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Ann Vasc Surg. 2011 Jul;25(5):697.e9-12. doi: 10.1016/j.avsg.2010.12.023. Epub 2011 Apr 21.

Successful endovascular repair of two ruptured thoracic aortic aneurysms in nonagenarians.

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Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, TX, USA.



Ruptured thoracic aortic aneurysm (rTAA) is a catastrophic and mortal event. Thoracic endoVascular aortic repair (TEVAR) has emerged as an alternative to open repair. We report the first two successful TEVAR performed for rTAA in nonagenarians.


Patient 1 was a 92-year-old man with multiple comorbidities with a 5.6 cm thoracic aortic aneurysm who was admitted for anticoagulation for pulmonary embolism. Twelve hours later, he was found to be hypotensive and the X-ray showed an opacified left hemithorax (Fig. 1). A 40 mm × 20 cm Gore TAG stent-graft (W. L. Gore & Associates, Inc., Flagstaff, AZ) was deployed to successfully exclude the rupture. The postoperative course was uncomplicated and on day 9, he was discharged to a skilled nursing facility. Patient 2 was a 94-year-old man with a history of multiple comorbidites and endovascular aneurysm repair for ruptured abdominal aortic aneurysm 3 years earlier, who presented to the emergency room in hemorrhagic shock. Computed tomography scan revealed hemomediastinum and left hemothorax suggesting thoracic aorta rupture (Fig. 2A). Emergently, a 34 mm × 30 cm Gore TAG stent-graft was deployed (Fig. 2B). A left chest tube was placed. Postoperative course was briefly complicated by acute renal failure and pneumonia and on day 14, he was discharged to a rehabilitation center.


TEVAR for rTAA is an effective option and advanced age alone should not deter definitive repair of the thoracic aorta.

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