[A case of thoracoabdominal aortic aneurysm ruptured into the right extrapleural cavity]

A 63-year-old man of thoracoabdominal aortic aneurysm was transferred to our department. Thoracic and abdominal enhanced CT scan revealed a Crawford's type I A thoracoabdominal aortic aneurysm ruptured into the right extrapleural and retroperitoneal spaces. Without any more additional examination, graft replacement and reconstruction of a lower intercostal artery were performed with an aid of femoro-femoral bypass. Although the postoperative course was complicated by hypertension, hypoventilation and liver dysfunction, the patient recovered from the operation and 10 months later he is leading an almost normal life. Since emergency operation of thoracoabdominal aneurysm is the most courageous challenge because of the difficulties of exposure and visceral organ protection against ischemic, there have been only nine cases with successful surgery in Japan. Now we actively reconstruct lower intercostal and lumbar arteries to prevent spinal cord ischemia without ESCP monitoring in emergency cases.