Hybrid surgical management of a saccular aneurysm of the aortic arch

Akchurin RS, Imaev TE, Komlev AE, Osmanov MR, Nikonova ME, Podkidkin IA
Department of Cardiovascular Surgery, Federal State Facility «Russian Cardiological Scientific and Production Complex» under the Ministry of Public Health and Social Development of the Russian Federation, Moscow, Russia

The present article aims to describe a clinical case of hybrid surgical intervention consisting in complete prosthetic repair of the aortic arch in a high-risk male patient diagnosed with a gigantic saccular aneurysm of the aortic arch. The patient was subjected to a hybrid operation – an operation of endovascular prosthetic repair of the thoracic portion of the aorta with the Gore Tag stent graft in a combination with bypass grafting of the left common carotid and left subclavian arteries with the Gore bifurcated stent graft, autovenous aortocoronary bypass grafting of the CA without artificial circulation.

The postoperative period was uneventful with the patient’s favourable convalescence and rehabilitation occurring within the shortest terms possible. According to the findings of MSCT-aortography, fulfilment of the arteries of the aortic arch with contrast medium was satisfactory. The residual cavity of the aneurysm was completely isolated from the blood flow, with no endoleak. The arteries of the aortic arch were opacified through the bifurcation prosthesis from the ascending portion of the aorta.

Hybrid surgical interventions appear to possess all positive properties of endovascular (according to the findings of the EVAR1 and EVAR2 Trials) and traditional open surgery, thus allowing of both avoiding threatening complications and minimizing the terms of rehabilitation. This technique might thus be considered a useful tool to be included into the basic armamentarium of the vascular surgeon as an option of revascularization.

KEY WORDS: hybrid surgery, bypass grafting, debranching, thoracic aorta aneurysms, aortic dissection, open surgery, endovascular interventions, endograft, EVAR, Gore, Gore Tag.

P. 146

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