A case of successful surgical treatment of patient with rare vascular anomaly – hypoplasia of infrarenal abdominal aorta

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Abstract

Aim. To demonstrate a case of treatment of a patient with a rare vascular anomaly – hypoplasia of infrarenal abdominal aorta.

On a clinical example of female patient U., 41 years of age, with critical ischemia of the lower limbs and diagnosis «hypoplasia of the abdominal aorta» made on the basis of the clinical and instrumental data, the manifestations, diagnostics and potentials of the successful surgical treatment of the given pathology were demonstrated.

Conclusion. Clinical manifestations of hypoplasia of the aorta depend on localization of the lesion and involvement of renal arteries. The commonest clinical sign is arterial hypertension and symptoms associated with the elevated arterial pressure. Hypoplasia of the aorta may also be manifested by hypertrophy of the upper limbs in combination with poor development of muscles of the lower limbs. More aged individuals present with arterial insufficiency leading to clinically significant ischemia of the lower limbs. Thus, in the case described, the patient already had ischemic trophic ulcers of the lower limbs. Without treatment, secondary arterial hypertension and cardiac failure may lead a patient to early death. Today, irrespective of the etiology, the only effective method of treatment of this disease is surgery. In case of our patient, resection of the hypoplastic segment of the aorta and its prosthetics were performed. This permitted to restore circulation in the lower parts of the body and further led to complete healing of trophic ulcers of the shin and to normalization of the systemic arterial pressure.

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About the authors

Alexander F. Kharazov

Vishnevsky National Medical Research Center of Surgery; Russian Medical Academy of Continuing Post-Graduate Education

Email: harazik@mail.ru
ORCID iD: 0000-0002-6252-2459
SPIN-code: 5239-8127
ResearcherId: Q-8901-2018

MD, PhD, Associate Professor of the Department of Vascular and X-Ray Endovascular Surgery; Senior Researcher of the Vascular Surgery Departmen

Russian Federation, 2/1, Barrikadnaya st., Moscow, 125993; 7, Bolshaya Serpukhovskaya street, Moscow, 117997

Vladimir A. Kulbak

Vishnevsky National Medical Research Center of Surgery; Lomonosov Moscow State University

Email: v_kulbak@mail.ru
ORCID iD: 0000-0001-6743-4012
SPIN-code: 1111-0538

MD, PhD, Associate Professor of the Department of Surgery of the Faculty of Fundamental Medicine; Researcher of the Vascular Surgery Department

Russian Federation, Moscow; Moscow

Naida M. Basirova

Russian Medical Academy of Continuing Post-Graduate Education

Author for correspondence.
Email: dr.basirova@mail.ru
ORCID iD: 0000-0002-8933-5602
SPIN-code: 1957-4287

PhD-student of the Department of Vascular and X-Ray Endovascular Surgery

Russian Federation, Moscow

References

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  2. Roques X, Bourdeaud’hui A, Choussat A, et al. Coarctation of the abdominal aorta. Annals Vascular Surgery. 1988;2(2):138-44. doi: 10.1016/S0890-5096(06)60796-6
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  4. Van Meursvan Woezik H, Wolff ED, Essed CE, et al. Tandem coarctation of the thoracic aorta with hypoplasia of the abdominal aorta. The Thoracic and Cardiovascular Surgeon. 1985;33(1):44-7. doi: 10.1055/s-2007-1014082
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  11. Celik T, Kursaklioglu H, Iyisoy A, et al. Hypoplasia of the Descending Thoracic and Abdominal Aorta: A Case Report and Review of Literature. Journal of Thoracic Imaging. 2006;21(4):296-9. doi: 10.1097/01.rti.0000213555.61752.3a

Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Trophic ulcers of the lower limbs: а – the right lower limb

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3. Fig. 1. Trophic ulcers of the lower limbs: b – the right lower limb

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4. Fig. 1. Trophic ulcers of the lower limbs: c – the left lower limb

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5. Fig. 2. Aortoarteriography: occlusion of the infrarenal abdominal aorta: а – occlusion of the aorta distal to the orifices of the renal arteries

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6. Fig. 2. Aortoarteriography: occlusion of the infrarenal abdominal aorta: b – contrast enhancement of distal sections of the aorta through collateral network

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7. Fig. 4. Intraoperative photo: hypoplastic portion of the aorta

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8. Fig. 3. CT-angiography of the abdominal aorta, iliac arteries and arteries of the lower limbs: а – multiplanar reconstruction, lateral projection

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9. Fig. 3. CT-angiography of the abdominal aorta, iliac arteries and arteries of the lower limbs: Fig. 3. CT-angiography of the abdominal aorta, iliac arteries and arteries of the lower limbs: b – 3D picture, side view

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10. Fig. 3. CT-angiography of the abdominal aorta, iliac arteries and arteries of the lower limbs: c – 3D picture, front vie

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11. Fig. 5. Intraoperative photo: prosthesis of the infrarenal abdominal aorta

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Media Registry Entry of the Federal Service for Supervision of Communications, Information Technology and Mass Communications (Roskomnadzor) PI No. FS77-76803 dated September 24, 2019.



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