Comprehensive Treatment of Total Arch Replacement in a Patient With Liver Cirrhosis: A Case Report

TL;DR

A 78-year-old woman with liver cirrhosis successfully underwent total arch replacement surgery after preoperative treatments to manage bleeding risks.

Contribution

The paper presents a novel approach combining partial splenic embolization and endoscopic injection sclerotherapy to safely perform surgery in patients with liver cirrhosis.

Findings

Endoscopic injection sclerotherapy and partial splenic embolization reduced bleeding risks in a cirrhotic patient.

The combined preoperative treatments allowed safe transesophageal echocardiography and total arch replacement surgery.

Platelet count improved after the interventions, enabling successful surgery.

Abstract

A 78-year-old woman with liver cirrhosis due to chronic hepatitis C visited our department for treatment of a thoracic aortic aneurysm. Her Child-Pugh classification was class A, and her model for end-stage liver (MELD) disease score was 8. As she also had thrombocytopenia associated with splenomegaly and esophageal varices, endoscopic injection sclerotherapy and partial splenic embolization were performed before total arch replacement surgery for treating esophageal varices to reduce the bleeding risk during transesophageal echocardiography and for thrombocytopenia, respectively. After endoscopic injection sclerotherapy and partial splenic embolization, the platelet count increased; hence, total arch replacement surgery was performed. By combining partial splenic embolization and endoscopic injection sclerotherapy, we were able to safely perform transesophageal echocardiography and total arch replacement surgery in the perioperative period.

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