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TCTAP C-177 Two Case Reports of Huge Mycotic Aneurysm Successfully Treated by Multilayer Stent Graft
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
S309
Case Summary. Stent graft covers left carotid artery is disaster situation during TEVAR procedure. In this emergent situation, Chimney technique used left subclavian artery is good alternative treatment option of restoration of left carotid artery blood flow. TCTAP C-177 Two Case Reports of Huge Mycotic Aneurysm Successfully Treated by Multilayer Stent Graft Jong Hyun Choi,1 Han Cheol Lee,1 Jin Sup Park,1 Hye Won Lee,1 Jun-Hyok Oh,1 Kwang Soo Cha,1 Taek Jong Hong1 1 Pusan National University Hospital, Korea (Republic of) [CLINICAL INFORMATION] Patient initials or identifier number. KYJ, KDH Relevant clinical history and physical exam. CASE1 A 69-year-old woman presented with a 2-month history of persistent chest discomfort and hoarseness. She was bedridden state due to her spinal stenosis, and had been treated with pulmonary tuberculosis for 4 months. CASE2 A 67-year-old man was visited our hospital presented with abdominal pain. Patient is a smoker without other significant past medical history. On arrival in the emergency department, his body temperature was 38.2C and heat rate was 130 bpm. His blood pressure was 170/ 110 mmHg. Relevant test results prior to catheterization. CASE1 Computed tomography (CT) scan was taken in order to check her symptom, we found 8.2 cm thoracic aortic mycotic appearing aneurysm just distal to the left common carotid artery. But, other Inflammatory markers, such as white blood cell, CRP were within normal ranges. CASE2 CT scan shows the dissecting aneurysm at descending aorta and other infection focuses were not found in CT. White blood cell count and CRP was elevated (WBC 28680/uL, CRP 11.12 mg/dL).
Relevant catheterization findings. CASE1 We advanced pigtail catheter via right femoral artery and aortography was done. Huge aortic arch anerysm was shown, which arise from just distal to left common carotid artery and involve left subclavian artery. CASE2 Two days after, the follow up CT shows saccular aneurysm with concealed rupture. We conducted aortography, descending aorta aneurysm was shown.
S310
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
artery partially. So, we deployed a stent graft in the innominate artery by chimney technique. And then a 14x60mm bare stent, 14x80mm bare stent (Zilver) was inserted to previous chimney graft to support. This triple layer stent graft was performed in order to make resistance to tuberculosis infection. Left subclavian artery was embolized by coli. CASE 2 Rt. femoral artery was punctured. The 36x30x200 mm thoracic aortic stent graft was carefully inserted to the dissecting aneurysm formation site through the right femoral artery under a fluoroscopic guidance. And then, additional stent graft (38x32x200mm, S&G) was implanted to the first stent graft in an overlap manner. In follow up aortography, the dissecting mycotic aneurysm was fully covered with double layer stent graft. There was no evidence of endoleak. Antibiotics were continuously applied during admission, CRP was decreased to normal range. The patient was discharged in good status 3 month after the stent graft procedure and in the subsequent 10 months has remained well with no complications.
[INTERVENTIONAL MANAGEMENT] Procedural step. CASE 1 Right carotid to left carotid bypass was performed before TEVAR. Both radial arteries and right femoral artery were punctured. First, a 48x38x180 mm aortic stent graft (S&G) was carefully inserted through the right femoral artery, 48x38x150 mm second aortic stent graft and 48x48x180mm third aortic stent graft were implanted to the first stent graft in an overlap manner. Aortic stent grafts covered in innominate
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
S311
TCTAP C-178 Hexapus Stent Grafting for Thoraco-abdominal Aortic Aneurysm I-Ming Chen1 Veterans General Hospital, Taiwan
1
[CLINICAL INFORMATION] Patient initials or identifier number. G.C.C Relevant clinical history and physical exam. A 52-year-old female suffered from severe back pain and was transferred to our hospital. She is a heavy smoker and also has the history of hypertension without regular medical control. Chest CT showed a huge throaco-abdominal aortic aneurysm.
