Abstract
Background: Insertion of tubular stentgrafts in the management of the thoracic aortic aneurysm has recently become a popular alternative to open surgery. The classical surgical procedure for ruptured thoracic aortic aneurysm is associated with mortality rates of up to 50% and prolonged intensive care hospitalization. However, endovascular procedures have been associated with significantly lower morbidity and mortality rates. Case: A 64-year-old man was transferred to our hospital due to back pain and dyspnea. He was alert, with a blood pressure of 124/60 mmHg and a pulse of 100/minute, and the conjuctivae were pale. Chest X-ray and ultrasound examination revealed extensive left hemothorax, chest-abdominal contrast computed tomography (CT) identified an aneurysm with a maximal diameter of 8 cm at the level of Th 6–10, and ruptured thoracic aneurysm was diagnosed. Considering the aortic diameter at the proximal and distal site of the aneurysm and a sufficient landing zone, endovascular stent-graft placement appeared viable. However, we postponed the surgery until the next morning due to the preparation of devices, and monitored him under strict control of blood pressure. He entered the operation room under general anesthesia, and a Dacron covered Z stent was implanted via a cut-down of the right femoral artery. After the surgery, intra-aneurysm thrombus formation was favorable. The respiratory condition was poor due to marked obesity, and tracheotomy was required. Results: The general condition gradually improved thereafter, and he was discharged 24 days after the operation. He has been monitored for 18 months, and chest CT scan after four months showed disappearance of aneurysm and hematoma. Conclusion: We think endovascular stent-graft repair seems to be technically feasible for critical patients with ruptured descending aortic aneurysm.
