Hybrid treatment of aberrant subclavian artery aneurysm. Case report.
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A 62-year-old man was incidentally diagnosed with a completely asymptomatic aberrant right subclavian artery (ARSA) aneurysm with a maximum diameter of 4.5 cm. This condition presents a postrupture mortality rate of 50% and the morbidity-mortality rates reported in the literature with traditional open repair procedures are of 25%. In our patient we planned a hybrid procedure and excluded the aneurysm by performing, first, a right carotid-subclavian bypass with ligation of the subclavian artery upstream from the vertebral artery and the internal mammary artery and, the day after, by covering its origin from the aortic arch with the placement of a thoracic endoprosthesis. A third session was necessary, three days later, because of a leak; a complete resolution of the condition was achieved by embolizing the still perfused residual aneurysmal sac with Balt metallic coils. (+info)
Staged hybrid treatment of complex ascending aortic and distal aortic arch pseudoaneurysm after repair of aortic coarctation.
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A 49-year-old operated for aortic coartaction patient presented with thoracic and ascending aortic aneurysm. He was asymptomatic. Angio-magnetic resonance nuclear scan and angiography revealed an ascending aortic aneurysm (5.2 cm), bicuspid aortic valve, 6-cm proximal descending aortic pseudoaneurysm at the site of the previous operation with involvement of the left subclavian artery. Restenosis at the original site of coarctation and aortic arch hypoplasia distally to the brachiocefalic trunk was also found. The operation performed was a "modified Bentall - De Bono". The pseudoaneurysm was not accessible through median sternotomy due to the massive lung adhesions following the previous surgery. The left common carotid artery was explanted from the aortic arch and connected with a graft to the ascending aortic conduit. A proximal neck suitable for landing zone of the endovascular stent-graft was then established. The postoperative course was uneventful. After two weeks, the patient was readmitted. The exclusion of the thoracic descending aortic pseudoaneurysm by endovascular implantation of the stent-graft prosthesis was performed. The left subclavian artery was excluded because left vertebral artery was closed. The patient did not develop hand claudicatio. The procedure was successful. (+info)
Spinal cord ischemia after endovascular treatment of infrarenal aortic aneurysm. Case report and literature review.
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Spinal cord ischemia is a rare but catastrophic complication after endovascular treatment of infrarenal aortic aneurysm: only 14 cases are reported in the literature. A patient with a 6 cm infrarenal aortic aneurysm extending to both common iliac arteries and high surgical risk was submitted to endovascular repair with exclusion of both hypogastric arteries and surgical revascularization of the right hypogastric artery. The patient presented paraplegia, apallesthesia and superficial hyposensitivity immediately after the procedure. A spinal cord drainage was positioned with little improvement of superficial sensitivity. We undertook a systematic review of the literature on this topic. (+info)
Treatment of a large postsurgical para-anastomotic aortic aneurysm using endovascular stent grafts. A case report with four-year follow-up.
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This case report describes the outcome of straight endograft placement for treating a large para-anastomotic aortic aneurysm (PAA). A 43-year-old woman was admitted to the emergency department because of a vast PAA (8.7 cm in maximum transverse diameter). Since 1983, she has undergone multiple vascular operations for arterial occlusive disease. In 1990, an aortobifemoral bypass operation was performed. In this most recent intervention, we implanted three tube Excluder(R) endografts. The procedure was uneventful. Considering the size of the aneurysm sac, particular attention was paid to possible sequelae during the over 4-year follow-up period. No complications developed and the last computed tomography (CT) scan showed a remarkable decrease of 50 mm in aneurysm size. In conclusion, the use of straight endografts seems to be effective and lasting, even in large para-anastomotic aneurysmatic lesions. (+info)
Anesthesia for endovascular surgery of the abdominal aorta.
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BACKGROUND AND OBJECTIVES: Endovascular surgery for aneurism of the aorta is less invasive than the conventional procedure besides other advantages such as the absence of abdominal incision, absence of ligature of the aorta, and reduced postoperative recovery time. Since it is a relatively new procedure and to presenting a series of changes that should be known by the anesthesiologist, the objective of this report was to review the most relevant aspects of endovascular surgery, allowing more adequate perioperative anesthetic management. CONTENTS: A brief description of the technique of endovascular aneurism repair, possible vantages and disadvantages of its use, as well as potential complications are discussed. CONCLUSIONS: Knowledge of the changes secondary to the endovascular procedure allows a more adequate anesthetic conduct and improves the postoperative results in those patients. (+info)
Challenging endovascular repair of a critical aortic endograft migration and massive type III endoleak.
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