Abstract
To date, an open surgery for thoracoabdominal aortic aneurysm (TAAA) remains to have high mortality and complication rates. However, we accomplished an open surgery for an 80-year-old patient with TAAA and severe aortic valve stenosis (AS) using axillary artery perfusion. He presented with left lateral chest pain and his CT showed saccular TAAA with a maximum diameter of 98 mm which was located from diaphragm to the celiac artery (Modified Crawford Classification Extent 5). The diagnosis was impending rupture of TAAA. Five years ago, he underwent endovascular repair for abdominal aortic aneurysm with Endurant, and the bare stent of Endurant was positioned near the TAAA. Consequently, we clamped only the descending aorta but occluded the abdominal aorta with a balloon. During the procedure, we used femoral vein to axillary artery bypass, to prevent cardiac accidents related to severe AS and rupture of TAAA because femoral perfusion cannot support cardiac output after clamping the descending aorta. In terms of an operative method, the minimum extent of the aortic aneurysm repair was selected to shorten clamping time and minimize invasiveness of this procedure. In conclusion, we believe that using axillary artery perfusion and choosing the appropriate procedure are most important issue when performing open surgery for TAAA with severe heart complications.
