Krónikus aortadissectio talaján kialakult thoracoabdominalis aneurysma endovascularis kezelése fenesztrált sztentgrafttal

Osszefoglalo. Az aortadissectio kronikus stadiumaban kialakulo thoracoabdominalis tagulatok megoldasa multidiszciplinaris megkozelitest, nagy felkeszultseget es fejlett technologiat igenyel. A jellemzően tobblepcsős műtetsorozat mortalitasa es morbiditasa az endovascularis technologia fejlődesevel csokkent, de meg mindig jelentős. A fenesztralt endovascularis aortaműtet a thoracoabdominalis nyitott műtet alternativaja, mely kisebb mortalitassal es morbiditassal, rovidebb korhazi tartozkodassal jar. Aortadissectio eseten tortenő alkalmazasa az aorta lumeneben levő membran miatt kihivast jelent. Esetbemutatasunkban egy 56 eves nőbeteget demonstralunk, aki tiz evvel korabban A-tipusu dissectio miatt aorta ascendens rekonstrukcion esett at. A kovetes soran csaknem a teljes aorta tagulata alakult ki, melynek megoldasa harom lepesben tortent. Az első lepesben a disszekalt aortaiv nyitott műtetjet vegeztuk 'frozen elephant trunk' technikaval, majd az aorta descendens tagulatanak endovascularis kezelese tortent sztentgraft-implantacioval. A műtetsorozat zaro lepese egy fenesztralt endovascularis aortaműtet volt, mely egyben ezen technikanak az aortadissectio eseteben tortent első hazai alkalmazasat jelenti. Orv Hetil. 2021; 162(31): 1260-1264. Summary. Thoracoabdominal aortic aneurysms developing in the chronic phase of an aortic dissection require multidisciplinary approach, experienced operators and advanced technology. The mortality and morbidity rate of these multistage operations were reduced with the latest technical achievements in endovascular repair, but they are still significant. Fenestrated endovascular aortic repair, an alternative of thoracoabdominal open repair, is associated with less mortality and morbidity, shorter hospital stay. Using fenestrated devices in aortic dissection is usually technically demanding due to the dissection membrane. We report the case of a 56-year-old woman, who underwent ascending aortic repair due to type A aortic dissection. During the follow-up, a large thoracoabdominal aneurysm developed involving also the arch. We performed a three-stage operation starting with the open repair of the aortic arch using a 'frozen elephant trunk' device followed by a thoracic endovascular aortic repair of the descending aorta. The final stage was a fenestrated endovascular aortic repair, which is the first use of this technique in aortic dissection in Hungary. Orv Hetil. 2021; 162(31): 1260-1264.