Journal of Nippon Medical School: Vol.69 No.1 page.049

Journal of Nippon Medical School

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ArticleTitle Surgical Endovascular Stent Grafting for a Ruptured Penetrating Atherosclerotic Ulcer of the Aortic Arch

AuthorList Masami Ochi¹, Mimiko Tabata¹, Shunichiro Sakamoto¹, Yohsuke Ishii¹,Shigeo Tanaka¹, Kazuo Ichikawa² and Tatsuo Kumasaki²

Affiliation ¹Department of Surgery II, Division of Cardiovascular Surgery and ²Department of Radiology, Nippon Medical School

Language EN

Volume 69

Issue 1

Year 2002

Page 49-52

Received August 20 2001

Accepted October 1, 2001

Keywords penetrating atherosclerotic ulcer, endovascular stent graft

Abstract Penetrating atherosclerotic ulcer (PAU) is defined as an atherosclerotic lesion in which an ulceration occurs in the diseased aortic intima leading to disruption of the internal elastic lamina. It may cause a pseudoaneurysm formation or transmural aortic rupture. We describe a patient in whom a ruptured PAU in the distal aortic arch was treated successfully by a surgical endovascular stent graft. Through a median sternotomy and under deep hypothermic circulatory arrest, the aorta was transected between the left common carotid and subclavian arteries. A dacron prosthetic graft with self-expanding original Z type stents attached inside of the distal half was inserted through the aortotomy to exclude the PAU. By performing the procedure through a median sternotomy, we could eliminate dissection around the ruptured aortic wall. The stented graft was secured safely in the thoracic aorta to exclude the ruptured ulceration located distal to the left subclavian artery. PAU should be recognized widely as a distinct cardiovascular surgical problem which may lead to intramural hematoma with or without dissection or rupture.

Correspondence to Masami Ochi, MD, Department of Surgery II, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
m-ochi@nms.ac.jp

ArticleTitle	Surgical Endovascular Stent Grafting for a Ruptured Penetrating Atherosclerotic Ulcer of the Aortic Arch
AuthorList	Masami Ochi¹, Mimiko Tabata¹, Shunichiro Sakamoto¹, Yohsuke Ishii¹,Shigeo Tanaka¹, Kazuo Ichikawa² and Tatsuo Kumasaki²
Affiliation	¹Department of Surgery II, Division of Cardiovascular Surgery and ²Department of Radiology, Nippon Medical School
Language	EN
Volume	69
Issue	1
Year	2002
Page	49-52
Received	August 20 2001
Accepted	October 1, 2001
Keywords	penetrating atherosclerotic ulcer, endovascular stent graft
Abstract	Penetrating atherosclerotic ulcer (PAU) is defined as an atherosclerotic lesion in which an ulceration occurs in the diseased aortic intima leading to disruption of the internal elastic lamina. It may cause a pseudoaneurysm formation or transmural aortic rupture. We describe a patient in whom a ruptured PAU in the distal aortic arch was treated successfully by a surgical endovascular stent graft. Through a median sternotomy and under deep hypothermic circulatory arrest, the aorta was transected between the left common carotid and subclavian arteries. A dacron prosthetic graft with self-expanding original Z type stents attached inside of the distal half was inserted through the aortotomy to exclude the PAU. By performing the procedure through a median sternotomy, we could eliminate dissection around the ruptured aortic wall. The stented graft was secured safely in the thoracic aorta to exclude the ruptured ulceration located distal to the left subclavian artery. PAU should be recognized widely as a distinct cardiovascular surgical problem which may lead to intramural hematoma with or without dissection or rupture.
Correspondence to	Masami Ochi, MD, Department of Surgery II, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan m-ochi@nms.ac.jp