Management of the Difficult Distal Anastomosis During a Type II Thoracoabdominal Repair in a Patient with ACTA2 Mutation
Gayan De Silva, Linda Schulte, Puja Kachroo, Luis Sanchez, John W Ohman
Washington University School of Medicine, Saint Louis, MO
OBJECTIVES: The surgical management of patients with ACTA2 mutations are fraught with known vessel fragility and present a technical challenge for tissue manipulation. This is further compounded by the difficulty managing the distal aortic bifurcation when the degeneration involves the common iliac arteries.
METHODS: We present the case of a young male with a known ACTA2 mutation with a degenerative type II TAAA with involvement of the iliacs.
RESULTS: Successful repair using a distal bifurcated component and proximal quadfurcated branch graft, with discussion of the cannulation strategy employed and the cannulation options.
CONCLUSIONS: The multidisciplinary care of patients with connective tissue disorders is essential, and this case illustrates the complimentary role each service plays in the care of patients with thoracoabdominal aneurysm and the difficult distal anastomosis.
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