Nonanastomotic Rupture of a Woven Polyester Graft Caused by a Tacking Stitch After Aortic Arch Replacement Noritaka Okada, MD, PhD, Hideki Oshima, MD, PhD, Yuji Narita, MD, PhD, and Akihiko Usui, MD, PhD Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
FEATURE ARTICLES
Fig 2.
Fig 1.
A
77-year-old man patient, who had undergone an arch replacement with a single polyester woven graft (Gelweeve, Vascutek, Ltd., Inchinnan, UK) for an arch aneurysm 5 years previously, presented with persistent chest pain. Three-dimensional computed tomographic images (Fig 1) showed a reconstructed aortic arch with a single four-branch woven graft without any areas of interposing anastomosis, and also revealed the presence of a psuedoaneurysm (yellow arrows) accompanied by Address correspondence to Dr Okada, Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya; 466-8550, Japan; e-mail: [email protected].
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
pledget-like objects (blue arrows). A sagittal computed tomographic view (Fig 2) also showed the image of the objects, which were strongly suspected to be pledgets (blue arrow) located on the graft, at a site some 3 cm distal to the point of the bleeding (yellow arrow). The pledgets were used to adjust the length of the lesser curvature of the graft as a part of a U-stitch in the previous operation, according to the operation notes. The rupture was successfully repaired by direct closure with the patient under femorofemoral cardiopulmonary bypass assist, which confirmed the graft rupture to have been caused by a tacking stitch. This nonanastomostic graft rupture in contemporary vascular prostheses, especially when occurring in a thoracic lesion, is considered to be an extremely rare phenomenon, with very few similar reports in the pertinent literature, except for a rupture caused by mechanical stress in such areas as the groin region and subclavian region.
Ann Thorac Surg 2015;100:2370 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2015.09.007
FEATURE ARTICLES
Fig 2.
Fig 1.
A
77-year-old man patient, who had undergone an arch replacement with a single polyester woven graft (Gelweeve, Vascutek, Ltd., Inchinnan, UK) for an arch aneurysm 5 years previously, presented with persistent chest pain. Three-dimensional computed tomographic images (Fig 1) showed a reconstructed aortic arch with a single four-branch woven graft without any areas of interposing anastomosis, and also revealed the presence of a psuedoaneurysm (yellow arrows) accompanied by Address correspondence to Dr Okada, Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya; 466-8550, Japan; e-mail: [email protected].
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
pledget-like objects (blue arrows). A sagittal computed tomographic view (Fig 2) also showed the image of the objects, which were strongly suspected to be pledgets (blue arrow) located on the graft, at a site some 3 cm distal to the point of the bleeding (yellow arrow). The pledgets were used to adjust the length of the lesser curvature of the graft as a part of a U-stitch in the previous operation, according to the operation notes. The rupture was successfully repaired by direct closure with the patient under femorofemoral cardiopulmonary bypass assist, which confirmed the graft rupture to have been caused by a tacking stitch. This nonanastomostic graft rupture in contemporary vascular prostheses, especially when occurring in a thoracic lesion, is considered to be an extremely rare phenomenon, with very few similar reports in the pertinent literature, except for a rupture caused by mechanical stress in such areas as the groin region and subclavian region.
Ann Thorac Surg 2015;100:2370 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2015.09.007
