title: Treatment of a rapidly expanding thoracoabdominal aortic aneurysm after endovascular repair of descending thoracic aortic aneurysm in an old patient.
abstract: BACKGROUND
  Aortic pathology progression and/or procedure related complications following endovascular repair should always be considered mostly in older patients. We herein describe a hybrid procedure for treatment of rapidly expanding thoracoabdominal aneurysm following endovascular treatment of a descending thoracic aortic aneurysm in an older patient.
  
  
  METHODS
  A 82-year-old man at 18 months after endovascular surgery for a contained rupture of descending thoracic aortic aneurysm revealed a type IV thoracoabdominal aneurysm with significant increase of the aortic diameters at superior mesenteric and renal artery levels. A hybrid approach consisting of preventive visceral vessel revascularization and endovascular repair of entire abdominal aorta was performed. Under general anaesthesia and by xyphopubic laparotomy, the infrarenal aneurysmatic aorta and common iliac arteries were replaced by a bifurcated woven prosthetic graf. From each of the prosthetic branches two reverse 14 x 7 mm bifurcated PTFE prosthetic grafts were anastomized to both renal arteries and to the celiac axis and superior mesenteric artery, respectively. Vessel ischemia was restricted to the time required for anastomosis. Three 10 cm Gore endovascular stent-grafts for a total length of 15 cm, were used. The overlapping of the stent-grafts was carried out from the bottom upwards, starting from the aorto-iliac prosthetic body up to the healthy segment of thoracic aorta, 40 mm from the previous stent-grafts.The patient was discharged on the 9th postoperative day.
  
  
  CONCLUSIONS
  This technique offers the advantage of a less invasive treatment, reducing the risk of paraplegia, visceral ischaemia and pulmonary complications, mostly in older patients.
authors.affiliation: Department of Cardiac Surgery, University of Napoli Federico II, Napoli, Italy. etditom@hotmail.it.
authors.forename: Vito
authors.initials: V
authors.lastname: Mannacio
authors.forename: Michele
authors.initials: M
authors.lastname: Mottola
authors.forename: Danilo
authors.initials: D
authors.lastname: Ruggiero
authors.forename: Andrea
authors.initials: A
authors.lastname: D'Alessio
authors.forename: Giuseppina Gabriella
authors.initials: GG
authors.lastname: Surace
authors.forename: Ettorino
authors.initials: E
authors.lastname: Di Tommaso
authors.forename: Bruno
authors.initials: B
authors.lastname: Amato
authors.forename: Gabriele
authors.initials: G
authors.lastname: Iannelli
mesh_terms: D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D018450:Disease Progression; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D008297:Male; D012086:Reoperation