Galyfos George, Sigala Fragiska, Basigos Gerasimos, Karantzikos Georgios, Katsaragakis Stilianos, Filis Konstantinos
Division of Vascular Surgery, First Propaedeutic Department of Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
Division of Vascular Surgery, First Propaedeutic Department of Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
Ann Vasc Surg. 2016 Oct;36:294.e7-294.e11. doi: 10.1016/j.avsg.2016.03.024. Epub 2016 Jul 15.
Severe calcification of the aorta or iliac vessels remains a major concern when planning open or endovascular treatment of an abdominal aortic aneurysm (AAA). Therefore, we present a unique case of an AAA with concomitant severe calcification of the entire infrarenal aortoiliac region and discuss on proper management.
A 70-year-old patient with a symptomatic AAA was scheduled for repair. The diagnostic investigation revealed a 70-mm-diameter AAA with severe calcification of the neck and the iliac and femoral arteries, raising major concerns regarding the proper repair strategy. Under careful consideration of all the risks and parameters, the patient underwent a hybrid treatment with endovascular balloon occlusion of the aortic neck and careful clamping just proximal to the bifurcation. Minimal mobilization of the aorta, careful transecting and drilling of the aortic wall, and careful suturing of a straight graft were part of the whole strategy. One-year follow-up of the patient is unremarkable.
In cases of AAA with significantly calcified aorta and aortic bifurcation, careful preoperative planning is imperative, taking into consideration the individualized characteristics of each patient. Hybrid techniques including proximal endovascular occlusion, careful mobilizations, aortic wall drilling, and tight suturing of the graft could be a reasonable strategy for such patients. However, larger case series is needed to prove the efficacy of this method.
在计划对腹主动脉瘤（AAA）进行开放手术或血管腔内治疗时，主动脉或髂血管的严重钙化仍然是一个主要问题。因此，我们报告了一例独特的AAA病例，其肾下腹主动脉髂总动脉区域伴有严重钙化，并探讨了合适的治疗方法。
一名70岁有症状的AAA患者计划接受修复手术。诊断检查发现一个直径70毫米的AAA，其颈部、髂动脉和股动脉严重钙化，这引发了对合适修复策略的重大担忧。在仔细考虑所有风险和参数后，患者接受了一种混合治疗，即通过血管腔内球囊闭塞主动脉颈部，并在分叉近端小心地进行钳夹。主动脉的最小程度游离、小心地切开和钻开主动脉壁以及小心地缝合直型移植物是整个治疗策略的一部分。对该患者进行的一年随访结果无异常。
对于主动脉和主动脉分叉显著钙化的AAA病例，必须进行仔细的术前规划，同时考虑每个患者的个体化特征。包括近端血管腔内闭塞、小心游离、主动脉壁钻孔和移植物紧密缝合在内的混合技术可能是这类患者的合理治疗策略。然而，需要更大规模的病例系列来证明该方法的疗效。
