About the journal

Cobiss

Srpski arhiv za celokupno lekarstvo 2013 Volume 141, Issue 1-2, Pages: 89-94
https://doi.org/10.2298/SARH1302089D
Full text ( 359 KB)


Hybrid procedure in the treatment of thoracoabdominal aortic aneurysms: Case report

Davidović Lazar B. ORCID iD icon (Medicinski fakultet, Beograd + Klinički centar Srbije, Klinika za vaskularnu i endovaskularnu hirurgiju, Beograd)
Ilić Nikola (Medicinski fakultet, Beograd + Klinički centar Srbije, Klinika za vaskularnu i endovaskularnu hirurgiju, Beograd)
Končar Igor ORCID iD icon (Medicinski fakultet, Beograd + Klinički centar Srbije, Klinika za vaskularnu i endovaskularnu hirurgiju, Beograd)
Dimić Andreja (Klinički centar Srbije, Klinika za vaskularnu i endovaskularnu hirurgiju, Beograd)
Čolić Momčilo (Klinički centar Srbije, Klinika za vaskularnu i endovaskularnu hirurgiju, Beograd)
Sinđelić Radomir (Medicinski fakultet, Beograd + Klinički centar Srbije, Klinika za vaskularnu i endovaskularnu hirurgiju, Beograd)

Introduction. Treatment of thoracoabdominal aortic aneurysms is a major problem in vascular surgery. Conventional open repair is associated with significant rates of mortality and morbidity and therefore, there is a need for better solutions. One of them is a hybrid procedure that includes visceral debranching. This paper presents the first such case performed in Serbia, with a brief overview on all published procedures worldwide. Case Outline. A 57-year-old woman was admitted to the hospital because of thoracoabdominal aneurysms type V by Crawford-Safi classifications. Because of the significant comorbidities it was concluded that conventional treatment would bear unacceptably high perioperative risk, and that the possible alternative could be the hybrid procedure in two stages. In the first stage aortobiliacal reconstruction with bifurcated Dacron graft (16×8 mm) and visceral debranching with hand made tailored branched graft was done. In the second act, the thoracoabdominal aneurysm was excluded with implantation of the endovascular Valiant stent graft, 34×150 mm (Medtronic, Santa Rosa, CA). Control MSCT angiography showed a proper visceral branch patency and positioning of the stent graft without endoleaks. Nine months after the procedure the patient was symptom-free, with no aneurysm, diameter change and no graft-related complication. All visceral branches were patent. Conclusion. So far about 500 cases of visceral debranching have been published with the aim of treating thoracoabdominal aneurysms, and still we have no valid guidelines concerning this method. However, in carefully selected high-risk patients this is an excellent alternative to open surgery of thoracoabdominal aneurysms.

Keywords: thoracoabdominal aneurysms, visceral debranching, hybrid procedure