Espinosa Gaudencio, Grochowicz Lukasz, Pascual Ignacio, Lavilla Javier, Olavide Isidro, Hernández Miguel David, Landecho Manuel Fortún, Lucena Juan Felipe, Bastarrika Gorka, Del Pozo José Luis, Gavira Juan José, Alegre Félix
Department of Vascular Surgery, Clínica Universidad de Navarra, Pamplona, Spain.
Ann Vasc Surg. 2013 Oct;27(7):974.e1-6. doi: 10.1016/j.avsg.2012.11.010.
In the last 20 years, endovascular procedures have radically altered the treatment of diseases of the aorta. The objective of endovascular treatment of dissections is to close the entry point to redirect blood flow toward the true lumen, thereby achieving thrombosis of the false lumen. In extensive chronic dissections that have evolved with the formation of a large aneurysm, the dissection is maintained from the end of the endoprosthesis due to multiple orifices, or reentries, that communicate with the lumens. In addition, one of the primary limitations of this technique is when the visceral arteries have disease involvement. In this report we present a case where, despite having treated the entire length of the descending thoracic aorta, the dissection was maintained distally, leading to progression of the diameter of the aneurysm. After reviewing the literature, and to the best of our knowledge, we describe the first case in which renal autotransplant was performed to allow for subsequent exclusion of the aorta at the thoracoabdominal level using a fenestrated endoprosthesis for the celiac trunk and the superior mesenteric artery.
