A case report of One-Stage Surgery for a giant Arch-Descending Aortic Aneurysm by TEVAR under Circulatory Arrest

P0005 

Abstract Submission 

Takanori Hishikawa (1), Takeki Ohashi (1), Soichiro Kageyama (1), Akinori Kojima (1)

(1) Nagoya Tokushu-kai general hospital, Kasugai city Aichi, Japan

Takanori Hishikawa    -  Contact Me
Nagoya Tokushu-kai general hospital

Takeki Ohashi    -  Contact Me
Nagoya Tokushu-kai general hospital

Soichiro Kageyama    -  Contact Me
Nagoya Tokushu-kai general hospital

Akinori Kojima    -  Contact Me
Nagoya Tokushu-kai general hospital

Takanori Hishikawa    -  Contact Me
N/A

Objective: In the treatment of thoracic aortic aneurysms, one-stage total thoracic aortic replacement presents risks in older and frail patients, and two-staged descending aortic replacement using the elephant trunk is also considered very invasive. Currently, thoracic endovascular aortic repair (TEVAR) is performed as a two-staged procedure of the elephant trunk technique. However, two-staged TEVAR is difficult to perform in cases of intravascular atheroma, intramural thrombus, rupture, or imminent rupture conditions.

Methods: The invasiveness of surgery can be minimized by performing an ascending arch replacement through a median sternotomy, inserting the elephant trunk during circulatory arrest, and performing TEVAR while maintaining circulatory arrest. Blood can be pumped through the sheath from the femoral artery to blow off the debris in the aorta upon resumption of circulation, reducing the risk of peripheral emboli.

Results: In this study, we report the case of a 67-year-old man with a giant aneurysm from the arch to the descending aorta who underwent a one-stage frozen elephant trunk and TEVAR procedure which covered the aortic aneurysm without paraplegia. The patient presented with a 2-year history of cough, exertional shortness of breath, significant weight loss, and an imminent rupture risk. The patient's recovery was uneventful, and he was transferred on postoperative day 64 for rehabilitation in preparation for discharge.

Conclusions: This method allows for minimally invasive surgery as it allows for the replacement of the ascending and descending aorta in a single-stage procedure through median sternotomy. However, the risk of paraplegia should be considered because the descending aorta is covered in one stage.

Descending/Thoracoabdominal Aorta