Visceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the Bentall procedure with the elephant trunk technique: A case report
Introduction. Reconstruction of chronic type B dissection and thoracoabdominal aortic aneurysm (TAAA) remaining after the emergency reconstruction of the ascending thoracic aorta and aortic arch for acute type A dissection represents one of the major surgical challenges. Complications of...
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| Format: | Article |
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Military Health Department, Ministry of Defance, Serbia
2014-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2014/0042-84501400023M.pdf |
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| author | Marjanović Ivan Šarac Momir Tomić Aleksandar Rusović Siniša Sekulović Leposava Leković Marko Bezmarević Mihailo |
| author_facet | Marjanović Ivan Šarac Momir Tomić Aleksandar Rusović Siniša Sekulović Leposava Leković Marko Bezmarević Mihailo |
| author_sort | Marjanović Ivan |
| collection | DOAJ |
| description | Introduction. Reconstruction of chronic type B dissection and
thoracoabdominal aortic aneurysm (TAAA) remaining after the emergency
reconstruction of the ascending thoracic aorta and aortic arch for acute
type A dissection represents one of the major surgical challenges.
Complications of chronic type B dissection are aneurysmal formation and
rupture of an aortic aneurysm with a high mortality rate. We presented a
case of visceral hybrid reconstruction of TAAA secondary to chronic
dissection type B after the Bentall procedure with the elephant trunk
technique due to acute type A aortic dissection in a high-risk patient. Case
report. A 62 year-old woman was admitted to our institution for
reconstruction of Crawford type I TAAA secondary to chronic dissection. The
patient had had an acute type A aortic dissection 3 years before and
undergone reconstruction by the Bentall procedure with the elephant trunk
technique with valve replacement. On admission the patient had coronary
artery disease (myocardial infarction, two times in the past 3 years),
congestive heart disease with ejection fraction of 25% and chronic
obstructive pulmonary disease. On computed tomography (CT) of the aorta TAAA
was revealed with a maximum diameter of 93 mm in the descending thoracic
aorta secondary to chronic dissection. All the visceral arteries originated
from the true lumen with exception of the celiac artery (CA), and the end of
chronic dissection was below the origin of the superior mesenteric artery
(SMA). The patient was operated on using surgical visceral reconstruction of
the SMA, CA and the right renal artery (RRA) as the first procedure.
Postoperative course was without complications. Endovascular TAAA
reconstruction was performed as the second procedure one month later, when
the elephant trunk was used as the proximal landing zone for the endograft,
and distal landing zone was the level of origin of the RRA. Postoperatively,
the patient had no neurological deficit and renal, liver function and
functions of the other abdominal organs were normal. Control CT after 6
months showed full exclusion of the aneurysm from the systemic circulation
without endoleak and good flow through visceral anastomosis. Conclusion. In
patients with comorbidities, like in the presented case, visceral hybrid
reconstruction of chronic dissection type B with TAAA could be the treatment
of choice. |
| first_indexed | 2024-04-12T19:03:29Z |
| format | Article |
| id | doaj.art-96391c3fcec643c2ac261f3c70d2b448 |
| institution | Directory Open Access Journal |
| issn | 0042-8450 |
| language | English |
| last_indexed | 2024-04-12T19:03:29Z |
| publishDate | 2014-01-01 |
| publisher | Military Health Department, Ministry of Defance, Serbia |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj.art-96391c3fcec643c2ac261f3c70d2b4482022-12-22T03:20:05ZengMilitary Health Department, Ministry of Defance, SerbiaVojnosanitetski Pregled0042-84502014-01-0171987988310.2298/VSP121230023M0042-84501400023MVisceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the Bentall procedure with the elephant trunk technique: A case reportMarjanović Ivan0Šarac Momir1Tomić Aleksandar2Rusović Siniša3Sekulović Leposava4Leković Marko5Bezmarević Mihailo6Clinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrade + Faculty of Medicine of the Military Medical Academy, University of Defence, BelgradeClinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrade + Faculty of Medicine of the Military Medical Academy, University of