Two-Debranch TEVAR with a Functional Brain Isolation Technique and Abdominal Debranching for a Thoracoabdominal Aortic Aneurysm with a Shaggy Aorta
- VernacularTitle:Shaggy aortaを伴う胸腹部大動脈瘤に対して腹部DebranchおよびFunctional brain isolation法を用いてTEVARを施行し塞栓症を回避し得た1例
- Author:
Takumi ARIYA
1
;
Kazuhiro OHKURA
1
;
Tsunehiro SHINTANI
1
;
Kayoko NATSUME
1
;
Yuto HASEGAWA
1
;
Naoya KIKUCHI
1
Author Information
- Keywords: thoracoabdominal aortic aneurysm; shaggy aorta; functional brain isolation; abdominal debranch; thoracic endovascular aortic repair
- From:Japanese Journal of Cardiovascular Surgery 2023;52(6):434-438
- CountryJapan
- Language:Japanese
- Abstract: A 72-year-old man presented with a thoracoabdominal aortic aneurysm which had been diagnosed six years earlier. Surgical intervention was planned due to aortic diameter enlargement up to 57 mm and back pain. Although he had a shaggy aorta, a preoperative work-up revealed pulmonary dysfunction, which made open repair via thoracotomy challenging. Therefore, a decision was made to proceed with two-stage thoracic endovascular aortic repair (TEVAR) with debranching and functional brain isolation. In the first operation, iliofemoral bypass with debranching of four abdominal vessels was performed via median laparotomy to secure the access route and distal landing zone. In the second operation, two debranching TEVAR was performed. The functional brain isolation technique was employed using cardiopulmonary bypass and balloon occlusion of the left subclavian artery to prevent an embolic stroke from the shaggy aorta during the stent graft deployment. In addition, embolic protection of abdominal branches and lower extremities was established using a balloon occlusion and a sheath in the iliac arteries. The postoperative course was uneventful with no embolic complications. Although the shaggy aorta is not evaluated in Japan SCORE or Euro SCORE, it is a risk factor for perioperative stroke. Those patients would benefit from a tailored approach to prevent embolic complications.
