Complex aortic aneurysms including arch and thoracoabdominal aortic aneurysm is a life-threatening condition. This high-risk surgery requires surgical skills, expertise and carries a tremendous challenge to cardiovascular surgeons. Such a complex case was surgically corrected at Hubballi based Suchirayu Hospital.
The team lead by Cardiac Surgeon, Dr. Sharan Hallad, treated a complex dissecting aneurysm of thoracic aorta with arch aneurysm (distal arch) using a hybrid technique i.e. aortic arch debranching with TEVAR (Thoracic Endovascular Aortic Reconstruction).
61 year/male who was diagnosed with Stanford B/Debakey 3a dissection and aneurysmal dilatation of distal arch (7cm), dissection involving thoracic aorta just adjacent to its subclavian artery for a length of 9.1cm with true and false lumen, which was filled with intramural thrombus.
A Gross mediastinal shift to the right side was noted. Earlier these cases require open arch repair with CPB, Hypothermic circulatory arrest and these are associated with high mortality of 15 to 40 percent, like frozen elephant trunk. This was treated with hybrid repair which includes aortic arch debranching were in RT innominate. Lt. common carotid artery and subclavian artery are disconnected from arch and they are connected to ascending aorta with trifurcated Dacron grafts to maintain brain and upper limb circulation.
Once this was done, he was shifted to Cath Lab for endovascular aortic stenting which will isolate the dissection, promote thrombosis and fibrosis of false lumen and also prevents further dissection and enlargement of that portion. Patient withstood the procedure very well; he was extubated after 14 hrs and only one unit of blood was transfused.
The outcome of the surgery is very encouraging and patient has shown steady progress said Dr. Sharan Hallad. He also expressed his thanks to the Cath-Lab team for excellent coordination & support because aortic debranching was done in OT then he was shifted to Cath Lab for TEVAR. Perhaps this is the first time in North Karnataka where in a complex aneurysm with dissection such as this case has been treated with arch debranching and TEVAR.
