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Case Reports in Vascular Medicine
Volume 2013, Article ID 978625, 5 pages
http://dx.doi.org/10.1155/2013/978625
Case Report

Novel Visceral-Anastomosis-First Approach in Open Repair of a Ruptured Type 2 Thoracoabdominal Aortic Aneurysm: Causes behind a Mortal Outcome

1Department of Vascular Surgery, Haukeland University Hospital, Jonas Lies Vei 65, 5021 Bergen, Norway
2Department of Vascular Surgery, Karolinska University Hospital, 171 76 Stockholm, Sweden

Received 31 October 2012; Accepted 13 January 2013

Academic Editors: N. Espinola-Zavaleta, P. Heider, P.-H. Huang, N. Papanas, M. Sindel, and S. Yamashiro

Copyright © 2013 Einar Dregelid and Alireza Daryapeyma. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Case reports to analyze causes and possible prevention of complications in a new setting are important. We present an open repair of a ruptured type 2 thoracoabdominal aortic aneurysm in a 78-year-old man. Lower-body perfusion through a temporary extracorporeal axillobifemoral arterial prosthesis shunt was combined with the use of a branch to the permanent aortic prosthesis to enable rapid visceral revascularization using a visceral-anastomosis-first approach. The patient died due to transfusion-induced capillary leak syndrome and left colon necrosis; the latter was probably caused by a combination of back-bleeding from lumbar arteries causing a steal effect, an accidental shunt obstruction, and hemodynamic instability towards the end of the operation. The visceral-anastomosis-first approach did not contribute to the complications. This approach reduces the time when visceral organs are perfused only via collateral arteries to the time needed for suturing the visceral anastomoses. This may be important when collateral perfusion is marginal.