Simultaneous Open Abdominal Aortic Replacement and Thoracic Stent-Graft Placement: Report of a Case

Abstract

A 77-year-old man with severe chronic obstructive pulmonary disease was admitted to our hospital for surgical treatment of a proximal descending thoracic aortic aneurysm (dTAA) and an infrarenal abdominal aortic aneurysm (AAA). The patient had poor respiratory function; however, a simultaneous abdominal aortic replacement and thoracic stent-graft placement were successfully performed without any complications. This case report demonstrates that simultaneous abdominal aortic replacement and thoracic stent-graft placement for multiple aneurysms may be feasible and can safely be performed in selected high-risk patients, despite the many problems associated with the treatment of aortic aneurysms using stent grafts.

Endovascular repair for concomitant multilevel aortic disease☆

“…Thus complete repair of multilevel disease could provide the best early and long-term prognosis and could be advocated as the treatment of choice. In the current series, our mortality rate compares favourably with other series, though it reports only few cases; moreover, SG treatment has been associated with fewer early complications and deaths than simultaneous or sequential conventional repair in high-risk patients, despite long-term efficacy and clinical outcome remains uncertain [3,[8][9][10]; therefore, elderly patients with co-existing cardiopulmonary diseases would most benefit from a less invasive, but nonetheless complete, repair of this challenging procedure. PAU has been first described in 1986 and reported to affect elderly patients with advanced atherosclerosis and risk factors [11]; hence, PAU is potentially associated with a high incidence of morbidity (such as hypertension, coronary artery disease, and carotid artery occlusive disease).…”

“…However, on the other hand 30% of the reported deaths after descending thoracic aneurysm repair has been associated with coexisting untreated infrarenal aneurysm rupture [3,7]. With the development of endovascular SG technology, staged and simultaneous repairs of concomitant thoracic and abdominal aneurysms have been yet published, but these have mainly employed combined open and endovascular techniques [8][9][10], as opposed to our use of simultaneous endovascular repair of both diseased aortic areas, particularly for high risk patients. Although guidelines have never been produced, and some authors suggested no reason for endovascular AAA repair in patients without significant risk factors, we believe both aneurysms could be excluded simultaneously, since this seems a much simpler and less invasive approach.…”

“…Abdominal aortic disease included atherosclerotic infrarenal (nZ3) and juxtarenal (nZ1) aortic aneurysms. Mean abdominal aortic aneurysm (AAA) diameter was 67G13 mm (range, [5][6][7][8]. Mean thoracic aortic lumen measured 33.5 mm (range 30-38 mm).…”

No Increased Risk of Spinal Cord Ischemia in Delayed AAA Repair Following Thoracic Aortic Surgery

“…[18][19][20] Earlier studies evaluating the results of hybrid repair with thoracic stent grafts and an open abdominal approach have shown similar findings. [21][22][23][24] Results regarding morbidity and mortality after staged repairs have been less favorable and are limited to those involving patients undergoing initial AAA repair followed by delayed thoracic aortic surgery. Our experience has shown that 40% to 50% of the patients who develop SCI after TEVAR also have a history of prior open or endovascular AAA repair.…”

Simultaneous thoracic endovascular aortic repair and endovascular aortic repair is feasible with minimal morbidity and mortality

“…Most of these studies involved hybrid repair with thoracic stent grafts and an open abdominal approach. 1,[9][10][11] Fewer case reports have evaluated concomitant endovascular repair of both aortic segments. [12][13][14] We report our experience treating combined thoracic and abdominal aortic aneurysms simultaneously with endoluminal stent grafts.…”