TEVAR For TAA Rupture With Hemoptysis
Ryoji Kinoshita, Hidetoshi Uchiyama, Yohei Yamamoto, Masahiro Oonuki.
Tsuchiura Kyodo General Hospital, Tsuchiura city, Ibaraki, Japan.
BACKGROUND: A rupture of the thoracic aortic aneurysm into the lung with hemoptysis is a rare condition, and there have been several case reports of open thoracic surgery in the past. However, in elderly patients, treatment is often difficult because of the high degree of invasiveness. In this study, we performed TEVAR for rupture of the thoracic aortic aneurysm into the lung in five elderly patients and reported the results.
METHODS: Five patients underwent TEVAR for rupture of the thoracic aortic aneurysm into the lung in our department between June 2018 and February 2020 were included in this study.
RESULTS: The mean age was 79.6 years, 4 males and 1 female. 2 patients were in shock vital due to massive hemoptysis. All patients had saccular aneurysms with a mean maximum diameter of 55 mm, three of which were descending aortic aneurysms, one was a ULP caused by SINE at the distal end of the frozen elephant trunk for repair of acute type A aortic dissection, and one was a pseudoaneurysm at the distal anastomosis site after arch replacement. Emergency surgery was performed in all patients. 4 of 5 patients could be extubated in the operating room. 3 of 5 patients had high fever or high inflammatory reaction at the time of onset (one of them had positive blood culture at the time of admission), and antibiotics were administered for at least 3 weeks after surgery because of the suspected complication of infection. CT at discharge showed no endoleaks in all patients. The mean hospital stay was 19 days, and there were no early deaths. In two patients who did not continue oral antibiotics for a long period after discharge, stent grafts migrated due to prosthetic graft infection, requiring additional TEVAR in these cases.
CONCLUSIONS: TEVAR is a minimally invasive procedure with excellent early outcomes for elderly patients with rupture of the thoracic aortic aneurysm into the lung. However, long-term postoperative antibiotic therapy is essential for prevention of infection and stable maintenance of the stent graft because of the high risk of prosthetic graft infection due to direct contact with lung tissue.
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