CONGRESS ABSTRACT

An 80-year-old male with a medical history of hypertension, dyslipidemia, smoking, multi-district arteriopathy, cerebrovascular encephalopathy, and COPD was admitted with severe, acute, retrosternal, and interscapular pain and dyspnea. Angio-CT showed "unrupted aneurysm of the aortic arch, near the origin of the left subclavian artery, bovine aortic arch, left hemothorax and subtotal atelectasis of the left lung. Additionally, there was a second aneurysm of the descending thoracic aorta near the diaphragm and a further aneurysm at the aortic bifurcation measuring 46mm, partially thrombosed, with chronic thrombotic occlusion of the external iliac arteries, and revascularization at the level of the common femoral arteries bilaterally. The carotid artery Doppler ultrasound showed bilateral subcritical stenosis of the common carotid arteries. The severe peripheral arteriopathy did not permit a conventional TEVAR procedure, and the "contained" rupture of the aorta precluded the possibility of a transapical approach via thoracotomy. Therefore, a transaortic procedure via sternotomy was decided. A GORE TAG endograft was chosen because it lacks distal freeflow, expands from distal to proximal, and provides immediate stabilization of the proximal neck when released from the ascending aorta. After performing a median sternotomy, two temporary epicardial electrodes were placed on the anterior wall of the right ventricle to ensure controlled hypotension during prosthesis deployment via overdrive pacing. The ascending aorta was cannulated using the Seldinger technique with a 7 French introducer, replaced with a 22 French introducer over a stiff guidewire, tunneled through the skin, and secured to reduce tension on the aorta during the procedure. A 37mm diameter, 150mm length GORE TAG endograft was introduced and released in overdrive pacing. The angiographic control showed a successful procedure with total aneurysm exclusion without endoleak. The postoperative course was regular, and the patient was discharged on the ninth postoperative day. Conclusion: The transaortic procedure via sternotomy can be considered for the treatment of thoracoabdominal aortic aneurysms in cases where vascular access is not suitable or available.