case report ruptured aortic patient transferred

We report a case of successful total aortic arch replacement using selected cerebral perfusion for ruptured distal aortic arch aneurysm (DAAA) into the pericardial space. A 75 year-old man who had preoperative episode of severe chest pain and tachycardia was transferred to our hospital.

Full Answer

What is an aortic aneurysm?

An abdominal aortic aneurysm (AAA) is defined as a dilation of the subdiaphragmatic aorta to a diameter greater than 3.0 cm. AAAs are found in up to 7% of men and 1% of women aged 50 years and older, particularly smokers [1]. Up to 80% of aneurysmal ruptures can occur in previously undiagnosed aneurysms [2]. Most undiagnosed patients with AAA remain asymptomatic unless they develop a complication. Rupture, the most common complication of AAA, is also the most lethal [3]. Most AAAs will rupture into the retroperitoneal cavity, rendering ultrasound for a quick diagnosis ineffective. Depending on the rupture site, the presentation varies and may be very nonspecific, one of the reasons why ruptured AAA is frequently misdiagnosed [4].

What is an AAA?

An abdominal aortic aneurysm (AAA) is defined as a dilation of the subdiaphragmatic aorta to a diameter greater than 3.0 cm. AAAs are found in up to 7% of men and 1% of women aged 50 years and older, particularly smokers [1]. Up to 80% of aneurysmal ruptures can occur in previously undiagnosed aneurysms [2].

Is evar surgery safe?

Compared to traditional open repair of AAA, EVAR represents a far safer, minimally invasive technique that is sometimes performed as an outpatient procedure. EVAR helps to avoid the hemodynamic and acid/base fluctuations of open repair that exert a huge metabolic strain on the (typically older) patients [9]. Since the approval of endovascular stents for this purpose, the United States has seen rates of EVAR procedures increase sixfold [10]. In geriatric patients, EVAR has proven to avoid common complications such as delirium (following vascular surgery), and expands treatment options for those who would not be candidates for open repair [11].

Introduction

Abdominal aort aneurysm is an asymptomatic and potentially lethal disease which its rupture is an emergent situation and has a fatality rate of 100% if untreated. Misdiagnosis causes delays for the treatment and it can be catastrophic. Depending on the patient’s status during admission, the mortality ranges from 20% to 70% even in treated patients.

Case Report

A 55-year-old male with acute abdominal pain was transferred to our emergency department and took under evaluation of general surgery and urology clinics with suspicious of renal colic and ileus. At the presentation, serum urea level was 80 mg/dl, creatinin level was 2.97 mg/dl and hemoglobin level was 7.5 g/dl.

Discussion

rAAA is a catastrophic condition and the role of rEVAR is still controversial due to the absence of well-supported evidences. Mortality is higher after OR than EVAR according to retrospective studies [4-7] and confirmed by the Swedish Vascular Registry.