Open prosthetic repair of descending aortic aneurysm after its primary endoprosthetic repair

• Published in: Angiologii͡a︡ i sosudistai͡a︡ khirurgii͡a Vol. 27; no. 4; p. 131
• Main Authors: Shlomin, V V, Grebenkina, N Iu, Shloĭdo, E A, Bondarenko, P B, Puzdriak, P D, Drozhzhin, I G, Karpov, I A, Vedernikova, E S, Kositsyna, I M
• Format: Journal Article
• Language: English; Russian
• Published: Russia (Federation) 2021
• Subjects: Aged, 80 and over; Aorta, Abdominal - diagnostic imaging; Aorta, Abdominal - surgery; Aortic Aneurysm; Aortic Aneurysm, Abdominal - diagnosis; Aortic Aneurysm, Abdominal - surgery; Aortic Aneurysm, Thoracic - diagnosis; Aortic Aneurysm, Thoracic - etiology; Aortic Aneurysm, Thoracic - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Female; Humans; redo aortic surgery; temporary aortic bypass graft; stent graft explantation; thoracic aorta endoprosthetic repair; late complications of endoprosthetic repair; abdominal aorta endoprosthetic repair; thoracoabdominal aneurysm
• ISSN: 1027-6661
• DOI: 10.33529/ANGIO2021415

Presented in the article is a clinical case report regarding management of an 82-year-old female patient with late complications after staged treatment for an aneurysm of the descending and abdominal portions of the aorta, with the first stage consisting in endoprosthetic repair of the descending aortic portion and the second stage (after 4 months) in endoprosthetic repair of the abdominal aortic portion. Outpatient computed tomography performed 9 months after endoprosthetic repair of the abdominal aorta revealed an increase in aortic diameter over the distance between two stent grafts in the thoracic and abdominal aortic portions from 44 mm to 76 mm. In May 2019, a repeat operation was performed: resection of the aneurysm of the distal portion of the descending aorta on temporary subclavian-femoral and prosthesis-femoral shunts, with dissection of part of the thoracic stent graft, followed by formation of a proximal anastomosis between the endoprosthesis and a 30-mm linear Dacron prosthesis, and a distal anastomosis above the celiac trunk. The woman was discharged on POD 16. Follow-up computed tomography performed 8 months later demonstrated a type II endoleak from the inferior mesenteric artery and growth of the abdominal aortic aneurysm, thus requiring embolization of the ostium of the inferior mesenteric artery via the system of the superior mesenteric artery, with a good clinical effect and a decrease in the diameter of the aortic abdominal aneurysm.