title: Emergent repair of a complex dissecting aneurysm in the thoracic aorta.
abstract: Endovascular treatment of complex thoracic pathologic conditions involving the aortic arch can often be appropriate and safe; however, minimally invasive procedures are not always feasible, especially in emergent cases. We report the case of a 78-year-old woman who emergently presented in hemorrhagic shock with a ruptured chronic dissecting aneurysm that involved the aortic arch. Eight years earlier, she had undergone aortic valve replacement and plication of the ascending aorta, which was complicated a day later by Stanford type B dissection, malperfusion, and ischemia that required an axillobifemoral bypass. At the current admission, we successfully treated her surgically through a left thoracotomy, using moderate hypothermic extracorporeal circulation and advanced organ-protection methods. We discuss the surgical indications and our operative strategy in relation to open surgical repair versus endovascular treatment in patients with complex conditions.
authors.affiliation: Vascular Surgery Department, Scientific Institute H. San Raffaele, Vita-Salute University School of Medicine, 20132 Milan, Italy.
authors.forename: Efrem
authors.initials: E
authors.lastname: Civilini
authors.forename: Luca
authors.initials: L
authors.lastname: Bertoglio
authors.forename: Daniele
authors.initials: D
authors.lastname: Mascia
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.forename: Roberto
authors.initials: R
authors.lastname: Chiesa
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation; D004630:Emergencies; D005112:Extracorporeal Circulation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007036:Hypothermia, Induced; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Aneurysm, dissecting/radiography/surgery; aortic aneurysm, thoracic/radiography/surgery; aortic diseases/surgery; aortic rupture/surgery; treatment outcome; vascular surgical procedures