Surgeon-modified fenestrated endograft for urgent an aortic arch aneurysm: case report.
Vito GallicchioDanilo BarbarisiFlavia CondòRosaria SciarrilloLoris FloraPublished in: Journal of cardiothoracic surgery (2023)
We report the case of an endovascular repair of an aortic arch aneurysm by a surgeon-modified fenestrated endograft with a single fenestration in a high-risk patient unfit for open surgery. A patient of 84 years, chronic ischemic cardiopathic, suffering from prostate adenocarcinoma in chemotherapy treatment, came to our hospital for post-traumatic fracture of the right femur. During the hospitalization, the patient exhibited dysphonia and respiratory disorders for several days, therefore, the patient performed Computed Tomography Angiography (CTA) that found the presence of voluminous aneurysm of the aortic arch with a maximum diameter of about 74 mm. The patient was treated with a hybrid-staged procedure; in the first instance, with a carotid-carotid-succlavium bypass to preserve the cerebral and upper limb vascularization and then, the procedure was completed by implanting the surgeon-modified fenestrated endograft with stent delivery to the patient with a fenestration on the anonymous trunk. This surgeon-modified fenestrated endograft was created by modifying a standard endograft by a single fenestration following the three-dimensional reconstructions of the CTA images. The procedure was successfully completed and postoperative course was uneventful. Computed Tomography Angiography demonstrated the exclusion of the aneurysm, patency of the implanted endograft modules, and absence of signs of endoleaks and / or cerebral or medullary ischemic complications.
Keyphrases
- case report
- coronary artery
- minimally invasive
- upper limb
- prostate cancer
- abdominal aortic
- squamous cell carcinoma
- robot assisted
- computed tomography
- machine learning
- subarachnoid hemorrhage
- magnetic resonance imaging
- blood brain barrier
- ischemia reperfusion injury
- brain injury
- lower limb
- surgical site infection
- combination therapy