de Donato G

How should I treat a massive pulmonary haemorrhage secondary to a TEVAR procedure in a patient with a thoracic aortic aneurysm and a type B aortic dissection

*Corresponding author: Adult Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, Italy. E-mail:andreatog@hotmail.it PRESENTATION OF THE CASE A 37-year-old man was referred to our institution for a descending aortic aneurysm associated with a thoracoabdominal aortic dissection. The patient, affected by aortic coarctation, had been previously treated with a surgical replacement of the isthmic aorta with a Dacron graft. After the intervention, he developed a type B dissection of the remaining descending aorta. The aortic lesion was treated with endovascular grafting to cover the entry tear. Three years later, he presented with a huge aneurysm (90×80 mm) which surrounded the endograft (Figure 1). He was referred to our centre and we planned to extend the endovascular grafting of the aorta up to the coeliac artery with a 5 cm overlap of the previously implanted graft (Figure 2). The procedure was performed in the cardiac catheterisation laboratory using a C-arm angiographic system with digital subtraction angiography (DSA) capability (GE Healthcare, Little Chalfont, Buckinghamshire, United Kingdom). The procedure was carried out under general anaesthesia and with mechanical ventilation. Transoesophageal echocardiography was used to monitor the instrumentation in the aorta and detect potential endoleaks. Right radial access was obtained and a pigtail catheter (6 Fr) (Cordis Corporation, Fremont, CA, USA) was introduced to perform aortography during the procedure. CASE SUMMARY