Salvage of an Acutely Ruptured Thoracic Aortic Aneurysm during CPR

Abstract

Purpose: To report the successful endovascular treatment of a ruptured thoracic aortic aneurysm during cardiopulmonary resuscitation. Case Report: A 72-year-old woman with a type B aortic dissection treated conservatively for 8 years was referred for rupture of a 16-cm aneurysm of the descending thoracic aorta. During transfer to the operating room, the patient suffered cardiac arrest; cardiopulmonary resuscitation (CPR) was initiated. A few minutes later during CPR, the surgical procedure began with a cutdown of the right femoral artery and insertion of a guidewire and an aortic occlusion balloon, which was inflated at the origin of the left subclavian artery (LSA). Blood pressure was immediately measurable. By only partially deflating the occluding balloon, a thoracic stent-graft was advanced above it and deployed at the origin of the LSA while rapidly deflating and retracting the occluding balloon. Three stent-grafts were required to cover 27 cm of the descending aorta. The patient was partly ventilator dependent for 3 months due to a massive pleural hematoma that was not evacuated. At the 10-month follow-up, the patient is fully recovered without any sign of respiratory dysfunction or any other sequela. CT scans reveal that the massive hematoma is almost completely resolved. Conclusions: This case illustrates that optimal collaboration between anesthesiologists, interventional radiologists, and vascular surgeons with appropriate resources can significantly expand the possibilities of emergent treatment in the face of aortic rupture.

Experimental and Clinical Studies in Ruptured Abdominal Aortic Aneurysm : Aspects of Hypothermia and Endovascular Treatment

“…Interestingly, the first ruptured aneurysm was a thoracic aortic rupture in a patient who was taken to the operation room (OR) during cardiopulmonary resuscitation (CPR) in 2001. 43 Almost immediately after introduction of the EVAR during 1990s debates on pros and cons started. Numerous comparisons between EVAR and open surgical repair have been carried out based on long-term treatment durability, [44][45][46] postoperative complications, 47 mortality, 48,49 quality of life and patient´s experiences, 50 gender aspects, 51 cost effectiveness, 52,53 preferences in treating octogenarians, 54,55 preferences in treating inflammatory or mycotic aneurysms, 56,57 preferences in treating active smokers, 58 preferences in treatment of obese patients, 59 preferences regarding need of redoes and a custom-made approach decided by artificial intelligence.…”