HYBRID APPROACH IN THE CASE OF A TYPE B COMPLICATED AORTIC DISSECTION

Lavinia Iftene1,H. Moldovan2
1”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
21st Department of Cardiovascular Surgery, “C.C.Iliescu” Institute of Cardiovascular Diseases
Corresponding author: Lavinia Iftene
Phone no. 040755299988
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Abstract

Thoracoabdominal aortic pathologies remain an intimidating surgical challenge for the field of cardiovascular expertise, having conventional open repair associated with significant rates of mortality and morbidity. Studies conducted by Dake Michael and Nienabar Christoph have reported the use of thoracic "stent-grafts" in patients who were believed to be at excessive risk for open surgery, pioneering an alternative procedure known as Thoracic EndoVascular Aortic Repair (TEVAR). Nowadays a significant number of patients with thoracoabdominal aortic aneurysms are unsuitable for TEVAR owing to the absence of graft seal zones. In such situations we rely on the‘‘Hybrid’’ technique which allows the creation of proximal and distal landing areas in order to expand the appliance of the endovascular repair. Throughout this article we present the appliance of TEVAR in the case of a 48-year-old male, reported smoker, revealing a history of untreated hypertension and exertion angina, describing symptoms such as antero-posterior thoracic pain for the last hour before admission. CT scans guided us to the complete diagnostic of Stanford Type B Acute Aortic Dissection emerging from the origin of the left subclavian artery to the celiac trunk, right Suprarenalian Tumor and left pleural effusion. The HEART Team’s decision was to institute strict preoperative antihypertensive treatment followed by hybrid debranching and TEVAR. The acknowledgement of a complete patient history ( in our case the recognizing of pheochromocytoma and extensive coronary disease) is critical to the institution of optimal decisions regarding the management of patient's follow-up, especially when such devices still have significant limitations and shortcomings to promote wide application to all patients and pathologies.

Keywords: hybrid approach, aortic dissection, complicated 2B

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