Abstract
BackgroundAortic pathology progression and/or procedure related complications following endovascular repair should always be considered mostly in older patients. We herein describe a hybrid procedure for treatment of rapidly expanding thoracoabdominal aneurysm following endovascular treatment of a descending thoracic aortic aneurysm in an older patient.Case presentationA 82-year-old man at 18 months after endovascular surgery for a contained rupture of descending thoracic aortic aneurysm revealed a type IV thoracoabdominal aneurysm with significant increase of the aortic diameters at superior mesenteric and renal artery levels. A hybrid approach consisting of preventive visceral vessel revascularization and endovascular repair of entire abdominal aorta was performed. Under general anaesthesia and by xyphopubic laparotomy, the infrarenal aneurysmatic aorta and common iliac arteries were replaced by a bifurcated woven prosthetic graf. From each of the prosthetic branches two reverse 14x7 mm bifurcated PTFE prosthetic grafts were anastomized to both renal arteries and to the celiac axis and superior mesenteric artery, respectively. Vessel ischemia was restricted to the time required for anastomosis. Three 10 cm Gore endovascular stent-grafts for a total length of 15 cm, were used. The overlapping of the stent-grafts was carried out from the bottom upwards, starting from the aorto-iliac prosthetic body up to the healthy segment of thoracic aorta, 40 mm from the previous stent-grafts.The patient was discharged on the 9th postoperative day.ConclusionThis technique offers the advantage of a less invasive treatment, reducing the risk of paraplegia, visceral ischaemia and pulmonary complications, mostly in older patients.
Highlights
To emphasize the possibility of an unforeseeable accelerating growth of aortic aneurysm and of an alternative treatment, we describe a case of a rapidly expanding thoracoabdominal aneurysm, treated by an hybrid procedure, after an emergent endovascular repair for a contained rupture of a descending thoracic aortic aneurysm
Thoracic endovascular aortic repair (TEVAR), by positioning of three 42-42,46-42,44-40 mm stent-grafts (Talent, Medtronic Inc., Santa Rosa, USA), under local anaesthesia and light sedation, as previously described elsewhere [1],was successfully performed and the patient was discharged in good condition on the 5th postoperative day
A hybrid approach consisting of preventive visceral vessel revascularization and endovascular repair of the entire abdominal aorta was planned
Summary
The risk of thoracoabdominal expansion should be kept in mind after thoracic aortic repair [1].Conventional surgical treatment still entails a substantial operative mortality [2].To emphasize the possibility of an unforeseeable accelerating growth of aortic aneurysm and of an alternative treatment, we describe a case of a rapidly expanding thoracoabdominal aneurysm, treated by an hybrid procedure, after an emergent endovascular repair for a contained rupture of a descending thoracic aortic aneurysm.Full list of author information is available at the end of the articlePresentation of the case A 82-years-old man was admitted in June 2010 to the emergency care unit because of lypotimia and chest pain.After cardiologic evaluation, excluding coronary artery disease, the patient underwent spiral multislice computed tomography (CT-scan) showing a contained rupture of a descending thoracic aortic aneurysm, a maximum diameter of 63mm. 32 mm. distant from the origin of the left subclavian artery. Conclusion: This technique offers the advantage of a less invasive treatment, reducing the risk of paraplegia, visceral ischaemia and pulmonary complications, mostly in older patients. To emphasize the possibility of an unforeseeable accelerating growth of aortic aneurysm and of an alternative treatment, we describe a case of a rapidly expanding thoracoabdominal aneurysm, treated by an hybrid procedure, after an emergent endovascular repair for a contained rupture of a descending thoracic aortic aneurysm.
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