Successful endovascular repair of two ruptured thoracic aortic aneurysms in nonagenarians

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