RESUMO
A ruptured thoracoabdominal aortic aneurysm is an urgent situation requiring emergency surgery during which it is necessary to decrease the scope of the intervention in a patient at an extremely high surgical risk. A combination of surgical and endovascular techniques makes it possible to minimize surgical injury, blood loss, to shorten the duration of internal organs ischaemia, to reduce the risk of paraplegia. Presented herein are the results of emergency hybrid intervention for a ruptured thoracoabdominal aortic aneurysm, accompanied and followed by description of the technical aspects of performing the surgical and endovascular stages. The early postoperative period was complicated by thrombosis of the left superficial femoral artery on the background of atherosclerotic lesions, which was successfully eliminated by means of endovascular intervention with endovascular prosthetic repair. After 10 months, the patient underwent a cardiosurgical intervention. Combining surgical and endovascular techniques made it possible in an emergency situation to save the patient's life and to provide its good quality in the remote period of follow up (4 years after the hybrid operation).
Assuntos
Aneurisma Roto , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Complicações Pós-Operatórias , Trombose Venosa , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico , Aneurisma Roto/fisiopatologia , Aneurisma Roto/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/cirurgia , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Hematoma/diagnóstico , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Risco Ajustado/métodos , Stents , Resultado do Tratamento , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia , Trombose Venosa/cirurgiaRESUMO
A multilevel aneurysmatic lesion of the aorta is a rare pathology. The authors describe herein a clinical case report regarding stage-wise treatment of a patient presenting with aneurysms of the thoracic and abdominal portions of the aorta and a haemodynamically significant lesion of coronary and carotid arteries. Strategy of surgical management was decided upon collegially. Successful endoprosthetic repair of the aneurysm of the thoracic portion of the aorta required closure of the left carotid artery with a graft, which, taking into consideration an existing occlusion of the right internal carotid artery, demanded preliminary carotid-subclavian bypass grafting. The clinical course of progressing angina pectoris (75% stenosis of the anterior descending artery with a poststenotic aneurysm) also increased the risk of the surgical stage. The authors provide a detailed description of the planning procedure, stages, and technical aspects of the operations performed. No complications were encountered. The duration of the follow up period amounted to 15 months. There was regression of the symptomatic manifestations, accompanied and followed by complete thrombosis of the aneurysmatic zones stented. A hybrid approach demonstrated efficacy and safety in staged treatment of complicated combined pathology of the aorta and its branches.
