Iatrogenic thoracic aortic tear during intravascular aneurysm repair due to undiagnosed lung cancer invasion
Panagiotis Hountis, Mihalis Argyriou, Ioannis Koukis, Ion Bellenis
CaseRepClinPractRev 2007; 8:161-164
Background: The simultaneous surgical management of thoracic aortic aneurysm and lung cancer is an extremely rare combination in the literature and still today debate exists on the proper in one or two stage repair as well as the preferred way of reconstruction.
Case Report: A 67 year-old female smoker was admitted in our Department for the intravascular stending of a descending fusiform aortic aneurysm measuring 6,2 x 6 cm in diameter. We decided to treat this patient by placing a thoracic aortic graft under Intra-Arterial Digital Subtracting Arteriography guidance. Unfortunately, during the catheterization for the graft
placement, the descending aorta was damaged and the patient was emergently sent to the operating room for arterial reconstruction. A left lower mass invading the aorta was found at thoracoctomy. The thoracic aorta was occluded distally and proximally with a total ischemia time of thirty minutes and placement of a 20 mm PTFE graft. An uncomplicated typical left lower lobectomy was also performed at the same time. The patient had an uncomplicated clinical course and was discharged on the 17th postoperative day. The histological examination revealed an adenocarcinoma of the left lower lobe.
Conclusions: The simultaneous existence of a descending thoracic aortic aneurysm and lung cancer of the left lower lobe is extremely rare but it can exist and in such cases, the cancer is commonly mistaken as atelectasis created by the pressure the aneurysm forms on the lobe. We believe
that aneurysms in such cases should be treated first by endovascular stent - grafts, following by a left thoracotomy. However, in cases this is not possible, or in emergent cases, aneurysm repair and left lower lobectomy can be performed at the same time.
Keywords: Aortic Aneurysm, Abdominal, Aortic Aneurysm, Thoracic, Lung Neoplasms