Surgical correction of a saccular descending aortic aneurysm

A 46 year-old-man, treated in childhood for aortic coarctation and hypoplasia of the aortic arch with a prosthetic graft  from the ascending to the descending aorta, presented with a saccular aneurysm at the thoracic aorta. The aneurysm involved the distal anastomosis of the previously constructed prosthetic graft (Figure 1).

Figure 1.

Tomographic image of the 6x4cm aortic aneurysm (A) and the 3D reconstruction (B) displaying the aneurysm and the graft between ascending and descending aorta (arrow).

Because of the presence of widespread and lasting adhesions, the operation has been carried out in two days in a staged fashion: on day 1 reopening of the chest at the previous thoracotomy, lysis of the adhesions and exposure of the aneurysm; on day 2 resection of the part of the lung adherent to the aneurysm (Figure 2A) by surgical stapler (arrow), thus avoiding damage to the aneurysm during dissection; exclusion of the aneurysm with a Dacron^® patch (Figure 2B) during a short period of circulatory arrest in deep hypothermia.

One-month CT confirmed excellent surgery result (Figure 2C).

Figure 2.

Intraoperative view (A) and (B). (C) tomographic 3D reconstruction of the aorta at 1 month after the surgical repair (arrow).