Successful hybrid treatment for a ruptured thoracoabdominal aortic aneurysm in a patient with systemic lupus erythematosus

Abstract

A 49-year-old woman with a 27-year history of systemic lupus erythematosus (SLE) was admitted to our hospital with sudden-onset severe back pain. An emergency multidetector computed tomography (MDCT) revealed a ruptured thoracoabdominal aortic aneurysm (TAAA) 80 mm in diameter. Considering her condition and comorbidities, we performed an emergency hybrid treatment: visceral reconstruction followed by endoluminal aneurysm exclusion. She recovered uneventfully, except for the need for temporary hemodialysis. TAAA complicated with SLE is extremely rare. To our knowledge, this is the first successful report in the English literature of a ruptured TAAA in a patient with SLE who underwent hybrid treatment.

Keywords: SLE; hybrid treatment; ruptured TAAA.

Fig. 1

A→D: upper slice→lower slice Preoperative MDCT shows ruptured TAAA 80 mm in diameter and severe calcification of the entire aorta. MDCT: multidetector computed tomography; TAAA: thoracoabdominal aortic aneurysm

Fig. 2

(A) front view, (B) lateral view Preoperative three-dimensional CT angiography scan shows large type III TAAA. The celiac artery was occluded at its origin and was perfused with collaterals from the SMA. CT: computed tomography; TAAA: thoracoabdominal aortic aneurysm; SMA: superior mesenteric artery

Fig. 3

(A) front view, (B) lateral view White arrow: graft to the left RA, Black arrow: graft to the SMA Postoperative three-dimensional CT angiography scan shows good positioning of the stent-grafts, no sign of endoleak and well visualization of visceral bypass graft. There observed adequate opacification of the celiac artery by the collateral flow from the SMA. RA: renal artery; SMA: superior mesenteric artery; CT: computed tomography