A Case of a 4-Stage Operations, Including TEVAR through the Descending Aorta as an Access Route, for Multiple Aortic Aneurysms Complicated by Severe COPD
- VernacularTitle:重症COPD併存多発性大動脈瘤に対し下行大動脈をアクセスルートとしたステントグラフト内挿術等4期的手術を行った1例
- Author:
Tomonori SANO
1
;
Keiji IWATA
1
;
Takanori SHIBUKAWA
1
;
Yumi KAKIZAWA
1
Author Information
- Keywords: multiple aortic aneurysms; multistage surgery; descending aortic approach; TEVAR; COPD
- From:Japanese Journal of Cardiovascular Surgery 2025;54(1):31-36
- CountryJapan
- Language:Japanese
- Abstract: We report a case of performing a 4-stage operations, including TEVAR through the descending aorta as an access route, for multiple aortic aneurysms complicated by severe COPD. The patient was a 71-year-old woman. A chest X-ray suggested a thoracic aortic aneurysm (TAA). CT scans revealed significant aortic tortuosity and six aortic aneurysms, including a TAA with a maximum diameter of 65 mm. However, due to severe mixed ventilatory impairment with an FEV1 of 39% and a %VC of 64%, a multi-stage surgery including TEVAR was chosen from the perspective of surgical tolerance. Additionally, due to severe calcification and stenosis extending from both iliac arteries to the femoral arteries and significant aortic tortuosity, careful planning for endovascular access was necessary. In the first stage, TEVAR was performed through the descending aorta as the access route for the TAA. In the second stage, a prosthetic graft replacement (abdominal four-branched reconstruction) was performed for the thoracoabdominal aortic aneurysm. In the third stage, TEVAR was performed using a prosthetic graft branch as the access route for the remaining TAA. In the fourth stage, additional TEVAR was performed for the endoleak, and EVAR was performed for the abdominal aortic aneurysm and common iliac artery aneurysm, completing the treatment in four stages. By carefully designing treatment strategies, such as access routes for endovascular stent-graft insertion with a focus on minimal invasiveness, severe postoperative complications, including respiratory issues, were successfully avoided.
