Rozwarstwienie tętniaka piersiowo-brzusznego z towarzyszącymi obustronnymi tętniakami tętnic biodrowych wspólnych i wewnętrznych powikłane pęknięciem tętniaka lewej tętnicy biodrowej wewnętrznej - opis przypadku

Abstract

Background. Thoracoabdominal aortic aneurysms (TAA) represent about 10% of all aortic aneurysms. The classic operation by Crawford’s method presents a great burden to the patient. Hybrid surgery, a combination of classical and intravascular techniques, significantly reduces operative trauma and helps to achieve better treatment results.
Material and methods. This study presents the case of a 68-year-old patient treated conservatively for 5 years because of thoracic-abdominal aorta stratification associated with an aneurysm of the abdominal aorta and both common and internal iliac arteries. The patient was treated by a hybrid operation. At the first stage, a thoracic aorta stentgraft was implanted, and at the second stage, during the same operation, the abdominal aorta aneurysm and common iliac artery aneurysms were cut out. An aortic reconstruction was made with a bifurcated prosthesis 18/9mm, and the lower mesenteric artery was implanted to the aortic-biiliac prosthesis.
Results. There were no complications observed in the post-surgery period. A control angio-CT study was performed revealing no leakage of blood outside the stentgraft and no contrasting of the false channel, and showed good blood perfusion of the visceral organs.
Conclusions. Hybrid surgery, due to lower risk of ischaemia of the spinal cord, visceral organs, cardiac complications, and perioperative mortality, is a promising method for the treatment of TAAs. Every case of TAA should be considered individually, taking into account both the patient's general condition and the aneurysm morphology.