Introduction. Thoracoabdominal aortic aneurysm (TAAA) type IV represents an
aortic dilatation from the level of the diaphragmatic hiatus to the iliac
arteries branches, including visceral branches of the aorta. In the
traditional procedure of TAAA type IV repair, the body is opened using
thoractomy and laparotomy in order to provide adequate exposure of the
descending thoracic and abdominal aorta for safe aortic reconstruction. Case
report. We reported a 71-yearold man with elective reconstruction of the TAAA
type IV performed by transabdominal approach. Computed tomography scans
angiography revealed a TAAA type IV with diameter of 62 mm in the region of
celiac trunk and superior mesenteric artery branching, and the largest
diameter of 75 mm in the infrarenal aortic level. The patient comorbidity
included a chronic obstructive pulmonary disease and hypertension, therefore
he was treated for a prolonged period. In preparation for the planned aortic
reconstruction asymptomatic carotid disease (occlusion of the left internal
carotid artery and subtotal stenosis of the right internal carotid artery)
was diagnosed. Within the same intervention percutaneous transluminal
angioplasty with stent placement in right internal carotid artery was made.
In general, under endotracheal anesthesia and epidural analgesia, with
transabdominal approach performed aortic reconstruction with tubular dakron
graft 24 mm were, and reimplantation of visceral aortic branches into the
graft performed. Postoperative course was uneventful, and the patient was
discharged on the postoperative day 17. Control computed tomography scan
angiography performed three months after the operation showed vascular state
of the patient to be in order. Conclusion. Complete transabdominal approach
to TAAA type IV represents an appropriate substitute for thoracoabdominal
approach, without compromising safety of the patient. This approach is less
traumatic, especially in patients with impaired pulmonary function, because
there is no thoracotomy and any complications that could follow this
approach.
Elective reconstruction of thoracoabdominal aortic aneurysm type IV by transabdominal approach
