Successful Endovascular Stent-graft Treatment of a Ruptured Thoracoabdominal Aortic Aneurysm with Coverage of the Celiac Axis

(Department of Cardiovascular Surgery, Tokyo Metropolitan Hiroo General Hospital, Tokyo, Japan)

Tsuyoshi Hachimaru Masazumi Watanabe Satoru Kawaguchi
Hideki Nakahara
A 73-year-old woman was referred to our hospital for treatment of a ruptured thoracoabdominal aortic aneurysm(TAAA). Computed tomography(CT)showed a ruptured saccular TAAA(maximum diameter, 70mm)located just above the celiac trunk. The patient chose to undergo endovascular repair because of the high risk associated with conventional repair, so an emergency endovascular stent-graft treatment was performed. The collateral pathway from the superior mesenteric artery(SMA)to the celiac branches via the pancreaticoduodenal arcades was confirmed by selective angiography of the SMA before stent-grafting. The stent-graft was successfully deployed just proximal to the origin of the SMA with intentional coverage of the celiac axis to achieve sealing. Postoperatively, the patient was free from abdominal organ disorder or paraplegia/paraparesis and was discharged from the hospital after 36 days procedure. Follow-up CT scans performed at 1 week, month and 6 months showed patency in the SMA and the celiac branches, and there was no evidence of an endoleak. A less invasive endovascular repair procedure such as this can be an alternative treatment of a ruptured TAAA.
  Jpn. J. Cardiovasc. Surg. 39:69-73(2010)

Keywords:ruptured thoracoabdominal aortic aneurysm, stent-graft, landing zone, celiac axis, collateral circulation