Promoting a Hybrid Technique for Repair of Thoracic Aortic ...
Hybrid Repair of Aortic Arch Aneurysm
Castigliano M Bhamidipati DO MSc, James N Irvine BS, Klaus D Hagspiel MD†,
Alan H Matsumoto MD†, Megan C Tracci MD JD, John A Kern MD
†Department of Radiology & Medical Imaging
Department of Surgery
University of Virginia School of Medicine, Charlottesville, VA
Corresponding Author,
John A Kern, MD
Associate Professor of Surgery
Division of Thoracic and Cardiovascular Surgery
University of Virginia Health System
P.O. Box 800679
Charlottesville, VA 22908
Office: 434-982-4301
Fax: 434-243-5781
Email: jkern@virginia.edu
ABSTRACT
Hybrid repair of thoracic aortic aneurysm has been used with increasing frequency over the past decade as indications for endovascular therapy have continued to expand. Hybrid techniques may avoid and limit the morbidity and mortality associated with sternotomy or thoracotomy, mechanical circulatory support, and hypothermic arrest. We present the case of extensive aortic aneurysmal disease initially needing open ascending aortic and subsequent thoracoabdominal repair. However, due to continued enlargement of the aortic arch, ultimately hybrid extra-thoracic, extra-anatomic complete aortic arch debranching and transcatheter endografting was pursued with favorable mid-term results.
CASE SUMMARY
In late 1998, a 68-year-old non-smoker active female with treated hypertension and hypercholesterolemia, and no prior vascular disease, was managed with empiric intravenous antibiotics and aggressive beta-adrenergic blockade for an occult locally inflammatory abdominal aortitis. Serial erythrocyte sedimentation rates remained above 90mm/hour, and imaging studies revealed a concomitant aortic dissection distal to the inferior mesenteric artery. Repeated imaging analyses also revealed an incidental ascending aortic aneurysm ( ................
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