Endovascular Stent Grafting of a Perforated Descending Aorta Caused by Empyema

(Advanced Medical Emergency and Critical Care Center, Yamaguchi University School of Medicine, Ube, Japan and First Department of Surgery, Yamaguchi University School of Medicine*, Ube, Japan)

Koji Dairaku Akira Furutani* Satoshi Saito*
Norio Akiyama* Kouichi Yoshimura* Hiroaki Takenaka*
Kimikazu Hamano*
We performed endovascular stent grafting of a perforated descending aorta, caused by empyema after surgery for lung cancer , in a 75-year-old man. After diagnosing hemorrhage from a perforation of the proximal descending aorta, caused by left empyema, the perforation was repaired with a saphenous vein patch and a pectoralis major muscle flap. However, re-hemorrhage from the same lesion occurred 2 months postoperatively. Temporary hemostasis was achieved with gauze packing and he was transferred to our hospital for endovascular stent grafting. The infection did not resolve after fenestration, so the descending aorta was cropped out to the fenestration lesion. Therefore, endovascular stent grafting was performed on the same day. Postoperatively the bleeding stopped completely without any signs of graft infection, and he was transferred to another hospital on postoperative day 9. No re-hemorrhage or graft infection of the aortic perforative lesion occurred in the early postoperative period. However, the patient died of massive bleeding from the aorta wall of the proximal stump of the stent graft, caused by recurrence of the infection 2 months after the 2nd operation. In this situation, endovascular stent grafting provides the only chance of saving the patientfs life. If endovascular stent grafting is performed as a lifesaving procedure, meticulous operative technique is imperative.
@Jpn. J. Cardiovasc. Surg. 34: 25-28 (2005)