Treatment of massive hemoptysis after thoracic aortic aneurysm repair.
Treatment of massive hemoptysis after thoracic aortic aneurysm repair.
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DOI：
10.1186/s42155-022-00293-3
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发表时间：
2022-03-15
影响因子：
1.2
通讯作者：
Shinmoto H
中科院分区：
文献类型：
--
作者：
Morimura F;Hamamoto K;Edo H;Ishida O;Tsustsumi K;Tamada S;Kuwamura H;Enjoji Y;Suyama Y;Sugiura H;Watanabe S;Ozaki I;Shinmoto H
胸主动脉瘤修补术后大咯血是一种罕见但可能致命的疾病。由于罪犯血管入路的复杂性，血管内管理是一种具有挑战性的治疗选择。一位81岁的女性因大量咯血被转诊到我院。她有移植物置换和胸主动脉腔内修复术（TEVAR）治疗胸主动脉夹层的病史。计算机断层扫描（CT）显示，在接受TEVAR治疗的降主动脉瘤附近的左下肺叶出现大面积肺不张伴血肿。对比增强CT显示肺不张中左肺韧带动脉（PLA）外周侧存在假性动脉瘤和异常血管增生。PLA通过复杂的侧支通路继续到达右侧肩胛下动脉。右侧囊下动脉的诊断性血管造影显示左侧PLA外周侧存在假性动脉瘤和异常血管，伴体循环-肺动脉分流。通过侧支通路使用氰基丙烯酸正丁酯对左侧PLA进行经导管动脉栓塞（TAE），实现了完全栓塞。患者咯血得到控制，出院。我们报告了一例胸主动脉修复术后PLA断裂导致大咯血的病例。通过复杂侧支通路的TAE是治疗咯血的一种可行且有效的治疗方法，即使在接受手术或腔内TAA修复术的患者中也是如此。
Massive hemoptysis after thoracic aortic aneurysm (TAA) repair is a rare but potentially lethal condition. Endovascular management is a challenging treatment option due to the complexity of culprit vessel access. An 81-year-old woman was referred to our hospital with massive hemoptysis. She had a history of graft replacement and thoracic endovascular aortic repair (TEVAR) for dissecting TAA. Computed tomography (CT) showed massive atelectasis with hematoma in the left lower lung lobe adjacent to the descending aortic aneurysm treated with TEVAR. Contrast-enhanced CT revealed a pseudoaneurysm and proliferation of abnormal vessels at the peripheral side of the left pulmonary ligament artery (PLA) in the atelectasis. The PLA continued to the right subscapular artery via a complex collateral pathway. Diagnostic angiography of the right subcapsular artery revealed a pseudoaneurysm and abnormal vessels at the peripheral side of the left PLA with a systemic-pulmonary artery shunt. Transcatheter arterial embolization (TAE) for the left PLA via the collateral pathway with N-butyl cyanoacrylate achieved complete embolization. The patient’s hemoptysis was controlled and she was discharged. Here we presented a case of massive hemoptysis due to PLA disruption that occurred after TAA repair. TAE via a complex collateral pathway is a feasible and effective treatment for hemoptysis, even in patients who have undergone surgical or endovascular TAA repair.