Debranching Thoracic Endovascular Aortic Repair (TEVAR) for Thoracoabdominal Aortic Dissecting Aneurysm Involving the Visceral Arteries: A Case Report.

Abstract

Surgical repair of thoracoabdominal aortic aneurysms (TAAA) is a complex procedure that is associated with marked morbidity and mortality. Endovascular TAAA repair, initially reserved for patients at high risk, has yielded promising results and is performed on an increasing range of patients. This case report describes a hybrid approach-a combination of endovascular and open repair-for a patient with high-risk TAAA after aortic dissection. A 79-year-old man had undergone aortic replacement for chronic aortic dissection 20 years previously. His saccular TAAA, extending from the Th12 level to the renal artery origin, demonstrated progressive enlargement (56-60 mm) on computed tomography (CT) scans and compressed the celiac artery. In light of the patient' s age and thoracotomy history, a hybrid repair strategy involving total debranching thoracic endovascular aortic repair (TEVAR) with four-branch abdominal reconstruction was selected to minimize surgical risk. The surgery was performed via a midline abdominal incision. Bypass surgery was first performed using a quadrant artificial graft to restore left renal, right renal, superior mesenteric, and common hepatic artery blood flow. The celiac artery was coiled, and TEVAR was completed. Intraoperative contrast and postoperative CT showed no endoleak and a patent debranching graft. The patient recovered without complications and was discharged 10 days postoperatively. The findings for the present hybrid procedure indicate that debranching TEVAR is less invasive and yields better outcomes than open aortic replacement, particularly for patients at high risk.