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Urgent Thoracic EndoVascular Aortic Repair of Acute Aortic Syndrome in Patients with Comorbidities
Mitsuhiro Kawata1, Tsuyoshi Taketani2, Sei Morizumi1, Yoshihiro Suematsu1.
1Tsukuba Memorial Hospital, Tsukuba, Japan, 2Mitsui Memorial Hospital, Tokyo, Japan.

OBJECTIVE: Acute aortic syndrome (AAS) is associated with high mortality and morbidity. Furthermore, AAS in patient with comorbidities may be judged by the age or its comorbidities that a conventional open surgery is impossible. Thoracic endovascular aortic repair (TEVAR) using a commercially available device has emerged as an alternative to open surgery.
We report four successful TEVAR performed for AAS detailing our experience.
METHODS: From April to December 2012, in our hospital, there were four urgent TEVAR for AAS. All of them were survived.
RESULTS: [CASE 1] A 93-year-old woman with renal dysfunction was taken to the emergency room due to severe back pain who was diagnosed as 5.7 g/dl of hemoglobin level and ruptured TAAA (Crawford V). Urgent visceral debranching TEVAR (Celiac a., SMA) was performed after making a general condition improve. On day 15, she was discharged to home.
[CASE 2] A 75-year-old man with a history of CABG (patent LITA-LAD and SVG-OM), TEVAR for distal aortic arch, and cerebral infarction, who presented to the emergency room at massive hemoptysis.
It was diagnosed as the stent graft dislodgement, 80 mm of saccular ruptured TAA. Urgent debranching (LtCCA, LtSCA) TEVAR was performed. On day 17, he was discharged to home.
[CASE 3] A 87-year-old man. Vomiting by an esophageal transit obstacle and aspiration pneumonia were repeated from one-month before. He was taken to the emergency room by diagnosis of impending ruptured TAA (descending, 90 mm, saccular). Urgent TEVAR was performed. On day 2, he could walk. Feeding-tube was endoscopically inserted on day 3, and a tube feeding started. On day 36, he was discharged to home.
[CASE 4] A 63-year-old woman with aortoiliac occlusive disease who was diagnosed ruptured TAA (descending, 70mm). After sternotomy, antegrade TEVAR was performed from the ascending aorta. On day 14, she was discharged to home.
CONCLUSIONS: TEVAR is safe and effective option for life-threatening AAS in patients with comorbidities. Regular follow-up is mandatory.

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