Emergency thoracoabdominal aortic repair: distal-first approach with two previous aortic repairs.
Vinci Naruka, Ujjawal Kumar, Irfan Rasheed et al.
✦ AI-curated · Sources linked
Case in brief
A 59-year-old man with preoperative haemodialysis and two prior aortic repairs—a frozen elephant trunk for acute type A dissection and subsequent thoracic endovascular repair—presented with chest pain. Imaging showed a 74 mm descending thoracic aneurysm with features of impending rupture and a type Ib endoleak. Because further endovascular treatment was considered unsuitable, he underwent emergency open thoracoabdominal repair. A distal-first strategy enabled reconstruction despite chronic dissection and distal perfusion challenges. Neuromonitoring was preserved; he recovered well, was discharged home 5 weeks after surgery, and imaging showed a patent repair.
What made this case unusual
The distal-first open repair addressed a complex aneurysm after two previous aortic interventions, with chronic dissection complicating distal perfusion and the proximal anastomosis incorporating both prior endografts.
Diagnostic / clinical pearl
In selected complex thoracoabdominal repairs after prior aortic interventions, a distal-first sequence can facilitate reconstruction when chronic dissection makes distal perfusion challenging.