ABI) showed normal level. He was discharged on the 13th postoperative day.
Subject(s)
Aortic Aneurysm, Thoracic , Aortic Dissection , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Aged , Aortic Dissection/diagnostic imaging , Aortic Dissection/surgery , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis , Dilatation , Humans , Ischemia , Male , Retrospective Studies , Stents , Treatment OutcomeABSTRACT
A state in which thrombus is found in both right and left atria with thrombus penetrating the foramen ovale is called as impending paradoxical embolism (IPE). A 42-year-old man was found to have poor oxygenation and shock when his body was turned prone after induction of anesthesia. We inserted percutaneous cardiopulmonary support (PCPS), and his blood pressure was maintained. Transesophageal echocardiography revealed right heart pressure overload and left atrial thrombus. Computed tomography (CT) showed thrombosis in both main pulmonary arteries. The patient was judged to require emergency surgery. Bilateral pulmonary artery thrombus and thrombus between the right and left atria was removed under hypothermia using a heart-lung machine. Postoperatively, thrombus was detected in the bilateral posterior tibial vein and peroneal vein. He had a good postoperative course. There were few reports of IPE with pulmonary embolism that developed during operation.
Subject(s)
Embolism, Paradoxical , Pulmonary Embolism , Thrombosis , Adult , Echocardiography, Transesophageal , Heart Atria/diagnostic imaging , Humans , MaleABSTRACT
Echographic examination for leg vein thromboembolism was carried out in 123 patients scheduled for thoracic surgery. Preventive measures for thromboembolism were conducted after the risk assessment. Echography was done after surgery in 72 cases, most of which were cases of lung malignant tumors, and thromboembolism was detected in 4 cases. Thus, the incidence rate of venous thromboembolism was 5.6%( 4/72). There was no patients who developed pulmonary thromboembolism during the examination period, suggesting reasonable risk assessment and preventive measures in our procedure.
Subject(s)
Leg/blood supply , Postoperative Complications/diagnostic imaging , Thoracic Surgical Procedures , Ultrasonography , Venous Thromboembolism/diagnostic imaging , Adult , Aged , Female , Humans , Incidence , Lung Neoplasms/surgery , Male , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , Risk Assessment , Venous Thromboembolism/epidemiology , Venous Thromboembolism/prevention & controlABSTRACT
A pedicled pericardial fat pad (PPFP) is often used in pulmonary resection to reinforce bronchial sutures. Here, we assessed the significance of PPFP by serial chest computed tomography (CT). Ten cases in which bronchial stump were covered with a PPFP in the past 6 years were reviewed. The procedures were pneumonectomy (3), lobectomy (6), and a segmentectomy. According to the CT value evaluated serially PPFP was recognized as fat tissue until 1~2 postoperative months. No cases of bronchopleural fistulae was encountered in this series. The coverage of the sutures with the PPFP was thought to contribute to the prevention of bronchial fistula by staying around bronchial stump for at least 1 to 2 months.
Subject(s)
Adipose Tissue/transplantation , Bronchi/surgery , Pneumonectomy/methods , Tomography, X-Ray Computed , Adipose Tissue/diagnostic imaging , Adult , Bronchial Fistula/prevention & control , Female , Humans , Male , Middle Aged , Pericardium , Postoperative Period , SuturesABSTRACT
Aneurysms of the aortic arch are technically challenging to repair with thoracic endovascular aneurysm repair (TEVAR). Various optional techniques such as debranching or hybrid TEVAR enable landing zones to extend, however, there is still room for improvement. We have performed total debranching to facilitate TEVAR with adequate central neck length more than 2.5 cm. In summary our procedure has 3 features:mini-thoracotomy to minimize its surgical stress which might cause post-operative respiratory failure, side-to-side anastomosis of trifurcated graft with ascending aorta to avoid its kinking after chest closure, and the usage of Pruitt-Inahara shunt tube during anastomoses of the carotid artery.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/methods , Stents , Sternotomy/methods , Adult , Aged , Aged, 80 and over , Aorta/surgery , Female , Humans , Male , Middle Aged , Thoracotomy/methodsABSTRACT
A 63-year-old male patient was admitted to the hospital complaining of chest pain. He had undergone aorto-bifemoral bypass and percutaneous coronary intervention due to Leriche syndrome and ischemic heart disease. Radiological examination revealed complete obstruction of the right coronary artery(#2) as well as the bypass graft. He was successfully treated with the simultaneous operation of coronary artery bypass grafting( CABG) and ascending aorta to bifemoral artery bypass.
