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Ruptured distal aortic arch aneurysm associated with arteriosclerosis obliterans
T Sakurada1, Y Kikuchi, H Osawa
1Department of Cardiovascular Surgery, National Obihiro Hospital, 16, West-18, North-2, Obihiro, Hokkaido 080-8518.
Summary
A ruptured aortic arch aneurysm was successfully treated with total aortic arch replacement. This complex surgery utilized deep hypothermia and selective cerebral perfusion, even with challenging arterial access due to arteriosclerosis obliterans.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Aortic arch aneurysms are life-threatening conditions requiring complex surgical intervention.
- Rupture into adjacent thoracic spaces presents significant management challenges.
- Patient comorbidities, such as arteriosclerosis obliterans, can complicate surgical planning and execution.
Observation:
- A 73-year-old male presented with a ruptured distal aortic arch aneurysm.
- The aneurysm had ruptured into the pericardial space, mediastinum, and right pleural space.
- Severe arteriosclerosis obliterans necessitated alternative arterial cannulation strategies.
Findings:
- Successful total aortic arch replacement was performed.
- The procedure employed deep hypothermia and systemic circulatory arrest.
- Selective cerebral perfusion was utilized to protect brain function during aortic reconstruction.
- Extracorporeal circulation was established via right axillary artery perfusion.
Implications:
- This case highlights the feasibility of complex aortic arch repair in challenging clinical scenarios.
- The successful management underscores the importance of tailored surgical approaches for aortic aneurysms.
- Advanced techniques like selective cerebral perfusion and alternative arterial access are crucial for optimizing outcomes in high-risk patients.