Elsevier

Journal of Vascular Surgery

Volume 30, Issue 3, September 1999, Pages 555-560
Journal of Vascular Surgery

Repair of type IV thoracoabdominal aneurysm with a combined endovascular and surgical approach,☆☆,

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Abstract

We report an unusual case of type IV Thoracoabdominal Aneurysm (TAA) with Superior Mesenteric Artery (SMA), celiac artery, and bilateral renal artery aneurysms in a patient who underwent an earlier repair of two infrarenal Abdominal Aortic Aneurysm (AAA) ruptures. Because of the presence of the visceral artery aneurysms and the earlier operation through the retroperitoneum, standard surgical treatment via a retroperitoneal approach with an inclusion grafting technique was considered difficult. A combined surgical approach achieving retrograde perfusion of all four visceral vessels and endovascular grafting allowing exclusion of the TAA was accomplished. Complete exclusion of the aneurysm and normal perfusion of the patient’s viscera was documented by means of follow-up examinations at 3 and 6 months. The repair of a type IV TAA with a Combined Endovascular and Surgical Approach (CESA) allowed us to manage both the aortic and visceral aneurysms without thoracotomy or re-do retroperitoneal exposure and minimized visceral ischemia time. If the durability of this approach is confirmed, it may represent an attractive alternative in patients with aneurysmal involvement of the visceral segment of the aorta. (J Vasc Surg 1999;30:555-60.)

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From the Department of Vascular Surgery, UCLA Center for the Health Sciences and the Department of Vascular Surgery, State University of New York (Dr Panetta).

☆☆

Reprint requests: William J. Quiñones-Baldrich, MD, Vascular Surgery, UCLA Center for the Health Sciences, 10833 Le Conte Ave, #72-167 CHS, Los Angeles, CA 90095-6904.

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