[HSF] Leaking thoraco-abdominal aneurysm.

[David Harris]

I have been referred a 32 yr old female patient who
was turned down for surgery a year ago. She needed a
root, ascending, and arch replacement, with elephant
trunk, followed by repair of the descending part which
stretches to the diaphragm. She was turned down as the
aorta was heavily calcified.

She now presents with symptoms from the thoraco,
namely dyspnea, chest pain and hemoptysis. The distal
half of the descending aorta is surrounded by a large
round thrombus / contained leak, measuring 12 cm in
diameter. The lumen of the desc aorta measures 5 cm,
up to the diaphragm, where it is 3 cm, about 4cm above
the celiac.

Scan show ascending measuring 5cm, sinuses dilated
(there is mild to moderate aortic regurg), arch
measures 4cm, there is a neck of 3cm at the isthmus.
The aorta is heavily calcified from halfway up the
ascending, all the way to the T6 level. The ishmus is
spared a bit and is POSSIBLY clampable. A stent would
not be possible with peripheral access, as the left
subclavian attaches to the aorta at an angle, and is a
bit stenotic there, and the descending aorta makes a
90 degree turn at the level of the pulmonary ligament
towards the right before bending back towards the
left. The left external iliac artery is completely
occluded.

Any extra tips?(I think I have already made up my mind
what to do, but some confirmation, and gleaming pearls
would be greatly appreciated)

Dave Harris

Dr. David G. Harris, FCS, MMED,
Cardiothoracic Surgeon        
Suite 207                                
Kuils River Private Hospital,        
PO Box 1200, Kuils River, 7579, Cape Town, South Africa.            
Tel +27-21-9006411             
Fax +27-21-9006412      Mobile +27-83-3309587