Successful lung lobectomy for a lung cancer following thoracic endovascular aortic repair for a thoracic aortic aneurysm: report of a case

Abstract

Lung cancer and a thoracic aortic aneurysm were detected simultaneously in a 79-year-old male patient with diabetes. The aneurysm was first treated by thoracic endovascular aortic repair. A right lower lobectomy was subsequently performed after the blood flow of the bronchial and intercostal arteries was confirmed by computed tomographic angiography. The bronchial stump was covered with an intercostal muscle flap. The patient's postoperative course was uneventful. Thoracic endovascular aortic repair is a useful and less invasive treatment for such cases, but a blood flow evaluation of the aortic branches should be done following this procedure before a lung resection is considered.

Video-assisted thoracic surgery for cancer after thoracic aortic aneurysm repair

“…With an aging population, the need to manage patients with both aneurysmal disease and thoracic malignancy becomes increasingly important. While there are reports of patients in whom thoracoabdominal aortic aneurysm and lung cancer were diagnosed concomitantly and managed with either simultaneous open surgery or endovascular repair followed later by lobectomy, 4,5 our experience is unique in the literature. We present the above cases in support of an expanded role for VATS in the setting of prior open thoracic surgery.…”

Off-label use of thoracic aortic endovascular stent grafts to simplify difficult resections and procedures in general thoracic surgery

“…The main issue in the oncological setting is the tumour stage, as this influences long-term survival. Some authors suggest restricting prophylactic endografting to patients who have N0 or N1 nodal involvement only [1,14]. Surgical resection as part of a multimodal treatment concept in Stage IIIA and IIIB tumours with mediastinal nodal involvement is still controversial, and we also suggest limiting the selection to patients with N1 or no nodal disease.…”

Incidental extravascular findings in computed tomographic angiography for planning or monitoring endovascular aortic aneurysm repair: Smoker patients, increased lung cancer prevalence?

“…All the other patients were correctly addressed to the appropriate treatment or follow-up. In this context, performing HRCT of the lung to optimise morphological evaluation of lung nodules and/or adding advanced imaging procedure such as CT perfusion or CT volumetric assessment of lung nodules during CTA for the evaluation of vascular aneurysm, offers radiologists the possibility of performing a differential diagnosis between benign or malignant nodules, choosing the correct management for each patient[29-33]. Moreover, CTA can be performed in the emergency setting to exclude or confirm the presence of aneurysmal sac or EVAR complications or to investigate an abdominal pain after a doubtful ultrasound examination; incidental findings can also occur in that setting[34-37].…”