Abstract
An 80-year-old man was admitted to our hospital with a diagnosis of distal aortic arch aneurysm. A preoperative chest CT demonstrated a 54 mm in diameter distal aortic arch and coronary angiography revealed stenosis of LAD and the diagonal branch. We planned a thoracic endovascular repair after total arch replacement with a coronary artery bypass graft. A ZTEG-2P-30-200-JP was deployed at the proximal side of the elephant trunk, and a ZTEG-2P-34-152-JP was deployed. About 10 months later, a chest CT demonstrated a 90 mm in diameter distal native aortic arch, and anemia had increased to Hb 7.7 g/dl. A CT and angiography revealed a type II endoleak and so we tried to close the endoleak through a left thoracotomy approach. Twenty-eight months after the TEVAR, the patient had esophageal perforation and stent graft infection. At first, we resected the esophagus and reconstructed it with a gastric tube. Secondly, a descending thoracic aorta replacement was performed. The patient suffered from a cerebral infarction. However, infection was controlled successfully and he was transferred to another hospital for rehabilitation 69 days after the descending aorta replacement.
