Cas clinique Traitement endovasculaire d’un an evrysme de l’aorte abdominale apr es pneumonectomie gauche : Un bon choix Marco Agrifoglio, Stefano Zoli, Antioco Cappai, Piero Trabattoni, Rita Spirito, Paolo Biglioli, Milan, Italie Le traitement chirurgical d’un an evrysme de l’aorte abdominale apr es pneumonectomie est un d efi en raison de la fonction respiratoire alt er ee et des risques chirurgicaux accrus. Le traitement endovasculaire chez les patients anatomiquement adapt es  a haut risque-chirurgical offre d’excellents r esultats  a court terme et assure une bonne protection contre le d ec es li  e  a l’an evrysme. Dans cet article, nous rapportons le traitement endovasculaire d’un an evrysme de l’aorte sous-r enale chez un patient ayant eu une pneumonectomie. Treatment of abdominal aortic aneurysm (AAA) after previous pulmonary resection is a complex endeavor, with surgical risks highly increased by an often reduced pulmonary function. The traditio- nal surgical approach requires a complete median laparotomy that may further reduce the overall respiratory capacity, impairing postoperative dia- phragm movements. Successful surgical repair of aortic aneurysm in patients with pulmonary carci- noma has been reported anecdotally, but the overall effect of the surgery in these patients should not be underestimated. As compared with open surgery, endovascular aneurysm repair (EVAR) seems to be associated with lower short-term rates of death and complications, 1,2 and this is especially true when severe comorbidities are present. EVAR has been proposed as the initial treatment for patients with concomitant pulmonary carcinoma and AAA, but the association of both diseases is rare (<1%), 3 and pulmonary resection is often performed first for the fear of cancer progression. Although the specific role of EVAR remains to be defined, it may represent an appealing alternative for these high-surgical-risk patients. CASE REPORT A 72-year-old man with a history of hypertension was referred to our institution 5 years after undergoing left pneumonectomy for a lung cancer. At the time of tho- racic surgery, the abdominal aorta was only slightly enlarged with a maximum diameter of 3.2 cm. The risk of rupture at that time was considered minimal, and the pulmonary resection was performed without major complications. The patient was therefore enrolled on a yearly abdominal duplex sonography surveillance pro- gram. The last follow-up revealed a rapid increase in the size of the abdominal aorta (>1 cm per year) and the patient was scheduled for AAA repair, despite the fact that maximum diameter had not reached the widely accepted threshold of 5.5 cm. Chest X-ray study showed mediastinal shift with marked rotation and displacement of the heart shadow into the pneumonectomy space and hyperinflation of the right lung (Fig. 1). Pulmonary functional tests revealed a severe respiratory obstructive deficit, with a forced expiratory volume of 0.93 L (<30% of predicted) and a forced vital capacity of 2.45 L (<60% of predicted). Computed tomography (CT) scan confir- med the presence of a 4.4-cm fusiform infrarenal aortic aneurysm, and allowed us to detect two accessory renal DOI of original article: 10.1016/j.avsg.2010.11.009. Department of Cardiovascular Sciences, Centro Cardiologico Mon- zino, IRCCS, Milan, Italie. Correspondence : Stefano Zoli, MD, Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milan, Italie, E-mail: stefanozoli@gmail.com Ann Vasc Surg 2011; 25: 556.e7-556.e10 DOI: 10.1016/j.acvfr.2012.04.002 Ó Annals of Vascular Surgery Inc.  Edit  e par ELSEVIER MASSON SAS 598.e7