Thoracoabdominal Aortic Aneurysm Repair
Andrew Del Re, MD1; Jahan Mohebali, MD, MPH2; Virendra I. Patel, MD, MPH2
1The Warren Alpert Medical School of Brown University
2Massachusetts General Hospital
Thoracoabdominal aortic aneurysms (TAAAs) are generally asymptomatic and are discovered incidentally on thoracic or abdominal imaging. When they are identified, management is often expectant, depending on the size of the aneurysm and its rate of growth. Surgery is indicated for larger aneurysms and those that expand rapidly so as to avoid the catastrophic rupture of the aneurysm.
This article presents the case of a 70-year-old female with a TAAA, whom had been followed with serial computed tomographic angiography scans. The decision to operate was made when the aneurysm began revealing growth in diameter. Her anatomy was not conducive to endovascular treatment; therefore, her aneurysm was repaired using a traditional open approach.
Aortopexy for Innominate Artery Compression of the Trachea
Andrew Scott, MD; Carl-Christian A. Jackson, MD; Walter Chwals, MD
Tufts University School of Medicine
Tracheomalacia is a rare congenital condition that results in incompetence of the trachea, the main airway, leading to collapse of the trachea during respiration. Most often this is due to inadequate bone formation in the trachea, and this causes it to be dynamically collapsed, which can result in breathing difficulties for the child. Upper respiratory infections can also be more common. While most cases of tracheomalacia resolve by 18 to 24 months of age, a small percentage either continue or cause such severe breathing or feeding issues that surgical intervention is warranted. In cases where the innominate artery is the cause of compression of the weakened trachea, an aortopexy to elevate the vessel up to the sternum and away from the trachea is performed.
Thoracofemoral Bypass: A Retroperitoneal Approach
J. Miller Allan, MD; Victoria Aucoin, MD; Benjamin J. Pearce, MD
UAB Hospital
Surgical intervention for aortoiliac occlusive disease (AIOD) remains a vital tool in the management of AIOD. AIOD is caused by occlusion of the infrarenal and/or iliac arteries, often secondary to atherosclerosis. This article presents a case of a young, male patient with a history of familial hyperlipidemia and chronic tobacco use who underwent a thoracofemoral bypass (TFB) procedure via a retroperitoneal approach.
He presented with classic symptoms of bilateral leg pain when walking, nocturnal lower extremity pain, and correlated diminished lower extremity pulses. TFB was the preferred approach due to the aggressive, soft plaque burden extending into the suprarenal aorta, which precluded endovascular repair and would have increased risk for standard infrarenal aortofemoral bypass (AFB). This video and case report present a detailed explanation of a retroperitoneal approach to a TFB procedure.
Thoracoabdominal Aortic Aneurysm Repair – Part 1
Virendra I. Patel, MD, MPH
Associate Program Director, General Surgery Residency; Department of Vascular and Endovascular Surgery, Massachusetts General Hospital
Watch Dr. Patel as he performs a Type 1 thoracoabdominal aortic aneurysm repair with distal aortic perfusion through an atriofemoral bypass circuit. (Pre-print, Part 1 of 2).
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