Author: Sun Tucheng
Organization: Guangdong Provincial People’s Hospital
Abstract
The paper begins with an overview of the complications that can arise from poor stent deployment following aortic dissection surgery, using the case of a 21-year-old female patient. It discusses the intervention procedures performed in a hybrid operating room that successfully addressed issues related to compressed proximal stent sections and limited opening, restoring vessel patency.
Introduction
Sun Tucheng underscores the complexity of treating aortic dissections, especially when involving stent implants. Correct deployment is crucial for successful blood flow reconstruction, and poor deployment can lead to serious complications like blood pressure differentials, vessel restenosis, or occlusion.
Surgical Case and Intervention Handling
• Initial Surgery: The patient underwent Bentall’s procedure and aortic arch replacement due to aortic valve and ascending aorta disease. The sternal deformity (pectus excavatum) caused chest constriction, impacting stent deployment.
• Intervention in Hybrid OR: Post-surgery issues with the proximal end of the stent being compressed were resolved using balloon dilation and additional stent placement, ensuring restoration of normal blood flow.
Reasons and Strategies for Poor Stent Deployment
1. Proximal Deployment Issues:
• Cause: Thoracic deformities like pectus excavatum causing vessel torsion.
• Strategy: Use of CP stents in the hybrid OR and necessary vascular grafting.
2. Mid Stent Deployment Issues:
• Cause: Narrowing in the descending aorta.
• Strategy: Complete removal of the narrowed segment and new stent implantation.
3. Distal Deployment Issues:
• Cause: Chronic dissection causing a significant discrepancy between true and false lumen diameters.
• Strategy: Balloon dilation and vascular grafting to restore lumen size.
Conclusion
The analysis of this case shows effective strategies to resolve stent deployment issues, emphasizing the importance of intervention treatments in a hybrid operating room and multidisciplinary team collaboration, which help optimize postoperative recovery and long-term outcomes for patients.
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