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[Case of thoracoabdominal aortic aneurysm complicated with Buerger's disease]
1Department of Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan.
Insights
This case study details a rare thoracoabdominal aortic aneurysm (Crawford type III) in a patient with Buerger's disease. Surgical repair using a supplemental graft branch successfully prevented leg ischemia and paraplegia.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Aneurysm Research
Background:
- Thoracoabdominal aortic aneurysms (TAAA) present complex surgical challenges, especially when co-occurring with peripheral vascular diseases.
- Buerger's disease, a rare inflammatory condition affecting small and medium-sized arteries, poses unique risks for patients undergoing major vascular reconstruction.
Observation:
- A 65-year-old male patient presented with a Crawford type III TAAA and diagnosed Buerger's disease, characterized by occluded popliteal arteries.
- Computed tomography (CT) revealed a large aneurysm (95 mm width) extending from the descending thoracic aorta to the aortic bifurcation.
- Intra-arterial digital subtraction angiography (IA-DSA) confirmed bilateral popliteal artery occlusion.
Findings:
- The patient underwent a two-stage surgical repair: initial abdominal aorta graft replacement with a supplemental branch, followed by thoracoabdominal aorta replacement.
- Reconstruction included the celiac, superior mesenteric, and intercostal arteries under partial cardiopulmonary bypass.
- The supplemental graft branch proved crucial in preventing ipsilateral leg ischemia during the procedure.
Implications:
- This surgical strategy, utilizing a supplemental graft branch, demonstrates a viable approach for managing complex TAAAs in patients with concomitant Buerger's disease.
- Selective perfusion techniques during visceral branch reconstruction minimized ischemic complications.
- The successful outcome, with no paraplegia or leg ischemia, highlights the potential for favorable results in challenging vascular cases.
Abstract:
We report a rare case of 65-year-old man who developed thoracoabdominal aortic aneurysm of Crawford type III complicated with Buerger's disease. He was admitted to our hospital with chief complaints of upper abdominal and back pain. CT showed that the aneurysm extended from the descending thoracic aorta to the aortic bifurcation and its had a maximum width of 95 mm. Angiogram (IA-DSA) revealed that both popliteal arteries were occluded slightly above the level of the knee joint, although collateral vessels were visualized. He underwent preliminary graft replacement of the abdominal aorta with the end-to-side supplemental branch for cannulation. Subsequently we performed graft replacement of the thoracoabdominal aorta with reconstruction of the celiac and superior mesenteric arteries and intercostal arteries on under partial cardiopulmonary bypass. This supplemental branch of abdominal aortic graft was useful in preventing ipsilateral leg ischemia. During the reconstruction of the major visceral branches, the branches were perfused selectively via partial extracorporeal circulation. Post operative courses were uneventful without paraplegia and leg ischemia. Angiographic examination revealed excellent hemodynamic results.