Journal «Angiology and Vascular Surgery» • 

2020 • VOLUME 26 • №2

Surgical treatment of a patient with traumatic rupture of the aortic arch and late oesophageal perforation

Shlomin V.V.1, Nokhrin A.V.1, Orzheshkovskaya I.E.1, Bova V.I.1, Nefedov A.V.1, Mikhailov I.V.1, Bondarenko P.B.2, Puzdryak P.D.1, Dmitrievskaya N.O.1

1) Department of Vascular Surgery, Municipal Multimodality Hospital №2,
2) National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia

Described herein is a clinical case report regarding a patient presenting with traumatic rupture of the aortic isthmus with the development of a pseudoaneurysm occupying virtually the entire posterior mediastinum and measuring 20×10 cm in size. He was immediately treated as an emergency to undergo prosthetic reconstruction of the portion of the aortic arch and descending thoracic aorta by means of temporary bypass grafting with a synthetic graft in order to protect the visceral organs. The postoperative period was complicated by oesophageal perforation with the formation of an oesophago-paraprosthetic fistula, infection of the vascular graft, accompanied by the development of pleural empyema and mediastinitis. A second operative procedure was performed, consisting of subclavian-iliac bypass grafting on the right with a polytetrafluoroethylene graft measuring 20 mm in diameter, exclusion of the intrathoracic portion of the oesophagus, creation of a gastro- and oesophagostoma, retrieval of the vascular graft followed by suturing of the aorta, pleurectomy, decortication of the lung, and removal of the empyemic sac on the left. There was no evidence of ischaemia of the spinal cord or visceral arteries. One month postoperatively, he underwent a traumatological stage and 4 months thereafter plasty of the oesophagus with an isoperistaltic gastric pedicle, extirpation of the thoracic portion of the oesophagus, to be later on followed by closure of the oesophagostoma. The patient experienced no difficulties either while walking or during other physical activities, with the ankle-brachial index amounting to 0.9. With time, he developed difficult-to-correct pulmonary hypertension. Unfortunately, the patient eventually died of acute cardiopulmonary insufficiency 9 years after right-sided extra-anatomical subclavian-iliac bypass grafting.

KEY WORDS: descending thoracic aortic aneurysm, temporary bypass, graft infection, subclavian-iliac bypass grafting, extra-anatomical bypass grafting.

P. 182

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