Trattamento endovascolare di un aneurisma dell’aorta toracica rotto. Caso clinico

Surgical treatment of thoracic and thoraco-abdominal aneurysms presents an high incidence of intra- and postoperative complications. Natural evolution of such aneurysms suggests an adequate treatment and high operative morbidity and mortality justify an endovascular approach, especially in emergency. A 78-year-old patient was hospitalized for the rupture of a thoracic aortic aneurysm. CT scan detected a thoracic aortic aneurysm with massive emothorax. Considering the clinical condition and the anatomical criteria, an endovascular exclusion was planned. The left common iliac artery was exposed by extraperitoneal approach and the aneurysm was excluded by placing of 2 Talent endoprostheses inserted through a 10 mm PTFE graft previously implanted. Intraoperative angiography detected an optimal exclusion of the sac and the absence of endoleak. No major complications as paraplegia, bleeding, mesenteric or limbs ischemia occurred and postoperative CT scan confirmed the exclusion of the aneurysm and the endoleak absence. The patient was discharged on the 14 th postoperative day. Endovascular exclusion can be considered a valid and safe procedure, especially in emergencies treatment of thoracic aortic aneurysms.