Ann Cardiovasc Surg | Volume 1, Issue 3 | Case Report | Open Access

Hybrid Repair of Type IV Dissecting Thoracoabdominal Aneurysm Using an Aortic Cuff for Entry Tear Closure

Seiichi Yamaguchi^*, Hisanori Fujita, Tomoyoshi Kanda and Shigeyasu Takeuchi

Department of Cardiovascular Surgery, Chiba Emergency Medical Center, Japan

^*Correspondance to: Seiichi Yamaguchi 

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Abstract

The patient was a 68-year-old man. At 54 years of age, he had undergone open descending aortic repair of the ruptured chronic B dissecting aneurysm by surgical graft replacement. Subsequently, the dissection of the residual thoracoabdominal aorta enlarged. Computed Tomography (CT) revealed the upper abdominal aorta with a maximum diameter of 63 mm and intimal tear in the Left Renal Artery (LRA) and in the left common iliac artery. Furthermore, open repair by prosthetic graft replacement deemed to be high risk. Therefore, we decided to make simultaneous visceral hybrid TAAA repair with 1-vessel reconstruction. In general anesthesia open surgical LRA reconstruction was performed through transperitoneal abdominal approach using a Dacron® knitted graft of 6 mm. The endovascular aortic repair procedure was performed through the exposed left femoral artery. Aortography was performed through a pigtail catheter to determine the level of the proximal landing zone or the level of origin of the Right Renal Artery (RRA). An abdominal aortic cuff stentgraft was inserted over the super stiff guide wire. The proximal landing zone of the stent-graft was the level of the RRA orifice. The LRA was embolized at the orifice and ligated distally from the tear. The final aortogram showed exclusion of the false lumen and no endoleak. Postoperative course of the patient was without complications. At two years after endovascular procedure, CT scan showed complete thrombosis of the false lumen and aneurysm had shrunk to 57 mm

Keywords:

Hybrid repair; Endovascular repair; Thoracoabdominal aorta; Entry closure; Aortic cuf

Citation:

Yamaguchi S, Fujita H, Kanda T, Takeuchi S. Hybrid Repair of Type IV Dissecting Thoracoabdominal Aneurysm Using an Aortic Cuff for Entry Tear Closure. Ann Cardiovasc Surg. 2018; 1(3): 1011.