George E Philippakis
Introduction: Aneurysms of the descending thoracic aorta are potemtially life threatening situations. Treatment entails either conventional surgical treatment by means of a left lateral thoracotomy or the minimally invasive endovascular treatment. Surgery is indicated when the size of the descending aorta is over 5.5 cm, or there is rapid expansion of the aneurysm. Maximum size of the aorta in large series regarding treatment of aortic aneurysms is 10 cm. We describe a case of a 70 year old man presenting with a rapidly expanding descending aortic aneurysm of 12 cm in diameter at the time of surgical intervention, which had enlarged very rapidly within one year, for the first time in the literature. Presentation of case: A stent graft was deployed on the descending thoracic aorta, under angiographic guidance, with no evidence of endoleak after the procedure. Discussion: Endovascular treatment of descending thoracic aneurysms is commonly performed in patients of older age with comorbid situations, but now it is considered the treatment of choice in most patients, depending on the morphology of the aneurysm. The risk of morbidity or death is lower with endovascular treatment compared with open repair. Paraplegia is the most feared complication of endovascular repair of thoracic aortic disease, but the incidence of spinal cord ischemia is generally less when compared to open surgical repair. Conclusion: Aortic size is considered to be the most important factor regarding the decision towards surgical intervention on a nonemergent versus emergent basis.