PENETRATING AORITC ULCER FOUND ON VIDEO ASSISTED THORACOSCOPIC SURGERY
Majid T. Aized, MD, Alessandro Vivacqua, MD.
William Beaumont Hospital, Royal Oak, MI, USA.
OBJECTIVES: PENETRATING AORTIC ULCER FOUND ON VIDEO ASSISTED THORACOSCOPIC SURGERY (VATS), DURING WORKUP OF MODERATELY SIZED HEMOTHORAX TREATED EMERGENTLY WITH A TEVAR
METHODS: A 71 year old woman with a history significant for Hypertension was admitted through the emergency department with shortness of breath and diagnosed with a hemothorax. Placement of chest tube with large bloody output (500ml as soon as the CT was placed) but showed persistent opacification of the lower hemi thorax evincing a moderate to large retained hemothorax on subsequent chest x-rays and was subsequently evaluated with VATS.However, evaluation of the posterior chest during VATS revealed a penetrating ulcer of the descending thoracic aorta. Hemothorax was evacuated, the penetrating ulcer was covered with a large blood clot, there was ecchymosis present with clot overlying it and there was no active extravasation seen at that time.Patient was taken to the Hybrid OR emergently for possible coverage of the aortic penetration ulcer and a TEVAR of mid descending thoracic aorta using a 34 x 30 x 150 Medtronic stent graft was done.IVUS was used to confirm that the penetrating ulcer portion was covered by the stent graft
RESULTS: Postoperatively in the ICU, the patient was weaned off of pressors and was extubated. POD 3 Chest tube was removed and follow up CXR was done which showed clear lung bases bilaterally and no evidence of any fluid retained in the left chest.Patient was then discharged home postop day 3.Follow up CTA chest was done before discharge which showed:Descending thoracic aortic stent graft appeared patent throughout its entirety without evidence of endoleak. Interval resolution of previously seen left hemothorax CONCLUSIONS:In this day and era of recent advancement in the field of Vascular surgery, a penetrating thoracic aortic ulcer diagnosed on Video Assisted Thoracoscopic Surgery can easily be managed with a Thoracic Stent Graft and its coverage can easily be confirmed with Intravascular Ultrasound.
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