Aorta Remodeling after Endovascular Treatment of a Chronic DeBakey IIIb Aneurysm and Simultaneous Palliation of a Renal Cell Carcinoma

Abstract

We report the case of a patient with a chronic DeBakey type IIIb aneurysm who underwent thoracic endovascular aortic repair to seal the primary entry tear and stent-graft insertion to cover the re-entry tear at the renal artery. The procedure was performed in order to achieve complete thrombosis in the entire thoracoabdominal false lumen, leading to favorable aortic remodeling. Simultaneously, ethanol ablation and renal artery embolization were performed to treat a renal tumor suspicious of renal cell carcinoma. Radical nephrectomy then confirmed clear cell carcinoma. To the best of our knowledge, no other cases of this type have been reported in the Korean literature.

Keywords: Aortic dissection; Endovascular procedures; Renal cell carcinoma.

Fig. 1

(A) Initial preoperative computed tomography (CT) scan showing an acute DeBakey type IIIb aortic dissection with a maximum diameter of 36 mm. (B) Initial preoperative CT scan showing a renal cystic lesion about 23 mm in diameter on the right kidney (Bosniak IIF). (C) A CT scan performed twelve months later, showing that the aneurysm had grown to 46 mm. (D) Renal tumor formation on the right kidney.

Fig. 2

(A) Zone 3 thoracic endovascular aortic repair (TEVAR) in the supraceliac trunk. (B) Complete thrombosis in the false lumen. (C) A re-entry tear at the origin of the right renal artery (top). A Viabahn stent graft (6 mm diameter, 25 mm length; W.L. Gore & Associates, Flagstaff, AZ, USA) was inserted into the right renal artery (bottom). (D) Total ablation of the right renal artery using a mixture of 99.9% ethanol (9 mL) and lipiodol (1 mL) together with coil embolization. (E) A computed tomography scan taken 11 months later, showing favorable aortic remodeling with a decreased aortic diameter and resorption of the thrombosis of the false lumen.

Fig. 3

(A) Computed tomography scan showing an atrophied right kidney containing a renal tumor with a decreased diameter of 16 mm. (B) Gross finding after en bloc radical nephrectomy.