Lots of interesting abstracts and cases were submitted for TCTAP 2024. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-199
Ticking Time Bomb-Ruptured Aortic Aneurysm
By Bhishma Chowdary Donepudi, Pragathi Gurram
Presenter
Bhishma Chowdary Donepudi
Authors
Bhishma Chowdary Donepudi1, Pragathi Gurram1
Affiliation
AIG Hospitals, India1,
View Study Report
TCTAP C-199
Endovascular - Thoracic & Abdominal Aortic Interventions
Ticking Time Bomb-Ruptured Aortic Aneurysm
Bhishma Chowdary Donepudi1, Pragathi Gurram1
AIG Hospitals, India1,
Clinical Information
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
A 62 year gentlemen who is a known diabetic, hypertensive and severe Obstructive sleep apnea, chronic kidney disease, presented to the hospital with vague abdominal pain, generalised weakness, accelerated hypertension and exertional dyspnea. On clinical Examination was found to have mild abdominal pain with minimal tenderness. Peripheral pulses were well felt. Jugular venous was not elevated. Cardiovascular examination was normal.
Relevant Test Results Prior to Catheterization
Ultrasound abdomen showed Large Aortic aneurysm with possible contained rupture. CT Aortogram showed Focal significant saccular dilatation of distal thoracic and proximal abdominal aorta of 12 mm extending upto the level of D10-D11 proximaly and upto SMA origin at inferior margin of L2 vertebrae and -19 mm proximal to renal artery origin distally. Circumferential mural thrombus noted in right lateral wall. Features suggestive of sealed off aortic aneurysm rupture
Relevant Catheterization Findings
Aortogram and abdominal Laparotomy revealed Saccular Thoracic and Abdominal Aneurysm involving all branches with mural thrombus in lateral wall suggestive of Contained sealed off perforation with penetrating ulcers noted in thoracic aorta
Interventional Management
Procedural Step
Patient was taken up for surgical Debranching of common hepatic artery, superior mesenteric artery and renal arteries. Bench graft anastomised between right iliac artery at one end and to SMA, Hepatic artery and renal arteries at the other end. Later patient was shifted to cath lab for TEVAR of thoracic and abdominal aorta with stent grafts extending from Left subclavian artery to below renal arteries. Endurant stent graft II 20 x 20x82 deployed in Infra reanal aorta and a Valiant Thoracic stent graft 34x34x200 deployed just below the left subclavian artery. Another Valiant 28 x 14x 150cm stent overlapping infrarenal stent graft
Case Summary
Prompt clinical diagnosis and timely management of an Aortic aneurysm is very crucial. Understanding the nature of Aneurysm and branches involved helps in planning the procedural strategy. Heart team discussion between the surgeons and cardiologists helps tailoring the strategy for the patients. Hybrid procedure with appropriate debranching and TEVAR helps with minimal mortality and morbidity