Salvage of an acutely ruptured thoracic aortic aneurysm during CPR.
OBJECTIVE
To report the successful endovascular treatment of a ruptured thoracic aortic aneurysm during cardiopulmonary resuscitation.


METHODS
A 72-year-old woman with a type B aortic dissection treated conservatively for 8 years was referred for rupture of a 16-cm aneurysm of the descending thoracic aorta. During transfer to the operating room, the patient suffered cardiac arrest; cardiopulmonary resuscitation (CPR) was initiated. A few minutes later during CPR, the surgical procedure began with a cutdown of the right femoral artery and insertion of a guidewire and an aortic occlusion balloon, which was inflated at the origin of the left subclavian artery (LSA). Blood pressure was immediately measurable. By only partially deflating the occluding balloon, a thoracic stent-graft was advanced above it and deployed at the origin of the LSA while rapidly deflating and retracting the occluding balloon. Three stent-grafts were required to cover 27 cm of the descending aorta. The patient was partly ventilator dependent for 3 months due to a massive pleural hematoma that was not evacuated. At the 10-month follow-up, the patient is fully recovered without any sign of respiratory dysfunction or any other sequela. CT scans reveal that the massive hematoma is almost completely resolved.


CONCLUSIONS
This case illustrates that optimal collaboration between anesthesiologists, interventional radiologists, and vascular surgeons with appropriate resources can significantly expand the possibilities of emergent treatment in the face of aortic rupture.
Larzon
Thomas
T
Department of Surgery, Orebro University Hospital, Sweden. thomas.larzon@orebroll.se
Jansson
Håkan
H
Holmström
Björn
B
Lund
Philip
P
Norgren
Lars
L
Arfvidsson
Berndt
B
Berggren
Lars
L
Nydahl
Anders
A
Eriksson
Tomas
T
Jonsson
Thomas
T
Stenberg
Björn
B
D000208:Acute Disease; D000368:Aged; D000758:Anesthesia / Q000379:methods; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006801:Humans; D010348:Patient Care Team; D015641:Radiography, Interventional; D016879:Salvage Therapy; D015607:Stents; D014057:Tomography, X-Ray Computed