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[A case of progressive saccular aneurysm caused by localized dissection of descending aorta]
T Koyama1, K Nishimura, Y Kitanaka
1Division of Cardiovascular Surgery, St. Marianna University School of Medicine, Yokohama City Seibu Hospital.
Insights
This case report details a rare saccular aneurysm of the descending aorta, resulting from localized dissection. Surgical repair using a prosthetic graft was successful, highlighting a limited but viable treatment option.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Aneurysm
Background:
- A fifty-three-year-old male presented with chest pain, initially diagnosed with localized descending aortic dissection.
- Hypertension management was initiated for the partially thrombosed dissection.
Observation:
- A follow-up CT scan revealed significant dilatation of the false lumen.
- Magnetic resonance angiography confirmed a saccular aneurysm in the descending aorta's mid-portion.
Findings:
- Surgical intervention via posterolateral thoracotomy with femoro-femoral bypass was performed.
- A 70 mm x 45 mm saccular aneurysm at the T5 level, with posterior wall entry and organized thrombus, was identified.
- Successful replacement with a prosthetic graft was achieved.
Implications:
- This case highlights a rare presentation of a saccular aneurysm secondary to localized aortic dissection.
- Surgical management is effective for this uncommon condition.
- Further research into the long-term outcomes of such cases is warranted.
Abstract:
A fifty-three-year-old man was admitted because of chest pain. CT scan showed the localized dissection of the descending aorta which was partially thrombosed. The patient was followed by controlling of essential hypertension. He, however, complained of the second attack of chest pain after a year and 5 months. CT scan showed the increased dilatation of the false lumen as compared to that of previous examination. MR angiogram showed a saccular aneurysm localized in the middle portion of the descending aorta. An operation was performed through posterolateral thoracotomy in the 4th intercostal space with the aid of normothermic femoro-femoral bypass circulation. The aneurysm was located at the level of 5th thoracic vertebra with the size of 70 mm in length and 45 mm in diameter. Entry was observed in the posterior wall of the aorta, and the terminal end of the false lumen was occluded with the organized thrombus. The aneurysm was successfully replaced with a prosthetic graft. To the extent of our knowledge, only limited surgical cases of saccular aneurysm caused by localized dissection of the middle portion of the descending aorta have been reported.