Thoracoabdominal and suprarenal abdominal aortic aneurysm: surgical and critical care management

Ananciya1*, Sripreethi2, Jayamenon3

1Criticalcare Nurse, Kauvery Hospital, Heart City, Trichy, Tamil Nadu

2Nurse Educator, Kauvery Hospital, Heart City, Trichy, Tamil Nadu

3Nursing Superintendent, Kauvery Hospital, Heart City, Trichy, Tamil Nadu

*Correspondence

Abstract

Thoracoabdominal aortic aneurysm (TAAA) is a life-threatening vascular condition associated with high morbidity and mortality if left untreated. This case report describes a 51-year-old male patient who presented with thoracoabdominal and suprarenal abdominal aortic aneurysm and underwent successful open surgical repair with prosthetic graft/interposition tube graft placement. Postoperatively, the patient was managed in the intensive care unit with mechanical ventilation, hemodynamic monitoring, fluid resuscitation, pain management, and infection control measures. Continuous assessment of neurological status, peripheral perfusion, respiratory function, urine output, and bowel function was carried out. The patient showed gradual postoperative improvement without major neurological deficits or significant vascular complications. This report highlights the importance of early diagnosis, timely surgical intervention, meticulous perioperative management, and multidisciplinary critical care in improving outcomes following thoracoabdominal aortic aneurysm repair.

Keywords: Thoracoabdominal aortic aneurysm; Open surgical repair; Prosthetic graft; Interposition tube graft, Critical care management

Introduction

A thoracoabdominal aortic aneurysm (TAAA) is a pathological dilatation of the aorta involving both the thoracic and abdominal segments of the aorta. It is a life-threatening vascular condition associated with a high risk of rupture, dissection, and organ ischemia if left untreated. The disease commonly occurs due to degenerative atherosclerosis, connective tissue disorders, chronic hypertension, trauma, or previous aortic dissection.

Thoracoabdominal aortic aneurysm repair is one of the most complex procedures in cardiovascular and vascular surgery. The primary goal of repair is to prevent aneurysm rupture while maintaining adequate perfusion to vital organs such as the spinal cord, kidneys, liver, and intestines. Surgical management may be performed through open surgical repair, endovascular repair, or a hybrid approach, depending on the extent of aneurysm involvement and the patient’s clinical condition.

Open repair involves replacement of the diseased aortic segment with a synthetic graft through thoracoabdominal exposure, whereas endovascular techniques use stent grafts to exclude the aneurysm from circulation. Despite advancements in surgical techniques, anesthesia, organ protection strategies, and postoperative critical care, TAAA repair remains associated with significant morbidity and mortality, including complications such as spinal cord ischemia, renal failure, respiratory complications, and bleeding.

Case Presentation

A 51-year-old male patient with a history of chronic smoking and alcohol use presented with complaints suggestive of thoracoabdominal aortic pathology.

Lab Investigations

Other Investigations

Outcome of investigations

Clinical evaluation and imaging studies revealed a thoracoabdominal aortic aneurysm involving the descending thoracic and suprarenal abdominal aorta. The patient was admitted for elective surgical management.

Preoperative Management

  • Detailed clinical assessment and imaging evaluation (CT aortogram/angiography)
  • Blood pressure control and stabilization
  • Cardiac and pulmonary evaluation
  • Baseline investigations: CBC, RFT, LFT, electrolytes, coagulation profile, ABG
  • Cross-matching of blood products
  • Infection screening and prophylactic antibiotics
  • Smoking and alcohol cessation advice

Surgical Management

The patient underwent thoracolaparotomy with open repair of the thoracoabdominal aortic aneurysm using a prosthetic interposition tube graft. Intraoperatively, careful hemodynamic monitoring and vascular reconstruction were performed. Following surgery, the patient was shifted to the cardiothoracic intensive care unit for postoperative management. In the immediate postoperative period, the patient was mechanically ventilated and supported with vasopressors for hemodynamic stabilization. Continuous monitoring of blood pressure, heart rate, oxygen saturation, urine output, peripheral pulses, neurological status, and respiratory function was carried out. Bilateral peripheral pulses were palpable, and no neurological deficits were noted.  Postoperative findings included mild hypotension, respiratory acidosis, and reduced bowel activity, which were managed conservatively with intravenous fluids, ventilatory support, electrolyte correction, analgesia, and intensive monitoring.

Microbiological culture showed Streptococcus agalactiae, and appropriate intravenous antibiotic therapy was initiated. Gradually, the patient demonstrated clinical improvement with stable vital signs, adequate urine output, improving respiratory parameters, and satisfactory graft function.

The patient continued under multidisciplinary postoperative care with regular vascular and critical care follow-up.

Nursing Management

  • Frequent vital signs monitoring
  • Maintenance of airway and breathing
  • Assessment of drain output and surgical site
  • Monitoring bowel sounds and urine output
  • Prevention of pressure sores and DVT
  • Patient education regarding lifestyle modification and follow-up

Outcome

  • Hemodynamic stabilization
  • Adequate graft function
  • No major neurological deficits
  • Gradual recovery with multidisciplinary critical care support

Discussion

Thoracoabdominal aortic aneurysm (TAAA) is a rare but serious vascular disorder characterized by abnormal dilatation of the thoracic and abdominal segments of the aorta. If left untreated, it may lead to rupture, massive hemorrhage, organ ischemia, and death. Surgical repair remains the definitive treatment for large or symptomatic aneurysms. Open thoracoabdominal aneurysm repair is a complex procedure associated with significant perioperative risks including bleeding, spinal cord ischemia, renal dysfunction, respiratory complications, and hemodynamic instability.

In this case, the patient underwent successful thoracoabdominal and suprarenal abdominal aortic aneurysm repair with prosthetic/interposition tube graft placement. Postoperatively, the patient required intensive monitoring and ventilatory support in the ICU. Hemodynamic parameters such as blood pressure, heart rate, oxygen saturation, urine output, and peripheral perfusion were continuously monitored to detect early complications. Maintenance of adequate blood pressure and tissue perfusion was essential to prevent spinal cord and renal ischemia.

Conclusion

Thoracoabdominal aortic aneurysm is a complex and potentially fatal vascular condition that requires early diagnosis and prompt surgical intervention. Successful repair with prosthetic graft reconstruction, combined with intensive postoperative monitoring and multidisciplinary critical care management, can significantly improve patient outcomes. Continuous assessment of hemodynamic status, respiratory function, neurological status, pain control, and infection prevention played a vital role in the recovery of this patient. This case highlights the importance of coordinated surgical and critical care management in reducing postoperative complications and promoting successful recovery following thoracoabdominal aortic aneurysm repair.

References

  • Coselli, J. S., LeMaire, S. A., & Preventza, O. (2016). Open surgical repair of thoracoabdominal aortic aneurysms. Nature Reviews Cardiology, 13(9), 543–554. https://doi.org/10.1038/nrcardio.2016.88
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  • Johnston, K. W., Rutherford, R. B., Tilson, M. D., Shah, D. M., Hollier, L., & Stanley, J. C. (1991). Suggested standards for reporting on arterial aneurysms. Journal of Vascular Surgery, 13(3), 452–458. https://doi.org/10.1067/mva.1991.26737
  • Svensson, L. G., & Crawford, E. S. (1997). Cardiovascular and vascular disease of the aorta. W.B. Saunders Company.
  • Upchurch, G. R., Jr., & Schaub, T. A. (2006). Abdominal aortic aneurysm. American Family Physician, 73(7), 1198–1204.

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