Relevant test results prior to catheterization. Pre-op CAG: insignificant Pre-op pulmonary function test: severe obstructive pulmonary disease, FEV1/FVC:56% Pre-op carotid doppler: normal Normal renal and lover function Normal radial, ulnar, pedis dorsalis and posterior tibial artery pulsations Relevant catheterization findings. Using double barrel technique, I landed the proximal landing zone by putting 2 C3 excluder main body grafts over thoracic aorta first. After inserting 2 brachial sheaths, I cannulate Celiac trunk, SMA, bilateral renal arteries via 2 contralateral limb of main bodies via these 2 sheaths. Finally, I completed the stent grafting by extending the 2 ipsilateral limbs to bilateral common iliac arteries.
Case Summary. We report that two cases of multilayer endovascular repair had been good clinical outcome to treat of mycotic ruptured thoracic aortic aneurysm caused by tuberculosis and Bacterioides fagilis, not only simple lesion but also very complicated lesion. There were no recurrence of mycotic aneurysm and no endoleak in both patients’ follow up CT. When open repair is not possible due to patient co morbidity or complex rupture, this method will make resistance to inflammation of infection and can be attempted to prolong life, especially when faced with imminent death.
[INTERVENTIONAL MANAGEMENT] Procedural step. 1. Cut down 2femorals and puncture 2 brachial 2. After wiringfrom bilateral femoral arteries to ascending aorta, I inserted 2 C3 excluder Main body stent grafts via each femoral artery and landed the stent graft overhealthy thoracic aorta by double barrel method. 3. I cannulate the celiac trunk and SMA from r’t brachial artery into one of the contralaterallegs of main body stent graft and put viabahn stent into celiac and SMA first.And then overlapping the viabahn into the contralateral limb of main body stentgraft as sandwich stent grafting. 4. Icannulate bilateral renal arteries from l’t brachial artery into the other one of the contralateral legs of main body stent graft and put viabahn stentinto bilateral renal arteries first. And then overlapping
S309
Case Summary. Stent graft covers left carotid artery is disaster situation during TEVAR procedure. In this emergent situation, Chimney technique used left subclavian artery is good alternative treatment option of restoration of left carotid artery blood flow. TCTAP C-177 Two Case Reports of Huge Mycotic Aneurysm Successfully Treated by Multilayer Stent Graft Jong Hyun Choi,1 Han Cheol Lee,1 Jin Sup Park,1 Hye Won Lee,1 Jun-Hyok Oh,1 Kwang Soo Cha,1 Taek Jong Hong1 1 Pusan National University Hospital, Korea (Republic of) [CLINICAL INFORMATION] Patient initials or identifier number. KYJ, KDH Relevant clinical history and physical exam. CASE1 A 69-year-old woman presented with a 2-month history of persistent chest discomfort and hoarseness. She was bedridden state due to her spinal stenosis, and had been treated with pulmonary tuberculosis for 4 months. CASE2 A 67-year-old man was visited our hospital presented with abdominal pain. Patient is a smoker without other significant past medical history. On arrival in the emergency department, his body temperature was 38.2C and heat rate was 130 bpm. His blood pressure was 170/ 110 mmHg. Relevant test results prior to catheterization. CASE1 Computed tomography (CT) scan was taken in order to check her symptom, we found 8.2 cm thoracic aortic mycotic appearing aneurysm just distal to the left common carotid artery. But, other Inflammatory markers, such as white blood cell, CRP were within normal ranges. CASE2 CT scan shows the dissecting aneurysm at descending aorta and other infection focuses were not found in CT. White blood cell count and CRP was elevated (WBC 28680/uL, CRP 11.12 mg/dL).
Relevant catheterization findings. CASE1 We advanced pigtail catheter via right femoral artery and aortography was done. Huge aortic arch anerysm was shown, which arise from just distal to left common carotid artery and involve left subclavian artery. CASE2 Two days after, the follow up CT shows saccular aneurysm with concealed rupture. We conducted aortography, descending aorta aneurysm was shown.
