Jang AY, Oh PC, Kang JM, Park CH, Kang WC. Extensive complex thoracoabdominal aortic aneurysm salvaged by surgical graft providing landing zone for endovascular graft: A case report. World J Clin Cases 2022; 10(15): 5005-5011 [PMID: 35801037 DOI: 10.12998/wjcc.v10.i15.5005]
Corresponding Author of This Article
Woong Chol Kang, MD, PhD, Professor, Division of Cardiology, Gil Medical Center, Gachon University of Medicine and Science, 783 Namdong-daero, Incheon 1198, South Korea. kangwch@gilhospital.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 26, 2022; 10(15): 5005-5011 Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.5005
Extensive complex thoracoabdominal aortic aneurysm salvaged by surgical graft providing landing zone for endovascular graft: A case report
Albert Youngwoo Jang, Pyung Chun Oh, Jin Mo Kang, Chul Hyun Park, Woong Chol Kang
Albert Youngwoo Jang, Department of Cardiology, Gachon University Gil Medical Center, Incheon 1198, South Korea
Pyung Chun Oh, Department of Internal Medicine, Gil Medical Center, Gachon Cardiovascular Research Institute, Gachon University College of Medicine, Incheon 1198, South Korea
Jin Mo Kang, Division of Vascular Surgery, Gachon University Gil Medical Center, Incheon 1198, South Korea
Chul Hyun Park, Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Incheon 1198, South Korea
Woong Chol Kang, Division of Cardiology, Gil Medical Center, Gachon University of Medicine and Science, Incheon 1198, South Korea
Author contributions: Jang AY and Kang WC were the patient’s interventionists, reviewed the literature and contributed to manuscript drafting, writing, editing, and revising; Oh PC, Kang JM, and Park CH were interventionists or surgeons of the patient, who reviewed and edited the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Woong Chol Kang, MD, PhD, Professor, Division of Cardiology, Gil Medical Center, Gachon University of Medicine and Science, 783 Namdong-daero, Incheon 1198, South Korea. kangwch@gilhospital.com
Received: November 6, 2021 Peer-review started: November 6, 2021 First decision: December 27, 2021 Revised: January 7, 2022 Accepted: March 25, 2022 Article in press: March 25, 2022 Published online: May 26, 2022
Abstract
BACKGROUND
Surgical repair of complex abdominal aortic aneurysm is associated with a higher perioperative mortality and morbidity. The advent of endovascular aortic repair (EVAR) has reduced perioperative complications, although the utilization of such techniques is limited by lesion characteristics, such as involvement of the visceral or renal arteries (RA) and/or presence of a sealing zone.
CASE SUMMARY
A 60-year-old male presented with a Crawford type IV complex thoracoabdominal aortic aneurysm (CAAA) starting directly distal to the diaphragm extending to both common iliac arteries (CIAs). The CAAA consist of a proximal and distal aneurysmal sac separated by a 1 cm-healthy zone in the infrarenal level. Due to the poor performance of the patient and the expansive disease, we planned a stepwise-combined surgery and EVAR to minimize invasiveness. A branched graft was implanted after surgical debranching of the visceral and RA. Since the patient had renal and liver injury after surgery, the second stage EVAR was performed 10 mo later. The stent graft was implanted from the distal portion of surgical branched graft to both CIAs during EVAR. The patient has been uneventful for 5-years after discharge and is being followed in the outpatient clinic.
CONCLUSION
The current case demonstrates that the surgical graft can provide a landing zone for second stage EVAR to avoid aggressive surgery in patients with poor performance with a long hostile CAAA.
Core Tip: Complex thoracoabdominal aortic aneurysm (CAAA) is an aortic disease requiring aggressive surgery. Herein, we report a case where branched graft was implanted covering half of the aortic disease, followed by a stent graft inserted through endovascular aortic repair to minimize invasiveness in a patient with extensive CAAA.
