Hybrid treatment of a patient with a thoracic aortic aneurysm and lung cancer (case report)

• Papoyan S.A.
• Ter-Ovanesov M.D.
• Shchegolev A.A.
• Chernaya N.R.
• Amirkhanyan D.S.

Abstract

In this article, we present a clinical case of staged treatment of a patient with lung cancer and a thoracic aortic aneurysm. At the first stage, the patient underwent an extended upper lobectomy on the right with resection of the apical segment of the lower lobe of the lung and mediastinal lymph node dissection. At the second stage, a hybrid operation was performed, including partial debranching of the aortic arch and endovascular thoracic aortic aneurysm repair. The chosen approach made it possible to reduce the overall traumaticity of surgical interventions, while maintaining the radical nature of treatment.

This clinical example is an illustration of the fact that the modern hybrid strategy for the treatment of thoracic aortic pathology (in particular, the aortic arch) significantly expands the possibilities of treating patients with combined pathology, allowing to reduce the risks of both general surgical complications and cerebral circulation impairments. However, the place of this approach can only be determined after assessing the long-term results, in particular the risks and frequency of aortic remodeling.

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Papoyan S.A.; data collection and handling – Ter-Ovanesov M.D., Shchegolev A.A.; draft manuscript preparation – Chernaya N.R.; manuscript revision – Amirkhanyan D.S., Chernaya N.R.

For citation: Papoyan S.A., Ter-Ovanesov M.D., Shchegolev A.A., Chernaya N.R., Amirkhanyan D.S. Hybrid treatment of a patient with a thoracic aortic aneurysm and lung cancer (case report). Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 53–8. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-53-58 (in Russian)

Keywords:thoracoabdominal aortic aneurysm; endovascular aortic aneurysm repair; debranching; lung cancer; lobectomy

References

1. Andrushchuk V.V. Simultaneous surgical treatment of malignant neoplasms of various localizations and competing coronary heart disease. Medical Journal. 2005; 3: 13. (in Russian)

2. Lukin A.A. Problems of diagnosis and treatment of associated oncological diseases and atherosclerotic changes in the arteries. Collection of scientific papers. Edited by prof. A.A. Fokin and Honored Doctor of the Russian Federation Professor A.V. Vazhenin. Problems of vascular pathology in cancer patients. Chelyabinsk. 2002; 65–66. (in Russian)

3. Shalnova S.A., Drapkina O.M. Trends in mortality from diseases of the circulatory system and malignant neoplasms in Russian men and women 2000–2016. Rational Pharmacotherapy in Cardiology. 2019; 15 (1): 77–83. DOI: https://doi.org/10.20996/1819-64462019-15-1-77-83 (in Russian)

4. Kunihara T., Grun T., Aicher D., et al. Hypothermic circulatory arrest is not a risk factor for neurologic morbidity in aortic surgery: a propensity score analysis. Journal of Thoracic and Cardiovascular Surgery. 2005; 130 (3): 712–718. DOI: https://doi.org/10.1016/j.jtcvs.2005.03.043

5.  Di Eusanio M., Schepens M.A., Morshuis W.J., et al. Brain protection using antegrade selective cerebral perfusion: a multicenter study. Annals of Thoracic Surgery. 2003; 76 (4): 1181–1188. DOI: https://doi.org/10.1016/S0003-4975(03)00824-5

6. Zotikov A.E., Maryan D.I., Ilyin S.S., et al. Features of debranching technique for aortic dissections and aneurisms in thoratic and thoraco-abdominal aortas. Atherothrombosis. 2019; (1): 128–137. DOI: https://doi.org/10.21518/2307-1109-2019-1-128-137 (in Russian)

7. Waterman A.L., Feezor R.J., Lee W.A., et al. Endovascular treatment of acute and chronic aortic pathology in patients with Marfan syndrome. Journal of Vascular Surgery. 2012; 55 (5): 1234–41. DOI: https://doi.org/10.1016/j.jvs.2011.11.0894

8. Vivacqua A., Idrees J.J., Johnston D.R., et al. Thoracic endovascular repair first for extensive aortic disease: the staged hybrid approach. European Journal of Cardio-Thoracic Surgery. 2015; 49 (3): 764–769. DOI: https://doi.org/10.1093/ejcts/ezv274

9. Belov Yu.V., Abugov S.A., Charchyan E.R. Application of «hybrid» technologies in the treatment of patients with dissection of the entire aorta. Cardiology and Cardiovascular Surgery. 2008; 1: 80–83. (in Russian)

10. Hasegawa R., Hagino I., Nakajima M., et al. A successful case of simultaneous operation of aortic arch aneurysm and left lung cancer. Kyobu Geka. 1999; 52 (13): 1133–1136.

11. Aono Y., Higashiyama M., Kodama K., et al. Simultaneous operation of lung cancer accompanied with aortic arch aneurysm: report of a case. Kyobu Geka. 1998; 51 (7): 605–608.  

12. Makino T., Kawada K., Masuhara H., et al. One-stage operation for thoracic aortic arch aneurysm and left lung carcinoma: a case report. Journal of Cardiothoracic Surgery. 2016; 11 (1): 51. DOI: https://doi.org/10.1186/s13019-016-0440-0

13. Eguchi T., Fukui D., Takasuna K., et al. Successful lung lobectomy for a lung cancer following thoracic endovascular aortic repair for a thoracic aortic aneurysm: report of a case. Surgery Today. 2014; 44 (5): 940–943. DOI: https://doi.org/10.1007/s00595-012-0470-8

14. Jibawi A., Ahmed I., El-Sakka K., Yusuf S.W. Management of concomitant cancer and abdominal aortic aneurysm. Cardiology Research and Practice. 2011; 2011: 516146. DOI: https://doi.org/10.4061/2011/516146

15. Sun L., Qi R., Zhu J., et al. Total arch replacement combined with stented elephant trunk implantation: A new «standard» therapy for type a dissection involving repair of the aortic arch? Circulation. 2011; 123 (9): 971–978. DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.015081