[Thoracic Endovascular Aortic Repair for Ascending Aortic Graft Flexion with Hemolytic Anemia:Report of a Case].

A 63-year-old man, who underwent urgent ascending aortic replacement for Stanford type A acute aortic dissection 8 years before, was presented with consciousness loss. Hemolytic anemia( hemoglobin 6.5 g/dl, LDH 1,477 U/l, total bilirubin 3.8 mg/dl) was diagnosed. Contrast-enhanced computed tomography(CT) scans revealed severe flexion and stenosis of the replaced ascending aortic graft with intraluminal protrusion of the lesser curvature progressing as compared with 8 years before. Thoracic endovascular aortic repair, i.e. stent-graft implantation into the ascending aortic graft, under rapid pacing was successfully performed. The graft flexion/stenosis was slightly improved, and the intraluminal protrusion of the lesser curvature was covered by the stent graft. Anemia was completely resolved. Endovascular repair for graft flexion/stenosis bringing hemolytic anemia is far less invasive than redo aortic replacement and may be a useful therapeutic tool in limited cases.