Reparación endovascular de un aneurisma de aorta abdominal gigante y complejo asociado a un riñón en herradura

A systematic review and case presentation: Giant abdominal aortic aneurysm

“…61 Another disadvantage of EVAR in giant AAA is the lack of removing the large thrombus which does not alleviate the space-occupying effect. EVAR approach was mostly employed in difficult conditions such as in patients with horseshoe kidney, 62 para renal AAA, 63 duodenal obstruction, 47 aortocaval fistula, 54 and aorto enteric fistula. 15 EVAR in giant AAA in the literature resulted in one failure to require laparotomy, 17 and two deaths post-EVAR.…”

“…15,64 With open laparotomy, aortic cross-clamping is frequently difficult, and decreased surgical exposure can lead to unwanted traction upon the aneurysm neck or adjacent organs leading to increased venous injury, pancreatitis, and bowel injury may occur. 65 Simultaneously occurring conditions make AAA management challenging such as concomitant aortic dissection – case presented by Xu et al, 66 diverticular abscess, and abdominal aortic aneurysm, where percutaneous drainage of the abscess under ultrasound guidance was performed to drain abscess – Al Wahbi and Tamimi 67 horseshoe kidney, 62 in a Jehovah’s Witness, use of blood obtained by continuous cell salvage technique and the sixth postoperative day, recombinant human erythropoietin (epoetin beta) was commenced, 68 staged cardiac operation for ischaemic cardiomyopathy and performing abdominal aneurysmectomy first on cardiopulmonary bypass – mildly hypothermic (34° 8C) full-flow bypass by Pocar et al 69 Utilization of hypothermic cardiac bypass – Vural et al 70 suggest it as a useful method in giant AAA, operations where simple aortic clamping is not sufficient for AAA repair and repair of diseases TAA and AAA performing anastomosis with a bloodless surgical field without proximal clamping. 71–73 Complications were reported in cases 21 (35%) including multi-organ failure, ARDS, paralytic ileus, wound infection/dehiscence, ischaemic colitis, jaundice erectile dysfunction, gastric erosions, perigraft seroma, and graft infection enlisted in Table 3.…”