Extent II open thoracoabdominal aortic aneurysm repair in severe cachexia.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• A 62-year-old woman presented with a symptomatic Crawford extent II thoracoabdominal aortic aneurysm (73 mm diameter).
• The patient had severe dysphagia and dyspnea, with high operative risk due to extreme underweight (BMI 12.9) and COPD (Gold III).
• Endovascular repair was deemed unsuitable for symptom relief and aortic coverage.

Purpose of the Study:

• To describe the successful open surgical management of a complex thoracoabdominal aortic aneurysm in a severely debilitated patient.
• To detail the preoperative conditioning strategies and surgical techniques employed.

Main Methods:

• Preoperative conditioning included nutritional support (percutaneous endoscopic gastrostomy) and respiratory optimization, increasing weight to 43 kg (BMI 15.8).
• Open repair was performed via left thoraco-phreno-laparotomy under deep hypothermia (18°C) with hypothermic circulatory arrest (24 minutes).
• Techniques included femoral arterial and right atrial cannulation, controlled proximal anastomosis, and selective visceral/renal protection due to unsafe distal clamping.

Main Results:

• The patient experienced a prolonged postoperative recovery with respiratory complications requiring tracheostomy.
• No other major complications were observed during the perioperative period.
• At 6-month follow-up, the patient's compressive symptoms resolved, and she was living independently.

Conclusions:

• Open surgical repair of thoracoabdominal aortic aneurysms is feasible even in extremely high-risk patients with significant comorbidities.
• Comprehensive preoperative conditioning and advanced surgical techniques like hypothermic circulatory arrest are crucial for successful outcomes.
• This approach can effectively resolve compressive symptoms and improve quality of life in carefully selected patients.