title: Endovascular repair of a type III thoracoabdominal aortic aneurysm in a patient with occlusion of visceral arteries.
abstract: The successful endovascular repair of a type III thoracoabdominal aortic aneurysm (TAAA) with the use of a tube endograft is reported. A 56-year-old male with a 6.4-cm type III TAAA, a 4.2-cm infrarenal abdominal aortic aneurysm, and chronic renal insufficiency presented with flank pain, nausea, acute anuria, and serum creatinine of 6.1 mg/dl. Acute occlusion of the left solitary renal artery was diagnosed and emergent recanalization with percutaneous transluminal angioplasty and stenting was performed successfully, with reversal of the serum creatinine level at 1.6 mg/dl. Further imaging studies for TAAA management revealed ostial occlusion of both the celiac artery (CA) and the superior mesenteric artery (SMA) but a hypertrophic inferior mesenteric artery (IMA) providing retrograde flow to the aforementioned vessels. This rare anatomic serendipity allowed us to repair the TAAA simply by using a two-component tube endograft without fenestrations (Zenith; William Cook, Bjaeverskov, Denmark) that covered the entire length of the aneurysm, including the CA and SMA origins, since a natural arterial bypass from the IMA to the CA and SMA already existed, affording protection from gastrointestinal ischemic complications. The patient had a fast and uneventful recovery and is currently doing well 6 months after the procedure. To our knowledge, this is the first report in the English literature of successful endovascular repair of a TAAA involving visceral arteries with the simple use of a tube endograft.
authors: First Department of Surgery, Vascular Division, LAIKON Hospital, Athens University Medical School, 17 Agiou Thoma str., Goudi, 11527, Athens, Greece. cklonaris@yahoo.com
authors: Chris
authors: C
authors: Klonaris
authors: Athanasios
authors: A
authors: Katsargyris
authors: Athanasios
authors: A
authors: Giannopoulos
authors: Sotiris
authors: S
authors: Georgopoulos
authors: Chris
authors: C
authors: Tsigris
authors: Othon
authors: O
authors: Michail
authors: George
authors: G
authors: Marinos
authors: Elias
authors: E
authors: Bastounis
mesh_terms: D015901:Angiography, Digital Subtraction; D017130:Angioplasty; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D003097:Collateral Circulation / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014781:Viscera / Q000098:blood supply*