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. :Absztrakt: A thoracoabdominalis aortaaneurysmák kezelése az érsebészet egyik legnagyobb kihívása. Sürgős esetekben ezen komplex aneurysmák endovascularis ellátásának lehetőségei limitáltak. Az óriás méretű (10 cm-t meghaladó) thoracoabdominalis aortaaneurysma rendkívül ritka jelenség, ellátása mindig betegspecifikus, egyedi kezelést igényel. A tervezett kezelés alacsonyabb morbiditási aránnyal jár, különösen a gerincvelő-sérülés tekintetében. Esetünkben egy 19,2 cm maximális átmérőjű, Crawford V típusú thoracoabdominalis aortaaneurysma sikeres kezelését mutatjuk be. A férfi beteget először akutan, nyitottan operáltuk tartott ruptura miatt, majd később halasztott időpontban endovascularisan folytattuk ellátását. 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. Az anatómia, az extrém méret, a kompressziós tünetek és a haemothorax miatt a nyitott műtéti megoldást választottuk, és intraoperatívan döntöttünk végül a kétszakaszos ellátás mellett. Első lépésben a rupturált szakasz ellátására egy aortoaorticus Dacron interpositumot implantáltunk úgy, hogy a visceralis szakaszt egy ferde ’patch’ segítségével rekonsruáltuk, majd a második lépésben végeztük el a mellkasi sztentgraft beültetését. Az egyéves kontrollon a beteg panaszmentes volt, ’endoleak’ nem ábrázolódott. Az óriás aortaaneurysmák ritka klinikai entitások, főleg a thoracoabdominalis régióban. A kompressziós tünetek, a haemothorax és a jelentős anatómiai változások miatt az endovascularis beavatkozás kivitelezhetősége erősen kérdéses. Ruptura esetén azonnali ellátásuk jelenleg szinte csak nyitottan végezhető. A többlépcsős beavatkozás csökkentheti a gerincvelő-károsodás veszélyét, ezért megfelelő anatómia esetén megfontolandó ennek a ritka betegségnek a kezelésében. Orv Hetil. 2020; 161(7): 269–274.
journal_name
Orv Hetiljournal_title
Orvosi hetilapauthors
Berczeli M,Oláh Z,Szatai L,Daróczi L,Sótonyi Pdoi
10.1556/650.2020.31676subject
Has Abstractpub_date
2020-02-01 00:00:00pages
269-274issue
7eissn
0030-6002issn
1788-6120journal_volume
161pub_type
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