Setozaki Shuji, Katayama Hideyuki, Shimomura Shuntaro, Takeuchi Akira, Tsuneyoshi Hiroshi
Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, JPN.
Department of Cardiovascular Surgery, Numazu City Hospital, Shizuoka, JPN.
Cureus. 2024 Dec 30;16(12):e76616. doi: 10.7759/cureus.76616. eCollection 2024 Dec.
Thoracoabdominal aortic aneurysm (TAAA) repair remains one of the most challenging procedures and is associated with high mortality and complication rates. Careful consideration of the surgical strategy is essential, particularly in cases involving extensive replacement and high-risk patients. A 61-year-old man with a 55-mm TAAA was referred for surgical treatment. Seven years earlier, he had undergone artificial vascular replacement for an infrarenal abdominal aortic aneurysm. His medical history included a myocardial infarction with a left ventricular ejection fraction (LVEF) of 20% and an apical thrombus. Additionally, he had chronic kidney disease, cerebral infarction, angina pectoris, hypertension, dyslipidemia, diabetes mellitus, and hyperuricemia. The preoperative plan involved a staged approach, beginning with total arch replacement (TAR) using the frozen elephant trunk (FET) technique and coronary artery bypass grafting (CABG), followed by thoracic endovascular aortic repair (TEVAR) and hybrid repair with abdominal debranching. The patient was discharged without complications. Although thoracoabdominal aortic surgery carries a high risk of mortality, it can be performed safely with careful preoperative assessment and the development of an individualized surgical strategy.
胸腹主动脉瘤（TAAA）修复术仍然是最具挑战性的手术之一，且与高死亡率和并发症发生率相关。仔细考虑手术策略至关重要，尤其是在涉及广泛置换和高危患者的病例中。一名患有55毫米TAAA的61岁男性被转诊接受手术治疗。七年前，他曾因肾下腹主动脉瘤接受人工血管置换术。他的病史包括心肌梗死，左心室射血分数（LVEF）为20%以及心尖血栓形成。此外，他还患有慢性肾病、脑梗死、心绞痛、高血压、血脂异常、糖尿病和高尿酸血症。术前计划采用分期手术方法，首先使用冻结象鼻（FET）技术进行全弓置换（TAR）和冠状动脉旁路移植术（CABG），随后进行胸段血管腔内主动脉修复术（TEVAR）和腹部去分支杂交修复术。患者出院时无并发症。尽管胸腹主动脉手术具有很高的死亡风险，但通过仔细的术前评估和制定个体化的手术策略，可以安全地进行手术。
