[The utilization of the "simplified technique" in the simultaneous management of independent thoracic and abdominal aortic aneurysms. A clinical report]. / Aneurismas independentes da aorta torácica e abdominal tratados simultaneamente pela "técnica simplificada". Caso clinico.

The coexistence of independent aneurysms of the thoracic and abdominal aorta in a single individual, with operative indication has been regarded, since ever, as an enormous challenge to the vascular surgeons and is a source of controversy, regarding the hierarchy, priorities and methods of expeditious management. The authors report the clinical case of a 65 years old male, with a descending thoracic aortic aneurysm, extended to the abdominal visceral vessels, having 6.5 cm of maximum size, together with an infrarenal aortic aneurysm, with 4.5 cm of major diameter. The patient underwent the surgical treatment of both aneurysms, in the same operation, utilizing the "simplified technique", introduced by ourselves in 1984, for the management of thoracoabdominal aortic aneurysms. The efficacy, safety and excellency of the procedure as well as of the clinical result, assessed by angio-CT scans, allow us to enhance one more indication for the "simplified technique" in the management of complex aortic pathology, thus justifying its presentation and divulgation.

[Chronic contained rupture of a descending thoracic aortic aneurysm simulating an esophagus tumor. Conventional surgical management]. / Aneurisma da aorta torácica descendente em rotura contida simulando neoplasia do esófago. Traramento cirúrgico convencional.

The authors report the clinic case of a 54 years old male, whose chief complaints were dysphagia for solid foods, epigastralgias and remarkable weight loss, of 20 kilos in two months. Admitted in another hospital with the diagnosis of esophagus tumor, an upper G.I. endoscopy disclosed an extensive external compresion of the esophagus middle third and the CT-chest scans revealed a large descending thoracic aortic aneurysm, in chronic contained rupture, as the cause of the compression. The patient was immediately transferred to our hospital and underwent the conventional surgical management, consisting in the aneurysm resection and replacement with a 30 mm Dacron prosthesis. The post-operative course was uneventful and reviewed four months following the operation he was found in good condition, asymptomatic and displaying a remarkable weight gain. In era of a progressive expansion of the field of the endovascular management of thoracic aortic aneurysms, some cases, like the present clinical case, seem to represent a formal contraindication to the endovascular technology, due to the irreducible external compression of organs such as the esophagus, thus remaining an exclusive indication for the conventional surgical management.