PDF(Pubmed)
Abstract：
BACKGROUND: The classical elephant trunk (ET) technique is a very useful surgical procedure; however, haemolysis in the aorta associated with ET has been previously reported. It normally occurs within several years after the surgery, and it is a rare case of rapidly progressing haemolysis 10 or more years after aortic arch replacement with ET.
METHODS: A 53-year-old man with a history of Stanford type A aortic dissection (DeBakey type Is), who was treated with total arch aortic replacement and aorto-femoral bypass using a prosthetic graft 17 years ago, developed severe progressive haemolytic anaemia. The ET used for the initial surgery was narrowed, and mechanical haemolysis was suspected. We assumed that progressive mechanical haemolysis occurred because of degeneration of the prosthetic graft. Thoracic endovascular aortic repair was performed, and haemolysis and anaemia were mitigated postoperatively.
CONCLUSIONS: Haemolysis occurred 17 years after the initial surgery with ET. When haemolysis is suspected in a patient with ET, it must be identified as a cause of haemolysis even if 10 years or more have passed since the ET was inserted. To prevent this complication, attention should be paid to an appropriate ET length and diameter to avoid folding of the ET, particularly when the true cavity diameter is small.
METHODS: A 53-year-old man with a history of Stanford type A aortic dissection (DeBakey type Is), who was treated with total arch aortic replacement and aorto-femoral bypass using a prosthetic graft 17 years ago, developed severe progressive haemolytic anaemia. The ET used for the initial surgery was narrowed, and mechanical haemolysis was suspected. We assumed that progressive mechanical haemolysis occurred because of degeneration of the prosthetic graft. Thoracic endovascular aortic repair was performed, and haemolysis and anaemia were mitigated postoperatively.
CONCLUSIONS: Haemolysis occurred 17 years after the initial surgery with ET. When haemolysis is suspected in a patient with ET, it must be identified as a cause of haemolysis even if 10 years or more have passed since the ET was inserted. To prevent this complication, attention should be paid to an appropriate ET length and diameter to avoid folding of the ET, particularly when the true cavity diameter is small.
摘要：
背景：经典的象鼻（ET）技术是一种非常有用的外科手术；但是，先前已报道与ET相关的主动脉溶血。它通常发生在手术后的几年内，这是一种罕见的病例，在主动脉弓替换为ET后10年或更长时间快速进展的溶血。
方法：一名53岁男性，有StanfordA型主动脉夹层（DeBakey型Is）病史，17年前，他使用人工移植物接受了全弓主动脉置换术和主动脉股动脉旁路术，严重进行性溶血性贫血.最初手术使用的ET缩小了，怀疑是机械性溶血。我们假设进行性机械性溶血是由于假体移植物的变性而发生的。进行胸主动脉腔内修复术,术后溶血和贫血缓解。
结论：首次ET手术后17年发生溶血。当怀疑ET患者出现溶血时，即使自插入ET以来已经过去了10年或更长时间，也必须将其确定为溶血的原因。为了防止这种并发症，应注意适当的ET长度和直径，以避免ET折叠，特别是当真正的腔直径较小时。
方法：一名53岁男性，有StanfordA型主动脉夹层（DeBakey型Is）病史，17年前，他使用人工移植物接受了全弓主动脉置换术和主动脉股动脉旁路术，严重进行性溶血性贫血.最初手术使用的ET缩小了，怀疑是机械性溶血。我们假设进行性机械性溶血是由于假体移植物的变性而发生的。进行胸主动脉腔内修复术,术后溶血和贫血缓解。
结论：首次ET手术后17年发生溶血。当怀疑ET患者出现溶血时，即使自插入ET以来已经过去了10年或更长时间，也必须将其确定为溶血的原因。为了防止这种并发症，应注意适当的ET长度和直径，以避免ET折叠，特别是当真正的腔直径较小时。
