Abstract
We present the case of a 75-year-old man with repeated lower limb hematoma caused by consumptive coagulopathy from a type B chronic aortic dissection. His abdominal aorta was replaced with a Y-shaped graft 30 years prior to admission. As his previous aortic stent graft treatment failed, he underwent open surgical prosthetic graft replacement of the descending aorta under deep hypothermia. To reduce intra- and postoperative bleeding, we avoided cutting the ribs and intercostal arteries. The aneurysm was approached only through the 8th intercostal space; however, as the proximal descending aorta was inaccessible from this site, total endoscopic or endoscopic-assisted procedure was performed to approach the proximal descending aorta. All intercostal arterial orifices were securely closed by suture. The postoperative course was uneventful, and he was discharged home on postoperative day 11. The endoscopic surgery reduced impairment of collateral vessels during surgery and might have reduced the risk of paraplegia.
Similar content being viewed by others
References
Scott DA, Denton MJ. Spinal cord protection in aortic endovascular surgery. Br J Anaesth. 2016;117:ii26–ii31.
Wynn MM, Acher CW. A modern theory of spinal cord ischemia/injury in thoracoabdominal aortic surgery and its implications for prevention of paralysis. J Cardiothorac Vasc Anesth. 2014;28:1088–99.
Griepp RB, Griepp EB. Spinal cord protection in surgical and endovascular repair of thoracoabdominal aortic disease. J Thorac Cardiovasc Surg. 2015;149:S86–90.
Afifi RO, Sandhu HK, Zaidi ST, Trinh E, Tanaka A, Miller CC 3rd, et al. Intercostal artery management in thoracoabdominal aortic surgery: To reattach or not to reattach? J Thorac Cardiovasc Surg. 2018;155:1372–8.
Funding
No funding was received for the publication of this paper.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have declared that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Sako, H., Tanaka, H., Takayama, T. et al. Endoscopic-assisted aortic replacement of the descending aorta through the 8th intercostal space to preserve collateral vessels: a case report. Gen Thorac Cardiovasc Surg 68, 1027–1030 (2020). https://doi.org/10.1007/s11748-019-01198-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-019-01198-0