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Never Ending Story: Twice Open Aortic Surgery, Triple Tevar And Embolization Of An Aneurysm In One Patient
Doreen Richardt, Hans-Hinrich Sievers, Christian Auer, Jan Goltz, Markus Kleemann.
University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
OBJECTIVE: A 71-years old female was admitted to our emergency room with intense pain, syncope, dyspnea, hematothorax and acute decompensation due to an acute perforated aortic aneurysm in the descending aorta. In her history she had cardiac surgery with replacement of the ascending aorta and the aortic arch in april 2015 with wound healing deficit over two months and TEVAR (3 stents) in june 2015 with residual endoleaks type Ib and II. She had a stroke ten days before emergency admission with epilepsy and a lot of additional comorbidities.
METHODS: An interventional procedure was discussed, but not possible due to anatomic reasons. Therefore a re-re-operation as ultima ratio procedure and a partial replacement of the decending aorta was done. Patient survived and recovery was unexpected satisfying.
RESULTS: Over three months after this high-risk procedure the patient developed an increasing endoleak type II and an aneurysm of the descending aorta with a diameter of 10 x 8.2 cm. The lung on the left side was heavily compressed due to the aneurysm with atelectasis. Open surgery was discussed in detail but denied due to the very high risk.
Finally an embolization of the nidus of the endoleak in the thoracic aorta, the truncus intercostobrachialis, was done with Ethylen-Vinyl-Alkohol (Onyx).
CONCLUSIONS: The patient did well and was discharged at home a week after the procedure.
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