Two-stage combined endovascular and surgical approach for recurrent thoracoabdominal aortic aneurysm.
OBJECTIVE
To present a 2-stage combined endovascular and surgical approach for recurrent thoracoabdominal aortic aneurysm (TAAA).


METHODS
A 78-year-old man with previous surgical repairs of infrarenal abdominal and descending thoracic aortic aneurysms was referred for dysphagia due to an enlarging 9-cm aneurysm extending from the mid thoracic to the suprarenal aorta. Because no suitable endograft was available, an open repair was attempted, but the presence of a "frozen" chest made the redo procedure extremely difficult. A 2-stage treatment was thus decided upon. First, a retrograde bifurcated bypass graft was implanted from the abdominal aortic graft to the superior mesenteric and celiac arteries. Twenty days later, the TAAA was successfully excluded with a stent-graft, during which spinal fluid drainage was performed to prevent paraplegia. At 6 months, computed tomography showed patency of the endoprosthesis and visceral grafts. At 1 year, the patient remains asymptomatic.


CONCLUSIONS
This case illustrates that a 2-stage combined endovascular and surgical approach may be a safe and effective alternative to reoperation for recurrent TAAA.
Chiesa
Roberto
R
Vita e Salute University, San Raffaele Hospital, Milan, Italy. roberto.chiesa@hsr.it
Melissano
Gemano
G
Civilini
Efrem
E
Setacci
Francesco
F
Tshomba
Yamume
Y
Anzuini
Angelo
A
D000368:Aged; D000800:Angioplasty, Balloon; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation; D002445:Celiac Artery / Q000601:surgery; D003131:Combined Modality Therapy; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D017538:Mesenteric Artery, Superior / Q000601:surgery; D011093:Polyethylene Terephthalates; D012008:Recurrence; D012086:Reoperation; D015607:Stents
D011093:Polyethylene Terephthalates