Jang Albert Youngwoo, Oh Pyung Chun, Kang Jin Mo, Park Chul Hyun, Kang Woong Chol
Department of Cardiology, Gachon University Gil Medical Center, Incheon 1198, South Korea.
Department of Internal Medicine, Gil Medical Center, Gachon Cardiovascular Research Institute, Gachon University College of Medicine, Incheon 1198, South Korea.
World J Clin Cases. 2022 May 26;10(15):5005-5011. doi: 10.12998/wjcc.v10.i15.5005.
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.
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.
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.
复杂腹主动脉瘤的外科修复与较高的围手术期死亡率和发病率相关。血管腔内主动脉修复术（EVAR）的出现降低了围手术期并发症，尽管此类技术的应用受到病变特征的限制，如内脏或肾动脉（RA）受累和/或存在密封区。
一名60岁男性患者，患有Crawford IV型复杂胸腹主动脉瘤（CAAA），起始于膈肌远端直接延伸至双侧髂总动脉（CIA）。该CAAA由一个近端和远端动脉瘤囊组成，在肾下水平由一个1厘米的健康区域分隔。由于患者身体状况较差且病情进展，我们计划采用分步联合手术和EVAR以尽量减少侵袭性。在对内脏和RA进行手术去分支后植入了一个分支移植物。由于患者术后出现肾和肝损伤，10个月后进行了第二阶段的EVAR。在EVAR期间，将支架移植物从手术分支移植物的远端部分植入至双侧CIA。患者出院后5年情况良好，正在门诊接受随访。
当前病例表明，手术移植物可为第二阶段的EVAR提供一个着陆区，从而避免对身体状况较差且患有长节段不良CAAA的患者进行激进手术。
