Endoscopic-assisted aortic replacement of the descending aorta through the 8th intercostal space to preserve collateral
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CASE REPORT
Endoscopic‑assisted aortic replacement of the descending aorta through the 8th intercostal space to preserve collateral vessels: a case report Hidenori Sako1 · Hideyuki Tanaka1 · Tetsushi Takayama1 · Takafumi Abe1 · Yuriko Abe1 Received: 30 June 2019 / Accepted: 23 August 2019 © The Japanese Association for Thoracic Surgery 2019
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. Keywords Aortic surgery · Endoscope · Paraplegia · Aortic dissection · Aneurysm
Introduction Various strategies have been attempted to reduce the risk of paraplegia during descending and thoracoabdominal aortic aneurysm repair. Moreover, the most important strategy is the maintenance of an adequate perfusion pressure gradient to the spinal cord. Thus, maintaining an adequate mean systemic pressure and avoiding increases in cerebrospinal fluid (CSF) pressure are the most important methods to implement this strategy [1]. Herein, we present the case of a patient who underwent endoscopic-assisted descending aorta replacement. In this case, only the 8th intercostal space was opened for prosthetic graft replacement of the descending aorta, and we used total endoscopic or endoscopicassisted surgical procedure to the proximal descending aorta that was inaccessible from the 8th intercostal space. Since intra- and postoperative bleeding is considered the most
* Hidenori Sako sakoh@oka‑hp.com 1
Department of Cardiovascular Surgery, Oita Oka Hospital, 3‑7‑11, Nishitsurusaki, , Oita 870‑0192, Japan
life-threatening factor in maintaining systemic pressure, we tried not to cut the muscles and bone as much as possible.
Case Patient characteristics A 75-year-old man was admitted to our hospital due to repeated lower limb hematoma. His abdominal aorta was replaced with a Y-shaped graft 30 years prior to this admission. At 2 years prior to his admission, he experienced acute type B aortic dissection, and an aortic stent graft was attempted. However, the stent graft treatment failed because the device could not go through his abdominal prosthetic graft. Therefore, he co
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