Repair Of A Saccular Aortic Arch Aneurysm In A Patient With BehcetíS Disease And Multiple Aortic Aneurysms. A Case Report.
Tamer M. Abdalghafoor, Hatem Sarhan, Mohamad Elkahlout, Laith Tbishat, Dina Alwaheidi, Abdul Wahid Al-Mulla.
Hamad Medical Corporation, Doha, Qatar.
Abstract Behcetís disease (BD) rarely causes an aortic aneurysm. When diagnosed, management of an aortic aneurysm poses challenges that may include determining effective medical treatment and both timing of and type of intervention. A case of aortic arch aneurysm in a patient with Bechetís disease who had successful surgical repair is presented. A 30-year-old male patient who had undergone previous repair of an abdominal aortic aneurysm presented an aortic arch aneurysm that was incidentally discovered by thoracic computerized tomography (CT), which showed a large saccular arch aneurysm distal to the origin of the left common carotid artery. He underwent successful urgent surgical repair 10 months after surgical repair of an abdominal aortic aneurysm (AAA). BD is a complex multisystemic disease. Cardiovascular involvement as described in the literature van vary between 2% and 45%. Cardiovascular manifestations of BD include vascular and cardiac involvement. Arterial involvement is the main cause of death in BD. CT scan and magnetic resonance imaging (MRI) are the gold standard techniques for identifying these aneurysms. Medical management based on immunosuppression should be initiated before surgical intervention to produce a decrease in post-operative complications. Timing of and type of intervention are crucial. Surgical intervention is the gold standard for treatment. However, with the advances in transcatheter intervention, endovascular repair is an alternative in some of the cases. However, AAA surgery remains the mainstay intervention. In particular, AAA surgery is challenging in that it requires protecting the brain during a period of total circulatory arrest. Antegrade cerebral perfusion via the axillary artery is one of the standard techniques that improves aortic arch surgery. Aortic aneurysms resulting from BD are rare. Arch aneurysms remain surgically challenging and have a poor prognosis if not repaired. Hypothermic circulatory arrest with antegrade cerebral perfusion (HCA with ACP) via the axillary artery has a significantly positive impact on aortic arch surgery.
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