S310
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
artery partially. So, we deployed a stent graft in the innominate artery by chimney technique. And then a 14x60mm bare stent, 14x80mm bare stent (Zilver) was inserted to previous chimney graft to support. This triple layer stent graft was performed in order to make resistance to tuberculosis infection. Left subclavian artery was embolized by coli. CASE 2 Rt. femoral artery was punctured. The 36x30x200 mm thoracic aortic stent graft was carefully inserted to the dissecting aneurysm formation site through the right femoral artery under a fluoroscopic guidance. And then, additional stent graft (38x32x200mm, S&G) was implanted to the first stent graft in an overlap manner. In follow up aortography, the dissecting mycotic aneurysm was fully covered with double layer stent graft. There was no evidence of endoleak. Antibiotics were continuously applied during admission, CRP was decreased to normal range. The patient was discharged in good status 3 month after the stent graft procedure and in the subsequent 10 months has remained well with no complications.
[INTERVENTIONAL MANAGEMENT] Procedural step. CASE 1 Right carotid to left carotid bypass was performed before TEVAR. Both radial arteries and right femoral artery were punctured. First, a 48x38x180 mm aortic stent graft (S&G) was carefully inserted through the right femoral artery, 48x38x150 mm second aortic stent graft and 48x48x180mm third aortic stent graft were implanted to the first stent graft in an overlap manner. Aortic stent grafts covered in innominate
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
S311
TCTAP C-178 Hexapus Stent Grafting for Thoraco-abdominal Aortic Aneurysm I-Ming Chen1 Veterans General Hospital, Taiwan
1
[CLINICAL INFORMATION] Patient initials or identifier number. G.C.C Relevant clinical history and physical exam. A 52-year-old female suffered from severe back pain and was transferred to our hospital. She is a heavy smoker and also has the history of hypertension without regular medical control. Chest CT showed a huge throaco-abdominal aortic aneurysm.
Relevant test results prior to catheterization. Pre-op CAG: insignificant Pre-op pulmonary function test: severe obstructive pulmonary disease, FEV1/FVC:56% Pre-op carotid doppler: normal Normal renal and lover function Normal radial, ulnar, pedis dorsalis and posterior tibial artery pulsations Relevant catheterization findings. Using double barrel technique, I landed the proximal landing zone by putting 2 C3 excluder main body grafts over thoracic aorta first. After inserting 2 brachial sheaths, I cannulate Celiac trunk, SMA, bilateral renal arteries via 2 contralateral limb of main bodies via these 2 sheaths. Finally, I completed the stent grafting by extending the 2 ipsilateral limbs to bilateral common iliac arteries.
Case Summary. We report that two cases of multilayer endovascular repair had been good clinical outcome to treat of mycotic ruptured thoracic aortic aneurysm caused by tuberculosis and Bacterioides fagilis, not only simple lesion but also very complicated lesion. There were no recurrence of mycotic aneurysm and no endoleak in both patients’ follow up CT. When open repair is not possible due to patient co morbidity or complex rupture, this method will make resistance to inflammation of infection and can be attempted to prolong life, especially when faced with imminent death.
[INTERVENTIONAL MANAGEMENT] Procedural step. 1. Cut down 2femorals and puncture 2 brachial 2. After wiringfrom bilateral femoral arteries to ascending aorta, I inserted 2 C3 excluder Main body stent grafts via each femoral artery and landed the stent graft overhealthy thoracic aorta by double barrel method. 3. I cannulate the celiac trunk and SMA from r’t brachial artery into one of the contralaterallegs of main body stent graft and put viabahn stent into celiac and SMA first.And then overlapping the viabahn into the contralateral limb of main body stentgraft as sandwich stent grafting. 4. Icannulate bilateral renal arteries from l’t brachial artery into the other one of the contralateral legs of main body stent graft and put viabahn stentinto bilateral renal arteries first. And then overlapping