Prevention of Embolization in Concomitant Endovascular Therapy for Thoracic and Abdominal Aneurysms with Severely Atheromatous Aorta

Abstract

A 74-year-old man with multiple aortic aneurysms and shaggy aorta was simultaneously treated by conventional open repair for an abdominal aortic aneurysm and endoluminal stent grafting for a thoracic aortic aneurysm. We performed intermittent clamping of the visceral and carotid arteries under an extracorporeal circulation circuit without a blood flow pump, which lead to the avoidance of embolization in spite of the disadvantage of endoluminal stent grafting for atheromatous aorta.

Keywords: endoluminal therapy; multiple aortic aneurysms; severely atheromatous aorta.

Fig. 1

CT shows an atheroma-rich aorta with an obstruction of the right common iliac artery, a saccular aneurysm in the thoracic aorta, and a fusiform aneurysm in the abdominal aorta. CT: computed tomography

Fig. 2

A photograph showing a graft with the end of the limb sutured to the graft body. The limbs were then cut at the lines to make a tetra-furcated graft.

Fig. 3

Two pictures and a schema showing the operating field after grafting of the abdominal aorta. Visceral vessels are taped with tourniquets. A sheath (24 Fr GORE DrySeal Sheath with Hydrophilic Coating, W.L. Gore & Associates, Flangstaff, AZ, USA) is inserted to a graft limb for the access route of ET, and the drainage tube is inserted to another graft limb and perfusion to the femoral vein. ET: endoluminal therapy; CA: celiac artery; SMA: superior mesenteric artery; RA: renal artery; FV: femoral vein; TAA: thoracic aortic aneurysm

Fig. 4

Photographs showing the large amount of debris that was captured by the filter (a) and (b). Postoperative 3D-CT showing successful Zone 2 TEVAR without any endoleak (c). 3D-CT: three-dimensional computed tomagraphy; TEVAR: thoracic endovascular aortic repair