CC1 Emergent Endovascular Repair of a Ruptured Descending Thoracic Aortic Aneurysm in an Arresting Patient

Area of Science:

• Vascular Surgery
• Cardiovascular Medicine
• Emergency Medicine

Background:

• Ruptured descending thoracic aortic aneurysms are life-threatening emergencies.
• Traditional open repair carries high mortality, especially in hemodynamically unstable patients.
• Emergent endovascular repair offers a less invasive alternative.

Purpose of the Study:

• To present a case of emergent endovascular repair of a ruptured descending aortic aneurysm.
• To highlight the successful management of an actively arresting patient.
• To demonstrate the feasibility of rapid endograft deployment in a critical scenario.

Main Methods:

• A 75-year-old woman with a descending thoracic aortic aneurysm presented with back pain and syncope.
• Computed tomographic angiography confirmed aortic disruption and mediastinal hematoma.
• During induction, pulseless electrical activity arrest occurred; cardiopulmonary resuscitation was initiated. Emergent femoral artery access was obtained, and a thoracic endograft was rapidly deployed using fluoroscopic guidance alone, followed by thoracotomy for hemothorax evacuation.

Main Results:

• The patient regained a pulse immediately after endograft deployment, with cardiopulmonary resuscitation discontinued after 30 minutes.
• Postoperative cooling and lumbar drain placement were performed.
• The patient recovered all neurological and end-organ function, with no aneurysm progression at 6-month follow-up.

Conclusions:

• Rapid introduction and deployment of a descending thoracic aortic endograft for ruptured descending aortic aneurysm is safe and effective in an arresting patient.
• This approach can successfully manage critical aortic emergencies, preserving vital functions.
• Endovascular repair is a viable option for hemodynamically unstable patients with descending thoracic aortic emergencies.