Gigantic 25-cm abdominal aortic aneurysm Dainis Krievins, MD, PhD,a Svetlana Thora, MD,a and Christopher K. Zarins, MD,b Riga, Latvia; and Stanford, Calif

A 69-year-old man presented to the hospital in June 1993 with a prominent, visibly pulsatile abdominal mass (A). The patient had a history of smoking, hypertension, hepatitis C, and tuberculosis and had noted a pulsation in his abdomen for several years but had never sought medical attention. Physical examination demonstrated a very large, nontender, pulsatile mass with a soft bruit. Translumbar aortography revealed a gigantic infrarenal abdominal aortic aneurysm (AAA) measuring 25 cm in diameter with a large mural thrombus extending to the aortic bifurcation and both common iliac arteries (B). The patient was prepared for urgent open surgical aneurysm repair under general anesthesia and gave informed consent for photographic documentation and publication of his case. At operation (C), the aneurysm was readily exposed; the transverse diameter was measured with a centimeter scale and recorded as 25 cm by the surgeon. After infrarenal cross-clamping, the aneurysm was opened, a massive mural thrombus was removed, and a bifurcated 22  10-cm knitted Dacron aortoiliac graft was sewn in place (D). Excess aneurysm wall was trimmed, and the remaining aneurysm wall was closed over the graft. The patient received one unit of Cell Saver blood transfusion, was extubated immediately after the operation, and had an uneventful recovery. He was discharged from the hospital on day 12 and had no subsequent events related to the aneurysm or surgical repair. He survived for 7 years, dying of heart failure at the age of 76 years. The majority of AAAs are discovered when they are 6 cm, with an annual rupture risk of 30% to 50% for aneurysms >8 cm. Thus, it is unlikely that patients with very large aneurysms survive for a long time. Indeed, aneurysms >10 cm are rare, with only a few reports of successful repair of giant aneurysms larger than 12 cm.1 The largest reported diameter in published cases of giant unruptured AAA is 15 cm.2,3 This report of a 25-cm gigantic AAA may represent the largest successfully repaired infrarenal AAA in the world’s literature. REFERENCES 1. Mumoli N, Invernizzi C, Luschi R, Carmignani G, Camaiti A, Bocci L, et al. Images in cardiovascular medicine: giant abdominal aortic aneurysm. Circulation 2010;122:e392-3. 2. Ebaugh JL, Raffetto JD. Images in clinical medicine. Giant abdominal aortic aneurysm. N Engl J Med 2010;362:66. 3. Bayam L, Tait WF, Macartney ID. Successful repair of a giant abdominal aortoiliac aneurysm in a Jehovah’s Witness. Vasc Endovascular Surg 2007;41:460-2. Submitted Dec 10, 2013; accepted Sep 8, 2014. From the Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Rigaa; and the Department of Surgery, Stanford University Medical Center, Stanford.b Author conflict of interest: none. E-mail: [email protected]. The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest. J Vasc Surg 2015;61:1067 0741-5214 Copyright Ó 2015 Published by Elsevier Inc. on behalf of the Society for Vascular Surgery. http://dx.doi.org/10.1016/j.jvs.2014.09.005

1067

Gigantic 25-cm abdominal aortic aneurysm.

Gigantic 25-cm abdominal aortic aneurysm. - PDF Download Free
389KB Sizes 0 Downloads 11 Views