J.Jpn. Surg. Soc.. 86(2): 225-232, 1985

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Original article

SURGICAL TREATMENT OF A FUSIFORM THORACOABDOMINAL AORTIC ANEURYSM WITH MARFAN’S SYNDROME
－A CASE REPORT OF RECONSTRUCTION OF FOUR MAJOR ABDOMINAL VISCERAL BRANCHES－

A fusiform thoracoabdominal aortic aneurysm involving celiac, superior mesenteric and renal arteries was successfully replaced in a 53-year-old female with Marfan’s syndrome who also had annuloaortic ectasia, dissecting aneurysm of descending aorta and bilateral subclavian arterial aneurysms. Exposure of the aneurysm was obtained with a thoracoabdominal incision by reflecting the abdominal viscera to the right. First the limbs of a 24×12mm dacron bifurcated prosthesis were attached to common iliac arteries in an end-to-side fashion. Then renal arteries were anastomosed end-to-end to the branes previously attached to the body of the prosthesis. With the temporary bypass from left subclavian to left limb of the dacron graft, reconstruction of the celiac and superior mesenteric arteries was performed by direct suture of orifices to the opening made in the graft. Proxymal anastomosis between descending aorta and the graft was made in an end-to-end fashion. The dissecting lesion of the proxymal descending aorta was wrapped by dacron mesh. The immediate postoperative course was uneventful except transient hepatitis and pneumonia. The patient was discharged 49 days after operation. One month later, however, she died suddenly. Autopsy could not reveal the exact cause of death.
Retrograde revascuralization combined with Crawford’s method was useful in shortening the occlusion time.

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