Giant Para-anastomotic Aneurysm after Thoracoabdominal Aortic Aneurysm Repair
10.4326/jjcvs.42.279
- VernacularTitle:胸腹部大動脈瘤切除術後10年の経過を経て発症した吻合部巨大仮性動脈瘤の手術経験
- Author:
Yohei Nomura
;
Daijiro Hori
;
Kenichiro Noguchi
;
Hiroyuki Tanaka
- Publication Type:Journal Article
- Keywords:
abdominal aortic aorta;
anastomotic aneurysm;
re-operation;
spinal prevention
- From:Japanese Journal of Cardiovascular Surgery
2013;42(4):279-283
- CountryJapan
- Language:Japanese
-
Abstract:
Para-anastomotic aneurysms may have dangerous complications such as rupture and thrombosis, with consequent loss of life. As these complications are associated with high mortality rates, early detection and prompt surgical treatment are important. Repair of para-anastomotic aneurysms may be challenging and the surgical approach should be carefully planned. A 66-year-old man had undergone thoracoabdominal aortic aneurysm repair 18 years previously. The diameter of the distal aortic anastomosis was gradually increasing. We comprehensively discussed the surgical approach preoperatively, including consideration of spinal cord protection. Abdominal aortic graft replacement was performed through a midline abdominal incision, with cross-clamping on the proximal side of the aneurysm, continuous intravenous infusion of naloxone, and segmental aortic clamping with distal aortic perfusion and selective visceral perfusion. The left renal artery was reconstructed, and the inferior mesenteric artery and lumbar arteries were preserved.
