Hybrid Technique for Extensive Aortic Arch Aneurysm after Thoracoabdominal Aortic Aneurysm Repair

Gaku Takinami＊	Hirofumi Midorikawa＊	Kyohei Ueno＊
Rie Kageyama＊	Megumu Kanno＊

（Department of Cardiovascular Surgery, Southern Tohoku General Hospital, Koriyama, Japan）

We report a case of operations using a hybrid technique for repeated extensive aortic aneurysm. A 71-year-old man had extensives aneurysms of the aortic arch and descending aorta. In the first operation, he had undergone thoracoabdominal aortic replacement with island repair for thoracoabdominal aortic aneurysm（Crawford type 3）at age 64. Six years later, computed tomography showed an aortic aneurysm around the region of the island repair and penetrating atherosclerotic ulcer（PAU). Therefore, he underwent abdominal debranching and thoracic endovascular aortic repair（TEVAR）at 70 years old. At the same time, he had an extensive aortic arch aneurysm. Considering the complicated surgical history and the affected region, we judged that conventional graft replacement was difficult. So, in the third operation, we performed TEVAR for the descending aorta at 71 years old. One month later, total arch replacement（TAR）with a frozen elephant trunk（FET）was performed（4th operation). The patient was discharged home 22 days after the 4th operation. This strategy of operations using hybrid techniques for extensive aortic aneurysm may be useful in high risk cases of surgical procedures and postoperative complications.

 

Jpn. J. Cardiovasc. Surg. 47:138-141（2018）

Keywords：extensive aortic aneurysm;frozen elephant trunk;debranching TEVAR;hybrid technique;thoracoabdominal aortic aneurysm