Minimally invasive treatment of a life threatening ruptured thoracic aortic aneurysm

We report a case of a life threatening thoracic aortic aneurysm rupture, treated successfully with minimally invasive approach. A 34-year-old man was admitted to our hospital in critical clinical condition, presenting with acute chest pain for 18 h, hematemesis and rapidly decreasing hemoglobin, despite massive transfusion done, severe hypotension, anuria and ileus. The patient had history of surgical aortic coarctation repair at age of 13. Contrast-enhanced CT images revealed a thoracic aortic aneurysm rupture with severe left-sided hemothorax. Based on the patient general condition, age and anatomy of the lesion, thoracic endovascular aneurysm repair (TEVAR) was done. Two stent grafts Valiant were implanted in the thoracic aorta covering the entry tear engaging the LSA ostium. Because of residual filling of the aneurysmal sac through left subclavian artery, vascular occluder was implanted, causing complete isolation of the aneurysm from the blood flow. Very short and successful recovery period was observed. Due to residual coagulum in left pleural space the patient was directed for VATS evacuation. Aortic aneurysm rupture is a potentially fatal condition, but when diagnosed early, it can be successfully treated by endovascular methods. In this case a totally non-surgical minimally invasive approach (TEVAR and vascular plug to isolate the dissection and VATS assisted hemothorax evacuation) resulted efficiently and in lifesaving manner with fast recovery without any sequelae despite the critical clinical presentation.