Esophageal necrosis after endoprosthesis for ruptured thoracoabdominal aneurysm type I: can long-segment stent grafting of the thoracoabdominal aorta induce transmural necrosis?
| Autor: | Geert Maleux, Kim Daenens, Philip Lerut, Mertens Johan, André Nevelsteen, Sabrina Houthoofd, Herbert De Praetere, Inge Fourneau, Toni Lerut |
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| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Aortography Time Factors medicine.medical_treatment Aortic Rupture Staphylococcus Blood Vessel Prosthesis Implantation Necrosis Aneurysm Hematoma Esophagus Fatal Outcome Ischemia medicine.artery Sepsis medicine Escherichia coli Humans cardiovascular diseases Superior mesenteric artery Aortic rupture Aged medicine.diagnostic_test Aortic Aneurysm Thoracic business.industry Endovascular Procedures General Medicine medicine.disease Mediastinitis Surgery Blood Vessel Prosthesis medicine.anatomical_structure Esophagectomy cardiovascular system Radiology Cardiology and Cardiovascular Medicine business Tomography X-Ray Computed |
| Zdroj: | Annals of vascular surgery. 24(8) |
| ISSN: | 1615-5947 |
| Popis: | Background To study the pathophysiology of esophageal necrosis after endoprosthesis was performed for a ruptured aneurysm and to define preventive measures and possible treatment options. Method A 72-year-old man with thoracoabdominal aneurysm type I and dysphagia underwent an emergent carotico-carotid bypass in combination with thoracic endovascular aortic aneurysm repair starting at a point distal to the brachiocephalic trunk and ending proximal to the superior mesenteric artery. On day 12, a decortication was performed for treating an infection in the remaining hematoma. However, further deterioration occurred as a result of mediastinitis secondary to the transmural necrosis of the middle third of the esophagus combined with accompanying mediastinitis. The patient’s family refused to give consent for further treatment by esophagectomy. He died 24 days after the initial operation. Conclusion Dysphagia aortica, mucosal abnormalities on esophagogastroscopy, and mediastinal compression by hematoma at the time of rupture draws our attention toward ischemia of the esophagus after thoracic endovascular aortic aneurysm repair. Repeated esophagoscopy can provide us with the opportunity to act before full thickness necrosis and mediastinitis occur. |
| Databáze: | OpenAIRE |
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