Hybrid aortic arch debranching and endovascular aneurysm repair for a thoracic aortic aneurysm impending rupture

Abstract

An aortic aneurysm (AA) is an increase in diameter of at least 50% greater than expected for the same aortic segment in unaffected individuals of the same age and sex. It may be asymptomatic except when ruptured or impending rupture. When ruptured it is a life threatening emergency with a significant mortality. On presentation most thoracic AA are incidental findings found on routine work up for other causes or may present with vague back pain. We present one such case in whom a thoracic AA was incidentally detected during routine preoperative workup for squamous cell CA of the tongue. As the thoracic AA was impending rupture and the patient carried a high perioperative mortality risk with conventional aortic surgery, the patient was managed by the heart team with a hybrid technique involving an initial arch debranching surgery followed by endovascular aneurysm repair (EVAR) of the AA using three overlapping stent grafts.

Keywords

• aortic aneurysm
• EVAR
• hybrid debranching
• thoracic aortic aneurysm