HYBRID SURGERY ON THORACIC ANEURISM RUPTURE: AN EFFECTIVE ALTERNATIVE IN A CASE WITHOUT DISTAL NECK

  • Vanda Pinto Departamento de Coração e Vasos, Serviço de Angiologia Cirurgia Vascular, Hospital de Santa Maria – Centro Hospitalar Universitário Lisboa Norte, Portugal; Centro Académico de Lisboa, Portugal
  • Augusto Ministro Departamento de Coração e Vasos, Serviço de Angiologia Cirurgia Vascular, Hospital de Santa Maria – Centro Hospitalar Universitário Lisboa Norte, Portugal; Centro Académico de Lisboa, Portugal; Faculdade de Medicina da Universidade de Lisboa, Portugal
  • Mickael Henriques Departamento de Coração e Vasos, Serviço de Angiologia Cirurgia Vascular, Hospital de Santa Maria – Centro Hospitalar Universitário Lisboa Norte, Portugal; Centro Académico de Lisboa, Portugal
  • Marta Rodrigues Departamento de Coração e Vasos, Serviço de Angiologia Cirurgia Vascular, Hospital de Santa Maria – Centro Hospitalar Universitário Lisboa Norte, Portugal; Centro Académico de Lisboa, Portugal
  • Ryan Melo Departamento de Coração e Vasos, Serviço de Angiologia Cirurgia Vascular, Hospital de Santa Maria – Centro Hospitalar Universitário Lisboa Norte, Portugal; Centro Académico de Lisboa, Portugal
  • Emanuel Silva Departamento de Coração e Vasos, Serviço de Angiologia Cirurgia Vascular, Hospital de Santa Maria – Centro Hospitalar Universitário Lisboa Norte, Portugal; Centro Académico de Lisboa, Portugal
  • Luís Mendes Pedro Departamento de Coração e Vasos, Serviço de Angiologia Cirurgia Vascular, Hospital de Santa Maria – Centro Hospitalar Universitário Lisboa Norte, Portugal; Centro Académico de Lisboa, Portugal; Faculdade de Medicina da Universidade de Lisboa, Portugal
Keywords: Descending thoracic aortic aneurysm, TEVAR, endoleak, hybrid surgery, debranching

Abstract

Endovascular treatment of descending thoracic aortic aneurysms (DTAA) is associated with low rates of morbimortality and is currently the first line of therapeutic intervention. Endoleaks are a well-known complication of this technique, with the consensus that the identification of type I endoleak implies its prompt correction. We present the case of a patient who underwent TEVAR for the treatment of DTAA, with exclusion of the aneurysm in the control angiography. The control CTA showed type Ib endoleak with growth of the aneurysmal sac, so treatment was proposed which the patient refused. The patient was subsequently admitted urgently with rupture of the aneurysm and was immediately subjected to debranching of the visceral trunks, followed by distal TEVAR extension. The hybrid treatment of thoracic aneurysms without a distal landing zone through the debranching of the visceral trunks and TEVAR is an alternative to conventional surgery and complex endovascular surgery that presents good results in patients with high surgical risk and also allows to treat patients in an urgent regime since it does not depend on the manufacture of fenestrated and/or branched endoprostheses.

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Published
2021-03-05
Section
Clinical Case

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