Aortic rupture after spinal correction for scoliosis in the presence of a thoracic stent graft Kevin Mani, MD, PhD, Matti Rantatalo, MSc, Anders Bjurholm,

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Presentation transcript:

Aortic rupture after spinal correction for scoliosis in the presence of a thoracic stent graft Kevin Mani, MD, PhD, Matti Rantatalo, MSc, Anders Bjurholm, MD, PhD, Stefan Thelin, MD, PhD, Lars-Gunnar Eriksson, MD, PhD, Anders Wanhainen, MD, PhD Journal of Vascular Surgery Volume 52, Issue 6, Pages 1653-1657 (December 2010) DOI: 10.1016/j.jvs.2010.06.155 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Saccular thoracic aortic aneurysm in a 56-year-old female with a history of motor vehicle accident 30 years prior to the detection of the aneurysm; (A) axial view and (B) cranial right posterior view of 3-D reconstruction of the aorta. Arrow, Aneurysm; LS, left subclavian artery. Journal of Vascular Surgery 2010 52, 1653-1657DOI: (10.1016/j.jvs.2010.06.155) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 The spinal column before (A) and after (B) correction surgery on anteroposterior chest radiograms. Note the extensive thoracolumbal deformity that was straightened during scoliosis surgery (black lines) resulting in a marked elongation of the column. Journal of Vascular Surgery 2010 52, 1653-1657DOI: (10.1016/j.jvs.2010.06.155) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 Three-dimensional and centerline straightened view reconstruction of the aorta before (A, C) and after (B, D) spinal correction surgery. Centerline measurement of the distance between the distal end of the stent graft and the origin of the celiac trunk (the S-A distance onAandB) showed an elongation of this aortic segment from 71 to 96 mm. Note the straightening of the shape of the descending aorta after scoliosis surgery (B) compared with before (A), and the widening of the distal stent graft at the site of rupture (B). Journal of Vascular Surgery 2010 52, 1653-1657DOI: (10.1016/j.jvs.2010.06.155) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 A generalized stress analysis by means of finite element method (MARC Mentat 2005r3; MSC Software, Santa Ana, Calif). Simulation of an axially split aorta modeled with a Neo-Hookean material model (C10 = 1 MPa). At the end of the stent, the aorta will be subjected to a higher shear stress. A shear band can be seen along the edge of the modelled stent. The equivalent Cauchy stress (effective value including all stress components) also shows its maximum value along the edge. Journal of Vascular Surgery 2010 52, 1653-1657DOI: (10.1016/j.jvs.2010.06.155) Copyright © 2010 Society for Vascular Surgery Terms and Conditions