Abstract
Treatment of thoracoabdominal aortic aneurysms is one of the most difficult challenges of vascular surgery. Endovascular options for complex aneurysms in urgent situation are limited. Thoracoabdominal giant aortic aneurysms are especially rare phenomena, each of them requires patient-specific treatment. Staged-fashion reconstructions may offer lower rate, especially for spinal cord injury. In our case report, we present a male patient, who had a 19.2 cm maximum diameter modified Crawford type V thoracoabdominal aortic aneurysm with contained rupture. The patient underwent an acute open repair and later a staged endovascular repair successfully. A 64-year-old male patient was admitted to our institution with complaints of chest and lower back pain in stable hemodynamic state. After evaluation, computer tomography angiography revealed a 19.2 cm maximum diameter thoracoabdominal aortic aneurysm, compression signs and hemothorax. Based on the anatomy, the serious compression symptoms and hemothorax associated with the gigantic aneurysm, we decided to perform open aortic repair. To reduce risk of spinal cord ischemia, intraoperatively we chose finishing the full reconstruction in a staged fashion. First, we performed an open repair with a Dacron interpositum distally using an oblique patch involving the visceral orifices. Later we implanted a thoracic endograft. At one-year follow-up, the patient was symptom-free, with no sign of endoleak. Giant aortic aneurysms are rare conditions, especially in the thoracoabdominal region. In the presence of compression symptoms, hemothorax and unsuitable aneurysm anatomy, open repair should be done. Staged repair offers a less invasive approach decreasing the risk of spinal cord ischemia. Orv Hetil. 2020; 161(7): 269-274.
Highlights
Treatment of thoracoabdominal aortic aneurysms is one of the most difficult challenges of vascular surgery
We present a male patient, who had a 19.2 cm maximum diameter modified Crawford type V thoracoabdominal aortic aneurysm with contained rupture
The serious compression symptoms and hemothorax associated with the gigantic aneurysm, we decided to perform open aortic repair
Summary
Rupturált óriás thoracoabdominalis aortaaneurysma sikeres kezelése két lépésben Berczeli Márton dr.1 ■ Oláh Zoltán dr.1 ■ Szatai Lilla dr. Daróczi László dr.2 ■ Sótonyi Péter dr.. A 64 éves férfi beteget mellkasi és hasi panaszok miatt vettük fel intézetünkbe(1) stabil hemodinamikai paraméterekkel. Kontrasztanyagos CT-angiográfiás vizsgálat igazolta a 19,2 cm legnagyobb átmérőjű, többszörös thoracoabdominalis aortaaneurysmáját, kompressziós jelekkel, haemothoraxszal és az alsó szakasz tartott rupturájával. Thoracoabdominal giant aortic aneurysms are especially rare phenomena, each of them requires patient-specific treatment. AMS = arteria mesenterica superior; CPB = cardiopulmonalis bypass; CTA = (computed tomography angiography) komputertomográfiás angiográfia; CSF = (cerebrospinalis fluidum) cerebrospinalis folyadék; EF = ejekciós frakció; EVAR = endovascularis aneurysmarekonstrukció; SCI = gerincvelő-ischaemia; TAAA = thoracoabdominalis aortaaneurysma; TC = truncus coeliacus; TEVAR = thoracalis endovascularis aneurysmarekonstrukció. 6 cm maximális átmérőjű intakt fusiformis aneurysmát egy relatíve szűkebb szakasz követte, ez alatt pedig egy óriás, tartottan rupturált TAAA-i látszott, amely a visceralis orificiumokat is érintette; a jobb oldali arteria renalis eredésében egy praeocclusiv stenosis is igazolódott A panaszai miatt végzett akut kontrasztanyagos komputertomográfiás angiográfia (CTA) kimutatta a 19 cm maximális átmérőjű Crawford V típusú thoracoabdominalis aortaaneurys-
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