EP12 ENDOVASCULAR SURGERY FOR TREATMENT OF PARANEOPLASTIC OBSTRUCTION OF THE DESCENDING THORACIC AORTA

Background and Aim: Rarely covered endovascular stent-grafts had been implanted in the thoracic aorta to perform the resection of the aortic wall infiltrated by an intrathoracic tumors. This we describe is a rare clinical case of a critical stenosis, for paraneoplastic syndrome, of descending thoracic aorta treated with TEVAR. Methods: A 61 years-old man, with an unknown history of tumor, was admitted in emergency with a diagnosis of critical stenosis of the descending thoracic aorta and visceral-organ and lower-limb malperfusion. The CT scan showed a voluminous mass infiltrating and occluding the descending thoracic aorta far from left subclavian artery and celiac axis, extending for 80 mm, associated with a voluminous retroperitoneal mass. A percutaneous biopsy performed after stent graft implantation, allowed to diagnose a retroperitoneal high grade undifferentiated pleomorphic sarcoma. Results: The procedure was performed in our hybrid operating room. Over a Back-up Meier wire and under fluoroscopy, through right common femoral artery, a Medtronic Valiant stent-graft was placed in the optimal position far from the celiac artery. To completely cover the stenotic tract the patient required one stent-graft. After stent-graft release, the paraneoplastic thrombus, mobilised from the descending aorta to the carrefour, was removed with a Fogarty catheter. The postoperative period was uneventful. Follow-up CT scan were performed at six months and showed complete patency of the descending thoracic aorta. Conclusions: The encouraging experience in the treatment of this patient indicate that endovascular surgery is a useful and less invasive alternative to open surgical operation for these uncommon disease too.