Treatment of a rapidly expanding thoracoabdominal aortic aneurysm after endovascular repair of descending thoracic aortic aneurysm in an old patient

BMC Surgery

Research Article

Andrea D’Alessio¹  Giuseppina Gabriella Surace¹  Danilo Ruggiero¹  Ettorino Di Tommaso¹  Gabriele Iannelli¹  Michele Mottola¹  Vito Mannacio¹  Bruno Amato² 

[1] Department of Cardiac Surgery, University of Napoli Federico II, Napoli, Italy;Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, University “Federico II” of Naples, Italy;

关键词: Aortic Aneurysm;    Superior Mesenteric Artery;    Common Iliac Artery;    Celiac Axis;    Endovascular Repair;   

DOI  :  10.1186/1471-2482-12-S1-S26

来源: Springer

【 摘 要 】

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.

【 授权许可】

Unknown   
© Mannacio et al; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.