Aortic Surgery Team Triumphs in Treating Complex Thoracic and Abdominal Aneurysm of Suspected Infectious Origin

A 64-year-old female with a history of hysterectomy and cholecystectomy presented with intermittent abdominal pain for a year. Despite evaluation at multiple hospitals, the vascular causes were not assessed properly. She was referred to Narayana Hospital, RN Tagore Hospital, Mukundapur.

Diagnostics:

Routine blood tests and imaging, including a CT Aortogram, identified two large aneurysms in the lower thoracic and upper abdominal aorta, suspected to be of infectious (mycotic/tubercular) origin.

Treatment Plan and Surgery:

Due to the size, anatomical complexity, and infected nature of the aneurysm, urgent surgical intervention was necessary to prevent rupture and life-threatening bleed. Preoperative preparation included nutritional, medical optimization and risk assessment. On November 5, 2024, a multidisciplinary

team headed by cardiothoracic and vascular surgeons performed a 14-hour surgery involving specialised selective visceral perfusion to maintain blood flow to vital organs while repairing the diseased aorta using a prosthetic graft.

Challenges:

The surgery involved mobilizing extensive organs, cutting through the diaphragm, managing significant blood loss, and ensuring organ function was uncompromised.

Postoperative care focused on preventing bleeding, sepsis, and ensuring functional recovery.

Recovery and Outcome:

The patient received comprehensive care from surgical, ICU, anaesthesia, nursing, and

physiotherapy teams. Despite her frailty, she recovered well and regained mobility. She was discharged 7 days post-surgery, with a total hospital stay of 9 days.

Highlight:

This case emphasizes the importance of considering aortic aneurysms in patients with diffuse abdominal pain. The patient's swift diagnosis and meticulous surgical execution

highlight the critical role of multidisciplinary care in managing life-threatening vascular diseases.

Conclusion:

Early diagnosis, multidisciplinary collaboration, and innovative surgical techniques enable the safe resolution of life-threatening aneurysms, emphasizing the role of precision and teamwork in high-stake interventions.