1. Open Surgical Repair in a Patient With Loeys-Dietz Syndrome and Extensive Vascular Compromise: A Case Report and Literature Review.
- Author
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Polania-Sandoval CA, Farres H, Lanka SP, and Erben Y
- Subjects
- Humans, Male, Aged, Treatment Outcome, Aortic Aneurysm, Abdominal surgery, Aortic Aneurysm, Abdominal diagnostic imaging, Embolization, Therapeutic, Computed Tomography Angiography, Aortography methods, Prosthesis Design, Aneurysm surgery, Aneurysm diagnostic imaging, Aneurysm etiology, Polyethylene Terephthalates, Vascular Patency, Loeys-Dietz Syndrome complications, Loeys-Dietz Syndrome surgery, Loeys-Dietz Syndrome diagnostic imaging, Blood Vessel Prosthesis Implantation instrumentation, Blood Vessel Prosthesis, Iliac Aneurysm surgery, Iliac Aneurysm diagnostic imaging, Femoral Artery diagnostic imaging, Femoral Artery surgery, Femoral Artery physiopathology, Endovascular Procedures instrumentation
- Abstract
Loeys-Dietz syndrome (LDS) has been associated with multiple vascular abnormalities involving the entire arterial tree. However, limited reports regarding compromise in the aortoiliac and femoral bifurcation are available. Further, recommendations for optimal approach, thresholds for diameter at the time of surgery, and surveillance are also limited. We present a case of a 67-year-old male patient with LDS and aneurysmal aortoiliac and enlarging common femoral arteries aneurysms, who underwent open surgical repair. His past surgical history included multiple vascular interventions for lower extremity claudication and bilateral hip replacements. The right hip arthroplasty was previously removed due to infection. From the vascular standpoint, the patient underwent staged endovascular left hypogastric artery embolization and open aorto-bi-profunda bypass with a Rifampin-soaked Dacron graft. At 5-month follow-up, he remains asymptomatic with healed incisions and patent bypasses. This case highlights the challenges in managing peripheral aneurysms in LDS patients, emphasizing the need for tailored treatment strategies. While open repair is preferred, endovascular options may be considered in selected cases. Surveillance remains critical with annual cross-sectional imaging. Surgical planning is intricate due to comorbidities, anatomical complexities, and previous surgical infection. Surveillance of these patients must be strict as multiple vascular and non-vascular complications may arise. Therefore, collaborative decision-making is essential for optimal outcomes in this known high-risk population with connective tissue disorders., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2025
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