Defence, BelgradeClinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrade + Faculty of Medicine of the Military Medical Academy, University of Defence, BelgradeFaculty of Medicine of the Military Medical Academy, University of Defence, Belgrade + Institute of Radiology, Military Medical Academy, BelgradeFaculty of Medicine of the Military Medical Academy, University of Defence, Belgrade + Institute of Radiology, Military Medical Academy, BelgradeClinic for Vascular and Endovascular Surgery, Military Medical Academy, BelgradeClinic for General Surgery, Military Medical Academy, BelgradeIntroduction. Reconstruction of chronic type B dissection and thoracoabdominal aortic aneurysm (TAAA) remaining after the emergency reconstruction of the ascending thoracic aorta and aortic arch for acute type A dissection represents one of the major surgical challenges. Complications of chronic type B dissection are aneurysmal formation and rupture of an aortic aneurysm with a high mortality rate. We presented a case of visceral hybrid reconstruction of TAAA secondary to chronic dissection type B after the Bentall procedure with the elephant trunk technique due to acute type A aortic dissection in a high-risk patient. Case report. A 62 year-old woman was admitted to our institution for reconstruction of Crawford type I TAAA secondary to chronic dissection. The patient had had an acute type A aortic dissection 3 years before and undergone reconstruction by the Bentall procedure with the elephant trunk technique with valve replacement. On admission the patient had coronary artery disease (myocardial infarction, two times in the past 3 years), congestive heart disease with ejection fraction of 25% and chronic obstructive pulmonary disease. On computed tomography (CT) of the aorta TAAA was revealed with a maximum diameter of 93 mm in the descending thoracic aorta secondary to chronic dissection. All the visceral arteries originated from the true lumen with exception of the celiac artery (CA), and the end of chronic dissection was below the origin of the superior mesenteric artery (SMA). The patient was operated on using surgical visceral reconstruction of the SMA, CA and the right renal artery (RRA) as the first procedure. Postoperative course was without complications. Endovascular TAAA reconstruction was performed as the second procedure one month later, when the elephant trunk was used as the proximal landing zone for the endograft, and distal landing zone was the level of origin of the RRA. Postoperatively, the patient had no neurological deficit and renal, liver function and functions of the other abdominal organs were normal. Control CT after 6 months showed full exclusion of the aneurysm from the systemic circulation without endoleak and good flow through visceral anastomosis. Conclusion. In patients with comorbidities, like in the presented case, visceral hybrid reconstruction of chronic dissection type B with TAAA could be the treatment of choice.http://www.doiserbia.nb.rs/img/doi/0042-8450/2014/0042-84501400023M.pdfaortic aneurysm, thoracicvascular surgical procedurestreatment outcomecomorbidity |
| spellingShingle | Marjanović Ivan Šarac Momir Tomić Aleksandar Rusović Siniša Sekulović Leposava Leković Marko Bezmarević Mihailo Visceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the Bentall procedure with the elephant trunk technique: A case report Vojnosanitetski Pregled aortic aneurysm, thoracic vascular surgical procedures treatment outcome comorbidity |
| title | Visceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the Bentall procedure with the elephant trunk technique: A case report |
| title_full | Visceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the Bentall procedure with the elephant trunk technique: A case report |
| title_fullStr | Visceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the Bentall procedure with the elephant trunk technique: A case report |
| title_full_unstemmed | Visceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the Bentall procedure with the elephant trunk technique: A case report |
| title_short | Visceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the Bentall procedure with the elephant trunk technique: A case report |
| title_sort | visceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the bentall procedure with the elephant trunk technique a case report |
| topic | aortic aneurysm, thoracic vascular surgical procedures treatment outcome comorbidity |
| url | http://www.doiserbia.nb.rs/img/doi/0042-8450/2014/0042-84501400023M.pdf |
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